These ideals are far from always achieved in human RCTs of con-
ventional medicines (Ioannidis 2005b, 2014, Prasad and Cifu 2015),
much less frequently in RCTs of homeopathy, and rarely in veterinary
RCTs. Di Girolamo and Meursinge Reynders (2016) reviewed the
effectiveness-of-intervention studies in five leading veterinary journals
and five leading medical journals for the year 2013. Median numbers
were 26 and 465, respectively, the veterinary studies were smaller and
only 2 per cent of veterinary RCTs v 77 per cent of human RCTs
reported power calculations, primary outcomes, random sequence
generation, allocation concealment and estimation methods. One
reason for these differences is cost; pharmaceutical companies must
necessarily make a profit and these are generally much smaller on
veterinary than on human medicines. Another factor is animal wel-
fare. Can we, the best scientific approaches notwithstanding, ethically
justify a placebo-controlled trial in calves with acute pneumonia or
dogs with severe osteoarthritis? These issues are not easily addressed.
Trials with negative results (however useful they might be) are
less likely to be published than those with positive findings, not least
because of journal editors’ interest in preserving or enhancing their
impact factors (Easterbrook and others 1991, Stern and Simes 1997,
Ioannidis 1998, Smith 2006). Independent replication of clinical trials
is important in establishing efficacy (Ioannidis 2005a, 2014, Anon
2013, Prasad and Cifu 2015). It permits a check on whether the initial
study might have had false-positive or false-negative results, or shown
an unrepeatable effect size. Ioannidis (2005a) reported on 49 human
clinical studies. Thirty-four reported a significant positive effect, but
when later retested the results were negative in seven cases and the
effect sizes smaller than in the initial report in seven more. The rea-
sons might include improved study design in the replication studies
reducing false-positive findings of the initial studies. Random ‘noise’
– chance variation – will result in false positives one occasion in 20
at the P=0.05 level of statistical significance. If a study measures 10
variables, chance alone will give a 50 per cent probability that one of
them will be ‘statistically significant’ unless statistical techniques are
adopted to adjust for that fact – which is not always done. However,
most false positives are likely due to other factors, particularly failure
to fully control for confounding factors – as mentioned above – such
as biases and the natural course of the diseases.
For the above reasons, doctors and veterinarians should always be
vigilant and constructively critical in making assessments both on the
basis of their everyday clinical experience and of clinical trial findings.
The assessment difficulties are likely to be greater when the end-point
measurements of efficacy are nebulous and/or subjective rather than
clear and/or objective, and so the risk of erroneously ascribing a spe-
cific treatment effect to an actually ineffective medicine will be higher.
Homeopathy is most frequently used to treat chronic conditions
with fluctuating signs, or acute, self-limiting conditions (Jacobs and
others 1998, Mathie and others 2007, 2010). These are precisely those
conditions for which assessment of treatment responses is most diffi-
cult and prone to error because of the natural history of the disease and
subjective biases, and so it is particularly important that responses to
therapy are not based purely on subjective assessments and anecdotal
experiences of veterinarians (Mathie 2007, 2010), or on the results
of poorly designed and conducted clinical trials, but rather on the
results of well-designed and conducted RCTs. This is well illustrated
by the example of homeopathic treatment of feline hyperthyroidism.
Two prospective ‘outcome studies’ (Mathie and others 2007, 2010) –
uncontrolled reports of how well practitioners and or clients believed
hyperthyroid cats responded to treatment – and one case series of four
hyperthyroid cats (Chapman 2011), each suggested that homeopa-
thy is an effective treatment for hyperthyroidism. However, a well-
designed, double-blinded RCT showed that individualised homeopa-
thy had no effect on hyperthyroidism, as assessed by blood thyroid
hormone level, heart rate and weight after 21 days, whereas standard
methimazole treatment was effective (Bodey and others 2017).
