For other new developments, see also the page devoted to the ongoing Veterinary Times homoeopathy correspondence, which is being updated whenever a new chapter appears.
The essential issue addressed by this site is one of the embracing of homoeopathy (and other forms of crank medicine such as radionics, which we understand is banned in the USA but is embraced by many British veterinary homoeopaths) within our science-based profession. The "establishment" attitude is that it is better that the alternatively-inclined take their animals to a vet than go to a lay witchdoctor, therefore it is better to have some veterinary surgeons to cater to this requirement. Well-meaning though it is, this view ignores some very serious concerns.
An alternative view has been put forward by Ramey (2003) to the effect that in a climate of attack on the "privileged" position of the professions, it is essential for us to keep our own house in order by requiring that all veterinary surgeons uphold the highest standards of scientific, evidence-based medicine. This is, after all, what is taught in veterinary schools, what our degrees demonstrate we are proficient in, and what the public expects from us. Problems which arise as a result of an animal owner's devotion to crank medicine are arguably much easier to pursue under animal welfare legislation if it is impossible for the Defence to represent plausibly to the Court that an accepted form of veterinary medicine has been applied to the victim. The idea that such problems can be avoided by sanctioning the practice of crank medicine by qualified veterinary surgeons is not supported by experience, which in fact demonstrates that many of these veterinary surgeons pose nearly as great a welfare risk as their lay counterparts. Or, as was further commented, "if you’re going to nail a dead chicken to a horse’s stall and call it therapy, why would you care whether or not the 'therapist' doing the nailing has a veterinary degree?" And while we're at it, surely representing chicken-nailing as legitimate medical practice is gross professional misconduct?
It has been suggested (Baker & Baker, 2003) that "Perhaps we should take the holding of a homoeopathic "qualification" as prima facie evidence for expulsion from the RCVS: we think a strong case can be made that it brings the profession into disrepute!" This echoes an earlier suggestion from Tanner (1991) that homoeopathically inclined veterinary surgeons should "let their membership lapse and ply their dubious art outside the profession." The BVVS strongly supports this position, while accepting that in that event colleagues with existing homoeopathic qualifications would obviously be free to turn them in and continue to practice evidence-based medicine as they were taught at veterinary school.
Failing that, we take the position that any veterinary surgeon who chooses to use methods such as homoeopathy should be seen as acting entirely on his or her own responsibility, without any suggestion of approval from our professional bodies. It should be made clear to clients that homoeopathy and other popular non-science-based "therapies" are not part of the veterinary curriculum for the very good reason that there is no evidence of efficacy, and at least in the case of homoeopathy it is scientifically impossible that there should be any efficacy. In choosing this type of approach for their animals they must understand that they are stepping beyond the boundaries of accepted veterinary medicine, even if the treatment is administered by a veterinary surgeon. So far as professional negligence or misconduct are concerned, it should no more be acceptable to treat (for example) a hyperthyroid cat with a homoeopathic remedy than it would be to treat it with meloxicam or piperazine for the same condition.
See also An open letter to the AVMA Practice Act Task Force and supporting signatories.
BAKER, S. J. & BAKER, C. R. (2003) Rose-tinted view no longer tenable. Veterinary Times 33:25, 3-4.
HUNTER, F. E. (1991) Homoeopathic debate. Vet. Rec. 128, 239.
RAMEY, D. W. (2003) Regulatory aspects of complementary and alternative veterinary medicine. J. Am. Vet. Med. Ass. 222:12, 1679-1682.
TANNER, E. J. (1991) Homoeopathic remedies. Vet. Rec. 129, 342-343.
In May 2003 George Tribe and Morag Kerr, acting in a personal capacity, wrote to the RCVS Registrar highlighting the widespread occurrence of fallacious claims by the homoeopathic veterinary fraternity that "the Royal College of Veterinary Surgeons, in the year 2000, recognised Veterinary Homoeopathy as a speciality," the VetMFHom is "recognised by the RCVS as a specialist qualification", or alternatively is simply "recognised by the Royal College". [The wording was finally changed in January of 2004, but these are exact quotes of what appeared there before that date.]
A reply was received from Miss Jane Hern, RCVS Registrar, dated 8th July 2003. This letter stated:
Dear Mr Tribe & Dr Kerr,
LISTING OF HOMOEOPATHIC QUALIFICATIONS IN THE RCVS REGISTER
Further to your letters of 2 and 29 May 2003, your concerns have now been considered by the Registration Sub-Committee, which is responsible for the content and format of the Register.
It has been agreed that the list of veterinary surgeons holding the VetMFHom qualification will in future appear on a different page of the Register so as to avoid any inference that they are recognised by the RCVS as a specialist qualification. The list will also be prefaced with a form of words that makes it clear that the qualifications are not in any way approved by the RCVS but are published so that the profession and the public know which veterinary surgeons have such a qualification. The rationale for this is that some animal owners wish to have their animals treated homoeopathically, and that it is better that they see a veterinary surgeon than a non-veterinary homoeopath.
