How is it possible to believe in homeopathy?

Re: How is it possible to believe in homeopathy?

Niall Taylor — Thu, 05 May 2011 15:54:01 GMT

[quote user="Rose Perkins"]Hi,

Know its been a while but any chance you have the details of those studies? I have to write an essay on placebos in veterinary medicine for my certificate and am struggling to find articles!

Thanks[/quote]

Hi Rose,

You are not the first to reason that looking at studies of homeopathy is an excellent way of investigating the placebo effect

There is a web site here http://www.rationalvetmed.org/ which critiques a number of studies, mostly human put forward in favour of homeopathy which might help you. If you let me know which studies you are interested in I'm sure I could find the details you need.

Cheers,

Niall

Re: How is it possible to believe in homeopathy?

Rose Perkins — Thu, 05 May 2011 15:37:40 GMT

Hi,

Know its been a while but any chance you have the details of those studies? I have to write an essay on placebos in veterinary medicine for my certificate and am struggling to find articles!

Thanks

Re: How is it possible to believe in homeopathy?

Sandy Edwards — Fri, 20 Aug 2010 23:53:09 GMT

[quote user="Arlo Guthrie"]

In an email to me, posted on another thread, Dr Ben Goldacre, the investigative journalist and author of 'Bad Science' stated:

"...homeopathy is demonstrated in meta-analyses of the most fair tests to perform no better than placebo"

Subsequently, Roger Meacock said:

"For me it is just a matter of time before the ability of science to measure homeopathic effects in an undisputable and verifiable way emerges and reaches popular awareness."

Roger (or anyone else who is knowledgeable on the subject of homeopathy), I am struggling with the contradiction between what I understand to be the fact stated in the first quote above and the hope/belief expressed in the second.

What I mean is that surely, if science DOES find a way to measure homepathic effects beyond placebo, the results of existing meta-analyses means that any such effect is going to be so small as to render homeopathy worthless in modern medicine.

In other words, if homeopathy actually DOES work to any substantial degree, surely the existing studies would have shown the benefits conclusively already.

[/quote]Hi enjoyed seeing you play with your band tonight at the end of newsnight tonight , you should upgrade your photo though your a lot greyer now lol

Re: How is it possible to believe in homeopathy?

Colin Cameron — Fri, 20 Aug 2010 16:41:05 GMT

[quote user="Daniel Furey"]Some time last year, hundreds of students gathered outside various Boot's stores and drank as much of a sleeping remedy as possible. To the best of my knowlege none of them died.[/quote]

Did they sleep well that night, or were they too busy passing the water?

Re: How is it possible to believe in homeopathy?

Niall Taylor — Thu, 19 Aug 2010 22:25:07 GMT

http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4126832&c=2

Ten PCTs pull NHS funding for homeopathy 19 Aug 10

By Lilian Anekwe

A prescribing advisory group covering ten PCTs has stepped in to prevent commissioners from funding homeopathic treatments, claiming the effects are not significant enough to warrant NHS cash.

The ruling by prescribing advisors in Manchester follows the Department of Health's decision last month to reject the Science and Technology Committee's call for a national ban on NHS funding for homeopathic treatment. The DH said that it was instead up to local commissioners to decide whether requests should be funded on a 'case-by-case basis'.

The Greater Manchester Medicines Management Group (GMMMG) has told PCTs and commissioners across the region that homeopathic treatments cannot be recommended, as an independent review commissioned by another trust, NHS West Kent, found they are neither clinically nor cost effective.

Tim Evans, chair of the GMMMG and chief executive of NHS Bolton, told Pulse he was keen not to appear to be wasting NHS resources.

'We are trying to standardise our approach across Greater Manchester so that we don't have postcode prescribing. We want the public to know that we are making conscious decisions about what our priorities our for NHS funds,' he said.

'The review concluded homeopathy does not have a significant enough impact to warrant the use of NHS funds, and that PCT resources should instead be directed toward other treatments.'

'The prescribing, referral and recommendation of homeopathy is a low priority and cannot be supported.'

Cheers,

Niall

Re: How is it possible to believe in homeopathy?

Daniel Furey — Thu, 19 Aug 2010 20:49:28 GMT

[quote user="Colin Cameron"]Has this water been skaken sufficiently and been tested for efficacy and safety!!!!![/quote]

Some time last year, hundreds of students gathered outside various Boot's stores and drank as much of a sleeping remedy as possible. To the best of my knowlege none of them died. Does this count as testing for safety or would that be too anecdotal?

And it is little wonder that no good trials exist for veterinary homeopathy- if the remedies carry a licence anyway why would anyone bother? Regardless of what you think of homeopathy, there's no way a system like that can be defended. Does human medicine have the same problem?

Re: How is it possible to believe in homeopathy?

Colin Cameron — Thu, 19 Aug 2010 17:47:54 GMT

Has this water been skaken sufficiently and been tested for efficacy and safety!!!!!

Re: How is it possible to believe in homeopathy?

Niall Taylor — Thu, 19 Aug 2010 12:21:09 GMT

[quote user="Colin Cameron"]Does this wording not suggest that these products actually do something to solve the disease under treatment.[/quote]

For clarity I was using the jargon homeopaths themselves use. A corrected form of words would be:

Instead of "human homoeopathic remedies" would be "water"

... and

Instead of "veterinary homoeopathic remedies " would be "water"

Apologies for the confusion.

This is supported by Ms Kate Chatfield of the Research Ethics Committee of the Society of Homeopaths who, when asked by Lord Broers at a recent House of Lords enquiry (http://www.publications.parliament.uk/pa/ld200607/ldselect/ldsctech/166/7022105.htm - Q 538) whether it was possible to distinguish one homeopathic remedy from another, replied "only by the label".

