AVMA Considers Resolution Acknowledging Homeopathy is Ineffective

A recent article in the Veterinary Practice News (VPN) revealed that the American Veterinary Medical Association (AVMA) is considering a resolution, proposed by the Connecticut Veterinary Medical Association (CVMA), relating to homeopathy, specifically, and to the role of science and scientific evidence in evaluating veterinary therapies more generally. The full text of Resolution 3 is available here, but the core of the measure consists is the following:

RESOLVED, that the American Veterinary Medical Association (AVMA) affirms that—

1. Safety and efficacy of veterinary therapies should be determined by scientific investigation.

2. When sound and widely accepted scientific evidence demonstrates a given practice as ineffective or that it poses risks greater than its possible benefits, such ineffective or unsafe philosophies and therapies should be discarded.

3. In keeping with AVMA policy on Complementary and Alternative Veterinary Medicine, AVMA discourages the use of therapies identified as unsafe or ineffective, and encourages the use of the therapies based upon sound, accepted principles of science and veterinary medicine.

4. Homeopathy has been conclusively demonstrated to be ineffective.

The resolution is supported by a detailed white paper, The Case Against Homeopathy.

The first three statements in the resolution are not likely to be controversial, and they are already included, usually implicitly, in a number of existing policy statements. The most directly relevant is the AVMA Policy on Complementary and Alternative Medicine, which states, “Claims for safety and effectiveness ultimately should be proven by the scientific method… Practices and philosophies that are ineffective or unsafe should be discarded.”

This has been the official policy of the AVMA for over a decade. However, no alternative therapy has ever been acknowledged to be ineffective or discarded, including homeopathy. There is, as the white paper makes clear, overwhelming evidence that homeopathy has no benefit beyond placebo, but because it is a belief system rather than a medical discipline, practitioners of homeopathy are unlikely to ever accept this. The final statement in the resolution is controversial only because this small group, passionate and ideologically committed to homeopathy, will undoubtedly challenge it vigorously.

And despite the fact that the vast majority of veterinarians do not practice homeopathy, any criticism of practices other veterinarians employ, regardless of the evidence against them, seems to have become virtually taboo within the profession. Collegiality and unity sometimes seem to take precedence over science and the interests of our patients and clients. However, there are a number of reasons why this resolution is important for the profession, as well as patients and their owners.

As has been discussed frequently before (1-8), offering homeopathic treatment without clearly identifying it as a placebo is unethical. It places patients at risk by substituting an ineffective therapy for real treatment, and it denies pet owners the right to make fully informed decisions about the care of their pets. Mainstream veterinary medicine has left behind bloodletting, purgatives, and many other 18th and 19th century therapies which failed the test of scientific validation, and it is not in the interests of our patients, our clients, or our profession to endorse a belief system like homeopathy which has similarly failed to generate meaningful evidence of real benefits beyond placebo effects in the last two hundred years.

Several organizations have endorsed the proposal. The Evidence-Based Veterinary Medicine Association has issued this statement urging passage of the resolution:

The AVMA has issued many policy statements acknowledging that veterinary medicine should be based on sound, legitimate science. The AVMA Policy on Complementary and Alternative Medicine, for example, states, “Claims for safety and effectiveness ultimately should be proven by the scientific method… Practices and philosophies that are ineffective or unsafe should be discarded.” However, despite overwhelming evidence and consensus among scientists that homeopathy is ineffective, a few veterinarians continue to promote it as an adjunct or alternative to conventional scientific medicine. This diminishes the credibility of the veterinary profession and does a disservice to our patients and our clients.

Other national veterinary groups, including the Australian Veterinary Association and the British Veterinary Association, have publically acknowledged that homeopathy is not an effective therapeutic approach. As the leading veterinary association in the world, it is important that the AVMA also demonstrate its commitment to modern, evidence-based medicine and the interests of our patients and the public. Resolution 3 protects the integrity of the AVMA and the veterinary profession as well as the trust of the public on which we depend.

The EBVMA Board of Directors unanimously endorses Resolution 3 and the supporting documents introduced to the AVMA House of Delegates by the Connecticut Veterinary Medical Association, and we encourage you to support passage of this important policy statement.

There have also been endorsements from the American College of Veterinary Clinical Pharmacology (ACVCP) and the American Academy of Veterinary Pharmacology and Therapeutics  (AAVPT). Not surprisingly, the Academy of Veterinary Homeopathy (AVH) and the American Holistic Veterinary Medical Association (AHVMA) are fighting the measure.  According to the VPN article,

Proponents of homeopathy welcome introduction of the resolution.

