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The Evidence

Rational Veterinary Medicine:

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Papers, listed by lead author: A


Aabel, S,. Laerum, E., Dølvik, S. and Djupesland, P. (2000) ‘Is homeopathic ‘immunotherapy’ effective? A double-blind, placebo-controlled trial with the isopathic remedy Betula 30c for patients with birch pollen allergy’, British Homeopathic Journal, vol. 89, pp. 161–168.

Apart from a couple of days there was no statistically significant difference between trial groups although for 10 days out of the 4 week test period the authors felt there was a "clinically interesting" (whatever that means) difference. No mention of randomisation in the abstract or of how blinding was achieved. The staggering conclusion: "treatment with Betula 30c during the pollen season deserves further attention". Well, it might if you’re desperate to sell homeopathy to people who trust you and you’re happy to turn a blind eye to the fact it simply doesn’t work.

Links: [abstract, pub med]
Responses: [comment, apgaylard]
Keywords: hayfever, isopathy, rhinitis

Adler, M. (1999) ‘Efficacy, safety of a fixed-combination homeopathic therapy for sinusitis’, Advanced Therapeutics, vol. 16, no. 2, pp.103–111.

An open label, practice based survey, no blinding, no placebo conrtol, yet bizarrely referred to as "evidence" by homeopaths... Just another customer satisfaction survey masquerading as science.

Links: [abstract, pub med]

Adler, R.H., Herschkowitz, N. and Minder, C.E. (2005) Letter to the editor, European Journal of Pediatrics, vol. 166, no. 5, p. 509.

A response to Frei (2005).

Links: [pubmed]

Albrecht, A. and Schutte, A. (1999) ‘Homeopathy versus antibiotics in metaphylaxis of infectious disease: a clinical study in pig fattening and its significance to consumers’, Alternative Therapies, vol. 5, no. 5, pp. 64–68. [permalink]

"Homeopathic metaphylaxis is significantly effective compared with placebo and routine low-dose antibiotic metaphylaxis for the incidence of [sic] disease and rate of disease of the respiratory tract among the animals studied... The routine antibiotic dosage of metaphylaxis is too low to be effective... to confirm whether antibiotic metaphylaxis may be replaced by homeopathic metaphylaxis, this study should be repeated independently."

Keeping large numbers of pigs together in close proximity, as practiced in intensive pig farms, can lead to widespread infection which, even at a mild or subclinical levels, can in turn result in considerable losses to the producer. Various measures are taken to combat this from Specific Pathogen Free and Gnotobiotic herds which attempt to screen a variety of disease causing organisms and exclude them from the herd, to the routine application of low-level antibiotics in the feed, a process known as metaphylaxis.

In this paper the authors attempt to contrast the use of antibiotic metaphylaxis with homeopathic metaphylaxis although they acknowledge that at the time of publication, no study had been carried out in Europe to actually determine the usefulness or otherwise of antibiotic metaphylaxis in the first place. Effectively they are attempting to compare a practice which is known to be ineffective (homeopathy) with another practice which is not known to be effective (low-level antibiotics).

The study looks at twelve subunits of 120 piglets each, pooled from at least 100 different breeding farms and studies the effect of the addition of various combinations of antibiotics and homeopathic remedies to the feed all observed over an eleven day period. Although the number of piglets is given as 1440 in the Materials and Methods section, the actual study only used 960 piglets in the comparison between the two types of metapylaxis, although this is not stated explicitly and some arithmetic has to be done using the numbers in Table 2 before the true situation becomes apparent. The remaining piglets were included in control groups, the results of which had no bearing on the comparison between homeopathic and antibiotic treatment (which is, after all, the stated aim of the paper). The 960 figure is the one used in a later subsequent systematic review (Mathie and Clausen 2014) involving this paper.

Even this reduced figure however, is not the end of the story regarding the true numbers of trial participants. With environmental disease (the subject of the study) it is each group of animals which is considered the ‘unit’, not each individual, since whether or not the piglets become affected with disease depends on their physical position in the barn and the health of their fellow group members, with whom they share a common airspace, trough and micro-climate, all routes whereby the type of infection under investigation would be transmitted. The individual piglet's succeptibility to disease depends as much, if not more, on which group they happen to be in as on their individual characteristics. In this case the piglets were subdivided into groups of twenty for the duration of the study, in effect giving not 960 trial participants, but only 48. This will have a major influence on the power of the study and arguably, should have been taken into account in the final analysis.

