previous page of letters
In the same issue of Veterinary Times as Mr. Gregory's homoeopathic apologia (in fact, immediately preceding it) a dermatologist published an article concerning the treatment of Pseudomonas aeruginosa infections in canine ears. One piece of her advice seems to have aroused the disapproval of the regulatory body responsible for overseeing the proper use of veterinary medicines in the UK.
[Volume 34, no. 30, 9th August 2004, page 30.]
EDTA tris not for use under cascade provisions
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.
STEVE DEAN, BVetMed, DVR, MRCVS,
Well now, this does rather raise a question we hadn't really considered before. Where do magic sugar pills sit within the cascade? Does the fact that their properties most certainly do not "appear to justify the view that the compound is medicinal by function" exclude them, or do the clear therapeutic claims made by their proponents lead to their inclusion? Enquiring minds want to know.
Meanwhile, however, Mr. Gregory's mind seems to be enquiring in quite different directions.
[Volume 34, no. 30, 9th August 2004, page 31.]
Why should we create other problems?
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?
PETER GREGORY, BVSc, VetFFHom, MRCVS,
Well, given the can of worms opened by Mr. Dean on the preceding page, we suspect Mr. Gregory is being a little premature in assuming that this correspondence is at an end.
Still, we're fairly sure that Mr. Gregory's tongue was just as firmly in his cheek as Mr. Taylor's. The next correspondent, however, has perhaps overlooked that little wrinkle. Never mind, his heart seems to be in the right place!
[Volume 34, no. 31, 16th August 2004, page 31.]
Dismayed by nonsense....
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.
D. M. TANSEY, MVB, MRCVS,
Mr. Tansey, repeat after us. Mr. Taylor was joking! And indeed, if you really do know what "deterministic quantum teleportation of atomic qubits using a semiconductor nano-crystal energy transfer pump" means, we suggest you tell him, because we strongly suspect he made it up. Never mind, the only thing we'd really take issue with is the idea that naïveté in any way absolves the homoeopaths of responsibility for fraud.
After Mr. Dean's explanation of the restrictions imposed on practitioners by the cascade legislation, well, somebody had to say it....
[Volume 34, no. 32, 23rd August 2004, page 27.]
Ear infections, cascade and homoeopathy....
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.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
This is no minor matter. It's possible that the VMD may consider homoeopathy not to fall within the cascade because of the absence of any active ingredient in the remedies. This might lead one to conclude that there was no problem with safety and no problem with residues. However, the moment you allow any of the homoeopaths' claims of physiological effect, you automatically open the door to the possibility of unwelcome effects and dangerous residues. And since nobody has any idea how the alleged effect happens, it's all a very scary big unknown - and the VMD doesn't care for scary big unknowns. We wonders. Yesssss, we wonderssss....
It was a month before a reply was printed, but when it was - paydirt!
[Volume 34, no. 36, 20th September 2004, page 39.]
Use of medicines under the cascade
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.
STEVE DEAN, BVetMed, DVR, MRCVS,
We'd like to repeat that, if we may.
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.
The very first letter in this sequence was entitled "Time for statement on unproven medicines". Well, it took 18 months, but we've finally got one.
And quite coincidentally, the seriousness with which the RCVS regards breaches of the cascade legislation was amply demonstrated by a report in the Veterinary Record which appeared a couple of days later.
[Veterinary Record, vol 155 no. 12, 18th September 2004, p. 347.]
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.
Mr. Swift broke the cascade legislation in two ways: by administering a product (Dectomax) licensed only for cattle and sheep to a cat, despite the availability of dozens of suitable products licensed for feline use; and by mixing together seven different preparations (kaolin, pectin, Systemax wormer, gentamicin, Flagyl, Baytril and Tylan) in such a way as to invalidate the terms of the product licences even though some of these preparations are in fact licensed for cats.
He did not use anything completely uncharacterised or unlicensed, and in this respect might be considered to be committing a lesser offence than the use of the completely unlicensed EDTA-tris. Or homoeopathic remedies, for that matter.
Nevertheless, these offences (committed after two written warnings instructing him to cease and desist) were considered sufficient to impose the severest penalty available to the Disciplinary Committee - Mr. Swift was struck off.
In contrast he was merely suspended for the criminal conviction for a sexual offence against a child, and regarding the careless stomach tubing of the cat (which resulted in the cat's death from inhalation pneumonia) sentence was deferred.