“This is a wonderful chance for us to educate other vets about the benefits of homeopathic veterinary medicine,” said Jeff Feinman, VMD, CVH. “The main argument [against] homeopathy is that it’s implausible, and we will show that that’s not true at all. The research is just now catching up with the basic science.”

It will be interesting to see how homeopaths attempt to make the argument that homeopathy is actually consistent with basic scientific knowledge, given the strong case to the contrary (for example, The Science of Homeopathy).

I suspect the attempt will involve some reference to quantum physics. By virtue of being strange, counterintuitive, and impossible to truly understand without fluency in advanced mathematics, quantum physics is a popular rope among proponents of pseudoscientific therapies like homeopathy. The argument seems to be something along the lines of, “Quantum physics is weird and true. Homeopathy is weird. Homeopathy must be true.”

There are a number of problems with this fallacious argument, including the fact that there is no demonstrated connection between the oddities seen at the subatomic level and the notion that water which once had some kind of substance in it magically remembers that substance and can thus cure patients afflicted with symptoms that might or might not be caused, in healthy patients, by that substance.

Another argument the AHVMA brings up in their comment about the resolution is that no homeopaths were consulted by the CVMA in developing the proposed resolution. The AHVMA says, “when anyone considers a modality, they should talk to people who are considered experts in the field.” This sounds quite reasonable, but it skips over the fact that homeopathy is not a recognized medical specialty in which one can legitimately be said to be an expert. Though homeopaths have gotten together and created certification standards for themselves, these are not recognized by the American Board of Veterinary Specialties, The European Board of Veterinary Specialties, the American Board of Medical Specialties, or any other organization responsible for identifying and accrediting medical experts. Astrologers and Psychics have organizations that accredit practitioners of these methods, but that’s not a mark of legitimacy to those practices.

Ordinary veterinarians are capable of evaluating the scientific evidence and drawing a reasonable conclusion on the merits of homeopathy. Homeopaths, on the other hand, will never acknowledge the lack of evidence supporting their claims since to do so would be to invalidate their own profession. So the suggestion that the AVMA should set up a “task force” to evaluate homeopathy and advise the House of Delegates is like arguing that creationists should advise school boards on how to teach evolution. We don’t need task forces with specialists in bloodletting, faith healing, or other belief systems claiming, against significant evidence, to be medical therapies, and there is no reason to have one for homeopathy.

The AVMA House of Delegates will debate Resolution 3 on January 5. The delegates consist of representatives of the state veterinary medical associations and a number of allied organizations. The list of delegates can be found here. I encourage all veterinarians to contact their delegates and urge them to support this resolution.

References

  1. Smith, K. Against homeopathy-A utilitarian perspective. Bioethics. 2012;26(8):398-409. which is reviewed at this link, for those who do not have access to the journal: http://www.sciencebasedmedicine.org/index.php/placebos-as-medicine-the-ethics-of-homeopathy/
  2. Freckelton I.Death by homeopathy: issues for civil, criminal and coronial law and for health service policy. J Law Med. 2012 Mar;19(3):454-78.
  3. Smith, K. Why homeopathy is unethical. Focus on Alternative and Complementary Therapies 2011;16(3):208–211.
  4. Shaw D. Homeopathy is where the harm is: Five unethical effects of funding unscientific “remedies.” J Med Ethics. 2010;36:130-131
     
  5. Shaw D. Unethical aspects of homeopathic dentistry. Br Dent J. 2010 Nov 27;209(10):493-6.
  6. Ernst, E. The ethics of complementary medicine. J Med Ethics 1996; 22: 197-198.
  7. Rollin, B. and Ramey, D. “Ethics, Evidence, and Medicine” in Ramey, D., Rollin, B. Complementary and Alternative Veterinary Medicine Considered. Iowa State Press, 2004.
  8. Rollin, B.  An ethicist’s commentary of the case of a veterinarian utilizing homeopathic therapy. Can Vet J. 1995 May; 36(5): 268–270.
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23 Responses to AVMA Considers Resolution Acknowledging Homeopathy is Ineffective

  1. Art says:

    The vet down the street from me with the Multi million dollar fancy hospital advertises homeopathy. Will this resolution if passed help stop him from doing that? It seems to be a good start saying that we should not be selling medicine with no medicine in the bottle but the law should not allow doctors human or animal to do that. the avma should say homeopathy needs to be against the law. GM is not allowed to sell you a car with no engine and transmission. Why should a doctor be allowed to sell a bottle of medicine that has only water in the bottle?
    Art Malernee Dvm
    Fla Lic 1820

