Homeopathy for Nasal Fungal Infections in Dogs?

A case report recently appeared in the Journal of the American Animal Hospital Association (online only edition) describing the complete resolution of nasal aspergillosis (a fungal infection) in a dog following the use of an ultradilute homeopathic remedy. So what does this mean? Is this evidence for a clinical effect from homeopathy? Is it justification for further research? Is it justification to start giving these remedies to dogs with aspergillosis along with, or instead of conventional treatment?

Epstein, S. Hardy, R. Clinical Resolution of Nasal Aspergillosis Following Therapy with a Homeopathic Remedy in a Dog. Journal American Animal hospital Association 2011;47:e110-e115.

To begin with, a case report is the least useful form of published evidence. It is essentially an anecdote, though with more detail than the usual testimonials and anecdotes used to advertise unproven therapies. It is a story told about a single individual patient, with no attempt to control for the biases that make all anecdotes of very limited usefulness in figuring out whether a medical treatment works or not. Case reports are useful for identifying new observations that might or might not ultimately lead to useful conclusions based on more formal investigation. What they cannot do is prove any particular hypothesis. So on the most basic level, this case report is not evidence that homeopathy is an effective therapy for nasal aspergillosis, or anything else.

The conclusion of the paper, and the conclusion almost always drawn from such case reports, is that further study is needed to determine if the apparent association between the treatment and the outcome (in this case, the apparent resolution of the disease) is a true association or a coincidence, and if there might be a causal relationship between treatment and response. However, there is ample reason, both within this case report and in other evidence and information available to us, to argue that no further study is in fact justified by this report.

The case against homeopathy in general has been exhaustively made many times (e.g. 1, 2, 3). In brief, the theory of like-cures-like and potentization by dilution and succussion are inconsistent with the well-established fundamental principles that underlie all of the rest of chemistry, physics, and medicine, and there is no evidence that suggests these principles might be true despite this inconsistency. Decades of research has failed to establish any consistent benefit from homeopathy greater than placebo. So for this case report to be taken as evidence that homeopathy cured this patient requires, essentially, that it be seen as a miracle that defies established science. It is not simply an extension of previously documented theory and evidence, but a narrative akin to the healing miracle stories told in support of religious claims. If it is true, it represents a fundamental change in how we understand reality.

The alternative, which seems far more plausible to me, is that this dog experienced a resolution of his disease, or at least his symptoms, that was either spontaneous or aided by the conventional therapy he had received prior to being given the homeopathic remedy. Spontaneous resolution of nasal aspergillosis in dogs has not been reported in the literature. However, other kinds of aspergillosis have been demonstrated to go away without treatment, including invasive pulmonary aspergillosis in humans, and aspergillus granulomas in humans. And in my own practice, I have seen presumed spontaneous resolution of nasal aspergillosis in a dog. The patient, a middle-aged golden retriever, had been having nosebleeds for several weeks when he was brought to see me. Rhinoscopy with biopsy and culture ultimately confirmed invasive nasal aspergillosis. The owners declined treatment due to the cost, and after a couple months the nosebleeds ceased. The dog never had any further nasal symptoms and died of an unrelated disease several years later. I know one other veterinarian with a similar story of a dog whose symptoms went away with no anti-fungal treatment.

I doubt if the authors of the current report with consider spontaneous resolution as an alternative explanation for the result seen in their case even had these two cases been published, but it is a far more plausible explanation than that homeopathy cured the patient. The only way to know for certain, of course, would be to compare homeopathic treatment with no treatment to see if those cases treated only with homeopathy recovered any more often than those not treated at all. However, this would be unethical since spontaneous resolution is likely rare, the disease is serious, and there are established effective conventional therapies available. I would argue that even comparing homeopathy with conventional treatment would be unethical since there is no sound, plausible case to be made that homeopathy has any benefit, and using it exclusively would amount to not treating the patients at all.

That leaves using homeopathy as a “complementary” or “integrative” therapy along with conventional treatment as the only ethical option. Again, there is no reason to think it would increase the chances of success for conventional therapy, but such a study could be rigorously and ethically done. If it turned out homeopathy significantly improved the outcome in a properly designed and conducted study, it would indeed be miraculous and require skeptics such as myself to re-evaluate the whole method of homeopathy. This is certainly a reason for practitioners of homeopathy to seek such a study.

