This is a full length article, so please pop the kettle on, make a brew, sit down and enjoy!
The current situation
The fundamental right to the freedom of choice in the healthcare of our animals is currently being eroded by governing bodies in several countries including the UK by the Royal College of Veterinary Surgeons (RCVS), which published a controversial statement on Complementary and Alternative Medicine (CAM) in 2017. This most recent position statement effectively bans alternative treatment unless conventional treatment is given before or alongside, thus rendering it complementary.
This article will demonstrate that alternative veterinary modalities used exclusively may, in certain circumstances, be in the best interests of the animal. They may also be useful as an integrated part of the animal’s overall veterinary healthcare package. Unfortunately, the RCVS’s view on CAM casts a wide shadow on treatment protocols and can limit vets from referring animals on for CAM treatments. Many CAM modalities can be offered as successful first line treatment, giving a valuable alternative to the purely pharmaceutical drug approach, which may bring with it the risk of unwanted side effects and antibiotic resistance.
To this end, the RCVS 2017 statement will be discussed and critically analysed, followed by the response of CAM4animals, a consumer group representing a wide range of animal owners, farmers, and CAM vets and practitioners. The article will conclude by suggesting a possible way forward to benefit all concerned, particularly our animals.
It is important to state that all vets, including those who use CAM and holistic approaches, are governed by their professional codes of conduct and the welfare of the animal must be paramount in whatever treatment is selected. In no way does this article seek to dismiss conventional treatments as a first line option or in emergency situations.
The ongoing discussion around the RCVS statement
“Homeopathy exists without a recognised body of evidence for its use. Furthermore, it is not based on sound scientific principles. In order to protect animal welfare, we regard such treatments as being complementary rather than alternative to treatments for which there is a recognised evidence base or which are based in sound scientific principles. It is vital to protect the welfare of animals committed to the care of the veterinary profession and the public’s confidence in the profession that any treatments not underpinned by a recognised evidence base or sound scientific principles do not delay or replace those that do.”
Anyone who is familiar with homeopathic research would take issue with this statement, starting with the first line: “Homeopathy exists without a recognised body of evidence for its use.” This is unquestionably incorrect. Research studies continue to be published in peer reviewed journals, demonstrating the effective use of homeopathic remedies in animals. A prime example of animal research can be found in the following study where homeopathy was used to replace antibiotics in a case of E. coli in piglets with highly successful results (Camerlink et al., 2010).
The Italian Homeopathic data base of veterinary research studies (Marino, F.V.) features a collection of studies on pets and/or livestock animals treated with homeopathic medicines. The source is mostly PubMed (The US National Library of Medicine) and many have positive findings, with several demanding more research. There are also extensive studies listed here: Americans for Homeopathy Choice (2019). These sites are simply a sample of specific veterinary research: there are many more. It is difficult to imagine how the RCVS can dismiss such evidence, or at least fail to research it further. In addition, there are many high-quality research trials on humans via these data bases: (CORE-Hom) and (Bell, I. 2018).
Similarly, I question “Furthermore, it is not based on sound scientific principles.” Homeopathy has its own, very strict set of principles which I outlined in an earlier article ‘Clarification of the Basic Homeopathic Principles’ (Hpathy.com: 2017).
In short, homeopathy is not based on the same principles as conventional medicine in that it treats the whole individual rather than singular symptoms and is hard to test using the randomised controlled trials (RCT’s) by which conventional medicine is typically gauged. However, there is on-going revolutionary research giving insight into how homeopathy might work as evidenced by the New Horizons in Water Science Conference at The Royal Society of Medicine in 2018. Eminent scientists (with no homeopathic bias) including Nobel Laureates, were assembled from around the world. They met to discuss the latest in their findings and revealed that current research is bridging the gap between mainstream science and the cutting-edge science surrounding the homeopathic mechanism of action and Ultra High Dilutions.
The RCVS considers that there is a lack of scientific rationale for homeopathy, thus it needs to be complementary rather than alternative. The words “lack of evidence base” in reference to homeopathy are touted frequently despite the fact many trials have been undertaken, as detailed above. In addition, it is difficult to quantify the vast number of cases treated which are evidenced empirically. What has to be taken into account, are the paradigmatic differences in the two systems of medicine. Systematic reviews, meta -analysis, RCT’s and controlled studies rarely do justice to homeopathic treatment because homeopathy treats the patient and not the disease.
It is imperative to understand that some things do not always make scientific sense in the first instance. However, knowing that they do exist, such as the phenomenon that is gravity, means it can be acceptable for them to be outside the realm of what science can currently explain. Another example is the action of aspirin, which was widely used, and its effectiveness lauded many years before its action was understood. (Walach, 2001). In addition, it is worth considering that both Louis Pasteur and Galileo were initially ridiculed and discredited, yet their theories were eventually embraced and changed science as we once knew it.
The RCVS statement goes on to say: “It is vital to protect the welfare of animals committed to the care of the veterinary profession.” Absolutely. This is why those of us involved in holistic medicine integrate it into our practices; we are not limited to one approach, we have the benefit of education and experience in many different therapies. This optimises rather than threatens animal welfare. The response to the global antibiotic resistance crisis is a good example. The College of Medicine and Integrated Health (2018) stated that “GPs who are trained in complementary medicine including homeopathy, prescribe less antibiotics than GPs without integrative medicine training.” This statement is applicable to those vets who also have the advantage of extensive training in both systems of medicine. This should be embraced and applauded by critics. Indeed, banning the use of homeopathy as a first line treatment under RCVS’s new guidelines is counterintuitive given the dangers surrounding antibiotic use, particularly where further research is being encouraged into homeopathy and herbs: (IAHV: 2017) and (NIHM: 2018).
My advice would be: if homeopathy or other CAM modalities work, is safe and prescribed by qualified vets or doctors, then use it. Veterinary medicine also has to deal with resistant superorganisms, adverse drug reactions, and the problems caused by polypharmacy. Alternative methods of treatment should be widely researched and, where proven to be effective, incorporated into treatment regimes. Likewise, it goes without saying that a purely conventional approach should be subjected to the same scrutiny in terms of research and results.
The RCVS’ rationale and The Faculty of Homeopathy’s response
The RCVS states: “We consider that this welfare need is best served by the use of treatments underpinned by sound scientific principles, and would recommend that both vets and animal owners have this uppermost in their minds when considering treatment.”
The Faculty of Homeopathy’s statement in response to the RCVS can be read in full here. Their response reflects the concerns of their members and pet owners who embrace holistic health modalities. They point out that the RCVS states it expects veterinary surgeons to offer “treatments underpinned by a recognised evidence base.”
The Faculty states: “The evidence base for many conventional medicines used in veterinary practice as well as human medicine is inconclusive. If the RCVS were to apply the same evidential criteria used for homeopathy to all treatments, there would be far fewer clinical options available to the profession.”
There is growing interest in homeopathy from animal owners as they see conventional medicines regularly failing or producing adverse side-effects. This is especially true in livestock farming where there is a drive to reduce the dependence on antibiotics in the light of concerns about antimicrobial resistance, AMR. At such a time, it is contradictory that the RCVS fails to engage with vets who are best placed to offer advice on the appropriate use of homeopathy.
It is clear that by adopting their position in relation to homeopathy and other complementary therapies, the RCVS is limiting the clinical freedom the veterinary profession has always enjoyed. Moreover, in allowing a vocal minority to influence a policy stance, the RCVS has set a dangerous precedent where similar groups could not only influence and further restrict clinical freedom in the future, but also stifle innovation, research and the development of new treatments. This presents a far greater threat to animal welfare than homeopathy could ever do.
The RCVS statement has taken away its members’ freedom to choose what is the best course of treatment for an ill animal. The RCVS has also applied a blanket ban to the use of all alternative therapies even where there are successful trials. This blinkered approach is not just applicable to the RCVS. For instance, acupuncture for humans has become the latest casualty. NICE has failed to include it as a recommended treatment for urinary incontinence (British Acupuncture Council, 2019) even though they were alerted to a high-quality study demonstrating its effectiveness.
The response to the RCVS from CAM4animals
Following on from this, an Animal Owners Charter was devised in order to further support holistic health choices and ensure informed choice (and consent) for all proposed treatment plans for their animals. Much of the Charter should be common practice since it is included in the RCVS Code of Conduct. Nevertheless, there are animal owners who have not experienced this, hence the need for the Charter.
