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Veterinary Homeopathy

Posted on June 5, 2009 by skeptvet

What is it?

Homeopathy was invented in the late 18^th and early 19^th century by Samuel Hahnemann. While there is some variations in specific homeopathic practices, the fundamental system invented by Hahnemann is still the basis for modern homeopathy. In a time before scientific, evidence-based medical practices, doctors frequently did more harm than good with traditional but not systematically tested therapies like bleeding, purging, and the administration of toxic substances. Hahnemann recognized the lack of success, and even active harm, of contemporary treatments and tried to create an alternative.

He first came up with the so-called Law of Similars. This principle states that something which causes certain symptoms in a healthy person should be able to relieve those symptoms in a sick person. Hahnemann’s apparent basis for this idea was that when he or other healthy people took certain remedies used in his era to treat specific diseases, the healthy subjects seemed to develop symptoms similar to the disease the remedy was supposed to treat. No consistent evidence has ever been found to support this idea that like cures like. Furthermore, modern testing of agents used in some homeopathic remedies has not confirmed that they even cause the symptoms they are believed by homeopaths to cause.

Hahnemann reasoned that giving sick people substances which caused signs of illness in healthy people would probably do harm, so he decided these substances should be greatly diluted before being used as remedies. He even became convinced that the more one diluted a substance, the greater its curative power. Homeopathic remedies are generally diluted many hundred or thousands of times, and it has been clearly shown that most no longer contain even a single molecule of the original material used to make them. Homeopathic practitioners do not dispute this, but they claim that the water (or sometimes alcohol) used for dilution retains some mysterious memory of the substance and so can be used as a cure. Again, no reliable evidence exists that dilution strengthens a substance’s curative properties or that water retains a memory of something that it no longer contains.

Finally, Hahnemann believed that to make his diluted remedies truly effective, they had to be activated by succussion (vigorous shaking). This, in his words, made the substance “excited and able to act spiritually upon the vital forces.” The combined effect of dilution and succussion led, in Hahnemann’s view, to the potentization of the substance, making it an effective remedy.

Hahnemann did not believe diseases had physical causes, such as the bacteria, viruses, toxins, and other sources of illness recognized by science today. He saw diseases as ailments of the spirit rather than the body, and this idea still influences modern homeopathy. Many homeopaths dispute the very basis of science and medicine and prefer theories based on spiritual forces, mysterious undetectable energies, exotic interpretations of quantum mechanics, or semiotics. These practitioners argue that the scientific evidence against their claims is unimportant because they do not accept that scientific research is a useful way to determine if a medical therapy is safe or effective. They are frequently inconsistent in this, however, in that when they find a study which seems to support their practices, they are quick to publicize the fact.

Does It Work?

There is no reliable evidence to support the underlying concepts of homeopathy. No research has shown that like cures like, or that diluting and shaking a mixture gives it any special curative powers. Most homeopathic preparations are so dilute that even homeopaths acknowledge that no traces of the original substance used to make them can possibly remain. Numerous attempts have been made to find physical evidence for any change in the water or alcohol vehicle after dilution and succussion, but no such evidence has been found by any properly conducted, repeatable study.

The clinical studies of homeopathic treatments in human patients overwhelmingly demonstrate that such treatments are no better than a placebo. The best quality scientific studies require blinding, where the patients and researchers do not know whether each subject is getting the real treatment or a fake (placebo) treatment. And many other factors complicate interpretation of human clinical trials, so confidence in the results can only come from consistent, repeatable outcomes of numerous well-designed trials conducted by different investigators.

Multiple reviews over the last decade of the best quality studies, with reasonable numbers of subjects and good controls for bias, have found no benefit from homeopathic treatment beyond a placebo effect. Most telling is a 2005 review which compared homeopathic treatments to new, conventional pharmaceutical treatments for the same conditions. The homeopathic treatments showed marginal effects consistent with a placebo, whereas the conventional medicines showed clear, unequivocal effectiveness. This is an example why homeopathy is typically used only to treat chronic, naturally waxing and waning or self-limiting conditions with subjectively reported symptoms. Homeopathy is not generally applied to acute, life-threatening illnesses with objectively measurable signs that would not respond to a placebo treatment.

As is usually the case, the veterinary studies on homeopathy are few and of generally poor quality. While animals are not subject to the same psychological influences as human patients, the owners and veterinarians monitoring their symptoms are. The best veterinary studies of homeopathy, those that have been properly blinded or looked at objective laboratory measures of effect, have not found any benefit from homeopathic treatment.

Is it Safe?

Few direct harmful effects of homeopathic preparations have been reported. Those that are least diluted (less than 500 times) could conceivably contain traces of the original substance, and some allergic reactions to these have been seen in humans. This has not been reported in animals.

