More Vet-Bashing in the Daily Mail

Re: More Vet-Bashing in the Daily Mail

Bob Russell — Tue, 06 Apr 2010 12:17:55 GMT

Can we please ask the pharmaceutical industry for a licenced POM-V placebo injection. My suggestions as to the name - Placebovet, Placebovet Plus, Placebocare, Placebodale, Placebomax or perhaps Homeovet!

It does not seem to take much to convince the VMD as to the efficacy, safety etc of a new medication if you are a big enough pharmaceutical company so as long as there are no double blind placebo (human medical equivalent) trials we should be fine.

I realise it will take a year or two for the licence to be granted but hey-ho!

Please note that any comments in this post are for educational and fun purposes only and any suggestions of bad behaviour by drugs companies or government bodies is purely unintentional and I do not want to go to prison. A short break would be nice though.

Re: More Vet-Bashing in the Daily Mail

Anthony Todd — Fri, 26 Mar 2010 22:56:17 GMT

http://www.theaustralian.com.au/news/health-science/the-promise-of-placebo-power-healing-secrets/story-e6frg8y6-1225845575117

Read this in today's Australian and begin to realise the power of the placebo.

Brings home the oft heard plea "Can't you give it an injection or something" and explains, to a large extent, the "success" of alternative medicine provided the patient is a "typical placebo responder".

My tooth is getting better already!

Re: More Vet-Bashing in the Daily Mail

Vikki Moran — Fri, 26 Mar 2010 22:03:02 GMT

i am a longstanding member of the veterinary voodoo society! in fact I am particularly successful with using soffban and vetrap voodoo effigies. I tend to find though that the use of too much elastoplast reduces the efficacy, but that application of hair (from the target patient) using tissue glue (with care!) enhances efficacy, of course i havne't done double blind trials, but it has certainly worked for me, the one time i did it, and that means it always will!!

Re: More Vet-Bashing in the Daily Mail

Niall Taylor — Fri, 26 Mar 2010 11:51:05 GMT

[quote user="Vikkivet"]why is that if there is so much evidence, it has to be searched for, and only by those who are open minded enough....?[/quote]

The convoluted phraseology I am constrained to use for fear of offending our homeopathic members and risking this thread being turned into yet another string of bickering has obviously led you to believe that I am more sympathetic towards homeopathy than is the case.

Far from being sympathetic I am opposed to its use by veterinary surgeons since there is not a jot of evidence to support it so it can only be bad for animal welfare and bad for the reputation of the profession. That's what I meant by "real" evidence - real as in the type you mentioned; peer reviewed, blinded, randomised trials and meta-analyses as opposed to "homeopathic" evidence - as in published virtually entirely within homeopathic journals and/or otherwise of extremely poor quality and dubious methodology (as in the recent paper in Vet Record by Hill, Hoare, Mathie et al).

If you want a bit of a laugh and to get a idea of my true feelings about homeopathy have a look at a transcript of a rather lengthy Vet Times correspondence on the web site of the British Veterinary Voodoo Society (http://www.vetpath.co.uk/voodoo/index.html). The letter page is here - http://www.vetpath.co.uk/voodoo/vettimes.html.

You could even join - new members always wanted!

Oh, and congratulations and welcome to the 1,000+ club! Arlo will be sending you the homeopathic signature of a magnum of Champagne via the internet as we speak (yes, homeopaths claim to be able to do that too!) - careful though, don't take to little of it!

Cheers,

Niall

Re: More Vet-Bashing in the Daily Mail

Martin Jones — Fri, 26 Mar 2010 09:38:05 GMT

[quote user="Richard Allport"]

just a report of a Dogue de Bordeaux with Wobblers that dramatically improved with acupuncture. Except I shall probably be told it was a spontaneous improvement and no connection at all with my treatment. Amazing how many spontaneous improvements occur after starting treatment with acupuncture or homoeopathy. Still, I'm all for spontaneity!

