Meaning of properly trained

RE: Meaning of properly trained

Clare Tapsfield-Wright — Fri, 20 Apr 2018 11:04:14 GMT

To Mark Carpenter

I have made an effort to read all your posts with a open mind, and look at the evidence you have directed us towards, and you clearly believe in homeopathy and feel that you are a principled vet. I remain however completely unconvinced by the theories you propound and I think that you discount the evidence that does not agree with your chosen belief.

I live and have worked in a community where alternative therapies are very popular and I have seen many cases over the years where in my opinion well meaning owners have allowed their animals to suffer unnecessarily before seeking conventional veterinary attention. There is no doubt that animals have recovered after homeopathic treatment ( last week my own dog had colitis and responded to being given water and nothing else), and that owners respond and feel better to being listened to at length. The homeopathic consultation obviously provides something people want, and they want to believe in it. In my experience the same people who use homeopathy are also medicating their animals with all sorts of other remedies, conventional and otherwise, causing other problems and so simply the stopping all treatment and the passage of time can produce a positive outcome from a homeopathic consultation. Animals recovered from disease before the days of antibiotics and other medications and always will.

I think however that you really underestimate just how damaging it is to hold out false hope backed by poor science. I have been subjected to this, as has Arlo with his daughter, throughout my autistic son‘s life and it is not confined to homeopathy but every other supposed remedy or regime that offers a cure to those who are desperate. I think it preys on the grief of those who are faced with the loss of the child they thought they were going to have and who would do anything to make things better for them. How happy I would be if a non invasive treatment could make my son able to speak and make sense of the world around him and participate in human relationships. I would love it to be true and if I had given my son a homeopathic treatment the week before he said his first word at the age of six years I would have been tempted to believe in it. The fact is that it happened without external intervention and I have not exposed him to any medications whatsoever , or any weird intensive training programmes which might have made me personally feel better because I was doing something, but at what cost to him.

If consenting adults want to use homeopathy on themselves I have no problem with their choice, but not for those who cannot consent, or for animals who are in their owners care and in our care as veterinary surgeons and also at a financial cost to the owner who trusts us . I have less of a problem accepting and understanding why an untrained person would recommend faith healing or homeopathy rather than a fellow veterinary surgeon who has received a degree and the consequent right to practice veterinary treatment based on proven, research based, peer reviewed knowledge.

I support the RCVS statement that “any treatments not underpinned by a recognised evidence base or sound scientific principles do not delay or replace those that do” . That is the nub of the matter. I remain unconvinced by your arguments and think you should be as willing to open your own mind and contemplate the ramifications and unintended consequences of your own beliefs as you are to request that we do.

RE: Meaning of properly trained

Dinu Catilina — Fri, 20 Apr 2018 10:14:11 GMT

Mark, there is a slight confusion here. Yes, if you don’t do any orthopaedics then it’s difficult to comment on how a procedure was done but you should have no issues to check the literature for evidence on the procedure’s overall efficacy.

Its the same with homeopathy. Those who comment on it do not comment on how you make the dilutions but rather on their efficacy.

RE: Meaning of properly trained

Niall Taylor — Fri, 20 Apr 2018 09:10:56 GMT

[quote user="Mark Carpenter"]I would not comment on orthopaedic procedures... because I have had no more than basic training in these areas.[/quote]

Why not? If you found an orthopaedic surgeon was regularly employing a technique that the body of evidence showed to do more harm than good, you'd be perfectly within your rights to criticise them on that basis, regardless of how much orthopaedic surgery you performed yourself.

Besides, orthopaedic surgery is different. Orthopods use techniques which employ recognised principles and bones heal by a variety of well understood biological pathways. So it wouldn't be too much of a stretch to believe a specialist when they said their preferred technique worked without necessarily looking at the primary evidence for oneself. Homeopathy on the other hand claims pure water or sugar can cure disease by unknown means (purely speculative mechanisms notwithstanding). If someone is claiming that they can heal fractures or cure cancer (or teleport DNA) by that means then it is quite legitimate to insist on cast-iron proof rather than simply taking someone's word for it.

