Hi Everyone. This post has been brewing for a considerable period of time. I have decided to release it finally, rather than have the same conversation with people, over and over again, about the evidence base of Homeopathy.

In short: Homeopathy does have an evidence base. This evidence base is, when taken as a whole and evaluated in light of the way Homeopathy is practiced, positive. Homeopathic methodology does indeed contain many aspects which makes evaluating Homeopathy in a clinical trial difficult, but these problems are slowly being overcome through improved clinical methodologies. Other lines of evidence supporting Homeopathy include laboratory studies and historical records of Homeopathy’s use, particularly in infectious diseases.

Now to begin, clinical trials are the standard method by which modern Allopathic medicine evaluates the outcome of most interventions, and have been taken up by other branches of medicine as well. This method is, on the whole, designed to compare a treatment, and a non treatment (often termed a placebo) a treatment deliberately calculated to be ineffective. The results are numerically calculated in some way and compared to one another using a number of statistical tools. Results are either statistically significant (i.e. found by the methods being used to be greater than what would occur by chance) or statistically insignificant (found by methods to be within the bounds of what would occur by chance).

Homeopathy has been evaluated by means of clinical trials for hundreds of years. However the nature of Homeopathic prescribing, the deeply detailed nature of casetaking, the therapeutic nature of casetaking itself, and the multiple adjustments and refinements of potency needed during therapy, which makes placebo control difficult all combine together to make clinical trials challenging to undertake for genuine, pure Homeopathy. Methodological refinements have indeed been made to the clinical trial procedure over the past several difficulties, but they have not been completely successful, often creating outcomes in which the controls of a clinical trial result in data which are less than what one would expect from clinical practice.

Within the basic framework of a clinical trial, many variables can influence results, biasing the results in a particular direction. The kinds of influence have been assessed by researchers over the years, and tabulated. Several such measures exist, but the one in this link is particularly widely used.

Homeopathy has been examined by multiple clinical trials to determine efficacy throughout the years. Many of these trials have been negative. Many have been positive, until recently, the compilation of the data from these trials had not been done in such a way as to examine the validity of Homeopathy as a whole. Recently however this strategy has been adapted. Termed a Meta-analysis, this method has been used in a number of fields with sufficient research, allowing for larger conclusions to be drawn. I will go through them, followed by a summary table at the end of this discussion.

The first meta-analysis was preformed in 1991 by Kleijnen and published in BMJ. It found, in the small amount of clinical trials available at the time, a positive result.

The next meta-analysis was published in the Lancet in 1997 by Linde. Of 185 trials found, 115 met inclusion criterea, with 89 having adequate data for inclusion. Linde did not differentiate methodology, but pooled studies of all varieties of Homeopathy regardless and found an Odds ratio of 2.45 (with a 95% confidence interval of 2.05-2.93). This is a strongly positive result.When corrective factors for publication bias were added, the odds ration decreased to 1.78 (1.03-3.1), weaker but still positive. Analyzing only high quality trials resulted in results of 1.66 (1.33-2.08). Linde was repeatedly criticized for lumping data of different quality together, and for lumping together trials of individualized and nonindividualized homeopathy, so further studies were conducted.

Ernst also conducted several reviews in this period this first (Ernst E: Are highly dilute homeopathic remedies placebos? Perfusion 1998;11:291.) purported to reanalyze Linde’s 1997 analysis in light of criticisms that it evaluated many conditions, included nonindividualized trials, and include lower potency preparations that could potentially contain molecules of the original product.His analysis of the, in his view, higher quality studies, shows an odds ratio of 0. Hahn has criticized this study as including only 5 studies, and thus far less valid than Linde’s original 1997 analysis, despite it’s flaws.

In 1998 Linde conducted a study of clinical trials of individualized Homeopathy. he found a number of methodological and quality issues, but pooling the data regardless, found a positive result with an odds ratio of 1.62 (95% CI 1.17-2.23). However, when the analysis was restricted to only higher quality trials, no significant effect was seen, though a positive trend was observed Odds ratio of 1.12 (0.77-1.44). As discussed above, the many issues in clinical trials of Homeopathy at the time, make this conclusion not terribly surprising, though this problem is remedied in more current research. Linde explored this in a subsequent article in 1999 exploring the effect of trial quality on effect size in Homeopathy studies. He found that higher trial quality often produced smaller effect sizes. This is important, as many critics seized upon this as proof of lack of efficacy of Homeopathy, forgetting that other research has shown this effect to be consistent throughout medical research ( ie not a specific problem to Homeopathy).

