EDTA tris not for use under cascade provisions

Dear Editor,

Sue Paterson's article on ear cleaning (28th June issue) raises some interesting issues.  The properties of ethylene diamine tetra acetic acid tris (EDTA tris) would appear to justify the view that the com­pound is medicinal by function.  It has clear antibacterial effects and acts as a potentiating agent for certain antibiotics.  Therefore, to desc­ribe this material simply as an ear cleaning agent is misleading.  The author suggests that EDTA tris, used to treat infections of the ear, could be used under the provisions of the prescribing cascade.  As an unauthorised veterinary medicine this product should not be used under the cascade provisions.

Veterinary surgeons using the prescribing cascade and, in particula­r, using extemporaneous products, should satisfy themselves that a product is safe for use and ensure that owners of treated animals are fully aware of the exceptional circumstances under which the treat­ment is being given.

Veterinary surgeons should keep in mind that extemporaneous products should be used exceptionally, usually in single animals and made up for that purpose.  EDTA tris does not appear to meet this definition.  Furthermore, such products have not been independe­ntly scrutinised in terms of safety, for either the user, the animal, or the environment.  In addition, the efficacy is unproven, with anecdotal evidence being the only justification for use.

The production of an extemporaneous treatment through the practice of mixing, for example, EDTA tris with products authorised for use as injectable treatments, carries the considerable risk that the efficacy and safety of the authorised medicine could be adversely affected.

Authorisation of veterinary medicines is based upon an assess­nent of data and provides label warnings that allow the veterinary surgeon to assess the risks to individual patients following use.  Unlicensed medicines, such as EDTA tris, have not been authorised and, therefore, no assessment of data has been carried out.  There are no clinical indications or warnings that can be reliably provided that offer any form of independent advice or guidance to the veterinary surgeon.  In such situations, veterinary surgeons can only rely on limited past experience and word of mouth to justify safety and efficacy.

Yours faithfully,

STEVE DEAN, BVetMed, DVR, MRCVS,
VMD Director and Chief Executive,
Veterinary Medicines Directorate,
Woodham Lane, New Haw, Addlestone, Surrey, KT15 3LS.

Why should we create other problems?

Dear Editor,

For those of your readers who have not completely lost either interest or the plot, here are some of the references to which I alluded in my article (28th June issue).

Sukui, N. C. De. A, Sinhababu, S. P. and Sukul, A. (2003)  Potentized Mercuric chloride and Nux vomica facilitate water permeability in an erythrocytes of a fresh-water catfish Clarius batrachus under acute ethanol intoxication.  J Altern Complement Med. 9 (5): 719-25.

Datta, S., Mallick, P. and Bukhsh, A. R. ( 1999)  Efficacy of a potentized homoeopathic drug (Arsenicum Album-30) in reducing genotoxic effects produced by arsenic trioxide in mice: II. Comparative efficacy of an antibiotic, actinomycin D alone and in combination with either of two microdoses.  Complement Ther Med. 7 (3): I 56-63.

Kundu, S. N., Mitra, K., and Khuda Bukhsh, A. R. (2000)  Efficacy of a potentized homeopathic drug (Arsenicum-Album-30) in reducing cytotoxic effects produced by arsenic trioxide in mice: IV: Pathological changes, protein profiles, and content of DNA and RNA.  Complement Ther Med. 8 (3): 157-65.

Mitra, K., Kundu, S. N. and Khuda Bukhsh, A. R. (1999)  Efficacy of a potentized homoeopathic drug (Arsenicum Album-30) in reducing toxic effects produced by arsenic trioxide in mice: II. On alterations in body weight, tissue weight and total protein.  Complement Ther Med. 7 (1): 24-34.

[These references are reproduced exactly as printed, though we can't help feeling that there aren't two different "part II" papers in the same series.  Maybe when Mr. Gregory actually gets round to reading them - and the best of luck to him, we've tried and they're tough going - he might issue a correction.]

For those who are obsessed by financial reward, I am sure these trials can be easily replicated.  However, after what happened to Benveniste, I would personally advise steering well clear of Mr Randi, his challenge or his disciples.  In any case, the only person I know of who parts with a million easily is Russian and owns an English football club.

On a more positive note, I was intrigued to read that my friend Niall Taylor has espoused "voodoo".  Mohammed said that a man's religion is his own affair, but in respect for my colleague I felt obliged to carry out some investigations via the Internet (www.religioustolerance.com).

I discovered that Vodun (to give it its correct name) is a religion practised by over 60 million people world-wide.  It emerged as the result of the fusion of several African belief systems among the slaves of the Caribbean.  The name (meaning Spirit) can be directly traced to the West African Yoruba people who lived in 18th and 19th century Dahomey (which occupied parts of today's Togo, Benin and Nigeria).

Today, there are two virtually unrelated forms of the religion.  Firstly, there is the actual religion, practised in Benin (where it is the official state religion), Dominican Republic, Ghana, Haiti, Togo and various centres in the US.  Secondly there is an evil, imaginary reli­gion, which was created for Hollywood movies, complete with "voodoo dolls", violence, bizarre rituals, etc.  It does not exist in reality, except in the minds of most non-Voduns.

Religions similar to Vodun can be found in South America where they are called Umbanda, Quimbanda or Candomble.

The central belief of Vodun is that the universe is all one.  Thus, what you do to another you do to yourself: we are "mirrors" of each other's souls".  This seems an admirable philosophy and one to which I for one can happily subscribe.  Indeed, it is a great pleasure to be able to end this correspondence on such a note of mutual understanding.