The primary danger of homeopathic treatment, however, is that it is often used in place of properly proven scientific diagnosis and treatment. This allows the disease and suffering of the patient to persist, and possibly to progress past the point where otherwise beneficial conventional treatment can be effective. And since many homeopaths reject the basic scientific explanations of disease or the legitimacy of scientific medical research, these individuals often recommend against conventional therapies, including medicines and immunization. This exposes patients to unnecessary risk and suffering.

Summary

Ø There is no evidence for the reality of the principles underlying homeopathy, such as the Law of Similars or the notion that diluting and shaking a substance gives it curative powers.

Ø The clinical research evidence in humans overwhelmingly demonstrates that homeopathic treatment is no more than a placebo, affecting a patient’s beliefs and feelings about their disease but not the disease itself.

Ø The clinical research evidence in animals is sparse and of poor quality. The best studies done to date show no benefit of homeopathic treatment.

Ø Homeopathic treatment by itself is unlikely to be harmful. However, since it has no real effect on the body and yet can create a perception of improvement in symptoms through the placebo effect, the use of homeopathy can delay legitimate scientific diagnosis and therapy, thus prolonging suffering and potentially denying the patient effective relief.

References and More Information

Barker Bausell, R., Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, 2007

The North American Society of Homeopaths, Research and Philosophy Web Page, http://www.homeopathy.org/research.html#Philosophy

Ramey, D., Rollin, B., Complementary and Alternative Veterinary Medicine Considered, Iowa State Press, 2004

Saxton, J., Gregory, P., Textbook of Veterinary Homeopathy, Beaconsfield Publishers, 2005

Shang, A., et al., Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet Aug-Sep 2005;366(9487):726-32

Sing, S., Ernst, E., Trick or Treatment: The Undeniable Facts About Alternative Medicine, W.W. Norton & Company, 2008

The Cochrane Collaboration, The Cochrane Reviews, a searchable database of systematic reviews of the human medical literature at http://www.cochrane.org/reviews/

Posted in Homeopathy | 2 Comments

Veterinary Chiropractic

Posted on June 5, 2009 by skeptvet

What is it?

Chiropractic is primarily the manipulation of bones in the spine in an effort to treat or prevent disease or to reduce discomfort. Though therapeutic manipulation of bones in the spine and elsewhere has a long history, chiropractic as it is understood today was invented in the late 19^th century by Daniel David Palmer. He conceived the notion that all disease results from vertebrae in the spine being out of place (so-called “subluxations”), and that forcefully manipulation of the vertebrae (an “adjustment”) can prevent or treat disease. He gave varying explanations for this idea over time, often claiming that nerves carried a spiritual energy, called “innate intelligence,” and that obstruction of the flow of this energy by vertebral subluxations caused medical symptoms. There is no reliable evidence that vertebral subluxations as Palmer described them exist or cause disease, and even some chiropractors do not believe that subluxations are real or can be detected and treated by chiropractic methods.

Nevertheless, many chiropractors, especially those that still believe in Palmer’s subluxation theories, reject modern scientific explanations of illness. It is not unusual for these practitioners to deny that infectious organisms, such as bacteria and viruses, cause disease, and they frequently recommend avoiding accepted medical prevention or treatment, such as vaccination and antibiotic therapy.

Other chiropractors have rejected the subluxation idea and the claim that manipulation of the spine can prevent or treat disease in other parts of the body. These practitioners focus on the possible usefulness of chiropractic manipulation to treat back pain only, and often recommend both chiropractic and conventional medical therapy.

There is little consistency to the kind of therapy chiropractors provide. While most forcefully manipulate the spine, there are many different techniques and much controversy in the chiropractic literature about them. Chiropractors often utilize other treatment methods as well, applying heat, cold, laser light, magnets, electrical stimulation, and topical products to the patient, and recommending other alternative treatments such as herbal products. Overall, there is no universally accepted definition of what chiropractic is, what kinds of treatments it encompasses, or what conditions it might be useful for.

Chiropractic theory and practice has been applied to animals since Palmer’s time. Despite the dramatic and obvious differences between the anatomy of the human spine and that of all other mammals, chiropractors have often asserted that subluxations occur and cause disease in veterinary patients in the same way as in humans, and they have recommended therapeutic adjustment for animals. Even many chiropractors who do not believe in subluxation theory claim to be able to identify and treat back pain and other problems in animals.

Does It Work?

Despite decades of research and the use of imaging methods such as x-rays, CT scans, and MRI, no reliable evidence for the existence of Palmer’s vertebral subluxations has been found. Studies, even in journals devoted to chiropractic, have shown that common methods for detecting subluxations are unreliable. Individual chiropractors do not consistently identify the same sites for supposed subluxations in a given patient, nor can multiple chiropractors examining the same person agree on where the patient’s problem is located. Research studies show that the identification of a specific spot in the back as the source of a problem is essentially the same as picking a location at random.