  2. Narda G. Robinson says:

    I think it would still be regulated by the states. Compare with this item about the NY veterinary board:

    Regulators caution New York DVMs on homeopathic medicine

    July 8, 2008
    By: Jennifer Fiala
    For The VIN News Service

    Albany, N.Y. — Veterinarians who prescribe homeopathic medicine must be able to offer a scientific rationale for doing so, at least in New York state, at least 4 years ago….

    http://news.vin.com/VINNews.aspx?articleId=10084

  3. Lauren Bowling, DVM says:

    I think that a skilled homeopathy practitioner can actually help pets (I’ve experienced this with acupuncture). However, many practitioners do not truly study homeopathy the way that they study western medicine, so “homeopathy” is not viewed as very effective. It definitely needs to be used under a licensed homeopathic veterinarian.

  4. skeptvet says:

    The AVMA has no legal authority, so the statement would just be advisory. States regulate veterinary medicine. The resolution specifically refers to this:

    Although veterinarians may legally employ any therapy that complies with the applicable laws and regulations governing the practice of veterinary medicine, the AVMA believes that veterinarians have an ethical duty to society, and to patients and their owners, to base medical judgments and recommendations on the best available scientific evidence.

  5. skeptvet says:

    The problem is not with the training of homeopaths but with the lack of an effect to homeopathic treatment. A well-trained psychic can’t really predict the future, and a well-trained homeopath can’t make water into medicine.

  6. Art says:

    Albany, N.Y. — Veterinarians who prescribe homeopathic medicine must be able to offer a scientific rationale for doing so, at least in New York state, at least 4 years ago…. >>>> I gave him drops of water and called it medicine so he would not need acupuncture.

  7. That link to the avma delegates is not working for me. Gets to the website but no delegates pop up. Might be just my computer…
    At long last the evidence based medical community is being heard!

  8. skeptvet says:

    The list is only available to AVMA members, so you have to login at the bottom of the page to see the delegates names. Let me know if that doesn’t work.

  9. This resolution is sadly misinformed and quite regressive. Most of you have opinions about homeopathy, but no knowledge. Homeopathy is practiced all over the world, including in clinics and hospitals (about 700 hospitals in India). The Royal Homeopathic Hospital in London has been there for 100 years and was hugely successful in the Cholera and Typhus epidemics of the 1800’s. The oft repeated rumor that there is no research on homeopathy is absolutely false. Here is just a small sample of the research behind homeopathy. Furthermore, the Swiss Government recently concluded a multi year study of homeopathy and based on that recommend that homeopathy be covered by their national health care system.

    http://hpathy.com/scientific-research/research-in-homoeopathy/

    Now it remains to be seen whether people will allow themselves to be informed, or just go on repeating the same misinformation.

    Alan V. Schmukler
    Editor – Hpathy.com

  10. skeptvet says:

    It seems clear that you haven’t read the documentation supporting the resolution, or that you are simply so convinced by your own experiences with it that you don’t care about the evidence. Nowhere does it say “there is no research on homeopathy.” It says very clearly that the research is generally of poor quality, that it does not consistently and repeatably show a benefit beyond placebo, and that the better one controls for chance, bias, confoudning, and other sources of error the less likely one is to get a positive result. All of that is compatble with the claim that homeopathy is nothing more than a placebo, and as the white paper illustrates numerous reviews of the evidence have reached this conclusion. It is true the Swiss government paper reached a different conclusion. The only reason for this is that they changed the standard, accepted rules of evidence to rely on lower quality and poorly controlled studies, thus allowing the bias of the reviewers to be supported (see this review of the report and its flaws)So your claim that opponents of homeopathy are uninformed is nonsense.

    As for the Royal Hoemopathic Hospital, the white paper supporting this resolution clearly illustrates the conclusions of the House of Commons Science and Technology Committee that homeopathy is ineffective and should not be funded under the national Health Service. The British Medical Association, the Royal Pharmaceutical Society of Great Britain, and other similarly informed groups have also acknowledged that the evidence clearly shows homeopathy cannot and is not an effective therapy and should not be funded by NHS. The funding of homeopathic treatment under the NHS is a historical relic and the product of influential individual believers (notably the royal family) that is otherwise inconsistent with the scientific evidence. So that is no convincing argment for homopathy.

    The claims for the use of homeopathy during the 19th century to treat epidemics are purely anecdotal reports from homeopaths with no objectivity or reliability. I have already discussed these, and provided links to comprehensive evaluations of them, in this article.

