Over the last few months, I have followed the progress of a resolution introduced to the American Veterinary Medical Association House of Delegates identifying homeopathy as an ineffective therapy incompatible with evidence-based medicine. The story can be traced through several articles describing the resolution, delineating the evidence on which it is based, and critically evaluating the response and arguments put forward by defenders of homeopathy:
There have also been a series of letters to the editor of the Journal of the American Veterinary Medical Association (JAVMA) talking about the resolution and the issues it raises as well as more generally about CAVM. Unfortunately, JAVMA is not an open access journal, so only subscribers can access these links (in order from oldest to most recent). However, I thought it might be helpful to have links to the discussion collected in one place for the sake of those interested and able to access the journal:
The most recent letters concerned reported comments by Dr. Douglas Aspros, AVMA President, and Dr. Kenneth Bartels, House Advisory Committee Vice Chair. Both opposed the resolution not on scientific grounds but on the basis of political considerations and a clear misunderstanding of the intent and the issues involved. One response to their comments attempted to clarify these issues so that the debate about homeopathy can stay focused on what is important: the way in which therapies are evaluated, ideally through rigorous scientific research, and the importance of adhering to this standard in order to protect the welfare of patients. This letter had to be rather drastically edited to be acceptable to JAVMA, which is not surprising considering it is quite critical of the AVMA leadership, but hopefully it still provides a useful perspective:
As a supporter of the AVMA House of Delegates resolution identifying homeopathy as ineffective, of course I was disappointed it was not adopted. I appreciate the intentions of those who opposed the resolution, and I believe that most are smart people who care about the welfare of their patients. However, I also believe that, as stated in the materials supporting the resolution, homeopathy is no more than a placebo. If this is so, then using homeopathy without informing clients of this would be unethical; good intentions alone cannot legitimize homeopathy if it is not effective.
Even though the resolution was not adopted, it did accomplish one of its purposes, which was to initiate a discussion of the scientific and ethical issues concerning homeopathy. The evidence and arguments of both sides are now available for all to evaluate. Unfortunately, recent comments reported in the JAVMA News article on the resolution could be interpreted as mischaracterizing both the resolution and the intent of those proposing it.
For example, the news report summarized AVMA President Douglas Aspros’ comments as arguing that the resolution “is divisive without benefit to the AVMA or AVMA members, and he hopes the AVMA will avoid considering such resolutions in the future” and that “passage of the resolution wouldn’t stop anyone from practicing homeopathy or change the opinions of those who hate homeopathy.” Dr. Kenneth E. Bartels, the House Advisory Committee vice chair, reportedly objected to the resolution because, in the words of the reporters, it “could put the AVMA on a slippery slope toward examining many other modalities such as acupuncture, low-level laser therapy, and chiropractic care.”
To me, these comments suggest a belief that the resolution was motivated by emotion (“hate” of homeopathy), was intended to change the opinions of homeopaths or prevent them from practicing homeopathy, and should not have been offered because it was divisive and might lead to the critical evaluation of other alternative therapies. If accurate, such comments misrepresent the purpose of the resolution and imply priorities I find troubling.
It is inappropriate to suggest the purpose of the resolution was anything other than generating a productive discussion about an important issue and protecting the interests of patients and clients. I do not hate homeopathy, I simply view it as ineffective and unsafe.
I also believe the AVMA should act in the interests of the public and our patients even if this risks offending some members. We cannot meet our ethical obligations as medical professionals if we prohibit debate on important scientific and ethical questions simply because some might not welcome such a debate.
Finally, the principles of evidence-based medicine require that all medical therapies be subject to critical evaluation on an ongoing basis. Shielding certain therapies from the scientific evaluation conventional practices undergo as a matter of course, solely because they are identified as complementary or alternative, is not in the best interests of our clients or patients.