Falling for ‘hope-based’ medicine instead of science
By Dr. Narda Robinson
July 15, 2009
Complementary and alternative medicine is currently at a crossroads, at a place where veterinarians must choose between belief-based practices and science. If enough veterinarians insist on raising the bar so that we know what we’re doing and why based on the latest research-driven insights, we will better meet our clients’ expectations.
Society holds doctors to high standards and expects more from them than from lay practitioners. What we do and what we say may carry more weight simply because of our background, but we have the responsibility to use that authority carefully and not abuse it.
This “Aesculapian authority,” as the philosophy professor Bernard E. Rollin calls it, is “both powerful and perilous.” Aesculapian authority, long applied to physicians and now to veterinarians, automatically turns the healer into an expert, rightly or wrongly, with special knowledge and highly valued skills. This authority, writes Rollin, “dates back to centuries ago when medicine was a product of ‘natural philosophy,’ this power stems from the concept that the physician has license to control by reason of God-given grace. People believe — in a vague and almost unconscious way — that he has special connections with the world of the unknown, philosophically and spiritually.”
When a veterinarian or physician treats with herbal medicine or homeopathy, the technique may gain added credibility, whether or not that is justified. The unknowns of complementary and alternative medicine touch so commonly on unknowns that this Aesculapian authority can grow even larger, bordering on dangerous territory. It means that unless we indeed have insights based on facts instead of faith and hope, we are letting our clients and patients down. I reject placing my patients’ health and well-being at the mercy of hope. While I embrace the value of a positive outlook and good intentions, my human patients and veterinary clients come to me expecting treatment based on facts, not myths and metaphors.
I need to know how healing methods work and what their potential drawbacks are well before I recommend them.
This decision arose when I found I continually felt a visceral unease at Chinese herbal medicine seminars where instructors presented lists of herbs in formulae that I was to memorize and then prescribe based on metaphors. Is the tongue red? Then the patient has a “Heat” condition. Give them a heat-releasing tonic. Is the pulse jumpy? Then sell them something with a name like “Spirit Calm.”
What? Am I really supposed to prescribe biochemically active products based on an instructor’s claims of effectiveness and safety, especially when said teacher him- or herself is manufacturing and touting these products? Should I ignore the fact that they teach next to nothing about the herbs’ mechanisms of action, their safety in the species for whom I was prescribing these products, and their potential for drug-herb interactions? No matter how cute the products’ names, such Wise Sage, Gentle Spirit or Dynamic Soldier, I need to know what’s in these products and why, and what I’ll be doing to my patients by giving this to them!
In fact, there’s so much “hope” involved in herbal prescribing, especially in Traditional Chinese Veterinary Medicine that I developed a list: “The Top Ten Hopes One Needs to Adopt in Order to Successfully Prescribe TCVM Herbs.”
1. You have to hope that the product is safe, because there is no manufacturing oversight for Chinese herbs. You are counting on the ability and reliability of whoever is selecting and mixing the herbs to properly identify the plants, to not substitute herbs because another botanical is less expensive or more available. Herbal substitution is an intrinsic part of Chinese herbal medicine, but it can be deadly. For example, we have learned that, on occasion, plants from the Aristolochia species, which can cause renal failure, were substituted for other common herbs such as stephania and akebia.
2. You have to hope that the ingredients on the label match what’s in the bottle and that the manufacturer did not add a little something “extra,” i.e., undisclosed pharmaceuticals, to make sure that this company’s product outperforms competitors. At least one brand of the popular Yin Chiao tablet for sinusitis had been found to contain an undisclosed pain reliever, caffeine, and an antihistamine. I remember some of my human patients raving about this product and now I know why. Should your dog and cat be receiving human medications in his or her “natural” Chinese herb? No.
3. You have to hope also that whatever pesticides (including DDT-type agents), fungicides, herbicides and fumigants applied in the growing, storing, or transporting process will not harm your patients.
4. You have to hope that processing agents such as sulfur, heavy metals and residues from sterilizing gases will not endanger them, either.
5. You have to hope that herbs you’re promoting as better because they’re “organic” in China truly are, because organic farming as a whole in China has raised many questions related to commitment to upholding organic standards.
6. You have to hope that the contents in the bottle, whether plant, animal, mineral, drug, contaminant or otherwise will not interact with other treatments your patient may be receiving, such as chemotherapy, immunosuppressive agents, or anesthetic drugs.
7. You have to hope that you won’t be too disgusted or dismayed by what actually passes as a Chinese “herb.” This includes animal feces, insect parts, earthworms, scorpions and cute little seahorses. It also includes products from endangered species such as tiger bone and rhinoceros horn. Certain products contain parts of dogs. You have to ignore the inhumane “farming” practices of manufacturers who raise bears for their bile and other animals for their biological substrates with little to no concern for those animals’ welfare.
8. You have to hope that viruses from animal products and humans (such as cooked placenta) will not contaminate your patients.
9. And then there is the list of hopes that as a Chinese herbal prescriber, you are making a justifiable herbal recommendation based on a real diagnosis.
Here you have to hope really hard. Here’s why: most Chinese herbal prescribing applies folkloric methods of diagnosis invented centuries or millennia ago. None of these methods has been proven reliable scientifically, even for when applied to humans, the species for which they were designed.
In fact, the likelihood of any two Traditional Chinese Medicine practitioners to come to the same diagnostic impression for a patient, even in humans, is low. For years, I have questioned those who have no qualms using arcane and folkloric methods to “diagnose” animals’ diseases based solely on the appearance of the tongue, the feel of the pulse or the taste of the herb. I have asked how they can feel comfortable relying so heavily on methods that have yet to be proven reliable even when applied for humans, the species for whom these methods arose, but I never receive a satisfactory explanation, other than it’s “tradition.”
Sadly, there is no “tradition” for making herb potions for dogs and cats based on tongue and pulse diagnosis and Fluffy’s “Five Element” personality makeup. It’s all been invented in the past two decades in the United States by practitioners who hope or assume that these methods work in small animals because they want them to!
Furthermore, the metaphorical Traditional Chinese Veterinary Medicine diagnostic “patterns” that supposedly tell us whether the liver has been invaded by wind or the spleen by dampness (whatever those metaphors actually mean physiologically) also means that we have to hope the herb our instructor promised us would work to eliminate wind or dispel damp is actually going to. We have to hope that our instructor is right because there’s no way to measure liver wind or spleen dampness. They are archaic metaphors generated even before paper was invented. Why are we entrusting our animals’ and patients’ health to such out of date systems?
10. Finally, we have to hope that the person assembling the formula has something more to base the mixture on than purely experimentation on our patients, seeing if a little more of this or a dash of that might make the stuff more “powerful.” The reality is that this backroom trial-and-error experimentation can cause serious harm, even when done in human herbal practices. Articles from China itself have called for more examination into the potential harm of Chinese herbs.
Sometimes, when I raise these issues to those in my profession who are stuck in the hoping-for-wellness model, they recoil. “We know it’s real! We learned from the Master! We know it works! You’re just a naysayer! You’re a doubter!” And we’re back to practicing medicine as a religion.
I am by no means saying that Chinese herbs don’t work or have potentially powerful physiological effects, because they often do work and benefit patients significantly. Some may even benefit animals with cancer by stimulating immunity and controlling inflammation.
What I am saying is that we as veterinarians should know what we’re doing and why we’re prescribing them. And not abuse our Aesculapian authority.
Dr. Narda, I have long wondered — and worried — about the quality of what’s in bottles of herbs from China. Given what we know about their rogue operators and nearly non-existent quality control, I think the concern is more than legitimate. Who knows what the heck’s in those bottles, vs. what’s suppose to be in there.
Melamine, anyone?
Comment by Gina Spadafori — July 15, 2009 @ 5:55 am
Chinese medicine has been around for thousands of years - much longer than Western medicine - and has most definitely not “been invented in the past two decades in the United States by practitioners who hope or assume that these methods work in small animals because they want them to”.
It is refreshing to me that, unlike Dr. Robinson, more and more veterinarians are open to exploring holistic and alternative therapies, be it TCM, Chinese Herbs, energy therapies, and more. There is ongoing research on the human side into the benefits of these therapies by organizations such as the National Center of Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH), which is designed to answer questions about alternative therapies. I feel that this open-mindedness, and willingness to explore these therapies from a scientific angle, will benefit human and animal health tremendously.
Comment by Ingrid King — July 15, 2009 @ 6:15 am
Outstanding. Thank you.
I have always cautioned people that the medicinal herbs that work do so for a reason — they are biochemically active in the body — and this means that they can have undesired effects, overdose, etc.
The fantasy “medicine” that cures in a day and cannot possibly hurt you is just that — a fantasy.
While I’m all-too-willing to believe you when you say that alternative practitioners are employing Chinese herbals based on half-understood folklore, it’s also true that the veterinary profession relies on equally unreliable “data” for many conventional practices.
Perhaps even more than human doctors.
For example, the latest greatest NSAID or topical parasite control — suddenly pushed on every client for every patient, because the drug company rep had such a great pitch and also gave us all this cool swag. Where is the peer-reviewed long-term double-blinded clinical study that shows that this product performs better and is safer than an aspirin or a flea comb? Don’t get me started on $5/pill antibiotics that fail in serial, when amoxicillin clears up the problem in a week for two bucks.
Or the reflexive medical orthodoxy based on selectively-remembered anecdote + endorsement by “authority” + repetition: Spay before six months, every animal, every breed. Always do surgery for HD or a ruptured ACL. PennHIP is more clinically predictive than OFA. All dogs need regular dentals under general anesthesia.
Again: long-term, peer-reviewed, double-blinded, statistically robust studies — let’s have ‘em. Or in some cases, just an application of common sense. (Hey, this eight-year-old dog’s teeth are perfect. Maybe we don’t need to knock him out and mess with them.)
When that Asclepiad Authority jumps the track of medicine strictly defined, and starts to proclaim that Hills — who just happened to provide free books and an instructor for that one and only nutrition class in vet school — makes a superior complete and balanced pet food, and that raw diets kill, then I start getting more than a little tetchy.
When Asclepius flies completely off the trestle bridge and starts making authoritative proclamations on training methods without ever having trained anything in its life I become downright territorial.
So my point is not to come on here and vet-bash, but really to put your excellent critique of the trap of faith-based alternative medicine into the context of an all too-common complacency that leads to commercialized faith-and-folklore-based “conventional” medicine, supported by the corporate equivalent of that Asclepiad Authority rather than the scientific method.
Comment by H. Houlahan — July 15, 2009 @ 6:25 am
Wow Ingrid, way to totally miss the point!
Comment by H. Houlahan — July 15, 2009 @ 6:28 am
Yeah, Ingrid, you might want to read her post again … AND look at her bio. She’s a professor of VetMed at CSU SPECIALIZING in evidence-based complementary and alternative veterinary medicine.
And her point about if you can trust what’s in those bottles … well, if you do without reservations, I have some stock in Menu Foods to sell you.
Hope-based commenting, this is.
Comment by Gina Spadafori — July 15, 2009 @ 6:36 am
Ingrid, you wrote: “It is refreshing to me that, unlike Dr. Robinson, more and more veterinarians are open to exploring holistic and alternative therapies, be it TCM, Chinese Herbs, energy therapies, and more.”
Perhaps you should consider doing more research on the topic. Our program in integrative medicine at Colorado State University is one of the few in veterinary medical colleges that is actually doing this research.
For example, I am currently performing a randomized, double-blind study on the value of herbs for lameness in dogs , I have been researching on the comparative neuroanatomy of acupuncture for almost a decade, and we are looking into studying low level laser therapy.
My research team has published the only two studies ever done examining Chinese tongue diagnosis in dogs and the reliability of this method or lack thereof. So please examine the facts before stating that I am not open to exploring holistic and alternative therapies.
Furthermore, if you have any evidence that tongue and pulse diagnosis in dogs and cats, or Five Element personality assessment, was historically performed in China, I would love to see it. This would surprise me, given that dogs and cats are still regarded as food in certain parts of Asia, including China.
And yes, Chinese medicine has been around a long time. That doesn’t mean we should continue to believe in outdated and incorrect notions about physiology because we in the West have an inbuilt fascination with exotic ideations of healing. And it doesn’t mean that the folkloric practices applied to humans are suitable for dogs and cats unless they are tested and proven so. As I implicated in my piece, I think our furry family members deserve more.
Comment by Dr. Narda — July 15, 2009 @ 6:41 am
I must second Heather’s comment, specifically about Hill’s products. When a vet insists that r/d is “the only way this dog is going to lose weight” and refuses to even look at the ingredients list in r/d versus any other food to explain WHY r/d will work and nothing else will, and the client must accept it ‘on faith’ that the vet knows…well, that’s abusing the Aesculapian authority and making me wonder how much other information is unreliable too.
Comment by KateH — July 15, 2009 @ 6:45 am
Dear H. Houlahan:
Thanks for your reflections. I agree that mainstream approaches also need to be examined critically.
Here’s an article I wrote for Veterinary Practice News on changing views about CCL repair: http://www.veterinarypracticen.....epair.aspx that generated some “discussion” as well.
Comment by Dr. Narda — July 15, 2009 @ 6:46 am
EXCELLENT article.
I’ve spent the last 15 years working in biological control research, and many, many, many people, upon hearing what I do for a living, talk to me about the “latest” in herb/natural/holistic practices, and are greatly surprised when I don’t fall all over myself agreeing with them. My favourite line EVER from one believer (and unfortunately, it was my brother):
“Sea salt is better for you because it doesn’t have any chlorine.”
I have learned not to argue the point with most people, but simply to leave them with a favourite quote:
“Arsenic is natural; hemlock is organic”
I’m not against natural remedies or holistic medicine, but I do call BS when I see it.
Comment by K. B. — July 15, 2009 @ 7:41 am
I have the same “hopes” for the ingredients in commercial pet foods . . .
Comment by catmom5 — July 15, 2009 @ 7:52 am
very very very important. Why would anyone trust Chinese anything to be safe these days, even if there were science behind the treatments?
But uh oh, Gina, she said “Fluffy”!
:-)
Comment by EmilyS — July 15, 2009 @ 8:13 am
Clearly, I need to reread Dr. Robinson’s post again, and clearly, I missed the point and reacted to one isolated comment that really rubbed me the wrong way. My bad - should have given this more thought before posting my knee-jerking comment.
I was in no way questioning Dr. Narda’s credentials, and I apologize if I offended anyone.
Comment by Ingrid King — July 15, 2009 @ 8:13 am
It seems more often than not that both human medicine and animal medicine choices made by supposably competent professionals have more to do with the skills of the company representative that just brought lunch and trinkets that the actual science and common sense.
That fact that society keeps trying to push us to trust the professionals above makes us ripe for the well inentioned charlatan efforts from other “medical” fields.
Lately my first request with anything a vet wants to give my dogs is to know exactly how, and how likely, it will cause harm. Only after that is settled will we discuss how it might help.
Comment by Wendy — July 15, 2009 @ 8:28 am
But uh oh, Gina, she said “Fluffy”!
:-)
Comment by EmilyS — July 15, 2009
Yeah, well, I may have to get over that. Seems a lost cause.
Comment by Gina Spadafori — July 15, 2009 @ 8:31 am
Dr. Narda, your response has given me quite a bit of food for thought. I will explore the sites you referenced. I’m sure they will enhance my understanding of the various viewpoints, both scientific and evidence-based, on alternative therapies, specifically in veterinary medicine.
I once again apologize for jumping to a rather uninformed conclusion.
Comment by Ingrid King — July 15, 2009 @ 8:51 am
Dr Narda, do you know of any studies thta are looking at alternative/complimentary/whatever the word is today treatments for osteosarcoma? Looking for folks working in this field for a friend who has an interest and is in the process of setting up a foundation.
Comment by Cait — July 15, 2009 @ 9:33 am
Heather - brilliantly said.
In fact, as I was reading this post, every time I was finished a “hope” my head said “just like in pet food.” However, your assessment was even more correct - “just like in ALL treatments!”
Dr. Narda - I agree with you… to a point. Perhaps it’s because I have fed raw for so long, but the “no double blind study” argument lost its effect on my LONG ago. Sometimes things just work, cause they do. Yes, we must fully understand the dangers (and everything is potentially dangerous, despite manufacturer’s claims to the contrary) but personally when push comes to shove I don’t have to understand every mechanism to understand that a treatment works. And yes, all products are NOT created equal and care must be taken…
I think care must also be taken not to throw the baby out with the bath water.
Just as with pet food, not all manufacturers are equal - some are, well… scum, and others are quite ethical. The trouble, admittedly, is trying to discern which is which. And it’s not always who you think…
Comment by Kim — July 15, 2009 @ 9:35 am
Heather - You said exactly what i wanted to express, and probably better than i could have. Spot On.
Comment by Sarah — July 15, 2009 @ 9:38 am
Many years ago, I worked for a pharmaceutical company that had a drug that was and is highly regarded in the treatment of its target chronic disease. The product is effective. It’s safe. You have to go to real and inventive efforts to do something with it that’s not safe. Because of the mode of delivery for serious cases, it was not widely recommended for children at that time (it involved glass bottles which could break if dropped), and so the company also marketed another, generic drug for the same chronic disease. This generic drug was delivered in a form easier for children to use correctly, but required regular monitoring with blood tests because it IS a potentially dangerous drug, with the therapeutic levels and the toxic levels not far apart.
The safe, brand-name drug—we had the original monograph in our company library. This drug was well-tested for safety and efficacy. Mechanism of action, though—I read the paragraph on mechanism of action in the monograph many times. It always said the exact same thing. It took me a number readings to figure out what it was saying though, they were so carefully obscure about it.
What it said, translated into plain language, was, “We have no freaking idea why this works.”
The other drug, the one that had therapeutic and toxic levels so dangerously close, that one, they knew exactly how it worked.
Didn’t mean it was safe to skip the twice-monthly monitoring blood tests.
I’m not knocking the importance of asking how something works. Knowing how it works can make it a lot easier to use correctly, to use safely, to know where problems might arise, to know what you shouldn’t combine it with.
But it doesn’t trump actual clinical evidence of both safety and efficacy.
(Which of course, in turn doesn’t eliminate the problem of not knowing what’s really in those bottles of “natural” Chinese herbs. Or not knowing how to test for what the herbs are claimed to do.)
Comment by Lis — July 15, 2009 @ 10:23 am
Okay, fill me in…what’s wrong with “Fluffy” (too diminutive)?
Of course, I’m someone who had a white cat named Snowball…
Comment by Dr. Narda — July 15, 2009 @ 12:28 pm
Just me being cranky:
http://www.petconnection.com/b.....nd-fluffy/
Comment by Gina Spadafori — July 15, 2009 @ 12:30 pm
Cait —
I don’t know of anyone studying osteosarcoma from a complementary/alternative perspective currently.
We did submit a grant application a while ago to evaluate Asian mushrooms as an adjunctive approach, and acupuncture as a pain control measure for patients with osteosarcoma through the Morris Animal Foundation, but didn’t receive funding, unfortunately.
Comment by Dr. Narda — July 15, 2009 @ 12:30 pm
Regarding this last above comment by Dr. Narda - I remember hearing that some cat vaccines have created osteosarcoma tumors at the innoculation site - my own cat Doris did develop an osteosarcoma tumor at her vaccination site - Fortunately it was discovered early and removed - she lived many more years and did not die from cancer (rather unrelated problems of old age) - but is it known that vaccines can cause osteosarcoma tumors? And if so in cats only?
Comment by mary francis — July 15, 2009 @ 2:39 pm
Mary Francis, those are fibrosarcomas, not osteosarcomas.
Comment by Christie Keith — July 15, 2009 @ 3:29 pm
Christie Keith, sorry about that, thanks for the correction.
Comment by mary francis — July 15, 2009 @ 3:34 pm
Ingrid, thanks for your posts. I know this is a tricky topic with potential volatility. I appreciate hearing all your thoughts and am glad we resolved things.
Comment by Dr. Narda — July 15, 2009 @ 4:16 pm
sorry for the tumor mix up but I still wonder is the fibrosarcoma tumor caused by vaccination injection? (at least in cats) or is this just something unknown - my own mix up of tumor names made me laugh - remembering the wonderful Gilda Radner as Emily litella confusing all the fuss about Youth in Asia and endangered feces - Jane Curtin would correct her - its euthansia and endangered species…oh nevermind.