As the Dalai Lama says, "Humans must face death, old age and disease as well as natural disasters that are beyond our con­trol. But these sufferings are quite sufficient for us. Why should we create other problems due to our own ideology, just different ways of thinking?

Yours faithfully,

PETER GREGORY, BVSc, VetFFHom, MRCVS,
Holistic Veterinary Medicine Centre,
The Village Works, London Road,
East Hoathly, Lewes, East Sussex BN8 6QA.

Dismayed by nonsense....

Dear Editor,

I am increasingly dismayed by the nonsense and crackpot ideas that are appearing more frequently in Veterinary Times.

The 12th July edition contains a letter by Niall Taylor under a heading "Towards a new dawn of enlightenment", where he claims to have corrected a bovine dystocia from a distance of two miles by manipulatimg a voodoo doll.  Then he seeks to justify this by using some quantum theory terminology and claiming our "Newtonian minds" will never grasp his views.

We are not all as dumb as Mr Taylor might think.  I have almost finished a BSc(Hons) in mathematics with the Open University, and I am very familiar with the concepts of the Newtonian view of the universe and the modern quantum view of things.

When Mr Taylor uses a phrase like "deterministic quantum teleportation of atomic qubits using a semiconductor nano-crystal energy transfer pump", I know what it means.  However, I'm not sure that Mr Taylor does.  It seems that every group of people with oddball or obscure ideas is trying to give credibility to their philo­sophy by quoting results from quantum theory.  They try to validate their strange ideas by pointing out that quantum theory is also strange.  Quantum theory is based on rules of logic and mathe­matics, something which has no place in homoeopathy or voodoo as far as I can see.

I suspect Mr Taylor is hoping to baffle and scare us all with big words he hopes we won't understand, and call us all Newtonian and imply we are rigid in our thinking.  I'm sure I am more adept in the non-Newtonian mindset than he is, and have a deeper under­standing of the quantum world than he does, and am more open in my thinking than he is, and I can certainly spot a crackpot idea and gullible thinking when I see it.

The bottom line is that there is nothing scientific, logical or sensible in homoeopathy or voodoo.  Modern quantum ideas in no way support these superstitions.  I hope that it is the case that the veteri­nary practitioners who charge fees for some of these "alternative" treatments are merely being naïve, because otherwise they are committing fraud.

Yours faithfully,

D. M. TANSEY, MVB, MRCVS,
Petherton Veterinary Surgery,
26 Broad Street, Barry, South Glamorgan CF62 7AD.

Ear infections, cascade and homoeopathy....

Dear Editor,

I write with reference to Steve Dean's comments (9th August issue) concerning EDTA-tris, Pseudomonas ear infections and the cascade.  There I was about to order some, but now I am set to thinking: is Mr Dean concealing about his person a thoroughly successful method for treating these cases using products higher up the cascade?  Perhaps he would care to share it with the group.

At least EDTA-tris is based on a well-reasoned, scientifically sound idea.  If rational, but unlicensed, interventions such as this are unlawful then one wonders how a small profession such as our own is ever to try new modes of medical treatment.  It would seem to me reason­ble to apply the cascade principle correctly and still justify EDTA­-tris as a valid treatment option, given the well-recognised difficulties met in treating this condition and the dearth of truly effective licensed treatments for it.

It's stuck record time again.  If we are being asked to consider atti­tudes to the fuzzier edges of veterinary medicine, might Mr Dean care to tell us exactly where on the cascade magic water sits?  Readers may be interested in the following, which has been shown to me on that new-fangled Internet thingy: one of the profession, practising in the UK, claims a 60 per cent success rate in treating hyperthyroid cats by homoeopathy.  [The original page seems to have been deleted by the administrators of the H'pathy Forum.  Fortunately the Voodoo Society is able to refer to a copy saved before this was done.]

Hyperthyroidism in a 15 year old cat: "Yes I have reported many cases of Feline hyperthyroidism that have responded well to Homoepathy [sic].  The protocol I use is to combine Flor de Peidra, Iodum and Thyroidinum 30c and dose twice daily indefinately [sic].  The ideas for this are not entirely my own, coming from the works of Jouanny and Khalsa, modified further by my experience (and I have a good case load being CVS for a Cat Charity).  I would also give a constitutional treatment if clearly detectable.  However, I have also reported that the treatment is not 100% (more like 60%) successful, and if the case is not clearly responding well within 6 weeks I would seek alternate solutions.  It is also not a permanent 'cure' as symptoms will recur if treatment is withdrawn...." - Mark Elliott, BVSc, VetMFHom, MRCVS, MIPsiMed, PCH.

Now, there's a definitive and testable claim of medicinal effect if ever I saw one, and with well-stated percentages attached.  Could Mr Elliott produce a set of 10 or 20 consecutive case records of animals reated with homoeopathy alone showing their associated T₄ val­ues?  However, with or without those supportive data, where is the cascade here?  We have a properly licensed and reliable drug in met­himazole for the straightforward initial or chronic medical therapy of this condition.

In contrast, might I suggest that a respected dermatologist's advocacy of a novel idea in the treatment of a difficult disease should be fairly low on the VMD's to-do list.

Yours faithfully,

SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
Chevers Pawn Veterinary Centre,
Rookery Road, Blackmore, Essex CM4 0LE.

Use of medicines under the cascade

Dear Editor,

I would like to thank Simon Baker (23rd August issue) for providing a further opportunity for me to comment on the use of veterinary medicines under the cascade.  In his letter, he raises the important issue of how veterinarians may try new modes of medical treatment.  New medicinal treatments should be thoroughly researched, documented and then assessed and authorised by the regulatory authority before veterinarians are able to use them legally.

