There has been quite a bit of public discussion and debate about veterinary homeopathy this year. This is due in large part to the Connecticut Veterinary Medical Association (CVMA) resolution presented to the American Veterinary Medical Association (AVMA) House of Delegates identifying homeopathy as an ineffective and unscientific therapy. Though the resolution was ultimately relegated to “consideration” by a committee unlikely to act on it in any substantive way, it did expose the overwhelming evidence that homeopathy is nothing more than a placebo. The resolution also stimulated a vigorous, often highly emotional response from supporters of homeopathy, and several complex but ultimately unconvincing attempts to present homeopathy as scientifically valid and legitimate.
A key organization involved in promoting and defending homeopathy is the Academy of Veterinary Homeopathy (AVH). I have written about them several times in the past, including a detailed look at their recommended Standards of Practice and coverage of the AVH lawsuit against the American Association of Veterinary State Boards (AAVSB) attempting to force recognition of their continuing education courses when the AAVSB ruled they did not meet acceptable scientific standards. The most recent issue of the Journal of the Academy of Veterinary Homeopathy provides some useful insights into how the members of this organization think and how they plan to continue promoting this discredited therapeutic approach.
As I have discussed before, proponents of alternative therapies generally, including homeopaths, tend to rely heavily on case reports as supporting evidence. Case reports are simply structure, published anecdotes, and while they are useful for suggesting hypotheses to test, they prove absolutely nothing. They are no more reliable than any other medical miracle story.
Yet the AVH goes so far as to call their annual meeting “The AVH Annual Case Conference,” and the journal reports almost exclusively anecdotes and no formal, controlled studies. Though there are controlled clinical trials done to investigate homeopathy (which, when looked at carefully, do not support any real effects), homeopaths still rely on uncontrolled individual observation as the core type of evidence both to validate specific homeopathic interventions and to guide the development of the discipline. This is fundamentally inconsistent with scientific and evidence-based medicine, which recognizes the low reliability and high risk of bias associated with such evidence.
Many of the case reports share some common elements:
- There is no objectively confirmed definitive diagnosis.
- Conventional therapy (whether appropriate or inappropriate) is identified as having failed.
- Conventional medical practices are frequently implied to have caused or worsened the problem.
- Homeopathy is claimed, or implied to have cured the problem.
All of these cases are therefore emotionally compelling arguments against conventional medicine and for homeopathy which, unfortunately, include absolutely no control for bias or error and actually prove nothing. This is marketing, or perhaps more accurately proselytizing, masquerading as science.
Here are a couple of examples:
a three-year-old miniature stallion…presented with acute and persistent seizure activity which occurred a week after a rabies vaccination coupled with a very traumatic tooth floating experience. The complementing video clips clearly demonstrated the symptoms, patient care and the progression to full recovery!
a two-year FS, mixed breed dog presented after an array of suppressive and intensive therapy (including a ligated carotid artery) for a chronic purulent and bloody nasal discharge. Once every(!) diagnostic and therapeutic technique had been tried, [the owner] turned to homeopathy. [The homeopath], using Aurum, guided [the pet] and her guardian through the re-emergence and eventual clearing of suppressed skin, emotional, digestive and nasal symptoms.
A family crisis results in a serious symptom emerging [in a MN DSH]: a suspected nasal squamous cell carcinoma…Gradual, ascending potencies (along with nutritional support from CoQ10, Standard Process Cataplex ACP and Feline Immune Support) resolved all symptoms. Since the last remedy, he has remained well for over a year. [This illustrates] Aphorism 17 regarding cure: “through taking away the entire complex of perceptible signs and befallments of a disease, the internal alteration of the life force which is lying at its base (consequently the totality of the disease) is simultaneously lifted.”
one of her patients was sent home to die in an anemic almost comatose state after diagnosis with inoperable bleeding tumors. Her courage and patience in prescribing assisted this very fragile individual to make what so far is a complete and miraculous recovery.