Comment by mary francis — July 15, 2009 @ 5:04 pm
Yes, injection site sarcomas are believed to be caused by some vaccinations. The sort of “working theory” based on present knowledge and evidence is that certain ingredients in some vaccines, known as “adjuvants,” are probably to blame, because the rate of fibrosarcomas for vaccines without adjuvants, and for non-vaccine injections (say, insulin) is very much lower.
However, the exact cause or mechanism of injection site sarcomas in felines isn’t known.
http://www.avma.org/vafstf/default.asp
Comment by Christie Keith — July 15, 2009 @ 5:36 pm
And, because of the potential development of fibrosarcomas at vaccination sites, injecting the rabies vaccine and other vaccines at interscapular (i.e., between the shoulder blades) locations is no longer recommended, though there are still some vets that continue to place them there, unfortunately.
If a vaccine-associated fibrosarcoma arises, it’s more effective to amputate a limb than try to get clean margins when excising a tumor from between the shoulder blades.
http://www.vin.com/mainpub/fel.....acmain.htm
Comment by Dr. Narda — July 15, 2009 @ 5:56 pm
This is a great article. What has always amazed my husband and me (both physicians) is how many people will ask a million “skeptical” and frankly suspicious questions about a conventional well-proven and tried treatment, yet will enthusiastically endorse a “natural” or “alternative” treatment without asking a single question or requesting any references.
Regarding Chinese herbs imported from China, I personally would not let any Chinese-produced substance get anywhere near my or any of my animals’ body. I am sure the melamime debacle is just the tip of the iceberg.
Comment by silkenpaw — July 16, 2009 @ 2:03 pm
Honestly, this post made me a little sad. I think Dr. Robinson brings up some terrific points, and she raised a lot of safety issues I think we used to take for granted that absolutely can’t be overlooked anymore.
Maybe this is just my own personal biases speaking, because Gina can say terrible things about PETA all day long and I’ll find it amusing, rather than troubling. That said, this particular compelling, logical argument was couched in a lot of patronizing, critical, sarcastic vocabular, and that bothered me. I honestly don’t have very strong thoughts on the subject matter myself, but I suspect that this post served one of two purposes: angered the people who believe in TCVM, or made the people who already didn’t believe still more skeptical. The Pet Connection articles that I love are the ones that make people reconsider their point of view, not the ones that polarize us further.
I’ve liked Dr. Robinson’s posts until now, and I’m grateful to her for sharing this information with us. But I did feel compelled to comment on the tone. I hope the next Pet Connection post I read will be back to the tone that I like so much - well-informed, intelligent and opinionated, but without the harsh sarcasm.
Comment by Dana — July 16, 2009 @ 2:31 pm
Dana,
I frequently receive negative feedback when I raise questions about holistic medical practices.
I had to get used to that right away.
I found early on a pressure to either declare allegiance to the holistic groups or join up with the complete naysayers, because neither camp allowed much middle ground. That said, I remain solid in my middle-of-the-road position: open-minded but wanting facts, not fluff(-y).
With this piece, though, I’m speaking directly from experience. It may sound like sarcasm, but it’s actually true. These were hopes that I personally found I had to maintain in order to “successfully” prescribe Chinese herbs as I was taught to do by both human and veterinary so-called “Chinese herbal masters”.
That doesn’t mean the herbs were a success. It means that for me to successfully recommend them (i.e., sell them to patients/clients), I had to accomplish all these hoping steps so that I wouldn’t acknowledge to myself that what I was doing was not based on much more than my belief in the teacher, the metaphors, and the product line. That wore off fast for me.
Once I realized how little there was to go on insofar as assuring safety and effectiveness, it was like seeing the Wizard of Oz operate from behind the curtain. I couldn’t continue to recommend herbs based on their ability to move Qi, extinguish liver fire, or remove dampness from the spleen.
Now when I do recommend herbs or nutraceuticals, I do so in a direct fashion by discussing the pro’s and con’s of the products and how they work biochemically (if known) and what medications they may interact with.
This is especially important to do with my cancer patients who are receiving chemotherapy. Will their herbs interfere with chemo and make it less effective? Will the plants actually stimulate cancer growth rather than slow it down?
I didn’t learn any of this from the “masters”. I found it out myself by searching the literature. The masters didn’t know the answers to the questions I would ask and generally gave me vague reassurance that there wouldn’t be a problem. That was insufficient.
So, I found myself inspired to move in a different direction, and to build a program at CSU not on hopes and beliefs, but on facts.
While it’s a smoother road to travel to spout the holistic party line, it is my commitment to intellectual honesty that keeps me bucking the trend. I am fortunate to have research opportunities that will provide real answers.
Comment by Dr. Narda — July 16, 2009 @ 4:39 pm
Many veterinarians are concerned about quality of medicine and it would seem a very admirable quality of a person to express that concern. Unfortunately, in a piece like this, the opinions expressed about homeopathy (I don’t know about Chinese medicine) are expressions of ignorance. I have practice exclusively veterinary homeopathy for 30 years and this is a 200 + year old system of medicine that is more rigorous and more proven than any of the conventional medicine out there today. Dr. Robinson, for whatever reason, without any training in homeopathy and without understanding about it, judges it harshly. I would ignore this as the usual prattling of the uninformed except that she is also on the board of the American Association of Veterinary State Boards that approves continuing education for veterinary training and classes. She reviewed my application for a meeting in homeopathy and rejected it, even though I have been presenting approved meetings since 2001 (approved by the same organization) and have trained over 500 veterinarians in homeopathy. The AVMA has requested that there be skillful and adequate training for homeopathy and yet Dr. Robinson has rejected the very classes that do this training. It is important to understand there is a difference between informed conclusion and prejudice and a piece like this, unfortunately, has too much of the latter.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 9:22 am
Dr. Pitcairn, I’m not speaking for Dr. Robinson here, but I do think you’re reading a lot into a single line:
“When a veterinarian or physician treats with herbal medicine or homeopathy, the technique may gain added credibility, whether or not that is justified.”
Your past dealings and concerns certainly do fill in some of the background of these discussions at the veterinary level, and I certainly look forward to the continued discussion here. But seems to me the concern you express is based not on this piece, but on your previous interactions with Dr. Robinson.
Curious: Do you think the standards of quality as they exist in China today are a matter of concern for anyone trusting that a product “Made in China” means that the contents actually match the labeling?
Mind you, as a person who covered the pet-food recall of 2007, I am also carrying my own baggage into this.
Comment by Gina Spadafori — July 20, 2009 @ 10:14 am
Dr. Pitcairn,
As we’ve discussed before, I have indeed had training in homeopathy and have written on homeopathy in several articles. I urge you not to promote misinformation about me. Just because we don’t agree on certain things does not make it okay to make things up about me.
Back to the issue at hand, after your practicing veterinary homeopathy for 30 years and teaching it hundreds of veterinarians, why is there still no convincing evidence that veterinary homeopathy works? Instead of taking your unhappiness to a public forum and raising points that are largely irrelevant to the piece I wrote, why don’t you put your DVM and PhD to good use and offer up some research support?
Comment by Dr. Narda — July 20, 2009 @ 10:50 am
Regarding the AVMA’s views on homeopathy and training that Dr. Pitcairn alluded to in comment #33, I have been unable to find any validation to Dr. Pitcairn’s claims that the AVMA “has requested that there be skillful and adequate training for homeopathy”.
Instead, what I read in the AVMA Guidelines for Complementary and Alternative Veterinary Medicine as listed at http://www.avma.org/issues/pol.....dicine.asp is that “The AVMA believes that all veterinary medicine, including CAVM, should be held to the same standards. Claims for safety and effectiveness ultimately should be proven by the scientific method. Circumstances commonly require that veterinarians extrapolate information when formulating a course of therapy. Veterinarians should exercise caution in such circumstances. Practices and philosophies that are ineffective or unsafe should be discarded.”
And, a recent article in The Veterinary Journal [2009;180:141-148] called “Homeopathy and the curse of the scientific method” by Karen L. Overall and Arthur E Dunham, both from the University of Pennsylvania, wrote this in their conclusion about homeopathy:
“When an approach declares itself outside the accepted methodologies of science, it should not and cannot be taken seriously by scientists…If homeopathy and other CAMs wish to be considered by scientists, they must be shown to be valid using methods that science uses to evaluate all treatment modalities. If these fields are not willing to comply with these rules they cannot be considered scientific and cannot be used in any set of scientific and medical best practices. Quite simply, the onus is not on the rest of the scientific community to provide and prove others’ experiments — it is on the proponents of CAM.
Comment by Dr. Narda — July 20, 2009 @ 12:38 pm
Controlled, double-blinded, randomized, peer-reviewed, statistically significant laboratory and clinical research trials.
Why is this too much to ask?
Especially for a modality as easy to do this with as homeopathy. It’s not like acupuncture, say, where there can be a lot of confounding factors.
Control bottle (placebo) has distilled water.
Experimental bottle has the homeopathic substance under review.
If you can tell the difference I will eat the groundhog that Pip dragged home yesterday.
Comment by H. Houlahan — July 20, 2009 @ 1:45 pm
Heather, there are actually as many, if not more, confounding factors with homeopathy as with acupuncture. Don’t misunderstand what I’m saying here; I am simply laying out the theory so it can be discussed, not saying this theory has been proven.
In classical homeopathy, treatments are not chosen based on a diagnosis nor a disease category. You could have ten dogs with parvo in front of you, and all ten could, by using homeopathic case taking and prescribing, get different remedies. This is even more pronounced with chronic and complex diseases than it is for acute diseases. Homeopathy is based on the idea of treating PATIENTS, not DISEASES, so it’s not possible to adapt a study that you’d use to test, say, the efficacy of ampicillin in treating staph to test the efficacy of arsenicum album in treating parvo. Because the entire theoretical basis of homeopathy is that you don’t treat parvo; you treat a dog who has parvo.
Again, I’m not saying this “excuses” homeopathy or any modality from the scientific method. I *am* saying that, if you’re going to test a system of medicine, the test needs to be designed to actually test that system of medicine, not its substances when used within a different system of medicine.
Comment by Christie Keith — July 20, 2009 @ 3:17 pm
Easy-peasy.
Your homeopathic practitioner prescribes the remedy for each patient.
The researcher randomly assigns that patient to the control or experimental group.
An assistant who is blinded is given the coded bottle to deliver to the patient or, in the case of an animal, the patient’s owner. The patient is sent home either with whatever the practitioner prescribed, or the placebo.
The outcome is evaluated by yet a third, blinded party.
Might require an especially large sample size, but there you have it.
Now, if you want to evaluate the efficacy of a *particular* homeopathic remedy, then your patient pool must be even larger.
But it’s not up to the skeptics to fund and conduct these trials. It’s up to those who are making claims of efficacy to meet the standards of the scientific method.
Because those are not negotiable.
And do note, I make an honest effort to apply this standard to all claims that don the mantle of science.
I have a very open mind about complementary therapies. Professor Chaos and I were the first people I know to put our dogs on nutraceuticals. This was after he researched it for an article, and concluded that (at that time) the rigorous scientific evidence of efficacy wasn’t there, but the anecdotal evidence was provocative, and even the biggest skeptics agreed that there were no side-effects or potential for harm at normal doses.
We did a little blinding ourselves, and could see a difference in our dysplastic dog. Good enough!
The good large-scale studies came later, and were validating enough to support our own observations.
Now everybody takes this stuff, and the trouble comes in quality control, since there are so many unscrupulous manufacturers out there. (A recent study of gingko biloba for preventing acute mountain sickness is a great case in point. What were first inconclusive results, when re-sorted based on who manufactured the refined gingko, found that one company’s product was useless, while another’s had a definite, statistically significant positive effect on the patient’s chances of contracting, and the severity of, AMS. Now that’s GOOD SCIENCE. That answers a question the researchers weren’t even asking.)
But homeopathics has had, as its proponents keep reminding us, hundreds of years to demonstrate efficacy via the scientific method.
Comment by H. Houlahan — July 20, 2009 @ 5:22 pm
Dr. Robinson said:
“As we’ve discussed before, I have indeed had training in homeopathy and have written on homeopathy in several articles. I urge you not to promote misinformation about me. Just because we don’t agree on certain things does not make it okay to make things up about me.”
I am glad to hear you have had training in homeopathy. Perhaps you could detail what that training is. Of course I know you have had none with me and as there is no other homeopathy course in the US but mine (and the only one accredited by the Academy of Veterinary Homeopathy) then I would like to know where you had training, how many hours, if classroom or by email, etc.
I asked this of you before when my meeting was rejected and you would not answer me, so I am asking again. If you really have had training then you will not be afraid to tell me what it is. Fair enough?
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 6:55 pm
Now that we’re discussing homeopathy, if you miss this YouTube video on homeopathy in the E.R., you’re missing one of the funniest videos ever made, in my and many others’ opinions.
http://www.youtube.com/watch?v=HMGIbOGu8q0
Comment by Dr. Narda — July 20, 2009 @ 6:58 pm
From Gina:
“Your past dealings and concerns certainly do fill in some of the background of these discussions at the veterinary level, and I certainly look forward to the continued discussion here. But seems to me the concern you express is based not on this piece, but on your previous interactions with Dr. Robinson.
Curious: Do you think the standards of quality as they exist in China today are a matter of concern for anyone trusting that a product “Made in China” means that the contents actually match the labeling?
Mind you, as a person who covered the pet-food recall of 2007, I am also carrying my own baggage into this.”
Yes, there is a background to this. Within the alternative therapy veterinary community, Dr. Nardison is known as one who is very critical and judgmental of other practices within this group. She has taken the position that only what she teaches and uses is legitimate. This is no secret. There are several other major teachers of Chinese Medicine and acupuncture that are alienated from her for just this reason. Note in her piece:
“This decision arose when I found I continually felt a visceral unease at Chinese herbal medicine seminars where instructors presented lists of herbs in formulae that I was to memorize and then prescribe based on metaphors. Is the tongue red? Then the patient has a “Heat” condition. Give them a heat-releasing tonic. Is the pulse jumpy? Then sell them something with a name like “Spirit Calm.”
She is saying as a new student to Chinese medicine that rather than learn the 3000 year old system of medicine and use it as taught, she “knew better” and has developed her own interpretation of Ch. medicine which she considers superior. On what basis? From the standpoint of another culture that has a different standard?
So my objection to what she is presenting is that she has a hidden agenda, one that is opposed to homeopathic practice. This is not the only place she has come out against it. I have just asked her to tell us her training & practice with homeopathy and I am anticipating it will be very minimal. Imagine how it would be to take a “short course” in Ch. medicine and then to judge it from my limited understanding and experience. Dr. Robinson is, unfortunately, one of those that during the current crisis in alternative veterinary medicine is trying to eliminate the use and teaching of homeopathy. This is why I speak out.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:04 pm
Yes, Heather, I agree… and studies like that have been done. I wasn’t suggesting they couldn’t be or haven’t been, I was simply addressing the point you made, for the purposes of this discussion only.
Personally, I have used homeopathic remedies in the past, for myself as well as my dogs. My opinion is that they do have some effect, but that even if they work exactly as described by the body of literature of homeopathy, there are not enough vets who have the knowledge or experience to use them effectively for it to be useful to most pet owners.
I’m also not a “true believer,” in the sense that I’m perfectly willing to believe or disbelieve in the efficacy of homeopathy based on what the science shows us. But I think science has already shown there is something more than water there, which certainly doesn’t prove anything about how that substance will work in a living body, but isn’t meaningless, either.
In other words, I’m not willing to die on this hill, but I’d be lying if I didn’t say I think one day at least some of the premises of homeopathy will be both proven and understood, and such proof and understanding will be fully compatible with science and reason.
Comment by Christie Keith — July 20, 2009 @ 7:05 pm
From H. Houlahan:
“Controlled, double-blinded, randomized, peer-reviewed, statistically significant laboratory and clinical research trials.
Why is this too much to ask?
Especially for a modality as easy to do this with as homeopathy. It’s not like acupuncture, say, where there can be a lot of confounding factors.
Control bottle (placebo) has distilled water.
Experimental bottle has the homeopathic substance under review.
If you can tell the difference I will eat the groundhog that Pip dragged home yesterday.”
There are hundreds of very adequate studies showing the efficacy of homeopathy. That they are ignored does not mean they do not exist.
Here is one study, for example — double-blind, placebo controlled.
Is Homeopathy A Placebo Response?
Controlled Trial Of Homeopathic Potency, With Pollen In Hay Fever As Model.
David Taylor Reilly, Morag A. Taylor, Charles Mcsharry, Tom Aitchison.
The Lancet, Vol. II, No. 8512, October 18, 1986, pp. 881–886.
The hypothesis that homeopathic potencies are placebos was tested in a randomized, double-blind, placebo-controlled trial. The study model chosen compared the effects of a homeopathic preparation of mixed grass pollens with placebo in 144 patients with active hay fever.
The homeopathically treated patients showed a significant reduction in patient and doctor assessed symptom scores. The significance of this response was increased when results were corrected for pollen count and the response was associated with a halving of the need for antihistamines. An initial aggravation of symptoms was noted more often in patients receiving the potency and was followed by an improvement in that group. No evidence emerged to support the idea that placebo action fully explains the clinical responses to homeopathic drugs.
The remedy tested was a preparation of mixed grass pollens in 30C potency. Patients selected were aged over 5 with at least a 2 year history of seasonal rhinitis and current symptoms. Supplementary objective evidence of the diagnosis was sought when possible by skin testing and/or IgE antibody measurement.
Patients took a tablet of remedy or placebo twice a day for 5 weeks. After randomization there was a placebo run-in week giving a baseline for analysis. Throughout the five weeks patients had access to an “escape” antihistamine (chlorpheniramine 4 mg, up to three daily).
RESULTS Only the homeopathically treated group showed a clear reduction in symptoms. This response began after the run-in week and progressed to a peak in the post-treatment phase. Analysis confirmed that the response was significant. The statistician’s analysis confirmed that only the active group showed a significant fall in symptom scores over the 5 weeks with a significant difference between the groups when compared in the final week (p = 0.02).
Response to homeopathy led to a decreased need for these drugs, homeopathy responders taking on average 1.8 tablets and placebo responders 4.1 tablets in the final week.
DISCUSSION The response was most evident in the post-treatment phase, suggesting that unnecessary repetition of the dose may have temporarily aggravated the symptoms. Indeed the potency used caused occasional aggravations of symptoms, with some individuals deteriorating sharply on swapping to active treatment. The results confirm those of the pilot study and demonstrate that homeopathic potencies show effects distinct from those of placebo.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:11 pm
Here is another study:
Is Evidence For Homeopathy Reproducible?
David Reilly, Morag A. Taylor, Neil G.M. Beattie, Jim H Campbell, Charles McSharry, Tom C. Aitchison, Roger Cartor, Robin D. Stevenson.
The Lancet 1994; 344: 1601–06.
Twenty-eight patients with allergic asthma (most sensitive to house dust mites) were randomly allocated to receive either an oral homeopathic remedy or identical placebo.
The study was a randomized double-blind assessment of 2 parallel groups — one treatment, the other placebo. Patients were in the study for 8 weeks. The medicine used was allergen material prepared in a homeopathic pharmacy to a 30C potency. The allergen chosen was on the basis of the largest skin test wheal concordant with the allergy history of the patient.
The frequency of remedy dose is not indicated but it is mentioned that the medicine was given by the pharmacist directly on the tongue.
The allopathic treatment was not altered, e.g. not discontinued. Daily diaries (to assess condition) were kept by each participant. Respiratory function was assessed as:
1) Expiratory volume, measured with an electronic spirometer.
2) Reactivity to histamine, measured with a dosimeter, by having the patient inhale increasing doses of histamine.
RESULTS
An improvement in treated patients was evident within 1 week of starting treatment and persisted for up to 8 weeks (p = 0.0003).
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:12 pm
A third:
Twenty-three patients with rheumatoid arthritis in a treatment group were compared with an equal number of patients in a control group. All patients were on orthodox first-line anti-inflammatory treatment which was continued unchanged. The evaluating doctor did not know if the patient was on placebo or not.
A variety of remedies were prescribed, primarily non-antipsoric remedies which were changed as indicated by the patient’s condition. Study period was for 4 months.
