200 years ago Homeopathy predated the cutting-edge advances of modern medicine. These concepts are individualised medicine, the ability of emotional distress to cause serious chronic disease, like treats like, epigenetics and the Vital Force.

On the 2nd November 2017 the RCVS Council issued a statement asserting that homeopathy is not based on 'sound scientific principles'. This demonstrates that the Council does not understand what science is, namely: observation of phenomena; hypothesis; predicting; testing, experimentation and data-gathering; refinement and alteration; expansion or rejection; theory (1).

This is exactly how the principles of homeopathy were realised, and why it expanded to become the second most widely used medicine in the world (WHO - 2).

It is not 'Science' to say that phenomena that do not fit the accepted paradigm should be rejected; that is anti-science and stifles progress..

We do not actually understand most of our universe. Consider basic questions such as why do we sleep, how do animals migrate, how do paracetamol and many anaesthetics work, and how did life begin? We have theories but are short on answers. We don't know what makes up 80% of the matter of the universe – the so called dark matter. After spending trillions we may be beginning to get a glimmer of how the most obvious thing in the world works, namely gravity.

It is ridiculous to say 'It is not sound science because we don't know how it works'. The fact that 'science' has yet to understand the mechanism of homeopathy is likely to be due to two things: homeopathy lacks the billion-dollar profits of the pharmaceutical industry for research, and it works by an advanced mechanism, as yet undetectable by 21st Century Homo Sapiens.

To quote Brian Cox:

The establishment has routinely turned on those who go against accepted dogma.

Copernicus and Darwin are obvious examples, among many. Another is Einstein who turned the Victorian materialist universe on its head. His concepts were so revolutionary that much of the scientific community initially rejected them as being too outlandish.

Hahnemann was probably the most extraordinary genius in the history of medicine, and his ideas were far ahead of his time, also in many areas outside of homeopathy, such as in the compassionate treatment of the insane. His homeopathic theory was original and revolutionary.

Homeopaths are criticised for returning to the work of a man from 200 years ago, but physicists delight in studying Einstein. Geniuses are in short supply. Fortunately there are a few working currently in homeopathy, which has enabled it to undergo great advances in the last 30 years.

The five homeopathic concepts were initially ridiculed, but subsequently all of them except one are now accepted by modern medicine, which has only caught up with two of them in the last few years.

1. Individualised Medicine

This is a medical procedure that separates patients into specific genetic groups. Medical decisions, practices, interventions and products are then tailored to the individual patient, based on their predicted response to or risk of disease. To quote Professor Johnson, chief clinician, Cancer Research UK:

Unlike 'conventional' medicine from the 18th to the end of the 20th Century, Homeopathy was always about the individual. There is no such thing as a homeopathic remedy to treat chronic arthritis in a dog. Each individual dog may require a different remedy. The choice will be based on the exact objective symptoms, character, behaviour, phenotype and a detailed history. This is why homeopathy is not suited to unsophisticated double blind trials. Future conventional medicine won't be either.

2. Serious Chronic Disease is Caused

by Mental Stress 

It has been accepted for a few years in human medicine that stress is an important factor in the development of chronic disease, and recently the veterinary world is beginning to come on board.

However in 2010 the Veterinary Times published a case of osteosarcoma successfully treated using homeopathy, leading to annoyed letters being sent by some vets wondering why the character of the dog and the stresses it had experienced were relevant. One author described the possibility of homesickness causing osteosarcoma as 'farcical'. At that time few people knew about Adverse Childhood Experiences (ACE). These demonstrate an association of stresses experienced as a child with health problems when an adult. This has been a notable landmark in epidemiological research, and has recently produced more than 50 scientific articles and 100 conference and workshop presentations. (3,4,5)

Hahnemann had realised very early on in his homeopathic practice that understanding mental stress and emotional history was crucial in the choice of remedy. There are no drugs in conventional practice that take into account the physical pathology together with the mental and emotional state, which may be why this area has been poorly explored by modern medicine.

It is obvious to a vet taking a homeopathic consultation that animals are affected by specific emotional stresses, and subsequently develop disease in exactly the same way as humans. Their prescriptions reflect this. All remedies treat mental and emotional symptoms as well as physical. It is only recently that mainstream science has accepted that animals experience emotions (7). Animal emotions were never mentioned in my six years at Cambridge.