    The resolution is simply a clear statement that science should be the foundatuion of veterinary medicine, not tradition, anecdtoe, personal belief. And the science has failed to validate the theory or the clinical claims for homeopathy after 200 years of trying. It is hoemopaths who steadfastly refuse to accept the evidence but who continue simply repeating the same misinformation.

  11. joe lillard says:

    go to nationalcenterforhomeopathy.org and read the hundreds of studies – also, consider nanoparticles – google it.

  12. skeptvet says:

    Read the white paper and you will see a long list of veterinary clinical trials as well as multiple systematic reviews of the human literature. There are indeed hundreds of studies. Most are not properly randomized, blinded, or controlled for bias, chance, and other sources of error. Most are conducted by committed believers in homeopathy setting out to find what they already think is true. The process of evidence-based medicine is not simply putting together sloppy studies to prove what you believe or blindly accepting everything published regardless of the quality of the research. It is about making a reasoned judgment based on the level and quality of the evidence and the consistency of this evidence with everything else we know. In 200 years, homeopaths have failed to produce a body of convincing reseach to show that homeopathy could or does have clinical benefits.

    Perhaps you should google Evidence-Based Medicine

  13. Jeff Perret, DVM says:

    The comments of Alan Schmukler, Lauren Bowling and Joe Lillard are distressing in so many ways. How can (at least two of) you have a DVM degree without understanding what it means for a given drug or treatment modality to pass the rigors of scientific scrutiny? It boggles the mind, and makes me sad.

  14. skeptvet says:

    Yes, it is always hard to understand how people trained as doctors reconcile scientific medicine with a vitalist belief system like homeopathy. However, the ability of human beings to carry multiple mutually incompatible ideas in their heads at the same time is impressive.

  15. Art says:

    I try to remember that lies are apparently a survival mechanism for humans to survive. Do you really think Obama believes in Jesus Christ,Bill Clinton thinks he didn’t inhale and the majority of vets think pets need annual vaccinations?
    Art Malernee Dvm

  16. Rod says:

    AVMA’s House of Nannies aims at homeopathic vets. The delegates would rather treat the dog’s symptoms with steroids than heal the whole body. They vote against what they cannot understand and refuse to learn. http://cavalierhealth.org/blog.htm#December_18,_2012

  17. skeptvet says:

    A petty and evidence-free complaint. A careful look at the CMVA resolution and the evidence for it will show anyone with an open mind that there is good reason to accept the obvious; that hoemopathy doesn’t work.

  18. v.t. says:

    Rod, putting aside that little fear-mongering propaganda piece on the link you posted, have you actually read AHVMA’s response to the CVMA’s proposal?

    http://www.ahvma.org/images/stories/ctproposalevaluation.pdf

    Can you honestly tell us after reading that spiel that the executive director of the AHVMA shouldn’t be the laughing stock of homeopaths? Cherry picking at it’s finest, and incredibly inept at arguing her own “facts”, that’s Nancy Scanlon. That the members of this organization supported her response is even more astonishing than the fact that homeopathy doesn’t work at all. Perhaps next time they should choose a real homeopathic “expert” to argue their case (not that it would matter, homeopathy still won’t work, see?)

  19. phayes says:

    I suspect the attempt will involve some reference to quantum physics. By virtue of being strange, counterintuitive, and impossible to truly understand without fluency in advanced mathematics, quantum physics is a popular rope among proponents of pseudoscientific therapies like homeopathy. The argument seems to be something along the lines of, “Quantum physics is weird and true. Homeopathy is weird. Homeopathy must be true.”

    Deliciously ironically, it’s quantum physics that makes homeopathy implausible enough to clearly illustrate the pseudoscientific fragility in the [‘orthodox inference’-based] foundations of EBM science. 🙂

  20. skeptvet says:

    it’s quantum physics that makes homeopathy implausible enough to clearly illustrate the pseudoscientific fragility in the [‘orthodox inference’-based] foundations of EBM science

    Huh?

  21. phayes says:

    Well the first part of my cryptic (sorry!) comment was meant as shorthand for saying that the homeopathy proponents are holding their weirdness/plausibility meters upside down: quantum physics takes far more weirdness out of the world than it puts in to it. In particular it makes homeopathy far less plausible than it is in the (classical) context in which, as far as physics is concerned, the existence of stable atoms is weird and inexplicable.

    The second part alludes to EBM’s naivety about science and inference, as illustrated by its failure to recognise that CTs of homeopathy are farcical cargo cult science, not science.

  22. skeptvet says:

    Ah, now I get it. Thanks!

  23. Pingback: American Holistic Veterinary Medical Association (AHVMA) & its Foundation (AHVMF) | The SkeptVet Blog

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