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Research

Review
OPEN ACCESS

Comparison of veterinary drugs and veterinary

homeopathy: part 1
P. Lees, D. Chambers, L. Pelligand, P-L. Toutain, M. Whiting, M. L. Whitehead

For many years after its invention around 1796, homeopathy was widely used in people
and later in animals. Over the intervening period (1796-2016) pharmacology emerged as
a science from Materia Medica (medicinal materials) to become the mainstay of veterinary
therapeutics. There remains today a much smaller, but significant, use of homeopathy by
veterinary surgeons. Homeopathic products are sometimes administered when conventional
drug therapies have not succeeded, but are also used as alternatives to scientifically based
therapies and licensed products. The principles underlying the veterinary use of drug-based
and homeopathic products are polar opposites; this provides the basis for comparison between
them. This two-part review compares and contrasts the two treatment forms in respect of
history, constituents, methods of preparation, known or postulated mechanisms underlying
responses, the legal basis for use and scientific credibility in the 21st century. Part 1 begins
with a consideration of why therapeutic products actually work or appear to do so.

We are all trying to understand our own age, and we rightly use the past to help or, in the absence thereof, by the pharmacopoeias currently used
us to do so. But we cannot gain this understanding unless we pay the past the officially in the member states. A homeopathic medicinal product
respect it deserves. We must understand just how different it was (Moore 2010). may contain a number of principles’. For homeopathic medicinal
products, mechanisms of action are unknown (vide infra).
Why medicinal products work or seem to work Nevertheless, there are several possible explanations as to why and
European Union (EU) terminology refers to medicinal substance- how products in both categories work or appear to work. They may
based products. In this review these will be termed drug-based possess genuine efficacy (something actually happens) or ‘apparent
products. A drug may be defined as a medicine or other substance efficacy’ (something is only perceived to happen). In addition, there
that has a physiological effect or acts on a pathophysiological process, is also ‘indirect or vicarious efficacy’; for example, an owner wrongly
when ingested or otherwise introduced into the body. For drug-based perceives a behavioural problem in a dog and this triggers undesired
products, clinical use is based on established pharmacological actions behaviours. If treated, by a product of either class, the owner might
and, in many cases, on established molecular mechanisms. In this then cease triggering the negative behaviour and the product, without
review, such conventional medicinal products specifically exclude direct action, receives credit for achieving a positive outcome.
homeopathic products. A summary of the use of homeopathic
products in animals in the EU has been provided by the European Coincidence
Council for Classical Homeopathy (2007). The EU definition Commonly, there is an understandable but regrettable reluctance
(Directive 2001/83/EC, as amended) of a homeopathic medicinal to accept that coincidence might be the explanation for a given
product is ‘any medicinal product prepared from substances observation. The fact that many illnesses resolve, irrespective of
called homeopathic stocks in accordance with a homeopathic treatment given, means that resolution or improvement and treatment
manufacturing procedure described by the European Pharmacopoeia may simply be coincidental. If a veterinarian gives a treatment and the
animal gets better, there is a strong cognitive bias (the post hoc ergo
propter hoc bias [Rudolf 1938, Pinto 2001, Gay 2006]) to believe that
the treatment is responsible, but this assumption might be misplaced.
Veterinary Record (2017) doi: 10.1136/vr.104278 Any cure can be confounded by many factors, which render estab-
lishing a causal relationship between treatment and cure difficult.
Confounding factors may mask an actual association or, more com-
P. Lees, CBE, BPharm, PhD, DSc, 0HQ, UK monly, falsely indicate an apparent association between treatment
FRoySocBiol, HonAssocRCVS, P-L. Toutain, DVM, DSc(PhD) and outcome, when there is no actual association (Skelly and others
Drhc(Gent), HonFellowECVPT, Toxalim, Ecole Nationale Veterinaire de 2012). For every effect, we commonly assume that there must be a
L. Pelligand, Docteur Veterinaire, Toulouse, France specific cause, preferably the one favoured by each of us individually.
CertVA, DipECVAA, DipECVPT, M. L. Whitehead, BSc, PhD, BVSc, Factors to be considered when assessing the efficacy of any product
PgCert(VetEd), FHEA, PhD, MRCVS, CertSAM, MRCVS, Chipping Norton include: specific effects of the treatment, placebo effect, bias in observ-
M. Whiting, BSc, BVetMed, MA, PhD, Veterinary Hospital, Banbury Road, ers’ assessment of patients’ response to treatment, the natural course
DipECAWBM(AWSEL), MRCVS, FHEA, Chipping Norton, Oxon OX7 5SY, UK of the disease, and effects of concurrent management of the illness, as
Royal Veterinary College, Hawkshead discussed below.
E-mail for correspondence:
Campus, Hatfield, Hertfordshire AL9
martincnvets@gmail.com
7TA, UK Specific effect of the treatment
D. Chambers, BVSc, MSc, MRCVS, Provenance: not commissioned; If the treatment is actually effective, where efficacy may be
Hall Manor, Kelly, Lifton, Devon PL16 externally peer reviewed underpinned by many preclinical studies and manifest in controlled

170 | Veterinary Record | August 12, 2017

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clinical trials, that is called a specific effect. It is the active constituent(s)
of the drug-based product or, for a homeopathic product, the unknown
mechanism, which provides the claimed benefit. For a drug-based
product, efficacy is achieved if a sufficient number of molecules
reach and persist at the site of action (the biophase) for a sufficient
period of time to act upon a biochemical/physiological pathway.
Alternatively, a drug may act on some factor involved in a disease
process; this would include a direct or indirect action on a parasite or
microorganism present in or on the body. Beyond ‘working’ (or not),
the degree of efficacy (ie, magnitude of response and the establishment
of dose-effect relationships) is pivotal to the demonstration of efficacy
for drug-based but not for homeopathic products.
Placebo effect
Placebo effects are the main reason used by critics to explain apparent
homeopathic effects, and are part of the ‘baseline’ to which the
efficacy of any medication – conventional or homeopathic – is
compared in randomised controlled trials (for example, Hektoen 2005,
Shang and others 2005, Kayne 2006, Teixeira and others 2010, Brien
and others 2011, Mathie and others 2012, Smith 2012, Vijayakumar
2012, Campbell 2013, Mathie and Clausen 2014). A placebo is
a medical intervention that has a non-specific psychological or
psychophysiological therapeutic effect and is thus lacking any known
specific effect for the condition treated (McMillan 1999), but products
with specific efficacy can also produce placebo effects. Placebo effects
impact patients’ perception of their symptoms far more than they do
the physiological and pathological processes of disease; any placebo
effects on these more objective aspects of disease are typically small
in magnitude and clinically irrelevant (Hróbjartsson and Gøtzsche
2010, Wechsler and others 2011). The basis of the placebo effect in
people is experiencing a beneficial effect, arising from belief in the
treatment, and based partly on confidence derived from consultations,
leading to expectations on the part of the patient. In addition,
there may be behavioural conditioning (Enck and others 2013).
Mechanisms underlying the placebo effect are still poorly understood;
they might be multiple and indeed might differ from circumstance to
circumstance. A veterinary example is the display of separation-related
behaviour in dogs, for which a conditioned placebo effect, suppressing
signs of distress, was demonstrated (Sümegi and others 2014). It
is clear that the placebo effect can and sometimes does operate for
both homeopathic and drug therapies. Even if the mechanism(s)
are obscure, the accepted view is that (in human medicine) a half to
one-hour chat with a sympathetic and convincing homeopath can
yield positive outcomes; all the collateral benefits of old-fashioned,
reassuring, paternalistic medicine. This will be especially true where
mind-over-matter considerations are pre-eminent to outcome. In
Bavaria, it was reported that 88 per cent of GPs sent patients home
with prescriptions for placebo drugs, the corresponding figure for
the whole of Germany being 50 per cent (Jutte and others 2011,
Kupferschmidt 2011).
In veterinary medicine, it is less easy to conceive if and how an
animal can distinguish mentally between a homeopathic and drug-
based product, if both are identical in presentation and similarly
administered. For the huge majority of medical conditions, a placebo
effect seems to be unlikely and counter intuitive, particularly as an
animal cannot normally be expected to have the cognitive capacity
to expect recovery or healing. The placebo component of the effect
of a homeopathic veterinary product is presumably limited normally
to the judgement of outcome, based on the subjective evaluation of
the caregiver (veterinarian or animal owner) (Conzemius and Evans
2012, Talbot and others 2013, Gruen and others 2014, 2017). As in
human medicine, a sympathetic veterinarian might provide the basis
for placebo-induced benefit in the owner, for both drug-based and
homeopathic products. The problem then is that the veterinarian and/
or animal owner believes (wholly sincerely) that a beneficial response
has occurred, but the animal may continue to suffer. Nevertheless, the
potential beneficial effect of human contact on the health and physi-
ological state of animals can be real (Mills and Cracknell 2013). In
daily practice, this non-specific treatment effect may be especially
important whereas, in a randomised controlled clinical trial, it will be
randomly distributed between the treatment and control groups and
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of lesser importance in studies in animals than in people.