Niall

Re: How is it possible to believe in homeopathy?

Colin Cameron — Thu, 19 Aug 2010 00:58:01 GMT

[quote user="Niall Taylor"]human homoeopathic remedies[/quote]

[quote user="Niall Taylor"] veterinary homoeopathic remedies [/quote]

Does this wording not suggest that these products actually do something to solve the disease under treatment. Should these products therefore not be subject to the same scrutiny as conventional drugs in that to say they are remedies should require some evidence of efficacy? I am still waiting for any Veterinary Homeopath to answer my original posting

Re: How is it possible to believe in homeopathy?

Niall Taylor — Sat, 14 Aug 2010 12:39:35 GMT

[quote user="Daniel Furey"]It begs the question why these changes came about at the last minute though. What made them change their minds?[/quote]

That's a very interesting question and one that has caused a lot of head scratching in certain quarters!

There are enormous vested interests at play here. The are obviously a number of vets practicing homeopathy as all or part of their business who would no longer have been able to do so legally - presumably they would have lobbied. Then there is the very influential organic sector who positively endorse the use of sugar tablets in lieu of real drugs in the treatment of disease in livestock. The soil association in particularly has a powerful lobby in the more exalted circles of power.

Then there is the possibility of other, more underhand pressure - a lot of important and influential people are very pro-homeopathy and it's not beyond the realms of possibility that there has been some influence on our lords and masters in that respect. Steve Dean of the VMD seemed in particular to do a rather dramatic about face. One moment he was writing to the Vet Times in April 2005 saying "Currently, there are no authorised veterinary homoeopathic remedies in the UK. Authorised human homoeopathic remedies can, however, be used by a veterinary surgeon under the prescribing cascade, provided there is no alternative authorised veterinary medicinal product", [http://vetpath.co.uk/voodoo/vettimes5.html#dean3] the next all was silent.

So after a pretty unequivocal statement that homeopathy can't be used if there are proper alternatives available we heard nothing. The next thing was that the 2005 regulations came out with homeopathic remedies being given 'grandfather' rights and a special exemtion from the need to prove they work or that they are safe. Were the veterinary bodies 'got at' in any way? Dunno, noone is saying, but a few of us are perusing the honour's lists every year with great interest!

It is known that Prince Charles tried, highly unconstitutionally, to influence the outcome of the recent Parliamentary committee discussion of NHS funding of homeopathy (http://tiny.cc/niagj). I'm only saying!

[quote user="Daniel Furey"]Did they come across evidence that it works?[/quote]

Not atall, remedies had to be excluded from the requirement to provide evidence in order to fit them in to the regulations.

[quote user="Daniel Furey"]Is there anything to stop someone releasing a "remedy" that really is just water/sugar/whatever and hasn't gone through the whole succession business?[/quote]

I can do no better than to quote paragraph 128 of the report of the parliamentary sub-committee discussing the funding of homeopathy:

"The absence of a requirement to show evidence of efficacy means that the MHRA’s current arrangements would allow a person to seek, for example, a licence for a confectionary product as long as he or she persuaded a number of people that it was a homeopathic product with therapeutic effects. Such a development would, rightly, bring the licensing arrangements into disrepute."

And that is exactly the position that the VHD has put itself in by its backward step in enshrining the veterinary regulations in their current form. The point is, once you've done away with the need for evidence, the field is open for anyone to claim anything they like is a legitemate therapy. Why stop at homeopathy?

Cheers,

Niall

Re: How is it possible to believe in homeopathy?

Daniel Furey — Sat, 14 Aug 2010 11:46:41 GMT

I stand corrected.

It begs the question why these changes came about at the last minute though. What made them change their minds? Did they come across evidence that it works?

It does pretty much put to bed the idea of some conspiracy by Big Pharma though (how I hate that terminology)

Another thought, have I got that right or can a remedy be licensed as long as it makes no specific claims as to what it treats- in which case no proof of efficacy is needed. Is there anything to stop someone releasing a "remedy" that really is just water/sugar/whatever and hasn't gone through the whole succession business?

Re: How is it possible to believe in homeopathy?

Niall Taylor — Thu, 12 Aug 2010 20:03:52 GMT

[quote user="Daniel Furey"]

I'm not sure its a loop hole. Homeopathic solutions aren't veterinary medicines so they aren't subject in the jurisdiction of the VMD. I have a feeling its the same for neutraceuticals, though I'm not sure on that.

Not to say that they shouldn't have any regulation, but exactly why should they be made illegal anyway?

[/quote]

Homeopathic remedies do come under the auspices of the VMD and at one point were nearly excluded from use under the cascade. At the last minute as the latest round of legislation was being developed an exception was made and homeopathic remedies were granted a special license under the regulations so that they could have the same status as real drugs but they are exempted from the need to demonstrate effectiveness or safety as real drugs are. Hom vets can now legitimately use them as first line instead of, say antibiotics and hom vets can claim that their remedies are "approved by the VMD" thus dragging the whole process even further into disrepute.

See page 11 of this document to see what an easy ride homeopathy has been given by our governing body:

http://www.rcvs.org.uk/shared_asp_files/uploadedfiles/rcvs/ee2f6576-688f-4bf0-9e79-ec51ecda1260_an25_vmrs.pdf

Also page 42 of this the veterinary medicines regulations (2010 draft) - http://www.vmd.gov.uk/publications/consultations/VMR10/amendedregs_clean.pdf

And this leaflet obligingly prepared by the VMD about homeopathy - http://www.vmd.gov.uk/publications/consultations/VMR10/VMGN09.pdf

Homeopathic remedies should be excluded from the cascade because they are unable to prove efficacy or safety in the same way that all real drugs do. Prescription regulations should have nothing to do with them.