CAM4animals audit reveals shaky foundations for RCVS position statement
After much lobbying, CAM4animals received the documents used by the RCVS on which they based their statement. CAM4animals conducted an in-depth audit of the RCVS documents and found that they were factually weak, scientifically flawed and narrow in scope. In summary they found the following:
In addition, CAM4animals is concerned that RCVS Council members have been seemingly influenced by non-veterinary organisations which promote science scepticism regarding CAM in general and homeopathy in particular. The result is that RCVS’s own members are now placed in the vulnerable position of being formally disciplined and having to provide evidence to support the use of treatments they are legally and professionally qualified to practice and which have supporting evidence from their professional bodies. Evidence the RCVS appears to have chosen to disregard.
The RCVS denies that there has been any change to their position and yet repeatedly states that only treatments backed by sound, scientific evidence can be given. Although their statement is clearly biased towards making this relevant to CAM and homeopathy in particular, it is logical that this evidence requirement should apply to all treatments. Yet we know that many treatments offered by conventional vets have not been backed up with specific research on their application to a broad spectrum of species, but vets are able to choose to use such treatments without fear of censure from the RCVS. The RCVS has placed the onus on the vet to provide the evidence to support his/her use of an alternative treatment. The RCVS do not see their role as researchers which may go some way to explain why they did not examine homeopathy and other CAM adequately when considering their latest position statement. The implications of publishing the statement without engaging with all relevant stakeholders and gathering all the evidence in support of these treatments is consequently jeopardising animal welfare and compromising the position of their holistic veterinary colleagues.
What is particularly significant and disturbing is the fact that the RCVS report was based on flawed studies. These are outlined below and shown in more depth here.
Science & Technology Committee EC2 Report, 2010
The Lancet Report, Shang et al., 2005
NHMRC, The Australian Report, 2013
EASAC Statement on Homeopathy, 2017
Given all the post publication stakeholder responses to the statement and CAM4animals findings -particularly the flawed reports and the influence of non-veterinary organisations which promote science scepticism – everyone should be gravely concerned about how these documents were used as the ‘evidence’ on which the RCVS Council decided to change a well-balanced and long held policy statement.
In addition, I feel there is a vast amount of confusion around homeopathy as evidenced by the chaotic analysis of a study which concluded that homeopathy only appears to work because of ‘perceptual errors’: (RCVS: 2017) which stated (my emphasis):
“Therefore, animals with conditions that could be treated by an approved veterinary medicine are going without effective treatments in favour of ineffective homeopathic products. Furthermore, not all homeopathic products are neutral in their effect and are sometimes administered in highly concentrated forms that can potentially harm patients. Although homeopaths report that their remedies are effective when used in their practice, efficacy beyond placebo is not apparent in well-controlled clinical trials that eliminate biases and other non-specific effects.”
I am seriously not sure how homeopathy can be referred to as “placebo” and “ineffective” and then, in complete contrast, “all homeopathic products are not neutral in their effect and sometimes administered in highly concentrated forms that can potentially harm patients” in the same paragraph. This nonsensical account of homeopathy goes to show the ignorance with which it is frequently faced. There is a knock-on and compounding effect with one poorly written paper being incorporated into the next and so on. Furthermore, there is a frequent lack of understanding by critics of this very complex therapy which requires much in-depth study and practice.
The Austrian model – one to take on board
Detractors: social media and sceptic organisations
This had a mere 3,335 supporters. In contrast, the petition adopted by CAM4animals has almost 22,000 supporters, including animal owners, farmers, vets and CAM practitioners. From 2016 – 2017, The Good Thinking Society promoted Mr Chambers’ view on homeopathy and his position onto the RCVS Council. He worked with the now President of the RCVS to release the statement on CAM in November 2017. This situation, with reference to CAM detractors and their negative effect on veterinary practice as a whole, will be covered in more depth in my next blog in this series for CAM4animals.
The British Association of Homeopathic Veterinary Surgeons (BAHVS) in response to Mr Chambers’ petition issued a statement.
“The whole premise of this campaign is based on the blatant misrepresentation that homeopathic medicines are ‘only water’. This is plainly not true. A global initiative of over 100 researchers from a multiplicity of disciplines (GIRI- Groupe International de Recherche sur l’Infenitésimal: http://giri-society.org/ ) has been studying solutions described as ‘ultra-dilutionse’ for 30 years. They have observed unequivocal evidence of their bioactivity. PubMed alone contains more than 100 papers. Recently, researchers have proven existence of nanoparticles in such solutions.” Since this response was made, considerable developments have been made in relation to such cutting-edge science, see here: (Salter, C: Dec 2018).
Once again, the very fact the petition by Danny Chambers exists, shows how little research these uninformed and sceptical disparagers have done. Chambers stated after the RCVS published its statement, ‘‘I recognise that the majority of veterinary homeopaths are acting with the best of intentions, but unfortunately being well-intentioned but deluded is no substitute for being right, especially when the consequences could lead to unnecessary suffering and even death.’ (Chambers, D, cited by Fearon, R: BMJ.)
When you consider iatrogenic disease (adverse effects of drugs), this statement is not only erroneous in the light of the evidence above, but also short sighted and almost laughable; the irony does not escape me. As with all vets, no homeopathic/holistic vet would intentionally harm an animal. They would simply choose the best method of treatment out of the many options available to them, giving them a greater choice than those limited to one approach – an approach which may come with a host of potential problems and adverse effects.
As was pointed out by the Veterinary Record, “A spokesman for the BAHVS said the (RCVS) council had been ‘seduced’ into a ‘precedent setting restriction on the clinical freedoms the profession has always enjoyed.” The RCVS was now in a position where it could be accused of “putting profits before probity” and “corporations before conscience”, said the spokesman (No evidence for homeopathy, says RCVS, 2017 (Fearon, R. BMJ,: no date)
It is important to note that these claims of suffering and poor practice by anti-CAM campaigners are widely bandied about, but in fact no cases of poor practice by CAM practitioners have actually been brought to the RCVS. All vets are bound by Codes of Professional Conduct. If cases of poor veterinary practice – whether through conventional treatments, lack of treatment, maltreatment or even, in the highly unlikely event, by CAM treatments – are identified, then vets or their clients should bring these to the attention of the RCVS and let them be addressed by their disciplinary procedure.
Peter Gregory, veterinary dean of the Faculty of Homeopathy, said: “This drives a coach and horses through the Royal College’s reasoning for adopting its anti-homeopathy stance. The argument that homeopathy endangers animal health is spurious, unsubstantiated and wrong.” He continued: “Growing numbers of pet owners and farmers are seeking a more holistic approach to animal health and have found homeopathy can help to achieve this. In light of the Secretary of State’s statement, I call on the Royal College to look again at its position on the use of complementary medicines in veterinary practice.” . Thus, the division of opinion is still evident, and all are looking for justice to be done, for the sake of the animals and those treating them.
The way forward
By implementing the above, I feel all the RCVS objectives would be achieved. We would be putting the animal first by enabling a wider range of treatments to be available at the discretion of a qualified vet.
The statement from the RCVS, to make conventional medicine the first line of treatment, has been critically analysed here and contested. However, it is appropriate to re-iterate this article does not seek to dismiss conventional treatments as first line or emergency treatment options.
In summing up, I suggest that there should be an overall recognition of the benefits of alternative medicine and that it should be integrated into general veterinary care to be used as first line treatment where appropriate. In addition to homeopathy, this includes chiropractic treatment, osteopathy, acupuncture, herbs, massage and other therapies which have been proven to be effective both empirically and in controlled trials. As shown here, all these therapies are currently seen as complementary under the new RCVS statement and cannot be used in the first instance.
I would strongly suggest that observation and judgment must always take precedence over statistical analysis alone, and that the benchmark for so called standards is changed to include those which have already been proven to be effective.
Clinical evidence in the form of numerous studies, RCTs, Real World Trials and those documented empirically, has been referenced within this article. These demonstrate that the homeopathic approach improves the health of animals and successfully treats a wide range of clinical conditions in veterinary medicine beyond the placebo effect.