Peer-reviewed clinical trials and systematic reviews
As discussed above, for clinical trials in people and animals, there exist
widely accepted (but not always applied) standards, procedures and
guidelines on study design and conduct and the statistical evaluation of
data generated, with recommended features including randomisation,
blinding, positive and/or negative (placebo) controls and sufficient
number of animals. These general principles are explicated in detail in
various published guidelines for designing and/or assessing RCTs (for
example, Schulz and others 2010, Higgins and Green 2011, Sargeant
and O’Connor 2014). Systematic reviews use this type of objective
methodology to formally assess the design, conduct and reporting of
published controlled clinical trials to minimise the effects of bias, and
there are formal, objective protocols and guidelines for conducting
systematic reviews and meta-analyses (see Higgins and Green 2011,
Zoonoses and Public Health 2014, PRISMA 2017). Clinical trials in
both human and veterinary medicine, which have been objectively
evaluated as meeting high standards and thus ensuring high-quality
evidence, provide a huge body of evidence, which inevitably is not
universally complimentary to drug-based products and extremely
rarely supports a positive outcome from homeopathic trials.
A means of boosting animal/patient numbers is to take a number
of trials of sufficient quality of design and conduct, and analyse the
composite of those trials – a meta-analysis. There are several objec-
tive methods for assessing the quality of meta-analyses and systematic
reviews. This is one major function of the Cochrane Collaboration
(
www.cochrane.org/), an international not-for-profit organisation
of collaborating medical professionals tasked with determining the
effectiveness of treatments, which produces systematic summaries of
research literature in healthcare.
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For homeopathic products used in people, there is a large base of
peer-reviewed published clinical trials, and several reviews thereof
(Linde and others 1997, Cucherat and others 2000, Jonas and others
2003, Shang and others 2005, Milazzo and others 2006, Ernst 2010,
Mathie and others 2014, 2017). Shang and others’ (2005) meta-anal-
ysis assessed every clinical trial conducted in people published up to
that time investigating the efficacy of homeopathy. Poor-quality trials
were excluded to provide a demanding but fair test. Shang and others
(2005) found a small positive effect of homeopathic treatments over
placebo, much smaller than the positive effect of conventional treat-
ments over placebo. Given the difficulty of completely removing bias
in clinical trials, and the fact that even the best-quality trials were not
ideal, their finding was consistent with residual bias affecting the trial
results and the authors, therefore, concluded that the apparent ben-
efits of homeopathy were compatible with placebo effects. However,
the data reported by Shang and others (2005), in and of itself, does
not allow the conclusion to be drawn that the small positive effect
reported was not a specific effect of homeopathic products.
As pointed out by Hektoen (2005) ‘animal studies may.... be more
useful than human studies in determining whether homeopathic
remedies have specific effects in comparison with a placebo’. Mathie
and others (2012) collated RCTs of veterinary homeopathy, and iden-
tified 38 substantive peer reviewed articles suitable for future review.
Mathie and Clausen (2014) carried out the first systematic review of
RCTs of veterinary homeopathy compared with placebo (18 RCTs,
12 therapy and six prophylaxis) quantifying effect size. Only one trial
was free of vested interest (eight were unclear) and risk of bias was
high in 11, low in one and unclear in six. They concluded; ‘mixed
findings from the only two placebo-controlled RCTs that had suit-
ably reliable evidence precluded generalisable conclusions about the
efficacy of any particular homeopathic medicine or the impact of indi-
vidualised homeopathic intervention on any given medical condition
in animals’. Mathie and others (2014) also carried out a systematic
review and meta-analysis of randomised placebo-controlled trials of
individualised homeopathic treatments in humans. The conclusion
was that they ‘may have small, specific treatment effects ... the low or
unclear overall quality of the evidence prompts caution in interpreting
the findings. New high quality RCT research is necessary to enable
more decisive interpretation’.
