Page 15 - Autumn 14

The first International Evidence Based Veterinary Medicine conference by Edward De Beukelaer, UK
In a flurry of enthusiasm or maybe craziness I submitted an idea for a presentation on homeopathy at this international evidence based medicine conference. To my surprise they accepted. To their credit though, there was already some room made available to treat the subject of alternative medicine. I was asked to prepare a poster.
The board of the IAVH decided, it was a good idea to participate and they kindly paid the conference fee. This was very helpful, because I already overspent my yearly budget. The poster briefly explained 4 cases of high blood pressure (from 250 mmHg to >300 mmHg) in dogs who were all successfully treated using homeopathy. I then pointed out that the remedies were: Aur-m-n, Limestone Burren later followed by Graphites, Natrum carb and Thuja: all different for each case.
I attended with an open mind curious to see what was going to happen. It all started well, as I sat next to Dr Rachel Dean, who is director of the Centre for Evidence Based Veterinary Medicine of Nottingham University. During coffee break we discussed my poster and the particular nature of homeopathic medicine. She was very positive about it all and E-mail addresses were exchanged. We will see what happens next.
The talks of the first day were varied and left me impressed about the honesty of the various speakers. There is a real drive to making sure that evidence in medicine should be made reliable. Interestingly, several times it was repeated never to listen to drug companies' reps: Just stop seeing them!
These are a few interesting statements on which most speakers agreed:
• The decision of the practitioner is always going to be the result of the available evidence, the particular situation of the client/patient and the practitioner's own experience.
• Guidance does not mean a rule: guidance should always be adapted to the individual case.
• Treating a patient with a single condition is not the same as treating a patient with multiple conditions. One cannot extrapolate the evidence from treating one condition to treat this same condition, when the patient suffers with a number of other conditions.
• Tell your clients that you don't know, when you don't have the elements to make a correct judgment or give the right advice; when the information is not available, or not available to you.
• Question experts, check whether what they say is based on reliable evidence and not just based on 'eminence'.
• There is a need to provide the practitioner with useful information that applies to the reality of veterinary practice.
• Many questions remain about how best to integrate evidence based veterinary medicine into university/college teaching and how to bring it to the practitioner. It was recognised how difficult it is to change habits of practitioners.
Then it was poster session time. We were expected to stay with our posters between 7 and 8 pm. Bizarrely the two posters on alternative medicine (mine and one on acupuncture) were both right at the end of the room and were the only ones, who did not have direct lightning ... but hey, we were there, I should not complain. A few people came to read the posters, not many discussions flowing out of this, until I had the pleasure of running into Mr Simon Baker (interesting). During the coffee breaks I had already dragged a few people to the poster to ask their opinion about, how this information can be used to help the cause of homeopathy. There are a large number of difficulties with this but I may have a lead, which will be hard to put in place though.
The Friday morning we heard from two Americans, who produced large studies based on available evidence aiming at providing evidence based advice for the treatment of specific conditions. The possibility of side effects of medicines was always taken into account. One topic was canine atopic dermatitis, stressing the need for individualised treatments and another topic was improving CPR in practice. Then there was a presentation on how the new guidelines on CPR were
applied in a big practice and what the constraints and advantages were of this process (the links for the full publications of these studies are as follows: http://onlinelibrary.wiley.com/doi/10.1111/j.13 65-3164.2010.00889.x/full http://onlinelibrary.wiley.com/doi/10.1111/vec .2012.22.issue-s1/issuetoc.)
One American practitioner explained, how he was in the process of quality grading a large sample of 'randomly selected' articles (300) published in official journals and treating controlled clinical trials. His preliminary findings were that only a minority of these articles were complete and reliable.
The second part of the morning had a special mini session on CAM. In this session, two small conferences treated ethics in veterinary medicine (...) and one treated the huge difficulties of setting up a CRT to assess, whether homeopathy is effective or not. The fourth conference in this session questioned the origin of acupuncture. Dr David Ramey presented, what seemed like very thorough research on the origins of acupuncture. His conclusion was that precision acupuncture, the idea of qi, the use of fine needle and the naming of specific acupuncture points is something that developed in France/Western world in the beginning of the 20th century, thus demonstrating that there is no such thing as an ancient long tradition of veterinary acupuncture.
My conclusion is that the veterinary conventional world appears decided to put its house in order leaving no stones unturned for the benefit of the vet in practice and of course the patients. We will find out in the future what the outcome is going to be of this.
With regards to homeopathy, we will have to continue to find ways of proving that we can make a difference. The modern techniques of providing such evidence are stacked against us but that does not mean, it is impossible. I hope that my small link with the Nottingham University is going to prove fruitful. I will do my best to stay on their side and obtain some cooperation and will keep you informed. The fact that I treat patients in a conventional setting appeared to offer some credit in the eyes of our colleagues (even Mr Baker mellowed eventually and we left on good terms).
There are a few people, who have axes to grind with homeopathy but there were more people, who were open to the idea of homeopathy even when they cannot imagine that homeopathy could be effective. T
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