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 "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:
Might we also 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.
This has nothing to do with the question of efficacy (or otherwise) of homoeopathic remedies. 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.
So of course the Voodoo Society (or some of it at any rate) had to say that and more, more publicly. This does seem at first sight to be close to checkmate, but we can't believe it's that simple. Some loophole will be found, some exception made in the name of Prince Charles or something, and it will all be to do again. Don't you think?
[Volume 34, no. 41, 25th October 2004, page 26.]
What now for those who practise homoeopathy?
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:
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.
CAROLINE R. BAKER, MA, VetMB, MRCVS,
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
DAVID J. CUFFE, MVB, MA, MRCVS,
ALEX G. GOUGH, MA, VetMB, CertSAM, MRCVS,
WILLIAM T. JACKSON, DVSM, DrMedVet, FCIArb, MRCVS,
MORAG G. KERR, BVMS, BSc, PhD, CBiol., FIBiol, MRCVS,
JOHN J. OLIVER, BVetMed, MRCVS,
HOWARD C. ROBINSON, BVSc, MRCVS,
NIALL T. TAYLOR, BVM&S, MRCVS,
GEORGE W. TRIBE, BVM&S, MPhil, CBiol, FIBiol, FRCVS,
The veterinary regulating bodies, to nobody's great surprise, made absolutely no comment on this, and it was left to Mr. Gregory to see if he could find some way to wriggle round the problem. At about the same time a new paper in the infamous tradition of Benveniste came out, and Mr. Gregory decided that this speculative and only peripherally relevant publication settled the matter in favour of homoeopathy once and for all.
[Volume 34, no. 47, 29th November 2004, page 27.]
Homoeopathic medicines: biological activity shown
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.
PETER GREGORY, BVSc, VetFFHom, CertIAVH, MRCVS,
Mr. Gregory once again didn't bother to cite the reference for the study he referred to, but it seems likely it was this paper, whose principle authors work for Boiron, France's multi-million-euro manufacturer of homoeopathic remedies, who also sponsored the Benveniste work. It's a pity that some of these huge profits can't be spent on some simple studies to show that proving symptoms actually exist, or that homoeopathic remedies have any demonstrable effect whatsoever. This paper is so obfuscatory, so difficult to read, that one wonders of the authors are more intent on hiding something than in communicating their findings. It's impossible to figure out what's going on without at least seeing their raw data, but it is notable that none of the basic sciences seems interested enough to answer Professor Ennis's plaintive request to please figure out what's going on here. If we might hazard a guess, not a lot.
So far as the cascade goes, we're not sure if Mr. Gregory is trying to say that homoeopaths always practise within its remit, or whether he's rejecting it as a "cynical imposition". Of course Mr. Dean's letter was quite clear, but in the absence of any attempt to enforce the legislation, or even to warn practitioners in the way Mr. Dean chose to warn Miss Paterson, nothing will presumably go right on happening.
The next letter rather suggests we might have missed a relevant contribution in December. Never mind, we get the general picture!
[Volume 35, no. 1, 24th January 2005, page 27.]
No proof required for homoeopathy
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!
RICHARD LAVEN, BVetMed, PhD, MRCVS,
Hmmm, how might acupuncture be tested? Surely, by sticking needles in animals and observing what happens. In that case, doesn't that mean that the animals it's tested on are the patients? Which would also apply to homoeopathy, wouldn't it...?
This next letter is probably the most significant contribution to the debate to date. Homoeopaths have a wonderful habit of picking out spectacular recoveries and dressing them up as miracle cures. However, we all know of cases which have recovered unexpectedly, apparently no thanks to anything we did. What is really required is access to some homoeopathy casebooks, unedited, to allow an assessment of whether these miracle cures really do seem to occur often enough to warrant the interpretation that the homoeopathy is actually influencing the outcome. Mr. Edwards, who describes himself as a sceptic but obviously approached the subject with an open mind, found himself in the position of actually having access to such case records. This is what he found.
[Volume 35, no. 3, 7th February 2005, page 39.]
Homoeopaths 'guilty of deliberate fraud'
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.
