Rational Veterinary Medicine:
Papers, listed by lead author: K-
Kainz, J.T., Kozel, G., Haidvogl, M. and Smolle, J. (1996) ‘Homoeopathic versus placebo therapy of children with warts on the hands: a randomized, double-
“CONCLUSION: There was no apparent difference between the effects of homoeopathic therapy and placebo in children with common warts under the conditions of this study”
Links: [abstract pubmed]
Kaptchuk, T.J., Kelley, J.M., Conboy, L.A., Davis, R.B., Kerr, C.E., Jacobson, E.E., Kirsch, I., Rosa N Schyner, R.N., Bong Hyun Nam, B.H., Nguyen, L.T. Park, M., Rivers, A.L., McManus,C., Kokkotou, E., Drossman, D.A., Goldman, P. and Lembo, A.J. (2008) ‘Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome’, British Medical Journal, vol. 336, pp. 999-
“Objective: To investigate whether placebo effects can experimentally be separated into the response to three components—assessment and observation, a therapeutic ritual (placebo treatment), and a supportive patient-
“... For three weeks either waiting list (observation), placebo acupuncture alone (“limited”), or placebo acupuncture with a patient-
“... The proportion of patients reporting adequate relief showed a similar pattern: 28% on waiting list, 44% in limited group, and 62% in augmented group... The same trend in response existed in symptom severity score... and quality of life
“... Conclusion: Factors contributing to the placebo effect can be progressively combined in a manner resembling a graded dose escalation of component parts. Non-
A comparison of three groups of patients with IBD – one was an observation-
Kim, L.S., Riedlinger, J.E., Baldwin, C.M., Hilli, L., Khalsa, S.V., Messer, S.A. and Waters, R.F. (2005) ‘Treatment of Seasonal Allergic Rhinitis Using Homeopathic Preparation of Common Allergens in the Southwest Region of the US: A Randomized, Controlled Clinical Trial’, Annals of Pharmacotherapy, vol. 39, no. 4, pp. 617-
A paper which is described most eloquently by apgaylard as “small” -
And the fact that the statistical analysis was highly questionable was even admitted by the authors.
All in all this is a paper, the conclusions of which are very much to be sniffed at.
This rather aged paper is one of the homeopathic “usual suspects” that get trotted out at every opportunity by homeopathic apologists. As proof of the effectiveness of homeopathy it is pretty flimsy, one would doubt whether the results would be able to fight their way out of a damp paper bag in order to defend the cause, really, this one ought to be able to retire gracefully. Still, it is some of the best evidence they’ve got, so let’s have a look at it.
What the homeopaths say: Proponents tend to cherry pick a few of the more favourable remarks from the body of this meta-
In fact not having a plausible mode of action is an almost insurmountable hurdle for homeopathy. This isn't just someone commenting on say, a new antibiotic telling people "we haven't found out how it works yet but we've got a few ideas from the way others do and we have a set route which the investigation will take". It isn't just somebody with a vested interest in the status quo nit picking that "if it isn't 'science' then it can't work, no matter what the evidence says", although that this remark is simply prejudice is what homeopaths would like us to believe. Homeopathy's mechanism isn't just unknown it is, in any practical sense of the word, impossible. This is according to not just "essential concepts of modern physics" but to virtually every other branch of science as well -
When considering homeopathy in this way something called the 'simplicity principle' applies. This is really a philosophical version of every day 'common sense', which has ancient roots going back at least to Occam (Sehon, 2010) and, in a nutshell, means that any evidence that homeopathy works must be massively convincing -
Another favourite out of context remark from this paper is "The evidence presented in this review would probably be sufficient for establishing homoeopathy as a regular treatment for certain indications." while declining to mention that the authors had called into question much of that same evidence as a result of questionable methodologies, for example, "Double blinding... has to be checked by asking the patients in which group they believe that they were in during the trial... It is easy to state that a trial was double blind, but patients have many ways to break the code. This might explain small differences in favour of homoeopathy. Double blinding was not checked in any trial of homoeopathy." or bias, for example "When talking to authors of trials we identified at least six trials for which no manuscript had been submitted for publication. It is difficult to discover the true reasons for failure to submit an article for publication, but we think that the (possibly negative) results may have been an important factor in these cases.".