3. Like treats like

This had actually been a concept in medicine for centuries, referred to by Hippocrates and Paracelsus (8,9). However Hahnemann, through experiment and observation, was the first to develop a system that reliably employed the principle.

In 1790 he grasped the law of Like Treats Like, or the Law of Similars, when he observed that the symptoms produced by eating cinchona bark (containing quinine) were very similar to the symptoms of malaria. He postulated that this was likely to be why quinine could successfully treat malaria. He then conducted his 'provings' (experiments) on medicines. Groups of healthy volunteers took many different medicines and recorded the mental and physical symptoms they experienced with each.

These drugs were then given to patients displaying a similar symptom picture. These were the first systematic drug trials performed in the history of Western medicine. Nine years later, again through a process of observation, Jenner proposed vaccination.

While the principle is the same, homeopathy is only broadly similar to vaccination. Jenner used doses of a similar disease (cowpox) to prevent smallpox. Hahnemann used medicines which caused specific symptoms in healthy humans, to prevent and treat diseases with a similar symptom picture.

4. Epigenetics and Miasms

Epigenetics is the recent ground-breaking study of changes in organisms caused by modification of gene expression, rather than alteration of the genetic code itself, and has transformed the way we think about genomes.

Darwin wrote in 'On the origin of Species' (1859) that species arise and develop through the natural selection of small, inherited variations that increase the individual's ability to compete, survive, and reproduce. Previously in 1801 Lamark had proposed his theory of the inheritance of acquired characteristics, which was later rejected. Modern observation and accurate recording has revealed that in principle Lamark had a point.

The environment (e.g. exposure to toxins or chronic stress) can cause epigenetic changes, and these changes can be inherited, at least for a few generations. Stress and disease in the mother or father impacts the health of their offspring before they are even conceived.

In one study, female rats were exposed to a fungicide (vinclozolin) and it was found that epigenetic changes that occurred in the first generation male offspring were faithfully passed on through at least four generations (10). Scientists now think epigenetics can play a role in the development of cancer. Uncontrolled cellular growth can result from epigenetic change that silences a tumour suppressor gene.

Another example is an epigenetic change that ‘turns off’ genes that help repair damaged DNA, leading to an increase in DNA damage, which in turn, increases cancer risk. (11,12)

An individual's gene expression, health, and susceptibility to disease are changed by adverse conditions in the environment and these changes can be passed to subsequent generations in a non-Darwinian manner.

Epigenetics, or the equivalent in homeopathy, Miasm Theory, was fully understood by Hahnemann, and elucidated in his opus 'Chronic Disease', published in 1828.

Hahnemann came to his theory by spending years poring over his patients' case files. He observed many did well with acute problems but returned ill with chronic ailments. He discovered by detailed history taking and observation that the diseases to which his patients were susceptible, and the way each individual expressed disease, was determined by the illnesses that their parents and grandparents had suffered, especially if these illnesses were suppressed by medication. Using these observations, he developed a method of treating chronic disease. The story is a long one – Chronic Disease is 1600 pages long, but it was epigenetics 200 years ahead of its time.

5. The Vital Force

Homeopathy uses solutions which have been serially diluted one in a hundred many times, vigorously shaken at each stage. This means that in most remedies there is none of the original material substance left. Homeopaths understand these medicines contain an energetic pattern of the original starting substance.

Homeopathy states that in all living organisms the ultimate control of the functioning of the body and mind, including the immune system, lies with a dynamic energetic force called the Vital Force. To interact best with this force, an energetic medicine is preferable. The material body and all its chemical functions are simply the hardware. The Vital Force is the software, and is not detectable by early 21st century science.

However in one form or another this force has been assumed to exist by every race of humans as far back in history as we can determine, and is variously called the qi, spirit, astral and other bodies, soul, prana, ka, hun, atman and others.

I predict that the greatest scientific discovery of the 21st century will be the vital force. I wonder if homeopathy and Hahnemann will be acknowledged as the first to realise the action of this force in disease and cure? Somehow I doubt it, as although all the other cutting edge theories of Hahnemann have been completely vindicated by, and are central to, the most modern developments in medicine, the attacks upon homeopathy by the so-called sceptics continue. That is unsound science.

Our Pets are important to us, some for the job they do, others for their being part of our families. The bond between man and beast may never have been stronger. Yet strangely, at such a time, we are applying ever more toxic chemicals to them in the form of pesticides and wormers. And we are doing this ever more frequently with very little concern being raised about the short or long term side effects.