Niall

RE: Meaning of properly trained

Mark Carpenter — Thu, 19 Apr 2018 16:36:14 GMT

I need to repeat myself, this was not an attack, I do not and will never attack. This was a response to the name being offered as someone who was "properly trained in homeopathy", a name given by a third party, when the fact was that he had not been. Saying that someone was not trained in something is not an attack, Bob. Only if you want to see it that way. It was a response to a claim that was false. I can only repeat, I have utmost respect for Mike and for what he has done for the profession, and am sorry to have felt the need to comment on this at all, but this was as a result of his name being put forward incorrectly. As this site is offering a fantastic service in education of, and discussion between, veterinary surgeons, it is part of that discussion for a piece of false information to be respectfully challenged, and that is what I did. This could not have been done in any other way. If someone makes a false claim about a named individual which requires challenging, unfortunately that has already become "personal", but absolutely not of my choosing. I have absolutely no wish for a world of attacks, lacking respect and understanding. We are all veterinary surgeons; we all care about our patients and their welfare; probably most of us lose sleep when we feel there is more that we can do / should have done; we probably all started out as animal mad kids keen to spend a life helping them. We share so much, it is sad that there appears to be a concentration on the differences. Thank-you for your observations, Bob, and I hope you accept this response.

RE: Meaning of properly trained

Bob Russell — Thu, 19 Apr 2018 11:14:28 GMT

I attack homoeopathy not the individual homoeopath. I attack waving purple crystals anti-clockwise to reset the humors because I cannot see any scientific basis for a belief it may work.

With caution I can accept that acupuncture may work despite not understanding any mechanism. I had a shoulder injury improve after reflexology!!

I might have an open mind regarding homoeopathy if it was not for the mass of evidence that shows it is not effective.

This is the first time I have seen a specific clinician attacked on VetSurgeon in this way and I hope it will be the last.

RE: Meaning of properly trained

Mark Carpenter — Thu, 19 Apr 2018 06:17:31 GMT

Sorry you see it that way, Bob, truly. This was simply pointing out the facts, and was absolutely not a personal attack. I simply do not do that, it is the wrong way to achieve anything. As part of the group (and proudly so) who have been accused of witchcraft and black magic, and called charlatans, in the veterinary press, I know how it is to be attacked. Mike has contributed much to our profession, and has my admiration for doing so. My post simply reasoned why his being named as a trained homeopathic vet who then rejected it is, in my opinion, flawed. If you see nastiness in the post, then that is very sad, because that energy will never enter anything I post onto this site. I cannot repeat often enough that I respect everyone's choices, even when they may not agree with my own choices or experience, and I trust in the honesty of the motivations behind these choices, even if they may be potentially personally damaging to me. Even if a dog may try to bite you, he/she is simply seeking safety and love, but knows no other way to try to achieve it. Have a good day.

RE: Meaning of properly trained

Arlo Guthrie — Wed, 18 Apr 2018 19:10:09 GMT

[quote user="Bob Russell"]Veterinary Record 7 April 2018 Vol 182 No 14 page 407:

Significance of findings

the study contributes to extending current knowledge on the effectiveness of homeopathy ....

Homeopathy does not appear to be an effective treatment alternative for cases of mastitis.

No sh=t Sherlock![/quote]

At the danger of everyone suffering homeoapathy (sic), I struggle to get my head around the conclusions of this study.

I am not qualified to critique the study itself, so I don't personally know whether the results are solid or not.

