I MUST admit that over the last
month I’ve experienced something
of a paradigm shift. You might
remember that in last month’s
issue of Veterinary Practice I rather
railed against the new alcohol
scrub solution that cut pre time for
surgery down from five minutes to
a mere 90 seconds.
It reduced the time spent
preparing for surgery but lost some of
the fun too, I thought. But now I
simply can’t get enough of it. I take it
round in the car to whichever practice
I visit and extol its virtues to anyone
who will listen.
Ease of application, speed of
preparation. What could be better?
And yet what
has changed?
Not the
solution for
sure. Not the
evidence for
its efficacy of
action. No.
Much as I
hate to admit
has changed! But why? I haven’t
uncovered some amazing new facts
through detailed research. I’ve just
flipped from an anti stance to being
an arch advocate of the stuff.
But I don’t need to feel alone in
having such an apparently irrational
change of heart. Thomas Kuhn, the
famous philosopher of science, made
his name through his key book The
Structure of Scientific Revolutions,
published in 1962. In it he showed
that science does not always progress
in small gradual steps but rather major
changes happen as apparently sudden
revolutions. Paradigm shifts.
Transformation
The information is all there to fuel
such change, but it takes a particular
person or small group to effect the
transformation. Ironically it was in
1962, the year Kuhn published his
monograph,thatoneof themost
dramatic of these scientific
revolutions occurred. And I
particularly love it as much of it
happened in St John’s, my own
college.
Fred Vine was a geology student
there and with his supervisor
Drummond Matthews they put
together all the data which showed
that continental drift must be
occurring. We all know about
continental drift and plate tectonics
now. But then it was all new. It was at
that point that the paradigm shift
occurred.
The trouble was that the senior
fellow in geology at St John’s was Sir
Harold Jeffreys. He was tremendously opposed to continental drift, and
continued to be to his dying day. This
antipathy was reflected throughout the
university. The two departments of
geology and petrology were next to
each other in the same building, but as
Fred Vine tells in the aural history of
science at http://sounds.bl.uk/Oral-
history/Science/021M-
C1379X0025XX-0004V0, the heads of
department disagreed so profoundly
that the doors between the two sub-
disciplines were locked tight shut!
Indeed, the geo-physicists ended
up working near the vet school a
couple of miles away from the classic
geologists in the middle of
Cambridge, such was the disagreement
between them. And in that oral
history when Fred is asked whether he
was lectured by Jeffreys, he answers
with a laugh: “No, thank goodness, he
was an appalling lecturer apparently,
no, well I was only lectured over the
high table [in the dining hall] at St
John’s once, he told me I was an idiot
for believing in continental drift.
“Harold Jeffreys was about three
places from me I think, at least, off to
the right and I was minding my own
business and at some point I could
hear him saying, ‘That guy along there
believes in continental drift, it’s
completely rubbish,’ or something like
this, or words – something like that,
and I didn’t think it was terribly polite
– polite to reply [he laughs] because
he was …” And there the memory
fades away!
To be fair on Jeffreys, the reason
he would not believe that continental
shift occurred was that he could not
conceive of a mechanism to move the
proposed tectonic plates.
Well, that was 50 years ago. Move
on another couple of decades: I was a
student and we were told about this
ridiculous scientist Stanley Prusiner
who thought that a disease could be
transmitted from one individual to
another by a protein, a prion.
‘Slow virus diseases’
These neurodegenerative diseases like
Kuru in New Guinea cannibals were
called slow virus diseases because
whatever Prusiner said there must be a
nucleic acid-containing virus
somewhere in there mustn’t there?
In 1982 when I was in my second
year, Prusiner managed to get a paper in the prestigious journal Science on
scrapie in sheep. We proto vets loved
this, of course, but my fellow medics
were scathing. If he could only find
his infectious protein in cannibalistic
tribesmen or itchy sheep, it could
happily be put in the filing cabinet
labelled trash couldn’t it?!
Five years later and I was in my
lecture-free final year. The first
lecture-free year ever at Cambridge, as
Dick White had come back from
Tennessee with this great idea of
involving us in the clinic full time. We
still had our lectures to do, of course,
but that just meant we had to start by
SOAPing outpatients at 7am.
SOAPing them? We had to wash them
down before the day started?
No. “Subjective objective
assessment and plan” was just one of
the plethora of acronyms and phrases
Dick brought back over the pond.
Anyway, back to Prusiner’s prions.
We might have been exhausted
from our work on the clinics but
certain images stick in your mind
however tired it is. And one of those
was the first cow with BSE, staggering
around and bellowing with Dr Tony
Palmer our neurologist (how
wonderful to have a neurologist with the initials ACP!) for once stumped at this
new condition.
It was, of course,
mad cow disease that
yielded the paradigm
shift. BSE showed
that Prusiner was
correct after all,
leading to his Nobel
prize just 10 years
later.
And now plate
tectonics and prions
are standard parts of
science. So what is
there that now seems
crazy but might just
be the key step forward? Half of me
wants to say homoeopathy.
No obvious mechanism, few if
any well-controlled studies,
practitioners still referring back to a
cholera epidemic in 1854 as a key
piece of data. And yet … and yet
Stanley Prusiner was considered a
lunatic in the early 80s and nobody
believed Fred Vine before 1962.
Is there any decent evidence for
homoeopathy? A quick google of
“randomised trial of homoeopathy”
first gave me a paper in the British
Medical Journal on perennial allergic
rhinitis with a positive result – a 28%
reduction in clinical signs versus 3%
with the placebo. But the next one
was a rheumatoid arthritis study
published in Rheumatology where the reduction in pain scores using the
placebo were significantly better than
the homoeopathic treatment.
A meta-analysis of 89 placebo-
controlled trials published in the
Lancet showed that the effect of
homoeopathy was not entirely caused
by the placebo effect but there was
insufficient evidence to show clear
efficacy in any one condition. A
further analysis of the study, however,
showed that it was the homoeopathic
consultation and not the remedy that
had the effect.
Ideal opportunity
Veterinary cases should be an ideal
opportunity to test without a placebo
effect, shouldn’t they?
A study of a homoeopathic
remedy in foot-and-mouth disease in
an endemic area showed a significantly
greater reduction in rectal temperature
with Tarentula cubensis extract than with
placebo and significantly better
healing of mucosal ulcers and
improvement in appetite. The only
problem here is that we want to see
cessation of virus shedding, not just
improvement of clinical signs.
A study on reduction in the tick
Rhicephalus in calves with two homoeopathic remedies
noted one, from the
plant Allium sativum
which lowered tick
numbers significantly
more than in the control
animals or the other
treatment but has to be
set in the context of
many negative results.
Research on
homoeopathic therapy of
bovine endometritis, for
instance, yielded no
positive results and a
large study on somatic
cell counts in cattle
similarly showed no beneficial results while a much smaller
trial on dogs with atopic dermatitis
only managed improvement in a
quarter of the cases in an open
uncontrolled trial.
Oh dear. It’s difficult to work out
what is going on with such a
confusing mass of data and apparently
positive trials buried in a landslide of
inconclusive studies. Rather like a
novel idea only showing itself through
New Guinea cannibals and itchy sheep
to start with.
Perhaps what we need is a
paradigm shift. Maybe in another 30
years we will all have changed our
minds? Or maybe not!
- List of references available on
request to editor@veterinary-practice.com.