In so far as placebo effects occur in animals, for both drug-based
and homeopathic products, explanatory theories have been based on:
classical conditioning (as recognised in dogs responding to a saline
injection as if it were morphine [Pavlov 1927]); cognitive expectan-
cy; and release of endogenous opioids (McMillan 1999, Mills and
Cracknell 2013). For further discussion on each of these aspects see
Hektoen (2005). For in depth discussion on the placebo effect, see also
Meissner and others (2011). In many instances, the placebo effect has
been shown to work through recognised physiological/biochemical
pathways and encompassing both central and peripheral nervous sys-
tems. Enck and others (2013) discuss physiological pathways in pla-
cebo analgesia, involving the descending pain modulatory network,
and conditioned corticosteroid effects in patients with psoriasis.
Bias in observers’ assessment of patients’ response to
treatment
Doctors or veterinarians sometimes judge that a treatment has had
an effect on a patient when, in fact, it has not. There are many
examples in medical history of treatments that were thought to be
beneficial, but were later proven to be ineffective or even harmful;
well-known examples include blood-letting, use of anti-arrhythmics
after ischaemic heart disease, hormone replacement therapy to
prevent ischaemic heart disease in postmenopausal women, and
radical mastectomy rather than more limited surgery for breast cancer
(Prasad and Cifu 2015). Medical professionals are naturally inclined
to believe that, if a patient improves after a treatment has been given,
the improvement must have been a result of that treatment (post hoc
ergo propter hoc bias). This is one example of many cognitive biases
that can result in incorrect interpretation of the patient’s response
to treatment (Rudolf 1938, Croskerry 2003, Gay 2006, Kahneman
2012, McKenzie 2014, Matute and others 2015, Canfield and others
2016).
Other factors impacting on assessment of treatment
efficacy
Non-specific healing effects
In addition to placebo effects and observers’ bias, other non-specific
healing effects, regression to the mean (RTM) and the natural course
of disease may all impact on efficacy – perceived or real. As discussed
by Hektoen (2005), Mills and Cracknell (2013) and Talbot and others
(2013), the elements potentially involved in the total effect of any
treatment are: specific treatment effects statistically demonstrated in
clinical trials; non-specific effects of treatment (such as the placebo
effect); natural resolution of the signs of disease or deranged condition,
including self-healing; RTM; concomitant support for treatments,
such as nursing or reduced bodyweight; and combinations of these
factors. RTM was first identified by Galton (1886) and has been
discussed more recently by Morton and Torgerson (2003, 2005). In
a well-designed randomised controlled trial (Lees and others 2017),
all the factors listed, except the specific treatment effect, should be
evenly distributed between treatment groups. Thus, the improvement
in the placebo group is the sum of factors, such as non-specific
treatment effects, natural history of the disease, RTM and the effects
of concurrent nursing. These clearly must be non-specific effects,
because no treatment with a specific effect was given to the placebo
group. In the case of a veterinarian treating an individual patient, in
many cases it is not possible to differentiate between non-specific
effects and any specific effect of the treatment. For the individual
clinical veterinarian treating the individual animal, all of these
mechanisms may be operative, often resulting in treatments appearing
to be effective when, in fact, they are not.
Concurrent management of patients
Many medical treatments are associated with additional changes
in management of the patient, for example, nursing, rest, change
of diet and treatment with other drugs. Many of these factors can
lead to improvements in the disease that may be misattributed to the
treatment being evaluated. For example, an obese dog given a medical
treatment for osteoarthritis and also put on a weight loss diet may
have reduced clinical signs, because of weight loss rather than the
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medical treatment.
The natural history of disease
Many diseases have a natural history, leading to mortality or
morbidity or, more hopefully, partial or complete restoration of health.
As Voltaire said, ‘the art of medicine consists in amusing the patient
while nature cures the disease’. RTM comprises the natural fluctuation
of variables around a mean, and its impact can be considered by
way of example. A dog with osteoarthritis shows signs of reduced
movement, joint stiffness and pain. The owner seeks veterinary
advice, a medication is prescribed and the dog shows improvement.
If, even in the absence of treatment, the signs wax and wane (as may
well occur in the osteoarthritic dog), the owner and veterinarian
understandably, but in part or in whole wrongly, may attribute the
improvement to the administered product. Talbot and others (2013)
discussed this problem in relation to a feed supplement used in head-
shaking horses, a condition well known for its intermittency. RTM
may occur in an individual animal (as in the example cited above) or
as a group phenomenon and in both cases the observed increase or
decrease may be mistakenly attributed to a specific treatment effect
(Morton and Torgerson 2005).
The body’s natural healing mechanisms (and their interaction
with efficacious medicines)
The natural defence mechanisms of the body in microbial and other
diseases can prove highly effective in providing a clinical cure or,
better still, a microbiological cure (the gold standard). In microbial
disease, the administered drug acts in concert with many immune-
based mechanisms, notably the scavenging action of white blood
cells, working to defeat the invading pathogen. Drusano and others
(2010) calculated that, if antimicrobial therapy drives the bacterial
(Staphylococcus aureus) population down to between 102 and 103 colony
forming units/g, it is highly likely that the residual population will
be eradicated by the immune system and, moreover, will be achieved
with minimal amplification of resistant mutants.
In veterinary medicine, the use of antimicrobial drugs in proph-
ylaxis (now under challenge within the EU) is deemed to give the
immune-based pathways invaluable support. In metaphylactic use
(sometimes referred to as mass medication) drugs are administered
collectively to animals, in which the bacterial population exceeds
the capacity of the natural defences of the animals to work without
support. In therapy, especially in the presence of immune deficiencies
and heavy bacterial loads, the prudent use of antimicrobial drugs in
animals is essential to welfare through restoration of health. Their
actions may be attributable to: direct killing, reduced pathogen patho-
genicity or the enhancement of host immune pathways.
With other deviations from normal ranges, the body has the abil-
ity, through biochemical, physiological and endocrinological path-
ways, to restore systems to normal – the homeostasis of the body.
These systems are finely balanced and usually integrated, so that, for
example, there is a tonic influence of sympathetic nerves to arterioles
to keep them in a state of partial constriction. The same arterioles are
under an opposing tonic vasodilator effect of the nitric oxide system.
The system can fail, arterial blood pressure may rise and the resulting
hypertension may require the attention of a suitable drug. Thus, the
homeostatic pathways may be suboptimal in a hypertensive cat, but
they are most likely to be still operational and the pharmacological
agent may play only a minor but essential role in assisting the body to
restore homeostatic balance.
Likewise, there are innumerable integrated systems, keeping with-
in normal ranges blood glucose and blood cell counts. Drugs which act
on neural, physiological and endocrinological pathways are generally
working in concert with the body’s enzymes, neurotransmitters and
hormones and, even in the presence of a drug or homeopathically
energised water, it may be that it is the homeostasis which plays the
dominant and even the sole role. There will be many other circum-
stances, when the drug is required not to work in concert with but
to combat a deranged physiological system; if sympathetic nervous
vasoconstrictor tone to arterioles is increased, the drug is needed to
correct that. Many other drugs are used to counter natural physiologi-
cal processes, such as anaesthetics, while others suppress a natural and
172 | Veterinary Record | August 12, 2017
useful but unwelcome process, such as inflammation.
In summary, placebo effects are those beneficial effects arising
from use of a treatment that are not due to the properties of the treat-
ment itself, and therefore must arise from cognitive processes such as
belief and expectation. However, placebo effects are only one of many
non-specific factors that can give rise to an improvement from treat-
ment. As discussed above, other non-specific effects, that do not arise
from the treatment at all, include RTM, other coincidental improve-
ments, and effects of concurrent nursing or change of diet. Additional
factors can cause perceived but not real improvement, for example,
observer bias and selection bias. All of these non-specific effects may
occur together, and between them give rise to the improvement seen
in the placebo-control group in a randomised controlled trial; that is,
improvement that is not due to the specific effect of the treatment.
Because all of these non-specific effects occur in the placebo-control
group, they are sometimes referred to as ‘placebo effects’ although
strictly, this is an error of terminology because true placebo effects are
only one contributor to the totality of non-specific effects. In animals,
with far less ability to experience beliefs and expectations about the
healing effects of treatments, true placebo effects will contribute much
less to the non-specific effects than in people.
History
Homeopathy
The history of homeopathy has been covered elsewhere (Bellavite
and others 2005, Kayne 2006, Loudon 2006, Cook 2008, Campbell
2013). Briefly, the fundamental principle of homeopathy, that ‘like
cures like’, was proposed, in 1796, by Samuel Hahnemann (1755-
1843), as an alternative to other therapies then in use; primarily
herbalism, bleeding, purging, emesis, blistering and sweating (Porter
1997, Wootton 2006). By 1814, Hahnemann was using highly-
diluted homeopathic remedies similar to those used by homeopaths
today (Hahnemann 1814). Before inventing homeopathy,
Hahnemann qualified as a doctor and worked as a conventional
physician, then as a translator of scientific articles and a writer. He
also studied chemistry. He translated a conventional Materia Medica
(by William Cullen, 1710-1790) into his native German and found it
to be lacking. In its place, he devised and advocated the principles of
homeopathy.
Homeopathic remedies are based on three central tenets, ‘The Law
of Similars’ (similia similibus curantur), ‘The Law of Infinitesimals’
and ‘The Law of Succussion’, each arising from the writings of
Hahnemann, in particular his ‘Organon of Medicine’ (Hahnemann
2002). According to The Law of Similars, signs and symptoms can
be cured by substances that can cause those signs and symptoms in
healthy individuals (Hahneman 2002, Kayne 2006, Owen 2015). The
naming of homeopathic products is usually in Latin. Remedies are
listed in homeopathic Materia Medica (Hahnemann 1814, Boericke
2008, several others available at various Internet sites [International
Academy of Classical Homeopathy 2016]), together with the signs
and symptoms the remedy is thought to be effective for (Lilley 2008).