There was a significant improvement (p = 0.001) in subjective pain, articular index, stiffness and grip strength in those receiving remedies, whereas there was no change in the patients who received placebo.
Two physicians were involved in prescribing for the patients and there were no significant differences in the results which they obtained.
The results of this trial confirm the impression obtained from the preliminary study that homeopathic treatment is effective in the control of patients with rheumatoid arthritis. The design of the trial was such that differences in orthodox anti-inflammatory therapy and in the doctor treating the patient were eliminated. Both A.M. and R.G. (the two doctors) obtained significant improvements in pain scores, stiffness, grip strength and functional index in their patients on active homeopathy whereas their patients on placebo did not vary significantly. There were no statistical differences in the results obtained by the two doctors. It would therefore seem that the differences observed were due to the remedies administered and not to any psychological inter-relationship between patient and physician or to placebo response to the homeopathic substances. The fact that neither placebo group improved significantly is strong evidence that it is the drug and not the doctor which is effective.
It might be argued that the changes in the various parameters assessed, though statistically significant on rank testing, were small and of no clinical importance. However, similar changes in articular index and smaller changes in grip strength were obtained by Deodhar et al. (1973), when comparing the relative merits of four anti-inflammatory drugs.
The improvements obtained in the present trial were of a similar order of magnitude to those obtained in the pilot study (Gibson et al., 1978). The pilot study, however, was conducted over a period of a year, and it was possible to discontinue all orthodox therapy in 42% of the patients. In the present trial patients were on homeopathic treatment for 3 months only, and no attempt was made to reduce or discontinue orthodox therapy. All patients were actively encouraged to continue their orthodox drugs unchanged as any alterations might have made evaluation of the results misleading.
The enhanced response of those on conventional therapy plus homeopathy over those on conventional therapy plus placebo is a measure of the value of this addition to therapy in the management of the patient with rheumatoid arthritis.
Since the selections of a homeopathic remedy depends on the patient’s symptoms and on his reaction to his environment as a whole, treatment should be more effective in patients with good prescribing symptoms than in those with poor prescribing symptoms.
Another important point in the discussion of homeopathic treatment is the lack of toxic effects observed. Out of 23 patients on active treatment, only one dropped out. The reason for this is not known. None of the other 22 patients reported any toxic side effects over the 3 month period. In the previous study, conducted over a year, no patient experienced toxic side effects. In the present trial improvements in pain scores, stiffness and grip strength produced with homeopathy over 3 months compare favorably with those produced by gold and levamisole over 1 year (El-Ghobarey et al., 1978).
It is noteworthy that more than one third of the patients dropped out from both the gold and the levamisole series because of toxic side effects while no toxic effects were reported with homeopathy. From the data it therefore appears that homeopathy is a safer and probably no less effective alternative to present-day second-line drugs. Since approximately half of all side effects reported annually are due to anti-rheumatic therapy (Girdwood, 1974), this in itself is a very important consideration.
It is not known at present how homeopathic remedies work in the body. However the efficacy of his form of therapy in reducing pain may suggest that at least part of the effect might be endomorphin mediated, and further research to investigate this possibility would be of value. The response of patients given naloxone, to subsequent treatment with homeopathy, might help to elucidate this point.
The possibility that the use of homeopathy might become more widespread leads to the question of whether or not orthodox doctors would obtain such good results as their homeopathically trained colleagues. To become an expert homeopathic prescriber requires years of practice, and few conventional physicians are willing to undertake the additional trainings.
It therefore seems important to find some means of making homeopathic knowledge more accessible to the medical profession, and work on this problem is currently in progress.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:12 pm
Sorry, forgot to put the heading in the prior research article on arthritis:
Rheumatoid Arthritis: Evaluation By Double–blind Clinical Therapeutic Trial.
R. G. Gibson, Sheila L. M. Gibson, A. D. MacNeill & W. Watson Buchanan
The Glasgow Homeopathic Hospital and The Centre for Rheumatic Diseases, University Department of Medicine, Royal Infirmary, Glasgow, Scotland.
British Journal of Clinical Pharmacology (1980), 9, 453–459.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:14 pm
Here is a recent study showing anti-cancer activity of medicines diluted beyond the presence of physical substance, testing of homeopathic preparations:
Dynamized Preparations In Cell Culture
Ellanzhiyil Surendran Sunila, Ramadasan Kuttan, Korengath Chandran Preethi and Girija Kuttan
Amala Cancer Research Centre, Amala Nagar, Thrissur, Kerala–680 555, India
Although reports on the efficacy of homeopathic medicines in animal models are limited, there are even fewer reports on the in vitro action of these dynamized preparations. We have evaluated the cytotoxic activity of 30C and 200C potencies of ten dynamized medicines against Dalton’s Lymphoma Ascites, Ehrlich’s Ascites Carcinoma, lung fibroblast (L929) and Chinese Hamster Ovary (CHO) cell lines and compared activity with their mother tinctures during short-term and long-term cell culture. The effect of dynamized medicines to induce apoptosis was also evaluated and we studied how dynamized medicines affected genes expressed during apoptosis. Mother tinctures as well as some dynamized medicines showed significant cytotoxicity to cells during short and long-term incubation. Potentiated alcohol control did not produce any cytotoxicity at concentrations studied. The dynamized medicines were found to inhibit CHO cell colony formation and thymidine uptake in L929 cells and those of Thuja, Hydrastis and Carcinosinum were found to induce apoptosis in DLA cells. Moreover, dynamized Carcinosinum was found to induce the expression of p53 while dynamized Thuja produced characteristic laddering pattern in agarose gel electrophoresis of DNA. These results indicate that dynamized medicines possess cytotoxic as well as apoptosis-inducing properties.
Introduction
Homeopathy is a system of alternative medicine that has been practiced for more than 200 years. The homeopathic model of treatment is based on three pillars: ‘principle of similitude’, ‘experimentation of substances in healthy individuals’ and ‘dynamized medicines’. For a drug to be considered ‘homeopathic’, it should be potentiated (dynamized), experienced in healthy individuals and applied according to the principle of the similarity of symptoms.
In order to escape from the aggravation and intoxication caused by substances used in ponderal doses, Hahnemann started to dilute and agitate them (method of dynamization), observing that through this process the substances produced the same symptomatic manifestations. In this way, a dynamized preparation had the same effect as that of the mother tincture and produced similar reactions in the organisms. However, many drugs prepared in this manner are diluted to such an extent that they go beyond Avagadro’s number (1,2). Hence the action of homeopathic drugs, even though clinically manifested, was always debated in scientific community.
Recently, limited investigations on the efficacy of dynamized medicines in animal models as well as clinical trials have reported that potentiated Lycopodium clavatum has protective action against CCl4-induced liver damage in rats (3) and that chelidonium 30C could ameliorate both p-dimethylaminoazobenzene and azodye-induced hepatocarcinogenesis in mice (4,5). Anti-genotoxic effect of different dynamized medicines has also been reported (6,7): Arsenicum album was found to ameliorate arsenic-induced toxicity in mice as well as in clinical studies and could reduce the elevated antinuclear antibody titer and hematological toxicities (8,9). Homeopathic therapy for asymptomatic HIV carriers has also proven beneficial (10) and recently Rajendran (11) reported homeopathy as a supportive therapy in cancer. Pathak et al. (12) investigated Ruta 6 on regression of human glioma brain cancer cell growth clinically and found that Ruta induces severe telomere erosion in MGRI brain cancer cells but has no effect on B-lymphoid cells and normal lymphocytes. Banerji and Banerji (13) reported that Ruta was effective for intracranial cysticercosis.
Very few investigations have explored the action of dynamized medicine in in vitro cell culture systems. Podophyllum has been shown to inhibit adhesion of neutrophils to serum-coated micro plates (14). Traumeen S, a homeopathic formulation used clinically to relieve trauma and inflammation has been shown to inhibit the production of Interleukin-β, TNF- and Interleukin-8 by human T cells and monocytes in culture (15). Many homeopathic drugs at low potencies were found to potentiate oxidative metabolism in cultured cells (16).
We tried to evaluate the activity of selected homeopathic medicines in vitro for their cytotoxic and apoptosis-inducing activity by cell culture methods. Since the medications are not being used on animals we have used the term dynamized instead of homeopathic medicines (We are indebted to a referee for this suggestion). We have also compared the effect of dynamized medicines with that of mother tinctures.
Medicines
Our choice of medicines extensively used for cancer treatment was suggested by renowned homeopathic practitioner Dr Banerjee P, Kolkata, India. The dynamized medicines and their mother tinctures were procured from Willmar Schwabe, Germany.
These preparations were used:
Mother tincture, 30C, 200C
1. Thuja occidentalis
2. Hydrastis canadensis
3. Lycopodium clavatum
4. Conium maculatum
5. Carcinosinum
6. Ruta graveolens
7. Podophyllum peltatum
8. Phytolacca americana
9. Chelidonium majus
10. Marsdenia condurango
Cells
Dalton’s lymphoma ascites (DLA) and Ehrlich ascites carcinoma (EAC) cells were originally obtained from Cancer Institute, Adayar, Chennai and are maintained in the peritoneal cavity of Swiss Albino mice.
L929 cells (mouse fibroblasts) and Chinese Hamster ovary (CHO) cells were obtained from National Centre for Cell Sciences, Pune. They were grown and maintained in Minimum Essential Medium containing 10% fetal calf serum.
Discussion
Although the healing potential of homeopathic drugs is widely accepted, the exact mechanism of action is still unclear. In paragraphs 63–69 of Organon, Hahneman describes the mechanism of action through the ‘primary action’ of the medicine (dynamized or not) and the ‘secondary and curative reaction’ of the organism: ‘Every agent that acts upon the vitality, every medicine, deranges more or less the vital force, and causes a certain alteration in the health of the individual for a longer or a shorter period. This is termed primary action.
Although a product of the medicinal and vital powers conjointly, it is principally due to the former power. To its action our vital force endeavors to oppose its own energy. This resistant action is a property, is indeed an automatic action of our life-preserving power, which goes by the name of secondary action or counteraction’. We have tried to explain the mechanism of action of the dynamized preparations taking into consideration the original proposition by Samuel Hahnemann and have approached this problem by investigating the action of dynamized drugs in various cultured cells in a systematic scientific manner.
Cytotoxic activity of a drug is often considered a first step towards elucidating its possible use against cancer and all of the drugs selected are being used by homeopathic practioners against cancer. We found that in short-term cytotoxicity research, some of the dynamized preparations showed significant cytotoxic actions against cancer cell lines and at times the activity was higher than that of the mother tinctures. For example, Conium at 200C potency was more cytotoxic than its mother tincture and that the cytotoxicity induced by Carcinosinum was higher at 200C than at 30C potency indicating that dynamization induces the cytotoxic potential of these medications. Results were more pronounced during MTT assay in which a longer period of incubation was involved. Many dynamized preparations at potency of 200C inhibited the growth of L929 cells. Clonogenic assay using CHO cells is a standard method to determine growth inhibitory activity of the drugs and we found that dynamized preparations of Thuja, Hydrastis, Carcinosinum and Podophyllum at 200C potency almost completely inhibited the CHO colony formation. As in other cases, Conium 200C was more active than 30C. We have confirmed the cytotoxic potential of dynamized preparations by thymidine uptake, for the marker of the inhibition DNA synthesis. As in the case other experiments, DNA synthesis was significantly inhibited by several dynamized preparations.
Cytotoxicity could be produced in cells either by necrosis or by apoptotic induction. Apoptosis, which is known as programmed cell death is highly regulated by events taking place within the cell and is highly relevant with respect to the destruction and removal of transformed cells from the body. The induction of apoptosis could be an external agent and a cascade of reactions taking place within the cell produces an ultimate cell death. Some of the events via occurring during apoptosis include morphological changes in the cell, production of apoptotic bodies, damage to genetic material and finally induction of proteolytic enzymes, which produces cellular destruction. Apoptosis could be visualized by morphology and DNA laddering. In the present study, dynamized preparations induced apoptosis as observed from their morphology and DNA laddering. Moreover, dynamized preparation of Carcinosinum could induce the p53, which is considered to be a proapoptotic protein and involved in signal transduction pathway.
The mechanism of action of some of the homeopathic drugs has been proposed. Potentiated preparation of Ruta possesses protective action on normal B-lymphoid cells against H2O2-induced chromosomal damage (13). Moreover, the telomere erosion was enhanced in cancer cells by treatment with Ruta while normal cells showed no change. Thus, the telomeres that protect individual chromosomes of cancer cells are damaged by Ruta, which may be the mechanism of its therapeutic action in brain cancer (13).
The protective effect of Chelidonium against p-DAB-induced hepatic cancer may occur by the modulating effect of the drug on restoration of damage caused to several gene-regulated phenomena like enzyme activities and chromosomal abnormalities. This gives insight into the mechanism of action, which may be by means of interfering with the process of carcinogenesis by actively modifying actions of oncogenes or by activating tumor suppressor genes (5). Another mechanism of actions of homeopathic drugs may occur through immune modification. Benveniste (17) has shown that human basophils undergo degranulation not only at usual anti-IgE antibody doses but also at extremely high dilutions. Bastide (18)has shown the therapeutic effect of high dilution of –β interferon and thymic hormones on cellular immunity and had good therapeutic effect in immunodepressed patients. Similarly Bentwich et al. (19) revealed that small amounts of antigens are capable of specific antibody response. The role of immunity in the therapeutic efficacy of homeopathic medicines has also been reviewed (20).
Our results indicate that the dynamized preparation initially produces a secondary action on cells that is in line with the original proposition by Hahnemann on the mechanism of action of medicines dynamized or not. However, our limited knowledge in this area does not fully explain the mechanism of action of all drugs that we investigated. More scientific analyses are warranted to elucidate these interesting preparations of ultra dilutions.
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:16 pm
Ready for a groundhog recipe?
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:16 pm
Is Evidence For Homeopathy Reproducible?
David Reilly, Morag A. Taylor, Neil G.M. Beattie, Jim H Campbell, Charles McSharry, Tom C. Aitchison, Roger Cartor, Robin D. Stevenson.
The Lancet 1994; 344: 1601–06.
Twenty-eight patients with allergic asthma (most sensitive to house dust mites) were randomly allocated to receive either an oral homeopathic remedy or identical placebo.
The study was a randomized double-blind assessment of 2 parallel groups — one treatment, the other placebo. Patients were in the study for 8 weeks. The medicine used was allergen material prepared in a homeopathic pharmacy to a 30C potency. The allergen chosen was on the basis of the largest skin test wheal concordant with the allergy history of the patient.
The frequency of remedy dose is not indicated but it is mentioned that the medicine was given by the pharmacist directly on the tongue.
The allopathic treatment was not altered, e.g. not discontinued. Daily diaries (to assess condition) were kept by each participant. Respiratory function was assessed as:
1) Expiratory volume, measured with an electronic spirometer.
2) Reactivity to histamine, measured with a dosimeter, by having the patient inhale increasing doses of histamine.
RESULTS
An improvement in treated patients was evident within 1 week of starting treatment and persisted for up to 8 weeks (p = 0.0003).
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:19 pm
Dr Narda,
I’ll see your TM&WL Homeopathy AE sketch and raise you a fruitcake!
http://www.youtube.com/watch?v=9c_HsrZwCyg
Comment by JenniferJ — July 20, 2009 @ 7:31 pm
Dr. Pitcairn, I did not seen those several posts that you responded to this question from Gina, even though you quoted it:
Curious: Do you think the standards of quality as they exist in China today are a matter of concern for anyone trusting that a product “Made in China” means that the contents actually match the labeling?
I’m sure you just missed it. Care to comment now?
Comment by Lis — July 20, 2009 @ 7:40 pm
Lis,
I don’t study or use Chinese medicine and do not have knowledge of the quality of herbs and other health products coming from China. Of course we know that pet food has been contaminated, even baby food if I remember right. But then again, almost everything comes from China these days, so what are we going to do? Personally I would not take any nutritional products that come from China (if I knew they did - as they do deliberately mislabel I have read). Its a crazy world isn’t it?
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 7:43 pm
There are a lot of undercurrents to this discussion. There are many things on which I do not agree with Dr. Pitcairn, and many on which I do. But it was through his first book that I came to discover homemade diets and the holistic principles that transformed the lives of my animals, then and now.
I first discovered his work in 1986, browsing in a pet store’s book section. As I flipped through the pages of “Dr. Pitcairn’s Complete Guide to Natural Health for Dogs and Cats,” I saw that this was not just another book on what herb to use for itchy skin, or what special diet to give a diabetic cat.
Pitcairn was challenging his readers to change the way they perceived health, not just the substances they used to affect health.
He said, “We need to look at the whole picture of an illness and find therapies that will work with the whole body - not against it - in the healing process. To me, that is what constitutes a true cure. I often use the term ‘holistic’ to describe this approach to medicine. Unlike many who use the word, I do not equate it with ‘natural’, for it is certainly possible to use natural methods such as herbs, vitamins, and exercise but still fail to see the overall picture of what is happening.”
What is really needed, he said, “Is an entirely new understanding, not just the substitution of a vitamin for an antibiotic, or a mineral for a hormone.”
Throughout the next 23 years I changed my mind about some practices, but the principles I learned from him guide me to this day. Differ with Dr. Pitcairn on the issues all you want; that’s a right I honor. But please treat him with the respect he’s earned.
Comment by Christie Keith — July 20, 2009 @ 7:44 pm
Thanks Christie for the support. This is indeed what I am asking for. I expect the work I have done for 3 decades and the thousands of animals I have helped or cured with nutrition and homeopathy to mean something, to be respected. It is ultimately unfair for someone that does not have the training or experience to dismiss such work when coming from opinion. On a larger scale the movement started with my book and the books and work of others before me has grown to be a significant influence within medicine. It is poised to change medicine in a fundamental way. Unfortunately, because of its development and now prominence, there is, at this time, a backlash against it and an attempt to stamp it out. Regardless of the views of the different readers out there, be it known that if choice is taken from you, it will be regretted. The issue is not really the details of how medicines are made, it is that the choice in how your animal is to be treated is being taken away from you. How is this done? By making up things that are not true — like saying that homeopathy has not had supportive research or that after 200 years it has not been shown to work. Exactly the opposite is true, but that does not stop people from saying these things. I have had the, perhaps, unique experience of having worked and lived in both camps. The first part of my career was as a regular veterinarian, working with small and large animals. Then I went to Washington State University and worked there in clinics and on the faculty. From there to graduate school working towards a PhD in immunology, virology and biochemistry (granted in 1972). This was my “mainstream” life. When I began to see the limits of the style of medicine being used and explored nutrition and other options, and eventually focussing on homeopathy, I found that I was able to do so much more to help animals that is was almost no comparison. I could help animals that I could never help before.
Let me give you a couple of small examples. This week I had a wonderful report on an older cat with cancer I have been treating. It was diagnosed with a biopsy and was lymphoma with a large tumor on the neck of this cat. As one of the symptoms this cat had eaten almost nothing for several weeks and was expected to die soon. The ONLY treatment given was a single homeopathic remedy give several times, as needed, in low potency. This cat has responded marvelously, the tumor completely gone, the appetite back and he is gaining weight.
Another report a week ago was for a cat that went into severe kidney failure and which was treated ONLY with diet and homeopathic medicine and subcutaneous fluid injections. With this relatively simple treatment this cat has been kept alive comfortable for SIX years and is now aged 21.
As I work with animals like this, see how much good is accomplished with homeopathy is it not understandable that I want to share it with other veterinarians? Is it not also understandable how galling it is to have others with no experience doing this say that is this is just some kind of “false hope”?
If it is, why don’t their cases get better with “false hope”?
I ordinarily do not engage in these kind of futile discussions but am speaking out now because of the campaign to put down homeopathy — the intention being to eliminate it for availability for all of you. Think about it. You may not believe in or want to use homeopathy (for whatever reason), but do you really want a world in which no one has that choice?
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 8:56 pm
For what it’s worth:
“Five large meta-analyses of homeopathy trials have been done. All have had the same result: after excluding methodologically inadequate trials and accounting for publication bias, homeopathy produced no statistically significant benefit over placebo.” Goldacre B. Benefits and risks of homoeopathy. The Lancet. 2007;37(9600): 1672-1673.