[/quote]

Richard

No intention of interfering with your inalienable right to argue your position - it's a shame that you seem to be having to do it all by yourself, though. I would take exception to you lumping homeopathy and acupuncture together, as though to believe in one is to automatically be a devotee of the other. This is one of the main factors which leads us great unwashed to dismiss all non-allopathic treatments as 'alternative' or complementary'.

My own experience has been that homeopathy has been ineffective, but acupuncture is useful in a number of situations - and has been shown to be so; I do find that in cases of 'spinal' (yes, a very clinical diagnosis) arthritis, it's more effective than NSAIDs alone, but in some patients not as good as tramadol. Experience over evidence, perhaps.

Some people who plump for homeopathy are undoubtedly confused by doorknobs and the disappearance of the sun each day; others are far brighter than any of us. I would suspect that the vast majority don't care about mechanisms or evidence, because the patient is better and that's the most important thing.

Until the Mail starts to claim (and it will, given the disloyal nature of the British press) that homeopaths are baby-eating, money-grabbing deviants, then I suspect the great British public will continue to use free will in their choice of treatment.

On a different note, my understanding is that antibody titres are somewhat variable in reliability; the rabies titre shows that an animal has been vaccinated very recently (and has mounted a response), as opposed to having been bitten by a rabid bat; on the other hand, lepto titres tend to be all over the place, and those of us who have done hard time in cattle medicine can probably attest to the frustrations of trying to 'prove' immunity or recent infection.

The other point I'd make is that if one does find an acceptable titre to parvo, what recommendation can one make as to the timing of the next blood test? Will the dog be protected for the next month? The next six? A year? Vaccination is an insurance policy, so that if a patient is comes into contact with the relevant disease within a certain period of time, then it should be protected. Titres will only really tell us what the patient's immune system has done up to that point in time and we'd be on sticky ground if the patient then went on to contract the disease in question.

Distemper and parvo, every two to three years? Lepto, every year? KC only if the kennels ask for it, with the explanation that it's a necessary evil to get into the kennels of the clients choice, but probably won't stop the spread of coughing? I think most of us are already on this track anyway.

Re: More Vet-Bashing in the Daily Mail

Vikki Moran — Fri, 26 Mar 2010 07:25:18 GMT

ooh and i have broken the 1000 points barrier! where's my champagne arlo?? (hoping that if we keep suggesting it he'll think it's a good idea....? after all, if thousands of us believe it to be true, it must be!)

Re: More Vet-Bashing in the Daily Mail

Vikki Moran — Fri, 26 Mar 2010 07:24:24 GMT

[quote user="Niall Taylor"]there is plenty of real evidence out there for those prepared to look.[/quote]

why is that if there is so much evidence, it has to be searched for, and only by those who are open minded enough....? surely if there's so much strong evidence, why isn't it easily available? why isn't it all published in respected journals? why is in only available to those who are prepared to spend hours and hours searching until they can find something they can grasp onto and declare is the holy grail they have been searching for?

I am actually quite open minded about homeopathy but it does really get on my nerves that it's touted by those who practice it as being like some sort of magic or faith that only the worthy will understand.

I also worry that in justifying the use of homeopathy the old adage "do no harm" is so often used. i think you could argue that by withholding treatments that have much stronger evidence, that you are in fact doing harm? or in the playing around with this remedy and that remedy until you find something..? certainly i think it's acceptible for me to suggest that bu advising against vaccination, harm by ommission is certainly likely to occur. it's not just acts of commission that cause harm but acts of ommission too.

i'd also like to say that simply because thousands of homeopaths believe that homeopathy works isn't evidence! thousands of people believe that everything they read in the daily mail is true.

Re: More Vet-Bashing in the Daily Mail

Niall Taylor — Fri, 26 Mar 2010 07:06:53 GMT

[quote user="Richard Allport"]For the rest we will have to disagree as usual.[/quote]

OK maybe, but this isn't simply a question of opinions, there is plenty of real evidence out there for those prepared to look.

So, what about that last point - how do you know that your opinion that homeopathy or isopathy or whatever cannot protect against disease is more valid than that of the thousands of homeopaths who do believe it and recommend the use of nosodes in place of vaccination (as CHC does).