RICHARD EDWARDS, MSc, MA, VetMB, MRCVS,
Misrepresentation of clinical success, use of conventional medicines in such a way as to allow homoeopathy to be credited with any improvement, eye-popping profit margins, and worst of all, "brainwashing" of owners into believing that an improvement had occurred when in fact their pet was no better. Is there anything surprising about any of this? Perhaps the least surprising thing of all was the complete lack of any response from the homoeopaths taking part in this corrrespondence.
The next letter was merely another repetition that "it works" (sometimes), and it's OK to prescribe nice cheap sugar pills (carefully not considering the profit margins involved) because real medicine is expensive.
[Volume 35, no. 5, 21st February 2005, page 18.]
Conventional treatment not always the answer
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.
Mrs B. M. WILLIAMS, BVSc, LCCH, RSHom, MRCVS,
We're really not quite sure whether Mrs. Williams meant what she seems to be saying in that last paragraph. Homoeopathy works best when the patient has been ill for a long time and has had a great deal of conventional medication?
The author of the other letter published in the same issue of the journal seems to be catching on to how it all works, however.
[Volume 35, no. 5, 21st February 2005, page 18.]
Are gullible clients being hoodwinked?
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!"
MARTIN ATKINSON, BVSc, MRCVS,
The following week's edition was characterised by another prominent pro-homoeopathy article, this time an editorial piece featuring the election of John Saxton as the first veterinary surgeon to hold the office of President of the Faculty of Homoeopaths. It's complementary, my dear Saxton: homoeopathic vet lands leading role. This was the usual uncritical hagiography, noteworthy mainly for the remark that Mr. Saxton claims "some 130 members for BAHVS, but the numbers are growing". This compares unfavourably to the claim on the association's web site (unchanged for several years) that "The membership has now grown to 140", and that to a claim by Francis Hunter, the then-President of the association, in a letter in the Veterinary Record in March 1991, that the membership was then 150. This is some new homoeopathic definition of "growing", we take it! As the editor of Veterinary Practice told Mr. Taylor that his critical article would only be published once they had a pro-homoeopathy piece to balance it, we look forward eagerly to the critical piece which must be in the pipeline to balance this little lot.
Also appearing in the same issue was the first letter to take a serious look at the question of adverse reactions from homoeopathic remedies. How can sugar pills provoke adverse reactions, you might well ask? In exactly the same way as they "cure" - by attributing everything that happens following administration of the remedy to the action of the remedy. And when one starts counting in that vein, the results are quite surprising.
[Volume 35, no. 6, 28th February 2005, page 34.]
Homoeopaths steering clear of side-effects
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.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
This of course highlights the incongruity in the concept of licensing homoeopathic remedies. Why give medicinal licences to sugar pills? Why indeed? However, if you're going to go down that route, whatever can be the logic in then making the assumption that there can be no adverse reactions and no residue problems? Yet that is exactly how the regulations are formulated.
Mr. Taylor's next letter, which celebrated the second anniversary of the correspondence in fine style, refers to the consultation draft of the Veterinary Medicines Regulations (2005), which was at that time open for comment. The relevant section is Part 10, pages 36 and 37 of the linked document. In fact this draft did not represent a significant change to the then-current situation, and apparently it is mandatory to allow such registration under EU rules, for some bizarre and incomprehensible reason.  Nevertheless, it is a prime example of simultaneously implying that there is something to regulate, while at the same time acknowledging that actually there's nothing there at all.
Interestingly, Mr. Taylor has found another reference, different from Dr. Baker's, where homoeopaths themselves record an absolutely astounding incidence of adverse reactions.
[Volume 35, no. 8, 14th March 2005, page 22.]
Regulations will make VMD a 'laughing stock'
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.
NIALL T. TAYLOR, BVM&S, MRCVS,
1. University of Maryland, www.umm.edu/altmed/ConsModalities/AnIntroductionToCAMcm.html.
Immediately following that, this letter appeared. We're not entirely sure how much of this is a wind-up, but really, even if Mr. Swift did do all this, in what way is it more reprehensible than any other vet prescribing sugar pills for an animal? At least these patients weren't ill.
[Volume 35, no. 8, 14th March 2005, page 22.]
Is tapping the vial key to homoeopathic remedies?
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.
