Homeopathy evidence

Re: Homeopathy evidence

Evelyn Barbour-Hill — Thu, 04 Jun 2009 22:48:50 GMT

[quote user="Niall Taylor"] The "don't do something, just stand there" concept is something that is difficult for owners and vets alike to accept.[/quote]

The greyer such hair as one has left becomes, the more easily one's clients accept the advice that no medication is required.

Interesting phenomenon. Discuss.

Re: Homeopathy evidence

Evelyn Barbour-Hill — Thu, 04 Jun 2009 22:39:16 GMT

[quote user="Gillian Mostyn"]

Has noone else ever seen a cat become septicaemic and die from lack of early presentation of a CBA?

[/quote]

In complete honesty, I have not. But I don't doubt that you have, and other people too. The point is, what that abscess should have had was drainage, not necessarily antibiotic.

A deep seated one in dense or complex tissue might sometimes need antibiotic, of course. And there's logic in giving an antibiotic to a recent bite or a cellulitis.

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 22:33:12 GMT

[quote user="John Hoare"]By the way, what are your thoughts on Mathie et al, Homeopathy (2007) 96, 27-34 "Outcomes from homeopathic prescribing in veterinary practice: a prospective, research-targeted, pilot study.[/quote]

I think this paper shows that a lot of conditions regress to the mean or spontaneously resolve. As I said before, a homeopathic consultation will often be made when the animal is at its worst, therefore it can be expected that there will be improvement in 2 consecutive appointments.

Alex

Re: Homeopathy evidence

Gillian Mostyn — Thu, 04 Jun 2009 21:42:55 GMT

Has noone else ever seen a cat become septicaemic and die from lack of early presentation of a CBA?

Re: Homeopathy evidence

John Hoare — Thu, 04 Jun 2009 21:38:24 GMT

[quote user="alex gough"] Shang 2005. the findings "are compatible with the notion that the clinical effects of homeopathy are placebo effects." Alex [/quote]

Hi Alex,

Reference, Shang 2005, have you read Rutten and Stolper Homeopathy (2008) 97,169-177 "The 2005 meta-analysis of homeopathy : the importance of post-publication data. Conclusion "A review of data provided after publication of Shang et al's analysis did not support the conclusion that homeopathy is a placebo effect. There was intermingling of comparison of quality and comparison of effects, and thus matching was lost. The comparison of effects was also flawed by subjective choices and heterogeeity. The result in the subgroup from which the conclusion was drawn was further influenced by the choice of cut-off value for 'larger' trials. If we confine ourselves to the predefined hypotheses and the part of this analysis that is consistent with the comparitive design, the only legitimate conclusion is that the qualityof homeopathy trials is better than that of conventional trials (p=0.03) as well as for smaller trials with n<100 (p=0.0030.

By the way, what are your thoughts on Mathie et al, Homeopathy (2007) 96, 27-34 "Outcomes from homeopathic prescribing in veterinary practice: a prospective, research-targeted, pilot study.

Best wishes

Jack

Re: Homeopathy evidence

John Hoare — Thu, 04 Jun 2009 21:09:47 GMT

[quote user="beldather"]Don't worry, you'll have company on the run. completely agree with you. There is currently an excellent ongoing attempt to create a study to assess this exact possibility (other possibilities for final study also on the cards)on VIN. Be interesting to see the result (both in ability of an internet forum to design and execute such a study, as well as the result itself).
Unfortunetely I do not have a big interest in homeopathy, so won't deal with it. If a client wishes to become involved they are welcome to go and find themselves a practioner to address that issue.

Regards

Blair[/quote]

Hi Blair,

Why not design it in such a way that 'no treatment', 'antibiotic treatment' and 'homeopathic treatment' could all be compared with each other; It would make an interesting comparison, although one would have to assume that all participants were recording actual observed results.

Good luck

Jack

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 19:52:24 GMT

[quote user="alex gough"]I have a client waiting, so later I will post a list of reasons why ineffective treatments might appear to work, and also some further papers re homeopathy.[/quote]

Those other papers:

Barnes et al 2007 - J Clin Gastro. The use of homeopathy for the treatment of post-operative ileus. Concluded that their analyses "do not provide evidence for the use of a particular homeopathic remedy or for a combination of remedies for postoperative ileus. Several drawbacks inherent in the original studies and in the methodology of meta-analysis precudle a firm conclusion." However, they found that homeopathic dilutions less than 12C which may have had some of the original substance present, had some effect, whereas dilutions greater than 12C, which would have had none of the original substance present, had none.