In delving further into the RCVS statement and its supporting evidence, there has clearly been little attempt to present a balanced, unbiased view of CAM. The RCVS Council avoided communication with the College’s own CAM qualified members. It ignored positive studies in homeopathy and totally excluded consideration of all other forms of holistic modalities. Instead, to the detriment of animal welfare, they chose to lean on the side of denialism.
If you haven’t already done so, please sign the CAM4animals charter
Other homeopathic veterinary research sites
Category Archives: Veterinary
If we compare veterinary work to that of the practitioners on human beings, we see that the perspective is, by necessity, different. In the work with human beings, this information is important to determine, and as completely as possible:
- Time of occurrence
- Extension of symptom (to other parts)
- Accompanying symptoms (concomitants)
- Emotional state
- Mental functioning
We veterinarians work with a modified list:
- Symptom (sometimes observable but often reported by client, therefore interpreted)
- Location (sometimes apparent, but often not definable)
- Sensation (occasionally can be guessed at but not reliably known)
- Time of occurrence (limited to the waking or visiting hours of the client)
- Periodicity (if the client observant enough)
- Extension (subject to same limitations above)
- Amelioration (often available though not necessarily in a useful form—as in what drugs relieve)
- Aggravation (often available but subject to assumption and projection of the client)
- Accompanying symptoms (usually obtainable, though limited by client’s memory)
- Etiology (sometimes known, often speculated)
- Emotional state (with broad interpretation, often misunderstood)
- Mental functioning (difficult to assess unless grossly malfunctioning)
So, as veterinarians, we have very limited information which is often reduced to common symptoms and pathology, especially if the animal has been ill very long and already had extensive suppressive allopathic treatment. The mental symptoms, so important in human prescribing, are marginally useful but may not be clearly defined. A state such as “anxiety” has so many remedies in the appropriate rubric that it becomes basically useless. What we find most helpful and most reliable are physical symptoms as modified by modalities. If this is coupled with concomitants the information may be enough to find a similimum even in chronic and difficult cases. The repertories designed for human use, often emphasize those aspects which are not available to us. It is not that the information is not in the materia medica, but rather was not entered into the repertory. In this talk we will consider a few of the major repertories, how they were developed by the authors and how applicable they are to veterinary work.
What Is The Purpose Of A Repertory?
Our first question is basic. Why do we use a repertory? Let me answer this by quoting from Jahr’s preface to his book, Therapeutic Guide: The Most Important Results Of More Than Forty Years Practice. “It was in the year 1827 when I made my debut in the practice of homeopathy, at a time when the only resources at our command were the Materia Medica Pura…and a few cures reported. With these scanty means we had to get along as well as we could, and, by a diligent and attentive study of the drugs with whose pathogeneses we had become acquainted with at that time, familiarize ourselves with the characteristic symptoms of each drug and its special indications…. This was no small task, which could never have been accomplished, if the Materia Medica of that time had contained the large number of drugs that are offered at the present time to the beginner in homeopathic practice. Since the number of drugs known at that time did not exceed 60, and among these only 20 had been proved with exhaustive perseverance and correctness, we had it in our power to study them thoroughly without too much trouble…and apply them as such in accordance with their symptomatic indications. At this time such a careful study of our Materia medica is unfortunately not possible to the beginner in homeopathy. Overwhelmed by the accumulated mass of drugs and clinical observations, he scarcely knows which way to turn for at least one ray of light in the chaos spread out before him.”
Jahr’s Problem Relevant Today
Here we see the problem well described—that it is beyond our means to memorize the large mass of data available to us now. A repertory thus organizes information for us. It is a decided advantage to look up a symptom of interest and find listed the several remedies known to display this symptom in provings. In addition, Bönninghausen, in his repertory development, introduced the idea of grading remedies. This he did in 1832, with the production of his first repertory, The Repertory of the Anti-psoric Remedies, and brought a new tool into development for our use. We can often match the grading of the remedy with the intensity of the symptom in the patient, thus honing in more accurately to what the patient requires.
Thus, we have two advantages with a repertory:
- A rubric (symptom) lists all the remedies known to produce that symptom.
- The grading of remedies indicates those which have the symptom most frequently or prominently.
The Development of Repertories
Repertories have gone through an evolutionary development, along with the general progress of homeopathy as a science. With repertory use we have learned what remedies are polychrests and also which remedies are most suitable for treating chronic diseases. On the clinical side, we have correlated the repertory information with what is seen in patients. We have learned how to accurately translate the language of the proving into the language of the sick patient. We can say that over the 200 years we have been using homeopathy we have sifted out the information that is of most use to us in our work. The repertories will reflect this, as they are compilations, extractions, of the more complete, but less organized, information in the materia medica. Though the repertories were developed along certain lines, recent expansions of these works have, to some extent, changed the original purpose in their construction and use.
How Were Repertories Created?
How is a repertory constructed? We start with the information from a proving. If that information was simply listed, as a complete symptom, then the repertory becomes cumbersome and of no further use to us than a materia medica. A good example of this approach is Knerr’s Repertory of Hering’s Guiding Symptoms of Our Materia Medica. This is a complete repertory but very difficult to use. Symptoms are kept intact as, for example:
Extremities; KNEES; abscess; small opening over patella, oozing laudable pus, later
serous discharge, particularly early in evening: Iod.
Extremities; KNEES; pain; flexors of left, in, extending
around thigh, immediately above patella, as if
limb were severely grasped: chim. (chimophila)
Extremities; KNEES; rheumatism; inflammatory,
sore to touch, redness, followed by effusion, patella
being lifted up, with elastic swelling underneath and
around: stict. (sticta)
This is all very detailed information and of great use in clearly defining a symptom – but very slow for the process of evaluation and with much reading required.
The other way of processing this information is to break it up and put it in different places in the repertory. Instead of all the information in one long line, we enter each part in a different place in the repertory. When it comes time to work up a patient’s case then what we are attempting to do is to reconstruct the patient’s condition by re-assembling the information found in the repertory into a description that approximates it as much as possible.
How Complete Are The Repertories?
How well do the repertories reflect the information of the materia medica? Not as much as you would expect. Let’s look at a proving of Apis as an example. Using Allen’s Encyclopedia, General Section, which describes the provings symptoms, we can certainly find interesting and useful symptoms. Here is one.
(From effects of a sting) She was found to be in a spasm, generally tonic, but in a measure clonic; her knees were drawn up to her breast, and her hands and arms moved convulsively. Convulsions. The whole nervous system seemed most violently affected.
Now let’s see what we can find in Kent’s Repertory:
She was found to be in a spasm, generally tonic, but in a measure clonic = there is no rubric in Kent for spasms. Closest is “Convulsions, tonic” (83 remedies) in which
Apis is found in lowest grade. The rubric “Convulsions, clonic” (118 remedies) does not contain Apis.
Her knees were drawn up to her breast = not found in Kent.
In the Complete Repertory, we find these equivalent rubrics, but no Apis:
- Generalities; LYING; Amel.; during; legs drawn up (7): bell., cocc., coloc., gent-l., Magp., stram., verat.
- Generalities; LYING; Amel.; during; knee; chest position (2): choc., sep.
Her hands and arms moved convulsively = Kent has
“Generalities, convulsive movements” (73 remedies) with Apis in lowest grade. The rubrics “Convulsion, upper limbs” (45 remedies) and “Convulsion, hands” (31 remedies) do not contain Apis. However, we do find Apis, in lowest grade, here, in these two rubrics.
- Extremities; MOTION.; Upper Limbs; convulsive (15)
- Extremities; MOTION.; Hands; convulsive (7)
So we can see that Kent had to make a decision. Where to put this Apis proving information? It is indeed accurate to list it in the last two rubrics mentioned here, but why not under “Extremities, convulsions”? One could easily look there first, not see the remedy and miss it in a case. Unless you thought of the word “Motion” first instead of spams for convulsions, you could not get to it.
There are several other symptoms, ones we could recognize in animals, that are not accurately found in the repertory. Examples are:
Terrified starting during evening sleep. = only relevant rubric, though not containing Apis, is:
- Sleep; SLEEPLESSNESS; evening; starting, from (1): puls.
A close rubric is:
- Sleep; SLEEPLESSNESS; anxiety, from (21): arn., Ars., bell., bry., carb-an., caust., Cocc., cupr., kali-i., laur., lyss., mag-c., mag-m., merc., nat-c., nat-m., nux v., rhus-t., stram., sulph., thuj.