Thus, on the basis of evidence from RCTs, meta-analyses and sys-
tematic reviews alone, the small positive effects reported in people and
animals could be the result either of specific effects of homeopathy or
residual bias not fully controlled for in the trials (Cucherat and oth-
ers 2000, Shang and others 2005, Mathie and Clausen 2014, 2015a,
Mathie and others 2014, 2017). In light of the considerations discussed
in this review and part 1 (Lees and others 2017), on: the potential for
the natural history of diseases, placebo effects and subjective biases to
yield artifactual positive results; the difficulties in assessing evidence
and, particularly, of performing RCTs to ideal standards; and the
implausibility on theoretical grounds of homeopathic remedies hav-
ing any specific effect, it is overwhelmingly likely that small effects
observed in the RCTs and systematic reviews are the result of residual
bias in the trials. In contrast, the clinical effects claimed in veterinary
practice by homeopaths are often large (Mathie and others 2007, 2010).
Mathie and Clausen (2015b) conducted another systematic
review of RCTs of veterinary homeopathy, in which the control group
received an intervention (active controls) rather than a placebo. They
used Cochrane methods to assess risk of bias and derive effect size in
14 treatment and six prophylaxis studies. They concluded that, due
to the poor reliability of the data – no trial had sufficiently low risk of
bias to be judged reliable – the trials did ‘not provide useful insight into
the effectiveness of homeopathy in animals’.
Doehring and Sundrum (2016) performed a review of trials of
homeopathy used for the treatment of infectious diseases or growth
promotion in farm animals. Of 48 studies meeting their inclusion cri-
teria, 15 were doctoral theses and 33 were published in peer-reviewed
journals, of which 18 were in journals dedicated to homeopathy or
alternative medicine and 15 in veterinary journals. Their literature
review specifically included a wide range of trial designs, including
RCTs – eight of which had been excluded from Mathie and Clausen’s
(2014) systematic review of veterinary homeopathy RCTs for not con-
stituting reliable evidence, and lower-quality controlled studieswere unblinded and/or unrandomised and/or with a control group
that was not placebo-treated, and some observational studies thatno control group. For these reasons, there was substantial potentialnon-specific effects including bias, and many of the trials with find-
ings positive for homeopathy cannot be taken as good-qualitydence that homeopathy is effective. Doehring and Sundrum (2016)
found that the trials better designed to reduce non-specific effectsduced results less positive for homeopathy. They also found that trials
published in journals devoted to homeopathy or alternative medicine
were much more likely to be positive for homeopathy than trials pub-
lished in journals with a broader focus on veterinary medicineof 18 trials v six of 18 trials), indicating publication bias. The trials
that produced results positive for homeopathy included a very heter-
ogenous range of diseases, remedies and circumstances, but not onethem had been replicated. Doehring and Sundrum (2016) concluded
there was insufficient evidence to recommend that homeopathyused to replace or reduce antibiotics in the treatment of farm livestock.
Ethical and negative aspects of pharmacology and
homeopathy
As discussed by Jacobs and others (1998), homeopathy in peopleused most frequently in chronic and acute, self-limiting conditions.
Likewise, in small animal practice, there is a high prevalence of chronic
diseases, including allergies and joint diseases, for which drug-based
therapeutics offers real but often only palliative care. This can stimu-
late pet owners to search for and even insist on alternative medical
treatments (Hektoen and others 2004, Hektoen 2005). In farm animal
medicine, homeopathy has found favour with some organic farmers,
who rightly perceive the downsides of conventional therapeutics,
while being reluctant to acknowledge the upsides. The disadvantages
of drug-based therapeutics are, in some cases: failure to achieve ‘cure’
(ie, less than 100 per cent efficacy); toxicity to the treated animal; trace
amounts of drugs and their metabolites in meat and milk; and emer-
gence and spread of antimicrobial and anthelmintic resistance,only compromising the success of animal therapy but involving spread
of resistance factors into the environment (Toutain and others 2016a).
Hovi and Roderick (1999) reported that homeopathy wasmain alternative to antibiotic therapy on UK organic farms, account-
ing for 50 per cent of mastitis treatments. The use of homeopathic
products may be ideologically based (a preference for ‘natural’ prod-
ucts or a dislike of drugs as ‘chemicals’), a result of the above men-
tioned disadvantages of conventional therapies, and/or economically
based, using inexpensive homeopathic products and also no require-
ment to adhere to milk and meat withholding periods.