Extensive research has been done on humans for use of chiropractic treatment in many different diseases. As always, the best quality scientific studies require blinding, where the patients and researchers do not know whether each subject is getting the real treatment or a fake (placebo) treatment, and this is difficult since a patient familiar with chiropractic may be able to tell which treatment they are getting, and it is impossible to blind the person giving the treatment. Many other factors complicate interpretation of human clinical trials, so confidence in the results can only come from consistent, repeatable outcomes of numerous well-designed trials conducted by different investigators.

When the best quality studies, with reasonable numbers of subjects and good controls for bias, are reviewed they find spinal manipulation to be ineffective for almost all conditions in which it has been tested. There is some reasonable evidence that spinal manipulation does can provide mild relief for back pain (an improvement of about 10 points on a 100 point pain scale). This level of relief is no greater than that provided by conventional medical therapy such as stretching, exercise, physical therapy, and non-steroidal anti-inflammatory drugs.

As is often the case with alternative therapies, there is no high-quality research on spinal manipulation or other chiropractic therapies in animals. Only small studies with poor controls for bias and lack of objective measures of outcome have been done. At this time, any claims for the usefulness of chiropractic treatment in animals are unfounded. Significant underlying anatomical differences between humans and other mammals suggest that therapy useful only for lower back pain in humans is unlikely to be relevant to disease in our four-legged veterinary patients.

Is it Safe?

Mild side-effects, such as headache, soreness, dizziness, and numbness occur in roughly half of human chiropractic patients. Much more rare, but also much more serious events have been reported. Tears in vertebral arteries can occur following manipulation of the neck, and these have led to stroke and permanent disability or death in a number of patients. Fractures of the vertebrae and rupture of intervertebral disks have also been reported.

Many chiropractors make extensive use of x-rays despite the lack of any evidence that such imaging methods can identify subluxations or other lesions amenable to chiropractic treatment. Though the danger of a single x-ray is minimal, repeated x-rays can increase cancer risk.

Those chiropractors who oppose conventional therapies and preventatives, such as antibiotics, pain medications, and vaccines, can be responsible for unnecessary risk and suffering in their patients by discouraging the use of proven, effective medical treatment or disease prevention. And as chiropractic therapy is not useful for problems unrelated to the spine, employing such treatment for other illnesses can delay appropriate diagnosis and treatment.

Finally, since the only demonstrated benefit of spinal manipulation is relief of back pain in humans, and since this therapy is no more effective than conventional medical therapy for these symptoms, the risks posed by chiropractic therapy seem unjustified by the benefits.

No reliable research exists on the safety of chiropractic treatment for veterinary patients. Injuries to horses from chiropractic manipulations have occasionally been reported. It is likely that the risk of vertebral artery tears would be lower given the differences in anatomy of the spine. However, it is also likely that the benefits for treatment of back pain in humans would not be relevant to veterinary patients for the same reason. And the use of chiropractic in place of legitimate scientific diagnosis and treatment would present the same risks for animals as for humans.

Summary

Ø There is no compelling evidence for the reality of Palmer’s concepts of innate intelligence or vertebral subluxations. Subluxations cannot be reliably identified, and even many chiropractors no longer believe they exist.

Ø The best quality clinical research shows that spinal manipulation provides no benefit for most conditions. It can provide mild relief of back pain in humans, at best equivalent to conventional medical therapy.

Ø There is no good-quality research to suggest spinal manipulation is of benefit in animals. Significant differences in the anatomy of the spine make it questionable whether veterinary patients would experience the same causes of lower back pain as humans or that manipulative therapy would provide the same benefits.

Ø There are several mild side effects commonly associated with chiropractic treatment in people, including headache, soreness, dizziness, and numbness. There are also rare but serious risks that can lead to disability or death in humans. No reliable research evidence exists regarding the safety of chiropractic treatment in animals.

References and More Information

Barker Bausell, R., Snake Oil Science: The Truth About Complementary and Alternative Medicine, Oxford University Press, 2007

Ernst, E., Canter, P.H., A systematic review of systematic reviews of spinal manipulation. J R Soc Med 2006;99:192-6

Hestboek, L., Leboeuf-Yde, C., Are Chiropractic Tests for the Lumbo-Pelvic Spine Reliable and Valid? A Systematic Critical Literature Review. J Manip Physiolog Therap May 2000;23(4)

International Chiropractic Pediatric Association, Vaccine Information Website, http://www.icpa4kids.org/research/children/vac_info.htm

Leon-Sanchez, A., Cuetter, A., Ferrer, G., Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J Feb 2007;100(2):201-3

Ramey, D., Rollin, B., Complementary and Alternative Veterinary Medicine Considered, Iowa State Press, 2004

Sing, S., Ernst, E., Trick or Treatment: The Undeniable Facts About Alternative Medicine, W.W. Norton & Company, 2008

Stevinson, C., Ernst, E., Risks associated with spinal manipulation. Am J Med May 2002;112(7):566-71

Vohra, S., et al., Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics Jan 2007;119(1):275-83.