These side effects may be significant for man, beast and the environment – each individually is of concern, together they become a potential catastrophe. The widespread use of these agrochemicals in pets without diagnosis confirming need, and without full resolution of safety concerns, I would argue is certainly imprudent and potentially disastrous and must be reconsidered immediately.

Of course to get the wider community to address concerns there has first to be recognition that there is a problem, and therein lies the rub. There is something of an ostrich mentality when it comes to debate on this issue.

However, the near total ban announced by the EU this month (April 2018) on the use of a class of pesticide called Neonicotinoids for all outdoor use on crops, should force a rethink of what happens with their use in Pets.

In the UK the use of these chemicals to prevent infestation with fleas and ticks is arguably now a major source of environmental contamination as highlighted by the charity BUGLIFE (1). Scientific studies have long linked Neonicotinoid use to the decline of Honeybees, wild bees and other pollinators, but they are also highly toxic to aquatic life, and persistent in the environment.

BUGLIFE claims that the evidence shows contamination of freshwaters in the UK with these products can be traced back to their use on Pets.

There are also huge profits to be made from marketing of pesticides for pets to a consumer society that is easily manipulated. April sees the annual increase in articles and adverts in the Veterinary Press to get Vets on side. Television campaigns as well as emotive articles in the media of death and dire consequences for our animals if we don't comply with the rhetoric promote public demand.

Veterinary practice management software is set up to market these products creating text, email and postal reminders to encourage client compliance.

Pet “Healthcare” programmes bind clients into application of these chemicals with supply paid for on easy to manage direct debit. Once hooked you become a valued client, maybe even getting discounts on other services if you comply – all seemingly such a good deal.

There are also articles in the veterinary business journals that encourage “mining” clients data for gold (2) with software that can target the non-compliant – there is little escape for the unwary. This might be all very well if there was some logic and reason, as well as a sense of proportion, applied to the subject, but is there?

With the rise of large corporate practices, some might say financial targets arguably override other aspects of debate these days. My own experience of asking new clients who request these products is that they are unaware of the potential side-effects and the environmental concerns.

The actual need to worm, flea and repetitively chemicalise their pets has not been discussed. They have rarely read the information of the packaging, and are shocked and even angry that they have never been informed there might be a problem at all. There was no informed consent, no understanding of the potential for problems, no explanation of the risks to animal and human health in the process of sale, it was just what they were told to do.

But putting aside the financial debate we need to ask more about why we have been treating dogs and cats regularly in the UK with chemicals to try and prevent fleas, worms and ticks?

Why are we advised to try and prevent infestations that may not happen? Is there really any logic and sound science behind it? And what are the problems?

Its first always worth looking at what happens elsewhere and why.

In the journal “Companion” published by the British Small Animal Veterinary Association in December 2017 it was notable in a report from Norway that there “We don't routinely worm dogs other than pups and nursing bitches (because there is no need, not because we don't bother..)” (3) Norwegian Vets are not allowed to sell prescription only medicines (POMs), so there is also no financial incentive to prescribe other than for actual need anyway.

Similarly in Denmark prescriptions of POMs are only allowed after a positive diagnosis of infection and there is more awareness of environmental concerns from use of these products. Yes, they do have lots of Lungworm in some areas, but  from discussions I have had with Danish colleagues, it is not seen there as such a big deal by Vets or owners as it is marketed to be in the UK.

Lungworm can be a serious disease of course (though often subclinical or mild) but it is regional, seasonal and connected to a certain age group of dogs with a certain behaviour. Colleagues there report they split dogs into groups of different risk and recommend testing at different intervals on that basis – treating only if indicated. (4)

In the UK we are brought up to believe we must encourage regular worming of adult pets for roundworms and tapeworms due to the risks to pet and human health. One doesn't have to look far to see then that this is just not a sustainable or even an evidence based argument.

Worming of a pet only treats the current infestation and after just a few days new infestations can begin to establish as the eggs and infective forms of these parasites are pretty much endemic in the environment.

When I was at University, long prior to the advent of many of the newer chemicals, we were categorically told that to worm too frequently also led to a reduced immunity in the host species and greater levels of worms and egg shedding. Within only a few weeks of worming infestations have often re-established and eggs are being shed into the environment – this certainly happens more quickly than in a month, the now commonly recommended interval now by the pharmaceutical companies for the application of topical pesticides and wormers.