Comment by Dr. Narda — July 20, 2009 @ 9:17 pm
Yes, I have reports of meta-trial that showed positive response. The question remains unanswered: What is your training in homeopathy? Why won’t you tell us? I am not interested in your negative judgements about it as opinion counts for very little and putting up competing studies is also a waste of time. If your position is that no double-blind controlled study has been done to show efficacy of homeopathy then ONE study that shows it is enough. If you read what I put up you will see the evidence is there. In fact, if these were studies using your style of acupuncture, then you would accept them uncritically.
So I come back to this. Why won’t you tell us what qualifies you to judge homeopathy?
Comment by Dr. Richard Pitcairn — July 20, 2009 @ 10:14 pm
All, just to set the record straight (again) —
No one is trying to get rid of homeopathy, or put it out of existence. You can still have your faith in it and hope it works. I would love to see proof that homeopathic remedies can be used reliably for animals in place of or alongside pharmaceuticals. That would be great! I think dogs would readily ingest those homeopathic-coated sugar pills; cats might need them laced with liver. Dr. Pitcairn can still teach his courses as often as he likes and train as many veterinarian homeopaths as he’d like as well.
I would hope, however, that until these methods have been studied and met muster, that when these homeopathic veterinarian practitioners treat patients with homeopathic remedies, that they inform their clients about the lack of proven safety and effectiveness, as ethics would suggest.
Homeopathy is not part of the scientific community. It doesn’t come up to the level of any science-based medical practice. Maybe someday one or more of the Pitcairn-trained graduates will actually do some rigorous, methodologically sound research with repeatable outcomes in clinical veterinary patients.
By the way, Dr. Pitcairn, you might start reading the Chinese medicine literature before you continue attacking my acupuncture and Chinese medicine credentials in public as part of your ad hominem distraction from the issues. To wit:
http://www.today.colostate.edu/story.aspx?id=1029
Comment by Dr. Narda — July 20, 2009 @ 10:27 pm
I would hope, however, that until these methods have been studied and met muster, that when these homeopathic veterinarian practitioners treat patients with homeopathic remedies, that they inform their clients about the lack of proven safety and effectiveness, as ethics would suggest.
I think it’s admirable to plant one’s flag on the ideal of evidence based medicine. I truly do. But in the real world in which we obtain veterinary care for our animals, holding our veterinarians to this standard would bring most practices to a shrieking halt.
Look at the dozens of drugs used multiple times daily in every vet practice for which there is very little, or nothing, in the way of testing for the animals on which the drugs are being used.
Look at the ridiculous and scientifically indefensible vaccine protocols being recommended in practices all over the country.
Look at the crazy unscientific way the simplest bladder infections are mostly treated, with UA-only diagnosis and guesswork at the antibiotic choice.
Look at the way vets hand out Rimadyl like it was candy without using any of alternatives — including acupuncture, and including other approved veterinary drugs — that have far less risk and potentially equal benefit.
I’d also argue that homeopathy does in fact meet the requirements of an evidence-based system. These are the grades of evidence, and homeopathy can meet most of them, if not all:
Level I: Evidence obtained from at least one properly designed randomized controlled trial.
Level II-1: Evidence obtained from well-designed controlled trials without randomization.
Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
I’ve observed over the years that homeopathy is held to a very strange standard, both by its own practitioners and by those who, like me, much prefer the i’s dotted and t’s crossed when it comes to medicine and science. We all seem to want the entire system of medicine “proven,” but these kinds of studies can’t prove or disprove homeopathy as a system per se; they can only examine certain substances and practices and see how they play out in some kind of test.
I sometimes look at the design of a test of homeopathy and can see it was designed to fail. Other times, the study looks well-designed, and some of those show efficacy beyond that of a placebo, while others do not. But there are studies that meet the evidence grades above — it’s just that those do not prove that HOMEOPATHY as a system works, and never can, and never will, and weren’t designed to.
Those who say that any number of studies of remedies “proves” homeopathy does or doesn’t work remind me of something Carl Sagan once wrote about the existence of god. He said that it was just as unscientific to say we know there is no god as that we know there is, because the truth is, we do not know one way or another.
It sometimes strikes me that the scientific community’s aversion to homeopathy has become like those atheists Sagan was talking about, who were as certain there was no god as a fundamentalist is that there is a god.
I’d love it if all forms of medicine were not just evidence-based by the levels listed here, but rigorously tested by well-designed studies and found to be both safe and effective. I realize we don’t live in that world, but that doesn’t mean we should just throw the whole idea of science and proof out the window and believe anything anyone tells us — seriously, I think most people are far too gullible about what they believe.
So certainly, let’s study homeopathy. Let’s not act, however, as if it hasn’t been studied, nor that veterinary medicine isn’t practiced constantly without evidence basis. I wish that wasn’t true for either thing, and I certainly think there is a lot more evidence for conventional medicine than for homeopathy, but nonetheless… bad conventional practitioners do more damage to animals and the cause of science every day than all the homeopaths in America have done in a lifetime.
I don’t know if homeopathy “works” or not. I am pretty sure some homeopathic remedies have an effect, and frequently they act just as homeopathic theory says they would. I’ve even seen a marked difference in outcomes when working with an experienced homeopathic veterinarian as opposed to one who is not very experienced, which I think is a very provocative observation. There are also enough studies out there that have shown some effect beyond the placebo that I don’t think it’s absurd or stupid or gullible to give homeopathy a try.
The danger is, of course, that one will be treating a pet blindly, clinging to the dogma of the One True Modality (whatever it is) while their pet sickens and even dies, being essentially untreated. But I see this ALL THE TIME with people using conventional vets who’ve never even heard of homeopathy, but are ignorant as well about diagnostics or therapies or drugs that could help their patients.
Clinging to things that aren’t working, letting your dogma blind you to what’s really happening, is not unique to holistic medicine nor homeopathy, nor in my experience do more people make that mistake while using holistic or homeopathic vets than using conventional vets or TCM vets.
Someone is either observant and open-minded and capable of critical thinking, or they’re not. If they are, they’ll recognize snake oil soon enough, or see quickly that their pet is not improving, or that their veterinarian has no clothes, or whatever.
And if they’re not, they’ll stick with failing therapies, whatever they are, and keep taking their dog to an outdated vet who hasn’t changed his thinking in 20 years because their cat purrs when the vet examines her, or he has a great bedside manner, or he’s the cheapest vet in town — or to a homeopath or TCM vet or animal communicator or the guy down the street who sells supplements, even when it’s clearly not helping their pet, because that’s what people with that mindset do.
Comment by Christie Keith — July 20, 2009 @ 11:57 pm
Christie, that’s all well and good, but what Dr. Pitcairn has convinced me of here is that he’s totally unprofessional and I probably don’t want to give much credence to his opinion on anything.
Comment by Lis — July 21, 2009 @ 6:04 am
The only dog (and cat) I have in this fight is that I have pets to care for to the best of my ability. That makes me a voracious and skeptical student of veterinary medicine.
For what it’s worth, we wouldn’t likely have enough complementary and alternative veterinary medicine to be arguing about if it weren’t for Dr. Pitcairn. He’s like Nathan Winograd and Karen Pryor in this regard, a paradigm changer. Dr. Pitcairn’s book, like Winograd’s and Pryor’s, is one of only a handful in my life that after I read it, nothing was the same.
In any case, I don’t know enough about homeopathy to put in one of those tiny pills, so the discussion is interesting. Let’s please keep it on the subject, however, not the people.
Comment by Gina Spadafori — July 21, 2009 @ 6:12 am
With all due respect Narda, I am still waiting for the biography of your education in Chinese herbs and Homeopathy. Your link above led to more opinion. I would like to know what courses you have taken and with whom.
Comment by Christine Wilson, DVM — July 21, 2009 @ 6:55 am
Wow.
And I thought Dog Trainers were a pithy group.
Comment by Linda Kaim — July 21, 2009 @ 7:19 am
You usually don’t see these sorts of disagreements aired in public among veterinarians, which is an indication of how hot these topics are in veterinary medicine, and how strongly beliefs are held and advocated.
I also heard from the representative of a company that sells Chinese herbal medicines. He took issue with the suggestion that anything in the bottle was not as labeled or that there may be problems with any Chinese products. I suggested he add a comment, and we’ll see if he does.
I have no knowledge of his company whatsoever, but the problems with quality control and fraud in China have long been established, so it’s an issue well worthy of discussion. Kudos to his company for rigorous testing and quality control, but that hardly guarantees the output of an entire industry, much less a country with well-documented cases of deadly fraud. Dr. Robinson’s concern in this area is well-grounded in the larger sense, in my view.
In a somewhat related post, Dr. Patty Khuly on Dolitter this morning discusses how veterinarians are taught to assess the quality of supplements, which have many of the same concerns with regards to ingredients matching the label, just as anything manufactured in today’s global manufacturing arena. Check out her post, here. (I also added Dr. Kay, whom Dr. Khuly cites and whose book Christie gave a strong review to, to our blog roll.)
Comment by Gina Spadafori — July 21, 2009 @ 7:30 am
Narda, you said if anyone can provide evidence of tongue and pulse diagnosis being performed on dogs and cats it would surprise you.
Most of the information on veterinary medicine comes from the T’ang dynasty, which is usually recognized to have occurred from approximately 600 AD to 900 AD. During this period, due to the military requirements on the northern front many horses were raised specifically for the ever-increasing military presence and its purposes. Recognizing the tremendous importance attached to the health and welfare of the horse, the T’ang dynasty established an actual department and school of veterinary medicine. This was the first formal education of this type in the history of China and the world. Even though the T’ang dynasty is credited with the formalization of veterinary acupuncture, the Spring and Autumn Warring States period, which occurred from approximately 400 BC to 200 BC, produced the historic practitioner who to this day is considered “the father of Chinese veterinary medicine,” Shun Yang. However, the earliest recorded practitioner of veterinary medicine was during the Chou dynasty, around 950 BC.
Not specifically dogs and cats.. but veterinary acupuncture has been around for a long long time and has a proven track record, being practiced as it was created. I personally feel that you are doing a diservice to the world of Traditional Chinese Medicine by attempting to “modernize” it to your liking.
I recently purchased several medical texts from the late 1800’s and the one thing I found interesting was that every one mentions tongue and pulse diagnosis. These are American human medical texts. It seems that we have lost alot of what constituted a good physical exam.
I would also like to know your training in homeopathy and acupuncture. And what makes you qualified to determine what should and should not be taught as approved CE.
Those of us that have recognized the limitations of drug based therapies are yearning for training in veterinary alternatives. I applaud Richard’s class in classical homeopathy, it is an eye opening course and has allowed me to CURE a variety of illness that I would not have cured otherwise.
Comment by Marcia Martin — July 21, 2009 @ 7:42 am
Very, very interesting discussion. I didn’t have an opinion to begin with, having never really considered these particular issues (except the Chinese product connection; as much as is feasible, I now go without rather than purchase anything made or produced in China, most especially edible products), so I was open to hearting all sides.
From the information provided, its quality and the tone it was delivered in, I have formed the exact opposite opinion as Lis. Dr. Pitcairn is clearly intelligent, knowledgeable and experienced, and cares a great deal for the animals his work effects. His comments have been informative, detailed and professional, and put some needed balance into this discussion.
I’m glad he took the time to weigh in!
Comment by A.C. — July 21, 2009 @ 7:44 am
That is, I was open to “hearing” all sides. (Oh, for an edit button!)
Comment by A.C. — July 21, 2009 @ 7:48 am
“Wow.
And I thought Dog Trainers were a pithy group.
Comment by Linda Kaim — July 21, 2009 @ 7:19 am”
_____________________________
Linda, just to clarify the situation for you. There is a purge underway in veterinary medicine to eliminate most forms of alternative medicine. Here you are seeing some of this conflict for the first time. It is a critical time for all of you as consumers because if “the other side” wins you will have very limited choices in caring for your animals.
Dr. Robinson is a focus here because she recently joined a committee that evaluates teaching programs for continuing education for veterinarians. In most states veterinarians must complete so many hours of CE. Until now, many of these hours could be provided by teachers of alternative medicine, in my case, in courses of homeopathy. I have been teaching these course, approved by this organization, several times a year since 2001. Dr. Robinson joined this committee designated as the person that would review alternative medicine programs including homeopathy. As a result of that, for the first time my programs which had been approved in the past were rejected as “unscientific”. It was not that the content was so, but the very subject of homeopathy was designated that way. I was asked to provide the material from my classes for review and I sent several hundred pages of class material. This made no difference in their decision and the response was too short for the material to be reviewed so it was obvious that prejudice was not operational. I then found out that other programs including acupuncture, homotoxicology, chiropractic, herbal medicine were also being rejected so we then realized what was going on.
Why does it matter? If these programs are not approved veterinarians will not take training in them because to keep their licenses they must go elsewhere. That is how the study of these modalities is discouraged.
What was unfair about this was that Dr. Robinson had no training or experience with homeopathy and yet the process specified or implied that it was to be reviewed by “experts” that would understand the submitted programs and their content.
You will surely understand that this was seen as unfair and my objections (and that of others) was “tough luck” buddy. The organization basically said “well, you don’t have to deal with us — we don’t have any obligation to you”. So that is where it was left.
At this time none of my homeopathy programs have approval.
So, even though this is not the best format to air these issues, there is little choice as Dr. Robinson continues to attack homeopathy in various ways (as in this article about “false hope”) and it is part of a larger program of attack across the board of alternative medicine programs.
So, I suggest that readers look beyond their antipathy of this, what may seem a personal conflict, and realize this is a much larger issue and be aware of the significance of articles like this. You will be seeing more of this sort, including publications that attach homeopathy and other alternative modalities as it is part of the program underway.
I am sure I personally can continue to teach, at least to those interested and receptive, but my concern is with you, the consumer, as it is already difficult enough to find qualified practitioners and it will be even more so as a result of this current situation.
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 7:53 am
Dr. Pitcairn and I have already discussed my background. He only wants to shift the dialogue to a personal attack level so as to avoid having to deal with the real issues, which is his course failed to meet RACE standards.
The standards designated for RACE approval are listed at http://www.aavsb.org/RACE/ .
For all of you who want to rally around Dr. Pitcairn, instead of dissecting me and my qualifications, you might instead make a more meaningful contribution by helping Dr. Pitcairn meet the requirements of RACE.
You can review the Continuing Education Program Requirements at
http://www.aavsb.org/RACE/ProgramReq/
which specifically states: “All CE Program offerings shall be designed to reflect the educational needs of the veterinarian or veterinary technician and build on or refresh the participant in the standards for practice and courses as found in the curriculum of accredited colleges or schools of veterinary medicine or accredited veterinary technician programs.”
Note that these standards indicate that programs must “build upon or refresh the participant in the standards for practice and courses as found in the curriculum of accredited colleges or schools of veterinary medicine”.
Thus, one way to meet these standards is to petition the veterinary schools to start teaching homeopathy. When that happens, get back to me. For now, though, I’m moving on.
I have articles to write, research to complete, and a book to finish.
Comment by Dr. Narda — July 21, 2009 @ 7:54 am
[duplicate comment deleted]
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 7:56 am
I am a veterinarian and I trained with Richard Pitcairn in 1998 and since have also taken his advanced course and other advanced training in homeopathy. I am also certified in acupuncture and advanced Chinese Medicine with Chi Institute. I feel that is only recently that I have had the understanding and skills to treat advanced cases such as cancer, although homeopaths do not treat named diseases, we treat patients. I am treating a cat with agranulocytic mast cell tumor in spleen and intestine, that was give 2-4 months to live in November 2008, so we are 9 months into treatment. I am treating a cat with lung cancer given 1 month in Feb 2009, and a cat sent home a few months ago with inoperable liver cancer, and is now eating and feeling better. These are a few examples of extending life with homeopathic treatment, even in cases with advanced pathology. There are many other cases I have, for example dog with Cushing’s disease, dog with cruciate ligament problem, all improving with homeopathic treatment. I could add many other cases, as well as other practitioners could as well. It would be a sad day to see this option taken away from people and pets.
Comment by Dr. Barbara Noeldner — July 21, 2009 @ 8:15 am
I’m not sure what happened to No. 70. Did the software delete it? We didn’t. Upgrades can be a real pain.
Dr. Pitcairn, if this is a software glitch, please re-post.
Comment by Gina Spadafori — July 21, 2009 @ 8:18 am
Gina, number 70 was a duplicate of number 68, so I deleted it and posted, “Deleted because it was a duplicate.”
Comment by Christie Keith — July 21, 2009 @ 8:24 am
When I read comment 70, the first part looked like a duplicate of 68, but approximately the second half was different. My initial reaction was “duplicate comment,” but then I got to the latter part of it, and thought, oh, no, not duplicate.
Of course, maybe I’m just crazy (lots of evidence for that), but if possible, I’d take another look, comparing the ends of the comments rather than the beginnings.
Comment by Lis — July 21, 2009 @ 9:05 am
Dr. Robinson,
Excellent and insightful article. It is unfortunate that the discussion has become so personalized and has diverged from your primary topic into so many other areas of CAVM.
It is clear that faith is the basis for many of your opponents opinions, butressed by the usual abundance of personal anecdote, appeals to the authority of individual experience, and references to “scientific studies” which, when examined closely, fail to meet the standards of evidence required for acceptance into the mainstream of scientific medicine. As others have pointed out, the only reason these methods are “alternative” is not intellectual or institutional inertia, a conspiracy of venal veterinarians trying to suppress safe, effective, inexpensive cures or any other such nonsense. They are alternative because they cannot meet the objective standards of evidence science requires, and which have demonstrated superiority in evaluating safety and efficacy over traditional methods of anecdote and personal impressions. I know of no veterinarian, no matter how skeptical, who would not embrace homeopathy, acupucture, chiropractic, TCM, or any other such method if it passed the simple and easy tests required of scientific medicine and didn’t require faith in gurus or mystical forces like Ch’i, water memory, innate intelligence, and so on. All the conspiracy mongering and personal attacks are simply an evasion and a distraction.
But faith is, by its very nature, self-reinforcing. Belief begets belief, and humans are notoriously loath to give up beleifs regardless of evidence. We hate to have to accept the ambiguity and uncertainty of knowing our personal impressions are less reliable than the objective and impersonal process of science. There is a powerful pyschological incentive to reject evidence-basd medicine because it takes away our illusions. Supporters of CAVM can claim that because they have believed and practiced these methods, because they have “seen for themselves,” that their wisdom and position of authority must be respected. Sadly, their intelligence and passion and conviction may make them convincing to others, but they don’t make them right. Only well-designed and conducted research which take the biases of passion and conviction out of the evaluation process can prove their case, and such has not been produced despite many attempts. It is unfortunate that disagreement is perceived as disrespect, or that respect is expected to subbstitute for evidence, but such is the nature of faith-based medicine.
Thank you for your article. The passion generated in the responses is surely a testament to the insight of your comments and the challenge they present to the faith of others.
Comment by Brennen McKenzie — July 21, 2009 @ 9:15 am
The comments are word for word identical. I should have just deleted the second one entirely, as I often do with duplicate posts. I made the decision to note what I’d done simply because things seemed so heated I didn’t want consipracy theories, LOL.
And yet, I got one.
Comment by Christie Keith — July 21, 2009 @ 9:28 am
Dr. Robinson posted:
“Dr. Pitcairn and I have already discussed my background. He only wants to shift the dialogue to a personal attack level so as to avoid having to deal with the real issues, which is his course failed to meet RACE standards.”
Dr. Robinson and I have never discussed her background. I emailed her asking about her background and she refused to give that to me. Then the committee for CE approval (of which she is member) emailed me telling me not to contact her again. She has NEVER given one bit of information to me about her training in homeopathy. I hope this is clear.
Regarding my meeting the standards she mentions above, I did meet those standards and have been a RACE approved provider, no. 93, since 2001. None of my meetings have not been accepted until Dr. Robinson joined the committee as the reviewer of “alternative medicine programs” as given in the RACE newsletter.
I contacted the org. about why the standards had changed and was told they had NOT changed which, of course, does not make sense. If the standards have not changed then the way the are interpreted has changed by whoever is reviewing the submissions for homeopathy. I hope this too is clear. To refer back to the standards that have been in place for several years is disingenuous because obviously something has changed and to pretend that it has not is no explanation. When I contacted the org. about it, I was told I was still an approved provider but no explanation as to why the same material (in one case, exact same material previously approved since 2001) is no longer acceptable.
