The AVMA Guidelines for Complementary and Alternative Veterinary Medicine [CAVM] states: “It is not the intent of these guidelines to determine or describe the relative value of the individual modalities.” Therefore, this document irrelevant to any discussion on the merits of any particular therapy, including homeopathy.
The “white paper” (The Case Against Homeopathy
) is quite interesting, but it has multiple fatal flaws. Let me point out a few of the issues:
1. No authorship is claimed. Who wrote it? What are his qualifications? While HOD rules allow such resolutions to be considered, the unwillingness of the author to proudly set his name upon this paper suggests that he is not a credible sources—and he knows it. If he had any qualifications or expertise in the matter, he would have said so. AVMA should consider this lack of transparency and dearth of qualifications when evaluating this paper.
2. The author’s comparison of homeopathy to magic and voodoo, and his use of examples from ethnobotany and folks traditions that have nothing whatsoever to do with homeopathy, reveals his agenda: to kill homeopathy. It is not a real “white paper,” it is an editorial; an opinion piece. AVMA should regard this paper in light of its blatant bias.
3. The author states that “While habit, tradition, uncontrolled clinical experience, and anecdotes may appear to support the value of a given therapy, these sources of information are deeply unreliable.” However, any pharmaceutical company would tell you that “traditional” remedies have given us innumerable drugs (aspirin, digoxin, and taxol come readily to mind); and ongoing research into folk remedies and herbs is our greatest resource for future drugs.
Contrary to the author’s position, clinical experience and anecdotes are, in fact, evidence. EBM has yet to settle on a single system of classification for levels of evidence, let alone the incomplete version contained in the AVMA’s “Statement about the Resolution.” In fact, that statement lists only three levels; I know of no currently accepted system using less than four. A more comprehensive system (http://med.fsu.edu/userimages/EBMPyramid2008-02-26.gif) ranks the levels as follows from most to least reliable as follows:
A. Cochrane Systematic reviews
B. Other SRs and meta-analyses
C. Evidence guidelines
D. Evidence summaries
E. RCTs, Case Cohorts, Control Studies
F. Clinical Research Critiques
G. Other Reviews of the Literature
H. Case reports, case series, practice guidelines, etc.
The white paper itself could qualify perhaps next to last (“other reviews of the literature”); but even that is an overly generous score, given that it “reviews “only the papers most supportive of the author’s own position.
4. Table 3 admits in its title that the studies chosen for the list were “SELECTED.” Of course they were. It’s easy to find references to back up either side in virtually any scientific debate. The results of an individual study can also be interpreted in different ways, depending on the point one wants to make.
Take another look at Table 3—half of those references were published between 1966 and 1998. Or check the grand total of 72 references. Apparently, out of 4,622 items on homeopathy indexed on PubMed, the anonymous author could only find 72 (1.3%) that support his contentions? If AVMA is to take this issue seriously, then it should consider all studies on homeopathy, not just the 16 chosen by the die-hard “skeptic” who authored the white paper.
5. According to Table 3, science stopped working sometime in 2010, because no more recent citations are included. That is likely because newer research does, in fact, provide evidence for the mechanism of homeopathy, as well as strong evidence of its efficacy.
Coincidentally, 2010 was the same year that Homeopathy
published a report on a massive 2007 experiment in Cuba that used a homeopathic remedy to supplement its limited stocks of leptospirosis vaccine. The disease is a huge problem in Cuba, and it is monitored meticulously. A news report stated, “The homeopathic medicine was given to the 2.3 million population of the provinces usually worst affected. Within a few weeks the number of cases had fallen from the forecast 38 to 4 cases per 100,000 per week, significantly fewer than the historically-based forecast for those weeks of the year. The 8.8 million population of the other provinces did not receive homeopathic treatment and the incidence was as forecast. The effect appeared to be sustained: there was an 84% reduction in infection in the treated region in the following year (2008) when, for the first time, incidence did not correlate with rainfall. In the same period, incidence in the untreated region increased by 22%.” (Homeopathy Associated With Dramatic Reduction In Leptospirosis Infection In Cuban Population. http://www.medicalnewstoday.com/articles/197128.php
) The lead authors were not homeopaths; they were physicians and respected vaccine researchers. Cuba has since implemented homeopathic prophylaxis against leptospirosis for its entire population and is considering it for other diseases.
6. The white paper’s excessive reliance on the House of Commons Science and Technology Committee (HOC Committee) report on Homeopathy (HOC Committee 2010), which was ultimately rejected, is pathetic.
7. The white paper states that the articles supporting homeopathy are published “almost exclusively” in journals sympathetic to alternative therapies. Of course, it is logical that most of the articles on a given topic will be published in journals about that topic. One would not expect the bulk of articles on molecular biophysics to be published in the New England Journal of Medicine.