The vast majority of medical scientists, doctors and clinical veteri-
narians support the judicious use of drug-based products and vaccines
as the mainstay of veterinary therapeutics. However, culturalsocial differences occur between countries, and complementary thera-
pies, including homeopathy, are more extensively accepted and prac-
tised in, for example, France, Italy, Germany and India than in the UK.
that
had
for
evi-
pro-
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of
be
is
not
the
and
Pharmacology
Despite all the welfare benefits of safe anaesthesia, control of pain,
effective prevention and cure of diseases caused by microorganisms, hel-
minths and ectoparasites and many other benefits, there are significant
downsides to the use of drug-based veterinary products. There will be
many occasions when the drugs themselves are ineffective or effective
suboptimally. Many drugs are being used by doctors and veterinarians
despite an insufficient evidence base to prove their efficacy, some of
which will go on to be proven ineffective (Prasad and Cifu 2015). There
are side effects for virtually all drugs, which may be life threatening. Side
effects may be idiosyncratic (rare but marked toxicity with clinically
recommended dosage) but more usually are dose-related. Side effects
of conventional medicines arise from biochemical and physiological
mechanisms, and many drugs have characterised toxicological thresh-
olds and dose/response relationships in the same way as they have phar-
macological thresholds and dose/response relationships.
A negative aspect of current global concern is the emergence of
resistance to antimicrobial drugs. Relative to people, this is less of a
concern in terms of effective treatment of microbial disease in ani-
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mals, for which many drugs have retained a high level of efficacy,
but a major concern is the impact on the environmental resistome,
through the extensive use of antimicrobial drugs, in particular in farm
animal medicine. The significance of this as a potentially major pub-
lic health issue is increasingly recognised (Toutain and others 2016a).
For therapies of all classes, there is the universal dimension of clients’
expectations that they always should be administered tablets or an
injection when they visit the veterinarian or doctor. Carefully man-
aging this expectation would reduce the unnecessary dispensing of
drugs, most important for antimicrobial drugs, thereby reducing the
global problem of antimicrobial resistance.
Homeopathy
Homeopaths argue that, at least homeopathy does no harm. This is
questionable. Although it is unlikely that most homeopathic remedies
contain substances that could have a specific toxic effect. The World
Health Organization (2009) advises ‘there are a few aspects of the
production of homeopathic medicines that could constitute potential
safety hazards. Firstly, not all homeopathic medicines are administered
at a high dilution. Sometimes, a homeopathic medicine made from
source material, such as a mother tincture, is administered in the most
concentrated form... Secondly, homeopathic medicines are made from
a wide range of natural or synthetic sources including fungi, bacteria,
viruses and plant parasites... Some of these source materials constitute
potential safety hazards, even at high dilutions’.
In human patients, placebo effects can be of genuine value, as dis-
cussed in part 1 of this review (Lees and others 2017). However, in vet-
erinary medicine it will be very rare – unless specifically organised by
prior conditioning of the animal – that circumstances will be such that a
genuine placebo effect can be of benefit. In human medicine also, there
can be a counselling/psychotherapeutic aspect to homeopathic consults
that can be of benefit to the patient, and in veterinary medicine such
consults can be of benefit to animal owners, but not directly to the ani-
mals. Indeed, placebo effects engendered in owners – known as ‘car-
egiver placebo effects’ (Conzemius and Evans 2012, Gruen and others
2014, 2017) – can actually be detrimental to their animals because the
owners perceive an improvement that may not be present. Probably the
most harmful aspects of homeopathy are the delay in treatment, or the
withholding of conventional treatments completely, when ineffective
homeopathic remedies are given to animals that may be suffering, in
place of effective conventional treatments, as established by scientifi-
cally demanding regulatory requirements and/or published clinical tri-
als. Similarly, use of an ineffective homeopathic preparation, in place of
effective conventional vaccination, and withholding other prophylactic
treatments such as wormers, may be harmful to animal welfare. Use of
an ineffective treatment in these circumstances is unethical, particularly
because animals, like young children, have no voice in the treatment
they receive. Moreover, clients, including sometimes desperate owners,
should not be offered false hope through ineffective products. It is most
unlikely that a veterinarian prescribing a homeopathic product will
inform the client that it is lacking in specific efficacy. For clients who
insist on homeopathic treatments, even if fully informed, in veterinary
medicine, it is questionable whether client demand should take prec-
edence in those cases where there are clear animal welfare issues.