1999 - Vickers, Forsch Komplemtarmed

A systematic review of 120 preclinical investigations of homeopathy. The author found that lack of replication, severe metholodical flaws and contradictory results precluded any firm conclusion, but again cast doubt on the idea that extremely diluated homopathic remedies have biological activity.

2002 - Ernst, British Journal of Pharmacology

systematic review of all of the systematic reviews of homeopathy concluded that the published research does not support the use of homeopathic products. After 11 previous reviews were evaluated, the article concluded:

"Collectively they failed to provide strong evidence in favour of homeopathy. In particular there was no condition which responds better to homeopathic treatment than placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that best clinical evidence for homeopathy to date does not warrant positive recommendations for its use in clinical practice."

Jonas et al 2003. Homeopathy should not be substituted for proven therapies.

Shang 2005. the findings "are compatible with the notion that the clinical effects of homeopathy are placebo effects."

And finally, a paper showing why ineffective treatments catch on.

PLoS ONE. 2009;4(4):e5192. Epub 2009 Apr 15

From traditional medicine to witchcraft: why medical treatments are not always efficacious.

Tanaka MM, Kendal JR, Laland KN.

Evolution & Ecology Research Centre, School of Biotechnology & Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia. m.tanaka@unsw.edu.au

Complementary medicines, traditional remedies and home cures for medical ailments are used extensively world-wide, representing more than US$60 billion sales in the global market. With serious doubts about the efficacy and safety of many treatments, the industry remains steeped in controversy. Little is known about factors affecting the prevalence of efficacious and non-efficacious self-medicative treatments. Here we develop mathematical models which reveal that the most efficacious treatments are not necessarily those most likely to spread. Indeed, purely superstitious remedies, or even maladaptive practices, spread more readily than efficacious treatments under specified circumstances. Low-efficacy practices sometimes spread because their very ineffectiveness results in longer, more salient demonstration and a larger number of converts, which more than compensates for greater rates of abandonment. These models also illuminate a broader range of phenomena, including the spread of innovations, medical treatment of animals, foraging behaviour, and self-medication in non-human primates.

Alex

Re: Homeopathy evidence

Niall Taylor — Thu, 04 Jun 2009 19:51:49 GMT

[quote user="alex gough"]I suspect there are other reasons[/quote]

The only other that springs to mind is a variation on regression to the mean; the natural waxing and waning course of many diseases. Addison's disease, osteoarthritis, atopy and epilepsy could all fall into this category in veterinary species as well as diseases such as multiple sclerosis and rheumatoid arthritis in human medicine.

I'm sure Jack is correct in suggesting that many cases are treated unnecessarily in conventional medicine, that is a valid criticism. The "don't do something, just stand there" concept is something that is difficult for owners and vets alike to accept. But even if this is the case it has little bearing on whether or not homeopathy is effective.

Cheers,

Niall

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 19:28:44 GMT

Yes, it's entirely possible. Would be interesting to see trial results. Which is what I was saying anyway - things will often seem to get better because of an ineffective treatment, when in fact they would have got better anyway. This isn't just restricted to the complementary/alternative field. It is ridiculously easy to con ourselves into seeing an improvement when we want to believe we are helping, and the same applies to owners.

Alex

Re: Homeopathy evidence

beldather — Thu, 04 Jun 2009 19:02:42 GMT

[quote user="Evelyn Barbour-Hill"]It's my opinion (no trials, no controlled studies, sorry) that for most cat abscesses an antibiotic course is completely unnecessary and has no effect on the time to heal. (Runs for cover.....)[/quote]

Don't worry, you'll have company on the run. completely agree with you. There is currently an excellent ongoing attempt to create a study to assess this exact possibility (other possibilities for final study also on the cards)on VIN. Be interesting to see the result (both in ability of an internet forum to design and execute such a study, as well as the result itself).
Unfortunetely I do not have a big interest in homeopathy, so won't deal with it. If a client wishes to become involved they are welcome to go and find themselves a practioner to address that issue.

Regards

Blair

Re: Homeopathy evidence

Evelyn Barbour-Hill — Thu, 04 Jun 2009 18:34:23 GMT

[quote user="alex gough"]For example, most cats will get over a cat bite abscess eventually, but most of us would want to give antibiotics to speed the process up. [/quote]

I know, it's me going off thread (oo 'eck) but I suppose my point is that nothing is ever as simple as we would wish:

It's my opinion (no trials, no controlled studies, sorry) that for most cat abscesses an antibiotic course is completely unnecessary and has no effect on the time to heal. (Runs for cover.....)