There is no rubric about sleep issues from fear.
Another one has to do with restlessness, a characteristic of this remedy, Apis. We see this in the proving:
Restlessness; would constantly like to go from one
place to another. An extraordinary restlessness overcomes
him in the afternoon, with as much exhaustion
as if he had done very hard, manual labor. (After smelling the bee poison, when gathering a swarm).
Nervous restlessness. Nervous restlessness, during the latter half of the night.
Kent’s Repertory, no Apis in any of these rubrics.
- Mind; RESTLESSNESS; anxious, etc.; compelling rapid walking (5): arg-n., Ars., lil–t., sul-ac., Tarent.
- Mind; RESTLESSNESS; pacing back and forwards (1): plan.
- Mind; RESTLESSNESS; sitting, while (12): alum., cact., caust., ferr., iod., Lyc., mag-c., nat-m., plan., sep., sil., sulph.
- Mind; RESTLESSNESS; walking amel. (3): dios., nat-m., nicc.
- Generalities; MOTION; amel. (119 remedies)
- Generalities; MOTION; continued, amel. (37 remedies).
Apis is found here:
- Generalities; WALKING; amel. (113), Apis in lowest grade.
- Generalities; WALKING; fast agg. (65), Apis found in second grade, which is only confusing in regard to this symptom.
As for the exhaustion as if very hard, manual labor, Kent does not have any rubric for “Exhaustion”, the closest being “Generalities, weariness”. Apis is not there.
In regard to the restlessness at night, Apis appears in this rubric, second grade:
- Mind; RESTLESSNESS; night (169 remedies)
but not in this rubric, which is more definitive:
- Mind; RESTLESSNESS; midnight; after (9)
General feeling of lassitude, with trembling. = no such rubric in Kent’s.
During continual diarrhoea, weakness increases, and headache diminishes. = there is no rubric for “continued diarrhea” or for “chronic diarrhea” in Kents. There is no rubric for “diarrhea with weakness”.
We do find, under Generalities, this one:
- Generalities; WEAKNESS,; diarrhoea, from (46)
which contains Apis in second grade. What may be misleading here is the idea that the weakness is caused by the diarrhea instead of being a concomitant. There are several symptoms having to do with the serious clinical problem of prostration, the patient being so ill they are lying flat out (or must lie down) and cannot stand or walk. It is seen in very serious infectious diseases, toxic conditions, near death states.
Sudden prostration, with coldness.
Sudden prostration of the vital forces; severe vomiting; profuse diarrhoea; cold extremities; pale face; severe griping pains in the abdomen; pulse weak, scarcely perceptible at the wrist.
Heavy and prostrate in fever.
Was obliged to be led into the house; threw himself on the bed; unable to hold himself up.
Without feeling either weakness or faintness, she is yet suddenly compelled to lie down on the ground.
Sinks quite exhausted at stool.
There is no rubric for “Prostration” in Kent’s. The closest is under Generalities, “Collapse” (44 remedies) in which we find Apis as lowest grade. Apis is not in the subrubric, “Collapse, sudden”.
There are these rubrics:
- Generalities; COLLAPSE; vomiting, during (1): ars.
- Generalities; COLLAPSE; vomiting, after (4): Ars., lob., phys., verat.
But no Apis. Nothing about collapse with a weak pulse, or cold extremities, pale face, with abdominal pains, or with fever. No rubrics for suddenly having to lie down or exhaustion after a stool. There is
- Generalities, weakness after stool (60 remedies)
in which Apis is the lowest grade.
So we see from this short perusal, that the repertory does not have anything like a complete listing of symptoms from provings.
Well then, why not put all this information into a more complete repertory? This is the contemporary trend, especially with Synthesis and The Complete repertories. These are expanding on Kent’s repertory and pulling in information from Bönninghausen, as well as other repertories, provings, clinical studies and many other sources. Is this what we need? These larger repertories can be extremely useful for finding unusual or detailed symptoms but they have these disadvantages:
The number of rubrics is increased. There is much more material to look through when trying to find the common symptoms. The number of remedies in each rubric has also increased (see graph below). This results in many more for consideration in our final analysis than with the previous repertories. On a practical note, as the books become larger, physically, they become unwieldy, and too difficult to use. We experience information overload—too much of a good thing.
Comparison of Rubric Number
Repertory Remedy Numbers
How The Repertories Affect Case Analysis
Here is an example analysis, a common situation for us, showing us how a large repertory can overwhelm us with possibilities.
A young cat has developed a urinary condition, going frequently to the litter box, straining, licking the penis after urinating. The urine is yellow with occasional blood. Behavior change is not marked, though not as affectionate and seems anxious. The oddest behavior is that the cat will often go into the bathtub and sit there when having this problem.
That the cat is going into the cool bathtub for relief tells us this is likely a Pulsatilla case. Let’s do a repertory workup using the Boger/Bönninghausen Repertory and compare it to that of the Complete Repertory.
Now compare this analysis, which easily suggests Pulsatilla, to one from the Complete Repertory using the same rubrics (see next page). We see that the larger repertory, with more remedies in the rubrics, will simply give us too much information. Who would really have time to consider each one of these that come up in the Complete analysis? Would it not be of more use to us to have a repertory that will suggest the most likely remedy (as opposed to striving for completeness)? This is the plan of repertories like Jahr and Boger/Bönninghausen. Instead of attempting to have every possible remedy entered in each rubric, we can limit the rubrics to just those that are most frequently (most likely) needed. This gives us much more manageable rubrics, while at the same time maximizing our chance of finding the similimum. However, to do this accurately we must use a particular strategy. Before discussing analysis strategies, let’s next look at the different repertories and how they are designed.
How Repertories Are Planned
Let’s take a look at the strategies authors have used in developing repertories. They are not all the same. For one thing we have had an accumulating body of information that tells us what are the most commonly needed remedies. From this base I identify 3 approaches used in repertory construction.
The Kent Method
From The Development and Formation of the Repertory, by James Tyler Kent. “Not so many years after I was first a homoeopath, there fell into my hands the first Bönninghausen’s Repertory, Lippe’s Repertory, Biegler’s Diary, Minton’s Diseases of Women, and Jahr’s Repertory, which in form was very good. And Lippe’s Repertory, in characteristics and form was very good. I carried Lippe’s Repertory with me for a number of years, until it was not only interleaved but doubly and trebly interleaved, the pages so closely written upon that it was impossible to find what I had written into it; so that ended in confusion. But this was the one upon which my earlier reliance rested. “Then came the time, when I began to teach Materia Medica, in 1883, when I could readily see that we ought to have more. The Symptom-Register
(Allen’s great Encyclopædia), was so limited that it lacked half of the symptoms. Jahr’s Repertory was placed next in importance because it was a repertory of the grand old remedies, It was very good for these, but our pathogenesis had increased so much that it was no longer a satisfactory work ; it did not fill the requirements of my practice. So I began taking up these works and effecting a compilation. Eventually I had a large manuscript of most of the repertory. “I talked with Lee, of Philadelphia, as Lippe’s abridged form of a new repertory was in his hands and Lippe desired me to enter upon the work of helping or uniting with Lee to produce a complete repertory. At that time I had completed a Repertory of the Urinary Organs, of Chill, Fever and Sweat, with other sections partly complete. Lee went to work and got out Mind, and later I helped him to get out Head….” From this beginning the great work that was Kent’s Repertory was developed (1897). As we see, from a compilation of many sources. Yet, it was still not complete enough. From David Warkentin, Kent Homeopathic Associates— Most homeopaths have assumed that Kent contains virtually all of the reliable symptoms. This is far from true. First of all, the task of creating a comprehensive repertory is a huge one and probably impossible. For example, even though Kent intended to add Allen’s Symptom-Register into his repertory, he was only able to add a minority of the rubrics. (Allen’s work is still larger than Kent’s.) And secondly, Kent was in competition with other repertory authors, notably Knerr and Boger, and did not share information with them.
The Kent Plan of Analysis
In Kent we have an emphasis on general and mental symptoms. We use a hierarchy of classification to organize our symptoms in order of importance. The Kent strategy is 3-fold:
- Start with the general condition of the patient. This is what is predicated to the patient as a whole, along with modalities that affect these symptoms.