Homeopaths commonly recommend that drug-based products
should actively be avoided. The Academy of Veterinary Homeopathy
Standards of Practice (2017) states, ‘Concurrent treatment with many
drugs, herbs, acupuncture and other types of intervention can reduce
the effectiveness of homeopathic medicines ... only those medicines
that are homeopathic to the patient’s condition should be administered
... Concurrent drugs, herbs, and electromagnetic applications should
be avoided, when possible, to prevent the possibility of interfering
effects on the life force ...’ It is common for veterinary homeopaths to
claim that vaccination is harmful and that commonly used veterinary
medicines interfere with homeopathic treatment (for example, Gregory
2008, 2013b); ‘it is also well known among homeopaths that the action
of homeopathic remedies is severely reduced by concurrent administra-
tion of NSAIDs or indeed any other anti-inflammatory agents, such as
corticosteroids or ciclosporin’ (Gregory 2013b).
Another negative aspect of homeopathy is that, when offered
by veterinarians, it devalues conventional veterinary qualifications
through the use of ineffective and irrational treatments – failing to
differentiate veterinary surgeons from unlicensed healers and so
undermining confidence in mainstream medicine (Chambers 2013).
In veterinary medicine, homeopathy is practised by a small minority
of practitioners, with postnominals granted by homeopathic organisa-
tions, but used alongside recognised veterinary qualifications, without
any distinction being made between the qualifications that are recog-
nised by veterinary regulators and those that are not.
For discussion of the ethics of the practice of homeopathy on
human patients, see Shaw (2010) and Smith (2012). Among other
problems, both argue that the practice of homeopathy by doctors is
a waste of medical resources and that, when doctors practice home-
opathy but fail to acknowledge the placebo effect as the principal
basis for efficacy, they are being economical with the truth, providing
homeopathy with unwarranted credence, and weakening support for
science-based and evidence-based medicine. These factors all apply to
veterinary practice as well. However, 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 medi-
cine, these effects are of no benefit to animals, as veterinary homeo-
paths are effectively treating owners, not animals, when prescribing
ineffective remedies for the owner’s animals.
Acceptance of homeopathy
The doctor and science writer Goldacre (2008) wrote, in his book
Bad Science, ‘homeopathy is perhaps the paradigmatic example of an
alternative therapy: it claims the authority of a rich historical heritage,
but its history is routinely rewritten for the PR needs of a contemporary
market; it has an elaborate and sciencey-sounding framework for how
it works, without scientific evidence to demonstrate its veracity; and
its proponents are quite clear that the pills will make you better, when
in fact they have been thoroughly researched, with innumerable trials,
and have been found to perform no better than placebo’.
The practice of homeopathy confronts us with two clear, mutu-
ally exclusive hypotheses. One is that homeopathic remedies are
genuinely effective. However, that hypothesis is extremely implau-
sible, for all the reasons discussed in this two-part review. The other
hypothesis is that homeopathy has no effect beyond placebo effects
and that homeopaths’ judgement of the efficacy of their remedies is
incorrect. This is a simple and highly plausible hypothesis, for all the
reasons discussed in this two-part review, which appears consistent
with all available evidence.
Open discussion, debate and criticism of all medical treatments
must be encouraged. Opinions based on anecdote and experience are
unreliable. 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-based; governed by arbitrary laws, invented by the
founder, Hahnemann, which are immutable. As such, homeopathy is
not just unscientific, it is a genuinely mystical belief system.