Homeopaths also use repertories, which list signs and symptoms,
and for each give the remedies thought to be effective for that sign or
symptom (Boericke 2008). For example, insomnia can be treated by
the coffee bean remedy, Coffea cruda (Boericke 2008) – coffee con-
tains the central nervous system stimulants caffeine and theophylline
– or a common cold can be treated by the onion remedy Allium cepa
(Boericke 2008) – onions make the eyes water. For Hahnemann, as
for conventional medical doctors in the late 18th century, working
before the advent of science and modern medicine, the human body
was a black box; a medicine goes in and the effects (any change in
symptoms) come out, there being no knowledge of or much interest
in ‘the in between’. How the products of either category worked was
unknown and inconsequential.
Various forms of like-cures-like concept were present in medical
writings long predating Hahnemann, for example, Hippocrates in the
4th century BC and Paracelsus in the 16th century (Kayne 2006) and
the general concept was present among medics in the late 18th cen-
tury. The Reverend Edward Stone of Chipping Norton described in
1795 (one year ahead of Hahnemann) the treatment of agues by the
willow (bark and leaves) noting, ‘as this tree delights in a moist or wet
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soil, where agues (fever) chiefly abound the general maxim that many
natural maladies carry their cures along with them or that their rem-
edies lie not far from their causes was so very apposite to this particu-
lar case that I could not help applying it’ (Wood 2015). We now know
that, in this case, there is a conventional pharmacological explanation;
the willow contains the glycoside salicin, which has anti-inflamma-
tory and antipyretic effects. With advances in chemistry, this led in
1865 to the first synthetic analgesic drug of the non-steroidal anti-
inflammatory (NSAID) class, salicylate; this then led in 1895 to acety-
lated salicylate, aspirin, followed by a plethora of drugs of the NSAID
category. However, as a general principle, the like-cures-like concept is
arbitrary and has no general credibility, notwithstanding its apparent
but superficial symmetry. The general concept of ‘like-cures-like’ has
been practised by many cultures over the millennia (Fraser 1922).
Stone’s ‘like-cures-like’ is of a qualitatively different type to that of
homeopathy. In the Stone example the property of the substance used
to treat a disease that is ‘like’ the disease is some observable physical
attribute of the substance: in the case of the willow, it grows in damp
places, and – in the thinking of the time – diseases tend to occur in
damp places. This is a different ‘like-cures-like’ concept to homeopa-
thy, in which the property of the substance used to treat a disease that
is ‘like’ the disease is the ‘symptom picture’ induced in healthy volun-
teers by ingestion of the substance (in the early years of homeopathy)
or by ingestion of a remedy made from the substance (for much of the
history of homeopathy).
The fundamental principle of homeopathy is that something that
induces specific signs and symptoms will also cure the same signs and
symptoms. For veterinary medicine, we should note that animals do
not have symptoms; symptoms are what humans report (headache,
bellyache, disorientation), while signs are what we can observe and
sometimes measure (rise in body temperature, tachycardia). Therefore,
humans can have both symptoms and signs and non-human animals
show only signs; the symptoms are known only to the individual
animals.
Hahnemann’s second law, the Law of Infinitesimals challenges
the scientifically based principles of biochemistry, physiology, endo-
crinology and pharmacology, of more molecules producing greater
responses; the classical concentration/dose-response relationships (see
part 2 of this review; Lees and others 2017). In complete contrast,
Hahnemann’s second Law states that greater responses are achieved
with less, over a huge range of dilutions. With repeated dilutions in
(usually) water or alcohol, potency increases. A starting solution
(called the ‘mother tincture’) of the ‘active’ is diluted either 1:10 (deci-
mal) or 1:100 (centesimal), then that diluted solution is again diluted
by the same degree, and the process continued (Kayne 2006, 2008).
The degree of dilution of a remedy is referred to as its ‘potency’ – a
6c potency remedy has been diluted 1:100 six times (therefore, 10-12
dilution) and an 8d potency remedy has been diluted 1:10 eight times
(10-8 dilution). Homeopathic products are provided over a wide range
of ‘potencies’; in the UK 6c, 12c, 30c and 200c seem to be the most
commonly used, but homeopaths’ preference varies from country to
country (Kayne 2006). Most over-the-counter homeopathic remedies
are 30c.
The number of molecules of the ‘active’ agent decreases rapidly
with dilution and, as implied by Avogadro’s number (6 x 1023) beyond
12c (a dilution of 1x10-24) there is unlikely to be even one molecule of
the starting substance present in the remedy (Vickers and Zollman
1999). At 12c dilution of a mole of starting substance, there is a 60.2
per cent chance of one molecule remaining. At 30c (10-60 dilution),
to have one molecule of ‘active’ remaining would require a mass of
water molecules of 2.99x1034 kg, more than 15,000 times the mass
of the Sun of 1.99x1030 kg (Grimes 2012). It is estimated that there
are approximately 1080 particles in our universe – 1080 corresponds to
40c dilution.
Succussion is the basis of the third Law. It is a specific type of vig-
orous shaking or tapping at each dilutional stage (Kayne 2006, 2008);
this agitation is believed to ‘potentise’ or ‘dynamise’ the remedy, and
is what causes the claimed healing power to not only pass from the
less diluted stage to the more diluted stage, but to become more potent
as it does so. Hahnemann believed that he had made a breakthrough
discovery, while transporting his products in a horse drawn carriage.
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On the basis of uncontrolled observations, he judged that the vigor-
ous shaking this involved increased the potency of his remedies even
further beyond the dilution effect. Another equine contribution to
homeopathy came in the form of his bespoke striking board used for
succussion, constructed by a saddle maker, with leather on one side
and stuffed with horsehair.
The preparation of homeopathic products today, as historically,
involves shaking or tapping at each dilutional stage. A usual proce-
dure is to strike the container between 10 and 50 times against an
elastic object. According to Peter Fisher’s (homeopath and Clinical
Director and Director of Research at the Royal London Hospital for
Integrative Medicine) evidence to the UK House of Commons Science
and Technology Committee (2010) ‘you have to shake it vigorously….
if you just stir it gently, it does not work’. Repeated dilution and suc-
cussion achieves ‘potentisation’ such that the healing power – the
unidentified curative property – imparted to the remedy by the start-
ing substance is retained (indeed increased with each shaking) by
the water molecules. As Hahnemann wrote, the shaking procedure
releases ‘dynamic forces from the diluents which were preserved and
intensified with subsequent dilutions’. The nature of these ‘dynamic
forces’ is not known; like Hahnemann (2002) himself, many con-
temporary homeopaths refer to them using terms such as ‘vital force’
or ‘life energy’, as used in homeopathy texts (Kayne 2006, Nicolai
2008, Owen 2015), and apparent from internet searches for these
terms with ‘homeopathy’. These terms emphasise the mystical, vital-
ist nature of the belief system underlying homeopathic practice. The
mechanisms by which homeopathic remedies effect improvements
in signs or symptoms is not known, but homeopaths often refer to
their remedies ‘balancing’ unspecified ‘energies’ in the body, or cor-
recting a disturbance of the body’s ‘vital force’ (Bell and others 2004,
Kayne 2006). However, the nature of these energies is likewise not
known and their existence is unproven. They appear not to be detect-
able grossly, for example, by sight or touch, or by radiography, scin-
tigraphy, ultrasound or CT or MRI scans. All three laws of homeopa-
thy – similars, infinitesimals and succussion – are arbitrary, having
been invented by Hahnemann, but never demonstrated to have a
physical basis. Homeopaths often speculate that modern scientific
concepts such as electromagnetism or quantum effects (Kayne 2006)
might underlie the claimed efficacy of their remedies, and frequently
refer to the ‘vital force’ and the action of their remedies in terms of
‘vibrations’ and ‘resonances’ (Kayne 2006). Thus, homeopathy is
pseudoscientific.
Pharmacology
The history of pharmacology spans less than 200 years. It derived
from Materia Medica, which was practised for at least two millennia
up to the late 19th/early 20th centuries. Early practitioners were
Hippocrates and Galen. In the first known pharmacopoeia, the
physician Pedanius Dioscorides wrote, in the first century BC, ‘the
leaves of the willow being beaten small and drank with a little pepper
and wine do help such as are troubled with the Iliaco Passio (colic).
The decoction of the leaves and bark is an excellent fomentation for
the gout.’ His De Materia Medica, was in continual use for more than
1500 years.
Writing around the time of Hahnemann (mid 18th century)
Voltaire described pharmacology as ‘the pouring of drugs of which
one knows nothing into a patient of whom one knows less’.
Evolution of thinking 1796-2016
In 1796, the year of revelation to Hahnemann, there was available for
use in both human and to a lesser degree veterinary medicine, Materia
Medica (the use of plant parts or their extracts), blistering, bleeding,
purging, sweating and emesis as the main bases for treatment,
together with surgery, which in many cases was savage butchery. The
skilled surgeon’s greatest asset was speed rather than quality. Medical
treatment was largely based on the concept of balancing the four
humours, and bloodletting was the primary treatment (Porter 1997,
Wootton 2006).