- We look for and emphasize the mental condition, using this to further characterize our patient.
- We combine particular symptoms to create ones that are characteristic.
- The similimum must fit the general and mental symptoms of the patient yet may not have all the particulars of the case.
Kent decided that, besides the symptoms that are obviously general, we should emphasize also the reproductive symptoms of women and also the details of various discharges. That is, in his plan he elevates these conditions to the level of general symptoms. He bases this on his clinical experience and the conclusion that it is the individuality of the patient that determines this. Hahnemann had emphasized the importance of the mental state and Kent also brought this in as highly important whenever that information is available. He also organized information from the patient into symptoms that would be characteristic by bringing two of them together. For example, our patient could have diarrhea which is common, but having it every morning at 6 AM made it characteristic. In a way, he was reconstructing the patient’s symptoms from the repertory but in a way that made the information more useful. This was a use of Hahnemann’s advice to look for what was “unusual, rare and peculiar”. Lastly, he knew that the remedy, if it matched the essentials of the case could address particular conditions even if they had never been known before to be an expression of that remedy. It was the “general” match that was essential.
The Bönninghausen Repertory
The Repertory of the Antipsoric Remedies was created in 1833 by Bönninghausen and was the repertory that Hahnemann used in his practice. In 1846 Bönninghausen deleted and combined many of the rubrics to create a small concise pocket version: The Therapeutic Pocketbook. The Pocketbook became the standard reference work used by most American homeopaths including Stuart Close, Carroll Dunham, Guernsey, and T. F. Allen.
Bönninghausen created his repertory based on the results of his detailed and careful investigations of both provers and patients in regard to the information they reported. He found that, in both cases, most symptoms were incomplete in terms of containing all the desired information. We want, for example, the location, sensation, functional changes, conditions of aggravation and amelioration, and the concomitants. Yet very few provers or patients were able to give symptoms in this complete form.
From The Art Of The Homeopath In Taking The Case In C. Von Bönninghausen’s Work: “Noting these deficiencies in the Materia Medica, therefore, and realizing the importance of these auxiliary modifying and concomitant symptoms of disease, C. von Bönninghausen for many years diligently observed and collected all such symptoms as they appeared in the cases which came to him for treatment. Every case was examined symptomatically with this purpose always in view, to make every symptom as complete in itself as possible, covering the specific points of locality, sensation, conditions of aggravation and amelioration, and the concomitance or coexistence of other symptoms under the same circumstances.
“He soon learned that symptoms which existed in an incomplete state in some part of a given case could be reliably completed by analogy, by observing the conditions of other parts of the case. If, for instance, it was not possible by questioning a patient to decide what aggravated or ameliorated a particular symptom of the case, the patient would readily express a condition of amelioration of some other symptom.
“In reality the patient is not expressing many symptoms, but only parts of a very few complete symptoms, which the homeopath must bring together and complete. The perceptible symptoms of disease are often broken up and scattered through the different parts of a patient’s organism. The scattered parts must be found and brought together in harmonious relation according to the typical form.
“C. von Bönninghausen tells us in his Preface, From one point of view the indicated conditions of aggravation or amelioration have a far more significant relation to the totality of the case and to its single symptoms than is usually supposed; they are never confined exclusively to one or another symptom, but on the contrary, a correct choice of the suitable remedy depends very often chiefly upon them.
“In reality, then, they are the general characteristics. By observing them and applying this principle he was enabled to complete many symptoms from clinical observation; and experience has borne out the truth and reliability of his method.
So what Bönninghausen found was:
- Symptoms from provings could be completed from the observation of these same symptom fragments in patients.
- The modalities—conditions of aggravation or amelioration—have the status of general characteristics because they apply to all of the patient’s symptoms. (Of course, there will be exceptions.)
- Emphasizing the modalities and concomitants will often solve a case.
In addition, his strategy was to:
- Find what is characteristic of the patient by emphasizing modalities and concomitants.
- Generalize symptoms in the patient, even those affecting parts.
- Minimize use of the mental symptoms, as being difficult of accurate interpretation.
The Cyrus Maxwell Boger’s Edition Of The Bönninghausen Repertory
Thirty five years later, in 1899, Cyrus Boger made a new translation of the original Repertory of the Antipsoric Remedies into English. It was 232 pages. He continued to enlarge it until his death in 1935. He added so many additions and new rubrics that ist final size was almost five times bigger: 1040 pages. It is probably more correct to call this “Boger’s Repertory” than “Bönninghausen’s”.
David Warkentin: “This is the one of most valuable repertories ever created. Much of the information is more up to date than Kent’s and it contains many rubrics that aren’t included in Kent.”
From Rubrics In (Boger-) Bönninghausen Not In Kent, by Elizabeth Wright Hubbard, MD (Journal of the American Institute of Homeopathy, August, 1956. Vol. 49, No. 7, pages 203-206):
“Bönninghausen’s is most factual and classified: every symptom that refers to a part may be predicated of the whole. The interrelationship of symptoms and of remedies and the sequence of remedies are brought out. It opens a way into the wide fields of combinations. For Bönninghausen, the totality is made up of the general characteristics of the particular symptoms plus the condition, under the four general categories of locality, sensation, modality (aggravations or ameliorations) and concomitants.
“Roberts in his brilliant Principles and Practicability of Bönninghausen’s Therapeutic Pocket Book says it is based on the doctrine of concomitants, a concomitant being an attendant circumstance existing or occurring with other symptoms, having always a relation in time. The concomitant is the differentiating factor.
“Hahnemann says that ‘the characteristic symptoms represent that which is curable in each case of disease,’ in other words the common symptoms of the diagnosis do
not point the way to cure. Bönninghausen called chronic symptoms concomitants in acute ailments and often prescribed exclusively on them, although a drug should be findable covering both acute and chronic.
“The Bönninghausen method shines in cases without many mental symptoms; without rare, strange and peculiar symptoms; with few particulars; in cases where modalities predominate and concomitants are marked; cases showing pathological symptoms and objective symptoms.” That is, a very useful repertory for veterinarians.
Jahr’s And Boger’s Repertories
Jahr’s work was at the same time as Bönninghausen, but he emphasized (I believe) the known remedies as confirmed by clinical experience. In his book 40 Years Practice we see his emphasis on using what he was able to confirm himself. He developed rubrics that were smaller, yet contained the chief remedies for each symptom. The idea is to limit the rubrics to a usable size, yet make the accuracy of the rubric (in terms of containing the needed remedy) as high as possible. Thus we will see rubrics that are much smaller but ones that are developed from clinical experience.
Boger took a similar approach in his Synoptic Key. For example, if we take a common symptom, like fever, we find that in the Synoptic Key is listed 27 remedies. Compare this to the Complete Repertory where there are 700 remedies listed for the same rubric. Your first reaction may be that Boger is very limited and is therefore useless. But what if fever was very prominent in your patient and there was a 99% probability that the remedy needed was in this list of 27? You can see immediately the practical advantage to keeping the rubrics small and accurate.
These are the types of decisions that determine the plan of repertory construction, which in turn influences the size of the rubrics. Boger chose to be concise, to avoid excessive information while retaining a high degree of accuracy. This approach is very useful to veterinarians.
How Cases Are Worked
Let’s look at how the various repertories will work out cases. As these repertories were designed to be used with human beings, let’s start with a human case. Then we can compare that with animal cases to see what the differences are. From Harvey Farrington, described in his book Homeopathy and Homeopathic Prescribing, 1955—
This is the authentic history of a young woman of twenty, who contracted malaria while traveling with her family in Italy. Massive doses of quinine, prescribed by an Italian physician, stopped the chills and she was able to continue her tour. Not long after her return home she required a dose of Bromine, her constitutional remedy. Later, whether from the action of the Bromine or otherwise, the chills reappeared. Arsenicum alb. was prescribed by a local homeopath without result. The symptoms became alarming, and he gave quinine in massive doses, this time with only temporary palliative effect.
In prescribing for malarial patients homeopathically, the exact similimum must be found if a cure is to be expected. Since Arsenicum had been prescribed by a man of many years’ experience, and the case presented a number of Arsenicum indications, the physician who was called at this juncture worked the case out with great care, using Kent’s Repertory.