In 2000 Ernst again published another Meta-analysis, in which he criticized Linde’s 1998 analysis as flawed due to the weaknesses of the studies used. His response was to extrapolate trends based on Linde’s 1999 study of trial quality, and suggest a linear trend (when in fact the data is asymptotic), that trials with a perfect quality would theoretically move towards results of 0. This is strongly criticized by Hahn as prioritizing imagined and extrapolated data over real data, particularly bizarre when he had access to the real data.

The next meta-analysis was preformed by Cucherat et al in 2000 and published in the European Journal of Pharmacology. It took 118 trials, judged 16 to meet inclusion criteria, and then combined p values together to form a grand p value, an extremely unusual method of analysis, one which Hahn notes to be likely to give the least favorable statistical result to Homeopathy). Despite this odd method of analysis, the results of the analysis were positive with a grand P value of <0.000036 (i.e. the results had a less than 3.6 out of 100 000 chance of being due to chance). Studies with less than 10% dropouts had a slightly lower p value of 0.084 (8.4 out of a 1000 chance of being due to placebo) and studies with less than 5% dropout had a p value of 0.082, on marginally above the generally accepted threshold for statistical significance. However this standard was extraordinarily rigorous, with dropout rates of less than 20% being commonly accepted as adequate.

The next Meta-analysis of Homeopathy as a whole was Shang, published by the Lancet in 2005. This study took an extraordinarily bizarre approach of choosing 110 randomized controlled double blind trials, and then “matching” them to 110 comparable allopathic trials, with some high quality Homeopathy studies being excluded solely due to a comparable allopathic trial not being able to be found. The data in these 110 trials were not combined to creat an odds ratio. Instead the data from all but 21 trials of Homeopathy were excluded due to unspecified quality measures. The authors then excluded, for unclear reasons, all but 8 trials and came up with an insignificant odds ratio of 0.88 (0.65-1.19). Fascinatingly, the identity of these 8 studies were not listed in the original publication, but were released several months later, after the media circus around this result had died down. Skeptical organizations created a vast amount of propaganda using what we now call Fake News something we will also see occurring with the more recent NHMRC report. In both cases, the subsequently revealed errors were not reported in either the popular or skeptical presses.

These results have been heavily criticized by Homeopaths and statisticians, with the overall opinion that this trial should not have been published. These arguments are summarized by the Homeopathy Research Institute, but the most significant perhaps belong to Ludtke and Hahn. Ludtke analyses Shang to find that the results gained out of his analysis are highly dependent on the subsection of trials selected, with his results being almost entirely due to a single large nonindividualized trial of Homeopathy. Hahn comments that the funnel plot tool used by Shang is completely inadequate to evaluate treatment effects in different medical conditions and that in order to reach his conclusions of Homeopathy lacking effect beyond placebo, 90% of clinical trials must be excluded. In fact, it has been determined by Ludtke, that if Shang had included all 21 higher quality trials, even with his bizarre selection criteria, he would have found a statistically significant effect greater than placebo.

The next major metanalyses of Homeopathy was in 2014, by Mathie, published in Systematic review. It included all available RCTs, and rated all of them with several quality assessment measures. Unfortunately, again likely due to methodological issues, no trial rated as no risk of bias in all domains. However the trials that had low or unclear risk of bias in one domain were analyzed. 22 trials were had extractable data, and were subject to analysis creating a significant odds ratio of 1.53 (1.22-1.91). Restricting the analysis to trials rated as reliable evidence created an even higher odds ratio of 1.93 (1.16-3.38). This is explained wonderfully by Mathie himself in the following short presentation:

This analysis stands at the present day (April 2018 as of writing) as the most current, complete and unbiased of all reviews of Homeopathy. The low quality of evidence does merit caution, but the results do clearly indicate that the existing data do suggest that Homeopathy has an effect greater than placebo. This is the current state of the evidence from clinical trials, and to deny this is to go against the existing data.

Ernst has criticized the results as excluding one of his own trials. Mathie graciously explained on Ernst’s blog the exclusion criteria, but added Ernst’s data to his despite not meeting the criteria, finding the same results. This is published in a pdf separate from Mathie’s original article.