Human doctors not only practised but prided themselves in these
procedures. The period from 1780 to 1850 has been described as the
time of ‘heroic medicine’. A popular ditty of the day was penned by
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John Coakley Lettsome (1744-1815) founder and President of the
Medical Society of London ‘I, John Lettsome, blisters, bleeds and
sweats ‘em; if, after that, they please to die; I John Lettsome’ (Scott
and Scott 2008). Perhaps the initial success of homeopathy was due to
the fact that it obeyed Hippocrates’ first principle of treatment: above
all do no harm, giving it, over the conventional medicine of the time,
a better risk:benefit ratio.
If the reaction of Hahnemann to these medical practices was deri-
sion or despair, one can only, with the benefit of hindsight, sympa-
thise. Now, these barbaric procedures have been swept away by curios-
ity, observation, trial and error, experiment and serendipity (the bases
of the scientific method), facilitated by the advances in knowledge,
first of chemistry, then biochemistry/physiology, then cell and molec-
ular biology, all dependent on increasingly sophisticated measuring
and analytical techniques. It is true that throughout the 19th century
quacks continued to peddle quack medicines, but the ascendency of
the scientific method had largely put paid to the practice of quackery
by doctors by the first quarter of the 20th century, as opposed to the
practice of quackery by non-medical people, which continues.
On the veterinary scene, James White (1816) of Exeter, was way
ahead of his time when he wrote; ‘within these few years only, has
the veterinary art acquired a distinct appellation, and a solid founda-
tion in this country. Receipts handed down by traditionary skill, in
which ingredients were accumulated without judgment or discrimi-
nation, constituted the principles and practice of what was termed
Farriery… It is only since the institution of the [London] Veterinary
College, that the anatomy and physiology of the horse have been
properly investigated, and the effects of medicines on his body cor-
rectly ascertained, by numerous and appropriate experiments, both
in health and disease; so that a secure foundation is now laid; and, as
long as scientific men continue to study and practise the veterinary
art, it must necessarily be in a progressive state of improvement’.
The quack medicines of earlier centuries were largely based on
spurious or unsubstantiated Materia Medica products. Now, almost
nothing remains in 21st century therapeutics, except for some fine
examples of the active constituents of Materia Medica remedies;
we have quinidine, quinine, morphine, atropine, digitalis glycosides,
d-tubocurarine and, derived from the willow, salicylate and its succes-
sors. We still have major therapeutic uses for the extracted chemicals
of plants, but as drugs in 99 per cent plus purity form. Now, therefore,
we have better control of the dose, a lesser likelihood of overdose and
less opportunity for unwanted effects from the other constituents/
adulterants of the plants or their extracts. And, of course, we have over
the last 75 years, the example of the magic bullets (penicillin, strepto-
mycin, tetracycline and their derivatives and successors) isolated from
soil dwelling microorganisms or produced semi-synthetically or syn-
thetically in the laboratory.
The steady development of conventional therapeutics has been
an ongoing, often unplanned process, proceeding by an incremental,
bottom up evolution. It began with the ideas of the Enlightenment.
Charles Darwin, Claude Bernard (an early advocate of evidence-based
medicine [Morabia 2006]), Louis Pasteur and Robert Koch were chil-
dren of The Enlightenment and we are its great, great grandchildren.
Johnson (2010) has written that both biological and technological
developments comprise a ‘gradual but relentless probing of the adja-
cent possible, each new innovation opening up new paths to explore’.
As the scientific method was refined, and new technologies devel-
oped, more was learned about chemistry, biology, physiology, bio-
chemistry, microbiology and pathology, allowing the rational devel-
opment of treatments. Moreover, in the 20th century medical science
developed the randomised controlled clinical trial, allowing the objec-
tive testing of novel treatments.
In contrast, homeopathy was invented by one man, living at a
time of minimal scientific understanding of biology and pathology. It
has remained essentially unchanged. While there may now be many
more homeopathic remedies, the underlying concepts and philoso-
phy, and the methods of preparation (huge dilutions, succussion, etc),
are essentially the same; the Laws are inviolate. An assumption under-
lying homeopathy is that disease signs are an expression of a disturbed
vital force, affecting the whole organism and the treatment is intend-
ed to restore the ‘energetic balance’ of the individual (Bell and others
174 | Veterinary Record | August 12, 2017
2004, Kayne 2006, Nicolai 2008, Owen 2015). The actual mecha-
nisms remain obscure, implausible for most people and incompatible
with scientific knowledge accumulated over the last two centuries.
The belief system of homeopaths is vitalist in that it posits that
the phenomena of life are dependent on a force or principle distinct
from purely chemical or physical forces – there is something ‘special’
about living tissue, above and beyond its content of atoms and mole-
cules. Vitalism is a discredited scientific hypothesis that Ridley (2015)
describes as a superstition in headlong retreat. Vitalism underlies most
traditional healing practices, and the Hippocratic ‘four humours’ tra-
dition that dominated Western medicine until disproven by modern
science. Vitalism has been diminished by the advances in pharmaco-
logical, biochemical, cellular and molecular biologies, not least by the
discovery that ‘the secret of life’ – DNA – turned out to be an infinite-
ly combinatorial message, written in three-letter words in a four-letter
alphabet. This discovery is inconsistent with the concept of a ‘vital
force’. From psychology, superstitious adults tend to explain biological
processes in terms of vitalist causality and energy transmission, and
such conceptual confusions are associated with belief in alternative
medicine (Lindeman and Saher 2007), which is itself associated with
intuitive rather than rational thinking styles (Saher and Lindeman
2005) and belief in other supernatural and paranormal phenomena
(Grimmer and White 1990, Saher and Lindeman 2005).
In the words of Hahnemann, diseases ‘are solely spirit-like
(dynamic) derangements of the spirit-like power (the vital principle)
that animates the human body’. We put the question, does a spirit-like
power animate animal bodies too? Contemporary homeopaths still
refer to spiritual aspects along with ‘life energy’ or ‘vital force’ when
discussing the actions of their remedies (Kayne 2006). It is clear that
the gulf between homeopaths and the great majority of human and
animal doctors is not simply one of how to compare using common
standards (McKenzie 2012). It is a gulf of mind-set, between a proven
or plausible mechanism of action of the latter, and the mystical, super-
stitious beliefs of the former.
While homeopaths are vitalists, their belief system spreads more
widely. Homeopathic practice implies the belief that there is some
property – an ‘essence’ – in each of the substances or objects they
make their remedies from; it is that essence which gives rise, via
potentisation (dilution, succussion, etc), to the specific curative prop-
erties of the remedy. There are thousands of remedies, each with spe-
cific properties; that is, they treat only certain signs or symptoms or
patients and not others, and seemingly no limit to what substances
or objects remedies can be made from (vide infra). Hence, presum-
ably every substance or object contains an essence. The belief that
inanimate substances and objects, as well as animate objects such as
plants and animals, have an essence (especially if that is construed as a
‘vital force’) places homeopathy in the mystical tradition of animism
– the belief in a supernatural power that pervades, and can influence,
the material universe. Moreover, the essence is beneficial for humans
– indeed, potentising remedies for the treatment of ill humans and
animals seems to be the only identified function or use for the essence.
Hence, homeopathic beliefs are also ‘anthropocentric’ – believing that
the universe, with this essence existing in every substance or object,
exists as it does for the benefit of humans. These vitalistic, animistic,
anthropocentric beliefs are part of the mystical belief systems universal
to human cultures thoughout history.
Constituents
Homeopathic products
Contemporary homeopaths follow Hahnemann’s example of listing,
in Materia Medica, their remedies together with the ‘symptom
picture’ for each and dosage information (Lilley 2008). The
symptom picture is established primarily by means of ‘provings’ or
‘pathogenetic trials’ (vide infra) and partly by observations of clinical
responses to a remedy, and indicates which signs or symptoms the
remedy can be used to treat in a patient (Belon 1995, Kayne 2006,
Campbell 2013, Sherr 2015). For homeopathic products in humans,
the proving involves a group of several volunteers or just one person.
Each imbibes a number of doses of the remedy being ‘proved’, with
contemporary provings typically using remedies diluted beyond the
Avogardro limit. Each volunteer keeps a diary of the physical and
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emotional sensations experienced. On completion of the proving,
the ‘master prover’ collates information from the diaries and this
becomes the ‘symptom picture’ for that remedy and is recorded
for homeopaths to reference in practice (Kayne 2006, Riley 2008,
Campbell 2013, Sherr 2015). The scientific basis of homeopathic
provings is not established. Furthermore, for veterinary products
obvious practicalities dictate that these procedures cannot be followed
when the recipient is an animal.