Niall

Re: More Vet-Bashing in the Daily Mail

Michael Woodhouse — Thu, 25 Mar 2010 23:50:08 GMT

[quote user="Richard Allport"]My ploy didn't appear to work anyway, seems like if you reply to your own post you don't get extra points. It's my understanding that 'points mean prizes' so I'm looking forward to something exciting when I eventually break the 1000 point barrier![/quote]

You can chose. Would you like shaken water or sugar pills that supposedly have the shaken water on them?

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Thu, 25 Mar 2010 23:43:32 GMT

[quote user="Laurence Webb"]

Good idea. Arlo sends a case of champagne to each poster every time they reach another 1000 points

Sorry, daydreaming there for a second

[/quote]

My ploy didn't appear to work anyway, seems like if you reply to your own post you don't get extra points. It's my understanding that 'points mean prizes' so I'm looking forward to something exciting when I eventually break the 1000 point barrier!

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Thu, 25 Mar 2010 23:39:05 GMT

[quote user="Richard Allport"]And - advance warning - I'm afraid to inform everyone my name will be in the dreaded Daily Mail again this weekend, or possibly the next, nothing by Alison Smith Squire this time, just a report of a Dogue de Bordeaux with Wobblers that dramatically improved with acupuncture. [/quote]

In fact I've just found out it will be in May 2nd (You magazine, Mail on Sunday). Knowing my luck, the dog in question will drop dead before then!

Re: More Vet-Bashing in the Daily Mail

Laurence Webb — Thu, 25 Mar 2010 23:32:29 GMT

Good idea. Arlo sends a case of champagne to each poster every time they reach another 1000 points

Sorry, daydreaming there for a second

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Thu, 25 Mar 2010 23:26:00 GMT

I'm only posting again because I'm dying to get to 1000 points and I'm not that far off!

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Thu, 25 Mar 2010 23:23:22 GMT

[quote user="alex gough"]

It's funny how things like regression to the mean, concurrent treatments, owner expectation, clinician expectation, the placebo effect etc can colour our personal judgement of whether a treatment is effective. It's a peculariaty of the way the human brain works, looking for patterns where there are none, and mistaking correlation for causation.

Interestingly, people have been saying homeopathy must work because there is no placebo effect in animals. There are lots of other reasons why homeopathy might appear to work when it is actually ineffective, but a recent study shows that the placebo effect does actually exist in animals, particularly in epilepsy (see below).

[/quote]

Alex, I do agree placebo effects can occur in animals, but as the study you quote shows, can occur when using conventional drugs - so does that mean conventional drugs are always ineffective just because a placebo effect can occur?

The way I see it - first, do no harm, second, get the patient better. I always manage the first, usually manage the second. I believe it is a combination of the treatment I use and the intention to heal. Even if it were always placebo its a good end result. Isn't the aim to get our patients better without causing adverse effects?

Interestingly Hahnemann, the founder of homoeopathy, was scathing about the unscientific basis for bleeding, use of Mercury as treatment and other medical practices of the time. He realised the importance of hygiene and good diet.

He can also be found playing as a goalkeeper for Wolverhampton Wanderers apparently. Which for me, a fervent West Brom supporter, is a bit of a kick in the teeth, really.

Re: More Vet-Bashing in the Daily Mail

Michael Woodhouse — Thu, 25 Mar 2010 23:13:08 GMT

"The art of medicine consists of keeping the patient amused while nature heals the disease." (Voltaire)

Most of our patients would get better eventually!

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Thu, 25 Mar 2010 22:58:15 GMT

[quote user="Niall Taylor"]the unreliability of titre testing [/quote]

Niall, if titre testing is so unreliable, why is it used to decide whether pets that have had Rabies vaccinations are sufficiently protected to be given a pet 'passport' and travel abroad, then return? And are vaccines completely reliable?

For the rest we will have to disagree as usual.