Parasites rarely have life cycles that compromise or kill their hosts under normal evolutionary conditions. We do create a potential problem for many species by our manipulation of the environmental conditions under which we keep animals, but for pets its not really that intensive. And as adults we, and our pets, have evolved to live with a low level of infection, and there is even some argument that it is important to maintain health.

It is at times of reproduction that parasites seek to spread to new hosts and that is why worming of bitches/queens (but not in pregnancy as some of the drugs used can be teratogenic) and young is still important as these are the times of increased risk to life. Ask yourself – if most humans have worms anyway, including tapeworms, why are we not wormed regularly?

So if worming fails to completely prevent, should we then really be concerned over human risk from worms in our pets?

Taking a couple of examples:

With the common roundworm – Toxocara – of particular concern is ocular toxacariasis where the larva migrates into the eye of small children It can cause blindness along with some other associated conditions such as epilepsy. So obviously very serious if the child is unlucky enough to be affected. However, a very large study in Ireland (5) failed to conclusively show that infection was linked to dog and/or cat ownership, not least because laboratory results showed a high seropositive rate (31%) of children to exposure to the parasite, but only arguably at worst 12 cases per 100,000 of eye problems relating to the worm.

What did seem linked was geophagia (earth eating) and there was a suggestion that climatic conditions that supported the survival of the infective larval stage may have an impact on the higher level of cases in Ireland than other areas.

Whatever, it is clear, for all the worming of Cats and Dogs done there is no demonstrable decrease in human risk of this disease, and it is reported there are 34 million Toxacara eggs released per square kilometre per day (6), and yet it is at times described in the veterinary literature as the most common zoonosis to pass from dogs and cats to humans.

Whilst exposure levels are clearly very high, also clear is the very low risk of consequent disease from Toxocara. Compare this to Toxoplasma (a protozoan) transmission from Cats which is some 10 times more commonly reported as actually causing eye problems, as well as risking the unborn child (7). And yet we don't preventatively treat for that at all – personal hygiene is the way forward there. Hygiene is arguably the way forward for Toxacara too as the eggs only become infective in the external environment and contaminated food/pica/infected water sources are in fact the main routes to human infection.

In the UK it is said that children can accidentally ingest a flea infected with the larval stage of the Tapeworm, Dipylidum caninum. Infection can lead to diarrhoea and pruritis but is rarely serious in actuality – the stress of seeing tapeworm segments in a child’s stool or nappy is probably the main concern rather than it being a significant issue for human health. So again not really an argument for repeatedly chemically exposing everyone in reality.

In Europe and other countries (fortunately not the UK at the moment) there is a serious disease caused by a Tapeworm called Echinococcus granulosus. It is not that long ago I sat in a committee meeting where the Human health risks of Echinococcus granulosus entry into the UK through imported pets was raised.

Human deaths occur in Europe, including in young people, from this tapeworm. With an asymptomatic incubation period of 5-15 years before clinical signs are triggered treatment is not always successful even if diagnosed.  In dogs it causes no symptoms. Some have concerns (myself included) the Pets Passport scheme rules are not stringent enough to prevent this crossing onto our shores, and that scheme arguably has made the illegal import of dogs into the UK more prevalent.

Considering in the UK our pets live in our houses and sleep in our beds, it would be devastating if this parasite ever got over here. If it did then routine tapeworm treatments may well be justified. However, these are not really the main chemicals of concern and are a tablet format as well, so faeces can be more easily disposed of responsibly.

In dogs that travel there would certainly be a legitimate argument for more and targeted worming on return to the UK. Some would say why travel a dog and put it (and us) at risk at all? We certainly need more action on illegal imports and our loose borders before we have a mass panic when the first child dies, there is a press furore, and dogs are abandoned on the streets.

What about Ticks?

Clearly there is growing concern over zoonotic diseases transmitted by Ticks, with Lymes Disease being the most commonly recognised problem. But the dog itself is not going to give its owner the Lymes Disease – that will only happen if the owner is bitten by an infected Tick, and there are plenty of precautions that can sensibly put in place to manage ourselves.

Yes the dog is at risk itself, but there needs to be a logical approach to decrease risk by application of the least level of insecticide at an appropriate time that will kill the tick without it needing to bite the animal to get a lethal dose. Spot-on chemicals that rely on systemic (throughout the whole body) dissemination of the active ingredient with risk of attendant side effects, and which rely on the tick biting, are not logical to my mind. There are now very effective collars with less systemic and environmental risk (with good pet management) and which mostly kill without the need to bite, that can be used in affected regions. Although even these are not without some risk of exposure.

