Dialogue on homeopathy
Research is important to understanding any set of phenomena. When we consider that veterinary medical colleges in the United States generally lack faculty with training in homeopathy and that research topics are generally chosen on the basis of available expertise and financing opportunities, it is not terribly surprising that little veterinary-specific research in homeopathy has been undertaken. Because a lack of evidence cannot be taken, in and of itself, as evidence of a lack of effectiveness, I think it is prudent to conduct more research on homeopathy and then comment on the results.
As species-specific, problem-specific research on homeopathy is done, it becomes feasible to have a meaningful dialogue on the subject. I believe that such dialogue would be a more productive way to proceed than debating the plausibility of homeopathy. Arguments about the implausibility of homeopathy date from the 18th century and, in my opinion, are outdated, at least given my understanding of physics and nanoparticles.
Some researchers have demonstrated that ultradiluted homeopathic solutions do in fact contain measurable particles and have speculated that these particles could have physiologic effects. If this is true, then further research is warranted. Once we scientifically investigate these phenomena, we may be able to offer better explanations of their actions and develop evidence for or against their use. That entire process begins by looking. As president of the American Holistic Veterinary Medicine Foundation, I believe that this process is worthwhile. We plan on spending less time in debate and more time in evidence development, generating dialogue from our expanding knowledge base.
Richard Palmquist, dvm
President, American Holistic Veterinary Medicine Foundation Inglewood, Calif
I thank Drs. Simon and Gordon Baker1 for responding to my letter. I appreciate that although the authors are not trained in homeopathy, they have devoted valuable time gathering negative information on this modality and disseminating the information to our profession.
As clinicians, we must take precautions against promoting a double standard for the evaluation of evidence. Any discussion of the efficacy of homeopathy should avoid selectively citing studies and should instead involve a complete literature review, focusing on the unique design considerations for studies of homeopathy and omitting references to low-quality investigations and opinions.
Drs. Baker state, “Controlled trials of homeopathy in which bias and the opportunity for mistaken impressions have been eliminated have consistently shown that homeopathic remedies have no greater effects than placebos.”1 From this statement, one could be led to believe that all well-designed trials of homeopathy have shown it to be ineffective, yet this is not true. In fact, homeopathy has been reported to be efficacious in basic science studies, clinical trials, and reviews by national health care systems.
For example, a systematic review2 of 67 in vitro studies of highly diluted solutions found that an effect was reported for 73% of these studies. Similarly, a review3 of studies that attempted to reproduce results of previous studies involving highly diluted solutions found that 52 of 77 (68%) follow-up studies yielded effects comparable to those reported in the initial study.
High-quality controlled clinical trials have also been able to show that homeopathy has effects beyond placebo. The Faculty of Homeopathy Research website4 provides a complete list of such clinical trials through 2011.
Finally, national health care systems have analyzed various homeopathic remedies and found them to be safe and cost-effective. For example, in a study5 involving 499 children in France with rhinopharyngitis, a homeopathic approach yielded significantly better results than antibiotic treatment in terms of effectiveness, number of complications, and quality of life, with lower direct medical costs covered by the French social security system.
With regard to the undercover investigation of homeopaths in and around London referred to by Drs. Baker, I would point out that that investigation involved phone calls to homeopaths in England who were not members of the Faculty of Homeopathy, a legally registered body in the United Kingdom that admits only health professionals trained to practice homeopathy within their recognized domain of professional competence. Rather than showing that homeopathy is dangerous, this investigation showed what we already know: any medical practice can be dangerous when engaged in by nonprofessionals.
It is well-known that people tend to interpret and search for new evidence in ways that conform to their existing beliefs and prejudices. The ideal of evidence-based medicine is to look at all the evidence and remove any bias prior to interpreting it.
Shelley R. Epstein, vmd
Wilmington Animal Hospital Wilmington, Del
1. Baker SJ, Baker GJ. Complementary and alternative medicine (lett). J Am Vet Med Assoc 2013; 242:153–154.
2. Witt CM, Bluth M, Albrecht H, et al. The in vitro evidence for an effect of high homeopathic potencies—a systematic review of the literature. Complement Ther Med 2007; 15:128–138.
3. Endler PC, Thieves K, Matthiessen P, et al. Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10–23: a bibliometric study. Homeopathy 2010; 99:25–36.
4. Faculty of Homeopathy Research. Faculty: research. Available at: www.facultyofhomeopathy.org/research/. Accessed Dec 9, 2012.
5. Trichard M, Chaufferin G, Nicoloyannis N. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children. Homeopathy 2005; 94:3–9.
Veterinarian oversupply in small animal clinical practice
During the 1980s, the veterinary profession was inundated with dire predictions of shortages of thousands of veterinarians by the year 2000. Many practitioners, myself included, believed these claims to be wildly exaggerated, but the experts dismissed our opinions as unscientific and even accused practitioners of being self-serving and seeking to limit competition. On the basis of these predicted shortages, existing colleges of veterinary medicine increased their class sizes and new colleges were planned.
Today, it appears the consequences are being felt. The resulting combination of too-few job openings and crushing student loan debt has created a worst-case scenario for new graduates. With too many graduates competing for too few jobs, the veterinary profession in general and small animal clinical practice in particular have ended up with the same set of oversupply problems facing the legal profession.
Many of us back in the 1980s were able to foresee the future oversupply of veterinarians. Our warnings went unheeded. As Bob Dylan once sang, “You don't have to be a weatherman to know which way the wind blows.”
Richard H. McCormick, dvm
Miami, Fla
