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| Hpathy Ezine - December, 2007 | ||||
The Langford Canine Atopic Dermatitis Trial-- By John Hoare, mrcvs |
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This trial arose from the Data Collection Study carried out in the 6 months between 1st January 2005 and 30th June 2005. Full details of that study were published in Homeopathy (2007) Vol. 96, pp. 27-34. A brief summary of the outcome is that during a 6 month period, 8 veterinary members of the Faculty of Homeopathy recorded details of every consultation they made, and in the case of follow-up consultations they recorded the outcome on the Glasgow Homeopathic Hospital 7-point Likert scale(-3 to +3). There were 4 canine conditions that showed a +2 or +3 score in 50% or more of the cases, one of which was Canine Atopic Dermatitis [CAD].
It was then suggested that CAD would be a candidate for further investigation. I pointed out that the first point of contention would be “How do you know that you were actually treating atopic dogs, and not any other skin condition?” I therefore wrote to the secretary of the British Veterinary Dermatology Study Group asking how one made a definitive diagnosis of Atopic Dermatitis. He referred me on to Dr. Peter Hill. Peter is the Senior Lecturer in Veterinary Dermatology at the University of Bristol and is also the Chairman of the Atopy Committee of the BVDSG. I contacted Peter quoting our statistics and asked for advice on the diagnosis of atopy. He replied, suggesting a meeting at which Robert Mathie, the Faculty of Homeopathy Research Development Adviser, made a small presentation of the Data Collection statistics. Peter said that if we could demonstrate results half as good as those obtained in the study he would be very surprised. So, for the last 16 months or so Peter and I have been carrying out a preliminary trial into the effectiveness of homeopathy (as practiced by me) in the treatment of CAD. Briefly the protocol that has been developed is that Peter, or one of his assistants, makes the diagnosis. The client is then offered the chance to participate in the trial. If they accept they are given three month’s free homeopathic treatment at Langford. To give the trial a more acceptable ‘scientific’ face, Peter has developed an “Itch Score” chart for use in the trial. It comprises a visual analogue scale combined with written descriptions of itch manifestations and has been published in Vet Dermatol. 2007 Oct.(5): 301-8. As a side benefit, the scale has been used to determine the level of itchiness in ‘normal’ dogs by asking the owners of dogs attending Langford for other than skin conditions. It has also been used to assess the level of itchiness with which an owner of an atopic dog would be satisfied. These data will be published in the near future. It looks as though the average owner would settle for a residual itch score just slightly higher than that of a ‘normal’ dog. Peter has also developed a “Lesion Score” sheet which allows a severity score to be made for all types of skin lesion at all possible sites on the body. This too is to be published soon. It was developed because there often appears to be no relationship between the severity of the lesions and their itchiness; a phenomenon represented by the rubric “SKIN: Itching: eruptions, without” in the homeopathic world. As Peter says, the majority of owners are more concerned about the degree of itchiness than the presence of minor skin lesions such as redness, rashes and pimples. It may be that in the future it could be used to verify that Hering’s Law does apply to canine skin lesions. The only criteria for eligibility to enter the trial is that Peter has made a diagnosis of CAD. There are no criteria for prevention of entry. The owner then scores the dog’s itchiness and I make a normal full homeopathic consultation. There are no restrictions on my prescribing. I am allowed to prescribe any homeopathic remedy, in any potency at any frequency I wish. There are follow up consultations at 30, 60 and 90 days at which the Itch Score is taken, the case is re-assessed and a further prescription made if needed. I have been impressed by the seriousness which Peter has brought to the project. At the beginning he knew nothing about veterinary homeopathy. He has, however, come to realize that the basic differences between conventional and homeopathic medicine make normal Blind Trials impossible to set up. He did, however, notice that some dogs appeared to require a repeat dose now and again. As an add-on to the original trial we have tried, once the remedy was positively identified, giving two bottles to the owner – one containing the remedy and one placebo– to see if the owner can tell a difference in the patient’s response to the two. It might be that this will be a way forward for those who need to see the results of ‘blind’ trials before they can be convinced of any effectiveness. Peter has also come up with the concept of “The Perception of Illness”. I may perceive a dog to be getting better if the itch moves from head to tail, he will only see improvement if the itch score itself is reduced, even if the itch moves from rump to ears. The owner may also say that the dog looks a lot better even though the itch score remains constant. Peter wonders if the dog is scratching just as much, but is not so bothered by it; or if the owner is not so bothered by the degree of scratching because he/she knows that the dog is receiving homeopathic treatment, or even if Hering’s Law is valid. This will have to be discussed between us at some stage. Another interesting by-product of the trial is that 4th and Final Year Students are allowed to sit in on my consultations. The students fulfil the whole range of attitudes towards homeopathy. This does result in some meaningful discussions after the consultation ends. Peter also points out my use of MacRepertory to them. One of the points he makes, and which I had not appreciated before he did so, is that our conventional colleagues have nothing like MacRep or Radar to help them. “Why” he asks “would anyone go to the trouble and expense of producing such a program if they thought that they were only prescribing placebos? Even if they are mistaken, they must believe that homeopathy works!” It has taken 16 months to enroll the 20 cases that we wanted for the preliminary trial. Some of them, though, have not finished their course of treatment. Neither Peter nor I wish to give any indication of the degree of success or failure that we have seen. The politics of the profession make this a very sensitive issue, and we want to be sure that anything we publish is robust and able to withstand intense scrutiny. Both Peter and I have learned a lot from this preliminary study. We both hope that it will justify going on to a definitive trial, and we both know the many points of contention and are thinking of ways to overcome those difficulties. For my part, I have learned a great deal from working with Peter. I cannot emphasize too much just how much effort he has put into trying to make the project acceptable to both sides of the argument. I hope that we will have the chance to take it further, possibly even as a multi-centre project. If it has taken 16 months to enroll 20 cases, not all of which would have been suitable for the ‘Placebo phase’, how long would it take us to recruit a meaningful number? We would also be running up against the problem of funding. This trial so far has been run on a shoe-string. Langford has not charged for use of its facilities, I have given my time for nothing, and the Faculty of Homeopathy has kindly reimbursed my expenses. I have really enjoyed this, my first direct exposure to scientific evaluation of homeopathy. I have also enjoyed the co-operation of a first class scientist, with a truly open scientific mind. I just hope that the paper, when it is published, will go some way to supporting what I believe to be a wonderful medical therapy. ----------------------------------------------- By John Hoare, mrcvs veterinary surgeon, homeopath United kingdom
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