An important section is worth mentioning as it seems to be generally ignored in the process of wildly optimistic ‘spin’ is Kleijnen’s reference to an even older stalwart claimed, to this day, to offer proof positive for the effectiveness of homeopathy but which turns out to be nothing more than just another example of pro-
“A trial of very high quality was that of the Groupe de Recherches et d'Essais Cliniques en Homeopathie, initiated by the French Ministry for Social Affairs and performed by a group consisting of regular and homoeopathic researchers (Mayaux 1998). After the earlier publication of several trials in which homoeopathy was shown to decrease the time to recovery of bowel movements after abdominal surgery, this hypothesis was retested in a rigorous trial comparing four groups of 150 patients (two groups were treated with opium C15 and raphanus C5, one group with indistinguishable placebo, and one group was not treated). No differences at all were found. Will more of such trials for other indications show the same results and refute the existing evidence?”
So, the final verdict (and remember, this is one of the best pieces of evidence homeopaths can offer to support their case) is that the conclusion says it all, if you can interpret past the inevitable qualifiers: "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias".
I'll translate -
Klocke, P., Ivemeyer, S., Heil, F., Walkenhorst, M. and Notz, C. (2007) ‘Treatment of bovine sub-
Considering the positive results of homeopathic therapy of bovine mastitis, the presented study should evaluate the effects of two standardized homeopathic methods in sub-
Mastitis, even in its mild form where the only indication there is a problem is an increased number of cells (somatic cell count) in the milk, is a serious, painful and commercially important disease of the dairy cow. This paper, presented at the 3rd congress of Quality Low Input Food (QLIF -
But, after an upbeat first sentence, things go downhill rapidly until the final conclusion which is that homeopathy and nosodes are incapable of controlling mastitis and, yet again, performed no better than a blank placebo. Quelle surprise! Another nail in the coffin for the organic farming movement which makes a virtue out of witholding useful and safe drugs from sick animals.
Klopp, R., Niemer, W. and Weiser, M. (2005) ‘Microcirculatory effects of a homeopathic preparation in patients with mild vertigo: an intravital microscopic study’, Microvascular Research, vol. 69, nos. 1–2, pp.10–16.
Testing the homeopathic preparation Vertigoheel, only the abstract of this paper is available online and it makes no mention of blinding or randomisation, leaving the reader to guess about how reliable the conclusion “The data support a pharmacological effect on microcirculation from the treatment” actually is. Even the British Homeopathic Association admits the trial is non-
Links: [abstract, science direct]
Lees, P., Pelligand, L., Whiting, M., Chambers, D., Toutain, P-
Lees, P., Chambers, D., Pelligand, L., Toutain, P-
“... in human medicine there are, at least, recognised placebo effects, and the counselling/psychotherapy aspects of homeopathic consultations, that may be of value to those patients who seek out homeopathy. In contrast, in veterinary medicine, these effects are of no benefit to animals, as veterinary homeopaths are effectively treating owners, not animals, when prescribing ineffective remedies for the owner’s animals...
“... Conclusions on efficacy and safety will have most value when they are based on sound science and objective weighing of all available evidence. Science is bottom up and ‘evolutionary’, building upon previously established facts using the ‘parsimony principle’ – the simplest explanation possible. Homeopathy, on the other hand, is top down and faith-
These two works are, collectively, not so much clinical papers as a magnum opus.
The authors, all qualified, experienced and respected in their various fields (veterinary general practice and academia, veterinary medicine, pharmacology and toxicology, microbiology, anaesthesia, ethics and law), take a long, hard look at how homeopathy and its remedies compare with science-
The problems and pitfalls of assessing data occupies much of part 2 and the attitudes of homeopathic proponents to data is scrutinised in light of the various cognitive errors which can befall all of us during this process (but which some are more honest about admitting than others). Finally there is a section dealing with the ethics of homeopathy, specifically when applied to animals, and the various reasons why homeopathy is accepted by many, including qualified professionals and caring owners, despite all the clear evidence for its lack of effect beyond placebo.
This is a studied, measured and well researched couplet of papers with not a hint of polemic. If you want a thorough, considered and rational primer on veterinary homeopathy then this work – now open access thanks to the personal generosity of Arlo Guthrie, the owner of the VetSurgeon.org website – is your go-
It bears mentioning at this point if you want more detail on the wider subject of complementary and alternative veterinary medicine generally, your go to reference (after you’ve finished reading these two articles) is an excellent book by yours truly and Alex Gough, entitled 'No Way to Treat a Friend: Lifting the Lid on Complementary and Alternative Veterinary Medicine'!
Lewith, G.T., Watkins, A.D., Hyland, M.E., Shaw, S., Broomfield, J.A., Dolan, G., et al. (2002) ‘Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial’, British Medical Journal, vol. 324, pp. 1-
"... 242 people with asthma and positive results to skin prick test for house dust mite; 202 completed clinic based assessments, and 186 completed diary based assessments.