For myself, I think the limited resources available for clinical research in veterinary medicine could be better spent on more plausible approaches, but I see no reason such a study should not be attempted if proponents of homeopathy are willing to fund it. But given the paradigm-changing nature of a positive result, the quality of the research would need to be extraordinary (e.g. independently replicated double-blinded, randomized, controlled trials). Such studies have never before succeeded in proving the benefits of homeopathy, so I would not expect this case to be different.

Unfortunately, if such studies are never done, or if they are done and no benefit from homeopathic treatment is found, this case report will continue to be cited as a justification for trying homeopathy on dogs with nasal aspergillosis. The appearance of an anecdote in a journal doesn’t make it any more valuable as evidence, but it makes the story far more valuable as marketing. The American Holistic Veterinary Medical Association (AHVMA) has exhorted its members to publish such case reports for exactly this reason. In fact, a previous report of homeopathic treatment for nasal aspergillosis by the same author is specifically cited as an example of the kind of report needed to promote CAVM. That case was published in the AHVMA journal because mainstream journals declined to publish it due to limitations in the quality of the information gathered and provided.

The emphasis in this effort is clearly not identifying whether or not CAVM methods work but convincing mainstream veterinarians that they do, which presumably practitioners of these methods already know from personal experience despite the absence of supportive scientific evidence. This is a classic example of scientific publication used as marketing rather than as a genuine effort to figure out whether therapies actually are effective or not. Below is an excerpt from a paper in the AHVMA journal encouraging CAVM practitioners to publish case reports (emphasis added).

The Research committee of the AHVMA has recently been reactivated with the purpose of increasing the amount of published material, which can be used by veterinarians and other interested parties to demonstrate effective clinical uses of CAVM, as well as, to assist legislative and regulatory bodies such as state boards in properly evaluating consumer complaints and legislative requirements regarding CAVM practitioners and practices. (AHVMA 2006a) This committee is working to increase the number of high-quality, useful pieces of literature, which can be used to establish the validity and applicability of CAVM, and sees this as an important action at this time. It is hoped that competent CAVM clinicians and researchers will use EBVM to document their successes. Establishing proper scientific literature and making it more readily available allows for more interested parties to learn about many of the miraculous results seen in CAVM practice. (AHVMA 2006b) Doing such actions allows for the expansion of knowledge, the expansion of CAVM acceptability and for the improvement of our profession;”

Case reporting is one way that CAVM practitioners can record their results publicly so that others can benefit from their labors. We know that investigator bias can affect research results and quantum physics has clearly demonstrated that the observer can affect the results of phenomena in the physical universe. This effect can lead to positive results that are not repeatable by others, as well as negation of procedures due to improper environment….

Critics of CAVM are quick to point out the lack of double-blind randomized studies in our field, often without recognizing the situation present in conventional veterinary practice. In many situations, this type of study is not readily applicable to CAVM processes as therapy is individualized to each specific patient’s particular situation. As an example, homeopathic cases are not easily studied in this manner, while acupuncture and herbal medicine can be.

CAVM procedures do work. We all see this daily. Because of the increasingly cooperative efforts by board certified referral practices and CAVM practitioners, it is hoped that such barriers to publication will be minimized in the future as more and more cases are occurring which have excellent conventional and alternative documentation. Case reports have been perceived to be less important in the present environment of scientific literature as they form a lower level of scientific evidence. However, case reports are an important area of scientific enquiry and one that is entirely appropriate for the CAVM community.

 

 

 

 

 

 

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7 Responses to Homeopathy for Nasal Fungal Infections in Dogs?

  1. I guess when you journal has an impact factor of 0.76, you’ll publish almost anything. What an utter load of rubbish.

  2. Art says:

    Karen, The aaha journal in the early 70s I thought was the best journal in the profession for the small animal practioner. Of course homeopathic medicine was called quackery back then.
    Art Malernee dvm

  3. Guy McCardle says:

    Hi. You might be interested in reading my article on Veterinary Homeopathy at The Inconvenient Truth.