Selected veterinary practices may play a part in clinical trials of new medicines before they are fully authorised, but such a trial will be conducted under an Animal Test Certificate (ATC) issued by the regulatory authority.  The ATC will restrict the extent of the trials conducted and the data produced will be used in the assessment of the veterinary medicine prior to its authorisation.

Veterinary surgeons conducting trials outside these rules are clearly taking considerable risks [as] their actions could be more correctly described as research and, therefore, may require an ASPA licence from the Home 0ffice, even if the animal owners have given their consent to the treatment being used.

On an entirely different front, Simon Baker asks for some guidance as to where homoeopathic remedies sit within the cascade.  Homoeopathic remedies should be authorised in a similar manner to other forms of veterinary medicine.  Thus, assuming a homoeopathic remedy is authorised either as a veterinary or human medicine, it may be used under the cascade using exactly the same rules as any other veterinary medicine.  If, however, the homoeopathic remedy is not authorised for use as a human or animal remedy, then it may not be used under the cascade provision.  Veterinary surgeons may like to know that there are currently no homoeopathic remedies authorised for use as veterinary medicines in the UK.

Yours faithfully,

STEVE DEAN, BVetMed, DVR, MRCVS,
Chief Executive, Veterinary Medicines Directorate,
Woodham Lane, New Haw, Addlestone, Surrey KT15 3LS.

Homoeopathic remedies should be authorised in a similar manner to other forms of veterinary medicine.  ....  If [a] homoeopathic remedy is not authorised for use as a human or animal remedy, then it may not be used under the cascade provision.  Veterinary surgeons may like to know that there are currently no homoeopathic remedies authorised for use as veterinary medicines in the UK.

Vet to be struck off for refusing to comply with prescribing rules

THE name of a Kent veterinary surgeon who ignored warnings from the Royal College and continued a 'deliberate and blatant refusal' to comply with the legal requirements for the prescription of drugs was ordered to be removed from the RCVS Register on September 10.

Mr Laurence Lindsay Swift, of the St Francis Veterinary Clinic, Herne Bay, was found guilty of disgraceful professional conduct for carrying on prescrib­ing to feline patients a wormer licensed only for use in cattle and sheep several months after receiving letters ordering him to comply with the requirements of the prescribing cascade.

A second charge related to his use of an 'extemporaneous medicinal product' containing a mixture of seven different agents to treat gastrointestinal infections in small animals.  The RCVS Disciplinary Committee found him guilty of disgraceful professional con­duct for using this unlicensed product, for failing to obtain informed consent from the owners of a treated animal and for ignoring the advice contained in letters from both the Royal College and a senior colleague sent to inspect his practice.

Overall, Mr Swift had denied five charges of disgraceful professional con­duct of which three were found proven.  The committee found that his behav­iour during an incident in which he administered the unlicensed mixture by stomach tube to a fully conscious cat had demonstrated a degree of incompe­tence for which sentence was postponed for two years on condition that that he undertook appropriate CPD training.

On a separate charge, the committee found that a criminal conviction for indecently assaulting a 12-year-old girl rendered him unfit to practise veteri­nary surgery and for this it ordered that his name be suspended from the Register for 12 months.

What now for those who practise homoeopathy?

Dear Editor,

The letter which kicked off the homoeopathy discussion was entitled "Time for statement on unproven medicines" (John Newcombe and colleagues, 17th March 2003).  Now, 18 months later, a statement has finally appeared.  "Homoeopathic remedies should be authorised in a similar manner to other forms of veterinary medicine. ....  If [a] homoeopathic remedy is not authorised for use as a human or animal remedy, then it may not be used under the cascade provision.  Veterinary surgeons may like to know that there are currently no homoeopathic remedies authorised for use as veterinary medicines in the UK." (Steve Dean, 20th September 2004).  Thus, one may at the very least infer that the use of a homoeopathic remedy to treat a condition for which an authorised veterinary product exists is in breach of the cascade legislation.

This statement arose from discussion about another unauthorised medicine, EDTA-tris, which Mr. Dean declared could not be used legally by veterinary surgeons because of the cascade provisions.  At almost the same time the RCVS Disciplinary Committee announced its judgement in the case of a veterinary surgeon who had breached the cascade provisions in a rather different way - he had administered a product licensed for cattle and sheep to a cat, despite the availability of a number of suitable products licensed for feline use, and he had administered a concoction of products mixed in such a way as to invalidate the licensing conditions.

The seriousness with which the RCVS views these breaches of the cascade may be inferred from the severity of the sentence - Mr. Swift was struck off.  In contrast he was merely suspen ded for having a conviction for a sexual offence against a minor, and sentence was deferred on the matter of harming a cat (which later died) by the careless use of a stomach tube.

We appreciate that few of us are likely to attract the same degree of scrutiny into our consulting-room behaviour as Mr. Swift.  Nevertheless, if we were to engage in active public promotion of EDTA-tris, or his "Feldmar Formula", or the use of Dectomax in cats, we imagine the VMD and indeed the RCVS, might have some objections.

By the same token, now that we have confirmation that homoeopathic remedies also fall under the cascade provisions, will we now see the prohibition of:

• Organising meetings and educational courses promoting the use of homoeopathic remedies by veterinary surgeons
• Advertising these meetings in the veterinary press
• Publishing letters and articles commending homoeopathic remedies to veterinary surgeons
• Advertising a willingness to treat animals with homoeopathic remedies.

And finally, might we dare to hope that the RCVS Registrar will think again about the propriety of maintaining a list of such veterinary surgeons in the Register, something which only serves to allow the homoeopaths to claim RCVS approval for activities that the VMD confirms to be unlawful.