W. B. SWIFT, BVetMed, MRCVS,
The issue of Veterinary Times dated 28th March 2005 was unusually rich pickings for students of the wackier outposts of our profession. First, on page 2, we heard all about Liz Scrivener, who is "one of only two registered level three photonic practitioners in the UK", and the only one specialising in animal treatments. Photonic therapy is apparently the "scientific" application of light to those areas of the skin with increased electrical conductivity to produce physiological results. Oh, it stimulates acupuncture points. Just where this "treatment", given by a lay practitioner, stands in relation to the Veterinary Surgeons Act, was not revealed.
Next, on page 22, we were treated to "informed advice on herbal medicine". While it seems that those attending the four-day course described were actually veterinary surgeons, this time it was the Cascade legislation that unaccountably didn't rate a mention.
Finally, on page 38, we had the much-awaited "balancing article" to the pro-homoeopathy piece published on 28th February - except, oops, it wasn't. This edition of Your Shout was yet another pro-homoeopathy tirade. "Time for profession to heal thyself", by Mark Carpenter, was given an entire page to rail against the "increasingly vindictive and malicious comments" of the sceptic brigade. Yes, he knew it was all a big con, till he tried it and "it worked". Yet one more supposedly educated professional who can't tell the difference between an anecdote and evidence, unfortunately. We have no information as to how large his "silent majority" of the profession to whom he appealed turned out to be, or whether anything ever came of "V.E.T."
The only responses printed came from Dr. Baker and Mr. Swift, and we rather think these didn't quite represent the reaction Mr. Carpenter had been hoping for.
[Volume 35, no. 13, 18th April 2005, page 34.]
Homoeopathy anecdotes lacked evidence
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).
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
Mr. Swift came in as the seconder of that motion, except - dear Mr. Swift, we would urge you to apply the same degree of critical thinking to the evidence for acupuncture as you do to that for homoeopathy. Just because in that case something is actually done to the patient does not automatically mean that it works. Do tell us about this "energising" of needles! What sort of energy? How is it measured? What units do you measure it in? Does it obey the laws of thermodynamics? Seriously, if you have actually seen a casearian section performed on a cow with nothing but acupuncture as anaesthetic and restraint, we'd dearly like to hear about it. Otherwise, we'd caution you not to believe everything you read in the papers.
[Volume 35, no. 13, 18th April 2005, page 34.]
Case for homoeopathy tolerance not made
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.
WILLIAM SWIFT, BVetMed, MRCVS,
Finally, at the end of April, came the long-awaited backtracking on the legal position of homoeopathy within the veterinary profession. Of course it was clear from what Mr. Dean didn't say in his earlier letter that the existence of some homoeopathic remedies with human licences would allow these to be used by veterinary surgeons. However, once again Mr. Dean's contribution was more interesting for what it didn't say than for what it did.
[Volume 35, no. 14, 25th April 2005, page 34.]
Clarification on UK homoeopathic legislation
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.
STEVE DEAN, BVetMed, DVR, MRCVS,
Yes, there are some remedies with human product licences. However, does that give carte blanche to veterinary homoeopathy? We think not.
Do we really believe that this is how veterinary homoeopaths actually practise? And there are more conundrums, which we will allow Mr. Gough to touch on.
[Volume 35, no. 16, 9th May 2005, page 39.]
Still unclear on place of homoeopathic remedies
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:
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.
ALEX GOUGH, MA, VetMB, CertSAM, MRCVS,
All very good questions. Are we likely to get an answer? And a few more rather present themselves. Just supposing any homoeopathic remedies do obtain veterinary product licences - where would they then stand in the Cascade? Given that they would then be veterinary medicines, would that mean that every veterinary surgeon would be obliged to try homoeopathy before being permitted to move on to products with a human licence? We can envisage mass carnage among cases of Addison's disease, if that were to be the case! However, considering that homoeopathic remedies have these uniquely emasculated licences, with no requirement to demonstrate efficacy and no therapeutic indications, how can they function within the Cascade at all? Yes, this is silly, but then so is the whole idea of granting any sort of medicines licence to sugar pills. Can we ever hope for clarification?
And judging by the following week's issue, Mr. Gough was not the only colleague completely confused by all this.
[Volume 35, no. 17, 16th May 2005, page 28.]
More confusion over medicine rules
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.
PETER EDMONDSON, MVB, FRCVS,
Surely, after all that, Mr. Dean would write again! Mr. Dean? Hello?
But that was that. The end. After two years and two months, the correspondence came to a close.
back to Home Page