Niall

Re: How is it possible to believe in homeopathy?

Daniel Furey — Thu, 12 Aug 2010 18:43:01 GMT

Not to say that they shouldn't have any regulation, but exactly why should they be made illegal anyway?

Re: How is it possible to believe in homeopathy?

Simon Neuhoff — Thu, 12 Aug 2010 12:27:33 GMT

Surely the real question is "how the hell is (veterinary) homeopathy still legal?". Especially given the furore re the cascade etc - why are the VMD not coming down on homepaths? What loophole is being exploited or are they simply being ignored?

Re: How is it possible to believe in homeopathy?

Daniel Furey — Mon, 09 Aug 2010 21:19:48 GMT

Thanks. I'll have to read it in more detail tomorrow, only flicked through so far. But the way they randomised the control groups looks fairly sound as a first impression.

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Edit: Ok, plenty to say about that. Some aspects are good, some...not so good The "grading" of diarrhoea is about as vague and badly done as it possibly could be. I'd go into detail, except

a. I'm not sure anyone is really reading this

b. The following excerpt really irritates me:

[quote user="Paper"]Faeces samples were taken from three different litters and sent as a mixed sample to the lab of the Animal Health Service, Deventer for identification. Faeces were cultured to identify enteropathogenic E. coli, E. coli K99 and Salmonella. None of these were identified as present in the faeces sample.[/quote]

Emphasis mine. This isn't out of context- this is the only time the paper even mentions culturing for the bugs in question (apart from one short sentence which mentions E.coli contributing to the piglet mortality- but the paper did not bother to find a positive result to confirm this, nor say what strain or how they knew it was there). Before writing a study about the effects of homeopathy on E.coli, surely you should keep testing until you can actually prove it is actually there?

So how to decide if it's E.coli or not?

[quote user="paper"]Scours from E. coli bacteria were distinguished on the basis of colour and day of appearance.[/quote]

Because actually looking for E.coli in the piglets with diarrhoea would just be silly. They even exclude some positive diarrhoea results because it was the wrong colour (ugh...)

I won't patronise anyone by trying to explain why this is downright awful science.

What annoys me isn't the error itself, but the responses I got when I asked if (and how) they looked for E.coli:

[quote user="Roger Meacock"]Who said they didn't - you cannot diagnose E. coli diarrhoea without seeing if E.coli is there in the first place! [/quote]

[quote user="Roger Meacock"]I'm confused as to why you think they could possibly specify it as E. coli without checking? Your assumption seems to be that the people doing the trial are incompetent and have just decided to call all D+ as E.coli when there is no evidence that this is what has happened. [/quote]

Emphasis is mine again- for the irony rather than to prove a point.

Roger, I'm not going to assume you were lying to make the most of the fact that I hadn't read the paper- I'll give you some credit. But it seems to me you either hadn't read the paper properly, or did so a while ago and forgot some of the details.

That's fine, you weren't really quoting it as a reference, more using it as an example of a blind study in existence. But you could have at least said “I don’t really remember” or “I need to look again” rather than passionately defending something you could not have been sure about. I wouldn’t have wasted any time talking about it if you had. As it stands, I have wasted my time, and can’t help but feel slightly silly for doing so.

Re: How is it possible to believe in homeopathy?

Niall Taylor — Mon, 09 Aug 2010 18:30:34 GMT

[quote user="Arlo Guthrie"]I think the pig study is probably this one: Camerlink I, Ellinger L, Bakker EJ and Lantinga EA (2010) Homeopathy as replacement to antibiotics in the case of Escherichia Coli diarrhoea in neonatal pigs, Homeopathy, Vol.99 (57-62). [/quote]

The full paper is available for a limited period here - http://tinyurl.com/yh4dmxc. The same article in pdf form can be found here - http://tinyurl.com/28vhx3t.

Niall

Re: How is it possible to believe in homeopathy?

Daniel Furey — Sat, 07 Aug 2010 15:53:02 GMT

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Homeopathy (indeed any type of therapy) in a case with a hopeless prognosis is ethically rather sticky- if this discussion continues I’d like to talk about it in more detail later.

However, I have a few issues at the moment because I’m not really getting what I’d hoped for out of this discussion.

Please don’t question what I do clinically, because you only know what little I’ve told you. “don’t bother” is obviously paraphrasing, the actual answer is more longwinded and qualifies why I give the answer I do. I do explain that I recognise it works for some people, but hasn’t for me.

Outside the clinic I genuinely don’t know whether it works or not. I can see both sides of the argument (although I’m only discussing one side with you, you already know the other so what would be the point?). My personal opinion could affect my clinical opinions and advice in the long run (either by actively persuading people to try it, or blocking it entirely) but until I see it actually clearly working, or see that it absolutely doesn’t work I cannot take either stance. That is an end to the matter as far as you are concerned- it’s up to me to make my own mind from debating homeopathy itself, not debating what I currently do in practice.

You’ve made a couple of arguments for homeopathy that have been genuinely interesting, but these are all but lost in a sea of borderline personal attacks and accusations of bias and disrespect. Apart from tempting me to make crummy jokes (even your argument is homeopathic! Hahahasorry) it’s very boring. In this case, dilution definitely isn’t making it stronger.