And - advance warning - I'm afraid to inform everyone my name will be in the dreaded Daily Mail again this weekend, or possibly the next, nothing by Alison Smith Squire this time, just a report of a Dogue de Bordeaux with Wobblers that dramatically improved with acupuncture. Except I shall probably be told it was a spontaneous improvement and no connection at all with my treatment. Amazing how many spontaneous improvements occur after starting treatment with acupuncture or homoeopathy. Still, I'm all for spontaneity!

Re: More Vet-Bashing in the Daily Mail

Niall Taylor — Thu, 25 Mar 2010 18:23:34 GMT

[quote user="Richard Allport"]my initial suggestion would be to have this dog parvo titre tested, and then make a decision on whether or not to vaccinate[/quote]

Given the vanishingly small incidence of even minor vaccine reactions (I'm talking about proper reactions here, not the fictitious "vaccinosis" condition), the unreliability of titre testing and the serious risk of picking up a potentially life threatening infection there's no question that this advice is most irresponsible. It amounts to advising the owner to let risk his dog contracting a real disease incase it ends up with a made-up homeopathic-type one.

[quote user="Richard Allport"]there are no homoeopathic vaccines and you cannot vaccinate homoeopathically. There are homoeopathic medicines that may help to strengthen resistance to specific diseases, but they are not vaccines, and they cannot be relied on to give protection (in my view)[/quote]

Well, there are nosodes which, although they are isopathy, not homeopathy, allegedly operate in much the same way - infinitessimal dilutions in particular. And very many homeopaths DO believe they can be used to give protection against serious diseases.

Trouble is, since there is no evidence that either homeopathy or isopathy work and it's impossible to tell the difference between nosodes, homeopathic remedies or plain tap water you can't argue that their opinion is any less valid than yours Richard. That's the problem when you base a methodology on beliefs, and anecdotes rather than proper science.

Niall

Re: More Vet-Bashing in the Daily Mail

Anthony Todd — Thu, 25 Mar 2010 10:54:44 GMT

A few months ago I had a dental x ray which showed an area of bone resorption around a misplaced peg penetrating the side of a root.

Within days the gum, both laterally and medially in the area around that tooth swelled and became mildly painful.

It took a very conscious effort not to associate the Xray with the swelling, so it is easy to see how vaccination, being the only extra-ordinary event, is blamed for every malady known to man or even DailyMail readers.

Also the original was, I think, "You know how thick the average member of the public is, just realise that 50% are thicker than that".

You can substitute "Daily Mail readers" or even "Vet. Surgeons" if you want.

Re: More Vet-Bashing in the Daily Mail

Hannah Wynne Richards — Thu, 25 Mar 2010 10:23:35 GMT

As I understand it, the only proven contra-indication to vaccination in epileptics is to whooping cough vaccination in children. For this reason, I would not give an epileptic kennel cough vaccination (Bordetella ) but would give all other vaccinations as normal.

On a positive note, there was a good story in yesterday's Telegraph about a lurcher which had quarreled with a car, and was then treated at Cambridge

Wynne

Re: More Vet-Bashing in the Daily Mail

Alex Gough — Thu, 25 Mar 2010 09:06:58 GMT

I agree that sadly a lot of our work isn't evidence based, and that will always be the case because of the small numbers and limited research funding. There are some things we don't know, and have to use our experience for: For examples where we don't have evidence and have to use scientific principles and experience, do antidysrhythmics reduce the risk of sudden death in R on T phenomenon and VTach? Probably. Is aromatherapy of use in the treatment of GDV? Probably not. For examples where we do have good evidence: Is pimobendan alone superior to ace inhibitor alone in the treatment of cardiac failure from mitral vavle disease? yes. Does the weight of evidence suggest homeopathy is ineffective? Yes. Evidence will always trump experience, because it is so easy for us to be misled. With regard to antidysrhythmics, an infamous trial showed that humans with mild to moderate dysrhythmias, which were treated with anti-dysrhythmics, were more likely to die early than those who weren't treated, despite experience suggesting the contrary. Oh, and bleeding was carried out for centuries on the basis of physician experience.