So clearly the Human Risk from parasites of pets is, whilst not nil, negligible and quite arguably resolved in the main by good personal hygiene. Education of pet owners I would argue would go a lot further towards reducing risk to human health than selling chemical products.

Lungworm: Angiostrongylus vasorum

On the surface this appears to be a special case, with reports of it spreading throughout the UK, or at least the reports have increased and are recorded cumulatively as the marketing has raised awareness. However, the very marketing that seeks to strike fear into our hearts that our beloved pets will die a terrible death also contains the information to calm those fears –or does it? (8)

It is stated that there is a product that effectively resolves infections after just two doses 32 days apart (8). Great news, nothing to fear then? Do I believe that? No, nothing is that perfect, the treatment group was small, and reports are coming in of failures in preventative programmes now (from discussions with a testing laboratory).

That said my experience is that it works mostly, and I would prescribe it more frequently to a confirmed infected case as it seems illogical to treat at greater intervals than the pre-patent period of the worm and expect 100% efficacy anyway. It doesn't happen that way in other species, so I don't see why it would in dogs.

At least the number of deaths is not huge. Around 6 every quarter if reports are to be believed (there may be other cases missed diagnostically, or just not reported). From that figure one has to suspect clinically asymptomatic infection is more likely and the Danish approach already discussed is more logical as a way forward. And compare that to the estimated number of Road Traffic Accidents involving dogs in the UK, at around 100,000. Investment in training and a collar might be a better focus for marketing campaigns targeting responsible dog ownership.

The main source of spread is arguably the urban fox. Data shows infection rates of foxes at around 18% (50% in the south east) (8). Keen Springwatch fans will recall the coughing fox that was chased out of it territory in Brighton and travelled miles and miles before disappearing off the radar, presumably spreading infection all along its path? Its perhaps not politically correct to blame the fox, but in my opinion the movement of pets around the country is not enough to explain the spread of a condition where even the Kennel Club’s website explains: “Not every snail or slug carries the disease and lungworm's geographical limitations means infection is currently relatively uncommon, but it does rear its head from time to time”.

Logic says do not encourage urban foxes into your garden, if there has been case locally consider how best you protect your pet, but in my opinion the best route to take is to monitor your pet for infection and keep the products that are effective, effective, so they are there when you need them the most. Like antibiotics, if used indiscriminately resistance to currently effective medications is inevitable.

What are the Side effects of these chemicals? What are their impacts on the environment?

There are now so many chemicals on the market that it would be difficult in one article to assess and present them all even if they were all known about and even published. Side effects that can affect the animal, associated animals (including humans) and worryingly also the environment are rarely researched as long term issues, published or even reported. And researching a negative result takes years and massive population cohorts to determine.

Add to that the UK reporting system of reporting adverse reactions is reliant on voluntary engagement, and various surveys in the human field with such systems suggest that as high as 95% of problems are never reported at all (9)

So we have to look at data sheets from manufacturers for acute reactions, and what long term human studies there are for more information. There is also a lot of information on governing agency websites of reports of adverse reactions, and a number of campaigning groups now becoming very active on the internet and on social media over concerns with some of the products being applied to pets.

Perhaps the most commonly used insecticide in spot-on preparations in pets is Imidacloprid – a Neonicotinoid.

Neonicotinoids are classified by the United States Environmental Protection Agency as both toxicity class II and class III agents and are labeled with the signal word “Warning” or “Caution.” Because the neonicotinoids block a specific neuron pathway that is more abundant in insects than warm-blooded animals, these insecticides are more selectively toxic to insects than mammals (10). Note the words – more abundant – not therefore not present….

The most available toxicity data of the neonicotinoids is with imidacloprid. These data indicate that it is less toxic when absorbed by the skin or when inhaled compared to ingestion. It causes minor eye reddening, but is non-irritating to the skin. Signs of toxicity in rats include lethargy, respiratory disturbances, decreased movement, staggering gait, occasional trembling, and spasms. There are no accounts of human poisoning, but signs and symptoms of poisoning would be expected to be those similar for rats (10).

Those are acute symptoms, but there are general population studies in humans reporting associations between chronic exposure and adverse developmental or neurological outcomes, including tetralogy of fallot (a developmental heart condition), anencephaply, autism spectral disorder, memory loss and tremors (11).