The published version describes only a small part of a larger study originally involving 4680 piglets, mentioned twice in the references as “Schutte, A., Ein beitrag zum Thema 'Einstallungsmetaphylaxae in der Schweinmast' [Metaphylaxis in pig fattening] [dissertation] Berlin, Germany: free university; 1991” and also “Schutte, A., Ist Forschung in der Veterinarhomoopathie gerechtfertigt? [Is research in veterinary homeopathy justified?] Berl Munch Tierarzlt Wochenschr. 1994; 107:229-236”.

No reason is given why this particular group of piglets, rather than any other from the original, much larger, group of subjects were chosen for inclusion in this paper. We are not advised what the results of the parent study were so it is not possible to be reassured that the published trial is representative of the larger study or whether, for argument’s sake, the published results might represent the “best” in the authors’ views. Unfortunately (or conveniently, depending on one’s views) neither of the original studies are available for study online.

The administration of the various treatments and assessment of the responses by the stockmen and “independent” veterinary surgeons is done without blinding. The authors state, due to material differences in the various compounds, "blinding was not possible", which means everyone involved with the trial knew exactly which type of medication each group of piglets was receiving. This could quite possibly have influenced their interpretation of the results. This omission is highly significant and considerably reduces, if not eliminates altogether, the usefulness of the conclusion, especially when considered along with the possible vested interests described later. From a homeopathic point of view too, no individualisation was performed, even though in other papers on the subject it has been claimed by homeopaths that no valid assessment of homeopathy is possible without it.

Vested interests abound, although close scrutiny and a little googling is required to find them. A declaration at the end of the paper announces, "This study was supported jointly by the Carstens Foundation in Essen, Germany and the Deutsche Homoopathie Union in Karlsruhe, Germany". In a paper translated into English from the original German, it has to be asked why the single phrase which hasn’t been translated is the one that tells us one of the sponsors was the German Homeopathic Union (Deutsche Homoopathie Union).

The Carstens Foundation - of which lead author, Henning Albrecht, was director at the time of publication - was founded by ex-German President and former Nazi, Karl Carstens, and his wife, Veronica. It is described as the leading funding institution in Europe for research into Homeopathy and naturopathy, and its long-term goal is the integration of complementary medicine and homeopathy into academic curricula and research.

The second author, Dr. Achim Schütte, is described elsewhere than in this paper as a researcher with the Carstens Foundation and “a veterinarian trying to integrate homeopathy and conventional medicine in the treatment of animals”. In 2006, he was responsible for launching the Veterinary Clinical Research (VetCR) database for veterinary homeopathy and he was previously the General Secretary of International Association for Veterinary Homeopathy (IAVH).

So, hardly a clean slate regarding conflict of interest there, with both authors and both sponsors all keen proponents of homeopathy and presumably not too upset at the apparently positive findings declared in the conclusion - the fact that the paper was published in a journal whose title is Alternative Therapies is just the final nail in the coffin.

Yet despite all the above, this paper is held up by many believers as firm evidence in favour of homeopathy. For instance, the Society of Homeopaths claims (wrongly) about this trial, "A combination homeopathic medicine was found to be as effective as antibiotic treatment for infectious diseases in pigs". As always, with homeopathy results count, and if the results are what homeopaths want then any methodological irregularities can happily be ignored.

You don't however, have to take the word of RationalVetMed on the matter of clear conflicts of interest, poor methodology and roughly three-quarters of the original trial subjects not being included in the study for undisclosed reasons and how all that reflects on the usefulness of this study when it comes to evidence for homeopathy. None other than the British Homeopathic Association (BHA) itself rejected this paper when it was considered in a recent systematic review of randomised controlled trials by homeopathic researcher Robert Mathie (Mathie and Clausen 2014). In Mathie's 2014 review the Albrecht 1999 trial was barred from inclusion on the grounds it was not free of vested interests and because of this and other factors there was a high risk of bias. Furthermore the absence of blinding was confirmed in both the trial personnel and the outcome assessors.