The components of homeopathic products are water (in some
cases alcohol also), dissolved gases, impurities (a variety of inorganic
and organic molecules of unknown amounts), and variable amounts
of the ‘active’ agent, dependent on the degree of dilution, but less than
one molecule at the high dilutions commonly used in practice and
supplied as over-the-counter remedies (Kayne 2006). ‘Nanoparticles’
of the starting material have been demonstrated in some commer-
cially available 30c and 200c remedies made from metals in India
(Chikramane and others 2010), presumably due to imperfect dilu-
tion, or contamination after dilution, during preparation. There are
thousands of remedies in published homeopathic Materia Medica
(Boericke 2008) and available via the internet, with frequent new
remedies being homeopathically ‘proved’ and used in practice (Kayne
2006, Riley 2008, Sherr 2015). There appears to be no restriction on
what can be used as an ‘active’ to create a remedy; ‘actives’ include
viruses, bacteria, animals, plants, minerals, chemicals, conventional
drugs, man-made objects, and physical radiations and energy fields
(the last two referred to as ‘imponderables’ by Hahnemann and mod-
ern homeopaths). Examples include: honey bee (Apis mel), emperor
dragonfly (Anax imperator), duck offal (Oscillococcinum), green igua-
na (Iguana iguana), human placenta (Placenta humanum [Welsh]),
Kentucky bluegrass (Poa pratensis), lava (Hekla lava), gunpowder
(Carbon-sulphur-kali-nitricum), permethrin, condom (Latex vulcani),
the Berlin Wall (Murus Berlinensis), Hadrian’s Wall (Vallum Aelium),
car exhaust fumes, electricity (Electricitas), magnetic field (Magnetis
poli ambo), emanations from televisions, X-rays (X-ray), and light
from the planet Venus (Venus stella errans) – all of which can be found
listed in homeopathic Material Medica or as homeopathic provings
on the internet, and can be purchased from homeopathic pharmacies
(www.helios.co.uk). Some homeopathic products contain sugar, but
this is not claimed to be essential to efficacy (except in the homeopath-
ic remedy Saccharum officinale, prepared from pure cane sugar as the
‘active’). Each remedy is claimed to possess specific healing properties,
which can be used to treat only certain signs or symptoms, but not
others, or only patients with certain characteristics, but not others; yet
homeopaths appear to believe that all remedies exert their effects via a
single (unknown) process (Kayne 2006, Nicolai 2008).
Remedies may be dispensed in liquid form, but can also be mixed
with or dropped or sprayed on to other pharmaceutical preparations
to create homeopathic creams, ointments, pills and powders (Kayne
2006, 2008). Once formulated, there are minimal costs to market-
ing, only extremely limited regulatory requirements to be negotiated,
with no comparisons with other products, homeopathic or otherwise,
required. Regulatory authorities recognise that the products are lack-
ing in ingredients with specific actions and it is assumed that no toxic-
ity will arise in the absence of actives. Therefore, it is further assumed
that there can be no residues in edible tissues of food producing species
and hence no meat/milk withholding periods are required.
Drug-based products
For each drug-based product, there must, by definition, be one or
more actives. However, it is rare for drugs to be marketed as the drug
substance alone. Almost invariably they are formulated, for oral, par-
enteral or local administration, as solutions, suspensions, tablets or
capsules, which contain other compounds, the excipients. Generally,
no therapeutic activity is claimed for the excipients, but they are
essential to ensure such properties as sterility and syringability and as
bulking or flavouring agents. While themselves not active on biologi-
cal systems, excipients can markedly influence pharmacological and
therapeutic outcomes. This occurs principally by affecting the rate and
extent of absorption of the active constituents.
Each active in conventional drugs is perceived to have a specific
chemical, biochemical or physiological mechanism of action by
Research
which it brings about its clinical effects, and sometimes other mecha-
nisms of action by which adverse effects arise. For many drugs the
mechanism of action is proven, and for most drugs without proven
mechanisms of action, scientifically plausible mechanisms exist. For
discussion of the bases of efficacy of constituents of homeopathic and
drug-based products, and the evidence regarding their clinical efficacy,
see part 2 of this review (Lees and others 2017).
Conflict of interest statement
None of the authors of this 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, an informal group of veterinary
surgeons countering the promotion and use of implausible and
irrational therapies by veterinary professionals.
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 1
P. Lees, L. Pelligand, M. Whiting, D. Chambers, P-L. Toutain and M. L.
Whitehead

Veterinary Record 2017 181: 170-176

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Research

Review
OPEN ACCESS

Comparison of veterinary drugs and veterinary

homeopathy: part 2
P. Lees, D. Chambers, L. Pelligand, P-L. Toutain, M. Whiting, M. L. Whitehead
Part 2 of this narrative review outlines the theoretical and practical bases for assessing the efficacy
and effectiveness of conventional medicines and homeopathic products. Known and postulated
mechanisms of action are critically reviewed. The evidence for clinical efficacy of products in both
categories, in the form of practitioner experience, meta-analysis and systematic reviews of clinical
trial results, is discussed. The review also addresses problems and pitfalls in assessing data, and
the ethical and negative aspects of pharmacology and homeopathy in veterinary medicine.

Assessment of efficacy
In medicine and therapeutics, treatments can be evaluated in terms
of two differing but complementary scientific frameworks. The
empiricist framework assesses whether the treatment actually works
in animals or people; that is, it has ‘clinical efficacy’ in the form of
a beneficial therapeutic effect measurable in laboratory animals or
clinical trials. The reductionist framework assesses how the treatment
works – investigating the mechanism of action at a submolecular,
molecular, cell, tissue/organ and/or system levels as tested in vitro, ex
vivo or in vivo studies – determining whether the treatment exerts
effects at these levels that can give rise to a clinical therapeutic effect.
A distinction should also be made between clinical ‘efficacy’ and
‘effectiveness’. Efficacy comprises performance of a drug under ideal,
controlled circumstances. Effectiveness, on the other hand, constitutes
performance under ‘real-world’ conditions. Thus, clinical efficacy
answers the question ‘does it work in clinical trials’ while clinical
effectiveness addresses the question ‘does it actually benefit patients
in practice’ (Godwin and others 2003, Gartlehner and others 2006).
In the whole animal, studies may be conducted in healthy ani-
mals, in disease models or in clinical subjects. For every level of testing,
controls and statistical analysis should be applied, as appropriate. This
approach is the basis of modern science-based medicine. Wherever
possible, a product will be tested for clinical efficacy and/or effective-
ness in randomised, double-blinded, placebo-controlled trials; these
provide the best evidence for the practice of evidence-based veterinary
medicine (EBVM), which consists of the application of the best avail-
able evidence to practice (Sackett and others 1996). Assessment of
clinical efficacy and effectiveness should be based on scientific analy-
sis of data rather than relying on the observations and experiences of
practitioners in carrying out their routine duties, because the latter is
Veterinary Record (2017) doi: 10.1136/vr.104279
P. Lees, CBE, BPharm, PhD, DSc, 0HQ, UK
FRoySocBiol, HonAssocRCVS, P-L. Toutain, DVM, DSc(PhD),
Drhc(Gent), HonFellowECVPT, Toxalim, Ecole Nationale Veterinaire de
L. Pelligand, Docteur Veterinaire, Toulouse, France
CertVA, DipECVAA, DipECVPT, M. L. Whitehead, BSc, PhD, BVSc,
PgCert(VetEd), FHEA, PhD, MRCVS, CertSAM, MRCVS, Chipping Norton
M. Whiting, BSc, BVetMed, MA, PhD, Veterinary Hospital, Banbury Road,
DipECAWBM(AWSEL), MRCVS, FHEA, Chipping Norton, Oxon OX7 5SY, UK
Royal Veterinary College, Hawkshead
E-mail for correspondence:
Campus, Hatfield, Hertfordshire
martincnvets@gmail.com
AL9 7TA, UK
D. Chambers, BVSc, MSc, MRCVS, Provenance: not commissioned;
Hall Manor, Kelly, Lifton, Devon PL16 externally peer reviewed
unreliable (Kohn and others 2000, Shojania 2003, Doust and Del Mar
2004, Hartman 2009, Oxtoby and others 2015, Prasad and Cifu 2015,
Saposnik and others 2016).
These approaches have provided good evidence of efficacy and/
or effectiveness and/or proven or plausible underlying mechanisms
of action for most conventional drug-based products, especially of
the more commonly used medicines; particularly in the human field,
in which products are tested far more than in veterinary medicine.
In contrast, as discussed below, attempts to demonstrate biological,
clinically relevant effects of homeopathic products in vitro have not
shown any clear successes, and the highest quality clinical trial evi-
dence has failed to show convincing evidence of efficacy of homeo-
pathic remedies (Shang and others 2005, Mathie and Clausen 2014,
Mathie and others 2014). From a scientific viewpoint, this is unsur-
prising given that homeopathic remedies commonly contain little or
no ‘active’ ingredient, implying that homeopathic remedies do not
exert effects via physiological/biochemical mechanisms that can be
scientifically measured.
Yet homeopaths in practice insist their treatments are effective (for
example, Kayne 2006, Mathie and others 2007, 2010, Gregory 2008,
2013a, Reilly 2008a, British Association of Homeopathic Veterinary
Surgeons 2017, British Homeopathic Association 2017). As discussed
in part 1 of this review (Lees and others 2017), homeopathic belief
proposes – and, importantly, homeopathic practice implies – that
during preparation of a remedy, the ‘active’ ingredient imparts an
unknown curative property to the remedy. This is presumably by
transference of this property to the diluent or by a transformation of
the diluent, because the curative property persists, and is most potent,
in highly diluted remedies containing no molecules of the starting sub-
stance. This curative property, latent in the starting substance, is made
active (‘dynamised’ or ‘potentised’ in homeopathic terminology) by
repeated, serial dilution and succussion (a specific type of agitation
of the remedy). The more dilution and succussion, the more potent
the healing power of the remedy. In the belief system of homeopathy,
this curative property is thought to be an ‘energy’, specifically a ‘life
energy’ or ‘vital force’ (for example, Kayne 2006, Nicolai 2008, Owen
2015d), that is often described as ‘vibratory’ and ‘resonant’. However,
homeopaths are unable to demonstrate this hypothetical ‘energy’
(vide infra). In the belief system of homeopathy, remedies work in
a wholly different manner to conventional drugs, frequently stated
to consist of an unspecified ‘balancing’ of undefined ‘energies’ (the
‘vital force’) in the body (Bell and others 2004, Kayne 2006). Thus,
the fact that there appears to be no scientifically conceivable way in
which homeopathic products could act on biochemical pathways
or physiologic processes underlying the diseases they treat is not an
impediment to their practice. The question to be posed is, can and
should homeopathy be evaluated using the same preclinical and clini-
cal methods and standards as for conventional drugs?