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 17:35:25 GMT

[quote user="alex gough"]I have a client waiting, so later I will post a list of reasons why ineffective treatments might appear to work, and also some further papers re homeopathy.[/quote]

As promised. Ineffective treatments might appear to work because of:

1. Incorrect diagnosis

2. Concurrent treatment

3. Placebo effect

4. Owner/client/patient/physican wishful thinking

5. Self-limiting diseases

6. Regression to the mean (often a client will seek help from an alternative practitioner when conventional medical treatment isnt helping, and the disease process is at its worst. In fact many disease processes fluctuate and get worse and better, so chances are the disease will be at its nadir at the time of the CAM consult, and will be about to get better anyway. A similar logic can be applied as to why football teams seem to do better after sacking their manager. This is often because the teams have been through a run of bad luck, ie outliers on their results, so the manager is sacked when the club is at its worst, and chances are they things would have improved anyway due to random chance. Put even more simply, if you toss a coin 10 times and get 10 tails, then you could conclude the coin is rigged and change coin, and then get a more even spread in the next 10 tosses of some heads some tails. But in fact by chance you would probably have got that anyway).

I suspect there are other reasons, Niall probably knows some, but those are just off the top of my head.

alex

Re: Homeopathy evidence

Niall Taylor — Thu, 04 Jun 2009 16:28:15 GMT

[quote user="John Hoare"]80% of clinical cases, including pyometritis cases and severe ear infections will respond to homeopathic treatments alone.[/quote]

Hello Jack,

I'd be interested to learn where the 80% figure comes from. Also, in what sense is the word "respond" being used here as there could be various interpretations of what that word can mean (eg some might assume "cure", others "temporary remission" etc)?

Cheers,

Niall

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 14:05:28 GMT

[quote user="John Hoare"]Do I take it from your reply that you regard pyometritis and severe ear infections as 2self-limiting diseases"?[/quote]

Potentially some very serious infections can improve on their own, although the animal may go through some suffering, or even die, before that happens. But there are other reasons why a serious condition can appear to get better when given an ineffective treatment. Incorrect diagnosis is a common reason why malignant cancers appear to get better, although in fact there is a small but significant percentage of people diagnosed with terminal cancer who survive, and this is without unconventional treatments. Similarly, some people can remain HIV positive lifelong without developing AIDS, whether or not they take homeopathy.

Another reason is concurrent treatment. For example, with your pyometra's that got better with homeopathy, did they have ovariohysterectomy? Antibiotics? Intravenous fluids? If not, were they actually septic? Did they have a large pus-filled uterus with elevated acute phase proteins and white cell counts, and signs of shock, or did they just have a vaginal discharge?

Alex

Re: Homeopathy evidence

John Hoare — Thu, 04 Jun 2009 12:20:38 GMT

[quote user="alex gough"]

[quote user="John Hoare"]

As I said before, if homeopathy does not work, then we as a profession are grossly over-treating our patients. 80% of clinical cases, including pyometritis cases and severe ear infections will respond to homeopathic treatments alone.

[/quote]

I agree there are a lot of self-limiting diseases out there, which will appear to respond to homeopathy. Whether they would get better more quickly with conventional treatment is the more important question. For example, most cats will get over a cat bite abscess eventually, but most of us would want to give antibiotics to speed the process up.

[/quote]

Hi Alex,

Do I take it from your reply that you regard pyometritis and severe ear infections as 2self-limiting diseases"?

Jack

Re: Homeopathy evidence

Alex Gough — Thu, 04 Jun 2009 09:18:57 GMT

[quote user="John Hoare"]Kleinenet al BMJ 1991(302:316-323 reviewed 107 trials of which 77 were positive for homeopathy. Of the 22 most rigourous trials 15 were positive. Amongst the conclusions was the masterful statement "The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would be ready to accept that homeopathy can be efficatious,if only the mechanism of action was more plausible. (my italics.) In other words they could not bring themselves to believe what their findings told them.[/quote]

To quote further from this paper - "At the moment, the evidence of clinical trials is positive, but not sufficient to draw definitive conclusions because most trials are of low methodological quality, and becase ofthe unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homeopathy, but only by means of well performed trials." and "Critical people who do not believe in the efficacy of homeopathy before reading the evidence presented here probably will still not be convinced; people who were more ambivalent in advance will perhaps have a more optimistic view now, whereas people who already believed in the efficacy of homeopathy might at this moment be almost certain that homeopathy works." In a later letter the authors noted that "The results of our review would probably be interpreted differently if laboratory studies showed convincing evidence that there is some action of high potencies."