The symptoms were as follows: Chill daily at 6 or 6: 30 p. m.; beginning between the scapulae, as though ice water were dashed down the back; preceded by faintness and yawning; accompanied by intense thirst, great restlessness with tossing about, coldness, numbness and aching of the extremities, cold buttocks, and a sensation as though a wind blew on the feet and legs. The chill was worse from drinking cold water and from the least movement under the covers.
Fever without thirst was accompanied by throbbing headache, faintness, nausea, moaning, oppression of the chest, gasping and restlessness. The face was flushed, the skin hot and dry, and there was chilliness from lifting the covers. The temperature during the heat rose to 104. 5 F. Restlessness was the most marked mental characteristic; therefore, it was given first place in the repertory study.
Farrington used Kent’s repertory with these rubrics (see below). A single dose of Rhus tox. was given. For three days there was no change. Then the chill was lighter and the fever not so high and there was less aching of the limbs. The next day there was only a slight chill in the evening, and from then on the symptoms gradually abated. The patient’s general condition improved and by the sixth day all symptoms had disappeared, and years have elapsed with no return.
Let us compare how the analysis would have gone with the Bönninghausen repertory.
We see that the analysis, using concomitants, can be much simpler, much more focused. Here is another analysis from Bönninghausen. This next analysis introduces a modality along with concomitants and with same result.
For comparison, let us look at a simple analysis using Boger’s Synoptic Key Repertory.
We see that it is possible to come to the same remedy using different approaches, yet with different degrees of efficiency.
An Animal Case
Moses, a 5 year old male cat, has become recently ill. He is very lethargic and completely lost his appetite. If made to stand he cries out. He has not moved for 24 hours. There is a fever going from 103.5 F. (39.7 C) to 105 F. (40.6 C). Blood analysis shows a normal WBC count, normal neutrophil levels but very low lymphocyte and monocyte numbers—suggesting a marked migration of these cells to some extravascular site. These values are also elevated:
SGOT, CPK (very high), direct bilirubin, & blood glucose. The SGPT is normal as are BUN and Creatinine.
Bryonia 30c, one pellet, was given every 4 hours for 4 doses. He recovered over the next 2 days and was completely normal afterwards. He remained free of illness over the next 2 weeks, after which contact with him was lost. For comparison, here is the same analysis from Kent:
And from the Complete Repertory:
We see that Bryonia shows up in all the analyses, yet to me, is more easily recognized in the first Bönninghausen analysis.
Star is a 7 months old, female, Harlequin Great Dane. She presents with a history of poor appetite and a thin condition. She is growing quickly but at about the proper rate for this breed. She is shy, doesn’t want touch of strangers. Physically there is limping in the left front leg though no lesion can be found. The ears are excessively waxy, and there is a red, dry, patchy area at the place where the abdomen joins the rear leg, mostly on the left side. Client had already given Arnica 200c for the limp and there was some temporary improvement for 5 days at which point the limp returned.
First Prescription was Phosphorus 10M, one dose.
Three week follow-up: More friendly, not so shy. “Very friendly in society.” Client emphasizes the great increase in energy. Still thin, though appetite all right. Still some ear wax. No limping. No skin lesion at prior location but some redness between the thighs where they rub together. We wait longer.
Seven weeks after first prescription: Client gives a dose of Parvovinum 200c in lieu of vaccination. (I am not sure if this was her idea or mine.)
Eight week follow-up from Phosphorus: Greenish discharge from the inner canthus of both eyes, worse on going in the sun. Back roached. Appetite not good, only “picks” at food. Still not as shy as before. Drinks almost no water. Skin eruption gone. Second Prescription was Pulsatilla 10M, once.
One week after Pulsatilla: Has not eaten for 3 days, a gradual decrease in appetite. Now wants to go off by herself. Acting more “cowardly”. Less eye discharge. She is looking thin.
Analysis from Boger/Bönninghausen
Third Prescription was Silica 200c, one dose.
One week follow-up of Silica: She is acting normal and eating well. She became well 3 days after the remedy given. She is slowly gaining weight. All skin irritation and redness is gone. There is no eye discharge. Not very shy now but client can see “there is that tendency”.
Six weeks follow-up: “She looked fantastic.” Skin normal, temperament very good. Sold to Finland and contact with her lost.
It is interesting to compare this complicated case with analysis from a larger repertory. Here it is from the Complete Repertory:
We can see a similar remedy group with this analysis, but many more remedies to consider, thus to my eye, a more complicated workup than is necessary.
We can see that all 3 remedies used in this case came up in the first analysis that was done. This was apparently chronic disease, likely inherited, so it took more than one remedy to work through it. This is, of course, not an unusual situation for many of our cases.
What Repertory Then?
I have found the most consistent usefulness, for animal cases, is to start with the Boger/Bönninghausen repertory, at times supplemented by Kent. With unusual symptoms, when I want to search most extensively, I use the Complete Repertory or Synthesis—or just as often ReferenceWorks for a materia medica search.
The advantage of the Bönninghausen method is the emphasis on information we are most likely to obtain with our animal patients—symptoms, yes, but also modalities and concomitants. This method de-emphasizes the mental symptoms (though they are there) in favor of physical conditions as modified by these other factors. In addition, there are some very useful rubrics not found elsewhere.
I also value the repertory by Jahr, which is smaller, simpler, but often adequate. One of my projects is developing the Jahr repertory for veterinary use. I am using this smaller repertory as a base and adding in rubrics from Bönninghausen and Kent to make it a more useful reference for our work. If we streamline the repertory for veterinary use and emphasize modalities and concomitants, a lá Bönninghausen‘s method, I think we will have a very useful and unique tool for our work.
The charts for comparison of different repertory rubric numbers and remedy numbers is from Roger Van Zandvoort, and compares the Kent repertory (version not specified), the Complete Repertory 4.5 and Synthesis 9.1 (information from Archibel’s website).
Rubrics In Bönninghausen Not In Kent, by Elizabeth Wright Hubbard, MD is from the Journal of the American Institute of Homeopathy, August, 1956. Vol. 49, No. 7, pages 203-206.
Repertories used in my analyses are the Bönninghausen repertory, the Kent repertory, and the Complete Repertory 2005, as provided by Kent Homeopathic Associates with the MacRepertory program.
Analyses shown are configured by calculating both totality and number of rubrics, so that those remedies appearing in the most rubrics and having the highest grading come up first.
Dr. Richard Pitcairn graduated from veterinary school in 1965, from the University of California at Davis, California, and worked on a PhD degree emphasizing the study of viruses, immunology and biochemistry. Working in a mixed practice he saw a wide variety of health problems, but to his disappointment, did not see the results that he expected using the treatments learned in veterinary school. He became interested in alternative medicine, nutrition and homeopathy. He found homeopathy to be intellectually complete and satisfying, and after studying and using it for some 20 plus years, has had remarkable success. Since 1992 he has taught a yearly course, The Professional Course in Veterinary Homeopathy, to train animal doctors in homeopathy. Dr. Pitcairn was a founding member of the Academy of Veterinary Homeopathy and also served as its president. With Susan Pitcairn he wrote two editions of Natural Health for Dogs and Cats, a classic in the field, which sold over 350,000 copies. http://www.drpitcairn.com/
Prejudice (& Hostility)
“Good science comes first from observation” – Chris Day June 2006
|Added August 2009: It is a source of great disappointment to us at the AVMC, that a minority of professional veterinary colleagues acts in an unprofessional and discourteous way when clients try to discuss the possibility of referral for alternative medicine. Whatever their opinions of alternative medicine, usually formed without first-hand experience of the subject, vets are supposed to assist clients with referrals, not obstruct them or give a rude reaction. As most clients who request referrals have already come to the end of the conventional options, it is difficult to see what gives rise to the objection. Pride and financial considerations should not enter into the equation, so we assume these are not the reason. The fact that there may be a way of helping a distressed and chronically ill patient should be a source of pleasure and interest for the caring veterinary surgeon.|
“What we don’t talk to, we don’t understand. What we don’t understand, we fear. What we fear, we destroy.” (Aboriginal proverb)
“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” (Arthur Schopenhauer 1788 -1860)
The practice of natural medicine, particularly homeopathy, is not a lucrative exercise. Manufacturing of the medicines is not highly profitable. There is also a great deal of hard work involved in specialised learning and the time-intensive nature of proper practice. For these reasons, there is poor availability of veterinary natural medicine but those who have taken it up enjoy the rewards, in job satisfaction (Why use Homeopathy?).