Apart from a misleading emphasis on uncontrolled anecdotes, the AVH journal illustrates the inconsistent attitude of the veterinary homeopathy community towards science and the disingenuous use of scientific research as a marketing tool.
Dr. Shelley Epstein is one of the most prominent homeopaths claiming that homeopathy is a proven and scientifically legitimate field. I have responded to her arguments in detail before (The Science of Homeopathy?, The Evidence for Homeopathy-A Close Look). Essentially, she simultaneously claims that randomized clinical trials support the efficacy of homeopathy (referring primarily to poor quality positive trials with high risk of bias and completely ignoring better quality negative trials and the systematic reviews of the literature which show no convincing evidence of a clinically measurable effect beyond placebo) and argues that typical RCT design is inappropriate to apply to “individualized” homeopathic therapy.
In this issue of the AVH journal, Dr. Epstein is reported as continuing to assert that there is consistent and reliable evidence for the mechanism and benefits of homeopathy, despite the lack of acceptance of this evidence by anyone in the scientific community, apart from practitioners of alternative therapies:
We have moved well beyond whether homeopathy can be measured, into being able to measure nanoparticle quality control issues among the starting homeopathic products; measure specific frequency differences between remedies and their potencies; measure variation in particle and aggregate size and shape; and measure elemental composition of the homeopathic particles. Studies are finding out how nanoparticles remain dispersed in solution via the hypotheses that trituration generates nanofraction formation, lactose acts as stabilizer to prevent aggregation, dilution allows larger raw particles to settle out and nano-clusters to disperse freely in the medium. Other research involves remedies as nanomedicines and how their dissolved silicate structures carry remedy information into the body.
I have discussed the subject of “nanoparticles” as a validation of homeopathy elsewhere. I have also previously addresses the subject of “hormesis,” which Dr. Epstein also attempts to stretch from a narrow scientific phenomenon having nothing to do with homeopathy into some kind of scientific validation of homeopathic principles. Such misuse of nanoparticle physics, quantum physics, and other obscure but legitimate scientific fields is a hallmark of pseudoscientific rationalizations of alternative therapies.
However, even more dramatic examples of pseudoscience taken seriously are available in the AVH journal.
One speaker openly discusses the true nature of homeopathy as a form of spiritual healing, a religious belief rather than an approach to medicine compatible with science:
Let’s look at Aphorism11 of the Organon:”…initially only the spirit-like, autonomic life force…is mistuned… Only the life principle…can induce in the organism the irregular functions that we call disease.” We know this, but it is still easy to get lost in the perceptions of material agents as causes of disease. When we use vision in homeopathy, it is not to observe the causal agent but to perceive the effects of this disturbance of the life force….Homeopathy is right in the mix with a growing evidence base to show that homeopathic preparations can affect gene expression. While gene expression is in the physical realm, it can be altered via an energetic medicine.
And in his presentation, the legendary veterinary homeopath Richard Pitcairn
continues to stretch our perceptions of time and reality. Thought provoking indeed was the discussion of multiple personalities. Some with individual disease processes were definitely confounding. In one personality there would be a documented severe eye injury which would completely and instantly disappear as he shifted to his other personality….Some multiples changed eye colors between the personalities.
How the AVH can simultaneous claim scientific legitimacy and promote nonsense like this is truly mysterious. However, the AVH appears to recognize that homeopathy has an image problem (though not that this problem is that too many vets recognize it for the pseudoscience that it is). The journal editor speaks directly to this subject:
holistic or CAVM or integrative veterinary medicine is taking a more prominent role. With that increased visibility and scrutiny comes the need to act and practice responsibly. We have often been viewed as the insurgents in veterinary medicine and…it behooves us to present ourselves in a more conventionally professional way. I think we need to be aware that every column we write, every blog we post or forum letter we write can have a far-reaching impact. This is doubly true if we are venting or criticizing colleagues, organizations or disciplines.