Intervention: After a four week baseline assessment, participants were randomised to receive oral homoeopathic immunotherapy or placebo and then assessed over 16 weeks with three clinic visits and diary assessments every other week...
Results: There was no difference in most outcomes between placebo and homoeopathic immunotherapy...
Conclusion: Homoeopathic immunotherapy is not effective in the treatment of patients with asthma...
Discussion: This randomised placebo controlled trail shows that homoeopathic immunotherapy is no better than placebo for the treatment of people with asthma who are allergic to house dust mite. Previous studies have suggested that homoeopathy is efficacious in the treatment of rhinitis and possibly asthma. Our study was substantially larger than any of the earlier studies and included a wider range of outcome measures. We found no evidence of difference measures between placebo and homoeopathy in our primary outcome at the end of the study..."
So, there we have it, a good, strong trial, which knocks the spots off any previous efforts and shows (yet again) that treatment with homeopathy is the same as treatment with a blank sugar tablet. There are the usual indignant huffings and puffings from homeopaths (who, of course have a vested interest) about how unfair the whole thing was and it doesn’t count because homeopaths didn’t get to design it and they reckon this was a study of isopathy rather than homeopathy (still just sugar tablets though!). But this are just the usual reasons homeopaths trot out when the evidence doesn’t suit their preconceptions, yet utterly ignore when they get the results they want. For example, have a look at the much smaller but broadly similar trial carried out by Reilly 1994, which also used diluted allergens to treat respiratory allergies in the same way as Leweth et al. 2002. You won’t find any complaints from homeopaths about whether this paper employed proper homeopathy or not though, since a hint of a favourable result was squeezed out of the poor unfortunate statistics after due pummelling. And that makes everything OK in the smoke and mirrors world of homeopathy.
Linde, K., Jonas, W.B., Melchart, D., Worku, F,. Wagner, H. and Eitel, F. (1994) ‘Critical review and meta-
Links: [abstract, pubmed]
BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo.
INTERPRETATION: The results of our meta-
What the homeopaths say: Despite the authors’ conclusion “we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition” the ENHR comment is ridiculously up-
Surely only a homeopath could regard findings that homeopathy wasn’t efficacious for any single condition ‘significantly in favour of homeopathy’.
Unfortunately however for the homeopaths two subsequent re-
So, this paper is out of date, has deeply flawed statistics and has been superceded by two subsequent re-
Jump back to the “Usual suspects” page for the next devastating weapon in the homeopathic arsenal of damp squibs...
“... when the analysis was restricted to the methodologically best trials no significant effect was seen...
“The results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies.”
So, the better the quality of the trial the less likely it is to suggest that homeopathy works! No wonder homeopaths seem to prefer to publish poor-
Links: [abstract -
Linde, K., Scholz, M., Ramirez, G., et al., (1999) ‘Impact of study quality on outcome in placebo controlled trials of homeopathy’, Journal of Clinical Epidemiology, vol. 52, pp. 631–636. [permalink]
"We investigated the influence of indicators of methodological quality on study outcome in a set of 89 placebo-
This is a reinterpretation of the lead author’s earlier work (Linde 1997, above) which completely overturned the, albeit weak, evidence of the original conclusion in favour of homeopathy and reported that the better the quality of the trial, the worse the results were for homeopathy. Homeopaths are always very keen to quote the Linde 1997 paper as irrefutable proof of how highly effective homeopathy is, but always seem to forget the Linde 1999 one -
Linde, K. and Jonas, W. (2005) ‘Are the clinical effects of homoeopathy placebo effects?’, Lancet, vol. 366, no. 9503, pp. 2081 -
No evidence was obtained to demonstrate that radionic healing reduced the faecal egg counts (FECs) of equine strongyles. In year 2, the group 2 horses (radionic healing) were compared directly with the horses receiving no treatment (group 1) and there were no significant differences in FEC between the two groups. In year 1 they could not be compared with untreated horses, but horses receiving occasional anthelmintic treatments occasionally had significantly lower FECs.
A mysterious black box, connected to the patient by invisible lines of energy no matter where either party is located on the planet; diagnosis and treatment both performed by interrogating a ‘witness’ (e.g. a piece of hair or a drop of blood); answers to clinical questions relayed via a swinging pendulum or a sticky pad. This is a completely bonkers mode of “treatment” which makes voodoo look mainstream and shouldn’t have required all the expense and inconvenience of a trial to tell any rational person that it had absolutely no effect on disease whatsoever.
Links: [citation, Veterinary Record]