I think everyone knows what bureaucracy can be like and realize how this game is played.
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 9:46 am
The comments are word for word identical. I should have just deleted the second one entirely, as I often do with duplicate posts. I made the decision to note what I’d done simply because things seemed so heated I didn’t want consipracy theories, LOL.
And yet, I got one.
Virtue is its own punishment. And I told you there was evidence I’m crazy.
Comment by Lis — July 21, 2009 @ 9:53 am
I think I posted the same thing twice. My apology. Using this blog is new to me but I am catching on.
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 11:01 am
Brennen posted:
“It is clear that faith is the basis for many of your opponents opinions, butressed by the usual abundance of personal anecdote, appeals to the authority of individual experience, and references to “scientific studies” which, when examined closely, fail to meet the standards of evidence required for acceptance into the mainstream of scientific medicine.”
I am glad this is clear to you but you are in ignorance of the facts. There is a huge body of evidence of the efficacy of homeopathic medicine. This body is almost completely ignored by the allopathic community and articles on this are not accepted by journals. It is a political issue, not an efficacy one. It is a turf war and the pharmacies and the allopathic community do not want competition.
Read the few research articles I posted, read the extensive literature on the history and politics of medicine before coming to these “clear” conclusions.
You may also be interested to know that a study of the medical system by the federal government Office Of Technology Assessment found that only 15% of all allopathic medical treatments were based on scientific studies. Not double-blind studies, studies with any contol group at all. The whole presentation that allopathic medicine adheres to a scientific standard and homeopathy does not is absurd. Every 5 years one half of all accepted allopathic knowledge is considered inaccurate. The illusion of objective reality is just that — an illusion.
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 11:09 am
There are a zillion journals out there. Maybe you need to start one exclusively for homeopathy/alternative medicine!
Comment by The OTHER Pat — July 21, 2009 @ 11:22 am
82
Comment by Gina Spadafori — July 21, 2009 @ 11:29 am
Well, for what it’s worth I used Dr. Pitcairn’s book as a jumping off point to the recipes I use to cook Kasey’s food—especially the part about getting enough of the required stuff like calcium into it.
But the aggressiveness of the commenting (although I understand the passion) kind of makes want to give it back to him. JMO.
Comment by Original Lori — July 21, 2009 @ 11:32 am
Original Lori,
You benefited from having the information from my book. It has helped countless other people as well. If you really are appreciative of that, then be willing to go to bat for the countless other people out there that also have need but may not have the opportunity you have had to access this information. I don’t think you quite grasp the importance of this, the desire of the larger part of the veterinary profession to restrict access to any alternative care or to having the information available to the public. Think of others. Think how you have been helped and how others deserve the same.
Comment by Dr. Richard Pitcairn — July 21, 2009 @ 11:46 am
You seem not to be getting the point about aggressiveness not serving your cause.
So, quite a few years ago, you wrote a great book about dog nutrition. That’s wonderful. Why does it mean I should take you seriously about how to treat my mother’s cat who has cancer? Because you’ll tell me I’m a dupe if I don’t?
Sorry, not a persuasive argument.
Comment by Lis — July 21, 2009 @ 11:58 am
If anyone is interested in a website that counterbalances Dr. Richard Pitcairn’s argument, it is http://skeptvet.com/Blog/
Comment by Colorado Transplant — July 21, 2009 @ 12:09 pm
Dr. Pitcairn,
Respectfully, your classification of disagreement over the evidence as “ignorance” and “political” is nonsense. I am very familiar with the evidence, but for anyone else who’d like a clear and detailed summary, as well as a good discussion of why not all published articles are equally reliable, I’d recommend the following:
Barker Bausell, R., Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, 2007
Ramey, D., Rollin, B., Complementary and Alternative Veterinary Medicine Considered, Iowa State Press, 2004
Shang, A., et al., Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet Aug-Sep 2005;366(9487):726-32
Sing, S., Ernst, E., Trick or Treatment: The Undeniable Facts About Alternative Medicine, W.W. Norton & Company, 2008
Anyone who would like a short summary with a focus on the veterinary side of the debate can read my own article here:
http://www.skeptvet.com/index......Homeopathy
While as colleagues we should be free to disagree about facts, I find your constant insistence that disagreement constitutes suppression of the truth, ignorance, or some sort of political conspiracy offensive and childish. I take your acceptancce of the befits of homeopathy in good faith, and I believe you have your patients’ best interests at heart eve though I disagree with you about the facts. Mature and respectful disagreement requires that you treat dissenting opinions likewise. If your belief in homeopathy is not a matter of personal faith, then you should not be so quick to dismiss other opinions as ill-motivated.
This tone strikes me as what I have come to call the “David and Goliath” myth that CAVM proponents often offer as a reason why their arguments have been rejected on other than a factual basis. Here is a brief discussioin of the pnenomenon:
http://skeptvet.com/Blog/2009/.....iath-myth/
Comment by Brennen McKenzie — July 21, 2009 @ 1:35 pm
As for the contention that “only 15% of allopathic medical treatments were based on scientific studies” this is incorrect and misleading. This assertion has been well-debunked here:
http://www.theness.com/neurologicablog/?p=51
Many mainstream practices have been “grandfathered in” (as, I might add, has the US Homeopathic Pharmacopeia, which was automatically exempted from proving safety and efficacy when food and drug safety laws were instituted in the U.S.)
These practices do not have the level of evidenee behind them they would require if invented today. However, the level of evidence behind mainstream medical practices is far higher than for alternative practices, and rather than considering centuries or millenia of unquestioned use to be a point in favor of a therapy, as does the CAVM community, scientific medicine holds all practices as open to criticism based on logic, reason, general scientific principles, and of course clinical evidence.
Comment by Brennen McKenzie — July 21, 2009 @ 3:03 pm
If I may do a big stretch, this argument you are all enjoying reminds me of when the mainstream media and dog food companies were dumping all over the anecdotal evidence streaming in from pet owners during the Menu Foods debacle. Because it was anecdotal, it was worthy of being ignored and could be dismissed as not worthy of investigation. And we all know what happened.
I also think there is a similarity between the City of Cambridge, Mass vs Henry Louis Gates Jr going on here. I as a pet owner, am not interested in your scientific ( versus racial) profiling of homeopathy. I am much more interested in finding viable solutions/treatments for my ailing pets! Consider acupuncture, a treatment that even 5 years ago was not looked upon as mainstream and where studies have not been able to prove it’s efficacy, has become much more accepted as a viable treatment for certain conditions affecting our pets.
So whether Dr. Pitcairn and Skip Gates are being combative in defending themselves or not doesn’t bother me in the least. They have cause. What does interest me is the preponderance of anecdotal evidence that supports Homeopathy as something more that can be added to a (w)holistic approach to promoting wellness and treating disease. I don’t see that as “faith” healing, although I do believe there have been studies done on that topic that point to a certain validity regarding the power of the mind over the body.
As for Dr. Pitcairn’s belligerence, there comes a point in all our lives when we get tired of proving ourselves over and over again, and we tend to get really frustrated with the same old same old fight for relevance. So cut a little slack. Let’s all take a deep breath, and try to find common ground in our collective search to better the lives of our companion animals through bettering their overall health.
Comment by Anne T — July 21, 2009 @ 4:43 pm
Anne T—I think that is what everyone here wants.
But it feels to me like Dr. Robinson and Dr. Pitcairn were having an active argument in another forum and we came into the middle of it. So instead of learning from both sides and forming my own opinion, or figuring out what I wanted to research further—as I usually do here, I felt like I do when my married friends argue in front of me. Awkward and like I wanted to be anywhere else.
Perhaps I’m the only one who felt that way, and if so, fair enough. I just wanted to point out that the opposite of the desired effect might be occurring. And if it truly is a battle for the right to make informed choices for our pets, if that really could get taken away, it’s worth more than that.
Comment by Original Lori — July 21, 2009 @ 4:57 pm
No Original Lori, you aren’t alone. I too felt like I was trespassing in a personal confrontation that made me very uncomfortable. Which is why I wanted to try my feeble best to bring things back to a ground zero: Pet wellness, how can we achieve it and maintain it? How can Homeopathy be incorporated as part of the envelope of modern veterinary medicine like acupuncture has become? As an instance, every time you give your dog Rescue Remedy to calm her or take it yourself, you are indulging in a form of Homeopathy. Even if it doesn’t test well empirically, there is huge ancedotal evidence to support Homeopathy.
How as pet owners can we help urge the medical and the homeopathic communities to drop their antagonism and prejudices and find common ground for the sake of our pets? I don’t know because it involves human behavior, and that is the Rubicon that is such a challenge to cross. I’d love to see a public discussion like this become a deciding factor into both sides rethinking their positions. I am a Pollyanna in many ways. I am always hopeful for a better outcome. In this case, I’d love to see both arts find some point of commonality.
Comment by Anne T — July 21, 2009 @ 5:25 pm
The problem with saying that anecdote is a good reason to try things and “can’t we all just get along” is that these unproven therapies aren’t benign. Contrary to the image Dr. Pitcairn and others paint of those of us trying to defend science and evidence-based medicine, we’re not doing it to be crotchety, to protect our turf, and so on. We’re doing it because we’ve seen unecessary pain and suffering caused by unjustified faith in alternative methods. I’ve seen dogs who wouldn’t walk on a leg with cancer and who creid whent he leg was touched, but their owner refused to allow me to give real pain medication because they were convinced that the homeopathic treatment they were using was enough. On my blog a visitor recently wrote a heartrending story of an acquaintance using an herbal preparation to treat their dog’s cancer and the gradual death and sloughing of the leg which they were told was a normal sign of healing. The dog ended up dying of the cancer anyway.
And MDs can point to just as tragic outcomes from a blind faith belief in unproven therapies. Delayed diagnoses that lead to death from diseases that could have been cured, toxic reactions to herbal preparations that have never been tested for safety, and so on. And in many of these cases, the remedies had plenty of anecdotal evidence and virtual guarantees from their providers that they were safe. No objective discussion of risks and benefits. Take a look at this website which colects many of these stories:
http://whatstheharm.net/
There is a real meaningful issue of finding the best way to help our pets, and both sides sincerely want the best. But there is a real right answer, and just accepting that it’s a difference of opinion and letting everyone do as they please causes real ahrm
Comment by Brennen McKenzie — July 21, 2009 @ 5:54 pm
Hello All ~
As a former veterinarian (now homeopath), I would like to interject just a few words.
I have been privileged to witness very satisfying results with both animals and people through the use of homeopathy. I feel graced in my life to have found this modality of health and healing ~ for my family and friends, as well as clients. One might say that seems like a “faith” attitude; but homeopathy (and many other alternative methods) is based on observable Energetic patterns in the Universe. It is far more consistent with Einsteinian model of physics than Newtonian ~ just thing, if E=mc(sq), then every single manifestation in the universe has its own energy pattern; and that energy can be released and used, for good or ill. Who would have thought, 75 years ago, that a single atom could released megatons of energy? Who could have proved that with a double blind study? The study of homeopathy involves the study of Nature herself, her patterns and relationships.
While there are, actually, a few rigorous scientific studies of homeopathic remedies ~and they have been demonstrated to work time and again ~ the double blind really doesn’t lend itself well to the highest use of Homeopathy. This is because one of the central features of taking a homeopathy case is that of individualizing (i.e., you might have 10 cases of strept throat, each requiring a different remedy). So just giving every case a dose of remedy X, that won’t work. Double blind studies are quite simplistic as compared to the complex process of attempting to elucidate the harmony disruption of the case, and see that disharmony reflected in a similar (observable) Energetic pattern elsewhere in the Universe.
It is a beautiful system, based perhaps in faith ~ in that it accepts that we, as humans, don’t know/understand everything and can’t explain everything. But we know what we see. One thing that we see is that, when an appropriate remedy or energy pattern is applied in a case, the cure is true and undisputable by all.
As I am no longer a veterinarian, I don’t have a vested interest in having RACE approval. I am liberated to study what fascinates me, and use it to best of my capacity, and (often)watch my cases overcome long-term chronic diseases.
I am expressing my full and true opinion here, in the interest of keeping doors open. I encourage all interested parties to keep an open mind and heart; as did Hahnemann, the father of homeopathy, whose motto was “Aude Sapere” — or, Dare to Question, to Know!
Respectfully submitted,
Betsy Harrison BA, BS, DVM, CVH (certified veterinarian homeopath)and DSHNY (diplomate, school of Homeopathy, New York).
Comment by Betsy Harrison — July 21, 2009 @ 6:07 pm
Ditto, Brennen, on why this debate needs to happen and the issues need to be aired.
I, too, have seen everything that you mentioned, including the lack of objective discussion about risks vs. benefits, the delay in proper diagnosis and treatment, and people being sold a bag of supplements without any knowledge of the contents, interactions, or supposed indications of the products.
Thanks for your voice of reason, the informative links, your expertise on these issues, and your calm rationality.
Comment by Dr. Narda — July 21, 2009 @ 6:14 pm
Brennan, you state your case with great clarity, with strength, and with facts to back up your convictions.
As to the human health, in which the Hippocratic Oath says (paraphrasing) that the physician should do no harm, why aren’t most people using homeopathy instead of scientific methods that have been proven by experiments.
I would think that homeopathy would spread like wildfire if it cured a lot of people, even without the science, or is it limited to just a few cases. No scientist am I, but this is my ordinary reasoning power I am using.
Comment by Colorado Transplant — July 21, 2009 @ 8:15 pm
True enough, Brennan, that some homeopathic cases do not go well. Also let it be said that some allopathic cases do not go well.
In fact, many cases have been vaccinated, antibiotic-ed and steroid-ed to the grave.
Indeed, to do no harm is an important tenet in healing. How many of us, when we reach for that steroid, can honestly believe that we are not doing harm?
It is true that homeopathy is used far less often (in our country today) than the pharmaceutical model of medicine. The question of “why” might have something to do with the power of Big Pharma. There is a lot of money and thus a lot of influence on even our legal system. A thinking person might wonder why, in a country of freedoms, we are losing the freedom of choice regarding what kind of healing modalities we wish to use, for ourselves, our children, and our loved ones.
And yet, due to the influence of big money from big pharma and medical lobbies, this is exactly what is happening ~ We have the state taking parents to court for not using the mandated medical system.
Does this not seem strange?
Comment by Betsy Harrison — July 21, 2009 @ 9:18 pm
It’s been insinuated that homeopathy is not based in science. This is a gross misconception as Dr Hahnemann was the consummate scientist and was adamant about the practitioner knowing what to expect from the patient in response to the remedies prescribed. As Dr Robison stated “I, too, have seen everything that you mentioned, including the lack of objective discussion about risks vs. benefits, the delay in proper diagnosis and treatment, and people being sold a bag of supplements without any knowledge of the contents, interactions, or supposed indications of the products.” I could easily make the same observation of patients seeking conventional treatment. I, too, have seen the lack of objectve discussion about risks vs. benefits, the delay in “proper” diagnosis and treatment, and people being sold a bag of medications without any knowledge of the contents, interactions, or supposed indications of the products. Bad practice exists no matter what the modality. To assume that there is only a single “right” answer when dealing with living systems is to deny the individuality of each patient and their particular situation.
How long will we continue to allow/accept patient suffering in the name of evidence based science? We are faced with more chronic illness today and at younger ages than ever before. Obviously something is not working in our current system of conventional medicine and application of our scientifically based data to our patients lives.
I am a practicing veterinarian whose practice is limited to classical homeopathy, chiropractic and nutrition. And while I value my conventional training and experience I can honestly say that my patients are healthier with my current approach to healing. The principles of homeopathy continue to apply to patients today as they did more than 200 years ago. Will they ever meet the double blind criteria insisted upon by my conventional collegues? That will remain to be seen but in the mean time I will continue to practice in the best interest of my patients and their caregivers and be thankful that a right to choose is available.
Respectfully,
Pamela J Ditonto, DVM
Comment by Pamela Ditonto — July 22, 2009 @ 1:30 am
Way to go, Dr. Narda, Brennen, - reverting to the original article here, good to see the abuse of various animals in TCM (applies to homoeopathy remedies, too, even if in small (!) quantities - look up homeopathic “proving” procedures - especially toad, for examples) called to account. I wish people looked at this stuff more attentively.
Comment by Rita Wing — July 22, 2009 @ 2:20 am
Didn’t homeopathy came way before Big Pharma?
Didn’t homeopathy have a chance to cure hundreds of people all over this land and England?
Sorry, I do not trust in faith when I am desparate for a cure for me, my family, or my beloved pets. I look for scientific cures. When all else fails, I then may turn to “faith”.
Comment by Colorado Transplant — July 22, 2009 @ 5:56 am
Rita — Good point! Same with Mom, the Colorado Transplant!
Comment by Dr. Narda — July 22, 2009 @ 7:40 am
Dr. Narda—would you be able to clarify a few points for me? I have read the comments and the article, but if am making you repeat something please forgive me.
1. Do you dismiss anecdotal evidence entirely? If a good number of people you know/client ssaid ‘hey I saw a positive different in my dog from x method’ for instance?
2. Do you feel that at the root of this argument is a battle for an owner/guardian to be able to look at many options and make her own informed guided choice on what is best for her companion animal? Because I think that is what is being put forward here by some of the commenters.
Comment by Original Lori — July 22, 2009 @ 8:11 am
Rita- Have you considered what “abuse” lab animals go through in the clinical trials for conventional drugs, current medical procedures, etc.? “Abuse” is not to be tolerated in any practice modality but unfortunately where there is human involvement, the potential exists.
Colorado Transplant- if you study the history of medicine it is actually quite interesting how and when the practice of homeopathy was forced from prevalence by pharmacy and organized medicine- hmmm. . .not much different than what we are seeing today!
Comment by Pamela J Ditonto, DVM — July 22, 2009 @ 8:20 am
Yes, homeopathy came way before Big Pharma. It has been the “since” Big Pharma (and the AMA) that it has been systematically suppressed. Once antibiotics were invented, our culture became quickly enamored with “better living through chemistry”, with the quick and easy fix, with the one-size-fits-all. Looking around us, we can see how much better our living has become through chemistry. But, as modern physics shows, it is Energy that precedes chemistry; if we want to go to the source of illness and actually cure, then we need to learn to pay more attention to Energetics, try to understand what lies behind that sick tissue manifestation. If the energy is still in disharmony, then the patient is not cured, even if the tumor is removed.
And yes, it has (and still does) have a following in England — about 1/2 the population uses it, including the Royal Family. It is also used to a great extent in other European countries.
Comment by Betsy Harrison — July 22, 2009 @ 8:39 am
Homeopathy certainly is used to a far greater extent in the UK and parts of Europe than it is here. Yet there is, again, no evidence that it works any bettter there than here. Even where it is widely used, there is none of the dramatic improvement in health and well-being among users one would expect if the claims made here about it were true. In fact, there is some limited evidence to the contrary, as this study from Norway, which found use of alternative medicine very generally defined actually was associated with lower rates of survival among cancer patients, suggests:
http://www.geocities.com/healt.....orway.html
This would seem to support my point that it homeopathy is not a wildly successful approach that is being suppressed by Big Pharma but an approach that simply does not have the benefits claimed for it. It hasn’t failed to prove itself for want of a fair chance but for want of the capacity.
The “free choice” argument is a popular strategy in the U.S. as it plays into the popular cultural suspicion of government and the respect for individual freedom. But the “choice” between methods which help and those which do nothing or even harm a patient is not a real choice. If one accepts that the government has any role at all in protecting public health, than one has to accept that establishing some reliable and objective standards of safety and efficacy is an appropriate government activity. If, of course, you believe government should stay out of everybody’s business alltogether, than you won’t accept this, but that’s really a political not a scientific debate.
History suggests to me, and to many others, that the methods of science are bettter at determining safety and efficacy than tradition and personal experiences. For a thousand years doctors and patients believed bloodletting, purging, cupping, casting out demons, and lots of other non-scientific method of treatment were helpful. Those people were just as smart as we are, but they had the same flaws and cognitive vulnerabilities. We now live longer and healthier lives and eschew those methods because we have developed a better way to determine what works and what doesn’t. This is not cultural chauvanism, it’s just a pragmatic evaluation of reality.