I certainly support respectful, substantive disagreement within the veterinary profession, and I have often been disturbed by the extreme, sometimes religious zeal with which proponents of alternative therapies sometimes respond to quite polite and evidence-based critiques of their methods. For example, one prominent supporter of homeopathy responded to the CVMA resolution presented to the AVMA by linking it to the Holocaust. Another once responded to a post of mine criticizing the American Holistic Veterinary Medical Association (AHVMA) by calling me a “shill for the pharmaceutical companies” and claiming that “threatened financially and ideologically, [he] must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.”
To be fair, I too have sometimes been guilty of letting my emotions get the better of me and expressing my objections to specific practices in an excessively personal and inflammatory way, especially in the early days of blogging about the subject. However, I think it is a greater problem that healthy debate about the merits of alternative therapies is often impossible due to the passionate hostility that often greets any criticism of such approaches. It would be better for our profession if we could keep our disagreements civil and focused on ideas and evidence.
Unfortunately, I suspect this call for a more thoughtful tone in responding to critics of homeopathy may be more about perception and public relations than a true desire for substantive and respectful engagement. This suspicion is heightened by the announcement in the AVH journal that,
The AVH has hired a public relations representative. Peter Gold has experience working with the National Center for Homeopathy (NCH) and other organizations. Our goals are to increase awareness about homeopathy, build membership and raise funds for AVH.Your contributions (case testimonials, anecdotes, homeopathy tips etc.) are also needed….
AVH is blessed to have marketing director Peter Gold, who has been very helpful promoting AVH and homeopathy. His latest accomplishment was establishing a connection with Dogs Naturally magazine. I’d like to give everyone a gentle push to submit your success stories to Peter and the magazine. This is an excellent opportunity to get the word out about homeopathy.
The summer issue of the AVH journal also provides an update on the AVH lawsuit against the AAVSB. The AVH lost their case at every level, including a final failure on appeal to the Virginia State Supreme Court. However, they still consider it a worthwhile effort:
There was speculation that perhaps the AVH’s stand against AAVSB may have been the instigation for much of the current interest in homeopathy, reorganization of the holistic review committee of RACE and the impetus for other similar suits from holistic veterinary organizations.it was well worth the fight and achieved some worthy goals.
It is telling that the AVH has a legal advisor who has helped them pursue a 4-year lawsuit and now a marketing and public relations advisor, both employed to promote homeopathy by means other than rigorous scientific research. This illustrates the purpose of this organization, which is to function as an advocacy and marketing agency and a support group for practitioners of homeopathy, not as a scientific “academy” investigating homeopathy in an objective way. Homeopathy is a faith-based system in which scientific evidence is never a reason to question or reject existing dogma. The selective use of research findings by the AVH is not about discovering the truth but about developing marketing tools to create the impression of scientific validity.
There’s nothing inherently wrong with promoting a practice one believes in, of course. It is simply worthwhile for anyone evaluating the claims or evidence put forward by the AVH and its members to be aware that the organization is not interested in questioning or investigating the dogma of homeopathy in any objective way, and that scientific evidence is only employed by this group as a marketing tool, not as an impartial guide to what is true or false. While the group may claim that science supports homeopathy, this claim is inconsistent with
- The AVH’s promotion of blatant mysticism and pseudoscience such as illustrated by this journal
- The AVH’s use of litigation and public relations efforts to gain acceptance for a practice that cannot be effectively promoted on the basis of its scientific merits
- The selective and biased use of scientific research to promote an unshakable belief rather than to identify effective and ineffective therapies.
The AVH purports to represent the mainstream beliefs and attitudes of veterinary homeopaths. If this is true, then there is no better illustration of why homeopathy as a discipline is inconsistent with science and should not be viewed as a legitimate veterinary therapy. The scientific evidence is clear and consistent that homeopathy is nothing more than a placebo, and all the litigation and public relations spin the AVH generates can do nothing to alter this.