Saturday, December 11, 2010

Homeopathic study reveals client satisfaction survey not best assessment tool

Another day, another customer satisfaction survey presented by Homeopaths as 'evidence'.

"Homeopathic prescribing for chronic conditions in feline and canine veterinary practice" involved 21 homeopathic veterinary surgeons collecting data on 400 cats and 1504 dogs over a twelve month period. Owners were asked to assess the clinical outcome on a 7 point scale (from -3, major deterioration, to +3, major improvement). Strangely, homeopathic prophylaxis, or 'immunisation' (the paper uses the word in quotes, presumably because it's not immunisation at all) were not included.

Conditions assessed in cats were dermatitis, renal failure, overgrooming, arthritis, hyperthyroidism and 'all others'. If you were a disbelieving skeptic, you'd probably hypothesize that something as serious as renal failure would not respond particularly well to a few drops of water. It is, in fact, this condition that stands out with a whopping 14.4% in the -3 and -2 rating. You would also expect other conditions that are variable in nature to score more highly. Again, arthritis is the stand out here with an 80% +2 or +3 rating of treatment.

In dogs arthritis also rated highly (beaten only slightly by spondylosis). Even lymphoma scored 40% in the +2 or +3 rating (though 53.3% rated the treatment -1, 0 or +1 — effectively no change). 'Fear' is an interesting result, scoring a stand out 68.4% in the middle range. EoR would have thought that a holistic treatment like homeopathy, which (purportedly) works on a whole body energetic level, would have been an ideal treatment for an emotional condition. Perhaps not, after all.

The paper notes that homeopathy was not the single variable in the survey. Many animals received multiple CAM treatments. Specialist referral and conventional treatment was high for lymphoma.

The authors note the limitations to their study:

Positive bias in outcomes data is an inevitable consequence of study design that is neither controlled nor randomised, and our overall 63.3% (cats) and 68.9% (dogs) with +2/+3 outcomes require further comment. These findings are in line with the 50 - 68% recorded in equivalent observations in humans.

Nevertheless, we have no intention of overstating the conclusions from this type of study. Because of the deliberate absence of a control group, we are unable to take into account many possible confounding factors such as waxing and waning of symptoms over time or regression to the mean. In addition, about 25% of cases overall did not receive FU [follow up] during the period of data collection; owner-assessed change in these animals is therefore unknown. Moreover, ‘desire to please’ is a normal facet of clinical information obtained directly from a client, and each owner will have differing views as to what constitutes moderate or major change in their pet’s state of health. As in all our other systematic observational studies, including that in horses, a causal relationship between homeopathy and clinical outcome is not an inference from this investigation.

EoR wonders if other homeopaths will be as cautious in their reporting of this study.

As an aside, EoR was fascinated to read that the study was supported, in part, by a donation from the Psionic Medical Society. EoR had never heard of them before, but they appear to be a UK charity that has been in existence since 1969 with the aim

To promote the study and improvement of the science and practice of psionic medicine for the relief of suffering and to promote understanding of its methods and application.

Mathie, RT, Baitson, ES, Hansen, L, Elliott, MF, and Hoare, J (2010). Homeopathic prescribing for chronic conditions in feline and canine veterinary practice. Homeopathy (2010) 99, 243-248. doi:10.1016/j.homp.2010.05.010.

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