Five representatives of the American Holistic Veterinary Medical Association attended the AVMA meeting, January 3-6, 2013, where Resolution 3 from the Connecticut VMA entitled, “Homeopathy has been identified as an ineffective practice and its use is discouraged,” was discussed. Two of these veterinarians were also representing the AVH: Dr. Ann Swartz, the AVH’s incoming president, and Dr. Shelley Epstein, AVH past president. They were all very pleased with the reception they received and how open minded and polite the delegates and officers of the AVMA were.
They reported that a large number of delegates either practiced a CAVM modality, had an associate in their clinic who used one, or referred to a veterinarian who practiced one. The majority of the attendees were eager to learn more about homeopathy and ask questions that had arisen during the past few weeks.
By the time the important meetings started (there were four major ones and many minor ones), the sentiment was heavily against this resolution. The minor meetings included the state district meetings. Dr. Epstein attended her District 2 meeting, which included PA, DE, VA, MD, DC and NJ. Dr. Ann Swartz attended her District 11 meeting which included OR, WA, AK, ID, WY and MT. The chair of District 11, Dr. Thomas Meyer from WA, also serving as the Vice President of the Executive Board (EB), immediately invited Dr. Swartz to “belly up” to the table with the rest of the delegates! (The usual procedure is for observers to sit at the back of the room.) Both doctors noted how important it was that individual AVH members had contacted their state delegates to voice their disapproval with the resolution and to resolve many of the misunderstandings that had been generated by the resolution. Dr. Swartz also noted that every delegate and alternate was supportive of the practice of homeopathy at the District 11 meeting.
The “Allied Associations” also held a meeting to discuss all the resolutions. (Drs. Swartz and Epstein did not attend this.) This group includes such varied organizations as the American Animal Hospital Association, American Association of Equine Practitioners, and the Student AVMA. The opinion of the Allied Associations was that this resolution should not be approved.
Our AVH representatives also attended the four major meetings. The first was the House Advisory Committee (HAC). This group had leaders from many aspects of veterinary medicine, including private practices, universities and government. The various speakers emphasized that it is important that the AVMA represent “all segments” of the profession, and that the AVMA’s job was bringing the profession together. They discussed many therapies that veterinarians perform, like stem cell therapy for example, have thin evidence bases. In fact, it was noted that many if not most of the therapies performed in day to day veterinary practice have a thin evidence base. They noted that clients have choices in the therapies they choose, and that it is most important that they can go to competent veterinarians.
The HAC voted unanimously, as per AVMA protocol, to recommend sending the resolution to the Council on Veterinary Services (COVS). This committee is also charged with the review of the AVMA’s Guidelines on Complementary and Alternative Therapies, which is due for its five-year review in March.
Just after the HAC vote on Resolution 3, Drs. Swartz and Epstein crossed the hall to attend the Executive Board (EB) meeting, which also renders weighty decisions on all the resolutions. At this meeting, Dr. Doug Aspros, AVMA president, stood up and declared emphatically that this resolution did nothing to further the AVMA. He went on to say that such resolutions should be discouraged in the future. The EB then voted to recommend “disapproval” of the resolution.
The third preliminary meeting and the one considered to carry the most weight was the Reference Committee 6 (RC6) meeting. This committee was charged with specifically reviewing this resolution in order to make a recommendation to the House of Delegates (HOD). Members of this committee represent various states and associations as well as the above committees and were responsible for sorting through mounds of documentation regarding all Resolutions.
All comments were in opposition to the resolution except for those of Dr. Arnold Goldman, the delegate from CT and sponsor of the resolution. Notable comments included the delegate from Alabama saying that he does relief work at a practice that uses homeopathy and it is a very well-run practice with attention to detail. The representative of the United States Uniformed Services, representing the Allied Organizations, noted that CAVM modalities should not be held to stricter rules of proof than any other modalities. Further, she noted that perhaps smaller groups representing modalities do not have enough proof because they do not have the funding for the research. Three members of the RC6, when called upon to give their opinions, stated that their minds had changed within the past 24 hours due to information or personal contacts they had received. The representative from the Student AVMA stated they had much discussion on Resolution 3 and decided they were against it (but would be fine if this were sent to the COVS).
