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Dr Hektoen replies: Homeopathy has existed for about 200 years. It has survived through several periods of popularity and decline, but has always had the ability to provoke. Due to the implausibility that the highly diluted homeopathic remedies have any specific effects, as well as the lack of documentation of clinical effects in the treatment of human or animal disease, this is understandable and no surprise. It may be such a provocation that leads Baker and colleagues and Ramey and colleagues into describing my stands and attitudes towards homeopathy in ways that I do not recognise, and that I do not think can be supported by what I have written in the paper (Hektoen 2005).
First, I do not accept the homeopathic principles of similars and potentisation. The description of these principles is included as background information, and I assume that the readers of The Veterinary Record are able to assess the scientific limitations of these principles themselves. Secondly, I would like to point out that the paper is not a systematic review trying to evaluate the evidence base regarding efficacy of homeopathic remedies. Therefore, no specific clinical trials are mentioned in the text, and thus none is omitted, not consciously and not unconsciously. However, the most important systematic reviews and meta-analyses that were available at the time the paper was written are referred to in the text. These were included to illustrate the status and amount of clinical research in this field, as well as the controversy of their conclusions (see, for example, Ernst 2002).
However, even if I agree with the ‘implausibility of homeopathy’, I do still think that it is justified to take an interest in this phenomenon. I also find it possible and justified to do research in this field, even when rejecting the homeopathic principles (although I am fully aware that there are many different views on this question as well).What makes the utilisation of homeopathy an interesting phenomenon from my point of view is the clash between the ‘unexplainable and unbelievable homeopathic theory’ and the numerous patients (or in veterinary medicine their owners) who utilise homeopathic remedies and apparently experience positive effects. These effects may be mediated by other mechanisms than specific effects of the remedies as such, but may still be valuable. Some of the questions raised are: Why do patients/owners choose a therapy that most medical doctors or veterinarians oppose? What motivates their decisions? Are they ‘fooled’, and if they are, by whom? How are these seemingly positive experiences mediated, and what implications does the utilisation of homeopathic remedies have for animal health and welfare?
A couple of years ago I interviewed a group of dairy farmers using homeopathic remedies as a part of their herd health management (Hektoen 2004). I did this in order to improve the understanding of the question ‘Why and how do dairy farmers use homeopathy?’. Positive experiences from treatment of personal health problems, desire to reduce the use of antibacterial drugs, personal involvement in herd health management and the desire to find alternatives when conventional veterinary medicine had no good solutions to offer were some of the factors motivating this use. Looking at health and production parameters, the only difference between these herds and control herds in which homeopathy was not used was a significantly lower use of antibacterial drugs in the herds using homeopathy. There were no obvious indications of negative implications for animal health or welfare. This does, of course, not demonstrate that the homeopathic remedies have any specific effects (most likely these results reflect a high clinical cure rate in cases of clinical mastitis). However, it demonstrates that these farmers are able to fulfil their aims of producing high-quality milk and reducing the utilisation of antibacterial drugs through the use of homeopathic remedies. This was a very important aim for them, and even though I am not able to support the homeopathic principles, I am able to understand that the farmers appreciate this as a good result.
These same farmers also provided an interesting perspective in relation to the statement: ‘Now doctors need to be bold and honest with their patients about homoeopathy’s lack of benefit’, quoted by Baker and others. These farmers all knew that homeopathic remedies are highly diluted, and they all found it hard to understand that these remedies could have any effect in disease treatment. However, the lack of understanding and documentation of effect was not important to them. They valued personal experience far more highly than scientific evidence or the opposition to homeopathy encountered within the veterinary profession. Therefore, I doubt that homeopathy will ‘disappear’ no matter how much the medical or veterinary professions dislike it or argue against it, and I doubt that studies like the one of Shang and others (2005) will end the discussion or the use of homeopathy. How we as veterinarians should relate to homeopathy is not basically a question of whether we should include an ‘unscientific discipline’ into our repertoire, legally allowed or not. It is more a question of how to relate to the owners who are using homeopathy for their animals. In my opinion it will probably be more beneficial for animal health and welfare to conduct an open dialogue than to display a completely critical attitude, also in the face of disagreement. The background for this is basically that it will reduce the risk that the owners will not also seek advice from conventional veterinary medicine. This is especially important in severe cases.
For me, the utilisation of homeopathy is an excellent example of the fact that veterinary medicine and decisionmaking in issues related to animal health and welfare in general is much more than medical interventions and their specific effects. The interest in homeopathic treatment among farmers and pet owners is in many ways a reflection of the inadequacy of conventional veterinary medicine to take into account their experiences, aims and personal motivations, and thus an inability to solve their problems. Dialogue does not automatically imply acceptance, but in the same way that patient-centred medicine may provide benefits within human medicine, a more client-centred medicine may provide benefits within veterinary medicine, also for the animals (see, for example, Shaw and others 2004). Studying the ‘unscientific utilisation of homeopathy’ has taught me a lot about farmers, their decision-making processes and also a lot about myself and the limitations of what I provide as a traditional, conventional veterinarian. This knowledge is relevant far beyond the question of specific effects of homeopathic remedies.
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