[quote user="John Hoare"]Lindt et al; 1997; Lancet (350:834-843) Are the clinical effects of homeopathy placebo effects? Ameta analysis of placebo controlled trials. They assessed the results from 89 trials, covering 10,500 patients and concluded that the clinical effects of homeopathy could not be explained soley by the placebo response and that more research is needed..[/quote]

LInde et al said "the results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single condition." Also, "our study has no major implications for clinical practice because we found little evidence for the effectiveness of any single homeopathic approach on any single condition." A critic pointed out that when the best trials were examined, the odds of a positive effect on the therapy was distinctly lower than in the overall study. Another critic noted that negative trials were less likely to have been published which would have skewed results. Finally, in a later study, the lead author himself noted in a later analysis, which evaluated study quality on outcome in placebo-controlled trials of homeopathy, that his original study "at least overestimated the effects of homeopathic treatments."

[quote user="John Hoare"]I would be interested to learn of the experience that taught you that homeopathy does not work, and which course you went on to study homeopathy. [/quote]

I've been interested in homeopathy for about 12 years now, have read a large number of papers, debated with homeopaths, read all the correspondence in the Vet Times, spoken to owners of animals treated with homeopathy, and have also read the textbook of veterinary homeopathy by saxton and gregory, as well as several human books on the subject.

[quote user="John Hoare"]

[/quote]

[quote user="John Hoare"]

By the way, can you explain how the placebo effect works in anaesthetised animals when the owner who knows and is agreeable to my use of homeopathic methods is not present?

[/quote]

There are a large number of reasons why a homeopathic treatment may appear to work when it doesn't, the placebo effect being just one.

I have a client waiting, so later I will post a list of reasons why ineffective treatments might appear to work, and also some further papers re homeopathy.

All the best,

alex

Re: Homeopathy evidence

John Hoare — Wed, 03 Jun 2009 22:04:38 GMT

[quote user="alex gough"]

There are numerous meta-analyses that show that homeopathy is no better than placebo. This is generally accepted in the medical and scientific communities now, whereas there is still some controversy over things like acupuncture and herbal medicine.

[/quote]

Hi Alec,

I would challenge your use of the wod "numerous".

Kleinenet al BMJ 1991(302:316-323 reviewed 107 trials of which 77 were positive for homeopathy. Of the 22 most rigourous trials 15 were positive. Amongst the conclusions was the masterful statement "The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would be ready to accept that homeopathy can be efficatious,if only the mechanism of action was more plausible. (my italics.) In other words they could not bring themselves to believe what their findings told them.

Boissel et al 1996, Report to European Commission, Brussels. Homeopathic Medicine research group, Chapter 11: (195-210).

This was a critical literature review on the effectiveness of homeopathy: overview of data from homeopathic medicine trials. An analysis of trials with clearly stated primary outcome measure. 15 trials using 2000 patients were analysed. Boissel asked the question "Does Homeopathy have an effect?". His answer was "Positive, but further reseach is needed.

Lindt et al; 1997; Lancet (350:834-843) Are the clinical effects of homeopathy placebo effects? Ameta analysis of placebo controlled trials. They assessed the results from 89 trials, covering 10,500 patients and concluded that the clinical effects of homeopathy could not be explained soley by the placebo response and that more research is needed..

The meta analysis that showed a negative response was Shang et al, Lancet 2005; 366; 726-732. It was however extremely flawed. For a full analysis of its flaws see the 8 letters in Homeopathy 2006: 95; 51-64.

I would be interested to learn of the experience that taught you that homeopathy does not work, and which course you went on to study homeopathy. It goes right against my experience. As I said before, if homeopathy does not work, then we as a profession are grossly over-treating our patients. 80% of clinical cases, including pyometritis cases and severe ear infections will respond to homeopathic treatments alone.

By the way, can you explain how the placebo effect works in anaesthetised animals when the owner who knows and is agreeable to my use of homeopathic methods is not present?