In fact, when it was first agreed that the list should be published in 2000, it was envisaged that the list would appear separately from the RCVS Recognised Specialists, Diplomates and Certificate Holders, in order to avoid confusion. Unfortunately, this direction had got lost in recent years.
I [In] addition to writing to you, I will also be writing to the BAHVS to advise them that the VetMFHom is not recognised as a specialist qualification and, as requested by the committee, I will ask that they amend their web site and any other publication accordingly, in order to avoid any misunderstanding.
Miss Jane Hern
One-and-a-half cheers, definitely. We were under the impression that the list had been there for longer than a couple of years, partly because on 9th March 1991 the then Vice-President of the BAHVS, wrote in the Veterinary Record that "At least the RCVS has now gone some way to recognising our diploma" (Hunter, 1991), and if it wasn't the appearance of that list he was referring to, we don't know what he was on about. (That letter was actually written to express outrage that the BVA had "once more" refused Specialist Divisional status to the BAHVS. In fact the application was rejected unanimously by BVA Council in December 1990, and there has been no further application. Nevertheless, the BAHVS web site still trumpets proudly in two places that "The BAHVS has attempted to gain recognition by the British Veterinary Association and to be granted the status of a non-territorial sub-division of that organisation.") However, no matter. We simply wonder why, if the profession had got on quite nicely without any such list for so long, it was suddenly thought necessary to include it in 2000.
We would, however, question the College's rationale as stated in Miss Hern's letter. We doubt very much whether the RCVS Register is a frequent resource for homoeopathically-inclined clients seeking a deluded veterinary surgeon to pander to their eccentricities. The danger that any apparently official listing will simply be used to legitimise counter-scientific approaches to medicine and persuade the undecided that "it must be all right, the RCVS approves" is surely greater than the danger of an animal being taken to a non-veterinary homoeopath (which is simply illegal, anyway) by an owner who can't find the relevant information - which is after all freely available on the BAHVS web site, among other places. However, the argument that having the list in the Register lets the rest of us know whom to avoid, perhaps has some merit!
Much will of course depend on the precise nature of the "form of words" which will preface the list in its new location. The sort of wording we'd really like to see is probably too much to hope for, but a sufficiently robust statement might actually do more good than no list at all.
We also wonder whether the RCVS will consider writing to Veterinary Times and Veterinary Review, where the fallacious claims were printed, to point out the error? Notice of clarification in the RCVS News and/or the appropriate section of the Veterinary Record wouldn't go amiss either, in our opinion. In a similar vein, is there any possibility whatsoever that the College will start to enforce the ruling that only approved qualifications should be used alongside one's MRCVS, with particular reference to professional stationery?
The BAHVS web site is however still unchanged (25th July, 14 days from our receipt of Miss Hern's letter). Any takers for a sweepstake on exactly how many days it will take them to comply with the RCVS instruction? We suggest thinking BIG numbers.... Of course, as that small and rather tacky site is designed and maintained by a company which appears to have gone bankrupt (no wonder, if that's the quality of their product), perhaps we might discover that they are unable to modify the page at all? We probably ought to amend our own home page a little, as the RCVS is clearly less supportive to "magical medicine" than it was when that was written, but let's wait for the BAHVS to make the first move!
Update, 1st October 2003. In conversation with Miss Hern, the Hon. Sec. was told that a letter had been received by the RCVS from the BAHVS, apologising for their misleading statements, and promising to amend their web site. However, we can't help noticing that the web site is still as it ever was. Come on, guys, a five-year-old could do that job in a few minutes!
Update, 14th November 2003. Small victory! In fact, maybe even a medium-sized victory. The 2003 edition of the RCVS Register arrived today, and indeed, the homoeopaths will not be happy. The list of 'qualified' homoeopaths is still under the list of MRCPaths, but the entire thing has been rearranged and there is now no question at all of them being able to claim Recognised Specialist status. In addition, the entry is prefaced by the following statement:
These qualifications are not accredited by the RCVS and are not accepted for inclusion in individual Register entries. The list, which may not be complete, is provided to assist those who might wish to contact a veterinary surgeon offering this type of service.
This isn't quite as robust as what we might have put, but let's face it, there's no way the RCVS would print the sort of remarks we would like to make about this activity. How long now will it take the BAHVS to amend that web site and the rest of their propaganda, we wonder? We're waiting.... We'd still like to see the list removed altogether, but on the other hand, the new form of words does have embarrassment potential for the water-shakers.