The final conclusion from Dr Mathie - research development advisor to the British Homeopathic Association and the Faculty of Homeopathy - this was not a trial which provided reliable evidence.

RationalVetMed wouldn't venture to disagree!

Links: [abstract - pubmed]

Alibeu, J.P. and Jobert, J. (1990) ‘Homeopathic therapy with Aconite for post-operative pain-agitation syndrome’, Pédiatrie, vol. 45, pp.465–466.

Links: [abstract, pub med]

Almeida, R.M.V.R., (2003) ‘A critical review of the possible benefits associated with homeopathic medicine’, Rev. Hosp. Clín., vol. 58, no. 6, pp. 324–331.

“As a result of the recent scientific research on homeopathy, it can be concluded that ample evidence exists to show that the homeopathic therapy is not scientifically justifiable.”

Links: [abstract - pub med]:[full text - pdf]:[full text - scielo, html]
Responses: [Fisher and Dantas (2004)]:[Almeida (2004)]

Almeida, R.M.V.R. (2004) ‘Homeopathy: do not accept as medicine what has no evidence and contradicts basic science’, (letter), Rev. Hosp. Clin., vol.59, no.3. [Author’s response to Fisher and Dantas (2004)]

A brilliant rebuttal by Almeida of the attempt by two leading proponents of homeopathy to discredit his paper. This letter in many ways is as informative, if not more so than the original paper (above). It certainly gives an excellent insight into the way the mind of the homeopath works - their inability to take any sort of criticism and deal with it rationally or in a scientific way and their extremely blinkered attitude to evidence, even evidence which has been refuted and discredited years previously. Fisher and Dantas hadn’t even read the original paper correctly before submitting their response - ‘nuff said!

Links: [full text scielo, html]

Altunc, U., Pittler, M.H. and Ernst, E. (2007) ‘Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials’, Mayo Clin Proceedings, vol. 82, no. 1, pp. 69–75.

CONCLUSION: The evidence from rigorous clinical trials of any type of therapeutic or preventive intervention testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition

Links: [abstract, pubmed]:[mayo clinic]:[full text, pdf, citeseerx]

Andersen, H.E., Eldov, P. (1995) Klassisk hom?opati - og dens brugere. Institut for Samfundsfarmaci, Danmarks Farmaceutiske H?jskole. 1995. Andersen, Helle Egebjerg. En unders?gelse af Klassisk Homøpati. Teorier, praksis og brugererfaringer. 1999. ISBN 87-987279-0-7

To illustrate the woeful lack of respect that homeopaths have for evidence, rather than convert it to RationalVetMed house style, I have preserved the layout that the prestigious-sounding European Network of Homeopathic Researchers (EHNR) have used for this so-called citation which they give as evidence in favour of their arcane art.

Readers will notice several puzzling things about the wording - several of the characters (‘ø’ in the original Danish) have been automatically replaced with a ‘?’ mark by confused character recognition programmes; a full-stop has crept in between the words “Homøpati” and “Teorier”, the second word having become capitalised as a result. Also, there are two dates - 1995 and 1999 and the lead author is given at the start as “Andersen, H.E” and then repeated half way through as “Andersen, Helle Egebjerg”. This so-called reference which has been so carelessly copied and pasted is actually two separate works by the same author, a Danish pharmacology PhD student at the time of writing, one of which is simply a rehash of the other.

The citation for the 1995 piece should infact read:

“Klassisk homøopati, - og dens brugere (which translates as “Classical homeopathy - and its users”) by Egebjerg Andersen, Helle; Eldov, Peter”

... while the 1999 work should be:

“En undersøgelse af klassisk homøopati, teorier, praksis og brugererfaringer (which translates as “A study of classical homeopathy, theories, practices and user (or patient) experience”) by Egebjerg Andersen, Helle.

The 1999 work is reported by Royal Library and Copenhagen University Library Information Service as an “Abridged version of the thesis ‘Classical homeopathy - and its users’” (“Forkortet udgave af specialet ‘Klassisk homøopati - og dens brugere’”) - i.e., the 1995 work.

This blind copying of multiple errors in the citation is a wonderful encapsulation of the attitude of the homeopath to evidence - it doesn’t matter what sort of evidence or how sloppy or inaccurate it is as long as someone has written somewhere that “homeopathy is t’riffic” then that’s good enough, slap it in a list, get it online and call it science.