The next, and probably lowest quality of analysis is the NHMRC review done in 2015, commissioned by the Australian government to evaluate the evidence of Homeopathy. This review has a number of methodological problems, which have been summarized expertly by the Homeopathy Research Institute. I will summarize them as follows (and much gratitude to HRO for presenting these points so succinctly):

• NHMRC did the review twice
• The first review, and even it’s existence, was not disclosed to the public
• the NHMRC, upon questioning, responded that the first review was low quality despite being conducted by the individual responsible for developing NHMRC’s guidelines on how to conduct evidence reviews
• FOI requests confirm that a member of NHMRC, Fred Mandelsohn, confirmed the first review to be high quality stating ““I am impressed by the rigor, thoroughness and systematic approach given to this evaluation [….] Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.” 
• NHMRC stated their results were based on over 1800 studies, when in fact they were based on only 176
• NHMRC has used a method which has never been used in any other review, declaring that only trials of over 150 participants would be accepted, excluding the vast majority of high quality homeopathic trials, which due to lack of funding tend to be smaller, and despite the fact the NHMRC routinely conducts studies of less than 150 participants
• The above rules resulted in exclusion of 171 of 176 studies, leaving only 5 to be used as the basis of the study
• The chair of the second review, Peter Brooks, signed a conflict of interest form declaring himself “free from any association with any organization whose interests are either aligned or opposed to Homeopathy” when he was a member of the anti homeopathy lobby group “friends of science in medicine”
• The NHMRC review included no homeopaths or experts in Homeopathy research, despite the NHMRC guidelines requiring such an inclusion

Rachel Roberts of the HRI presents this set of circumstance expertly in the video below.

The evidence against the NHMRC in frank academic bias and misconduct is so strong the HRI is pursuing a complaint with the relevant Ombudsman in Australia. The initial investigation has found sufficient evidence to warrant a full investigation of NHMRC’s conduct, which is ongoing.

The Skeptical media had a field day with this study, producing a deluge of articles and media misrepresenting the conclusions of the NHMRC review and using Fake News strategies to expand it’s reach to multiple audiences. The subsequent faults and criticisms of this report, and it’s current status of being investigated by the government has gone unreported.

The most recent metaanalysis of Homeopathy was done by Mathie in 2017, and focused on all nonindividualized trials of Homeopathy. This study focused on Randomized, double blinded control trials of nonindividualized Homeopathy, and found 75. 48 trials had high risk of bias, 23 uncertain and 3 had low risk of bias and were listed as reliable. The standard mean deviation was the measure used. 54 trials had extractable data and pooled data shows a SMD of -.33 (CI -.44,-.21) which was statistically significant. Adjusting for publication bias this was adjusted to a still significant -0.16(CI-.46, -.09). Reliable data resulted in an insignificant result of -.18 (CI -.46,+0.09). This result has gone unremarked in the greater skeptical literature on Homeopathy, despite both major negative reviews of Homeopathy (Shang and NHMRC) failing to differentiate these two types of studies.

Skeptical organizations and their sympathizers in the media have utilized the flawed negative studies, presented them without context, and used them as a justification for their already held conclusions that Homeopathy has no effect greater than placebo. This is not just a problem with skeptical organizations, as much of science journalism suffers from similar issues. Skeptical organizations however have embraced Fake News tactics in order to spread their message, having just as much culpability for the modern state of disinformation as other sponsored state actors using those same tactics to advance their political goals.

Conclusion:

This blog post reviews all the relevant meta-analyses of Homeopathy as a whole preformed. All meta-analyses preformed in at least a somewhat open and rigorous manner have found statistically significant effects suggesting Homeopathy has a greater than placebo effect, or at least a strong trend in that direction. The meta-analyses with questionable methodology, one of which is undergoing government investigation for academic irregularities, found negative results, which have been demonstrated to be a direct result of their exclusion of vast swathes of the Homeopathic clinical trial literature based on arbitrary and unexplained criteria.

The clinical data are flawed. Issues with methodology of randomized controlled clinical trial use in Homeopathy, combined with a lack of research funding have produced a lack of high quality trials and data. However, the data we have point towards Homeopathy having an effect greater than that of placebo.

There can be no argument with this conclusion, aside from new data emerging. Anyone who disputes this is going against the existing set of highest quality evidence on Homeopathy.

The Squamates are one of the very few well proven groups of animals. However, their provings tend to focus on the better known and more prominent venomous snakes, rather than the less prominent snakes, and lizards.