Even the ardent proponents of homeopathy and TCM here seem to believe this since they frequently claim scientific support for their practices. I have no problem with this, and arguing the merits of the science is a perfectly appropriate thing for us to do. But most of these proponents then follow these claims with statements suggesting that it makes no difference what the science says anyway because they know what they know, their experience validates their conclusions, and they will not be pursuaded.
This I think is a species of intellectual arrogance. I am committed to science because I acknowledge the weaknesses and limitations of my own ability to look at the world and draw valid inferences. I know I can be easily fooled, so I rely on a method that compensates for this. This seems a much humbler approach than simply asserting that years of tradition and experience cannot be wrong.
Finally, there is much use here of the tu quoque fallacy. This says that because mainstream scientific medicine makes mistakes and there are bad doctors everywhere, that this is somehow evidence in support of homeopathy, TCM, or other alternative therapies. There is no connection. Scientific medicine makes mistakes, but science is always changing and improving and these mistakes eventually get corrected. Scientists are imperfect human beings, but the scientific method applied over time but many individuals compensates for our flaws. Therapies based on unwavering respect for ancient traditions and validated primarily by personal experience and belief, on the other hand, have no reason to seek and correct mistakes. If Palmer and Hahnemann and the ancient chinese physicians had it right, then our duty is to follow their advice and not question or challenge it. Western mainstream medicine made this mistake in canonizing Galen and the other Greek physicians and accepting without question both wat they were right about and what they were wrong about. And medicine stagnated in a miserable state for centuries. The scientific method changed that and made active questioning and critique a virtue. I know some here will disagree, but the history of the succeeding couple hundred years suggests to me that the scientific approach works much better.
The lack of perfection is not an argument that no progress has been made or that the method doesn’t work. And it’s certainly not an argument that the exact oppositite philosophy is the better alternative.
Comment by Brennen McKenzie — July 22, 2009 @ 10:14 am
Dang, you’re an amazing writer, Brennen!
Comment by Dr. Narda — July 22, 2009 @ 11:25 am
You have said it all—with logic, with great style, and with a wide range of the historical knowledge of medicine, Brennen McKenzie.
You have certainly enlightened me even though I was already a believer.
Yes, it is true, there are some errors are made by modern day medical practitioners. However, I know many people and pets that have been saved by the scientific method.
Thank you for taking the time to write above piece, Brennen!
Comment by Colorado Transplant — July 22, 2009 @ 11:48 am
Original Lori,
Sure, I’ll clarify:
“1. Do you dismiss anecdotal evidence entirely? If a good number of people you know/client ssaid ‘hey I saw a positive different in my dog from x method’ for instance?”
Not at all; anecdotes precede research and give us ideas on what approaches to pursue. As Brennen so deftly indicates, we then submit these initial assessments to scientifically rigorous analysis to remove bias and subjectivity, to the extent possible.
“2. Do you feel that at the root of this argument is a battle for an owner/guardian to be able to look at many options and make her own informed guided choice on what is best for her companion animal? Because I think that is what is being put forward here by some of the commenters.”
This seems to be what many of those who have commented here would like you to believe, but it’s not true. In contrast, I think that owner/guardians should be provided a spectrum of reasonable options along with their attendant, relative risks and benefits so that the doctor and client can work together as a team to optimize outcomes and quality of life for our animal companions/family members. Often, this involves combining treatments that together produce the best outcome.
An example of this is integrative pain medicine and what we call multimodal analgesia regimens. This can include acupuncture, massage, low level laser therapy, along with non-steroidal anti-inflammatories, gabapentin, controlled exercise and omega-3 fatty acids.
I hope that helps.
Comment by Dr. Narda — July 22, 2009 @ 11:56 am
It does, Dr. Narda. Thank you! Sometimes it’s easy to get lost in the soundbytes.
Comment by Original Lori — July 22, 2009 @ 12:23 pm
Narda stated: For all of you who want to rally around Dr. Pitcairn, instead of dissecting me and my qualifications, you might instead make a more meaningful contribution by helping Dr. Pitcairn meet the requirements of RACE.
I don’t think we are dissecting your qualifications, I think we are asking for information that any “public” figure should be willing to give. I would very much like to know what your training has been. It is a simple question with a simple answer… why do you avoid answering it?
as for ce requirements: which specifically states: “All CE Program offerings shall be designed to reflect the educational needs of the veterinarian or veterinary technician and build on or refresh the participant in the standards for practice and courses as found in the curriculum of accredited colleges or schools of veterinary medicine or accredited veterinary technician programs.”
When I took the IVAS course many years ago, I do not believe TCVM was being taught at any veterinary school. The only reason that TCVM has become as accepted as it is today is because a few brave pioneers decided to learn a new system of medicine and adapt it to their patients. If we stop people from learning new modalities (even if alternative)then we stop the progression of our profession. Many of us have taken courses that are now deemed to be unacceptable.
Veterinarians have no problem jumping on the newest drug and giving it to their patients.. anyone remember proheart 6? Or giving drugs off label without scientific evidence that it works for what they are treating. Polo Ponies in Palm Beach county anyone? Do you really know that the 6 drugs you prescribed for that one dog are safe and effective if given together? Do you have studies to prove it?
The point is that the allopathic community does hold alternative medicine to a much different standard when it comes to scientific evidence.
Good TCVM and homeopathy both recognize that the body is energetic in nature and that healing can occur by manipulating that energy. To my knowledge we have no way to measure that energy and therefor no way to “prove” how they work .. YET.. physics will one day catch up with homeopathy and TCVM and we will be able to identify the vital force or the chi. Until that time, wouldn’t it be better to work together to create studies that are acceptable to the skeptics among you?
Marcia
Comment by Marcia Martin — July 22, 2009 @ 2:15 pm
Intellectual arrogance. well said.
Comment by Betsy Harrison — July 22, 2009 @ 2:33 pm
Narda,
I have seen an article that you wrote extolling the virtues of Reiki. I am not discounting reiki and have been attuned myself. Can you please post the studies showing that Reiki works to cure any illness? I am just wondering how you can write so highly of one method of energetic healing and yet discount others.
Comment by Marcia Martin — July 22, 2009 @ 4:13 pm
Marcia,
Tell me how you judge the validity of a training program in a given modality if the basis of making diagnoses and the instructions on how to treat have never been validated by science?
You’re essentially taking the instructor’s word that what they’re saying is real. In addition, the fact that some of the leaders of these courses have sell the very same products about which they teach raises conflict of interest questions that many taking those courses seem blinded to.
The “certification” programs created over the past couple of decades also give the misleading impression that there is something meaningful to certify, and that certification actually counts for something, other than hours spent in a classroom.
Many of the leaders and lecturers of these courses became the default “gurus” within a modality without having to be accountable for the validity of what they teach. Too few students enrolled in these programs seem to care, unfortunately.
In reality, anyone can certify anyone in anything. These are not AVMA-approved specialties, and will not become AVMA-approved until they can base their curricula on science, among other requirements.
The problem here is that the public is told to look for this or that certification, with some believing it may even be a “board” certification, or at least that the graduates have achieved some sort of expertise.
How does one define expertise in CAM and judge the value of what one learns, unless the material presented can actually withstand scrutiny apart from the guru’s word? Aren’t we back to testimonials then?
No, comparing one course containing unsubstantiated material to another is a waste of time. It’s the material, Marcia, that counts, not how committed one is to learning how to prescribe something, for example, that way too many scientific reviews indicate cannot be distinguished from placebo.
Comment by Dr. Narda — July 22, 2009 @ 5:01 pm
About Reiki — it is essentially a faith-based healing system that for whatever reason can sometimes bring people and/or their animals comfort. What’s the problem with that?
Comment by Dr. Narda — July 22, 2009 @ 5:05 pm
About Reiki - Why do we think it comforts animals?
Comment by Brennen McKenzie — July 22, 2009 @ 6:00 pm
Mainly from client reports.
Comment by Dr. Narda — July 22, 2009 @ 9:36 pm
I have no problem with reiki… I use it all the time. But you seem to pick and choose which faith based treatments are acceptable. You can’t accept homeopathy without concrete scientific evidence but you can accept and write positive articles about reiki based on a perceived level of comfort to the patient.
Devil’s advocate here, my clients “percieve” an improved level of comfort in their animals after they are given a remedy.. “what’s wrong with that”?
You just seem to be contradicting your own standards of what is acceptable and what is not..seems a bit arbitrary to me.
from Narda: How does one define expertise in CAM and judge the value of what one learns, unless the material presented can actually withstand scrutiny apart from the guru’s word? Aren’t we back to testimonials then?
I guess this is why we keep asking what your qualifications are to continually down play “the gurus” of the alternative medicine world. What makes your training and experience more valid than theirs?
It seems you think that we are all a bunch of blind sheep following a shepard over the brink. Most of us, take what we are given and then read the history of the modality, speak with others in the field who are doing the work, read case reports and the available scientific evidence before and after making our decision to pursue training in alternative medicine. I don’t think any of us take lightly learning that what we were taught in school is only the tip of the iceberg when it comes to healing our patients.
for instance, I was treating a conventional client for pancreatitis (I normally give fluids and a remedy) but I decided to go on VIN and see what the latest treatments were for pancreatitis. I found a very long article basically stating that the only treatment scientifically proven to be effective in the treatment of pancreatitis is IV fluids. And yet we continue to give antibiotics and antinausea meds etc on what basis? So homeopathy is just as scientifically valid in this case as conventional treatment.
If you intend to hold alternative modalities to a level of scientific justification, you need to shine that light on all the conventional therapies that are being taught and practiced with scientific justification. What’s good for the goose is good for the gander so to speak.
Marcia
Comment by Marcia Martin — July 23, 2009 @ 6:48 am
sorry that was without justification
Comment by Marcia Martin — July 23, 2009 @ 6:50 am
Wowsers - zippy discussion!
I am a traditionally trained veterinarian with no professional exposure to CAVM whatsoever. I am not opposed to it in the least, and I encourage my clients to utilize it if they are looking beyond what I can offer their pets.
I try not to draw hard-and-fast conclusions on things I know nothing about (well…I am pretty certain that Jerry Lewis is popular in France because he personally paid every one of them off…that’s a fact!) but the only time I have a beef with it is when an alternative therapy is used to the exclusion of a traditional treatment that is known to be effective. Complementary is a much better moniker than alternative, I think. The line between the two disciplines or ways of thinking blurs at times, though. If I had a headache and someone with a CAVM bent said ‘Here, try gnawing on this Willow bark’ that’s CAVM, but if my MD says ‘Here, take these 2 aspirin and call me tomorrow so I can get some dang sleep’ that’s traditional Western medicine. But, really, there’s no difference.
That being said, there are more things in heaven and earth, Horatio, and I am open to all of it.
Comment by Dr. Tony Johnson — July 23, 2009 @ 7:11 am
I think this may be the problem with classical homeopathy. We do use it to the exclusion of drug therapy. Most of my clients have had the conventional treatments and are not happy with the results and want to try something else. When you read the theory of classical homeopathy you can see how it is at opposites with drugs and why the two modalities are mutually exclusive.
And you said where conventional drugs have been proven to work.. show me one conventional drug that is capable of curing chronic disease.. allergies, pancreatitis, hyperthyroid, etc. Perhaps this is why we look for better options than giving our patients a lifetime of medication to suppress their symptoms. When was the last time you heard the word cure used at a conventional conference.. that has changed to manage..is that acceptable that we manage disease and we don’t cure it? It think that is why alternative medicine is so frightening to many because we do use the word cure and cure is our goal in a large percentage of our patients.
Comment by Marcia Martin — July 23, 2009 @ 7:30 am
Thoughtful answer - thank you.
I think some of this speaks to the very concept of ‘disease’ and ‘health’ itself. There are drugs available for conditions that didn’t even exist 10 years ago, and I think this is more a market strategy than medicine.
But to exclude all of traditional medicine is just as bad as relying on it to the exclusion of complementary therapies that are potentially helpful. It’s babies and bathwater. I can’t go into much detail on what the CAVM modalities might be that are helpful because I am not trained in it, but the word on the street from my clients who have utilized them have been generally positive.
OTOH…
I would cite the use of insulin therapy as valid example of a traditional cure in cats - diabetic cats, with the right diet and a course of insulin, can be cured of diabetes mellitus. Anything can be debated, and I am sure it will, but this is a pretty clear-cut case of a chronic condition that can be resolved permanently with proper treatment. The insulin actually reverses the diabetic state by making the body responsive to its own insulin and after a time insulin is no longer needed: cured. All better. No more medications needed, normal pussycat. Meow.
You could argue that the very disease itself, diabetes, was brought on as a modern malady - that in ancient and long-past ancestral kittyhood, cats never developed diabetes, thus both the disease and its cure are modern phenoms. And you wouldn’t be wrong. But I still maintain that the best way to approach any sick or injured cat/dog/capybara/accountant/chupacabra is to first know the extent of the problem, then decide which items on the menu of traditional or complementary treatments stand the best chance of getting them back to full capacity.
Comment by Dr. Tony Johnson — July 23, 2009 @ 8:01 am
“Perhaps this is why we look for better options than giving our patients a lifetime of medication to suppress their symptoms. “
Comment by Marcia Martin — July 23, 2009 @ 7:30 am
This is a HUGE issue with me. There is little to no difference between the substances used in homeopathy/TCM and what is used in “Western” medicine. Simply because it is not processed doesn’t make in NOT a medication.
Belladona isn’t any different than atropine.
Foxglove vs. digitalis.
Willow vs. aspirin. Etc., etc., etc.
I can go on and on. Just because you may label it “natural” doesn’t mean it is not medicinal. just because it’s natural, that doesn’t mean it’s safe. Just because it’s natural, that doesn’t mean it’s effective.
Comment by K. B. — July 23, 2009 @ 8:29 am
Tony, thank you for your great posts.
You wrote (message #120):
“But to exclude all of traditional medicine is just as bad as relying on it to the exclusion of complementary therapies that are potentially helpful.”
I think Marcia would agree with that we should not throw out conventional medicine. Rather, when we select classical homeopathy for a given patient, as much as possible, we need to use it singly *in that patient*.
Comment by Shiri Hoshen, DVM — July 23, 2009 @ 8:40 am
Dr. Robinson wrote:
“Tell me how you judge the validity of a training program in a given modality if the basis of making diagnoses and the instructions on how to treat have never been validated by science?”
I hope you’re not talking about homeopathy. Dr. Pitcairn multiple references to scientific articles that validate aspects of homeopathy, in posts 44-50.
Where you don’t have scientific backing, you use clinical observation. The rigorous research can follow.
Thank you, Narda, for your great instruction and inspiration when I was a vet student, and a student in your acupuncture course!
Shiri
Comment by Shiri Hoshen, DVM — July 23, 2009 @ 8:43 am
K.B. You have an excellent point! (with the minor exclusion of homeopathic dilution). This is why it is so vital that we continue to offer RACE approved alternative medicine courses. So, that we need to have the training in place to learn how to use these modalities safely and effectively.
Comment by Marcia Martin — July 23, 2009 @ 8:58 am
“If I had a headache and someone with a CAVM bent said ‘Here, try gnawing on this Willow bark’ that’s CAVM, but if my MD says ‘Here, take these 2 aspirin and call me tomorrow so I can get some dang sleep’ that’s traditional Western medicine. But, really, there’s no difference.”
Of course there is a difference, and a huge one. CAVM proponents will tell you chewing on bark is as effective but safer than taking a pill, but that’s just the fallacy that what is natural is somehow good. Salmonella and snake venom and roundworms are all natural! While aspirin is not a great example since it’s one of the “grandfathered” treatments that doesn’t have the sound evidentiary basis most prescription meds have, the fact is that most drugs we use have been extensively tested to determine the limits of how safe and effective they are, and they contain exactly what we think they do and nothing else the vast majority of the time. Most herbal CAVM preparations have never been tested, so we have to rely on the “ancient wisdom” or “personal experience” tests which are not very reliable. And they’ve been shown many times to contain a wide variety of ingredients, which makes drug interactions a concern, and to be not infrequently adulterated with know toxins (such as heavy metals) or real pharmaceuticals. So chewing on leaves is not the same as taking medicine, and the lattter is much more likely to help and not harm if used properly than the former.
http://www.sciencedaily.com/re.....162210.htm
http://www.nutraingredients-us.....ingredient
“You could argue that the very disease itself, diabetes, was brought on as a modern malady - that in ancient and long-past ancestral kittyhood, cats never developed diabetes, thus both the disease and its cure are modern phenoms. And you wouldn’t be wrong.”
This is in fact often argued, and it is usually right for the wrong reason. CAVM proponents will tell you that many diseases, especially neoplasia, immune-mediated diseases, and chronic idiopathic diseases, are diseases of modernity; they are cause by the toxins, unnatural foods, and other evils of modern life. There’s seldom any evidence for this assertion. What they ignore is that there is more neoplasia because or pets are living long enough to get it since scientific medicine has stopped many of them from dying of the infectious and parasitic diseases, trauma, and nutritional deficiencies they used to die from. And we’re seeing more complex, multifactorial, idiopathic diseases because we’ve figured out how to diagnose, treat, and often cure many others that “centuries of tradition” and methods such as homeopathy, acupuncture, and TCM didn’t succeed in eliminating. Sure, there’s plenty we don’t understand and can’t fix yet. And there are some diseases caused by commercial diets, vaccines, and other aspects of modern health care. But again, the claim that modern medicine isn’t perfect doesn’t imply that CAVM is bettter, and the evidence of history suggests pretty clearly that it isn’t.
Finally, CAVM claims to cure while they say mainstream medicine only treats symptoms. This is nonsense. As already discussed ad nauseum, claims of homeopathic cures have never been demonstrated by anything other than anecdotes and opinion.
One of my favorite encounters with CAVM was when a woman brought an old golden retriever to see me because her energy practitioner told her she had detected leukemia. Though the pet had no signs of illness at all, I ran a number of tests that failed to show any evidence of leukemia. A year later, the pet came back with a slight cough, and again the energy practitioner had told the owner there was cancer, probably in the lung this time. No such cancer appeared on x-rays, and the cough went away when the dog was treated for a bacterial upper respiratory infection. I asked the owner what had happened with the lymphoma that was previously “diagnosed” by her alternative provider. It turns out, not only was the energy practitioner not mistaken, she had apparently diagnosed lymphoma that was undetectable to the scientific methods I used and then cured it with homeopathy and manipulation of the patient’s energy.
So the CAVM healer will predict that an old golden retriever has cancer every year. Whenever the prediction is wrong, the energy healer will get credit for preventing or curing the disease. But, sooner or later, the dog probably will get cancer, since it is a common disease in the aged and in that breed. When that happens, she’ll get credit for predicting it, and probably for palliating its symptoms and delaying the course. This could explain a lot of the “cures” CAVM proponents lay claim to, and without objective research to validate their claims, how are we to know?
On the other hand, mainstream medicine may not be able to cure lots of diseases, but when we claim to cure bacterial infections, parasitic infections, exciseable cancers, traumatic fractures, feline diabetes, and lots of other real clinical diseases, we can back those claims up with evidence.
Comment by Brennen McKenzie — July 23, 2009 @ 9:00 am
Marcia said to Narda:
“But you seem to pick and choose which faith based treatments are acceptable. You can’t accept homeopathy without concrete scientific evidence but you can accept and write positive articles about reiki based on a perceived level of comfort to the patient…You just seem to be contradicting your own standards of what is acceptable and what is not..seems a bit arbitrary to me.”
I have to agree here. As I’ve said often, I think the main difference of opinion between CAVM proponents and EBM advocates is epistemological; what counts as evidence. EBM considers personal experience and opinion as a low-reliability form of evidence only useful for suggesting where to begin looking at a disease or treatment, not as true evidence of efficacy. This has to be applied as consistently as possible. I’m certainly willing to use anecdote or personal opinion as a rough guide when nothing better is available, sadly all too often in veterinary medicine, but when better quality of evidence is available, it should be given priority. And, though this isn’t the place for a long discussion of it, prior probability is a concept which can help us focus our limited resources on things which are most likely to turn out useful.
If reiki is truly beneficial in any way other than psychologically (aka placebo or non-specific treatment effects), then it requires overturning many well-established principles of physical science, which ought to require extraordinary evidence.