Furthermore this catalogue of revealing linguistic ignorance hasn’t stopped other homeopaths from slavishly copying and pasting the original onto other, pro-homeopathic, web sites obviously without even considering how wrong the citation appears, never mind taking the trouble to read and critique the paper itself. If the EHNR citation is entered in a search engine it is found that exactly the same form of words, question marks, errors, repetition and all, appears in some dozen or so sites all written by people so keen to promote homepathy, but too lazy to check the references they themselves are using.

The irony is that, even if we take the EHNR’s most optimistic interpretation of this study it is still merely a patient satisfaction survey (so no blinding or controls) where 27% of patients said their condition didn't improve after treatment with homeopathy, even when asked by a nice young post-grad researcher! The conditions addressed in the survey all appear to have been diagnosed by the patients themselves (who were already dissatisfied with conventional medicine) rather than a medical doctor and include vague symptoms such as “general pain” and non-symptoms such as “psychical pain”. Even the figure of 73% improvement following homeopathy quoted by EHNS is disingenuous since only 61% of those patients who improved could actually ascribe this improvement to homeopathy and only 18% reported a complete resolution of signs.

Links: [Royal Copenhagen University Library]:[open library (1999 publication)]:[Google books (1995 work)]:[JREF thread]

Arlt, S., Padberg, W., Drillich, M. and Heuwieser, W. (2009) 'Efficacy of homeopathic remedies as prophylaxis of bovine endometritis', Journal of Dairy Science, vol 92, no. 10, pp. 4945-4953 ( [permalink]

Endometritis is an infection of the womb which is particularly problematic in cattle as it means it makes it difficult to get them back in calf  and is therefore costly in terms of milk production (as a cow needs to have a calf before she will produce milk). So farmers spend a lot of time and money trying to work out how to reduce its incidence. It seems like whether or not to use homeopathy is now one less thing they’ll have to worry about though. As the authors of this paper say:

‘… the treatment protocols tested were not effective in preventing bovine endometritis or in enhancing reproductive performance in this study

Links: [Abstract, pubmed]:[full text (£)]:[full text pdf (£)]

Attena, F. et al. (2000) ‘Homeopathy in Primary Care: self reported change in health status’, Complementary Therapies in Medicine, vol. 8, no. 1.

Yet another patient satisfaction survey, purely subjective, no blinding, no controls, which are always more fun when the percentages are looked at the other way round from how the authors present them. In this case a staggering 26.5% of patients reported they hadn't experienced even a moderate improvement in their health status, a year after treatment. These were patients who had actually chosen to attend a homeopathic clinic so might reasonably be expected to look favourably on homeopathy but over a quarter of them thought it didn't do any good. Yet this paper is still quoted as positive evidence for homeopathy - laughable!

Links: [abstract, science direct]

Axelsson, E., Ratnakumar, A., Arendt, M.,Maqbool, K., Webster, M.T., Perloski, M., Liberg, O., Arnemo, J.M., Hedhammar, A. and Lindblad-Toh, K. (2013) ‘The genomic signature of dog domestication reveals adaptation to a starch-rich diet’, Nature, vol. 495, pp. 360–364. [doi:10.1038/nature11837] [permalink]

“... Ten genes with key roles in starch digestion and fat metabolism... show signals of selection. We identify candidate mutations in key genes and provide functional support for an increased starch digestion in dogs relative to wolves. Our results indicate that novel adaptations allowing the early ancestors of modern dogs to thrive on a diet rich in starch, relative to the carnivorous diet of wolves, constituted a crucial step in the early domestication of dogs.”

A team of scientists at Uppsala University have discovered that domestic dogs are considerably better at digesting starch than wolves. Although this will not come as a surprise to anyone who has ever been fixed by the steely gaze of Canis familiaris while trying to polish off a pizza with a clear conscience; it is something, as might be imagined, the fanatical raw-feeding lobby find hard to digest. The contention that dogs are simply “wolves lite” and are completely unable to process starch, is a pretty fundamental lynch-pin of their whole, illogical, house-of-cards position.

Links: [abstract, Nature]:[Uppsala University]:[BBC article]:[The Scientist article]:[Science News]
Keywords: raw meaty bones diet rmb barf food