Most notably, the two species of Tuatara, Sphendon punctatus and Sphenodon guntheri, the two remaining species of the ancient Rhynchocephalian lineage, remain unproven. Their addition to the materia medica would be most welcome.

In terms of the Squamata, proving work has been inconsistent, with much needing to be done to complete our understandings of the various groups and families.

Dibamidae have no remedies either potentised or proven at this date, any species would be very useful to the profession. Gekotta have only a single case, with not proven members. Sciniformata have only a single meditative proving. Lacerta are also very poorly represented in the material medica. Any provings would be well received. Particularily interesting would be some species that reproduce parthengonically, such as Zootoca vivipara.

Within the Toxicofera, the Iguania and Anguimorpha have only a few provings each, both needing much more work for an extensive understating to emerge.

The snakes are one of the few over proved groups within the animal kingdom. However the snake provings have focused on the larger families, the Elapidae, Viperidae and to a lesser extent the Booidae. Even within the caenophida the families Homolopsideae, Patreatidae, Vipidae, Lamprophiidae and Xenodermatidae have no provings or potentised specimens whatsoever. The Colubrae have only a few proven remedies. Provings of any of these snake would serve the profession well. However, snake provings in general should be seen a s a low priotiry, as in this rare case, we seem to have enough remedies from this class of animals.

Image Source: https://commons.wikimedia.org/wiki/File:Green_Mamba_cropped.JPG

So, a friend has recently asked me to comment on the latest video debunking Homeopathy. Watching the video, I was confronted by a number of logical fallacies, falsehoods, and even outright deceptions. So I decided to catalogue them, one by one.

1. The first problem in the video (about 2 mins into the video) is the exclusive assumption that the only possibly mechanisms for therapeutic efficacy at atomic, or molecular in nature. This is a fundamental assumption of many contemporary ideas about the nature of reality, found in modern materialism and the skeptical movement, but is not founded in the most current understanding of the sciences. Recent sciences have focused on the properties of solutes, the formation of large scale nanostructures in homeopathically prepared solutions. In short, the water and alcohol used to make homeopathic remedies is in no way the same as regular tap or distilled water not prepared this way. A summary research paper on this topic can be found here.

In a fun twist, one of the authors of that paper, a materials scientist, is fond of referring to the no atoms objection to Homeopathy as “high school chemistry”.

2. The idea of the memory of water (3 min). Many objections to the idea of a change in the properties of water having something to do with Homeopathy suggest that all water would contain an imprint of everything it ever came into contact with. This, in addition to being quite intellectually lazy, is experimentally disproven. In the research paper cited above as well as this one, a variety of experimental investigations have determine stable changes in homeopathically prepared solutions, differing from those of unprepared water.

3. The ancient allopathy fallacy (~3:20). Another objection to Homeopathy states that it’s popularity in the 19th century was due to the fact that Homeopathy was, at the least, not harmful, whereas the allopathic ( conventional) treatments of the time actively harmed the patients. This line of thinking ignored the statistics collected by Homeopaths of their work, showing mortality rates lower than would be expected from expectant treatment, and in some cases lower than those achieved with modern medicine and nursing care in the modern era. Take, for example, Pneumonia. Community acquired pneumonia has, untreated, a mortality rate of approximately 30% in the elderly, and 18% in individuals over 12 years old with competent immune systems (Kiple KF (ed.). The Cambridge World History of Human Disease. Cambridge: Cambridge University Press, 1993: 938-939.). Conventional treatment of allopathic medicine shows mortality rates ( in the present day) of about 13.7%. This rate has stayed remarkably stable historically, unlike many other infectious diseases, which wax and wane in terms of mortality. If Homeopathy was truly only not harmful, but lacked any healing power, the statistics from this time should show similar mortality rates.

In fact they do not. Homeopathy shows consistently lower mortality rates. I have reproduced screenshot from the Homeopathic book “The logic of figures” a book compiling 19th century Homeopathic statistics. In it, a mortality rate of 5.7% of 1098 patients is reported. As well a figure from American Homeopathic hospitals ( yes, such things existed once) reported a mortality rate of 2.8% on 11 526 patients (Fiske RE. A survey of the statistics of the homeopathic treatment of lobar pneumonia. Journal of the American Institute of Homeopathy 1928; 21: 886-993.). Definitely too large to be chance, and too low to be due to non harming the patient.