  4. Elizabeth Searles says:

    I respect the balanced search for information in regards to science/ medicine, though here’ s what I detect in this writer, and similarly rationally-heavy types: they start out from the perspective of disproving everything, rather like insisting that everyone is guilty until proven innocent…so right off the bat ,there’s a bias of sorts….not unlike the bias on the other extreme, as well….
    there’s little or no open-ness to anything that doesn’t fit their narrow parameters of success…
    Science is a valuable starting point: not a cure-all or know-all any more than the opposite…there’s plenty of “evidence” of flaw to illustrate that…
    to discount anecdotal evidence out of hand is to lose opportunity…
    to discount religious miracles, too, is narrow-minded….
    It is often anecdotal evidence that leads to studies that are crucially important …
    i.e. asbestos issues of past decades, various harmful drugs, various additives in our
    food supplies, i.e. hormones, antibiotics, trans-fats, etc
    Science, in fact, is leeding creedence to the value of religious practices, oddly enough,
    and has been used to remarkable effect in examining religious articles, and unusual experiences in recent years….i.e. examination of the Shroud of Turin, the tilma of Our Lady of Guadelupe, etc. ONe can always spin an argument or a result that suits their particular agenda, but the facts are the facts…
    For those who are already burdened with an unbending agenda, it’s all moot…
    That’s my point….there’s a lot of gray area in between worth exploring…we simply don’t know it all, (science is constantly learning how little it actually KNOWS)…
    # # #

  5. skeptvet says:

    It isn’t a question of open-mindedness. I’ll accept any idea, no matter how crazy it sounds, if adequate evidence can be generate to demonstrate it. The idea that my coffee table consists mostly of empty space, that all life on earth evolved from the same single-celled organism, and many other ideas even more preposterous are unquestionably true, and I accept them. The issue is what kind of evidence you accept as reliable. Thousands of years, most of human history, we relied on anecdote, individual experience, trial-and-error, tradition, and faith to tell us what was true and false in medicine, and we failed miserably at improving our health. In a tiny speck of time, a mere few centuries, science has led us to accomplishments that none of those things allowed. So trusting science above other forms of evidence is not narrow-minded, it is a sensible decision supported by history and enormous quantities of real evidence.

    Where we run into trouble is that it doesn’t allow everyone to believe whatever they find comforting without soomeone else pointing out the lack of evidence for their beliefs, That engenders the kind of resistance so often seen in the comments on this blog. But open-mindedness is not simply believing what we choose to regardless of whether it is actually true. That’s faith, and for all the comfort it can give us, it’s a lousy way to decide what kind of medicine will help us when we’re sick.

  6. Derek says:

    I have reviewed that paper you referred to in a last-ditch to treat my pet. I, like many owners of adopted dogs, cannot afford to treat a pet unless there is a simple and reasonable diagnosis from a veterinarian. The first problem is finding a “good” veterinarian. My guess is that reviews of “good” veterinarians come about as a result of of 2 biases: healthy animals lead to positive reviews, and expensive treatments of symptoms lead to the abatement of symptoms for long enough for the dog to survive to a normal dog age. Studies like the one you critique are scientifically flawed for the reasons you espouse. However, unless veterinary medicine is to reign in its scientific principles for the sake of short- or medium-term practicality, then your science offers no hope to pet lovers dealing with pet ailments within your own lifespan. For me, unless a fast cure is found based on the first instincts of veterinarians, then all hope is lost BEFORE the testing and diagnostic phase. For whatever the testing reveals portends a treatment that is well outside of reasonable cost. Therefore, given the short lifespan of dogs to begin, perhaps your science would best serve the practical needs of dog owners by studying the abatement of symptoms in non-fatal diseases. This would achieve the greater good for the greatest number. These are the biased thoughts of a scientifically, but not medically, trained pet owner currently grappling with the bloody mess streaming from my dog’s nostrils. I believe that most tests and treatments offered by veterinarians are patronizing attempts to mollify the owners, often themselves egged on by distraught children, and ways keep their practice afloat. At my most recent vet visit, the doctor praised “Dr Google” for bringing him so many patients.

  7. skeptvet says:

    You are confounding two problems. There is the problem of knowing the causes of disease and the risks and benefits of treatments, and that is best solved by science. No therapy is “cheap” no matter what it costs if it doesn’t actually work.

    And then there is the problem of whether or not pet owners can afford the treatments vets offer. That is a matter of economics and the choices people make about where to invest their resources. It will not be solved by choosing not to use science to understand the causes of disease and the risks and benefits of treatments. We can’t make pet health better by offering less effective therapies that are cheaper because we haven’t studied the properly to find out if they work or not. Ultimately, each person has to decide what is affordable for them from the options vets offer, but those options are worthless if we don’t know whether or not they work. I see all too many people who don’t consider the idea that owning a pet has a cost beyond the cost of the pet and the food they provide. When animals get sick, it is heartbreaking for owners when they cannot afford care, but it is also heartbreaking for vets to see pets suffering because people don’t always consider how they are going to pay for care if the pet gets sick some day. Pets are a luxury item, and they are often sacrificed when money is tight. Unfortunately for them, they are also living creatures capable of sufferring when caring for them is no longer affordable for their owners.

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