As an example, read the following string of quotes:

[quote user="Roger Meacock"]It was an observation that you seemed to be singling out problems you perceive with a homeopathic journal that already exist in more conventional ones yet you weren't questioning the existence of those problems in mainstream journals.[/quote]

[quote user="Daniel Furey"]It's not a paper from a mainstream journal that’s under scrutiny.[/quote]

[quote user="Roger Meacock"]It's mainstream for homeopaths as it is their subject! Why disrespect it so much just because you don't understand it and/or it doesn't fit in with your belief system?[/quote]

If you cannot see why your response was disproportionate (same word, same context whatever you say) then I cannot see any good reason why I should continue debating this topic.

Additionally:

[quote user="Daniel Furey"]I’m not exactly wracking my brains here to find potential faults[/quote]

[quote user="Roger Meacock"]I do mind wracking your brain to find problems/questions where there are none[/quote]

Please at least do me the credit of actually reading what I write.

In regards to the pig paper, you’ve picked up and answered 2 questions, sort of (you didn’t answer my further question on where and how they measured the E.coli), out of many. I’ve already made clear several times that I can only read the extract, which is why I need to hear the answer to most, if not all the questions before I take the evidence at face value.

Telling me “there are no problems or questions” is not a good enough answer when I’ve just asked a bucket load of them. It might be fair to say there aren’t any questions without good answers, but the response I’ve had so far suggests otherwise.

Considering the passive-aggressive answers I’ve received on the paper-(one that isn’t even very important in the scheme of things, it is one paper, its flaws don’t disprove homeopathy), I must admit I’m apprehensive about asking anything that directly questions the subject. Here goes nothing I suppose.

You said earlier that if homeopathy were to be conclusively proved, conventional medicine would die a death when people realised they could be cured and not just have their symptoms suppressed. Ok, so homeopathy is the underdog here, and if more people used and understood it over medicine, it could be revolutionary.

But homeopathy came into being with Hahnemann around the 1800’s, and the idea of like cures like was around at least a few hundred years before that. Most of the staples of modern medicine- antibiotics (1920’s) anaesthetics (mid 1800’s) as well as the ideas about bacteria as a cause of disease (1905 I think) and viruses, even veterinary medicine as a whole, have all arisen after homeopathy came into being.

My question is, if you say homeopathy should be able to surpass these elements of medicine, how did any of them manage to arise in the first place? None of them had a free pass- each challenged what was- at the time- believed about medicine and had to prove themselves just as homeopathy did . So how did they become the norm whilst homeopathy remained the alternative?

Re: How is it possible to believe in homeopathy?

Roger Meacock — Thu, 05 Aug 2010 23:12:15 GMT

[quote user="Daniel Furey"]

[quote user="Roger Meacock"]Either way the client is happier that they've tried[/quote]

They generally aren’t if it doesn’t work.

[/quote]

I don't agree. If a hopeless prognosis has been given which is usually the reason why people seek out other options such as homeopathy then they are comforted by the fact that they tried even if it isn't successful.

You may not block referrals if your client insists but if your advice is "Don't bother" when they first ask it is hardly an unbiased opinion. If you don't sit on the fence (your description of your position) you have admitted a bias, so please don't cry foul when I remind you of this fact with regard to other aspects of your post. Given such a negative response to the first enquiry there are probably a number of clients who will go elsewhere anyway and just not keep you informed.

The difference between how I used the word mainstream wasn't to insinuate non-mainstream as inferior which is what I read in your post that you were doing.

[quote user="Daniel Furey"]I would if they were only measuring the amount and severity of diarrhoea, something an anthelmintic directly affects. It’s an even more valid question here as piglets often are treated with blanket anthelmintics. If these ones weren’t, good, but the study needs to tell us that. [/quote]

You are completely missing the point that a control group is treated exactly the same as the test group so the use of anthelmintics is not relevent provided the statistical difference between the test and control groups is due to the treatment on test because everything else is the same. As I said these people are scientists but you don't seem to be crediting them with any scientific understanding or ability.

[quote user="Daniel Furey"]I’m confused as to why they’ve specified E.coli if they’re not checking what type of diarrhoea is being suppressed[/quote]

I'm confused as to why you think they could possibly specify it as E. coli without checking? Your assumption seems to be that the people doing the trial are incompetent and have just decided to call all D+ as E.coli when there is no evidence that this is what has happened.

[quote user="Daniel Furey"]And if they think (and can prove) that all causes of diarrhoea become less frequent then why didn’t they say so. [/quote].

It's not rocket science - the clue is in the title. They ONLY looked at E. coli diarrhoea (which requires identifying it!) so how could they possibly make any conclusion about anything else? They'd be slated for extrapolating across but it seems they can't win either way!

[quote user="Daniel Furey"]Pardon me for having high standards.[/quote]

I don't mind high standards. I do mind wracking your brain to find problems/questions where there are none and over-complicating what is a very simple study and result to try to discredit the paper and using bias against the journal to question the validity of the study within it. All this on just the abstract! I'm not asking you to grant special status to the paper because it's homeopathic I just expect a reasonable approach with an open mind which I'm finding hard to see despite your claim of being open and unbiased.

Re: How is it possible to believe in homeopathy?

Daniel Furey — Thu, 05 Aug 2010 20:28:29 GMT

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[quote user="Roger Meacock"]Either way the client is happier that they've tried[/quote]

They generally aren’t if it doesn’t work.

[quote user="Roger Meacock"]If you advise against it but the client tries it anyway and it works then you lose face and credibility and possibly a client. [/quote]

I think this largely depends on my reaction after the success. I haven’t been in this situation in respect to homeopathy. I have in regards to a controversial surgical procedure, and being frank about my surprise and why I got it wrong doesn’t compromise my credibility, nor did it lose me the client.

Also do I really have to repeat myself and say I do not block referrals?