Update, 26th November 2003. Definite signs of homoeopathic perfidy. Recall that in July the BAHVS was 'requested' to amend their web site to remove the misleading claims of RCVS recognition. In September Miss Hern mentioned having had a "very nice" letter apologising for any misleading statements and promising to remove them. In mid-November the new edition of the Register made the real position pretty clear. We did speculate that perhaps their webmaster was unable to alter the pages, as the company which had originally designed the site was in liquidation. However, that's obviously not the excuse, as the site has now been updated. The changes are small, but somebody has certainly been working on it. The only problem is, the wording of the claims of RCVS recognition (three separate mentions) is still entirely unchanged.
Update, 8th December 2003. A BVVS member pointed out to us that it was certainly not the case that the BAHVS is unable to update its website, as their stated webmaster also has a large web site of his own devising, which is advertised as "organic in nature, being frequently updated." (This web site mysteriously disappeared late in 2004, and readers can now only read of the marvels of crystal healing as understood by the ancient Atlanteans and other wonder therapies by consuting the Wayback Machine - search for www.alternativevet.org)
In that case, they should find it easy to comply with the RCVS Registrar's latest instruction. Miss Hern informs us, in a letter dated 4th December, that she has written again to the BAHVS to say that if the necessary changes to the "false and misleading statements about RCVS recognition of the VetMFHom qualification" on their web site are not made before 31 December 2003, further action will be taken. We await developments with interest.
Update, 8th January 2004. Although the BAHVS missed the 31st December deadline imposed by Miss Hern, the site was modified in the first week of 2004. It's sad that they still refer to the new Register listing as if it were an endorsement, but it's still a big improvement.
Update, 17th September 2004. The latest contributon to the Veterinary Times correspondence thread is worthy of a mention here in its own right.
[Volume 34, no. 36, 20th September 2004, page 39.]
Use of medicines under the cascade
I would like to thank Simon Baker (23rd August issue) for providing a further opportunity for me to comment on the use of veterinary medicines under the cascade. In his letter, he raises the important issue of how veterinarians may try new modes of medical treatment. New medicinal treatments should be thoroughly researched, documented and then assessed and authorised by the regulatory authority before veterinarians are able to use them legally.
Selected veterinary practices may play a part in clinical trials of new medicines before they are fully authorised, but such a trial will be conducted under an Animal Test Certificate (ATC) issued by the regulatory authority. The ATC will restrict the extent of the trials conducted and the data produced will be used in the assessment of the veterinary medicine prior to its authorisation.
Veterinary surgeons conducting trials outside these rules are clearly taking considerable risks [as] their actions could be more correctly described as research and, therefore, may require an ASPA licence from the Home 0ffice, even if the animal owners have given their consent to the treatment being used.
On an entirely different front, Simon Baker asks for some guidance as to where homoeopathic remedies sit within the cascade. Homoeopathic remedies should be authorised in a similar manner to other forms of veterinary medicine. Thus, assuming a homoeopathic remedy is authorised either as a veterinary or human medicine, it may be used under the cascade using exactly the same rules as any other veterinary medicine. If, however, the homoeopathic remedy is not authorised for use as a human or animal remedy, then it may not be used under the cascade provision. Veterinary surgeons may like to know that there are currently no homoeopathic remedies authorised for use as veterinary medicines in the UK.
STEVE DEAN, BVetMed, DVR, MRCVS,
Well, we rather fail to see how the homoeopathy point is "an entirely different front", as it seems like exactly the same question to us. However, although somewhat circumlocutiously worded, Dr. Dean's point seems clear enough. Lacking any authorisation for use as veterinary medicines (or as human medicines to the best of our knowledge) veterinary surgeons are not able to use homoeopathic remedies legally in the UK.
This raises a number of interesting questions.
Indeed, it is odd that Dr. Dean chose the EDTA-tris issue with which to highlight the proper use of the cascade, when on the reverse of the very same page as that article was an article by Peter Gregory extolling homoeopathy. Such articles appear fairly frequently, and it seems to be politically incorrect to critisise them (Niall Taylor's balancing anti-homoeopathy article was quite heavily censored).
However, we now seem to have a fairly clear statement that the use of homoeopathy by veterinary surgeons is illegal under the cascade. What is the VMD going to do about it? What is the RCVS going to do about it? (Bearing in mind that the Register still includes that list of homoeopaths, ostensibly to allow the public to find veterinary surgeons offering homoeopathy, which we now find is illegal.) What is the BVA going to do about it, in respect of the regular publication of advertisements for homoeopathic educational courses in the Veterinary Record? What are the journals which regularly publish pro-homoeopathy articles going to do about it? What are the universities going to do about it? What is the BAHVS going to do about it - or more to the point, what is anyone going to do about the BAHVS?
Realistically, it's unlikely that the Powers that Be are going to come down on veterinary surgeons using homoeopathy with the full force of the law - any more than they are going to come down on those who use EDTA-tris and similar unauthorised but well-regarded preparations. Nevertheless, how can the active and overt promotion of an illegal form of treatment possibly continue to be condoned?