A SATIRICAL website poking fun at veterinary homeopathy has become the unlikely symbol of a global backlash by conventional vets against their homeopathic colleagues.
The 鈥淏ritish Veterinary Voodoo Society鈥� (BVVS) is a parody, but its creators say they are making a serious point: that the claimed effectiveness of homeopathic veterinary medicine has no more solid scientific evidence behind it than voodoo. They object to a decision by the UK鈥檚 Royal College of Veterinary Surgeons (RCVS) to publish an official list of homeopathic vets, which they say undermines the credibility of conventional veterinary medicine.
The RCVS disputes this. It points out that the list carries a disclaimer declaring that the college does not recognise the major British homeopathic veterinary qualification. This is awarded by The Faculty of Homeopathy, a separate body that also promotes the development of homeopathy for humans.
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Homeopathic vets are not laughing either. They see the site as a slur on homeopathic medicine, and say it brings the whole veterinary profession into disrepute. They have lodged a formal complaint with the RCVS, which regulates the profession, asking it to censure the website鈥檚 editors and force them to take down the site. As New 杏吧原创 went to press, the RCVS was considering the complaint.
This bizarre episode has exposed a rift in the profession that extends far beyond the UK. Conventional vets and the organisations they belong to are fighting back against what they see as infiltration of their profession by non-evidence-based practitioners. The ethics of complementary medicine for animals and humans are different, because animals cannot choose to have complementary therapies. This, they say, puts vets under a moral obligation to provide the best evidence-based treatment, and the evidence that homeopathy actually works is, at best, flimsy (see 鈥淐ure or quackery鈥�).
The backlash against veterinary homeopathy is already in full swing in other countries. On 19 November, The Federation of Veterinarians in Europe (FVE) issued a policy statement urging its 200,000 members 鈥渢o work only on the basis of scientifically proven and evidence-based methods and to stay away from non-evidence-based methods鈥�.
鈥淭he FVE feels it should be clear to clients that vets work on the basis of evidence-based science,鈥� Jan Vaarten, executive director of the federation, told New 杏吧原创. 鈥淲hen vets go into homeopathy, it creates a false impression that it is also evidence-based.鈥�
鈥淲hen vets go into homeopathy it creates a false impression that it is evidence-based鈥�
In April, the European Board of Veterinary Specialisation issued a statement warning that its members could lose their status if they offer non-evidence-based treatments. The organisation represents and registers the 10 per cent of vets who go on to specialise in 20 or so fields, such as radiology. 鈥淭he basics of homeopathy are not in agreement with science,鈥� says Johannes Lumeij of Utrecht Veterinary School in the Netherlands, and EBVS president.
The Swedish Veterinary Association banned its members from homeopathic practice decades ago. Its president, Karin Ostensson, told New 杏吧原创 that the association takes the view that 鈥渉omeopathy does not rely on evidence-based science, and it is absolutely unacceptable for vets to work without a scientific basis鈥�.
In early September, the British Veterinary Association, which represents 10,000 vets, issued a statement attacking plans by the UK Medicines and Healthcare Products Regulatory Agency to license homeopathic medicines without demanding clinical trials. 鈥淣o genuine 鈥榩rovings鈥� of homeopathic remedies have ever successfully been performed in animals,鈥� the statement says. 鈥淭here is no evidence whatsoever of a physiological or therapeutic effect. Instead, the homeopathic ritual of case-taking and remedy matching appears to influence the owner to perceive the animal鈥檚 condition in a more favourable light, attributing coincidental recovery to the remedy and even imagining improvement where none is present,鈥� it says.
In the US, the American Veterinary Medical Association (AVMA) allows its 73,000 members to practise homeopathy or chiropractic, but keeps such therapies at arm鈥檚 length. 鈥淲e encourage those that use alternatives to help develop the science showing they work, particularly through double-blind placebo-controlled tests, but no one has done that yet,鈥� says Bonnie Beaver, who recently stood down as president of the association.
Members of the AVMA are not allowed to advertise themselves as a specialist in alternative therapies, and Beaver says she cannot imagine the association giving the kind of endorsement that homeopathic vets enjoy in the UK. 鈥淎 list would give a certain recognition level to the public, so it鈥檚 not something that would happen here.鈥�
The RCVS disputes this view. 鈥淲e would argue we鈥檙e not promoting homeopathy, but are taking a neutral stance,鈥� says council member Stephen Ware. He says the list provides a service by helping clients find qualified vets capable of doing homeopathy.