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Theoretical and actual bases for efficacy
Homeopathy
From a scientific, material perspective, homeopathic remedies are
physical entities, comprising vast numbers of molecules of diluent
– usually water and/or alcohol – with the only other components
being: many, few or no molecules of the ‘active’, dependent on the
degree of dilution; and any contaminants. Some remedies contain
other deliberate additives, such as sugar, but such additives are gener-
ally not claimed to contribute directly to the alleged healing effects
(Kayne 2006). These liquid remedies may be mixed with or dropped
or sprayed onto other pharmaceutical preparations to create homeo-
pathic creams, ointments, pills and powders.
Molecules of the ‘active’
Each batch of product, depending on the degree of dilution, might
contain many, few or no molecules of the starting substance or
‘active’; for dilutions beyond the Avogadro limit (1x10-24, expressed
in homeopathic notation as ‘12c’) there should be no molecules of the
‘active’ in the remedy (Kayne 2006). Homeopathic belief and practice
implies that for any one remedy, the presence or absence of molecules of
the starting substance, or the precise number of such molecules present,
is inconsequential for its medicinal effect. This must be the case,
because: homeopaths do not usually claim that the starting substances
per se can exert the medicinal effects of the ‘potentised’ remedies
produced from them; at the lower dilutions – those not beyond the
Avogadro limit – the ‘potency’ of the remedy increases with dilution,
it is negatively correlated with the number of molecules of ‘active’
present; homeopaths very commonly use remedies diluted beyond the
Avogadro limit, and claim that: such ultra-diluted remedies containing
no molecules of the starting substance are not only effective, but more
effective than less diluted remedies; and that increasing dilution of
the remedies increases their effectiveness, even at dilutions where no
molecules of the starting substance remain (for example, Hahnemann
2002, Kayne 2006, 2008).
For the great majority of substances from which homeopath-
ic products are made, the starting material per se is not claimed to
exert the healing effect of the remedy produced from it. Therefore,
the ‘curative property’ must be latent in the starting substance, and
is passed into the remedy during the preparation process, starting
with – depending on the nature of the substance or thing – dissolving,
grinding-up, soaking or percolating it in water and/or alcohol (Kayne
2006). This curative property then has to be activated (‘dynamised’,
‘potentised’ or ‘energised’) by serially diluting and succussing the solu-
tion or suspension (the ‘mother tincture’) so obtained (Kayne 2006).
Thus, eating onion does not cure a common cold but, homeopaths
claim, taking the remedy Allium cepa, prepared by grinding up onion in
diluent and then serially diluting and succussing the mother tincture
until there are few or no molecules of the onion in the remedy, can
cure signs and symptoms of a cold (Boericke 2008).
What property of the starting substance brings about the alleged
healing effect is not known. However, by simple reasoning, if it is not
molecules of the substance, then either some other property of the
substance is transferred to the water/alcohol, or the substance must
bring about some transformation of the water/alcohol itself. It is that
unknown transferred property or transformation of the water/alcohol
that must provide the alleged healing effect, once it has been further
enhanced with each round of dilution and succussion. As noted above,
this unknown property is often referred to by homeopaths as an ‘ener-
gy’ and, in homeopathic belief, as manifestation of a ‘vital force’.
Cowan and others (2005) found that water in the liquid state is
highly efficient at redistributing its hydrogen bonds with a ‘memory’
of less than 50 femtoseconds (<5x10-14 s). Water ‘memory’, of the
nature and duration required to comprise a mechanism of action of
homeopathic products – to transfer information from the starting sub-
stance to the patient who takes the remedy – is not known to physi-
cal, chemical and biological sciences. Consistent with this observa-
tion, studies of remedies diluted far beyond the Avogadro limit (ie, that
would not be expected to contain even one molecule of the ‘active’),
including comparisons with control solutions not produced from an
‘active’, have failed to provide any convincing, independently repli-
cated demonstration of any special physical or chemical property of
Research
the remedies (Aabel and others 2001, Milgrom and others 2001, Rey
2003, 2007, Roy and others 2005, Elia and others 2006, van Wijk
and others 2006, Rao and others 2007, Cartwright 2016). Aabel
and others (2001) and Milgrom and others (2001) failed to replicate
results from previous nuclear magnetic resonance measurements of
homeopathic remedies, and concluded that there was no difference
between homeopathic and control solutions. Examples of reported
differences awaiting replication include Rey (2003, 2007), who meas-
ured low-temperature thermoluminescence, and Cartwright (2016),
who used solvatochromic dyes. These reports are typical of these
types of studies in that they involved technically complex analytical
methods and lacked important control measures and other safeguards
against error, for example, in neither was the experimenter ‘blinded’
and in Cartwright (2016) the control solution was not repeatedly
diluted and succussed as the remedy was. The use of complex meth-
ods in the absence of control measures predisposes to false-positive
findings, especially if the experiments were carried out by believers
in homeopathy, and such false-positive findings may be more likely
to be published by journals specifically concerned with homeopathy
or other complementary and alternative therapies, if the journal edi-
tors and peer reviewers do not fully understand the methodology (Lee
and others 2002, Smith 2006, Doehring and Sundrum 2016). Such
factors are why independent replication is so important – not just for
homeopathy-related experiments, but for any new experimental result
(Ioannidis 2005a, Prasad and Cifu 2015). Further, it is notable that, for
the phenomena so far reported in such studies, there is no indication
of how the phenomena – if genuine – might contribute to the claimed
medicinal effects of the remedies.
Montagnier and others (2009) claimed to find electromagnetic
signals from bacterial deoxyribonucleic acid in extreme dilutions.
However, from a physical and technical perspective, this work is suspect
(Grimes 2012) and this finding has not been independently replicated.
We note that the curative property must interact with the physical
world in order to: pass from the starting material into a remedy; pass
from dilution to dilution; increase in potency as a result of succussion;
and cure diseases in a patient. Therefore, if this curative property exists,
the failure of modern science to detect any trace of it in remedies appears
astonishing. Any genuine difference between ultra-dilute remedies, or
between such a remedy and its diluted diluent-only control, would be a
fundamentally revolutionary finding for the fields of physics and chem-
istry in general. And if the curative property was found to be able to
treat almost any disease of a huge range of aetiologies and pathogen-
eses – infectious, inflammatory, toxic, neoplastic, structural, congenital
– that would be a fundamentally revolutionary finding for the fields of
biology and medicine. However, there is no proven, replicable difference
between ultra-dilute homeopathic remedies and control solutions made
from the same diluent to explain the alleged curative actions of homeo-
pathic remedies, and the ‘potentised’ curative property in homeopathic
products remains undetected by modern science.
Numerous studies claim to show that homeopathic remedies have
effects on in vitro cell preparations or experimental animal models
(many such studies are listed by Malik 2012, and Rational Veterinary
Medicine 2017). These studies typically show the same types of
design weaknesses as those searching for special physical and chemi-
cal properties of the remedies themselves, and are without independ-
ent replication to confirm the effects reported. There have been some
‘false alarms’, but none have been convincingly replicated. Possibly
the best known case was a paper published in Nature (Davenas and
others 1988) in which the eminent immunologist Benveniste’s
research group claimed that human basophils produced histamine
when exposed to anti-immunoglobulin E even at a dilution of 60c.
The findings were later shown to be due to observer bias (Maddox and
others 1988). The data had been generated by an unblinded technician
and subsequent multiple attempts by independent researchers to rep-
licate the findings failed (Maddox and others 1988, Hirst and others
1993). Benveniste continued to claim that the results were authentic
(Kayne 2006) and, later, that he could encode the effect electronically
and transmit it over telephone lines, to turn water into a homeopathic
remedy remotely (Jonas and others 2006). Belon and others (2004)
and Ennis (2010) concluded that ultra-dilute histamine solutions may
modulate basophil activation; but the effect was small and inconsist-
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Research
ent. It was further concluded that well-controlled, large-scale studies
are required to confirm the small and inconsistent effect. These have
not been forthcoming.
