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V

van Bree, F.O.J, Bokken, G.C.A.M., Mineur, R., Franssen, F., Opsteegh, M., van der Giessen, J.W.B., Lipman, L.J.A. and Paul A M Overgaauw, P.A.M. (2018) 'Zoonotic bacteria and parasites found in raw meat-based diets for cats and dogs', Veterinary Record, vol. 182, p. 50, (DOI: 10.1136/vr.104535). [permalink]

Yet another paper has just been published confirming the less than startling fact that raw diets for dogs contain what we professionals call 'germs and bugs'. A team of Dutch researchers looked at thirty five samples from eight commercially available brands of raw meat based diets (RMBD) and discovered bacteria such as E. coli, Listeria, and Salmonella, as well as parasites including Sarcocysts and Toxoplasma gondii in them. A staggering eighty per cent of the samples contained antibiotic resistant E. coli bacteria. This seething mass

 

Mmm, scrummy!

of fascinating flora and fauna are zoonotic, which is to say they can cause illness in humans ranging from gastro-enteritis through haemorrhagic colitis and kidney-failure, to death in new-born babies and abortion in pregnant women. The organisms can transfer from dog to dog as well as to owners either directly from the raw-fed dog or indirectly by the contamination of the surfaces and utensils used to prepare the raw-food; they will multiply at an alarming rate at room temperatures in food bowls. In many cases dogs can carry these micro-organisms, all the time shedding them into the environment, without showing any signs of ill health themselves. Furthermore such diets have been reported to cause problems in the dogs who eat them such as damaged teeth, perforated guts, hyperthyroidism and nutritional imbalance.

The study concludes, in that typically dispassionate way that published papers do, that owners should be made aware of the risks of feeding raw food to pets. RationalVetMed would venture a step further - just don't! There is no good reason to feed raw food to your pets and there are serious risks to you, your family and your pets if you do. If, despite the risks, you insist on feeding raw then that is up to you but don't kid yourself it has anything to do with supposed health benefits, because there are none. Your decision is purely and simply a lifestyle choice.

Links: [full text, vet record]
Responses: [science daily]:[phys.org]
Keywords: RMB, BARF

      

van Haselen, R.A., and Fisher, P.A.G. (2000) ‘A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee’, Rheumatology, vol. 39, pp. 714-719.

Objective. To evaluate the efficacy and safety of a homeopathic gel vs an NSAID (piroxicam) gel in the treatment of osteoarthritis of the knee.

Method. One hundred and eighty-four out-patients with radiographically confirmed symptomatic osteoarthritis of the knee were entered into a pragmatic, randomized, double-blind controlled trial and treated with 1g of gel three times daily for 4 weeks. Main outcome measures were pain on walking as a Visual Analogue Score (VAS) and a single-joint Ritchie index.

Results. One hundred and seventy-two of the 184 enrolled patients had endpoints for the main outcome parameters. The pain reduction was 16.5 mm VAS in the homeopathy group (n = 86) and 8.1 mm in the piroxicam group (n = 86): the difference between treatment groups was 8.4 mm (95 confidence interval 0.8–15.9). and after adjustment for pain at baseline it was 6.8 mm (95 confidence interval -0.3 to 13.8 ). There was no significant difference between treatment groups in the single-joint Ritchie index (P 0.78 )...

Conclusion. The homeopathic gel was at least as effective and as well tolerated as the NSAID gel. The presence of a clinically relevant difference between treatment groups cannot be excluded. The homeopathic gel supplemented by simple analgesics if required may provide a useful treatment option for patients with osteoarthritis.

   

I posted the excerpts from the abstract above a few years ago, meaning to get back to this paper at some point and have a proper look at it. The citation originally came from one of those endless lists homeopaths have of peer-reviewed ‘conclusive evidence’ that homeopathy works which, when looked at closely always (and I mean always) turn out to be complete duds.

For some reason it slipped my mind to do the follow up and it was only the other day, while doing some housekeeping on the page, that I re-discovered this section. On reading the abstract again I thought the results sounded fairly convincing - homeopathic gel was at least as effective as Piroxicam gel at treating arthritis of the knee. Maybe this is, finally, proof that homeopathy works after all. Then I had a closer look and discovered there were a couple of warning notes; hints that all was not well. In particular the phrase ‘pragmatic trial’ and the caveat that the gel might be a useful treatment ‘if supplemented by simple analgesics…’ set alarm bels ringing.