Nevertheless, that statement is simply not true. I reviewed a small sample of abstracts and papers indexed on PubMed. Journals that have published papers favorable to homeopathy (and which are not in any way sympathetic to CAVM) include:
· Annals of the New York Academy of Sciences
· Current Oncology
· Der Urologe (Urology; Berlin, DE)
· Experimental Biology and Medicine
· European Society for Philosophy of Medicine and Health Care
· European Journal of Pharmacology
· Frontiers in Bioscience (Scholar Edition)
· Immunology Today
· Immunological Investigations
· Journal of Allergy and Clinical Immunology
· Journal of Analytical Methods in Chemistry
· Journal of the European Histamine Research Society
· Journal of the Federation of American Societies for Experimental Biology (FASEB)
· Journal of Immunology
· Journal of Inflammation Research
· Journal of The Royal Society for the Promotion of Health
· Medical Hypotheses
· Molecular and Cellular Biology
· Preventive Medicine
· Wiener klinische Wochenschrift (Central European Journal of Medicine)
Moreover, completely disregarding every study showing positive results of homeopathy because the unknown author doesn’t like the journal in which it was published is hardly a scientific approach. It’s even more peculiar because 1/3 of the white paper’s own references are to the very journals dedicated to CAVM that it disparages.
For example, under the heading “direct harm,” the white paper states, “There have been some reports of detectable heavy metal contamination of homeopathic remedies.” That’s true only if you consider “some” to be equal to “one,” because that’s precisely how many reports actually exist. Ironically, that single report was published in the journal Homeopathy, which the author regards as completely unreliable as scientific evidence of anything. (If one compares this to any analysis of morbidity and mortality associated with legal prescription drugs, the white paper clearly overstates the risks associated with homeopathy.)
8. The author is critical of the quality of published studies on homeopathy. Perhaps he has not noticed that studies published in medical journals are not without flaws:
· Investigators found that studies with positive results and higher statistical significance are more likely to be published, and published years sooner, than studies with null or negative results. According to Cochrane Summaries, the entire validity of a systematic review is seriously threatened by such publication bias.
· A 2005 paper concluded, “Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true.” Subsequent papers by the author have shown that bias in published research is a widespread and fundamental problem.
· The NEJM was mightily embarrassed when it published a drug-company funded study defending its products against research showing the drug to be dangerous. The journal lost its prestige; and the editor later commented, “It is simply no longer possible to believe much of the clinical research that is published.”
9. The white paper falsely claims that the FDA “has made no attempts to regulate their use or require any evidence of safety and efficacy.” The FDA itself contradicts the author on its website:
“The Federal Food, Drug, and Cosmetic Act (the Act) recognizes as official the drugs and standards in the Homeopathic Pharmacopeia of the United States and its supplements (Sections 201 (g)(1) and 501 (b), respectively).” The FDA also recognizes the HPUS as “A compilation of standards for source, composition, and preparation of homeopathic drugs.” I personally spoke with an FDA representative, who was emphatic that FDA has no plans for any changes or challenges to the HPUS.
In summary, Resolution 3-2013 should fail for the following reasons:
1. It is prejudiced. The anonymous white paper in support of the resolution is highly biased, deeply flawed, and outdated. It relies on cherry-picked data, makes multiple false statements, and ignores recent findings supportive of homeopathy. The many errors, whether deliberate or not, make reliance upon it untenable. Moreover, it usurps the power of the state boards to define the practice of veterinary medicine. Frankly, it’s none of AVMA’s business what modalities (or drugs, or surgeries) individual veterinarians use as long as they are legal and within the scope of their state’s practice act. Furthermore, when an author knowingly makes even one false or misleading statement (and the white paper’s author makes many), it throws every other claim that author makes into doubt. The white paper simply cannot be relied upon as evidence of any truth.
2. It is petty. The resolution is uninformed and narrow-minded. It segregates and vilifies a specific segment of AVMA’s own membership. AVMA has already gone a long way down the path of alienating every CAVM practitioner by its resolution against raw meat diets, which many veterinarians recommend. I cannot imagine why AVMA wants to drive out so many members, but adopting this resolution would only increase the gap in understanding between EBM fanatics and veterinarians with an interest in expanding the tools available to help animals.
3. It is perverse. The public wants CAVM, and in particular, our clients want CAVM. Veterinarians themselves want knowledge and training in all CAVM modalities, including homeopathy. At conferences I’ve attended, the lectures on CAVM have been extremely popular. However, at this year’s AVMA conference, the lecturers on CAVM are individuals who are outspoken opponents of most or all alternative modalities. It is clear that a small group of highly vocal CAVM skeptics have already overtaken any remnant of common sense and fairness at AVMA. This resolution will take the AVMA further backward into an era more reminiscent of the Salem witch trials than a move forward into the demands of the new millennium. This resolution is completely antithetical to AVMA’s own best interests.