[quote user="Roger Meacock"]your biased opinion[/quote]

Disagreeing with you does not make me biased. Have I called you biased for disagreeing with me?

[quote user="Roger Meacock"]On the contrary... [/quote]

Good answer. It’s interesting that you don’t like homeopathic remedies being sold over the counter. Most doctors I speak to don’t like it very much either. I would consider it down to corporate greed rather than some convoluted conspiracy though.

[quote user="Roger Meacock"]...address the situation as to why the internal environment of the body favoured the pathogen[/quote]

What? It’s a pathogen- by its definition it is a bug that’s not supposed to be there. They’re living organisms that strive to compete, and are usually better at it than the native organisms. I consider my immune system to be pretty sturdy, but I’ve had an infection from a cat injecting (in its own special way) unfamiliar bacterial to an area where it shouldn’t be. What you say would be true if every infection was caused by commensals- and identifying why these particular infections flare up is just as important in medicine.

Oh come on. You used the exact same word to differentiate the journals not 2 posts ago. In fact in the very comment I responded to.

Nor is it a particularly bad word, come to think of it. My taste in music isn’t mainstream, but I don’t get ratty if people tell me that.

[quote user="Roger Meacock"]Who said they didn't - you cannot diagnose E. coli diarrhoea without seeing if E.coli is there in the first place! [/quote]

Then that’s a good start. So every piglet was shown to have a pathogenic E.coli- and no other infection- before diarrhoea was graded?

[quote user="Roger Meacock"]Do you usually question the validity of an antibiotic trial on the basis that it doesn't mention if an anthelmintic was given? I doubt it so why query it now[/quote]

You assume wrong (again). I would if they were only measuring the amount and severity of diarrhoea, something an anthelmintic directly affects. It’s an even more valid question here as piglets often are treated with blanket anthelmintics. If these ones weren’t, good, but the study needs to tell us that.

[quote user="Roger Meacock"]On the other side of that coin I expect you frequently prescribe pharmaceuticals in combinations that have never undergone trials in those combinations. [/quote]

Even if every possible trial existed, and was run by someone who didn’t have a stake in the right answer coming up, I’d never have time to read them all. But if I found a medicine was consistently not doing what it was supposed to, I’d want to see some solid proof before I tried it again. I’m not willing to treat homeopathy differently just because it’s “non-conventional”

[quote user="Roger Meacock"]You are expecting a greater burden of proof from a homeopathic trial[/quote]

No, I expect an equivalent proof. And not equivalent to a drug producer’s trial (which tends to be riddled with the same problems) but to a good, watertight study.

[quote user="Roger Meacock"]Conventional papers frequently specify a sub-type of E. coli, yet you criticise the paper for limiting to just E.coli[/quote]

Please read that again- I’m not criticising the paper for limiting to e.coli (and specifying the strain is important as most are commensals anyway). I’m confused as to why they’ve specified E.coli if they’re not checking what type of diarrhoea is being suppressed. And if they think (and can prove) that all causes of diarrhoea become less frequent then why didn’t they say so.

[quote user="Roger Meacock"]It would seem you are more interested in finding any way to discredit the paper rather than accept[/quote]

Pardon me for having high standards.

[quote user="Roger Meacock"]if you accept the paper as scientific evidence... [/quote]

I’m not exactly wracking my brains here to find potential faults. I’m by no means practiced at reading these kind of studies, so if I’m left with that many questions after one short extract there’s a problem. Again maybe most of those are answered by the full text, but if not then I would find it difficult to regard it as scientific evidence. It would be naive of me to do so.

You’ve already made it clear that you would be cross if I read the conclusion from a pharmaceutical trial and accepted it without questioning it. At the risk of repeating myself, why should I grant this trial special status just because it’s homeopathic?

Re: How is it possible to believe in homeopathy?

Roger Meacock — Thu, 05 Aug 2010 00:02:45 GMT

[quote user="Daniel Furey"]In a clinical setting I don't really have a choice but to take a side[/quote]

I disagree. I think a large number of vets give the advice to try it and see but also express the reservation that they'd be surprised if it works. I believe it's a win/win situation for you because if it works you haven't blocked it and if it doesn't work you already expressed the doubt. Either way the client is happier that they've tried. If you advise against it but the client tries it anyway and it works then you lose face and credibility and possibly a client. I agree with you however that it is important to refer to another MRCVS.

From what you say your biased opinion is based on what was probably a very short lecture that wasn't long enough to provide sufficient information to make a fully informed decision. I am pleased that you say your are open to have your mind changed but as I said in my last post it does require a lateral view of what we are currently taught in order to fully understand it.

[quote user="Daniel Furey"]You make the whole business sound like trial and error.[/quote]

On the contrary - if you look at a homeopathic materia medica and repertory the clinical observations are frequently far more detailed than you might currently record in your history taking and it is these fine attentions to detail that help indicate the appropriate remedy. Homeopathy done correctly is more complex than you might think and it is one of the reasons I'm not in favour of chemists stocking a small selection of remedies for people to choose off the shelf. It does homeopathy no favours but then if I'm being cynical I think it's one of the reasons why it's offered in that way.

With regard to infections the reason why they become a clinical issue in most cases is because the body's immune system failed to adequately do it's job and because the environment of the body was conducive to the infection. Antibiotics may kill the bacterial infection but does not necessarily deal with the lowered immunity or address the situation as to why the internal environment of the body favoured the pathogen. In many cases a bacterial pathogen population is reduced to below-clinical symptom level but concurrently selects for resistant bacteria that remain and will either cause "reinfection" at a later date in the same individual or may spread to others. Homeopathy and other alternative practices seek to return the body to an environment that favours the host rather than the pathogen and increases immunity that deals with the infection, naturally, in its entirety including those strains that would otherwise because multi-antibiotic resistant. It may or may not be a longer process but the long term result is better for all concerned.