There is no doubt that taking up natural medicine massively reduces practice profitability, compared with conventional practice. The differential may change, if the monopoly of supply of conventional prescription medicines is removed from veterinary practices. This would remove lucrative profit margins and force them to charge more realistic professional fees for their work, rather than relying on sales.
Whether economics plays a part, whether it is the classic primitive behaviour pattern, in which a community harries those who do not conform precisely, whether it is insecurity when faced with the unfathomable vastness of the boundless vistas presented by holistic medicine or whether it is simply fear of the unknown and personal insecurity therefrom, there is a significant amount of prejudice and hostility against natural medicine and particularly against homeopathic vets within the veterinary profession and its hierarchy. In recent years, this has been actively fuelled by a vociferous minority, who wish to see homeopathy banned. There are even tales of prejudice against homeopathy and other natural medicines within the RSPCA Inspectorate and hierarchy. There was a clear-cut case in which the Donkey Sanctuary at Sidmouth strongly advised a client not to consult the AVMC, despite a chronic and distressing condition having shown no signs of improvement whatever on conventional treatment (happily, the owner took no notice and the donkey is now fine – case report). There is no moral or ethical place for such an attitude, when animal welfare should be the objective. There is so much to do for animals and their welfare that it beats me how or why these people have the time and energy for such negative activity.
(The AVMC is conducting objective analysis of clinical outcomes from cases seen. These results are being updated on an ongoing basis. To view them, click here.)
It is a matter of record that the AVMC has frequently offered free help to the relevant authorities, in cases of widespread animal suffering or disease (notable examples have been such recent epizootics as: Foot & Mouth Disease in 2001, Avian Influenza in 2006, Seal ‘phocine distemper’ PDV outbreak in 2002, Koala Chlamydia – ongoing). Sadly, in each case, these offers have either been ignored or refused. This would appear to be a result of institutional prejudice against homeopathy, often despite the abject failure of conventional methods. The seal disaster killed 17,000 animals in 1988 and 18,000 animals in 2002, yet no help was accepted. Survival of the Koala Bear is threatened by venereal spread of Chlamydia. Similar offers of help have been made for Squirrel Pox in Scotland and Cumbria, Bluetongue in Southern and Eastern England and Avian Influenza in the swans at Abbotsbury, in Dorset, in the West Country. Natural medicine may have a lot to offer, when conventional medicine is at a loss. However, to date, it has not been given a chance to prove its worth, despite the failure of the drug approach in such situations.
“Nature loves variety – Society hates it“ (so said Professor Milton Diamond). Those who would knock homeopathy bleat on about science. I say: if science knows all the answers, who needs scientists? They can surely go home, as there would be nothing left to discover! The nature of homeopathy can be an obstacle to belief, in that the medicines used are often diluted ‘beyond the molecule’. This is a cause of incredulity, in many but why not suspend disbelief, while examining the results? In fact, I have lectured to and enjoyed dialogue with a group of atomic scientists, who had no problem getting their minds around the sub-molecular issues. If that community was not worried, with their intimate and awe-inspiring knowledge and understanding of molecular and atomic physics, why should I be? The first rule of good science is observation and the results have to be observed, however inexplicable they may at first seem. I have frequently invited veterinary surgeons, including officers of the RCVS, to attend our clinic and observe. Why has this never happened? Let’s suspend disbelief, objectively examine the outcome of homeopathic intervention and worry about possible so-called ‘scientific’ explanations later. It is frankly unscientific to do otherwise.
Just because it took place in a laboratory does not make it science. – Chris Day
Forget the laboratory. Forget ingrained theory and beliefs. Forget entrenched loyalties. Get out in the field, roll up your sleeves and observe the results in practice. That is the start of real science. That is the only way to counter the entrenched belief system that prevents acceptance of homeopathy. ‘It doesn’t work because it can’t work’ is a fair summary of many of the arguments ranged against homeopathy and is symptomatic of belief not science.
Beware ‘The King’s New Clothes’.
The words ‘science’ and ‘scientific’ are used in such a way as to prevent the listener or reader questioning the material. Do you remember the boy who hadn’t been told about the King’s New Clothes? Whenever the words are used to support an assertion or a commercial interest, take a really objective look and you might see the real ‘King’ behind the illusion.
It is often said that if you tell a lie often enough it becomes the truth. [“A lie told often enough becomes truth” Vladimir Lenin. – William James (1842-1910) the father of modern Psychology “There’s nothing so absurd that if you repeat it often enough, people will believe it.“]. However, call a thing red that is in fact blue will not make it red. No amount of ranting and clamouring will make it so.
There is a clamour for only ‘evidence-based medicine‘ to be acceptable. This same voice calls for homeopathy to be banned for lack of evidence. Sometimes this goes beyond the polemic into rabid rant. This seems very strange in the light of a recent BMJ report on evidence-based medicine (EBM), which states that, of 2,404 human treatments so far reviewed, only 15% were shown to be to be effective. 47% were of unknown effect. This report did not address harmful side-effects, nor did it draw attention to the fact that, in most cases, the evidence is only that a drug can suppress a symptom of the disease, rather than aid the patient to overcome a disease. One cannot expect modern conventional veterinary medicine to fare much better. If calls to ban medicine that is not evidence-based were to prevail, what would happen to 85% of conventional medicine? (See also Chris Day’s Blog)
The first step in good science is observation.
Experience (one of the best forms of evidence) shows that homeopathy is able to bring about a positive result in the large majority of cases seen, even after conventional methods have failed. In addition, a recent veterinary pilot clinical outcome survey, conducted by the British Homeopathic Association, yet to be published, showed very positive results. Published papers exist, to show that homeopathy is not without effect. These are conveniently ignored by the anti-homeopathy lobby.
Those who would ‘rubbish’ homeopathy will often claim that its so-called successes are only in self-limiting conditions. At the AVMC, we are scientific enough to know that some cases will resolve on their own, so making interpretation of any single result quite difficult. However, in referral practice, we know that the cases seen have defied many types of input before being presented for homeopathy, thus lessening the likelihood of them being self-limiting. Of course, the results of any veterinary intervention, conventional or otherwise, must be viewed to be possibly the result of self-limitation of the condition.
The six UK veterinary schools have reduced or totally removed student exposure to natural medicine, despite a unanimous motion by the AVS (Association of Veterinary Students), several years ago, for more ‘alternative’ content within the undergraduate curriculum. The reason for this reduction is not clear but, of course, academic posts are linked to research funding, in many cases, which comes from commerce. One veterinary school has recently re-opened the communication channel, which is very encouraging.
There are many signs of erosion of this prejudice, demonstrated by increased co-operation between vets on both ‘sides’. This is undoubtedly helped by proper ethical and professional conduct and openness, by veterinary homeopaths and by showing consideration and respect for mutual but healthy scepticism.
The Royal College of Veterinary Surgeons, until recently, separately listed the holders of the Faculty’s Membership qualification in its Register. This meant that, in homeopathy at least, there was recognition of the efforts that those vets who practice alternative medicine have put in, towards specialisation. Sadly, this listing has ceased, since 2006, for unclear reasons. The result is that it is more difficult for veterinary surgeons or for the animal-owning public to locate veterinary homeopathic referral services.
Some clients complain of resistance by veterinary surgeons to referral for homeopathy. If a veterinary practice refuses to supply a referral note or history, for homeopathic or other veterinary natural medicine, on request, then this should be a matter for discussion and diplomacy. We at the AVMC are happy to help in any way we can, on behalf of prospective clients and their animals. The RCVS Guide to Professional Conduct requires veterinary surgeons to co-operate with referrals and second opinions, when sought by clients.
If argument and professional rivalry pertain, in the management of a case, this can only be to the potential detriment of the patient. The AVMC always seeks a harmonious and co-operative route, in any dealings between veterinary surgeons. A sincere wish to help a sick animal, in any way possible, with frank and clear discussion should break down barriers. The animal patient is the priority in all our dealings and we try to ensure nothing can stand in the way of the best for the animal.