Just as with EDTA-tris, this is not a question of efficacy or lack of efficacy.  It is a question of the law, and as professionals, we are surely entitled to expect the law to be equitably and fairly applied by our regulatory bodies.

Yours faithfully,

CAROLINE R. BAKER, MA, VetMB, MRCVS,
The Good Companions Veterinary Clinic,
Roydon Road, Stanstead Abbotts, Hertfordshire, SG12 8HG.

SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
Chevers Pawn Veterinary Centre,
Rookery Road, Blackmoor, Ingatestone, Essex, CM4 0LE.

DAVID J. CUFFE, MVB, MA, MRCVS,
52 Abbeville Road,
Clapham, London, SW4 9NF.

ALEX G. GOUGH, MA, VetMB, CertSAM, MRCVS,
39 Southmead Road,
Westbury-on-Trym, Bristol, BS10 5DW.

WILLIAM T. JACKSON, DVSM, DrMedVet, FCIArb, MRCVS,
19 Ravenscroft,
Eastbourne, East Sussex, BN20 7HX.

MORAG G. KERR, BVMS, BSc, PhD, CBiol., FIBiol, MRCVS,
6 Corfe Close, Southwater,
Horsham, West Sussex, RH13 9RT.

JOHN J. OLIVER, BVetMed, MRCVS,
19 Manor Road,
Ashford, Middlesex, TW15 2SL.

HOWARD C. ROBINSON, BVSc, MRCVS,
Westcoats Farm, Stanhill,
Charlwood, Surrey, RH6 0ES.

NIALL T. TAYLOR, BVM&S, MRCVS,
Orchard Veterinary Group, Wirrall Park Road,
Glastonbury, Somerset BA6 9XE.

GEORGE W. TRIBE, BVM&S, MPhil, CBiol, FIBiol, FRCVS,
Moidart House, The Coopers,
Itchingfield, Horsham, West Sussex, RH13 0PQ.

Homoeopathic medicines: biological activity shown

Dear Editor,

Presumably your correspondents of the Anti-Homoeopathy Alliance are aware of the paper recently published in the peer-reviewed jour­nal, Inflammation Reseorch, which reports on yet another series of experiments à la Benveniste, confirming the biological activity of potentised solutions of histamine.  For the unprejudiced observer this will, presumably, settle once and for all the issue of the biological activity of homoeopathic medicines.

For the committed opponents of homoeopathy, however, this obviously necessitates a change of tactics.  Sadly for their cause, the lack of "homoeopathic medicines authorised for veterinary use" in the UK does not make the use of homoeopathy in animals "unlawful".

Not only are the vast majority of homoeopathic medicines pre­scribed by veterinary surgeons manufactured for medical use, but the pharmacies involved have Special Manufacturing licences.  In ad­dition, there are an increasing number of homoeopathic veterinary medicines authorised elsewhere in the EU.  Of course, the majority of patients referred to qualified veterinary homoeopaths have al­ready been through the cascade, often to their detriment.

There are also problems inherent in interpreting such a poorly ­drafted piece of legislation, designed as it is specifically to control the use of conventional medicines, and being completely inappropriate for the use of medicines which are prescribed on holistic principles.

I have yet to find a veterinary surgeon in general practice who views the cascade as anything else than a cynical and restrictive imposition on the rights of veterinary surgeons to use their clinical judgement when prescribing for patients under their care.  To wit­ness a group of veterinary surgeons invoking its provisions in an attempt to suppress the right to prescribe of a group of their col­leagues is incongruent to say the least.

As a lifelong footballer I have been saddened by the increasing propensity of professional players to call "foul" in a deliberate at­tempt to get an opponent a yellow or red card.  The motive in that case is obvious; that of the opponents of homoeopathy is more questionable, but equally disappointing, particularly when they also try and move the goalposts.  Of course, with a decent referee they would have long since departed for an early bath for persistently diving in the penalty area.

Once again misinformation is at the centre of this tiresome witch hunt, and once again one has to wonder what it is which really motivates its adherents.

Yours faithfully,

PETER GREGORY, BVSc, VetFFHom, CertIAVH, MRCVS,
Holistic Veterinary Medicine Centre,
The Village Works, London Road, East Hoathly, Lewes, East Sussex, BN8 6QA.

No proof required for homoeopathy

Dear Editor,

In response to Petra Kordel (20th December issue), the reason acupuncture and homoeopathy do not rely on animal tests is that, unlike conventional medicines, they do not have to prove they work!

Yours faithfully,

RICHARD LAVEN, BVetMed, PhD, MRCVS,
Woodhead, Eliock, DG4 6LD.

Homoeopaths 'guilty of deliberate fraud'

Dear Editor,

I have watched the debate regarding the merits, or otherwise, of homoeopathy and finally feel moved enough to contribute from my personal experience.

I have always been a sceptic about homoeopathy, but, given that professional colleagues appeared genuine in their beliefs that such methodologies could indeed be useful in the treatment of animals I was open to persuasion.

In January 2002, my practice purchased a primarily homoeopathic practice with a view to developing homoeopathy as a commercial venture.  I was persuaded by veterinary colleagues who produced data which appeared to indicate the validity of homoeopathic "trials" and even "scientific" papers, produced by one of the homoeopaths that we were about to take on as an employee, which quoted very impressive success rates in both horses and small animals.

One lives and learns though.  Once we had acquired the practice, we were able to gain access to the clinical records for many of the cases which appeared to validate the success of homoeopathic methodologies.  I was particularly surprised to discover that the use of depomedrone in this practice greatly exceeded that of our own (a significantly larger and wholly-conventional practice).  This did seem little strange to me at the time, since I had always been led to believe that corticosteroids were contraindicated in conjunction with homoeopathic remedies.