[quote user="Daniel Furey"]It's not a paper from a mainstream journal that’s under scrutiny.[/quote]

It's mainstream for homeopaths as it is their subject! Why disrespect it so much just because you don't understand it and/or it doesn't fit in with your belief system?

[quote user="Daniel Furey"]that bias stems from the reputation of certain journals more so than the content,[/quote]

A rather weak basis for bias I might suggest. Not all who shout loudest or who are in the majority are right ....

[quote user="Daniel Furey"]I don't see how, or why, you could make a claim that E.coli diarrhoea was reduced if you didn't check to see whether or not it was there.[/quote]

Who said they didn't - you cannot diagnose E. coli diarrhoea without seeing if E.coli is there in the first place!

[quote user="Daniel Furey"]Were all the sows kept in the same way, or was there a mix? Were they all fed the same way? were any given anthelmintics. [/quote]

You make assumptions that are unreasonable that the study wasn't standardised in the same way as if an antibiotic was being tested. This trial was carried out by scientists not uneducated lay people. Do you usually question the validity of an antibiotic trial on the basis that it doesn't mention if an anthelmintic was given? I doubt it so why query it now? On the other side of that coin I expect you frequently prescribe pharmaceuticals in combinations that have never undergone trials in those combinations. This is the unfair playing field that is thrown in the face of anything non-conventional and then questions are asked as to why there aren't more trials for homeopathy etc being put forward?! You are expecting a greater burden of proof from a homeopathic trial than the vast majority of medics (both human and veterinary) currently practice by!

[quote user="Daniel Furey"]If the homeopathic remedy was effective against all diarrhoea, why specify E.coli? [/quote]

Conventional papers frequently specify a sub-type of E. coli, yet you criticise the paper for limiting to just E.coli - why the double standard? No claims were made for the homeopathic treatment as a blanket treatment for all diarrhoea because no doubt such a paper would have drawn criticism for not being specific enough! It would seem you are more interested in finding any way to discredit the paper rather than accept the scientific evidence that homeopathy can be used effectively to treat E. coli diarrhoea in piglets. I don't see the problem except that if you accept the paper as scientific evidence it undermines the idea that homeopathy doesn't work and the implication for you is that you can no longer say "Don't bother" with a clear conscience if a client asks you about trying it ....

I accept that it is a challenging concept and the implication is that there is a gap in the knowledge of non-homeopaths. It is human nature to try to discredit that about which we do not know but as with other aspects of veterinary practice it is possible for different branches of speciality to work together.

Re: How is it possible to believe in homeopathy?

Daniel Furey — Wed, 04 Aug 2010 22:32:33 GMT

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[quote user="Roger Meacock"]given that the thread title of this discussion is highly suggestive that homeopathy cannot possibly work and that is a common mis-understanding[/quote]

It wasn't me who wrote the title. If it was, it would probably read "why should I believe in homeopathy". I guess before I go on I should explain why I want to ask that question.

When I say I'm sitting on the fence, that is perhaps over simplified. In a clinical setting I don't really have a choice but to take a side, not least because "give it a try, at the worst it won't work" isn't the kind advice I should be paid to give. I don't actively stop clients from going to a homeopath (as long as they are also an MRCVS- more on that another time) but if pressed for my opinion, as it stands my answer is "don't bother"

I don't consider my opinion biased because it doesn't stem from any pressure or teachings, but from my mind and what I see in practice. during my training most of the information I was told about homeopathy came from people who practice it- in guest lectures and on EMS. Save for one rant about voodoo medicine on rotations, no lecturer has ever presented the counter argument.

In day to day practice my opinion isn't especially likely to be changed, because the doubts I have are not likely to be challenged. But then who's going to challenge them? The only homeopath (non veterinary) I can air those doubts to responds to any comment with vitriol and personal attacks, which is pointless and boring.

I would ask you to bear in mind that when I question homeopathy, I'm not trying discredit you or any other homeopath. I question in to see what response I get, to help me make up my own mind. Remember, if my mind could not be changed, I probably wouldn't be here talking about it.

I'll try to keep everything else short as that's been a bit wordy. I hope it makes sense.

[quote user="Roger Meacock"] it might mean that an important obstacle to cure was left in place instead of being removed as it would have been in a non-study clinical situation. As you may be aware, a seemingly simple clinical presentation in different individuals frequently requires a different remedy[/quote]

You make the whole business sound like trial and error.

[quote user="Roger Meacock"] It is not as straight forward as using say a broad spectrum antibiotic for a scour.[/quote]

That would be poor medicine anyway, unless you knew there was a salmonella infection present or similar.

[quote user="Roger Meacock"]The vast majority of the time pharmaceuticals suppress symptoms which is not the same.[/quote]

As a quick example, if I were to treat a lungworm infection with an anthelmintic, how exactly is that covering the symptoms? The dog gets better because it doesn't have lungworm anymore. You could say the same with any other infection or infestation, and a considerable chunk of my time is spent dealing with those kind of problems.

It's not a paper from a mainstream journal that’s under scrutiny.

[quote user="Roger Meacock"]There was no intention to insult you[/quote]

I was tired and took it more personally than I needed to- and I'll admit that you have a point in that I'd be more open to a study proving homeopathy if it was in, for example, the BMJ. Although that bias stems from the reputation of certain journals more so than the content, nor does it come from university (where the BMJ isn't really that relevant.)