There are clear differences between the laws of homeopathy and
the scientifically determined laws of nature. Laws of nature are not
arbitrary; they are based on formal observation of phenomena, have
been thoroughly tested and for most of them the underlying mecha-
nisms have been elucidated. No law of nature is inconsistent with
physics, chemistry and biology, and many are related to each other in
ways that show them to be part of the same overall natural system. In
contrast, the three laws governing homeopathic remedies (‘like-cures-
like’, dilution/infinitessimals and succussion) are arbitrary. They have
not been subjected to rigorous testing, there is no known underly-
ing mechanism(s), and the Law of Infinitessimals in particular is not
only arbitrary, but explicitly contrary to the scientific understand-
ing of physics, chemistry and biology. Furthermore, the three laws
of homeopathy have no apparent relationship to each other. Thus,
there appears to be no a priori reason why a curative property that
would be efficacious on the basis of the particular type of ‘like-cures-
like’ favoured by homeopathy should also have stronger effects when
highly diluted and/or require succussion for its healing effect to be
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activated. And no a priori reason why potentisation of that curative
property requires both dilution and succussion.
No theory to explain the alleged specific healing effects of homeo-
pathic remedies is compatible, even marginally, with what is known
of bodily functions or the properties of disease-causing organisms.
The unknown ‘curative property’ of homeopathic remedies is super-
natural in that it acts ‘beyond scientific understanding or the laws
of nature’ (Oxford Dictionaries 2017). Its supernatural properties
include: it is present throughout most if not all of the physical world
but is undetectable by science even though it must interact with physi-
cal matter to have the properties attributed to it by homeopaths; it
increases in potency with increasing dilution; and it can be manipu-
lated by the initiated – trained homeopaths – in order to treat almost
any of a huge variety of diseases of widely differing aetiologies and
pathogeneses, without doing harm.
‘Magic’ is commonly defined as ‘the power of apparently influ-
encing events by using mysterious or supernatural forces’ (Oxford
Dictionaries 2017). In anthropology – the academic study of aspects
of humans within past and present societies, which field includes
magical and religious beliefs – ‘magic’ generally refers to ‘beliefs and
behaviours in which the relationship between an act and its effect is
not empirically or scientifically verified but, from a Western perspec-
tive, rests on analogy or a mystical connection’ (Moro 2012). Thus,
‘like-cures-like’ – in the absence of a scientific explanation and resting
entirely on analogy – is an explicitly magical belief in the ancient
tradition of sympathetic magic (Fraser 1922).
The practice of homeopathy by veterinary surgeons is accepted
by veterinary regulatory bodies around the world, including the Royal
College of Veterinary Surgeons in the UK (Viner 2016). The issues
discussed in this article and its companion (Lees and others 2017) raise
two key questions. First, is it appropriate for veterinary professionals
to treat animals on the basis of mystical beliefs requiring invocation
of supernatural forces. It can be argued that doing so diminishes our
science-based profession as a whole. As expressed by Hektoen (2005),
‘it is important for the veterinary profession to discuss the question of
whether veterinarians, as medical professionals, should recommend
or practise a theory with no scientific basis, and to what extent clients’
preferences and motivation for treatment should be acknowledged’.
Likewise, the Connecticut Veterinary Medical Association (2013)
advised that ‘the veterinary profession has an obligation to society
and to our clients to acknowledge the conclusions of science even
when there is not absolute unanimity within the profession. If we
wish to retain the trust of the public, upon which our work depends,
we must demonstrate that our recommendations are based on sound
science and that we are willing to put the welfare of our patients and
clients first even when some of our colleagues object’.