Still, what perplexes me (and I've seen similar things in other papers too), is how on earth the authors could conclude this:

Despite designing the study carefully around the correct use of homeopathy in the current RCT, the homeopathic treatment method was significantly less successful in curing clinical mastitis compared with antibiotic treatment strategy. In culture-positive cases, the antibiotic treatment provided suboptimal bacteriological cures but was more effective than individualised homeopathy whose effects appeared little different to those of placebos. However, on the cytological cure level, all three treatment methods were similarly ineffective.

i.e. homeopathy doesn't work

and then follow that with this:

The use of individualised homeopathy is therefore only recommended under specific conditions inter alia: treatment of mastitis caused by specific mastitis pathogens in combination with antibiotics (complementary therapy), timely and regular follow-up checks, enough time for a homeopathic clinical examination, knowledge of homeopathic principles and use of homeopathic remedies as an initial treatment until culture results suggest other treatment methods.

I don't understand the rationale for saying that homeopathy is recommended under any conditions, if you have just shown it to be ineffective.

RE: Meaning of properly trained

Iain Richards — Wed, 18 Apr 2018 17:52:27 GMT

Re the testimonial, Orf is well recognised as a self-limiting disease, nit fully understood and with an imperfect vaccine. To claim a cure is to misunderstand the disease. Mike, as he say's, got lucky with the timing.

RE: Meaning of properly trained

Arlo Guthrie — Wed, 18 Apr 2018 15:08:35 GMT

[quote user="Mark Carpenter"] We all know your views, and mine are also clear, so there is no purpose on repeating them in different words[/quote]

On that we agree!

I think I will just close by saying:

[quote user="Mark Carpenter"]Your minds will not be moved whatever is offered;[/quote]

I think I can speak for my fellow campaigners in saying that is completely untrue. If good quality evidence emerges that homeopathy is effective, and not just the consequence of regression to the mean, false cause fallacy, confirmation bias, assessment errors and statistical anomaly, we will all do a complete and immediate U turn. And with great pleasure too. Wouldn't it be truly wonderful for humankind - and I mean this sincerely - if what is essentially water could cure cancer.

[quote user="Mark Carpenter"]I will not allow my experiences over nearly 30 years to be dismissed as placebo, fabrication, or illusionary[/quote]

Sure, some of your cases will have been placebo, even you must recognise that! In the same way that some cases treated with conventional medicine will respond due to placebo. The rest? I for one do not doubt your integrity for a second, and nor do I think you have been seeing illusions. I think you are simply mistaken, as I was when I believed beyond doubt my daughter had got better, many times, over many years.

[quote user="Mark Carpenter"]by a minority who lack basic understanding in the therapies I used[/quote]

Niall addressed this point eloquently earlier. One does not need to be trained in the therapies you use in order to have an informed opinion on their efficacy. However, I would argue that we all have much more than a basic understanding about homeopathy.

[quote user="Mark Carpenter"]I believe that the seed of mistrust you have sown into the profession is not beneficial to our clients, animal welfare, or the future of the profession. [/quote]

Here we diverge dramatically. If you try and put yourself in my shoes, and imagine you have concluded, after much research, that a form of treatment is totally and utterly ineffective. Worse than that, you see evidence that people using that form of treatment die earlier than they should. Perhaps you can imagine that being something you could feel quite passionately about?

Imagine then that you had a sick child, and people tried to sell you that same treatment you knew to be ineffective. Take it from me, it really is hair-tearingly frustrating. And then I think of the other parents in a similar situation to me who are perhaps a bit less questioning...

Can you understand that someone with that viewpoint could take quite the opposite view to you: that campaigning to reduce the use of such a treatment would be in the interests of human and animal welfare, and of a scientific profession?

All we can do is agree to disagree.