[quote user="Roger Meacock"] I don't see why you have an issue with the abstract.[/quote]

I think my post has already dragged on a bit too long, so I'll make it brief

Issue one: I don't see how, or why, you could make a claim that E.coli diarrhoea was reduced if you didn't check to see whether or not it was there. How the piglets were kept would also be important- were they all mixed together or in separate units (where an outbreak of salmonella in the wrong unit could change the whole outcome). Were all the sows kept in the same way, or was there a mix? Were they all fed the same way? were any given anthelmintics. If the homeopathic remedy was effective against all diarrhoea, why specify E.coli?

Issue two: measuring length and severity- how was this done? It would be very difficult not to be subjective on this- how do you decide when scour starts, and when you count it as stopped (easy if it's on and off like a tap. sadly I suspect reality would get in the way of that). Was only one person in charge of marking every piglet every day (the only way it could be consistent, especially with something as open ended as severity). did whoever measured everything know which group was which? Did the person administering the remedies know which ones were the placebos.

Admittedly the full article may answer a lot of those points, but how many holes does it leave?

Re: How is it possible to believe in homeopathy?

Roger Meacock — Tue, 03 Aug 2010 22:40:08 GMT

[quote user="Daniel Furey"]I'm not saying conventional journals are any different. My point is I'm not willing to assume a homeopathic journal is any more reliable. It is just as likely to cherry pick as any journal.[/quote]

OK. Fair stance but given that the thread title of this discussion is highly suggestive that homeopathy cannot possibly work and that is a common mis-understanding then it is not unreasonable for a journal to favour positive studies and I don't see a problem with this because it is more informative for a homeopath to get information on what is useful in certain situations. Because of the process of practicing homeopathy a negative study does not imply homeopathy doesn't work in totality - it generally tends to mean that the wrong remedy was prescribed or that because trials only tend to like a single variable it might mean that an important obstacle to cure was left in place instead of being removed as it would have been in a non-study clinical situation. As you may be aware, a seemingly simple clinical presentation in different individuals frequently requires a different remedy. It is not as straight forward as using say a broad spectrum antibiotic for a scour.

[quote user="Daniel Furey"]It's a rather unfortunate typo as the actual sum is 4 million.[/quote]

A very small stick if not a twig then in terms of leverage and influence!

[quote user="Daniel Furey"]Those were really just extreme theoretical examples. No study could ever definitively prove either way. My point is, if a study could disprove the whole business, I doubt a homeopathic journal would print it.[/quote]

I don't see the point of using extreme theoretical examples. However you chose to single out that a homeopathic journal wouldn't publish such a paper and seemed to imply that a conventional journal would publish an equivalent article that disproved pharma. In reality I don't think either would publish something that was self-defeating to that degree and far more likely that the opposing journal would!

[quote user="Daniel Furey"]Also, medicine does cure conditions on a regular basis.[/quote]

I disagree. The vast majority of the time pharmaceuticals suppress symptoms which is not the same. It's the difference between removing the warning light on a dashboard compared to sorting the problem that causes the engine to overheat that switches on the oil temperature warning light.

[quote user="Daniel Furey"]That was a low attempt to discredit my opinion and I'm genuinely insulted. Unscientific bias? We're taught how to critically read a paper, albeit briefly.[/quote]

It was an observation that you seemed to be singling out problems you perceive with a homeopathic journal that already exist in more conventional ones yet you weren't questioning the existence of those problems in mainstream journals. There was no intention to insult you - I was simply pointing out a bias that I saw in your post. You have subsequently addressed that more after I questioned it and I welcome your position that are open to homeopathy proving itself although I don't see why you have an issue with the abstract. It isn't saying that all pig scour is caused by E.coli, it's just saying that the homeopathy was used on E-coli scours so as to minimise the variables that homeopathic papers keep getting slated for including. Your observation on why the numbers of E.coli were not quoted but rather the duration and severity of scour is not a problem. The presence of a pathogen is only a problem if the immune system cannot cope therefore the clinical presentation is far more relevent than the presence or not of the pathogen. That's where different thinking about disease is a fundamental difference.

Re: How is it possible to believe in homeopathy?

Daniel Furey — Mon, 02 Aug 2010 23:30:01 GMT

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Thanks for the reply.

I just want to throw this quote in again, to remind you exactly what I was questioning as I think it got lost in translation...

[quote user="Roger Meacock"]With homeopathy the individual remedies are of significantly less commercial value and on that basis the journal is far more likely to be more objective and true.[/quote]

I'm not saying conventional journals are any different. My point is I'm not willing to assume a homeopathic journal is any more reliable. It is just as likely to cherry pick as any journal.

[quote user="Roger Meacock"]I'd be surprised if the NHS budget for homeopathy was that high but it's still insignificant compared to the budget for pharma.[/quote]

So would I. It's a rather unfortunate typo as the actual sum is 4 million.

[quote user="Roger Meacock"]Wishful thinking but given the rest of your post it wasn't difficult to see which side of the fence you sit.[/quote]

I haven't told you what I think of homeopathy. I've told you what I think of the studies, it’s unwise to make that kind of assumption.

I'm actually sitting on the fence, and that is why I'm questioning rather than dismissing

[quote user="Roger Meacock"]Such a paper cannot exist because it is impossible to prove anything to that degree ... and given that homeopathy works it would obviously be a fix anyway.[/quote].

Those were really just extreme theoretical examples. No study could ever definitively prove either way. My point is, if a study could disprove the whole business, I doubt a homeopathic journal would print it.

Also, medicine does cure conditions on a regular basis. I'm not saying that because I think homeopathy doesn't (as I said, I'm not sure what to think yet). I say that because it seems a very peculiar statement.