Placebo Effect in Canine Epilepsy Trials

Muñana, K.R.¹; Zhang, D.²; Patterson, E.E.³

Source: Journal of Veterinary Internal Medicine, Volume 24, Number 1, January/February 2010 , pp. 166-170(5)

Authors:

Background:

The placebo effect is a well-recognized phenomenon in human medicine; in contrast, little information exists on the effect of placebo administration in veterinary patients. Hypothesis:

Nonpharmacologic therapeutic effects play a role in response rates identified in canine epilepsy trials. Animals:

Thirty-four dogs with epilepsy. Methods:

Meta-analysis of the 3 known prospective, placebo-controlled canine epilepsy trials. The number of seizures per week was compiled for each dog throughout their participation in the trial. Log-linear models were developed to evaluate seizure frequency during treatment and placebo relative to baseline. Results:

Twenty-two of 28 (79%) dogs in the study that received placebo demonstrated a decrease in seizure frequency compared with baseline, and 8 (29%) could be considered responders, with a 50% or greater reduction in seizures. For the 3 trials evaluated, the average reduction in seizures during placebo administration relative to baseline was 26% (P= .0018), 29% (P= .17), and 46% (P= .01). Conclusions and Clinical Importance:

A positive response to placebo administration, manifesting as a decrease in seizure frequency, can be observed in epileptic dogs. This is of importance when evaluating open label studies in dogs that aim to assess efficacy of antiepileptic drugs, as the reported results might be overstated. Findings from this study highlight the need for more placebo-controlled trials in veterinary medicine.

Abstract:

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Wed, 24 Mar 2010 23:36:10 GMT

Well, Michael, I see the evidence in the patients I treat each day and have done so for the last twenty years.There is a huge area of 'conventional' medicine as yet not evidence based but that doesn't stop vets and doctors continuing to prescribe treatments.

Personal experience is evidence, and there is research being carried out and evidence is accumulating of the efficacy of homoeopathy.

You can't see how professional people can recommend such treatments. The answer is that those of us who do find the treatments work. Simple as that.

Re: More Vet-Bashing in the Daily Mail

Michael Woodhouse — Wed, 24 Mar 2010 23:03:50 GMT

[quote user="Richard Allport"]Any thoughts on whether or not the homoeopathic treatment is helping to control the epilepsy?[/quote]

Since there is not a scrap of decent evidence to support homoeopathy in people or animals I can't see how Professional people can recommend such treatments. Are we not in the era of evidenced based medicine?

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Wed, 24 Mar 2010 23:02:23 GMT

Sorry, last part of message to Hanna, not Hannah.

Well, to anybody interested really, I suppose, but apologies for misspelling your name!

Re: More Vet-Bashing in the Daily Mail

Richard Allport — Wed, 24 Mar 2010 22:58:53 GMT

Alex, my initial suggestion would be to have this dog parvo titre tested, and then make a decision on whether or not to vaccinate. My own view is that, where possible, I prefer to avoid vaccinating epileptic dogs, and definitely avoid vaccination if there has been any adverse vaccine reaction previously. If not, and if titre level was low, and if there was a major risk of contracting parvo, I would probably recommend vaccination but with homoeopathic support to help minimise chance of adverse reaction.

In other words, take each case on its merits, avoid vaccination if possible and if reasonably safe to do so, but do vaccinate if significant risk. However, as I don't know all the details of this particular case, I couldn't really comment on the veterinary homoeopath's advice specifically.

Any thoughts on whether or not the homoeopathic treatment is helping to control the epilepsy?

And to Hannah - there are no homoeopathic vaccines and you cannot vaccinate homoeopathically. There are homoeopathic medicines that may help to strengthen resistance to specific diseases, but they are not vaccines, and they cannot be relied on to give protection (in my view)

Re: More Vet-Bashing in the Daily Mail

Hanna Bennett — Wed, 24 Mar 2010 18:54:02 GMT

presuming his own dog is vaccinated homeopathically, maybe he should prove the effectiveness of it but putting his dog in that kennels?