Accepted these studies presented limited and weak data, but enough to raise concerns and a call for more research. Other studies have raised concerns over high dose exposure leading to degenerative changes in the testes, thymus, bone marrow and pancreas. Cardiovascular and hematological effects have been observed. Long term low dose exposure has been associated with effects on the liver, thyroid and weight loss. In rabbits studies have raised concerns over reproductive toxicity, developmental retardation and neurobehavioural deficits. (12)

If we think of the problems we are seeing in general practice today, there has to be concern that some of the problems we see might be a consequence of acute and chronic exposure (including of Vets to animals that have had these applied). Remember always absence of evidence is not evidence of absence – it is better in my opinion to adopt a precautionary approach than to find out later one could have avoided the avoidable.

There needs to a common-sense proportionate risk based assessment of the need for control of parasites in pets.

Clearly other countries are leading the way and regard the environmental impacts as more important than occasional infection in pets. Treatment is not prevented, it just must be with correct diagnosis and investigation and the response be proportionate to the risks. This is no different than the current initiatives for antibiotic reduction that are widely recognised as responsible, even if there are individual casualties from time to time.

Consumers in general and the pet-owning public in particular need to be more mindful and questioning rather than trusting what they are told by manufacturers and those with a vested interest in selling products. Vets need to take the lead and educate the public to only use these products when absolutely necessary and only after diagnosis and only in the correct amounts to resolve a problem efficiently and effectively with appropriate disposal of any contaminated waste and fluids (stools, urine, waste from shampooing).

If applying any topical insecticide keep the pet away from children until it can be guaranteed that it is safe for them to be in contact.

Firstly before putting chemicals on your pet ask yourself - would you willingly apply pesticides and other chemicals to your children on a monthly basis? If not then why are you doing this to your pets? And anyway is the low-level exposure of humans as a result a potential route for harm? And what are the risks for the environment from using that product?

Then consider

• In Tick areas where the ticks are known to carry disease risk, use effective collars that act both as insecticide and repellent. Take these off on walks if the dog is going into water
• For ALL worms only to worm adults based on need. Send regular faeces samples to a laboratory for monitoring (2-4 times annually). Treat only for species identified as a concern, and at high levels indicating a problem.
• In all cases where worms are found in quantity investigate for concurrent disease that might have an impact on the immune system.
• Worm Cats and Dogs once they have given birth, and worm puppies and kittens through the at     risk period.

For Fleas and other ectoparasites, treat on first sign of infestation with an effective product until the problem is resolved. If concerned over long term problems use an effective collar during the spring/summer months, but take these off on walks if the dog is going into water.

It was in 1965 when I went to Liverpool Veterinary School.

Our year was the last one to use the horse as the type animal for anatomy, and also the last year to have a practical pharmacology exam.

We were given prescriptions and then made the appropriate medication: pills using a pillboard, cutter and cup; a lotion; a cream and a medicine. Points were gained for using the correct bottle or other container, sticking the labels on two thirds of the way up the bottle, and also for incorporating the correct materials. The Sub-dean called it ‘applied alchemy’. It will come as no surprise to you that homeopathy was never mentioned officially. If the topic was ever raised it was as a source of humour.

Although the use of antibiotics and steroids was firmly established in veterinary practice by the time I qualified, the use of Galenicals and herbals had not died out. I still remember using tabs digit leaf. They were small white tablets in which small pieces of leaf material could be seen quite clearly.

They were extremely effective and could be given to dogs of all sizes without any side effects being noticed.

However a pure glycoside was isolated in 1875 and declared to be “the active principle”. It’s full structure was not determined until 1962 when pharmaceutical chemists were able to manufacture it. That is when things started to go wrong for the medical professions.

The chemists claimed that digitalis leaves varied, one from another, and contained a multiplicity of ingredients so that each batch would be chemically different from each other.

In contrast, their compound (digitoxin) was pure and so each batch could be standardised. So in spite of there being no practical troubles or “side effects” with the use of the natural leaf, the artificial chemical ought to be a much better choice even though it had the effect of causing vomiting in 1% of users.

The professions bought into this argument, namely that artificial but standard chemical medicines were better than natural but slightly variable ones, even though they caused more adverse reactions. These were swiftly renamed “side effects” which sounded less damaging to the patient.