[quote user="Roger Meacock"] it seems you are more open to accepting a conventional study in a mainstream journal rather than an equally well-researched paper on homeopathy in a homeopathic journal. Therein is the unscientific bias that the present teaching seeks to propagate ... and does so very successfully it seems![/quote]

That was a low attempt to discredit my opinion and I'm genuinely insulted. Unscientific bias? We're taught how to critically read a paper, albeit briefly. The paper I was given was so flawed it left me with the impression that I could never trust a reference until I had read it. It was a paper from the veterinary record. You only think there's a bias because I'm questioning (from your viewpoint) the wrong journal.

And I'm questioning that because you've told us to expect an "objective and true" study. I still can't find the full article sadly, but the abstract didn't fill me with confidence. Maybe I might feel differently about the full article, but that’s the whole point behind reading it and not just blindly accepting it.

Re: How is it possible to believe in homeopathy?

Roger Meacock — Mon, 02 Aug 2010 21:29:06 GMT

[quote user="Daniel Furey"]NHS budget for it is 4 billion[/quote]

I'd be surprised if the NHS budget for homeopathy was that high but it's still insignificant compared to the budget for pharma.

[quote user="Daniel Furey"]It would be rather naive to assume a homeopathic journal could be completely objective and without financial pressure on it to show more positive studies.[/quote]

What makes you think conventional Journals are any different from pressures. Indeed on a number of occasions results of adverse effects of drugs have been actively buried. Surely there's nothing wrong in showing positive studies provided that those studies are properly conducted and peer-reviewed. There seems to be a big push for a double-standard to be acceptable here - pharma and conventional journals can be biased towards their own paradigm and biased against homeopathy but homeopathy cannot put forward convincing well-researched papers to support homeopathy? Maybe the homeopathic journals should concentrate on publishing papers on the adverse effects of pharmaceuticals or is that not allowed either?!

[quote user="Daniel Furey"]what if a paper appeared in a homeopathic journal demonstrated once and for all that it didn't, and couldn't work? A whole industry- the same one the journal relies on, risks collapse. What journal could you really trust to be objective in those circumstances?[/quote]

Wishful thinking but given the rest of your post it wasn't difficult to see which side of the fence you sit. Such a paper cannot exist because it is impossible to prove anything to that degree ... and given that homeopathy works it would obviously be a fix anyway.

[quote user="Daniel Furey"]A study in the Lancet or BMJ that shows an indisputably positive result for homeopathy might have far reaching consequences- for a start I would advise people to try it, maybe even take the degree myself- but it wouldn't spell the end for conventional medicine. Not by a long shot, so there isn't really any pressure to avoid printing it.[/quote]

Unfortunately that's not likely to happen due to the financial pressures of the existing paradigm. That's the reality which is why homeopathy has it's own journals. Conventional medicine won't die over night for sure but once people get the idea that conditions can be cured instead of supressed then conventional medicine will certainly significantly decline.

[quote user="Daniel Furey"]I would be reluctant to take the results of any study as read if there is an obvious potential bias. Studies quoted by drugs reps are (or should be) taken with a pinch of salt as those studies usually have flawed methods or exaggerated results (or both). I would take the same cynical stance with the above paper- why should I treat it any differently?[/quote]

I can't fault your logic in doubting both but it seems you are more open to accepting a conventional study in a mainstream journal rather than an equally well-researched paper on homeopathy in a homeopathic journal. Therein is the unscientific bias that the present teaching seeks to propagate ... and does so very successfully it seems!

Re: How is it possible to believe in homeopathy?

Roger Meacock — Mon, 02 Aug 2010 20:55:24 GMT

[quote user="Arlo Guthrie"]

[quote user="Roger Meacock"] [quote user="Arlo Guthrie"]The problem is that if one of the main advocates for homeopathy on this site is unable to meet scepticism with solid references, it fosters the idea that homeopathy is quackery.[/quote]Arlo - that's not good logic.[/quote]

Doesn't need to be. It's just how I feel.

[/quote]

That doesn't hold any water at all. The references exist (you found one of them!) which is why it maybe inconvenient but not relevant to their existence if I can quote them or not.

[quote user="Arlo Guthrie"]However, the difference is that the fundamentals in the other paradigms are (largely) already proven. So, for example, we know vaccines work, and a study now might concern whether a specific new vaccine works. Reviewers of such a study would not expect to be biased by the need to prove the central point that vaccination works.[/quote]

No they're not proven beyond doubt by any means - the paradigm that is currently dominant teaches that the same paradigm is proven because it self-perpetuates the status quo. Vaccines are a good example as they are not universally accepted in their current form as you suggest although the dominant paradigm presently teaches as you quote. The inventor of the human flu vaccine stated he would not have it himself and a study in 2006 concluded the human flu vaccine has no statistically significant efficacy. There are those within the vaccine industry now questioning the ability of the immune system to cope with mass vaccination. Others now question whether we are swapping a relatively small risk of disease for significant levels of immune diseases such as allergies and auto-immune conditions. The fact that vaccines are not adequately tested because they try to argue they are a essentially safe highlights the dangers of such assumptions.

[quote user="Arlo Guthrie"]homeopathy is thus far completely unproven.[/quote]

No. Those who argue for homeopathy to be banned would have you believe so. The rest of us recognise that research is emerging to prove that homeopathy has proven benefit whether we understand the science fully or not. Peer review is as I said the objective assessment by those who understand and are expert in that field. As yet (to my knowledge) the Lancet and Vet Record etc do not employ homeopathic peer-reviewers capable of properly undertaking the peer-review process for homeopathic papers.