So I did what I originally intended and started to have a closer look at the paper itself; I discovered my fears were entirely justified. In fact this is the worst type of homeopathic spin, the abstract bears little resemblance to the main body of the paper at certain crucial points and the paper is no more proof of homeopathy’s effectiveness than fly in the air (as my old mum would have said).

For a start the term ‘pragmatic trial’, particularly when used by homeopaths, equates to ‘sloppy’ and is a cover for trials which although claimed to be blinded, randomised, placebo-controlled and so forth are really nothing of the sort. Just a sciencey-sounding veil for poor methodology. In this case there was, despite the claims in the abstract, no blinding in the practical meaning of the word. It turns out the two types of gels under comparison are completely different in colour and smell from one another, the Piroxicam is white and relatively odourless while the homeopathic product - something called SRL gel - is brown and has a distinct smell of pine oil. What’s more they came in different sized packets and although the researchers wrapped the packs in obscuring plastic and made sure the screw tops were the same it would have been blindingly obvious to the participants which product was which. Even the authors confess it was ‘impossible to make both treatments identical’ and ‘masking was inevitably imperfect in this trial’. This is a recipe for introducing a whole range of perceptual and cognitive errors into the trial, any one of which would have rendered the results meaningless.

But there’s more. It turns out this ‘homeopathic’ gel stretches the definition of homeopathy to breaking point. In fact SRL gel is herbal and although, as well as the above mentioned pine oil, it contains ingredients sometimes found in homeopathic remedies such as comfrey, poison ivy and marsh-tea, the authors admit these are in the form of ‘tinctures of herbal ingredients’ which is to say they are infinitely more concentrated than in any homeopathic remedy, or, as they put it, ‘Its “homeopathicity” is related to the nature rather than the dilution of its ingredients’. Thus, one of the defining elements of the homeopathic remedy, namely homeopathic ultra-dilutions, is missing. Other ingredients of this so-called homeopathic gel are as follows: witch-hazel extract, carbomer, methyl paraben (also known as E218, a preservative with safety concerns), sodium EDTA (likely used in this case as a preservative), pine oil (a turpentine derivative) and triethanolamine (a tertiary amine used as an emusifier with some concerns over its environmental impact on aquatic species). And of course, that’s another key claim of homeopathy nailed - this stuff is no more ‘natural’ than a pig with a jet pack.

To recap, this is an unblinded trial, looking at a gel which, although it has the word ‘homeopathic’ on the label is nothing of the sort, and actually contains many questionable ingredients along with other herbal components such as witch-hazel and pine-oil which have known medical properties. An interesting study, worth reading in full, which casts doubt on the effectiveness of Piroxicam gel unless used alongside other forms of pain relief, but which tells us absolutely nothing about whether homeopathy is effective or not.

So that’s another few hours of my life wasted!

Links: [full text, rheumatology, html]:[full text, researchgate, pdf]:[full text, rheumatology, pdf]:[abstract pubmed]

van Sluijs, F.J., (2004 - November) ‘Can homeopathy withstand scientific testing?’, Veterinary Sciences Tomorrow

“In summary, it can be concluded that there has been a great deal of research on the effectiveness of homeopathy. Much of this research is methodologically weak and justifies no conclusion about the effectiveness of homeopathy. But there has also been good research, from which it is apparent that the effect of homeopathy is no greater than that of placebo.”

A useful summary by a Dutch veterinary surgeon of the state of veterinary homeopathy today.

Links: [original article]

Vickers, A., Goyal, N., Harland, R. and Rees, R. (1998) ‘Do certain countries produce only positive results? A systematic review of controlled trials’, Control Clin Trials, vol. 19, no. 2, pp. 159-66. [permalink]

Objective: To determine whether clinical trials originating in certain countries always have positive results.

Data Sources: Abstracts of trials from Medline (January 1966-June 1995).

Study Selection: Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England.

Data Synthesis: In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.

Conclusions: Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.

Links: [abstract, pubmed]

Vickers, A. J. (1999) ‘Independent replication of preclinical research in homeopathy: a systematic review’, Forsch Komplementarmed, vol. 6, no. 6, pp. 311-320.

“Conclusions:There is a lack of independent replication of any pre-clinical research in homoeopathy. In the few instances where a research team has set out to replicate the work of another, either the results were negative or the methodology was questionable.”