I fully acknowledge these kinds of therapies may have real benefits for people even if they don’t actually affect the disease in any way. People’s perceptions of their symptoms are affected by many things, and elaborate therapeutic rituals, compassionate contact with other people, and so on can make people feel better even if not actually changing anything but their perceptions. But in veterinary medicine, I really worry about treating the emotional needs of the owner and neglecting the actual patient’s suffering. I know you have said elsewhere that you would not eschew scientific therapies in favor of reiki but only use it along with these, so for you it may have some benefit to the owner at little risk to the patient. But if you start claiming that owner perception is evidence that there is an actual benefit to the animal, I think you begin to provide justification for people to use the treatment in lieu of scientific therapies, and that clearly can lead to harm.
We’re none of us perfect, and I’m sure if I participate in these discussions long enough, someone will catch and throw back at me my own inconsistencies. But I do feel that the underlying philosophical difference between CAVM and EBM is an important one, and while I fully endorse accepting as valid any CAVM therapy that can meet the standards of evidence we both feel are appropriate, I do think consistency and fairness in the application of these standards is important.
Comment by Brennen McKenzie — July 23, 2009 @ 9:14 am
Lancet Publishes Major Review of Research on Homeopathic Medicine
by Dana Ullman, MPH ©1998
The Lancet published the most significant and comprehensive review of homeopathic research ever published in its September 20, 1997, issue. This article was a meta-analysis of 89 blinded, randomized, placebo-controlled clinical trials. The authors conclude that the clinical effects of homeopathic medicines are not simply the results of placebo.
The researchers uncovered 186 studies, 119 of which were double-blind and/or randomized placebo-control trials, and 89 of which met pre-defined criteria for inclusion into a pooled meta-analysis. The reseachers found that by pooling the 89 trials together that homeopathic medicines had a 2.45 times greater effect than placebo.
Comment by Marcia Martin — July 23, 2009 @ 9:28 am
Here are a couple of studies showing the efficacy of homeopathy in treating childhood diarrhea in developing countries.
15. Jacobs J., Jimenez L.M., Gloyd S., Carares F.E., Gaitan M.P., Crothers D., Homeopathic treatment of acute childhood diarrhea, British Homeopathic Journal, 1993.
16. Jacobs J., Jimenez M., Malthouse S., Chapman E., Crothers D., Masuk M., Jonas W., Homeopathic treatment of acute childhood diarrhea : results from a clinical trial in Nepal., J. Altern. Complement. Med., 2000.
Comment by Marcia Martin — July 23, 2009 @ 9:35 am
One study using nonindividualized homeopathic treatment was sponsored by the British government during World War II and was conducted in 1941-42 on volunteers whose skin was burned with mustard gas.13 The study showed the efficacy of Mustard gas 30c as a preventive or Rhus tox 30c and Kali bichromicum 30c as therapy. The study was double-blind, placebo-controlled, and was conducted at two centers (London and Glasgow), both showing similarly positive results. A more recent analysis of the data further substantiated the statistical significance of this study.14
It should, however, be mentioned that the researchers also tested the efficacy of Opium 30c, Cantharis 30c, and Variolinium 30c, none of which provided any noticeable benefit. If this trial had tested only these medicines, the researchers might have concluded that homeopathic medicines were ineffective in treating mustard gas burns. Finding the correct remedy is the key to making homeopathy work.
Comment by Marcia Martin — July 23, 2009 @ 9:40 am
You could argue that the very disease itself, diabetes, was brought on as a modern malady - that in ancient and long-past ancestral kittyhood, cats never developed diabetes, thus both the disease and its cure are modern phenoms. And you wouldn’t be wrong.
Really? We have evidence of that?
Not too long ago, during a kerfuffle over food I believe, someone posted here the story of a two-year-old feral cat who, when trapped and brought inside after a totally natural diet until then of small rodents and insects, already had diabetes.
It’s hard to see how that is a product of the modern decadent kitty lifestyle, and hard to see how it’s consistent with the idea that, prior to moving in with humans, cats never, ever had diabetes.
I grant you, they probably didn’t live as long as indoor kitties with diabetes.
Comment by Lis — July 23, 2009 @ 9:40 am
Just playing devils advocate once again.. we are totally sure that feral cat wasn’t eating dry food left out for stray cats? Or eating dry food off of someone’s porch. I know very few feral cats who don’t get a healthy helping of dry cat food left out by good samaritans.
Comment by Marcia Martin — July 23, 2009 @ 10:06 am
Brennan, as always you make a very valid argument. The differnce between what you say and feel and what I say and feel and what Narda says and feels, is that Narda is the one passing judgment on what is acceptable in regards to continuing education in alternative medicine. She doesn’t have the luxury of picking and choosing her standards she must apply the same standards to Conventional medicine, acupuncture, homeopathy, chiropractic when determining what gets passed for RACE credit.
She seems to have certain biases when it comes to modalities that don’t appear to be based in fact but in her own ideas and opinions. This is not good enough when you are sitting in position of such power. She would be just as entitled to her opinion as you and I if she weren’t the one deciding whose courses get approved and whose do not.
So, it really isn’t a which modality is better argument, but an argument of how to set standards for CE that are applied fairly across the board and not applied based on personal feelings or whims.
Comment by Marcia Martin — July 23, 2009 @ 10:22 am
The Veterinary TCVM text that I quoted is Bole’s Cannon of Veterinary Acupuncture and Moxibustion, by Bole Zhenjing 502-557 CE. So, as you can see the Chinese have been treating animals using tongue and pulse diagnosis for hundreds of years.
Comment by Marcia Martin — July 23, 2009 @ 10:38 am
Dr. Tony Johnson said:
“If I had a headache and someone with a CAVM bent said ‘Here, try gnawing on this Willow bark’ that’s CAVM, but if my MD says ‘Here, take these 2 aspirin and call me tomorrow so I can get some dang sleep’ that’s traditional Western medicine. But, really, there’s no difference.”
Of course there is a difference, and a huge one. CAVM proponents will tell you chewing on bark is as effective but safer than taking a pill, but that’s just the fallacy that what is natural is somehow good. Salmonella and snake venom and roundworms are all natural! While aspirin is not a great example since it’s one of the “grandfathered” treatments that doesn’t have the sound evidentiary basis most prescription meds have, the fact is that most drugs we use have been extensively tested to determine the limits of how safe and effective they are, and they contain exactly what we think they do and nothing else the vast majority of the time. Most herbal CAVM preparations have never been tested, so we have to rely on the “ancient wisdom” or “personal experience” tests which are not very reliable. And they’ve been shown many times to contain a wide variety of ingredients, which makes drug interactions a concern, and to be not infrequently adulterated with know toxins (such as heavy metals) or real pharmaceuticals. So chewing on leaves is not the same as taking medicine, and the lattter is much more likely to help and not harm if used properly than the former.
http://www.sciencedaily.com/re.....162210.htm
http://www.nutraingredients-us.....ingredient
“You could argue that the very disease itself, diabetes, was brought on as a modern malady - that in ancient and long-past ancestral kittyhood, cats never developed diabetes, thus both the disease and its cure are modern phenoms. And you wouldn’t be wrong.”
This is in fact often argued, and it is usually right for the wrong reason. CAVM proponents will tell you that many diseases, especially neoplasia, immune-mdeiated diseases, and chronic idiopathic diseases, are diseases of modernity; they are cause by the toxins, unnatural foods, and other evils of modern life. There’s seldom any evidence for this assertion. What they ignore is that there is more neoplasia because or pets are living long enough to get it since scientific medicine has stopped many of them from dying of the infectious and parasitic diseases, trauma, and nutritional deficiencies they used to die from. And we’re seeing more complex, multifactorial, idiopathic diseases because we’ve figured out how to diagnose, treat, and often cure many others that “centuries of tradition” and methods such as homeopathy, acupuncture, and TCM didn’t succeed in eliminating. Sure, there’s plenty we don’t understand and can’t fix yet. And there are some diseases caused by commercial diets, vaccines, and other aspects of modern health care. But again, the claim that modern medicine isn’t perfect doesn’t imply that CAVM is bettter, and the evidence of history suggests pretty clearly that it isn’t.
Finally, CAVM claims to cure while they say mainstream medicine only treats symptoms. This is nonsense. As already discussed ad nauseum, claims of homeopathic cures have never been demonstrated by anything other than anecdotes and opinion. One of my favorite encounters with CAVM was when a woman brought an old golden retriever to see me because her energy practitioner told her she had detected leukemia. Though the pet had no signs of illness at all, I ran a number of tests that failed to show any evidence of leukemia. A year later, the pet came back with a slight cough, and again the energy practitioner had told the owner there was cancer, probably in the lung this time. No such cancer appeared on x-rays, and the cough went away when the dog was treated for a bacterial upper respiratory infection. I asked the owner what had happened with the lymphoma that was previously “diagnosed” by her alternative provider. It turns out, not only was the energy practitioner not mistaken, she had apparently diagnosed lymphoma that was undetectable to the scientific methods I used and then cured it with homeopathy and manipulation of the patient’s energy.
So the CAVM healer will predict that an old golden retriever has cancer every year. Whenever the prediction is wrong, the energy healer will get credit for preventing the disease. But, sooner or later, the dog probably will get cancer, since it is a common disease in the aged and in that breed. When that happens, she’ll get credit for predicting it, and probably for palliating its symptoms and delaying the course. This could explain a lot of the “cures” CAVM proponents lay claim to, and without objective research to validate their claims, how are we to know?
On the other hand, mainstream medicine may not be able to cure lots of diseases, but when we claim to cure bacterial infections, parasitic infections, exciseable cancers, traumatic fractures, feline diabetes, and lots of other real clinical diseases, we can back those claims up with evidence.
Comment by Brennen McKenzie — July 23, 2009 @ 11:38 am
Marcia — Here are some facts for you.
1. It is not my job alone to determine the RACE decisions. These are made as a committee.
2. You stated: “The differnce between what you say and feel and what I say and feel and what Narda says and feels, is that Narda is the one passing judgment on what is acceptable in regards to continuing education in alternative medicine. She doesn’t have the luxury of picking and choosing her standards she must apply the same standards to Conventional medicine, acupuncture, homeopathy, chiropractic when determining what gets passed for RACE credit.”
You might check with Healing Touch for Animals group on their RACE approval status before making more false accusations against me.
Here is an excerpt from the website “Elements of Energy LLC”:
http://www.elementsofenergy.com/resources.html
“Please note: The American Association of Veterinary State Boards (AAVSB) recently reversed their decision about granting Continuing Education for Healing Touch for Animals. If you feel as I do, that this holistic work benefits your animals, then we need to collectively speak-up and partner with the AAVSB to re-instate Continuing Education Credits for veterinarians and veterinary technicians. Working in partnership is HTA’s goal and serving our animal companion friends. This modality is important to everyone who has been touched by the gift of love that animals give to each and everyone one of us. Healing Touch for Animals WAS Approved by AAVSB & RACE
Healing Touch for Animals® was approved by The American Association of Veterinary State Boards (AAVSB), Registry of Approved Continuing Education (RACE) committee as a provider of Continuing Education Credit to veterinarians and veterinary technicians across the country.”
So, as you can see, Healing Touch (which is in the same faith-healing category as Reiki and frequently combined with it) lost their RACE approval as well.
And Brennen, I am not advocating Reiki or Healing Touch as even medicine, much less as evidence-based medicine. It is a faith-based method of supporting patients. I don’t know whether it works or not; clients report that it does, and there is some preliminary basic science research saying that something is happening, but nothing has been done in veterinary medicine, though I have tried to get a research project going without success.
I can live with or without Reiki. The fact is that many of my patients receive it based on my clients seeking it out without my even mentioning it. In order to better understand it, I have looked into it and pondered about it publicly. I even took the entire series of Reiki classes well before I even considered going to vet school, all the way through the attunement process which I thought was pretty hokey.
Still, both Reiki and Healing Touch are taught in many nursing programs and offered in human hospitals. It’s out there, and I can’t close my eyes to it because I need to know about it.
For sure, as Brennan indicates, there are pitfalls with the approach, most notably when non-veterinarians start to make diagnoses or therapeutic sugggestions without veterinary supervision.
One last thing. Marcia, thanks for calling homeopathy a “faith based treatment” as in #116. I’m glad that your patients do well with homeopathy and your clients are happy. Continue to practice as you see fit. However, if you want the courses approved by RACE, the modality has to meet the standards set by the AAVSB. These aren’t my standards, they are the AAVSB’s.
Comment by Dr. Narda — July 23, 2009 @ 11:45 am
Just playing devils advocate once again.. we are totally sure that feral cat wasn’t eating dry food left out for stray cats? Or eating dry food off of someone’s porch. I know very few feral cats who don’t get a healthy helping of dry cat food left out by good samaritans.
At the very least, this two-year-old feral was not eating exclusively or even primarily a kibble diet, and had not been doing so for six or eight years, which is the usual claim about why our poor unfortunate modern domestic cats get diabetes.
If you want to argue that any amount of kibble in the diet engenders diabetes in fairly short order, fine, but that’s a different argument, and has to deal with the equally valid anecdote of my sixteen-year-old cat who won’t accept anything but kibble as her primary food, and who does not have diabetes. The eleven-year-old, more open to non-kibble, but still primarily a kibble eater, also no diabetes.
In fact, only one cat I’ve owned in forty years of cat ownership has ever had diabetes, and that cat came from a remarkably unhealthy litter of which, at a eleven, she was the last survivor.
There’s a basic level of plausibility that has to be met, and if you want to argue based on anecdotes, I’ve got an awful lot of anecdotal counters to the idea that “any amount of kibble in the diet causes diabetes very quickly.”
Comment by Lis — July 23, 2009 @ 12:24 pm
Silly antedotic comment:
My cat heals me when I take a catnap with her.
Maybe on some level her touching my body heals her. Knowing her, she doesn’t cuddle up to me unless she gets a benefit from it.
People all over America are taking catnaps with their feline companions. Maybe there is a whole lot of healing going on—who knows?
I warned you folks ahead of time that it was a “silly argument”, but I am not a professional.
Comment by Colorado Transplant — July 23, 2009 @ 12:52 pm
Remember the story about the 5 blind men introduced to an elephant? My dog is the elephant. 5 vets ranging from holistic to chiropractic to teaching hospital to bone specialist. 4 diagnosis.
It feels special to have the statistical error that eventually corrects the scientific method. ::right!:: The dog doesn’t think so.
Comment by eli — July 23, 2009 @ 2:33 pm
Thanks for that, Colo Trans! I think we needed a little levity here.
I am a professional (at least that’s what they tell me!) and I appreciated it.
Comment by Dr. Tony Johnson — July 23, 2009 @ 2:34 pm
Thank you, thank you, thank you, Tony, I say as I am giving my body bow!
Comment by Colorado Transplant — July 23, 2009 @ 2:38 pm
Dr. Robinson, #134
“Finally, CAVM claims to cure while they say mainstream medicine only treats symptoms. This is nonsense. As already discussed ad nauseum, claims of homeopathic cures have never been demonstrated by anything other than anecdotes and opinion. One of my favorite encounters with CAVM was when a woman brought an old golden retriever to see me because her energy practitioner told her she had detected leukemia. Though the pet had no signs of illness at all, I ran a number of tests that failed to show any evidence of leukemia. A year later… [snip]… I asked the owner what had happened with the lymphoma that was previously “diagnosed” by her alternative provider. It turns out, not only was the energy practitioner not mistaken, she had apparently diagnosed lymphoma that was undetectable to the scientific methods I used and then cured it with homeopathy and manipulation of the patient’s energy.”
That is an interesting example, but from your description, it has nothing to do with classical homeopathy, and the meaning of “cure” in classical homeopathy.
Homeopathy is a term that is frequently misused. The fact that this practitioner called what s/he did “homeopathy” doesn’t make it so. :-)
Comment by Shiri Hoshen, DVM — July 23, 2009 @ 3:04 pm
Message #135:
“So, as you can see, Healing Touch (which is in the same faith-healing category as Reiki and frequently combined with it) lost their RACE approval as well.”
What changed on RACE, that courses that had been approved for many years are no longer being approved?
Comment by Shiri Hoshen, DVM — July 23, 2009 @ 3:09 pm
I have a question for Dr Pitcairn if I may. In what ways is homeopathy “more rigorous and more proven than any of the conventional medicine out there today”?
Comment by Lee — July 23, 2009 @ 4:46 pm
Sorry.. we got off topic with the cat diabetes…not my intention
Narda, I don’t for a minute believe that homeopathy is faith based medicine, I was using your words.
You keep stating there are not studies only ancedotal evidence for homeopathy.. I posted a number of references to studies showing the homeopathy is effective.. Have you read them? are your ignoring them? do they not meet the criteria for real studies?
Brennen, I hear your concern. I don’t know what an “energy practitioner? is.. was this a veterinarian? someone with training in chiropractic, acupunture or homeopathy? Can you tell us what this person’s training was or is? I get these clients also..what I find is these :”energy” practitioners or people who give multiple supplements are those who want to take advantage of the holistic market but have no training.. they buy a few books, learn to talk the talk but don’t have a real understanding of either TCVM or homeopathy. Narda, I think this is where the certifications such as they are, help the public chose a veterinarian has training.
I had a client come to me that whose dog was being treated at a human NAET clinic.. they kept telling her the dog did not have cancer.. pretty freaking clear osteosarcoma… I finally fired the client, and told her they were taking full advantage of her and the dog was suffering and needed to be euthanized. Period. She eventually came back to me with her new puppy.. I don’t like these situations anymore than the rest of you and I want standards and recognition of training etc. By recognizing and giving credence to the programs that are currently available we can help protect the public from these quacks.. there has to be some way to differentiate the “energy” healers from the trained TVCM and homeopathic veterinarians.
Isn’t there a common ground on which we can all meet and work together to help the entire profession grow and expand into new arenas?
Comment by Marcia Martin — July 23, 2009 @ 6:18 pm
Shiri and Marcia,
I don’t know all the details, but as I understood form the client, the pratitioner was something of a mixer, using a Vega unit for diagnosis and homeopathic preparations for treatment. Understand, since I don’t see any credible evidence that either of these approaches has real diagnostic or therapeutic value, it makes little difference to me how well-trained the practitioner is in using them. I suspect they are both harmless in and of themselves, but the problem comes with using such methods to produce a diagnosis and claim a cure when there is no objective way to validate that the diagnosis was real or that there was anything to cure. I acknowledge that as there are bad mainstream vets, likely there are bad homeopaths, but I’m not convinced that the “few bad apples” explanation really changes the overall pictre given my doubts about the underlying basis for the approach.
I certainly do think we can find common ground. As long as everybody is both respectful and willing to accept polite but vigorous criticism, I see no reason why we can’t have civil discussions about these issue. I have already stated that I accept the good intentions and the honest belief in their methods of the vast majority of CAVM providers. Likewise, I expect to be accorded the same presumption of honest intentions and sincere belief in my methods.
I find it is often surprisingly difficult to discuss CAVM with people who disgree with me about it. If I come back from a CE meeting or read an article and decide that the evidence no longer supports some routine practice, say high dose steroids for spinal trauma, well there may be some hesitation and resistance to change but people seem willing to seriously consider the new evidence. And even if they stick with the practice, they don’t see anything wrong with my challenging it. But if I do extensive research and conclude that a CAVM therapy is likely not of real benefit, users of that method frequently act as if I’ve insulted their mother. I’m labeled “closed-minded” or accused of being part of some conspiracy to protect my income by keeping pets sick, or some such nonsense. Personally, I suspect this is connected with the element of faith involved in CAVM, as I’ve said, but there are likely other reasons as well.
Anyway, I’m encouraged that most of us have managed to keep the discussion respectful and not personal, so hopefully there is room learning from each other in some way, even if we still come away with radically different perspectives.
Now whether such common ground will lead us to agreement on substantive issues is another question. I remain committed to being open-minded (though that’s a potentially troublesome term which I have discussed in detail here:
http://skeptvet.com/Blog/2009/.....ndendess/). However, I also remian comitted to what I suspect is a very different way of looking at how we know what we know, and that’s a pretty big chasm to bridge.