Contaminants
In the preparation of homeopathic remedies the starting ‘active’ is
rarely a pure or sterile substance, and so will be contaminated with
a variety of inorganic and organic chemicals and microorganisms,
but homeopaths regard these as being a natural part of the ‘active’
(Kayne 2006), presumably conceived as contributing to the curative
property in the remedy. Water inevitably contains many other
compounds, including dissolved gases (nitrogen, oxygen, carbon
dioxide and others), inorganic chemicals (sodium, chloride, calcium,
phosphate), organic molecules from animal and vegetable sources,
and possibly living microorganisms as sterility is not generally
claimed for homeopathic products. Many homeopathic remedies are
prepared using distilled water, which will eliminate or reduce some
of these contaminants. In general, homeopaths do not appear to
regard contaminants in the diluent as contributing to their remedies’
medicinal effects, even though any contaminants present in early
dilutions would presumably be ‘potentised’ by the later dilutions
and succussions. However, there is a class of contaminants that some
homeopaths (Anick and Ives 2007, Bell and Koithan 2012, Bell
and others 2015) have speculated may provide a mechanism for the
action of remedies diluted beyond the Avogadro limit – nanoparticles
either of the ‘active’ and/or of silica from the glass vials in which
the remedies are diluted and succussed. Molecules of the starting
substance, in the form of nanoparticles, have been found in some
Indian commercial ultra-high dilution (30c and 200c) remedies made
from metals (Chikramane and others 2010, Temgire and others
2016). The presence of such nanoparticles presumably constitutes
either incomplete dilution or contamination by some of the starting
substance after dilution. Bell and Koithan (2012) and Bell and others
(2015) speculated that nanoparticle contaminants in homeopathic
remedies could constitute a mechanism for transfer of information
via ultra-dilute remedies from the starting substance to the patient,
but have provided no evidence that it does so.
Selection of homeopathic remedies
In homeopathic practice, remedies are selected on the basis of
patients’ symptoms and signs (signs only in animals), and on other
characteristics of patients such as their temperament, preferences in
life or previous experiences (Gregory 2008, Lilley 2008, Nicolai 2008,
Reilly 2008, Owen 2015a, b, c, British Association of Homeopathic
Veterinary Surgeons 2017). The overall ‘symptom picture’ of the
patient is matched as closely as possible to the ‘symptom picture’
for the remedy, which is the collection of signs and symptoms that
the remedy is believed to the able to treat, as listed in homeopathic
Materia Medica (Owen 2015a, b, c). This is the practical application
of the principal that ‘like-cures-like’ – that signs and symptoms can be
cured by a remedy prepared from a substance that caused those signs or
symptoms in healthy individuals. The ‘symptom picture’ for a remedy
is primarily determined by a homeopathic ‘proving’ in which healthy
volunteers take the substance or, more commonly, a remedy prepared
from that substance, and then record their thoughts, feelings and signs
(Hahnemann 2002, Kayne 2006, Lilley 2008, Riley 2008, Sherr 2015).
Most provings are conducted using an ultra-dilute remedy, not
the undiluted starting material. Some remedies appear to have never
been subject to ‘provings’, including some of the common homeo-
pathic remedies (Campbell 2013), and toxicological observations or
‘therapeutic responses’ also contribute all or part of the ‘symptom pic-
ture’ for some remedies (Belon 1995, Kayne 2006, Campbell 2013).
Importantly, the ‘symptom picture’ does not just consist of the symp-
toms and signs associated with the illness the patient may have, but
includes other characteristics of the patient; for example, their tem-
perament, preferences in life, or previous experiences, most of which
conventional medicine would regard as incidental to the illness being
treated (Gregory 2008, Lilley 2008, Nicolai 2008, Reilly 2008, Owen
2015a, b, c, British Association of Homeopathic Veterinary Surgeons
2017). For this reason, identical symptoms and signs of illness may be
treated with different remedies in different subjects. The inclusion of
200 | Veterinary Record | August 19/26, 2017
these other factors in choice of remedy is a large part of what homeo-
paths mean when they refer to their therapy as being ‘holistic’; that
is, treating the whole individual, but from a conventional medicine
viewpoint this simply introduces a further degree of arbitrariness into
the selection of remedies. From a scientific perspective, there seems
to be no reason why ‘like’ should cure ‘like’ and the very concept of
treating an illness with a substance (yet alone a highly-diluted remedy
made from that substance) that reportedly created similar signs and
symptoms in healthy volunteers appears arbitrary.
From the above considerations, it is clear that any mechanism by
which homeopathic remedies act must differ fundamentally, not only
from the fundamental principles of pharmacology, but also from the
mechanisms of action of endogenous chemicals, such as hormones
and neurotransmitters – their action cannot be based on conventional
mechanisms of biochemistry and physiology, either in the patients’
body or in disease causing organisms.
Pharmacology
When drugs are used therapeutically, they may treat either the
underlying cause of disease/malfunction or the symptoms or signs
(signs only for animals) of disease. The armamentarium consists of
widely diverse classes of drugs, each with discrete mechanisms of
action and targeting specific biochemical pathways in the body or in/
on a disease-causing organism. Thus, antimicrobials, anthelmintics,
anaesthetics, analgesics and hormones all work in fundamentally
the same way (molecule to molecule interaction) but on differing
biochemical pathways. Even within a general group, such as
analgesics or antibiotics, the biochemical pathways differ for each
subclass of agent. In contrast, in the homeopathic belief system,
all remedies appear to be conceived of as acting via a single process
that, as discussed above, is typically described in terms of balancing
‘energies’ or restoring ‘vital force’.
The properties of drugs and the science underpinning their use
have been described in innumerable peer reviewed publications, the rate
of which has accelerated in recent years. Counting only those drug-
based papers classified as pharmacological, the numbers identified in
Web of Knowledge were 167 in 1950, 44,426 in 1980 and 90,931 in
2010. Of these, the number (and percentage of the total) classified as
veterinary pharmacology were 0 (0 per cent), 282 (0.635 per cent) and
3630 (3.992 per cent) (Lees and others 2013, Toutain and others 2016b).
Flower (2013) reviewed the basic principles of pharmacology; for
reviews of veterinary aspects, see Anon (2004) and Cunningham and
others (2010). The two pillars of pharmacology are pharmacodynam-
ics and pharmacokinetics.
Pharmacodynamics is the science of drug action on the body
or on a parasite/microorganism on or in the body; it is based on
the concept that drug molecules interact with cellular molecules.
Pharmacodynamics is studied qualitatively and quantitatively at sub-
molecular, molecular, organelle, cell, organ/tissue and whole animal
levels. Drugs act in the same manner as hormones, neurotransmit-
ters and autacoids (local hormones) on receptors or enzymes, either
to stimulate (an agonist) or to block (an antagonist) them or, for a few
drugs, to do both (partial agonists).
The key pharmacodynamic properties of all drugs are: efficacy –
this includes effectiveness, action on the receptor, ability to produce
a response and the magnitude of the response attainable; potency –
amount of drug required to produce an agonist or antagonist response,
usually measured as EC50 or IC50 (50 per cent of maximum attain-
able excitatory or inhibitory responses, respectively); and sensitivity
– the steepness of the relationship between concentration or dose and
response. In the laboratory, the drug-response relationship is usually
quantified in concentration/effect terms; in the animal it is usually
monitored as dosage versus effect. For a large majority of drug/recep-
tor interactions, the log of concentration relates to arithmetic response
in a sigmoidal manner (a monotonic relationship), and there is usually
a threshold concentration, below which no effects occur – even the
threshold concentration typically being far higher than the concentra-
tion of the ‘active’ present in most homeopathic products – and the
dose-response curve showing increasing effect with concentration;
that is, the opposite of the concentration/effect relationship claimed
for homeopathic products.
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For some drug actions, the dose-response relationship is not S
shaped; but inverted U or J shaped (Calabrese and Baldwin 2001,
Calabrese 2005). Vandenberg (2014) described non-monotonic dose/
response curves (NMDRCs) for natural hormones and endocrine dis-
rupting chemicals (EDCs) in biological systems, including cultured cells,
whole organ cultures, laboratory animals and human populations. She
provided evidence for NMDRCs in the EDC literature, specifically for
bisphenol A, and questions the current risk assessment practice where
‘safe’ low doses are predicted from high dose exposures. It has been
suggested (Bellavite and others 2010, Calabrese and Jonas 2010) that
this phenomenon of hormesis – a dose response phenomenon charac-
terised by a reversal of response with concentration, resulting in either
a J shaped or an inverted U shaped dose response curve such that a
response may increase with dilution over a limited range at low con-
centrations – provides plausibility to homeopathy. However, none of
the examples of hormesis go beyond or even near the Avogadro limit.
Moreover, the magnitude of hormetic effects is small (Calabrese and
Baldwin 2002) and hormesis occurs over a very limited range of con-
centrations (Calabrese and Baldwin 2002); in most cases the reversal of
the effect with increasing concentration occurs over less than a 10-fold
range (corresponding to the smallest unit of dilution, 1x, of homeo-
pathic remedies) and hormesis rarely extends over two orders of magni-
tude (corresponding to a 1c homeopathic dilution), let alone the many
orders of magnitude over which homeopathic products are alleged to
become more potent with increasing dilution. In addition, the shape
of the dose response curve differs from that of the monotonic nega-
tive ‘dose-response’ relationship claimed for homeopathic remedies.
Finally, hormesis is a spontaneous natural phenomenon, which does
not require homeopathic ‘potentisation’ in order to occur.
It could be argued that conventional vaccines are ‘homeopathic’
because they are made from something that can create, in healthy indi-
viduals, signs and symptoms of the disease the vaccines are used to
prevent. However, vaccines are not like the thing they are used to pre-
vent, they are the very thing (or a part of, or a modified version of, the
thing) they aim to prevent. Vaccines work in a well-characterised, sci-
entifically plausible way, by presenting antigens to the body’s immune
system. Homeopathic remedies, including the nosodes (Kayne 2006)
that are the homeopathic (strictly ‘isopathic’ as they are made from
something considered to be involved in causing the illness, for exam-
ple, a mosquito may be used to make a nosode to prevent malaria)
alternative to vaccines, do not employ that mechanism. Conventional
vaccines may contain relatively small amounts of the antigen, but it
is still very much greater than the Avogadro limit, and they are not
efficacious if diluted below a certain threshold. These properties make
conventional vaccines entirely different to homeopathic remedies.