Links: [abstract, pubmed]:[abstract, unbound medline]

Vickers, A. J., Van Haselen, R. and Heger, M. (2001) ‘Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial’, Journal of Alternative and Complementary Medicine, vol. 7, no. 2, pp. 141-148.

“This pilot study failed to find evidence that mercury 12C causes significantly more symptoms in healthy volunteers than placebo... If drug proving phenomena exist, they appear to be rare.”

Links: [abstract - pub med]

Vickers, A., and Smith, C. (2006) ‘Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes’, Cochrane Database of Systematic Reviews, 2009 Issue 3

The Cochrane database is one of the most respected resources of its kind in the world - if you want to find out what works, you go to Cochrane. The best they could find to say about Oscillococcinum, one of homeopathy's 'big guns' was ‘Though promising, the data were not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndromes. Further research is warranted but the required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes’.

The call for large sample sizes is significant. Often the conditions where homeopathy publicly claims its best results (what they claim in private is another matter) are mild, self limiting ones where it is difficult to define a proper start and finish time and where the course of the disease is variable and difficult to quantify. "Influenza-like syndromes" fit the bill exactly. Conditions like this generate a lot of ‘statistical noise’ and the more noise there is the more likely it is that error will creep in when the results are interpreted. The only way to overcome this noise and even out variation between individuals is to use larger and larger sample sizes. Until the massively rich homeopathic pharmacies are prepared to invest some of their billions in better research into their products we are stuck with trials which are effectively not fit for purpose.

N.B. The full text of this article has been superceded by a more current review in the Cochrane database on the same subject. Have a look at Mathie et al 2012 for the latest conclusions (hint: homeopathy still doesn’t come up smelling of roses).

Links: [abstract, pub med]

Vithoulkas, G. (2008) ‘British media attacks on homeopathy; Are they justified?’, Homeopathy, vol. 97, no. 2, pp. 103-106.

This is George Vithoulkas ticking homeopathic extremists off for believing you can make remedies out of far fetched stuff like moonlight and storms. As if mainstream homeopathic ingredients - dead bees, condoms and dinosaur bones and so-on - are any more credible.

Links: [abstract, pubmed]:[full text, pdf, modernhomeopathy.com]
Responses: [rational veterinary medicine]

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Walach, H. (1993) ‘Does a highly diluted homeopathic drug act as a placebo in healthy volunteers? Experimental study of Belladonna 30C in a double blind crossover design - a pilot study’, Journal of Psychosomatic Research, vol 37, no. 8, pp. 851-860.

‘Is homeopathy a placebo?’ the authors ask, and the answer, in a word, is ‘Yes’! But that doesn’t stop them twisting the evidence in the abstract to make it sound like it isn’t!

Links: [abstract pubmed]

Walach, H. (2000) ‘Magic of signs: a non-local interpretation of homeopathy’, British Homeopathic Journal, vol. 89, pp.127-140.  Also published (1999) in Journal of Scientific Exploration, Vol. 13, no. 2, pp. 291-315 [permalink]

Homeopaths hate it when sceptics describe homeopathy as magic; they hate it even more when one of their leading proponents does the same. Starting with a discussion of the work of eminent scholar of Jewish mysticism Gershom Scholem who contends that simply telling stories about the achievements of ancient gods enables us to replicate those same achievements, the author goes on to claim about homeopathy, "Although the original substance is diluted, it is still in some way 'present' and effective. This presence, I will contend in this paper, is a magical, not a causal presence... Magical presence and effects are wrought by signs, not by causes. In this sense, homeopathy is effective in a non-local way: it acts by magically activating connectedness". You couldn't make it up!

The author also confesses "The pillar of homeopathy, pathogenetic trials rests on shaky ground. The experiments conducted and published since World War II are not very persuasive from a scientific point of view. The ones conducted in the United Kingdom are... not very persuasive either. The experiments which I have conducted myself do not show a clear pattern of different or more symptoms with homeopathic substance than placebo. Modern homeopathic researchers like Jeremy Sherr or David Riley admit in personal discussions that very specific symptoms can be observed with placebo, however, these are rarely published. It seems to be an open secret that true homeopathic symptoms... can also be observed with placebo...".

