About a year ago the Connecticut Veterinary Medical Association introduced a resolution to the American Veterinary Medical Association House of Delegates recommending the AVMA acknowledge that homeopathy is an ineffective therapy and discourage its use. This resolution was supported by the Evidence-Based Veterinary Medicine Association, as well as a number of other veterinary groups, and I had a role in supporting it through the white paper outlining the scientific case against homeopathy. I have collected the series of articles and all the evidence associated with this resolution as well as links to discussion of this matter in the Journal of the AVMA (JAVMA).
The House of Delegates chose not to decide the matter but to refer it to the AVMA Board, which sent it to the Council on Veterinary Services (COVS) and Council on Research (COR). Given the statements of the AVMA president condemning the resolution as divisive, I assumed it would disappear forever at this stage. However, the COVS and COR have issued statements on the resolution, and the Board has sent it back to the House of Delegates for a vote. The essence of the COVS and COR statements is summed up in the title of this post
The scientific issue is disputed by almost no one, excepting of course homeopaths. Large quantities of scientific evidence, most of it of very poor quality and reliability, have been accumulated over 150 years, and homeopathy has never been demonstrated to be effective. The better one controls for placebo effects and bias in a study, the less likely one is to get a result compatible with the belief homeopathy works. And since homeopathy could not possibly work without a major revision of basic laws of physics and chemistry, this is surprising to no one, excepting again homeopaths.
These are essentially the findings of the Council on Research, though they are phrased a bit more diplomatically:
The COR scanned the literature for evidence on the clinical efficacy of homeopathic treatments. The council found that studies claiming a benefit from homeopathic remedies in veterinary medicine were either anecdotal in nature—that is, case reports—or were generally flawed in the experimental design or analysis. Furthermore, the council found that well-controlled clinical studies generally failed to substantiate any beneficial effect of homeopathic remedies. The COR concluded that there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.
While the COVS and the AVMA Board do not dispute this finding, they suggest that the use of a demonstrably ineffective therapy by veterinarians is not a problem.
The COVS recently revised the AVMA policy on Complementary, Alternative, and Integrative Veterinary Medicine—with approval by the HOD in July 2013—and believes the policy clearly states the AVMA’s position that the same standards should be applied to any treatment modality. The COVS believes that the AVMA should not at this time single out homeopathy or any other treatment modality in alternative or traditional medicine for additional scrutiny of effectiveness.
The board agreed that it is not the purview of the AVMA to adjudicate individual therapies, whether traditional or alternative, and that the current policy on alternative medicine is adequate. Therefore, the board recommended that the HOD disapprove the resolution on homeopathy.
The policy that this statement refers to is quite simple:
The AVMA believes that all aspects of veterinary medicine should be held to the same standards, including complementary, alternative and integrative veterinary medicine, non-traditional or other novel approaches.
- The foremost objectives in veterinary medicine are the health and welfare of the patient.
- Diagnosis and treatment should be based on sound, accepted principles of veterinary medicine and the medical judgement of the veterinarian.
- Veterinarians should have the requisite knowledge and skills for every treatment modality they consider using.
- A valid veterinarian-client-patient relationship must exist.
- Owner consent should be obtained prior to initiating treatment.
- Medical records should include outcomes of treatment.
- Veterinarians should be aware of and abide by local, state, and federal statutes.
All attempts to define CAM or discuss how it differs from science-based medicine have been eliminated. The statement indicates all medical practices should be held to the same standard, but doesn’t say what that standard is. Clearly, it is not the standard of evidence-based medicine.
The AVMA appears to feel that if a licensed veterinarian believes in a therapy and the therapy is legal, it is automatically ethical and appropriate to sell that therapy and make any claims one likes about its safety and effectiveness regardless of any scientific evidence to the contrary. The prerogative of veterinarians to do what they like clearly trumps the right of the public to give fully informed consent about the therapies they are offered. There is no ethical way to offer homeopathy without explaining that the scientific evidence shows it to be only a placebo, yet homeopaths clearly don’t do this. The AVMA doesn’t seem to care about this deception of clients. Nor does the organization appear to care about the harm done to patients when given placebo therapies instead of real medical care.
No one is suggesting that the AVMA individually evaluate the evidence for each and every medical therapy. But if veterinarians were offering bloodletting, astrology, or ritual sacrifice as medical therapies, how could the organization that represents some 80% of the profession not take a principled, evidence-based stand against such nonsense. Homeopathy has no greater claim to legitimacy or efficacy than these practices, yet it is more popular among veterinarians, and the AVMA values the power of a united lobby above the welfare of patients or the ethical treatment of animal owners.
My guess is that the House of Delegates will accept the recommendation to reject the resolution since the group initially seemed more concerned about the implied criticism of other veterinarians than about the truth of the statement that homeopathy is ineffective, or about the ethical issues involving clients and patients. I would love to be surprised, but I am not optimistic.
The Academy of Veterinary Homeopathy (AVH) and other homeopathy advocates will undoubtedly claim this as a victory, and it a political sense it is. The fact that no one accepts their claim that homeopathy is an effective therapy does not disturb the true believers so long as they are allowed to sell this quackery without interference or the public censure of the rest of the veterinary profession, which is apparently just fine with the AVMA.