4. The lifestyle objection (3:40) posits that Homeopathy has prescribed very strict lifestyle changes, which benefited the patients, and reduced the course and severity of their disease apart from the effect of Homeopathic medicines. This ignores the effect of Homeopathy on infectious disease, sampled above, in which Homeopathy acts immediately in acute situations, without the time for lifestyle changes to take effect. It also fails to explain why similar lifestyle changes prescribed by conventional physicians, with the addition of presumably efficacious medicines, failed to have an even greater effect than the lifestyle changes of Homeopaths, prescribed with presumed placebos. If lifestyle is all that is efficacious about this therapy, results such as those listed above with pneumonia should be available to any practitioner, even in the modern era, with appropriate lifestyle recommendations.

5. The modern medicine idea (4:20). The idea that western society is the longest living and healthiest society that has ever existed on the planet, and that this is exclusively due to modern western medical care, is again, categorically false. Modern Western societies life expectations are dropping (particularly in the United States). A number of historical societies enjoyed extremely long lifespans, with some having  a longer life expectancy than the modern west, with no access to modern medical care. Buettner, the author of a book on the subject, reports these factors as being critical in creating these blue zones.

• family engagement
• moderate physical exercise
• purpose and meaning in life
• stress reduction
• moderate calorie diet
• largely plant derived diet
• moderate alcohol intake
• Spirituality
• active social life

I would add, that the vast majority of the increased lifespan is the work of improved sanitation and nutritional status, as well as other public health measures. A recent study described this effect, with large numbers of the public misattributing the increase in lifespan to medical care, rather than public health.

5. The idea Homeopathy has no effect beyond placebo (4:45). This stament is again categorically false. Homeopathy has been analyzed in about 8 metanalyses. Of these 6 were positive. Two were negative. Both of these were questionable methodologically and so deserve greater exploration.

The most recent and famous one, is the NHMRC report, which was recently made quite famous on the skeptical media for it’s proclamation of Homeopathy’s inability to be statistically distinguished from placebo. This conclusion however was dependent on a number of assumptions and rules added to the review process, used nowhere else in the research literature, and without justification by the authors. The authors as well made a number of methodological failures, such as inability to understand certain research designs, and failure to distinguish individualized and non individualized methodologies. As well, there was an earlier report, currently under investigation by the Ombudsman for the NHMRC, which was shelved and replaced by the current report. There is suspicion the first report was favorable to homeopathy, and the organization was outcome shopping, looking for the results they wanted and adapting their methodology to suit. A full analysis of the NHMRC reports many flaws is in the video below.

The second negative metanalysis was the 2005 Shang analysis. The absolutely massive flaws inherent to it have been discussed elsewhere on my blog, but I will give here the excellent discussion of it by the Homeopathic research institute.

6. The placebo effect (5:20). This effect has recently become something of a deus ex machina for those who debunk systems of medicine not embraced by the public health system. In short, yes it is very real. However, Homeopathy has been repeatedly demonstrated to have effects beyond that of the placebo effect, including in the highest quality trials available on the subject, as analyzed by Mathie in 2014. You can watch Mathie’s presentation on his paper below. This argument ignores the available evidence, and actually goes against it.

7. The Big Sugar argument (~6:00). The argument is that Homeopathy is a 17 billion dollar industry, engages in lobbying and thus is somehow equivalent to the pharmaceutical industry. Firstly, lets assume the 17 billion dollar argument is correct. I frankly don’t know.

The global annual revenue for pharmaceutical sales is approximately 1.1 trillion annually. This is a truly staggering amount of money, and has given rise to the pharmaceutical industry’s well known activities in lobbying, research corruption and medical education. Homeopathy in the figure given in this video (and again, I have no idea what the accuracy of this figure is) total revenues constitute approximately 1.54% of this total.

To suggest that Homeopathy is a vast and profitable business is quite simply false. While one firm (Boiron) has achieved some size, with 614 million euros in total revenue in 2016, this pales in comparison with any of the top 10 pharmaceutical companies, each of which reports tens of billions of revenue in 2016. And remember, Boiron is the leader, a very large part of the homeopathic market is dominated by smaller pharmacies operating on small budgets, making specialty products and orders with relatively low incomes and profit margins. It is a labor of love for dedicated pharmacists, not a vastly lucrative field.

To compare the efforts at systematic corruption of the Homeopathic and pharmaceutical industries is incredibly disingenuous.