The public (i.e. the consumer) is ever more supportive of homeopathy. These days, despite residual professional prejudice, hardly a day goes by without some mention of natural medicine, in the national news or press. Twenty years ago, things were very different. In those days, an item on homeopathic medicine or organic farming, in the national press, was a very rare event.
Veterinary surgeons are not entitled to obstruct requests for referral or second opinion. On the contrary, the RCVS guidelines stipulate facilitation of such transactions. In today’s more ‘liberated’ and ‘enlightened’ environment, there should be no obstacle to obtaining the treatment you wish for your animal. We behave professionally and work for the benefit of the patient. This motivation should unite all vets.
Everyone is entitled to an opinion, of course. On this issue, as in so many walks of life, there appears to be a wide spectrum of differing views and reactions. There are those who are scornful, there are those that would mock, there are those who are downright hostile, there are those with little or no opinion. There are also those who are open-minded, professional and ethical enough to observe results and want for their patients anything which might help, and these are the vets who continue to ask for homeopathic help or to assist their clients in seeking homeopathic help, when asked.
At the end of all this, care and concern for animal welfare has to be the bottom line. If a system of medicine, however incredible, may help just 1% of patients not helped by established methods, it is worth exploring! It would appear that a great deal more than 1% of such patients are helped by homeopathy (outcome analysis).
At a time when there is such a high incidence of adverse reactions to prescription medicines, worldwide, many resulting in death, surely it behoves us to show some humility and to search earnestly for another way? The true picture of the current toll of modern pharmaceutical drug medication is very obscure. According to the Center for Drug Safety (in the USA), reported Adverse Drug Events (ADEs) result in more than 2.1 million injuries each year and the Journal of the American Medical Association reported that 100,000 Americans die annually of adverse reactions to prescription drugs. That organisation also states that the FDA’s Office of Drug Risk Assessment calculates only 1% of ADEs are reported. Coupling that with the very low efficacy claims (15%), made by the BMJ above, makes bleak reading. The above figures are therefore hopelessly underestimated. Figures from the veterinary world have not been found. Are we seriously being told that it is better to kill 100,000 American citizens (or many times that number) each year with drug medicine and who knows how many animals than to use homeopathy?
Perhaps one of the problems homeopathy has, on its path to mainstream acceptance, is the expert?
Science must look into the emerging field of bio-energetics, if it is to catch up and find some of the answers. Time should not be wasted on fruitless argument and ideological theorising.
For an introduction to the science of homeopathy:
Of course, not everyone is prejudiced. Some real scientists exist in the veterinary profession, as in others. Take the above excerpt from the National Geographic website (ignoring the U.S. spelling of ‘anesthetic’ and the misprint spelling of ‘complimentary’), for instance:
Our sentiments precisely! Animals first, prejudice not.
|Researchers there are exploring how acupuncture, in conjunction with anesthesia during and after surgery, can reduce the amount of anesthetic gas and post-operative pain medicine that a patient requires.
The reduction in medication can significantly lower the risk of adverse drug reactions in patients, according to Narda Robinson, a veterinarian and adjunct faculty member in the veterinary program at Colorado State University.
“I think the thrust of all this [research] is, how can we improve patient safety from medical procedures and [improve] their quality of life,” Robinson said.
“The more that veterinarians learn and accept acupuncture and some of the other complimentary [alternative] medical techniques, the safety of medical intervention for animals will be that much better.”
With regard to the recent rabid assaults on homeopathy within the NHS and on veterinary homeopathy, it is extremely boring and pointless for those who are more concerned with theory, dogma, reductionism and robotic and mechanistic medicine than with patient care and welfare to sound off on a subject of which they have neither experience nor understanding. Patients and patient care should be the central theme of medicine, not dogma and blinkered ideology. It’s a wonder they have the time in their lives to spend on such fruitless pursuits. In reading some of the of the arguments put forward, I can’t help wondering why I haven’t seen a single example cited of that fundamental requisite of real science – observation.
See also: Evidence-Based Medicine
See also: Chris Day’s Blog: http://chris-day.blogware.com
See also: Hacking Attack – July 2009 (Info)
Added 2009: In more sane moments, one is able to say let the non-scientists who attack homeopathy so volubly get on with their lives and let us get on with ours. In less tranquil moments, it is tempting to wonder why the ******* ******s don’t get off their backsides and witness the results of homeopathic treatment. Then they can start to form theories to explain them, based on true science (i.e. objective observation). Perhaps vested interest and the lucrative returns of ‘big pharma’ are too attractive and too comfortable to allow such objectivity.
Added July 2010: For how long can these -wits insult science by hiding behind that august word when they are patently being unscientific? How can they continue to be unprofessional in insulting homeopathy and their professional colleagues who have gone that step further than they have themselves and studied it and used it for the benefit of patients. For how long dare they go on insulting the intelligence of users of homeopathy (human patients and animal owners), who have been through the mill of conventional medicine without help, finally to find a solution in homeopathy? Are all these genuine folk really so deluded and so suggestible?
Those who would attack homeopathy state clearly that it has been proven not to work. However, all science and philosophy tells us that you cannot prove a negative. Furthermore, why ignore the scientific work that has been published, just because it doesn’t fit the paradigm? Plenty of work is published to show that homeopathy is different from placebo. If more scientific published work is required, those who clamour for the proof should abandon their total trust in and dependence on the sacred cow of randomised double-blind, cross-over trials, that currently hold pride of place. That form of trial is arguably a good tool to examine the efficacy of medicines that are designed simply to suppress symptoms (as long as you trust their veracity*); they are a hopeless tool for examining the capability of a medicine to heal a patient and which has no intention of suppressing symptoms.
If confronted with cases of healing against the odds, all they can say, with a dismissive gesture is “Things get better anyway“. Good science not!
Make no mistake, the recent ranting against homeopathy does not come from reasoned argument nor from a wish to promote science. How could it when all reasoned argument is rejected and cherished scientific principles are flouted in almost every sentence. There is clearly a more sinister objective.
What about all the animals that appear to improve or become well, coincidentally with the commencement of homeopathic medication (often after many years of other medication)? What is the most likely explanation? Why, with a casual wave, say ‘many diseases get better anyway‘ or why wheel out the old chestnut ‘placebo effect‘? Why did the animals choose to get better coincidentally with homeopathic treatment, in so many cases? Why didn’t ‘things get better’ while on other treatments? How do you convince a herd of cattle or pigs or a flock of sheep to take on and respond to the placebo effect, when they’re dosed via their drinking water? These mechanical responses to questions are distractions, smoke screens, and are there simply to prevent the need to think about the results.
The foregoing begs the question: “Is it ethical to ignore all the reports of recoveries against the odds?” Simple explanations of the mechanisms of homeopathy would be nice but, until such are available (and rest assured, the pharmaceutical industry’s billions will not be spent on such research), we have to rely on observations and, as medically-trained and vocational professionals, we have to leave no stone unturned in our mission to help patients, whether human or animal.
One of the proposed far-fetched and bizarre explanations for the success of homeopathic cases in veterinary practice is that homeopathic vets spend longer with their patients. If it’s that simple, why don’t other vets spend longer with their patients?
A little humility wouldn’t go amiss, from the conventional medical community, over the huge toll in misery, suffering, pain and even death, from drug-induced disease and iatrogenic disease. Just two web sites giving some information are offered as links here. There are probably more but these came up quickly on my search engine: http://www.pharmj.com/pdf/papers/pj_20030426_admissions.pdf and http://www.natural-law-party.org.uk/UKmanifesto/health11.htm They are offered here, not for party-political reasons or for any reason other than simply for the useful medical data contained therein. The financial burden of this phenomenon on the NHS is clearly massive and dwarfs any arguments over the funding of homeopathy on the NHS.
Dr James Le Fanu has written a challenging but very thought-provoking article in the Telegraph (5th July 2010) – http://www.telegraph.co.uk/health/healthadvice/jameslefanu/7869006/Doctors-Diary-James-Le-Fanu.html . However, such is the nature of the rabid opposition to homeopathy that Dr Le Fanu has drawn a storm of articles against his arguments.
I would have more respect for the criticisms were they to be based on true science and logic, rather than on oft-repeated mantras that have not been thought through. The saga goes on. Meanwhile, patients continue to suffer and to need help. For goodness sake, let’s get on with the business of helping patients and healing sickness!