Pharmacokinetics is the science of drug absorption into, and fate
within, the body. It encompasses dissolution, absorption, distribution
and elimination processes, the latter comprising biotransformation
(metabolism) and excretion pathways. Biotransformation involves
principally the liver but other organs, such as the kidney and lung,
may also contribute. Moreover, metabolism normally renders drugs
less active or inactive but, in the case of prodrugs, biotransformation
provides or enhances activity. Excretion involves, for most drugs, renal
and/or hepatic pathways (ie, elimination in urine or secretion into bile,
respectively). In ruminants, drug elimination in milk is significant for
establishing a withholding time in relation to human consumption.
These pharmacokinetic processes have been studied extensively,
both quantitatively and qualitatively. Pharmacokinetic processes,
which have been defined and quantified for a wide range of drugs
in a wide range of species, include clearance, absorption half-life,
elimination half-life, volumes of distribution (central, area and steady
state) and bioavailability (percentage of administered dose absorbed
systemically). As well as inevitable intra-animal (eg, day-to-day) vari-
ation and intra-species (eg, dog to dog) differences, many profound
inter-species differences (eg, dog to cat) in pharmacokinetic profiles
exist. Moreover, there is increasing evidence of pharmacokinetic
dependency on factors, such as age, breed, size and health status. For
example, population pharmacokinetics quantifies breed differences,
together with those associated with diseased compared to healthy ani-
mals. Indeed, for one drug, celecoxib, within breed differences were
reported in healthy beagle dogs; fast and slow metabolisers within the
Research
single breed were identified (Paulson and others 1999). For another
drug of the same class, mavacoxib, pharmacokinetic differences have
been defined between small and larger breeds in the clinical popula-
tion (Lees and others 2015a).
By quantifying the contribution of these factors to variability,
and by linking pharmacodynamics with pharmacokinetic proper-
ties, a rational basis for designing dose schedules for use in the clinical
population, is provided. This approach has been used to predict target
attainment rate doses of antimicrobial drugs for a given level of bacte-
rial kill (say 99.9 per cent) in a given percentage of the clinical popula-
tion (say 50 or 90 per cent) (Lees and others 2015b).
In contrast, there appears to be no equivalent of pharmacokinet-
ics in homeopathy; because the ‘curative property’ of homeopathic
remedies is undetectable, it is not possible to measure whether it varies
with location in the body, or over time, and so equivalents of parame-
ters and variables such as bioavailability, half-life and clearance cannot
be determined. For this reason, the posology of homeopathic rem-
edies – the ‘potency’ used, frequency of administration and duration
of treatment, must be entirely empirical, if not arbitrary. Kayne (2006)
and Nicolai (2008) discuss homeopathic posology in human patients.
Gregory (2008) observed that animals appear to need more doses of
homeopathic remedies than humans, that the smaller species need
much more frequent dosing, and that horses are far more sensitive to
homeopathic remedies than any other species.
Problems and pitfalls in assessing data
Irrespective of the differing proposed mechanisms of action of
homeopathic and drug-based products, the means of assessing clinical
efficacy and effectiveness should be applicable to both. These should
include the experience of clinicians in their daily practice, as well as
well-designed and statistically evaluated clinical trials incorporating
appropriate animal numbers and control treatments.
The ability of clinicians to accurately assess the efficacy of thera-
pies in practice is known to be highly unreliable, as demonstrated by
the many examples of therapies thought to have been effective by
the doctors that used them that were later proven ineffective or even
actively harmful (Doust and Del Mar 2004, Prasad and Cifu 2016),
and the high incidence of misdiagnosis – and hence mistreatment
– revealed by autopsy studies (Shojania and others 2003). There are
many causes of the unreliability of clinicians’ assessment of treatment
efficacy, and many of them are cognitive in nature, the result of biases
that are inherent to human perception and reasoning (Kahneman
2012, Matute and others 2015) and that influence clinicians’ judge-
ments in their everyday work (Croskerry 2003, Gay 2006, Hartman
2009, McKenzie 2014, Canfield and others 2016, Saposnik and others
2016). The degree of reliability of judgment varies with the type of
therapy; if a drug’s response occurs very quickly after administration,
is very large, very repeatable and markedly different to the animal’s
natural variation over time, it is easy for the clinician to make accurate
judgments on efficacy. Thus, practitioners can judge the effectiveness
of an intravenous general anaesthetic, such as alfaxalone or propo-
fol, very clearly. Within seconds of administration, the animal’s state
changes from conscious and responsive to unconscious and unrespon-
sive, in a highly repeatable way that would not occur if the animal
had not been given the anaesthetic. Assessing the response of a dog
in severe acute pain to an injection of a strong analgesic, such as mor-
phine, is also generally reliable, although the response is slower and
less readily observed. However, certainty declines as the time to, size
of, and repeatability of a drug’s effect decreases, and as the animals’
variation over time in the relevant characteristics increases. Thus, it
can be difficult to assess the effect of, say, a nutraceutical joint supple-
ment on a dog’s signs of arthritis six weeks after commencing dosing.
In the presence of uncertainty about treatment benefits resulting
from the fact that they are superimposed on natural variation of the
animals’ signs – and most illnesses will improve because of natural
healing mechanisms – various psychological biases result in clinicians
tending to over-estimate the effects of the treatments they have given.
There are many such biases (Rudolf 1938, Pinto 2001, Gay 2006,
Kahneman 2012, McKenzie 2014, Matute and others 2015, Canfield
and others 2016, Saposnik and others 2016); a particularly important
example is the post-hoc ergo propter hoc error, where an expected
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change after giving a medicine is attributed to the medicine, whether
or not the change was actually induced by that medicine. It is because
of the inherent uncertainties in assessing the response to treatments,
and the psychological biases that can mislead physicians in judging
their effectiveness, that randomised, blinded, controlled clinical trials
have been developed; these can largely, although often not perfectly,
remove the effect of errors in judgment. Unfortunately, many prac-
titioners are largely unaware of the many psychological biases that
influence their everyday clinical judgments – a greater awareness of
such biases would improve the practice of both veterinary and human
medicine, whether conventional or alternative (Croskerry 2003, 2013,
Gay 2006, McKenzie 2014, Canfield and others 2016).
The design, conduct and reporting of clinical trials is also subject
to a number of biases, in particular to confirmation bias, ascertainment
bias, selection bias and publication bias (Easterbrook and others 1991,
Stern and Simes 1997, Ioannidis 1998, 2005b, 2014, Ioannidis and
others 2001, Bekelman and others 2003, Lexchin and others 2003,
Chan and others 2004, Jadad and Enkin 2007, Viera and Bangdiwala
2007, McGauran and others 2010, Sargeant and others 2010,
Hróbjartsson and others 2012, Kahan and others 2015, Ahn and oth-
ers 2017). For clinical trials, the ideal features (rarely achieved in veteri-
nary medicine) are: independent investigators; blinding of the person
administering the product and the individuals making the response
assessment as well as those analysing the data, and also the patient in
human trials; a sufficient number of treated patients (often requiring
a power calculation); incorporation of a positive control (alternative
drug usually of the same group) and/or a negative control (usually
placebo-treated); allocation of treatments to groups on a truly random
basis; appropriate use of statistics; accurate and detailed reporting of
the methods and results; high-quality peer review; and replication of
the trial by independent investigators. Replication of clinical trials is
particularly uncommon in veterinary medicine. Objective guidelines
exist for assessing randomised controlled trials (RCTs) with regard
to these factors (Schulz and others 2010, Higgins and Green 2011,
Sargeant and O’Connor 2014). Two further essential features of the
ideal clinical trial are that: the trial design, and especially the intended
primary and secondary outcome measures, be published before con-
ducting the trial (which helps to prevent inappropriate post-hoc statis-
tical analysis); and the trial results be published regardless of the find-
ings. Major deficiencies in clinical trials in these two regards are being
addressed by the AllTrials (2014) and VetAllTrials (2015) initiatives. It
has been shown that RCTs carried out by investigators with financial
conflict of interest produce more positive results than trials carried out
by independent investigators (Bekelman and others 2003, Lexchin
and others 2003, Ahn and others 2017). All of these considerations
apply equally to the assessment of clinical efficacy or effectiveness of
drug and homeopathic products.
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
202 | Veterinary Record | August 19/26, 2017
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-
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stituting reliable evidence, and lower-quality controlled studies that
were unblinded and/or unrandomised and/or with a control group
that was not placebo-treated, and some observational studies that had
no control group. For these reasons, there was substantial potential for
non-specific effects including bias, and many of the trials with find-
ings positive for homeopathy cannot be taken as good-quality evi-
dence that homeopathy is effective. Doehring and Sundrum (2016)
found that the trials better designed to reduce non-specific effects pro-
duced 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 medicine (15
of 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 one of
them had been replicated. Doehring and Sundrum (2016) concluded
there was insufficient evidence to recommend that homeopathy be
used 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 people is
used 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, not
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 was the
main 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, cultural and
social 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.
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
204 | Veterinary Record | August 19/26, 2017
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
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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/181/7/198
Conflict 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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