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Decision making
Comments on the dilemma in the July/August issue: ‘Homeopathic vaccine’
  1. J. T. Lumeij, DVM, PhD

    Division of Zoological Medicine, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands

Abstract

The dilemma in the July issue concerned a dog owner who presented a litter of 15-week-old puppies, all of which had collapsed with severe diarrhoea, and you suspected parvovirus was the cause. The puppies had previously been taken to a neighbouring practice where they were vaccinated using a homeopathic nosode vaccine. The client had now come to you because of a subsequent loss of faith in the other surgeon (In Practice, June 2012, volume 34, pages 366-367). Discussing legal and ethical elements, Martin Whiting commented that the concepts of evidence-based medicine and informed consent were central to this scenario. The first veterinary surgeon was unlikely to have been acting outside the RCVS Code of Professional Conduct, provided that the client was fully informed of the risks and benefits of homeopathic and conventional vaccinations, they acted within their area of competence (including training in homeopathy) and did not compromise the welfare of the animal. However, evidence-based medicine should remain the foundation of veterinary work and some found it hard to reconcile the use of remedies with unknown efficacies, mechanisms and side-effects over conventional therapies where these factors were known or demonstrable. The risk to animal welfare was unknown when details of homeopathic remedies were unspecified, and this could compromise the vet's ability to inform the client sufficiently, as required for consent. It also diminished the vet's ability to robustly defend the therapeutic choice. Only with evidence could competency be measured and protocols audited to ensure that the profession's endeavours to safeguard the welfare of animals was realised.

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Division of Zoological Medicine, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands

Any comments?

Readers with views to contribute on ‘What if it was your dog?’ should e-mail them to inpractice{at}bva-edit.co.uk so that they can be considered for publication in the next issue, or fax comments to 020 7383 6418. The deadline for receipt of comments is Friday, September 14. Please limit contributions to 200 words.

J. T. Lumeij comments: From this description, the RCVS's Code of Professional Conduct is outdated and lagging behind international developments in the profession.

The prerogative of veterinarians to treat animals can only be defended when those treatments are based on scientific principles, not when veterinarians provide ineffective treatments. There is general agreement that homeopathy is not effective and that further studies are a waste of money.

The Federation of Veterinarians in Europe as well as the European Board of Veterinary Specialisation have taken disproving standpoints on the use of homeopathy. European veterinary specialists practising homeopathy will risk loosing their specialist status. The RCVS's recommendation that veterinary surgeons prescribing homeopathic medicine should be adequately trained lacks rationale due to the absence of any evidence-base.

Veterinary surgeons' primary duty to ensure the welfare of animals can only be accomplished by the use of evidence-based treatment modalities, or by plausible treatment modalities that are under continuous critical consideration. Homeopathic nosodes do not fit into either category.

In the scenario described, withholding an effective vaccine put these puppies at risk of developing a life-threatening infectious disease. It is a clear case of malpractice.

Notes

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘What if it was your dog?’, is presented and discussed by Steve McCulloch. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Homeopathic vaccine’, which was published in the June issue of In Practice, appears on page 495.

The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.

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