4. It is premature. Why this sudden rush to judgment now? While the mechanism of action of homeopathy has not been conclusively determined, recent research (excluded by the white paper) suggests several possibilities. Research is expanding. A reasonable judgment of any kind on homeopathy is not possible without simply ignoring studies published in late 2010 and thereafter. The issues are as yet unsettled, and future research may completely contradict the white paper’s allegations. If so, passing this this resolution now will make AVMA look pretty foolish.
A recent study on therapies for menopause stated: “…there has been a burgeoning interest in a number of botanical products as well as other complementary and alternative medicine strategies, such as acupuncture, magnets, homeopathy, and behavioral regimens. However the benefits of most of these strategies are either very limited or equivocal, and related safety issues are poorly understood. Future research is needed to identify new efficacious strategies, to understand side effects and safety issues, and to provide new options.” (Emphasis added)
The official U.S. Homeopathic Pharmacopeia currently states that “although the theoretical basis of its scientific methodology has remained constant, its format and documentation have evolved, and will continue to do so.” (Emphasis added.)
In the past few years, a very small group of alternative medicine “skeptics” has gained undue influence over the whole of veterinary medicine. This has been manifested in the shift within RACE to universally withhold approval for all courses on alternative modalities (many of which were identical to previously approved courses), AVMA’s and other organizations’ resolutions against raw-meat diets, and AVMA’s choice to turn over its conference CAVM lectures to people who are opposed to some or all modalities within CAVM. This small group, by being extremely vocal and using false arguments, wants very badly to be in control of the debate. They are attempting to establish their views as AVMA policy before it’s too late; i.e., before anyone else fairly evaluates the current science, and certainly before nanophysiology and other methods of measuring the effect homeopathic remedies are fully developed. It’s a sad day for veterinary medicine when the profession turns its back on progress.
AVMA would be very unwise to approve this resolution, as it is based on false and misleading information. I urge you to reject it.
Jean Hofve, DVM
P.O. Box 100324
Denver, CO 80250
AVMA Member #0034812
Angell M. Drug Companies & Doctors: A Story of Corruption. New York Times. 2009 Jan 15. http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption. Accessed 12/16/12.
Bagai U, Rajan A, Kaur S. Antimalarial potential of Nosode 30 and 200 against Plasmodium berghei infection in BALB/c mice. J Vector Borne Dis. 2012 Jun;49(2):72-7.
Bellavite P, Marzotto M, Chirumbolo S, et al. Advances in homeopathy and immunology: a review of clinical research. Front Biosci(Schol Ed). 2011 Jun 1;3:1363-89.
Belon P, Cumps J, Ennis M, et al. Histamine dilutions modulate basophil activation. Inflamm Res.
Bracho G, Varela E, Fernández R, et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.Homeopathy. 2010;99:156-166.
, Das D
, Dutta S
, et al. Potentiated homeopathic drug Arsenicum Album 30C inhibits intracellular reactive oxygen species generation and up-regulates expression of arsenic resistance gene in arsenite-exposed bacteria Escherichia coli. Zhong Xi Yi Jie He Xue Bao.
Gründling C, Schimetta W, Frass M.Real-life effect of classical homeopathy in the treatment of allergies: A multicenter prospective observational study. Wien Klin Wochenschr. 2012 Jan;124(1-2):11-7.
Ioannidis JP. Why most published research findings are false. PLoS Med. 2005 Aug;2(8):e124.
Khuda-Bukhsh AR. Towards understanding molecular mechanisms of action of homeopathic drugs: An overview. Molec Cell Biochem. 253: 339–345, 2003.
Magnani P. Conforti A, Zanolin E. et al. Dose-effect study of Gelsemium sempervirens in high dilutions on anxiety-related responses in mice. Psychopharmacology (Berl). 2010 July; 210(4): 533–545.
Pannek J, Jus MC, Jus MS. Homeopathic prophylaxis of urinary tract infections in patients with neurogenic bladder dysfunction.Urologe A. 2012 Apr;51(4):544-6.
Rutten L, Mathie RT, Fisher P, et al.Plausibility and evidence: the case of homeopathy. Med Health Care Philos. 2012 Apr 27.
Steinsbekk A, Lewith G, Fønnebø V, et al. An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children. Prev Med. 2007 Oct;45(4):274-9; discussion 280-1.
Sharma A, Purkait B. Identification of Medicinally Active Ingredient in Ultradiluted Digitalis purpurea: Fluorescence Spectroscopic and Cyclic-Voltammetric Study. J Anal Methods Chem. 2012;2012:109058.
Sherman S, Miller H, Nerurkar L, Schiff I. Research opportunities for reducing the burden of menopause-related symptoms. Am J Med. 2005 Dec 19;118 Suppl 12B:166-71.
U.S. Food and Drug Administration. CPG Sec. 400.400 Conditions Under Which Homeopathic Drugs May be Marketed.
http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074360.htm. Accessed 12/16/12.
Young NS, Ioannidis JP, Al-Ubaydli O. Why current publication practices may distort science. PLOS Med. 2008 Oct 7;5(10):e201.