I was also surprised at the apparently poor level of clinical work-up and diagnosis for many of these cases.  No doubt the converted homoeopaths will state that conventional and homoeopathic methodologies are entirely different, therefore obviating the need for traditional diagnoses to be made in favour of a more holistic approach.  However, with time, I came across increasing numbers of cases in which good-quality conventional medicine was able to improve the lot of many animals now under my care.  I became more and more concerned at, what I can only term the "brain-washing" of clients into thinking that, somehow, the homoeopathic treatments were actually working when it was patently clear to an objective outsider that they were not.  Many of these animals had been undergoing treatment for years without significant improvement.

I admit now that I am vehemently opposed to homoeopathic medicines.  It is my personal opinion that those who continue to contend that homoeopathic remedies work are, at best, either seri­ously misguided or, at worst, guilty of deliberate fraud.  One of the selling points used to entice us to purchase this practice was the fact that the profit on homoeopathic remedies was very significant.  Remedies charged out at over £10 actually cost pence to produce (including materials and labour).  Clearly, there was money to be made out of such a venture.

Any good veterinary surgeon knows the power that we all wield in the consulting room.  In the extreme, we have the power and the ability to convince a client that the perfectly healthy animal they bring into the surgery is suffering from some terrible terminal disease and should be euthanased immediately.  It is equally possible for a veterinary surgeon with "gift of the gab" to convince a client that an animal with an incurable disease is actually getting better with the help of a few sugar tablets.  In my view, neither of these situations is tolerable in our profession, yet homoeopathy persists.

Of course there are good and not so good conventional veterinary surgeons.  It is my contention, based on my experience of both types of practice, that cases which homoeopaths put up as examples of animals that have got better "under their care" are simply poorly-managed conventional cases originally, or they are one of the very many cases that improve spontaneously despite treatment that each of us sees every day.  I have yet to see a single case in which homoeopathy alone can be proven to have been the most likely reason for a case improvement.

I used to be a sceptic.  Now I am a cynical sceptic and I very much hope that the silent majority of this profession speak up soon and voice their own scepticism.  We have all sworn to uphold the wel­fare of animals in our care, yet we continue to allow practices which prevent the application of conventional treatments, which are proven to work, in favour of remedies which are based on myth, faith and possibly deliberate fraud.

Yours faithfully,

RICHARD EDWARDS, MSc, MA, VetMB, MRCVS,
Foxfield, Slindon Bottom Road,
Fontwell, West Sussex BN18 0SN.

Conventional treatment not always the answer

Dear Editor,

As a vet who practised "alternative medicine" alongside conventional for 22 years, and now have a referral practice for homoeopathy and acupuncture, I feel I am in a good position to make some points.

As a veterinary surgeon, I endeavour to stick to the principle that Samuel Hahnemann, the founder of homoeopathy, followed which is: "The highest ideal of therapy is to restore health rapidly, gently and permanently in the shortest, least harmful way."  In other words, get the animal better as quickly as possible, in a way that does not make it worse!

If I can do this with homoeopathy I will, but as far as I am con­cerned, even with a chronic condition, the animal should be improving within three weeks.  If I feel that conventional medicine is the only option, the animal will be referred back to this.  I think most of my homoeopathic colleagues would do likewise.

Many of the conditions that come to us as homoeopaths are either those that are "untreatable" by conventional means or where the animals are having side-effects from the drugs given.  By the time they come to us, they often have depressed immune systems due to side-effects of the drugs and are often very depressed in themselves.  The fact that some of these improve is remarkable.

Some of these cases may be misdiagnosed.  If so, then they may be sent back to conventional medicine if a realistic, conventional therapy is available which abides by Principle One.

Diagnostic techniques have come a long way in the past 20 years.  However, the cost of these techniques has become nearly impossible for 60 per cent of the population.  For instance, referring an animal to one of the veterinary schools for a medical work-up can cost £2,000 and that is before anything is done to make it better!  A stifle operation can cost £2,000 without the initial work-up charges or aftercare.  Drugs can cost £100 per month or more.

Is it any wonder clients are looking for an "alternative"?  It is a sad state of affairs when you are rung up by a pensioner who wants a home for her beloved cat, but who says she cannot afford to keep it as her last vet bill was £500.  I am beginning to wonder about the charging by some conventional vets.  I know that the running of vet­erinary surgeries has got increasingly expensive.  However, some of these charges appear to be making some vets very rich.

So sometimes homoeopathy does not work, but conventional medicine is not foolproof either.  Yes, sometimes the animal might get better on its own, but that can be said of conventional therapy too.  What we do know, though, is that some drugs do give side-effects to our patients.  Hornoeopathy very rarely does that.

The argument that there have been no trials to see that homoeopathy works is true, but this is difficult, as each remedy is selected individually to the patient, not to the disease it is trying to make better.  However, how often do the drugs which we give together in various combinations been trialled to see what effects they have on the body when given in combination?  Hardly ever.

I had one patient who came to me who was on seven different drugs for a respiratory problem.  Each time she saw a different vet at the same practice, they gave her a different drug.

Homoeopathy can have amazing results, even in cases that have had problems for many years.  However, as with all alternative medicine, the success rate could be said to be directly proportional to the amount of drugs the patient has had and the length of time the condition has been in existence.

Yours faithfully,

Mrs B. M. WILLIAMS, BVSc, LCCH, RSHom, MRCVS,
Park Farm, Lyneham, Chippenham, Wiltshire SN15 4NS.