RE: Meaning of properly trained

Mark Carpenter — Wed, 18 Apr 2018 13:52:52 GMT

Thanks for your reply, Mike, I really appreciate it. This was, and is, in no way a personal attack - I have come to recognise those in the recent couple of years, and have no desire to get involved in that. I, too, have a lot of admiration and respect for all you have done within the profession, and have absolutely no desire, nor motive, to bring any discredit to your many achievements and contributions. This post was just a response to Arlo's naming you as an example of a properly trained homeopathic vet who did not find it useful in practice. That is it. Nothing more. I should add that when you first do a new procedure, it is more clumsy and it takes a while to get the best results. This applies to homeopathy very much, and at the time you worked for Richard, his was still a conventional practice as I understand it, and he, too, was in relatively early days of his homeopathic life. We all progress and get better whenever we continue to practice any art. In addition, the training has improved beyond recognition. As someone who went through the whole 3 years of training in London, then had 2 years at the HPTG, the contrast was enormous. Everything evolves when given the freedom to do so.

There is nothing to be gained in reigniting the touch paper when clearly we are so far apart; I, though, will always retain the belief that every vet does what he or she can to benefit their patients, and for me to criticise what they do, I need to know more than the basics about it. I would not comment on orthopaedic procedures, CT scans, poultry medicine etc., because I have had no more than basic training in these areas. To critique a surgical procedure, I would feel that I should be properly trained, and then have tried it following this proper training, so as to take out "operator error" in the outcome. With respect, I do not think that there are any vets who would fulfil this.

I fully respect everyones views on this tinderbox of a subject, as I have made very clear in earlier discussions. Mine are equally passionately held, based on 26 years of homeopathic practice and 28 years of acupuncture, all within a very successful conventional practice framework, and backed by 5 years of homeopathic training. This training is extensive, costly, time consuming, family-time robbing, and the end result is that you get less financial rewards because there are not the drug sales, vaccines etc added to the cost of vets time, but this is not why I continued to study. It is because I saw results, and I was not prepared to allow any opportunity to help my patients pass me by. I am forever glad I made that choice, even if it appears strange to many, and involves a poorly understood mechanism of action.

As I said before, scientific advances are made by challenging the established "truths", acting on observations, and being prepared to adapt to change. None of the advances over the last few hundred years would have been possible if there had't been those individuals prepared to do this. Acupuncture is now widely accepted, and I even had referrals from orthopaedic consultants when they had no further way to go, and achieved excellent successes. When I began using it, it was classed as witchcraft too. How times have changed (for all but the incredibly closed minded, at least).

Once again, I will back out of this thread already. I know what responses will be there, and from whom they will come. We all know your views, and mine are also clear, so there is no purpose on repeating them in different words; this is tiresome and non-productive. This post was simply to comment and inform, not to aggravate and inflame, which is pointless. Your minds will not be moved whatever is offered; however, I will not allow my experiences over nearly 30 years to be dismissed as placebo, fabrication, or illusionary, by a minority who lack basic understanding in the therapies I used. I respect the opinion of all, and respect your right to practice the way you choose, and the motives for you doing so. It would be great if you could do the same. I believe that the seed of mistrust you have sown into the profession is not beneficial to our clients, animal welfare, or the future of the profession.

RE: Meaning of properly trained

Bob Russell — Wed, 18 Apr 2018 13:43:31 GMT

Veterinary Record 7 April 2018 Vol 182 No 14 page 407:

Significance of findings

the study contributes to extending current knowledge on the effectiveness of homeopathy ....

Homeopathy does not appear to be an effective treatment alternative for cases of mastitis.

No sh=t Sherlock!

RE: Meaning of properly trained

mike jessop — Wed, 18 Apr 2018 12:05:40 GMT

Thank you Mr. Carpenter, for your resume of a short period in my career. You might also have included my dabbling with acupuncture around that time under the guidance and tutelage of John Nichol. Back then there was only a 4 part modular course after which there was the opportunity to apply for the mysterious MFHom award. I don't remember any significant complexity to the awarding of the post-nominals back in the day. I was a regular at the Homoeopathic Association meetings. My diversion into the alternatives was due to working in an area of London where client usage was high. As a young graduate I was caught in the logic argument that if experienced vets and doctors were able to suspend their belief in the dilutions and non-science of homoepathy and acupuncture, there must be something that I was missing.