John Saxton, ex-president of the British Association of Homeopathic Veterinary Surgeons, says the list is not there to promote homeopathy. 鈥淚t鈥檚 to say these guys have this qualification, and if you have a client who wants homeopathic treatment, here鈥檚 a list to help you find them.鈥�
鈥淲e encourage those that use homeopathy to help develop the science showing it works. No one has done that yet鈥�
But David Ramey, a horse vet in California, and long-term sceptic of homeopathy, says that any blurring of the distinction between conventional and complementary vets should be resisted at all costs. 鈥淚f you try and incorporate everything under veterinary medicine, you start to erode the standards in practice,鈥� he says. 鈥淚 say keep the two apart, and let the market decide.鈥�
Cure or quackery?
Many orthodox vets argue that there is no genuine scientific evidence that homeopathy works. Very few reliable studies have been done on homeopathic treatments in animals, and of these most point to them having no more than a placebo effect.
A few have claimed positive results. Indian researchers led by Ram Naresh of the Indian Veterinary Research Institute in Izzatnagar, Uttar Pradesh, this year reported that a commercially available cocktail of homeopathic ingredients, including belladonna and arnica, was effective against mastitis in cattle. The homeopathic remedy healed 87 per cent of treated udder regions, compared with 59 per cent treated with conventional antibiotics (Homeopathy, vol 94, p 81).
The trials were not 鈥渄ouble blind鈥�, however, which weakens the result. In a double-blind trial there is no possibility of bias because neither the experimenter nor the patient (or in this case the farmer or owner) knows until the results are analysed which of the subjects received the treatment and which got the placebo. That way there is no chance for unconscious bias creeping in: for example, by cows treated with the homeopathic remedy being looked after differently.
An earlier double-blind trial, by British vet Chris Day in 1986, also claimed to show that homeopathic remedies cut the incidence of mastitis in cattle from 48 to 2.5 per cent. And in 1984, Day reportedly reduced the incidence of stillborn piglets with another remedy, caulophyllum (The Veterinary Record, vol 114, p 216).
The majority of studies have found no effect, however. In April, for example, The Veterinary Record reported results from a double-blind trial in which 250 cows received either a homeopathic remedy for mastitis or a placebo (vol 156, p 565). Milk from cows with mastitis normally has an elevated level of white blood cells. But when Mark Holmes at the University of Cambridge and his team counted white blood cells in milk before and after treatment they found minimal change in either case, suggesting the homeopathic remedy was no better than the placebo.
In 2003, Kerstin de Verdier of the National Veterinary Institute in Uppsala, Sweden, reported in Acta Veterinaria Scandinavica (vol 44, p 97) the failure of the homeopathic remedy podophyllum for diarrhoea in calves in a double-blind trial.
Recent reviews of the field 鈥� both animal and human 鈥� have also been negative. In August, Matthias Eggar and colleagues at the University of Bern in Switzerland published an analysis comparing 21 studies of homeopathic remedies with nine studies of conventional medicines. They concluded that 鈥渢he clinical effects of homeopathy are placebo effects鈥� (The Lancet, vol 366, p 726).
And last month in Trends in Pharmacological Sciences (vol 26, p 548) Edzard Ernst of the University of Exeter, UK, concluded that 鈥渃ontrary to many claims by homeopaths there is no conclusive evidence that highly dilute homeopathic remedies are different from placebos鈥�.
Homeopathic vets admit that evidence from large, double-blind, placebo-controlled trials is thin on the ground. But some argue that this is beside the point. 鈥淭here鈥檚 a strong body of anecdotal evidence over hundreds of years,鈥� says Larry Bernstein, president of the American Holistic Veterinary Medical Association. 鈥淭he problem is if you try to prove homeopathy using the scientific paradigm,鈥� he says. 鈥淲hen you do double-blind studies, you鈥檙e trying to standardise the therapy, but homeopathy is individualised to each patient, so if the remedy works in Andy, who says it will work in Bill?鈥