In both the HAC and RC6, the question arose as to how or why this resolution was developed. Dr. Goldman was present to address this in the RC6, explaining how they formed the Evidence Based Veterinary Medical Association (EBVMA) which believes no CAVM modalities are evidence-based. The EBVMA decided to start by isolating homeopathy which they considered the “weakest link” and “most indefensible” so that homeopathy would be separated from the other CAVM modalities. He felt that since this was not an issue that was isolated to CT, it should be brought in front of the entire AVMA.
Once all the representatives had spoken, Dr. Epstein was permitted to speak. She discussed how she has been an AVMA member for 31 years, minding her own business, practicing veterinary medicine and becoming involved with the research in homeopathy. She noted that she had a case report published in the prestigious JAAHA. Then two months ago, she received an email informing her that the AVMA had to consider a resolution discouraging its members from using homeopathy because it had been “identified” as “conclusively” ineffective. She felt that this was her personal Kristalnacht, that the walls came down around her and that she was being marginalized from within her own AVMA.
Dr. Epstein then felt it was important to revisit the question of how this resolution came about. She pressed Dr. Goldman to name the author of the White Paper. He acknowledged that it was written in part, although he was reluctant to specify what percent, by a non-CT individual. Dr. Epstein noted that this individual is an outspoken skeptic. She also noted that this information was germane to the discussion, as the White Paper was commissioned by the CT VMA and was presented to the delegates as if it were an impartial systematic review. She noted that in fact it was a cherry-picked paper, and was not in accordance with the impartiality expected of a systematic review or any paper claiming to be impartial. In that regard, it was important to question the authorship.
Dr. Epstein concluded by acknowledging that although it was not the intent of the CT VMA, the AVH and AHVMA welcomed a review by the COVS. This would allow an impartial committee to review the 200 papers they intend to submit as an encapsulated presentation of the evidence.
Dr. Swartz also spoke briefly and requested that the AVH have a say as to who is chosen to provide input to that committee.
Of note, all members of the RC6, except Dr. Goldman, spoke out against Resolution 3 and it was decided that the best course was to recommend sending it to the EB with a recommendation to refer it to the COVS.
The final meeting was the House of Delegates (HOD) meeting. The vote on the resolution was phrased as: Vote “yes” if you want Resolution 3 to be referred to the EB with a recommendation to refer it to the COVS, and vote “no” if you are opposed. The discussion from the floor included statements from the delegate from WA who noted that it was “hypercritical” and “arrogant” to condemn one modality. The delegate from WY also spoke out against Resolution 3. These delegates noted that a large percent of the drugs contained in Plumbs [veterinary formulary] do not have mechanisms of action delineated. The delegate from WA likened not knowing how acupuncture and homeopathy work to not knowing how a cat purrs--it just does.
Dr. Goldman and the alternate delegate from CT, whose name was not stated, spoke out against homeopathy. Dr. Goldman asked what harm there was in alienating a small number [of AVMA members] who do homeopathy? They noted homeopathy was “indefensible” and that the reputation of CAVM was “harmed by the inclusion of homeopathy.” The alternate noted that homeopathy has not changed in 200 years, and that “do no harm” is threatened by homeopathy. After these two members finished, the speaker explained that the discussion should be directed to the resolution and not conducted as a discussion on homeopathy.
A vote was then taken, with 77.6% voting “yes,” and 22.4% voting no. Of important note is that at least two states, PA and DE, voted “no” because they wanted the resolution dropped, not referred.
What is unclear is just what percent of the “yes” votes were voices of disapproval of the Resolution 3 versus skepticism wanting an impartial review by the COVS.
At this point, the EB will decide whether or not to forward the resolution to the COVS. No time frame was given, but it is anticipated that this will happen shortly as the decision of the COVS on this resolution will impact their revisions on the CAVM Guidelines.
A great opportunity has been afforded practitioners of homeopathy. Not only were so many more AVMA members educated about homeopathy over the past two months, but now practitioners of the modality will have the opportunity to provide the COVS with all the research, including basic science and clinical trials, that has been published since the AVMA’s first Guidelines on CAVM were developed a decade ago.
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