The medical professions bought into this new scientific – sounding approach to medicine production, not realising its full implications, i.e. you couldn’t patent a naturally occurring substance but you could patent a manufactured equivalent of an active principle. It was this ability to patent their products that lead eventually to the development of the modern powerful pharmaceutical industry

In the 60’s most medical cases were given a 3-day course of Streptopen injections, i.e. a penicillin/streptomycin mixture, usually in conjunction with Betsolan. 

The rationale was that the antibiotics would deal with any infection, whilst the steroid would stop any serious inflammation developing; or if inflammation was the prime concern the steroid would prevent infection developing whilst the immune system was suppressed.

In the late 1960s oxytetracycline began to replace Pen and Strep and the initial injection followed by a 5-day course of tablets began to emerge.

During the 70s and 80s not only did more, stronger antibiotics come on to the scene but so did more powerful and longer acting steroids appear.

This was when I began to get disillusioned with my career, particularly with respect to chronic inflammatory conditions.

I could suppress symptoms by giving increasing doses of steroids, but the symptoms returned soon after the steroids were stopped. 

I sort of fell into a cycle of periods during which I gave high doses which diminished the symptoms but caused a high thirst to develop followed by a low dose period in which the thirst disappeared but the symptoms only vanished for a relatively short period.

Then when the stronger, longer acting steroids appeared, we began to see adrenal gland malfunctions. It was all quite depressing.

It was at this stage of my career that I began to associate anal gland impaction with ear trouble. I discovered that almost invariably dogs with otitis external also had impacted anal glands and that the ears improved quicker if the glands were expressed. I also noted a progression of itchy skin going to recurrent A/G trouble and then onto ear problems. I couldn’t explain it then, but then I had not heard of Hering.

The consultation is at the very epicentre of veterinary medicine. It is the cornerstone of communication, diagnostics, client education, practitioner fulfilment and practice revenue. Sadly, in general veterinary practice today, it is almost impossible to achieve.

The average length of consultation in vet medicine is about 10 minutes, according to Robinson et al., writing in the Veterinary Record in 2014.

Bizarrely, within the 182 consultation study, the 9 minutes and 49 second median consultation time does not count time spent reading or writing clinical notes before or after the consultation, talking to the client in the waiting room, or preparing medications or samples once the client had left the room.

Maybe the authors live in an ideal world where irksome things like walking, greeting and doing a good job are now superfluous? Whichever may be true, it would suggest that a ten-minute vet consultation is typically not fit for purpose.

By my calculation, the 'average' (i.e. perfect, swift, uncomplicated, sterile, business-like and totally unrealistic) consultation, there needs to be nine stages: Preparation and note reading (at least 60 seconds), greeting (30 seconds), understanding owner's concern (at least 30 seconds), examination (at least 120 seconds), summary of findings (30 seconds), treatment (90 seconds), explanation of vet's expectation (at least 60 seconds), conclusion (90 seconds) and note writing/sample preparation (at least 60 seconds). This adds up to an absolute minimum of nine and a half frantic minutes.

That's 2 hours consulting in the morning, then 2 hours in the evening for most of their career. Is there any wonder that vets are renowned for heading up the professional suicide rates and mental health is now a hot topic.

​

Of course, some consultations will be shorter, some longer, but I would suggest all have a degree of rush, stress and compromise. Add simple and everyday complications like vet inexperience, complex cases, vets new to a colleague's ongoing case, long written histories, chatty clients, nervous animals and unforeseen circumstances, and you have the recipe for the perfect storm. 

The consequence of this stress bubble (the consultation) is poor communication through lack of time (increasing the chance of litigation), overuse of pharmaceuticals to 'get the client out the door' and migration of very able vets out of general practice into industry, child rearing or quitting vet medicine altogether.

Corporate practices are now prominent across the whole of the UK. Here, turnover of vets is high, often using younger clinicians, some with English as a second language and consultation length is tightly controlled. All these factors increase vet stress in the consultation, reduce consultation quality, helping neither the vet, the business, the client or the pet.

Pressured vets prescribe more drugs, treat less well, increasing the likelihood of repeat visits, so needing more drugs and further costly diagnostics. Who shoulders the brunt of the fallout created by short consultations?​

Your animal is the put-upon partner in this pressurised medical interaction. They suffer more vet visits, longer periods of ill health (as they are passed from vet to vet), increased likelihood of unnecessary intervention and living with an anxious, frustrated owner.