This paper is a real revelation about the true mind-set of the dyed-in-the-wool homeopath. This is homeopathy quietly casting off from reality and serenely sailing away in to the distant firmament; it is telling us, in a series of convoluted nods and winks, that homeopathy has nothing to do with science and everything to do with symbols and signs, ritual and belief. And actually, on that level, it has a distinctly refreshing honesty about it.

Links: [abstract, pub med]:[full text, PDF, BVVS]:[full text, PDF, semanticscholar]:[full text pdf J SCI EX]

Walach, H., Lowes, T., Mussbach, D., Schamell, U., Springer, W., Stritzl, G. and Haag, G. (2001) ‘The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis’, Britich Homeopathic Journal, vol. 90, no. 2, pp. 63-72.

“... There is no indication of a specific, or of a delayed effect of homeopathy.”

Links: [abstract - pub med]

Walach, H., Koster, H., Hennig, T. and Haag, G. (2001) ‘The effects of homeopathic belladonna 30CH in healthy volunteers - a randomized, double-blind experiment’ Journal of Psychosomatic Research, vol. 50 no. 3, pp. 155-160.

A randomized, double blinded, placebo controlled clinical trial with a good number of participants conducted by a prominent homeopath trying to find out whether it is possible to tell the difference between a homeopathic remedy and an inert sugar tablet, exactly the sort of trial that homeopaths are continually clamouring for.  The conclusion: ‘... There is no indication that belladonna 30CH produces symptoms different from placebo or from no intervention. Symptoms of a homeopathic pathogenetic trial (HPT) are most likely chance fluctuations.’ Oops! No wonder this one never appears on homeopathic evidence lists.

Links: [abstract - J Psy res]:[abstract - science direct]:[abstract, pub med]

Walach, H., J Sherr, J., Schneider, R., Shabi, R., Bond, A. and Rieberer, G. (2004) ‘Homeopathic proving symptoms: result of a local, non-local, or placebo process? A blinded, placebo-controlled pilot study’, Homeopathy, vol. 93, pp. 179–185. [permalink]

‘Is there evidence that homeopathic medicines produce specific symptoms different from placebo response?’

‘Qualitative Findings: The materia medica expert was not able to determine the correct medicine, either in step 1 (unrestricted choice), or step 2 (restricted choice)’

‘There was no significant difference between groups (Cantharis vs. placebo) either for typical or atypical symptoms during the proving period.’

‘... more typical symptoms found for [the] Cantharis intake were…accompanied by more symptoms typical for Cantharis in those provers who took placebo’

‘The materia medica expert was unable to determine the correct medicine from the randomly organised experimental data she was given’

Once this somewhat abstruse paper is examined it becomes apparent it is actually the perfect object lesson on the attitude of the homeopathic researcher to evidence.

To summarise; the research team got a group of healthy homeopathic students to keep a symptom diary for a while. Then, to test the effect of the proving of a homeopathic remedy, half of them were given a remedy (Cantharis), randomly chosen from a list of twelve different remedies, and the other half were given placebo, which they took for another period while continuing to record their symptom diary.

Once the test period was over, the diaries were scrutinised to see which symptoms coincided with those listed in the homeopathic materia medica for the chosen remedy before and after starting the proving and a comparison made between the control and verum groups for both periods. In addition the symptoms described by the participants were shown to an expert, ‘knowledgeable about materia medica and a well trained homeopathic doctor’ who attempted to identify which remedy had been given on the basis of what the participants had experienced.

The conclusion was that during the entire test period there was no significant difference between the control and verum groups with regards to reported symptoms, and the materia medica expert was unable to identify which remedy had been tested, even after she had been given a massive clue and told the twelve remedies from which the test remedy had been selected.

And you might be forgiven for thinking, well that’s that - there’s clearly no difference between ‘proving’ a homeopathic remedy or a placebo. Just another trial with negative findings for homeopathy - end of, move on, nothing more to see here.

You’d be wrong though. This is homeopathic thinking remember - abandon common-sense all ye who enter here.

As it happens, during the test period of the trial, once the participants started taking their pills the variety and number of symptoms recorded in both groups rose compared with baseline. Analysis also showed an increased correlation with symptoms found in the materia medica entry for Cantharis, again in both groups. The increase was sudden and, most importantly, was identical in both groups - no significant difference was found between them.