Are gullible clients being hoodwinked?

Dear Editor,

I have stood back from the recurring debate on homoeopathy that has raged through these pages, as I thought the subject was so vacuous as to be not worth wasting the energy of putting pen to paper.  But two recent cases highlight the gullibility of clients and how easily they could be hoodwinked.

I recently diagnosed a dog with thoracolumbar disc prolapse.  It was ambulatory, but with slight hind leg weakness and in some pain.

The owners could not afford spinal surgery, nor indeed was the dog in need of any surgical intervention.  I prescribed NSAID treatment and advised strict rest for six weeks.

I was somewhat disappointed, though hardly surprised, when two weeks later I received a call from the client to say that they had taken the dog to the local "healing" practice.  They said that with the application of some holistic therapy, it was better in two weeks not six, and added "so we won't be coming back to you, thank you".

In another recent case, a GSD bitch with severe EPI, SIBO and malabsorption syndrome was taken by its intelligent owners to a faith healer who laid her hand on the dog.  Her condition was miraculously cured.  The preceding months of careful dietary management and titrating the dose of pancreatic enzymes obviously had nothing to do with it, nor the fact that, despite this "miracle", the owners are continuing to keep her on a strict diet.

These incidents only reinforce my scepticism, but to avoid becoming too self-righteous, I remind myself of a scene from the TV series Silent Witness.  When Sam Ryan, the forensic pathologist, faces the apparent miracle cure of a nun with cancer by the admin­istration of Holy water, she says: "I would prefer to question the original diagnosis!"

Yours faithfully,

MARTIN ATKINSON, BVSc, MRCVS,
St Martins Veterinary Clinic, 126 Station Road,
West Drayton, Middlesex UB7 7JS.

Homoeopaths steering clear of side-effects

Dear Editor,

Homoeopathic colleagues would have us believe that sugar pills and shaken water have real effects on real diseases, yet the impres­sion is often given that these alleged effects come with no strings attached.

However, deteriorations in patients' symptoms are claimed to result sometimes from the remedies.  In the jargon of homoeo­pathy, these are called "aggravations".

So, just for once, let's take their assertions of efficacy at face value to look at safety instead, by turning to an interesting article recently published in one of their fanzines: "A preliminary audit investigating remedy reactions including adverse events in routine homoeopathic practice."  Thompson, E., Barron, S. and Spence, D. (2004) Homoeopathy 93: 203-209.  In this article we learn that: "Reactions were frequent: 28 out of the 116 patients (24 per cent) experienced an aggravation.  Thirteen patients (11 per cent) reported an adverse event, even though five of those were patients who also reported an aggravation followed by an overall improve­ment of their symptoms.  Thirty-one patients described new symp­toms (27 per cent) and 21 (18 per cent) a return of old symptoms".  Also, "Remedy reactions are common in clinical practice; some patients experience them as adverse events."

I do like the way they steer clear of that nasty phrase "side-effect" by careful use of euphemism.

In reality, I no more believe that these "adverse events" are caused by the remedies any more than are the supposed cures, but it's the homoeopaths who are keen to take the credit for cures.

Come on guys, you can't have it all ways.  If the remedies work, you've also got to accept responsibility for causing adverse reactions in an impressively large percentage of your patients.

I shall be fascinated to hear Steve Dean's thoughts on what the VMD should do about the use of unlicensed products off-cascade, for which practitioners claim adverse effects in a quarter of patients in the only piece of quantitative work I am aware of in this field.

Yours faithfully,

SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
House and Jackson Veterinary Surgeons,
Rookery Road, Blackmore, Ingatestone, Essex CM4 0LE.

Regulations will make VMD a 'laughing stock'

Dear Editor,

It is only a few months since we heard from Steve Dean, on behalf of the Veterinary Medicines Directorate (VMD), that the use of homoeopathic remedies was in contravention of the cascade system that permits only licensed medicines to be used to treat animals.  At the time, this seemed a small victory for rational thinking.  Now, however, it appears that even as this letter was being written, the VMD was in the process of compiling new regulations that will endorse those self-same remedies.

In Mr Dean's letter, he stated: "New medicinal treatments should be thoroughly researched, documented and then assessed and authorised by the regulatory authority before veterinarians are able to use them legally".

Homoeopathic remedies have been very thoroughly researched and no evidence for their efficacy has ever been found, so how is it now that the VMD is able to authorise their use?  The answer is a loophole, constructed specifically so that homoeopathic remedies are uniquely exempted from having to prove therapeutic effect or safety.  While this must come as a great relief to veterinary homoeopaths, such inconsistency is a cause of consternation to the rest of the profession.

To read, in the same draft regulations, that homoeopaths are forbidden from making therapeutic claims only adds to the confusion.  Homoeopaths have been selling remedies for years with no scientific backing, and it is doubtful that sub-section 2, paragraph 49 of schedule 1, part 8 of the regulations will change that.

On the contrary, homoeopaths will be only too happy to use the favourable parts of the regulations to lend themselves credibility, while at the same time overlooking the more troublesome aspects.

There seems little need for this endorsement; there is no scientific or medical justification for it and, in fact, the lack of a scientific basis runs the risk of making the VMD a laughing stock.  Homoeopaths themselves certainly do not need it to continue to ply their trade.  It would be interesting to hear from Mr Dean what form the lobbying from homoeopathic companies took and how powerful it was.

With a turnover of US$13 billion in 1990 alone¹, and little or no costs involved in research or safety trials, the homoeopathic industry could wield a fair amount of political pressure, not to mention hard cash, if it was in its interest to do so.  Is this an example of bureaucrats ignoring the little people while at the same time bending over backwards to accommodate big business?

