I recently saw an editorial in the online edition of the Australian newspaper The Brisbane Times which seemed to fit with the recent series of posts I did on the subject of regulation for complementary and alternative medicine, especially the one addressing regulation of supplements and homeopathy. The editorial, entitled The Bitter Pill of Non-Medicine, begins by succinctly stating the problem:
Australians spend $4 billion a year on so-called alternative medicines, hoping against the odds that a largely unregulated industry will deliver cures and health benefits denied them by medical professionals.
It then goes on to pose the question which I tried to answer in my series:
Surely authorities would prohibit the sale of pills, ointments, syrups and contraptions that had not withstood the rigours of medical testing?
Apparently, like the U.S. government, the Australian government has neither the resources nor the political will to require some independent evidence of safety and efficacy for CAM products. The assumption seems to be that while these products may be ineffective, they are generally harmless, so regulating them is not a priority. There is abundant evidence that this assumption is not always true, including the recent paper from Australia showing the very real harm children can experience when treated with these methods. However, even if it were generally true, the article asks whether unrestrained marketing of these products is still legitimate:
But does absence of harm justify government inertia on this front? How is the public to know the implied promises of proven capability are empty? Should not the elaborate claims of some promoters be met with more vigour, particularly given the willingness of pharmacists to add their good reputation to assurances of the medical worth of these products?
The author then points out the problem, also seen with CAM products in the U.S., that these products rarely comply with even the limited regulations that are applied to them:
In a recent test of 400 newly listed alternative medicines, it found 90 per cent of them did not comply with regulations, weak as they are. Most infringements were relatively minor but in 3 per cent of cases flaws were serious enough for the product to be removed from sale. But here is the sting. The tiger is so toothless that banned products can reappear on shelves – sometimes within 24 hours – after re-branding.
Since human psychology is pretty consistent across the world, it’s not entirely surprising that irrational attitudes towards CAM, and the consequent ineffectual public policy, are a worldwide phenomenon. But it does dampen one’s hopes for the eventual development of more appropriate policies.
Here is another timely AAHA article to help the homeopathic vets sales pitch their medicine that contains no medicine. I have read “Swedish veterinarians are prohibited from prescribing homeopathic
medicines.” The translated Swedish vet abstracts often seem to me less quacky than those translated from other non English countries. I wonder what laws were changed to prohibit Swedish vets from prescribing homeopathic medicines?I have read some countries have laws that you cannot sell thehomeopathic stuff to be used on kids under 8. Maybe we could at least get a law the the pet had to be over eight years old.
art malernee dvm
fla lic 1820
http://homeopati.dk/uploads/om_foreningen/ECCH/hom.%20treatment%20of%20animals.pdf
J Am Anim Hosp Assoc. 2010 Dec 16. [Epub ahead of print]
Effectiveness of the Homeopathic Preparation Zeel Compared with Carprofen in Dogs with Osteoarthritis.
Neumann S, Stolt P, Braun G, Hellmann K, Reinhart E.
Clinic for Small Animals, Institute of Veterinary Medicine, University of Goettingen, Germany.
Abstract
The authors compared the symptomatic effectiveness of a complex homeopathic preparation Zeel (1-3 tablets orally per day depending on body weight) to carprofen (4 mg/kg body weight) in dogs (n=68) aged >1 yr diagnosed with osteoarthritis in a multicenter, prospective, observational open-label cohort study in 12 German veterinary clinics. The active treatment period was 56 days. Symptomatic effectiveness, lameness, stiffness of movements, and pain on palpation were evaluated by treating veterinarians and owners. Clinical signs of osteoarthritis improved significantly (P<0.05) at all time points (days 1, 28, and 56) with both therapies. At the end of the treatment period, effectiveness was comparable in both groups. Both treatment regimens were well tolerated with only three treatment-related adverse events, all in the carprofen group.
PMID: 21164168 [PubMed – as supplied by publisher]
Skeptvet, despite the lax regulations over CAM products, your informative blog is helping to educate professionals in the field, some of whom will have an impact on regulatory policies. It is a much-needed endeavor, and I appreciate your commitment and professionalism.
Thanks! As I will discuss at greater length in an upcoming post, I am not convinced laws and regulations are all that effective in ensuring best, scientific practices in medicine and discouraging ineffective therapies. I am beginning to believe that educating pet owners and veterinarians is the most productive thing we can do to promote science-based medicine. It’s generally impossible to know how much of an impact one is having with this kind of endeavor, but I’m glad to be able to do what I can.
I also think that we need to cultivate an affinity for critical thinking and evidence-based medicine among veterinary students.
Absolutely! One of the most important goals of the EBVMA is to make EBM a deliberate and improtant part of the vetrinary curriculum. Of course, there has long been talk in society at large about the importance of “critical thinking,” yet I’m not sure it’s had much impact. We seem to be going through a bit of an Age of Endarkenment in which the value of belief for its own sake is held in higher esteem than the critical and objective appraisal of beliefs.
Thanks! As I will discuss at greater length in an upcoming post, I am not convinced laws and regulations are all that effective in ensuring best, scientific practices in medicine and discouraging ineffective therapies. >>>
If you “believe, like I do, that most of the homeopathic vets know the homeopathic treatments are not needed I suspect you are going to believe laws and regulation not more education is what they need. I guess there is no way to know which will work best, education or a jail cell without a good bull shit meter. The good news for me that I have found early this year is that there seems to be some places in the world where vets are not allowed to be homopathic (sweeden) I wish they spoke English so I could read more about it. I also do not think, from what I have read, vets are as the standard of care revaccinate dogs and cats every 1-3 years in some of the Scandinavian countries either. If I am right about the Scandinavian countries I think we need to find out what they are doing right and try to copy it be it education or laws and regulation.
Art Malernee dvm
fla lic 1820