At this point most researchers would have smelled a rat and had a jolly good look at the effectiveness of the blinding process to see if participants knew which remedy had been chosen from the list of twelve - why else would a placebo group appear to experience the same change in symptom pattern as the verum group? Alternatively, they might have considered the possibility proving symptoms are so vague they could apply to pretty much any remedy you care to name and in their enthusiasm for the trial the placebo group began to convince themselves of non-specific, generic symptoms. If this were true it would suggest provings are unreliable and more to do with a desire to please and the suggestibility of participants.

But no - instead the authors maintained this was a “non-local” effect (a concept inappropriately lifted from quantum physiscs) whereby “the effects [of homeopathy] are, by definition, not confined to a certain element of the system, eg to the medicine, but reside in the whole therapeutic procedure”. In other words, the fact that a homeopathic remedy was involved anywhere in the test meant it had a “non-local” effect on the placebo group, causing them to react as if they too were taking the remedy.

They go on to state “If a non-local model is pertinent, experimental procedures trying to isolate the causative principle in homeopathic medicines are likely to be doomed to failure”. In other words this whole trial has become nothing more than an elaborate excuse for why homeopathy fails to perform when compared to placebo. Apparently the reason is, in a placebo-controlled trial, the placebo turns into the remedy anyway.

For once, words fail me. By this logic there seems to be no possible way for a homeopathic remedy to fail to perform in any sort of trial. If homeopathy appears to cause an effect greater than placebo then hooray, homeopathy works; if homeopathy performs no better than placebo then, hooray, homeopathy works and what’s more, as an added bonus, it also turns the placebo into the same remedy so everyone benefits!

As someone once said, why would anyone need to buy a homeopathic remedy ever again?

Links: [abstract, Homeopathy]:[abstract, pubmed]:[full text, ResearchGate]

Walach, H., Jonas, W. and Lewith, G. (2005) ‘Are the clinical effects of homoeopathy placebo effects?’, Lancet, vol. 366, no. 9503, p. 2081. (this article is a response to Shang et al, 2005)

Links: [full text, Lancet]
Responses: [Shang et al (authors' response) 2005]

Walach, H., Jonas, W.B., Ives, J.,D., Van Wijk, R. and Weingartner, O. (2005) ‘Research on Homeopathy: State of the Art’, Journal of Alternative and Complementary Medicine, vol. 11, no. 5, pp. 813-829.

Links: [abstract, pubmed]:[full text, pdf, homeopathy.org]

White, A., Slade, P., Hunt, C., Hart, A. and Ernst, E. (2003) ‘Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial’, Thorax, vol. 58, pp. 317-321.

This is a randomised, double blind, placebo controlled trial of individualised homeopathic treatments, prescribed by experienced homeopathic practitioners, looking at quality of life indices which provides no evidence whatsoever that homeopathic remedies are superior to placebo in children with mild to moderate asthma. This is everything a homeopath could possibly wish for in a trial and still it shows it's utterly ineffective.

Links: [Abstract, BMJ]:[full text, html, BMJ]:[full text, pdf, BMJ]

White, P., Bishop, F.L., Prescott, P., Scott, C., Little, P. and Lewith, G. (2012) ‘Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture’, Pain, vol. 153, no. 2, pp. 455-462.

“Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture...

... acupuncture has no specific efficacy over either placebo. The individual practitioner and the patient's belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture.”

Links: [abstract, pubmed]:[fulltext pdf DCScience]:[fulltext pdf UCL]

Responses: [skeptvet blog]

Wolfensohn, S. (1991) ‘BOOK REVIEW The Homoeopathic Treatment of Small Animals (Principles and Practice) [author Day, C.E.I.]’, Journal of Small Animal Practice, vol. 32, no. 6, p. 295.

“If you must, borrow this book from a library. It will give you some insight into the homoeopath’s mind if you are curious but in this reviewer’s opinion, it has no place on the shelves of a veterinary practice.”
This is a review of arch veterinary homeopath Chris Day’s book, published in the prestigious Journal of Small Animal Practice. The reviewer pulls no punches, at one point stating ‘[Day] is very keen on what he calls the logic of homoeopathy but his attempts at logical argument are thin and woolly’  and describing Day’s peculiar theories about the homeopathic treatment of dental disease as ‘utter rubbish’. No argument from the chaps at RationalVetMed there.

Links: [abstract, Wiley]:[full text, pdf JSAP(Wiley)]

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