The risk of adverse reactions to homoeopathic remedies has been put at 39.7 per cent², but homoeopaths themselves are in denial about the possibility; in fact, they see the worsening of symptoms as a success rather than failure.  They have no system for self-regulation, or for the reporting of adverse reactions.  Now, one of the few bodies that might have been in a position to protect consumers is washing its hands of the problem, giving homoeopaths carte blanche to prescribe whatever they wish.

Perhaps Mr Dean could tell us to whom we are supposed to turn now in order to defend ourselves from unregulated and unproven therapies.

Yours faithfully,

NIALL T. TAYLOR, BVM&S, MRCVS,
Orchard Veterinary Group,
Wirrall Park Road, Glastonbury, Somerset BA6 9XE.

1.  University of Maryland, www.umm.edu/altmed/ConsModalities/AnIntroductionToCAMcm.html.
2.  Hentschel, C. et al. (1998) Reports of Complications in Homoeopathic Treatment, ch 10.

Is tapping the vial key to homoeopathic remedies?

Dear Editor,

I have taken over many homoeopathic cases, as a consequence of the retirement of a partner with a penchant for the art.  My problem has been in the continued management of cases in remission.  I decided I would undertake some clinical research using a multiple blinded, multiple crossover, fully randomised trial.  Some months ago in your periodical, Morag Kerr suggested taking a handful of any homoeopathic remedy to test for "aggravations" or the like.  I extended this a bit.  Each time a client, having insisted that their animal's continuing health was dependent on homoeopathy, requested their regular supply of sugar pills, I opened the huge wooden drawer and chose a few vials at random.  Sometimes one, sometimes up to half-a-dozen were selected.

Client feedback was impressive - all utterly delighted with the continued 100 per cent efficacy.  Eventually, all my clients were re-educated and are none the worse for it I'm sure.  Initially, I had been troubled by the ethical issue - surely consent should be obtained for blinded placebo trials?  But no.  Every vial in the drawer is identical except the label, containing no active ingredients whatever.  They are all placebos.  If the cascade allows the use of any, it allows the use of all.

Judging from the comments of some more modest homoeopaths, some failures do occur.  Not with me they didn't.  To what do I ascribe my 100 per cent success rate?  Surely not my assiduous approach to remedy selection.

Then I remembered being told that a critical step in the production of a remedy is the deft little tap given to each vial following instillation of the "mother-of-all-tinctures" to the top of the densely packed vial of attendant pills.  This brief percussion is, perhaps, intended to mix the contents, or send a shock wave to distribute the magic.  Or perhaps the intention of the prescriber is thus transferred to the remedy.  Once I saw a homoeopathic pharmacist throw all caution to the wind and tap the tube 20 times.  He was evidently having trouble concentrating sufficiently to impart the power.  So, this must have been the reason for my success.  The drawer in the partner's desk containing the vials had been deprived of beeswax for decades, and it juddered like a newt with the DTs every time it was opened.  Millions of vibrations!

If anyone wants to make me an offer for my enhanced-activity lactose... most of the labels are missing, but it really does not matter.

The profit on lactose tablets could be very high, but any practice adopting homoeopathy, to help margins, would do well to pursue the conventional approach to diagnosis first, and charging for it prior to reaching for the wacky tabs.

Yours faithfully,

W. B. SWIFT, BVetMed, MRCVS,
Coles Barn, Bore Place Road,
Chiddingstone, Edenbridge, Kent TN8 7AP.

Homoeopathy anecdotes lacked evidence

Dear Editor,

I read Mark Carpenter's complaints about the "poisonous and vindictive" tone of some of the letters written about homoeopathy.  I would remind him that I came from a position of "know little, care less" about homoeopathy, and it was entirely thanks to the woeful examples of homoeopaths and homoeopathic practice with which I was confronted that I reached my low opinion of their activities.

Mr Carpenter might also recall that it was the case of a hyper­thyroid cat, portrayed on a radio broadcast in full possession of the classic clinical signs of hyperthyroidism, which was proclaimed to be a successfully-treated case that set me off on the path of defending the profession from the forces of unreason.  Sadly, when I contacted the veterinarian, he was unable to recall the case featured in the broadcast.  Seemingly, an appearance on national radio is a singularly forgettable experience.  Thinking that another homoeopath might help, some months ago I communicated with one to suggest we compare a set of thyroxine levels in cats treated solely by homoe­opathy and treated by conventional means.  I found it very easy to produce a set of "before and after" results for my practice, just by phoning our usual referral lab.  I remain interested to see his com­parable set.  I find the anecdotes told in support of homoeopathy interesting as fireside tales, but lacking weight as evidence.  But are we always given the true facts even for these anecdotes?

Now I think about it, when he appeals for "Trust. Honesty. Respect." to be shown to practitioners who use long-acting steroid injections, perhaps he has homoeopaths in mind.  I do find it a pity that the homoeopathic side has delivered us another prolix slice of motherhood and apple pie instead of addressing very serious points.  It is they, not we, who need to get their house in order.

With all that said, how about I try and fashion an olive branch from these bits of barbed wire and broken glass?  Is there a member of the VetFHom sufficiently sure of their ground to entertain a mili­tant sceptic to "see practice" with them?  The sceptic promises to bite his tongue and nod benignly in front of clients and to "Trust. Respect" the "Honesty" of the member of the VetFHom not to spring-clean his or her premises to clear them of depomedrone!  I'm sure Veterinary Times would be interested in publishing a co­authored report.