The Cochrane Collaboration, The Cochrane Reviews, a searchable database of systematic reviews of the human medical literature at http://www.cochrane.org/reviews/

Posted in Chiropractic | 2 Comments

What is Open-Mindendess?

Posted on June 4, 2009 by skeptvet

When discussing the evidence for and against CAM, especially with passionate believers, the issue of “open-mindedness” almost always comes up. Despite my desire to be insightful and original, I can think of no better beginning for discussing this idea than the old cliché: Always keep an open mind–but not so open that your brain falls out!

Science is dedicated to the principle of letting the facts have the final word, and so pre-judging an idea is contrary to the core philosophy of science. Any idea should stand or fall on its merits, not merely one’s feelings or a priori biases. So when I encounter a new CAM therapy, or even new evidence regarding one I am already familiar with, I approach it with an open mind. This means that even if my intuition tells me the idea is nonsense, I ask questions about the principles and I ask for evidence, for data to support that it does what the person claims it does. If this evidence is high quality (meaning well-conducted scientific research, preferably replicated randomized placebo-controlled clinical trials), then I’m on board! If the evidence is suggestive but not definitive (a plausible rationale, supportive in vitro research, perhaps some case reports), then I reserve judgment pending further study. But if the evidence is of poor quality (individual testimonials, no matter how many, proprietary research by an organization selling the product, underlying principles that violate well-established laws of nature, appeals to authority or tradition, and so on), then it moves me not!

The fundamental misunderstanding many people have about “open-mindedness” is that it means either not judging something to be true or false at all, or applying no standard of quality to the evidence used to judge the verity of a proposition. I was recently read the riot act by another doctor at my practice for being rigid and closed-minded about alternative therapies. When questioned, it turned out that what she meant was that believing scientific research is superior to anecdote, personal impressions, and cultural traditions as a form of evidence is to be closed-minded. Unfortunately, this is an example of a dangerous misunderstanding that even an extensive education in medical science does not apparently protect one against.

The history of medicine offers countless examples of why many smart people over many generations can be wrong about whether a therapy works or doesn’t work. Bloodletting, cupping, and purging are excellent examples of therapies which persisted for centuries with widespread belief in their efficacy among medical professionals and the general public but which we now know are not beneficial, and can even be harmful. The unprecedented increase in the length and quality of life for most human beings since the advent of scientific medicine is further evidence that clinical judgment and tradition are inferior to properly-conducted research in determining the validity of medical interventions. Science deserves to be taken more seriously than intuition or tradition not based on some patriarchal, ethnocentric, narrative of hegemony (as the post-modernists would have it) but because it has demonstrated its epistemological superiority in the real world, and has changed fundamentally the nature of the human experience.

Why, exactly, we trust our judgment far more than it deserves is a complex and fascinating topic. I have listed below a number of books which investigate this question, and which I have found profoundly eye(and mind)-opening. It is clear that our perceptions are heuristic, quick and dirty methods for making fast and efficient judgments that worked more often than not in the evolutionary environment that shaped our brains. But in the far more complex and ambiguous world of modern medicine, we can do better. We can do science!

The accusation of closed-mindedness leveled so often at skeptics of CAM usually carries the implication of intellectual arrogance as well. This strikes me as wonderfully ironic. To say that I as an individual, no matter how smart and well-educated and experienced, can be led astray by cognitive errors that are intrinsic to the structure and operation of my brain and so that I must rely on the processes of science above my personal feelings and judgment is arrogant. However, to assert that my personal experiences “prove” the truth of something so thoroughly that any contradictory scientific research can be dismissed is to be “open-minded.” Clearly, this makes no sense. It is a weak post hoc rationale for doing what we desperately want to do—believe we are right because we feel like we’re right.

So open-mindedness, properly understood, means judging each idea on its own merits, not on where it comes from, what other ideas it resembles, or how brilliant or foolish it makes us feel. It means getting as close to an objective, dispassionate understanding of the facts as we can and then basing our conclusions on those facts, not on our intuition or gut feelings. In short, it does not mean we should not try to judge if something is true or not but that we should base these judgments on the kind of evidence that has proven reliable before. And this means scientific evidence, not anecdote or tradition or faith.

Veterinary Homeopathy

Veterinary Chiropractic

What is Open-Mindendess?

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A Book from the SkeptVet

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