Second, if homeopathic remedies have no specific effect; and it is
rare that placebo effects exerted through the owner will be beneficial to
the animal and, more commonly, the placebo effects on the owner will
be irrelevant or even harmful to the animal; and use of homeopathic
remedies may delay or prevent use of proven-effective conventional
treatments in ill animals, is use of homeopathy by veterinary surgeons
acceptable? If it is, the principle of informed consent implies that the
prescribing veterinary surgeon should inform clients that homeopath-
ic products have no benefit beyond non-specific effects and to fully
inform clients of the nature of placebo effects and that they will typical-
ly have no effect on their animal(s) (Whiting 2012). It would, moreover,
be ethical to insist on an immediate recourse to a proven conventional
therapy when any form of pain or other suffering is diagnosed. It is
not clear if this manner of proceeding is generally observed by homeo-
pathic veterinary surgeons at present, and it cannot be doubted that the
use of ineffective practices by veterinary surgeons, in the sincere belief
that they are effective, is capable of compromising animal welfare.
Conclusions
Homeopathy appears to be one of many examples from the history
of medicine, of therapies, conventional and otherwise, which were
thought to be effective but were later proved to be ineffective or even
harmful. One doctor, Samuel Hahnemann, working more than 200
years ago, at a time preceding modern science and medicine, proposed
a vitalist system of therapy that has persisted to the modern day
despite being incompatible with the modern scientific understanding
of the world, and despite the failure of high-quality clinical trials
to demonstrate efficacy for even one medical condition (House of
Commons Science and Technology Committee 2010, Australian
Government 2015; see supplemental material for this article). The
homeopathic curative property is not detectable by scientific methods
and, although homeopaths report that their remedies are effective
when used in their practice, efficacy beyond placebo is not apparent
in well-controlled clinical trials, which eliminate biases and other
non-specific effects. In human medicine, there may be a place for the
counselling/psychotherapeutic aspects of homeopathic consults and
the placebo effects generated by homeopathic products in patients
who believe in such treatments, but in veterinary medicine these
factors are unlikely to benefit patients, and the use of homeopathic
products in veterinary medicine is contrary to best evidence, irrational,
and inconsistent with current scientific and medical knowledge
(Chambers 2016, Whitehead and others 2016).
The pharmacological basis of therapeutics is, in virtually every
respect, the opposite of homeopathy. In the great majority of cases
it is based on increased effect provided by increased dose or concen-
tration up to a ceiling, the maximum attainable response. Doses are
determined by the application of data on each drug’s pharmacody-
namic and pharmacokinetic properties, established on a species basis.
Additionally, increasingly recognised is the need sometimes to adapt
dose not only for bodyweight but also for disease severity, condition
of animal, as well as age and breed differences in pharmacodynamics
and pharmacokinetics. Drug-based therapeutics emerged by evolu-
tionary processes from Materia Medica, which it has supplanted, and
it will continue to evolve with advances in clinical and non-clinical
sciences. As reviewed in this article, there are many disadvantages to
the use of drug-based products in veterinary medicine. However, their
benefits and their side effects are based on principles compatible with
modern scientific knowledge. They are subject to rigorous evaluation
for quality, safety and efficacy by regulatory authorities (unlike home-
opathic remedies; see supplemental material for this article). They
have contributed greatly to animal welfare and the relief of suffering.
Supplementary material
Appendix 1: UK Licensing requirements for drugs and homeopathic
remedies. Appendix 2: Assessments of homeopathy by governmental,
regulatory and veterinary professional bodies. To view please visit the
journal online
http://veterinaryrecord.bmj.com/content/181/7/198Conflict of interest statement
None of the authors of the article has a financial or personal
relationship with other people or organisations that could
inappropriately influence or bias the content of the paper. D.
Chambers and M. Whitehead are members of the Campaign for
Rational Veterinary Medicine.
Open Access
This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 4.0)
license, which permits others to distribute, remix, adapt, build upon this
work non-commercially, and license their derivative works on different
terms, provided the original work is properly cited and the use is non-
commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/
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Comparison of veterinary drugs and
veterinary homeopathy: part 2
P. Lees, L. Pelligand, M. Whiting, D. Chambers, P-L. Toutain and M. L.
Whitehead
Veterinary Record 2017 181: 198-207
doi: 10.1136/vr.104279
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