Comment by Brennen McKenzie — July 23, 2009 @ 8:30 pm
Brennen,
I’m sorry. I attributed your post #134 to Narda.
You said in post #145:
“I don’t know all the details, but as I understood form the client, the practitioner was something of a mixer, using a Vega unit for diagnosis and homeopathic preparations for treatment. Understand, since I don’t see any credible evidence that either of these approaches has real diagnostic or therapeutic value, it makes little difference to me how well-trained the practitioner is in using them.”
I don’t know what the Vega unit is. Using “homeopathic preparations” with a Vega unit is not classical homeopathy as practiced by the various veterinary homeopaths who have posted on this thread. Classical homeopathy is based on verifiable physical exam findings and history, not a Vega unit, psychic intuition, etc.
On the other hand, Marcia and Richard both gave references to scientific articles that did show efficacy of homeopathy, so I am not sure why you say that there is no credible evidence that homeopathy has therapeutic value?
“But if I do extensive research and conclude that a CAVM therapy is likely not of real benefit, users of that method frequently act as if I’ve insulted their mother.”
That’s funny, because I once came back from a CE meeting, and got that response from a colleague for challenging the idea that high dose steroids were useful in spinal trauma! :-)
In the case of spinal trauma, when we do or don’t reject the use of high dose steroids, we are not necessarily questioning all of conventional medicine.
When you say that you conclude “a CAVM therapy is likely not of real benefit,” are you concluding that the whole modality (e.g., all of homeopathy) is of no real benefit, or that it may not be of benefit when done in a certain way for a particular problem?
Regarding the problem of open mindedness, agreed!
Comment by Shiri Hoshen, DVM — July 23, 2009 @ 9:54 pm
Brennen: I get Error 404 when I clicked on skeptvet.com site posted above. I would love to read your posting—could you check it out?
Comment by Colorado Transplant — July 24, 2009 @ 4:52 am
Sorry if the link didn’t work. Here it is again, and if it doesn’t work this time you can simply go to the site (http://skeptvet.com/Blog) and look for the oldest post under the General category, “What is Open-Mindedness”):
http://skeptvet.com/Blog/2009/.....indendess/
Shiri,
Yes, well the debate over the evidence for and against homeopathy is a complex and controversial one. For one thing, users of the method have repeatedly told me that they don’t believe negative scientific studies either because they trust their own clinical experiences more or because the individualised nature of homeopathic diagnosis and treatment does not make it possible to study it in the paradigm of the clinical trial. Fair enough, but then this is what I call “faith-based medicine.”
However, many proponents of homeopathy will then cite positive studies as evidence that science has validated their approach, which seems a bit like cherry picking (or more formally “confirmation bias”) to me.
One can find a study to support almost anything because individual studies are of varying quality and reliability. I’ve previously written about the issues in interpreting studies, mainstream as well as alternative, here:
http://skeptvet.com/Blog/2009/.....c-journal/
One blogger refers to what I think is a useful concept, “Tooth Fairy Science.” You can conduct a well-designed study on how much money the Tooth Fairy leaves for teeth, breaking it down by type of tooth, number of teeth, age of the child, and so on. You could conduct valid statistical analyses of this data and then find statisticallly significantly variables. None of this means the Tooth fairy exists, of course. Such is the weakness of clinical trials, especially those designed without consideration of prior probability.
Anyway, as for the specific evidence cited in this thread, the Linde paper from Lancet 1997 is commonly referred to. Unfortunately, Linde and others have re-analysed the data set using stricter criteria for study quality and have not found the same result originally reported. The general trend as reported by Linde, Shang, Ernst and others (see the bibliography below) is that the larger scale and more well-controlled for bias the study, the less likely a positive finding will emerge. So while there are individual studies that show some positive results, the balance of the evidence is strongly in favor of homeopathic remedies as placebos, not physiolgically active therapies.
Not surprisingly, studies reported in journals devoted to homeopathy or alternative medicine are almost universally positive. This strongly suggests inadequate controls for bias. And please understand, I don’t mean this as a slur on the researchers. The same is certainly true of studies published or funded by drug companies, for example, which almost always find positive results for their products. Just as you might be reluctant to accept the evidence that a new drug was the miracle cure for cancer if the only research that supported this was done by the manufacturer of the drug, so I question the conclusions of studies conducted by those who already believe deeply in their hearts that homeopathy is an effective therapy. The purpose of the scientific method is to mitigate such inevitable personal biases, and it does so imperfectly but better than anything else.
So when I say I see no credible evidence that homeopathy is an effective therapy, I am not ignoring the literature, I am simply studying it closely and looking for a broad-based consensus among well-designed studies and systematic reviews, as I would do for any mainstream medical therapy as well, and I’m not finding it. I don’t claim such data will never appear, though I am doubtful based on the underlying plausibility issues, but the state of the data currently doesn’t support the claims of homeopathy.
Bibliography:
Snake Oil Science by R. Barker Bausell
A thorough examination of the principles and pitfalls of scientific research into medical therapies and a solid review of the evidence for and against many popular CAM practices.
Trick or Treatment: The Undeniable Facts about Alternative Medicine by S. Singh and E. Ernst
An outstanding review of many CAM practices from and evidence-based perspective.
Comment by Brennen McKenzie — July 24, 2009 @ 9:41 am
Thanks, Brennen, I reached your blog post on my last click!
Comment by Colorado Transplant — July 24, 2009 @ 10:58 am
Comment by Lee: In what ways is homeopathy “more rigorous and more proven than any of the conventional medicine out there today”?
I will do my best to answer this question as Dr. Pitcairn is not currently available to respond. New drugs actually undergo very little testing before they come on the market. In fact human medicines are tested for just a couple years before they get approved by the FDA and a detailed package insert is generated and marketing begins. They are not required to test the drug on the intended age group, or gender. Many of these drugs are for long term use (to treat chronic disease). The long term side effects as well as many short term side effects are not discovered until the drug is used in clinical practice. Remember Phen phen, and all the other countless drugs that have been touted as having fewer side effects. After a period of time the drug is pulled from the market because it has serious side effects like blood clot formation or death. Veterinarians are permitted to interpret the effects of drugs on humans and use them off label. This can be a very legitimate way to discover a novel use for a medicine. But, don’t for a minute think that all drugs used in Veterinary medicine have been tested on the type of animal they are being used in, or that we have a clue what the side effects are until it has been used in clinical practice for sufficient time. The first FeLV vaccine was released to use in thousands (millions?) of cats after having been tested only in 25. That’s right, 25 cats.
To understand how homeopathy is different from this you need to know how the remedies were studied and tested. I am a new student of homeopathy so others with more experience may have more to add. I have spent the past year trying to understand how homeopathy works and I don’t expect to be able to convey that knowledge to you in a paragraph. The testing is called a “proving” (an adaptation of the german word prufing which translates to testing). In the original provings done by Hahneman, on the premise of like curing like, he used healthy individuals and for safety gave the medicines in very small concentrations. He had them note every detail of every symptom they felt. Then this data was compiled into a master database where the remedy was scored for a given symptom. He spent 20 years analyzing this data and published it as a materia medica and repertory. This same information is what is used today to determine which remedy fits the case in addition to the volumes of research that has amassed since. The scientific method is not unique to conventional western medicine. You make an observation which leads to a conclusion, then you design a test of that conclusion. All tests are open to critique, and reason requires it be repeatable. Both the Chinese and Hahneman used the scientific method to develop their systems of medicine.
Previously, I thought I knew what homeopathy was based on books and a few seminars at conventions but, I came to realize I was most certainly ignorant of how homeopathy worked until I studied with Dr. Pitcairn. Understanding this subject requires a bit more than reviewing a few articles, or attending a couple of one hour lectures. I personally will consider myself a student in this area forever, and I continue to be humbled and intrigued by the things that I don’t yet understand.
Comment by Christine Wilson, DVM — July 24, 2009 @ 1:30 pm
Dr. Wilson,
When were the provings on animals done, and who performed them?
Comment by Dr. Narda — July 24, 2009 @ 2:54 pm
Comment by Christine Wilson, DVM — July 24, 2009 @ 1:30 pm
New drugs actually undergo very little testing before they come on the market.
(pardon me while I clean the spittle off my monitor) . . . Um - you’ve never worked in in drug development laboratory, have you?
Drug companies routinely request extended patent coverage on newly-introduced drugs because the SEVENTEEN YEARS of patent protection they are granted when they begin development and testing of a new compound generally are close to running out by the time they are able to actually start selling product. So they ask for a few more years of protection so that they can have SOME chance of recouping their 12 years or so of development and testing expenses that they’ve put into the project before they’re permitted to put it out onto the market:
http://books.google.com/books?.....p;resnum=5
Veterinarians are permitted to interpret the effects of drugs on humans and use them off label. This can be a very legitimate way to discover a novel use for a medicine.
Human doctors can do the same thing. (See: History: Discovery of: Rogaine. Viagra.)
Comment by The OTHER Pat — July 24, 2009 @ 2:55 pm
As soon as we can get the animals to write down their symptoms I will let you know. In the mean time I will send a spit rag to the OTHER Pat for her convenience.
Comment by Christine Wilson, DVM — July 24, 2009 @ 5:15 pm
However, many proponents of homeopathy will then cite positive studies as evidence that science has validated their approach, which seems a bit like cherry picking (or more formally “confirmation bias”) to me.
One can find a study to support almost anything because individual studies are of varying quality and reliability. I’ve previously written about the issues in interpreting studies, mainstream as well as alternative, here:
what? You mean because we publish successful studies that makes them somehow less credible? are the conventional medicine journals full of studies that didn’t work? I think not. Every group publishes their success.. How many conventional studies were proven to be incorrect.. I>E> high dose steroids for spinal injury was once the standard of care based on conventional scientific studies.. now new studies have proven the original studies incorrect.. Once again we get to a different standard of acceptance for alternative medicine studies.. I post and you refute them. YOu stand by the allopathic journals and their science but how often is that science overturned in the next study?
Comment by Marcia Martin — July 24, 2009 @ 5:33 pm
In all seriousness Narda, Dr. Pitcairn has 30 years of clinical data on thousands of animals that he has for years been working with to compile into a repertory for animals. This is a monumental task. It took Hahneman 20 years to compile his information. So, this endeavor is currently underway. I hope to see it happen someday.
As for the spittle woman. I checked my stores and, sorry, I am fresh out of rags. If you would care to be polite to me I might have a polite answer for you.
Comment by Christine Wilson, DVM — July 24, 2009 @ 5:39 pm
Understand, since I don’t see any credible evidence that either of these approaches has real diagnostic or therapeutic value, it makes little difference to me how well-trained the practitioner is in using them.”
This statement is a bit sad.. If you were to refer to a surgeon, wouldn’t you check his credentials? Or an oncologist.. the same? If someone is using an alternative medicine practitioner, I feel it is justified to ask their creditentials.. and most with one noticable acception are more than willing to give them.
People like this energy practitioner are giving the rest of us a bad name. If some untrained surgeon was butchering animals, you wouldn’t judge all surgeons by the same standard. But one untrained “holistic” vet will be the standard by which you judge us all.
In my current practice situation, I happen to share an office with a board certified critical care specialist.. she was highly skeptical of my methods when we first met.. but she saw some things that made her change her mind. We have worked closely on several cases that have been successful. She has even asked me to help her on some cases that were not responding to drug therapy and I have asked her help on animals that weren’t responding to alternative methods. The last was a dog that came in in DIC.. she did all the conventional treatments such as plasma and acid base balance etc.. and I gave a remedy, the dog did remarkably well.. would she have survived on homeopathy alone.. NO WAY.. would she have survived on conventional therapy alone, perhaps.. but I doubt it.. working together with mutual appreciation for each other’s expertise.. we saved a very critical dog.
It is nice when we can come together on common ground and work together.
Comment by Marcia Martin — July 24, 2009 @ 5:47 pm
Hi Brennan,
Going back to your post #148:
“For one thing, users of the method have repeatedly told me that they don’t believe negative scientific studies either because they trust their own clinical experiences more or because the individualized nature of homeopathic diagnosis and treatment does not make it possible to study it in the paradigm of the clinical trial. Fair enough, but then this is what I call “faith-based medicine.”
It is always a judgment call, when to trust your clinical experience, and when to trust scientific studies. I hope that you have gotten from this discussion that many homeopaths are very interested in research that uses proper homeopathic prescribing.
If you do not accept the research that supports homeopathy, and you need to see considerably more, that is fair, but be fair in your assessment. But please do not say that there is no credible evidence that supports the therapeutic value of homeopathy. It would be more accurate to say that you do not find the evidence extensive enough to be compelling.
Shiri
Comment by Shiri Hoshen, DVM — July 24, 2009 @ 6:03 pm
Hey - at least I’m not threatening to eat a groundhog!
Comment by The OTHER Pat — July 24, 2009 @ 6:41 pm
“Hey - at least I’m not threatening to eat a groundhog!”
Nor threatening ground hogs! :-)
Comment by Shiri Hoshen, DVM — July 24, 2009 @ 6:52 pm
Gina and Christie, did you notice Dr. Narda’s post count? She’s only be here a few months, too. LOL!
Comment by Anne T — July 24, 2009 @ 6:52 pm
In message #151, Dr. Narda wrote:
“When were the provings on animals done, and who performed them?”
As Christine said, the provings are largely based on verbal reports of the proving subjects, which cannot be done with animals. Of course, the process can be stripped down and adapted to animals, but there has not been any clinical need to do that.
I would also add that we don’t have the same toxicity problems with homeopathic medicines as with conventional drugs. Giving a homeopathic medicine to a cat based on experience with humans is not as likely to be as harmful as, say, giving acetaminophen or an NSAID to a cat, because these drugs are tolerated by humans. On the other hand, toxicities abound in our species too.
A third consideration is that while equine acupuncture is documented from centuries ago, I recall that my acupuncture training at CSU was based on transposition of points from the human. Animal point maps have evolved, but human transposition points is where it began. And what an incredible treatment system it is. Many animals and their owners are glad for the innovators who began clinical practice based on empirical evidence of success in humans.
Comment by Shiri Hoshen, DVM — July 24, 2009 @ 6:55 pm
I would also add that we don’t have the same toxicity problems with homeopathic medicines as with conventional drugs.
Of course not!
Homeopathic medicines are so “dilute” that there’s no measurable “active ingredient” involved.
Herbal remedies, acupuncture, chiropractic treatment, they all at least do something. Good, bad, or indifferent, there’s something there, and so the quality of the practitioner matters.
But many of the “herbal remedies” are of unreliable sourcing, and unreliable purity and dosage—and in some cases, the active ingredient is available in conventional medicines that are regulated for purity and dosage.
Comment by Lis — July 24, 2009 @ 7:38 pm
Anne T
If Christie and Gina do not know, Dr. Narda’s mom knows, and I am making #163. :)
Comment by Colorado Transplant — July 24, 2009 @ 7:43 pm
For those of you who may be getting a bit fatigued with the text-based discussion, I would like to invite you to watch this wonderful video by Richard Dawkins called the “Enemies of Reason”.
The link to part 2 is here:
http://video.google.com/videop.....5783230047
The video lasts over 47 minutes, but his excellent portrayal of some of the issues plaguing homeopathy begins at about 22:24 on the time scale in the lower right hand corner if you want to jump to that. But I wouldn’t. It’s all good.
In comparison to the spoof I linked to previously called “Homeopathy and the E.R.” by a British comedic pair, this is a serious discussion, but well worth the time.
For those who love or feel otherwise about Dr. Deepak Chopra, there’s an intense face-off between Richard Dawkins and Dr. Chopra right before the homeopathy segment.
Enjoy!
Comment by Dr. Narda — July 24, 2009 @ 9:35 pm
Marcia said:
“what? You mean because we publish successful studies that makes them somehow less credible? are the conventional medicine journals full of studies that didn’t work? I think not. Every group publishes their success.. How many conventional studies were proven to be incorrect.. I>E> high dose steroids for spinal injury was once the standard of care based on conventional scientific studies.. now new studies have proven the original studies incorrect.. Once again we get to a different standard of acceptance for alternative medicine studies.. I post and you refute them. YOu stand by the allopathic journals and their science but how often is that science overturned in the next study?”
I think you may not be understanding my point. I am not refering to the preferential publishing of positive studies (though this is a real problem in all research, so-called publication bias or the “file-drawer effect.”). I am saying that just because you can find a study that supports something doesn’t automatically mean the study’s conclusions are correct. One must look at the total available evidence, from initial consistency with well-established principles to in vitro results to animal models to actual clinical trials with real patients and diseases. No one study makes or breaks the conclusions on a given therapy. And all of this holds for mainstream medicine as much as for homeopathy.
What I am saying, then, is that just because you can cite studies that find a positive effect for homeopathic treatment, that is not a QED for the method. My interpretation of the preponderance of the evidence is this:
1. The underlying rationale is inconsistent with well-established scientific principles, and while it is possible that all we know of chemistry and physics is missing some crucial core fact that will validate the concepts of water memory or the “energy” that homeopaths refer to, I have yet to see it and it seems less plausible than the alternative explanation that such phenomena simply don’t exist.
2. In vitro studies (such as the Beneviste debacle) do not on balance support a measurable effect of homeopathic remedies. This is what I would expect, given the extreme dilutions of the preparations, and frankly many homeopaths would argue that we should not expect a measurable in virto effect since this ignores the totality of the individual assessment and treatment plan that supposedly differentiates homeopathy from mainstream medicine. However, again when a study does purport to show some effect, other homeopaths will claim it as validation, so there is some philosophical inconsistency among practitioners of homeopathy here.
3. Clinical trials are mixed, however the tighter the controls for non-specific (aka placebo) effects, the less apparent effect of homeopathic treatment. This strongly suggests that any clinical benefit is only on the perception of symptoms not on the actual disease process, which would perhaps make the practice of some psychological value but certainly does not support the curative claims often made for it.
As for pointing out that study results in scientific medicine can be overturned, you are absolutely right. That is, after all, part of the basic premise of science; that our understanding changes, evolves, and improves. Homeopaths, on the other hand, offer up Hahnemann’s original notes on provings as the core of the evidentiary package for homeopathy and sugggest that these somehow meet the standards of contemporary lab research (see post #150 above).
I understand that you and I disagree about the conclusions to be drawn from the evidence, but I do not believe I am being inconsistent in my standards. You accept as conclusive the results of studies that I would argue have methodological flaws that make their conclusions invalid and that, like the Linde 1997 paper, have been superceded by better analyses which you have not addressed. You, I suspect, are sufficiently convinced based on your own personal experiences, that homeopaty is effective that no negative research results will ever change your mind. I am pretty darned skeptical of homeopathy, but I remain open to the small possibility that as more studies are done the balance of the evidence may shift or new principles of physics and chemistry may come to light which address the plausibility issue. Until then, however, I stand by my conclusion that there is now no credible evidence that homeopathy is a valid clinical therapy.
Comment by Brennen McKenzie — July 24, 2009 @ 9:58 pm
Thank you Dr Martin for your reply. From what I’ve been reading in the posts on this blog it seems there are some or perhaps a lot of people practising homeopathy that is not considered to be the correct way. Would this be a reasonable conclusion? Do you know of anyone who isn’t a licensed veterinarian or doctor who can legally prescribe drugs to their patients?
Comment by Lee — July 25, 2009 @ 5:15 am
Lee, I am not totally sure what you are asking.
Comment by Marcia Martin — July 27, 2009 @ 9:59 am
Lee—could nurse practioner be the answer to your query?
Comment by Colorado Transplant — July 27, 2009 @ 10:51 am
There are lay people who are treating animals and humans without a medical license. Is this what you mean? Lay homeopaths?
Comment by Marcia Martin — July 29, 2009 @ 1:35 pm
Just a dog-lover here. A couple years ago a holistic vet sold me some Chinese herbs for my dog’s digestive trouble. There was no ingredients list on the bottle. In looking up the name of the herb online, I could find vague references only as to what it was supposed to do and what Chinese herb was supposed to be in it. Without even basic controls of food or pharmaceuticals in place to validate the actual ingredients the bottle, testing that it was safe, list of possible side effects, drug interactions etc., well - it went in the trash. Until this is available, I’ll put as much belief in Chinese herbs as I do in astrology. Thank you for the article, Dr. Robinson.
Comment by Marla — August 18, 2009 @ 3:13 pm