I did indeed work with Mr. Allport for 18 months. It was a very useful practice to learn from because the proximity of RVC and low client throughput meant I had lots of time to work cases up with a full range of specialists close by. I was asked to cover the homeopathic cases for holiday breaks. I saw no impressive results. I saw lots of mis-use of the homoepathic system eg all skin cases had sulphur, all female dogs had pulsatilla. It was simply a recipe book system of dispensing. I saw little evidence of true repertorisation of cases and detailed remedy selection.

I am pleased that you found my testimonial. It was my last hurrah into the practicing of magic. Having left the Allport centre of mystery I did want to be certain that applying the system as taught, made no difference. It didn't. It is only placebo and it is no better when the pills are sac lac or remedy. For those uninitiated, you can buy plain sugar pills. The success in treating the animals on Mr. Weekes' farm was timing in the case of the Orf problem. He had had 3 bad years and tried regular vaccines. It is likely that the immunity kicked in at the same time that he started using remedies. As for the mastitis, peaks and troughs occur and additional husbandry aspects such as hygeine, bedding and milking routines are likely to be more beneficial than pouring magic water into the troughs.

The alternative medicine crowd are generally a nice bunch (I will leave that open to consideration in light of some of the adverse comments made against some in the "conventional" veterinary world). Sadly they just don't seem open to self critique.

I saw absolutely no evidence of true effect in the time I used it. I did see cases get better as we all see on a fairly regular basis. Since binning the sugar pills, I now refer to them and missed homeopathy moments....

RE: Meaning of properly trained

Niall Taylor — Wed, 18 Apr 2018 10:12:45 GMT

I'm sure mike jessop would be the best person to comment on the specifics but really, this argument that only 'fully trained' homeopaths can properly judge the validity of homeopathy is a red-herring.

For a start there are a lot of practicing homeopaths around treating humans who have no medical degree and minimal formal training, being self-taught or having attended courses at local FE colleges. In the veterinary world, Roger Meacock for instance has never used any post-nominals in the letters he writes to the Vet Times to indicate he has formal qualifications in homeopathy yet all these people are presumably convinced that homeopathy works.

This is the 'no true Scotsman' fallacy -if someone has had a little training in homeopathy and then accepted its validity then they are a 'properly trained', if someone has had a little training in homeopathy yet has rejected its validity then they can't have been properly trained.

But the biggest objection to your argument is that one does not have to be trained as a practitioner in a medical modality in order to comment on it. I have no training in the firing of horses, phrenology or blood-letting. Yet, by virtue of understanding science I know they are ineffective methods of diagnosing and treating disease despite, in the past, thousands of advocates of these practices being convinced they not only worked but worked extremely well. It's the same with homeopathy; my objectivity means I understand it for what it is better than you do.

Niall

RE: Meaning of properly trained

J G Wray — Wed, 18 Apr 2018 10:00:34 GMT

Trigger warning [Admiration]

I like Mike Jessop and what he's done for the profession and tortoises.

When H&S became a thing, he was right at the forefront of getting BSAVA then BVA up to speed. BVA were rather unkind to him as I recall, giving him little credit to begin with for their own offering.

RE: Meaning of properly trained

Bob Russell — Wed, 18 Apr 2018 09:52:35 GMT

Why not get a little more personal?

I have some real issues with the behaviour and dodgy claims by certain alternative/complementary therapists but would never dream of dissecting his or her career choices.

Nasty post from someone I now have zero respect for.

RE: Meaning of properly trained

Michael Woodhouse — Wed, 18 Apr 2018 09:43:20 GMT

and this, Arlo Guthrie, is why I'm not participating in the forum until we have a negative vote button of some kind. I've wasted the energy typing all these words and never has 1 star been so apt.