Someone within easy reach of Essex would be preferable.  Any volunteers?  I can bring doughnuts (and a sheaf of T₄ results).

Yours faithfully,

SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
House and Jackson Veterinary Surgeons,
Blackmore, Essex CM4 0LE.

Case for homoeopathy tolerance not made

Dear Editor,

It just will not do for Mark Carpenter to plead persecution of a minority.  Nor is it reasonable to justify homoeopathy by drawing non-existent parallels with acupuncture.

The point is that however we treat animals (or humans for that matter), there should be evidence that it works, or perhaps prior to the gathering of supporting clinical data, a reasonable theory of how it might work.  Homoeopathy fails on both counts.

Acupuncture, on the other hand, can be seen to work; it may or may not stop someone smoking, or cure malaria, but it certainly does something: put a few needles in a cow, and energise them for long enough, and it lies down and a caesarean operation can be performed without further anaesthesia.

Responses similar to that of the old Labrador in Mark's piece are not that unusual.  I am, of course, delighted that Mark's son recov­ered from a worrying illness, but this happens occasionally with con­ventional medicine too, and sometimes with no treatment at all, most particularly in cases of viral infection or allergic disease.

The case for tolerance is not made: vaccination can be proved to have an effect, even if many doses are given unnecessarily and the benefits of compounded diets can be measured in many cases.

But, if we stand for anything in this profession it has to be evi­dence-based medicine.  We do not have to tolerate alternative belief systems.  I am all for choice, but the problem is that it is not the animals which are doing the choosing.  Homoeopaths should get off the fence - belief in their principles is diametrically opposed to those underpinning conventional veterinary degrees.

The RCVS should require resignation from those members who no longer defer to the degree which enabled them to register.

Yours faithfully,

WILLIAM SWIFT, BVetMed, MRCVS,
31 Pembury Road,
Tonbridge, Kent TN9 2JB.

Clarification on UK homoeopathic legislation

Dear Editor,

Mr Taylor (14th March issue) asks some questions of the Veterinary Medicines Directorate in regard to the authorisation of homoeo­pathic remedies.

Current EU and UK legislation already permits the authorisation of homoeopathic remedies: therefore, the proposed changes to the UK legislation have not, in any way, altered the existing basis of European legislation that has been in place since 1993.

As this is the first time, to my knowledge, this has been chal­lenged in the veterinary press, I can only assume that Mr Taylor, and possibly other veterinary surgeons, may not be aware that this is the case.

Can I also take this opportunity of clarifying one of the comments that is attributed to me.

The use of homoeopathic remedies is permitted under Euro­pean legislation.  Currently, there are no authorised veterinary homoeopathic remedies in the UK.  Authorised human homoeo­pathic remedies can, however, be used by a veterinary surgeon under the prescribing cascade, provided there is no alternative authorised veterinary medicinal product.

Mr Taylor makes several other comments about homoeopathic remedies, which I think are more for the homeopathic practitioners to respond to.

Yours faithfully,

STEVE DEAN, BVetMed, DVR, MRCVS,
Veterinary Medicines Directorate,
Woodham Lane, New Haw,
Addlestone, Surrey KT15 3LS.

Still unclear on place of homoeopathic remedies

Dear Editor,

Thanks to Mr Dean for attempting to clarify the situation regarding the use of homoeopathic medicines under the prescribing cascade (25th April issue).  Unfortunately, to me at least, the precise placing of homoeopathic remedies on the cascade is unclear.

The cascade states that in the event of a licensed drug not being available, the veterinary surgeon may prescribe, in the following order: a drug licensed for the same condition in other species or a dffferent condition in the same species; a medicine authorised for human use; a medicine made up on a one-off basis (a "veter­inary special").

Does an "authorised" homoeopathic remedy fall into the same category as a medicine authorised for human use? Does a homoeo­pathic remedy prepared in clinic count as a veterinary special?  To take some specific examples:

• is it unlawful to treat a dog suffering from arthritis with homoe­opathy, when veterinary licensed treatments are available?
• if it is decided that treating a case of allergic dermatitis with ster­oids is not warranted because of the risk of side-effects, do human-­authorised homoeopathy and human-licensed antihistamines have the same standing on the cascade?; and
• if a veterinary surgeon prepares and dispenses a homoeopathic remedy in-clinic for a condition in which a veterinary or human licensed drug exists, are they acting unlawfully?

I would call on Mr Dean to give a specific and detailed reply to these queries, which are a concern for vets who promote or oppose the use of homoeopathy in animals.

Yours faithfully,

ALEX GOUGH, MA, VetMB, CertSAM, MRCVS,
Downs Referrals,
59 Great Brockeridge,
Westbury on Trym,
Bristol, BS9 3UA.

More confusion over medicine rules

Dear Editor,

I am now more confused than ever about withdrawal periods from homoeopathy medicines following the letter from Mr Dean (25th April issue).  This letter states there are no authorised veterinary homoeopathic medicines, but we can prescribe licensed human homoeopathic medicines under the cascade system.

Under the cascade system, we have to apply a minimum withdrawal period of seven days for milk and 28 days for meat.  So, presumably, if a farmer uses unlicensed veterinary homoeopathic medicines, the similar withdrawal periods must apply, as the risk from these unauthorised medicines must be greater seeing as we have no idea what they contain.  Farmers can access lots of unau­thorised homoeopathic medicines with great claims and they seem to come with zero withdrawal periods.  Clarification for our farming clients from the VMD would be very helpful.

Yours faithfully,

PETER EDMONDSON, MVB, FRCVS,
Shepton Veterinary Group,
Allyn Saxon Drive,
Shepton Mallet,
Somerset, BA4 SQH.