Best wishes

Jack

Re: Homeopathy evidence

Alex Gough — Wed, 03 Jun 2009 21:04:25 GMT

I totally agree Matthew with regards to herbal medicine. There is an implication that "natural" means "safe", and I was quite shocked to realise how toxic tea tree oil could be to cats, which I found out when I had a cat die from a natural flea product containing this. Of course that is a single anecdotal case, and I cant say for sure that it was the tea tree oil, but the VPIS had had previous toxic cases from this product. However, herbal products may have some efficacy, although often the research is lacking, and there are numerous products that have crossed from alternative to conventional medicine such as bear bile (ursodeoxcycholic acid), milk thistle, foxglove (digitalis) etc.

However, I must defend homeopathy regarding its safety. In case you arent familiar, homeopathy involves choosing a drug/chemical/toxin on the basis of the symptoms it produces when taken (a process known as proving). On the basis that like cures like, which is taken as a given in homeopathy, although generally not borne out practically elsewhere, this drug/chemical/toxin is given to treat conditions that produce similar symptoms. However, this is obviously dangerous, so the founder of homeopathy, Samuel Hahnemann, invented the hypothesis that the more dilute the toxin/drug the more powerful it became. So most homeopathic preparations contain some sugar with no active ingredient. This explains why they are both safe and inefficacious. however, homeopaths would disagree with me on both points. Obviously they claim to have seen cases get better with homeopathy. But they also claim that when a patient gets worse when treated with homeopathy, this is proof of the efficacy of the product, because the patient is undergoing a "healing crisis" (Hering's Law).

So - I think homeopathy is safe and no better than placebo. Homeopaths think there are risks associated with its incorrect use, and that it is effective at treating a wide range of diseases (although they tend to be mild and self-limiting diseases).

Alex

Re: Homeopathy evidence

ms1083 — Wed, 03 Jun 2009 19:36:42 GMT

I am not going to comment on wether homeopathy or herbalism works. My feeling, however, is that as vets it is important we know the long term effects of any drugs we use and it is not ethically correct to use them if we do not. We have no idea on their safety, their correct dose or whether it causes any neurological/emotional effects. Unlike humans, animals can not speak to tell us so we are totally relient on properly planned and evidence based scientific research. I do not believe that we can simply extrapolate human medicine to animals as they are not humans - take paracetemol in cats vs dogs for example! Far more trustworthy critically reviewed science research is required before I even think of using these drugs.

Re: Homeopathy evidence

The SkepVet — Wed, 03 Jun 2009 16:36:55 GMT

Some USA human doctors sell homeopathic gas pills out of their waiting rooms. Calcium carbonate is promoted as a base for dilution which is the active ingredient not the homeopathic woo woo words listed on the box that comes before "in a calcium carbonate base". Tums "for the tummy" is sold in the USA which is calcium carbonate. I am not sure what the mark up would be for the homopathic gas pills. When I saw homeopathic pills in my MDs waiting roome I just changed physcians and checked to see if I could report the MD. Sad to say the FDA grandfathered in homeopathic medicine when it was started. Its not enough for the standard of care to be evidence based. Laws also need to be based on science. If a patient is handing out money, some doctors are going to get in line unless there is a law against doing so.

art malernee dvm

the SkepVet

Re: Homeopathy evidence

Alex Gough — Wed, 03 Jun 2009 15:36:09 GMT

[quote user="alex gough"]I would disagree that there is an overwhelmingbody of research to suggest that it is no better than placebo. [/quote]

[quote user="alex gough"]I would also suggest that those vets who are now practicing homeopathy have already re-examined their beliefs. Thery all began their veterinary career as 'conventional vets' and took on board the conventional view that homeopathy could not and did not work. Then some event occured which led them to re-evaluate their beliefs, look into the subject , tentatively try it out, and as they found that it worked they began to use it more and more.[/quote]

Well my journey went from being curious about homeopathy, to finding out whether it worked, to realising it didn't work, and now I am mainly curious about why intelligent, scientifically educated people believe in it. The reasons for this are complex and quite fascinating to my mind, and include: a failure to understand how personal experience can mislead one into erroneous conclusions (and this applies to everyone, not just alternative medicine practitioners); a recent mathematical model suggesting that ineffective therapies actually have a better chance of spreading in a society than effective ones; various logical fallacies, the post hoc one being the most common etc.

I am happy to debate the subject, although it would be lovely if the debate was more civil than the RMB debate.

alex