8.The Homeopathy harms by omission argument. This argument has been around since Homeopathy’s earliest days, in which it was argued that Homeopathic therapeutics harmed individuals from the delay of applications of more effective therapeutics, such as bloodletting and heavy metals. This argument is based on the assumption of Homeopathy consisting solely of a placebo effect, something we have seen above, is not true, both based on clinical trials, and on our discussion of serious infectious disease like pneumonia, above.

Secondly, individuals’ consumption of holistic or alternative medicine are not correlated to less educational status, an propensity towards being deceived, or other factors. Individuals choosing holistic care tend to have higher incomes, higher educational attainments, and in my experience, higher expectations of conventional care than it is able to provide, even at the best of times. Homeopathy has traditionally be the medicine of the upper classes, and still is to a large extent in Britain. It has traditionally been favored by individuals with higher educations, and the expectation that medicine should actually cure them. Dana Ullman wrote an entire book on this subject, detailing the many famous individuals who chose Homeopathy, and why they did so. Sue Young also has a comprehensive historical blog, showing a number of leading figures, presidents, suffragettes, scientists, all individuals of discrimination and worth, who chose Homeopathy for themselves.

9. The compassion argument (6:37). A key argument against Homeopathy and it’s efficacy is the argument that our longer consultations and personal empathy fill the needs of individuals in an impersonal and sterile health systems. This is a very poor opinion of medical practitioners. I may be extremely critical of the systematic legal oppression against Homeopathy and Naturopathic medicine instituted by the current medical system, but I would not accuse medical staff of anything but the highest regard, empathy and care for their patients in the vast majority of circumstances. Furthermore, I myself have a very busy practice, with appointments running often at 10-15 minutes. Not that much long than a conventional MD’s visit length. I get stressed and overwhelmed, and can sometimes fail to connect to patients. Yet, my treatments still work, despite that failing due to economic demands.

To suggest that Homeopaths and Naturopathic doctors get better results purely to to empathy is a profound insult to the dedicated medical staff throughout the world. We get better results because of our therapies and our work in harmony with the bodies’ inherent self healing mechanisms, instead of against them, as in allopathic care.

This video piles falsehood upon falsehood, in an, admittedly, quite visually lovely piece, but one of no serious intellectual value, or any real accuracy.

Hello Everyone.

I just wanted to let everyone know I wish you all a merry Christmas, Happy Holidays and to express how privileged and grateful I am to have you guys in my life as patients.

I hope we together have the best New Year, full of new discoveries, restored health for us all, and a universe transformed by our effort!

Much love!

Turtles are generally a very poorly proven group of vertebrates. We have only 5 proven members of this species, all from the Cryptodira. Any Members of the Pleurodira would be excellent candidates for proving. Some interesting candidates would be the African helmeted turtle (Pelomedusa subrufa) a species which has been observed engaging in mutuallist cleansing of parasites on warthogs and rhinoceros[i] shown here[ii] . Also interesting would be the mata mata turtle (Chelus fimbriata), with it’s exquisite body shape, used to camouflage itself amoung rocks and streams in South America.

In terms of the cryptodira, a multitude of fascinating species are available. Two separate, but very similar, species of giant Tortoises are extant, the Galapagos giant tortoise (Chelonoidis nigra) and the Aldabra giant tortoise (Aldabrachchelys gigantea). Both can be over 1m long, and upto 250 kg. Geographic isolation on islands. Both of these species are remarkably long lived, with some individual Aldabra giant Tortoises being recorded as living up 184 years.

Other intriguing species for proving would be the pig nosed turtle (Carettochelys insculpta) the only freshwater turtle with flippers instead of legs, and with a remarkle nose resembling that of a pig. Also interesting would be the eastern long necked turtle (Chelodina longicolis) which is remarkable for it’s long, almost snake like neck and it’s ability to secrete a foul smelling substance upto three feet when threatened.

[i] LightMatter. Online Image accessed November 26^th 2017. https://en.wikipedia.org/wiki/File:Galapagos_dominance_display.jpg

[i] Owen, J. Turtles groom warthog in never-before-seen behavior. Oct 8 2015. National Geograhic. Online document accessed November 26^th 2017. https://news.nationalgeographic.com/2015/10/151008-turtles-warthogs-africa-animals-science/

[ii] Photo by Greg Hume. Accessed November 26^th 2017. https://en.wikipedia.org/wiki/File:Helmeted_turtle_25.JPG

Image Source: https://en.wikipedia.org/wiki/File:Helmeted_turtle_25.JPG Photo by Greg Hume.