Homeopaths can bear criticism only when it is highly diluted. Any critique from the ‘outside’ is therefore dismissed by insisting that the author fails to understand the subtleties of homeopathy. And criticism from the ‘inside’ does not exist: by definition, a homeopath does not criticise his/her own trade. Through these mechanisms, homeopaths have more or less successfully shielded themselves from all arguments against their activities and have, for the last 200 years, managed to survive in a world of make-belief.
As I will show below, I started my professional life on the side of the homeopaths – I am not proud of this fact, but there is no use denying it. When the evidence told me more and more clearly that I had been wrong, about 10 years ago, I began expressing serious doubts about the plausibility, efficacy and safety of using homeopathic remedies to treat patients in need. Homeopaths reacted not just with anger, they were also at a loss.
Their little trick of saying ‘He does not understand homeopathy and therefore his critique is invalid’ could not possibly work in my case – I had been one of them: I had attended their meetings, chaired some of their sessions, edited a book on homeopathy, accepted an invitation to join the editorial board of the journal ‘HOMEOPATHY‘ as well as a EU-panel investigating homeopathy, conducted trials, systematic reviews and meta-analyses, published over 100 articles on the subject, accepted money from Prince Charles as well as from the ‘ueber-homeopath’ George Vithoulkas for my research, and even contributed to THE INTERNATIONAL DICTIONARY OF HOMEOPATHY. It would have not looked reasonable to suddenly deny my previously accepted expertise. Homeopaths thus found themselves in a pickle: critique from the ‘inside’ is not what they were used to or could easily cope with.
The homeopathic idyll was under threat, and a solution to the problem had to be found with some urgency. And soon enough, it was found. Homeopaths from across the world started claiming that I had been telling porkies about my training/qualifications in homeopathy: “Edzard Ernst has admitted that he has over the years lied or supported a lie about having homeopathic training. In reality he has had none at all! The leading so-called ‘expert’ and critic of homeopathy, Professor Edzard Ernst, has admitted that he has no qualifications in homeopathy. etc. etc. Diluting the truth to the extreme, they almost unanimously insisted that, contrary to my previous assertions, I had no training/qualifications in homeopathy. Thus, they began to argue, that I was an imposter and had insufficient knowledge, expertise and experience after all: Professor Edzard Ernst the leading ‘authority’ on homeopathy, and perhaps its most referenced critic, has no qualifications in homeopathy. William Alderson of HMC21 also claims that Ernst’s book Trick or Treatment? shows Ernst to be unreliable as a researcher into homeopathy. Opposition to homeopathy is based on propaganda, they stated. Others wrote that Edzard Ernst’ failure as a homeopath only proves he lacked some basic qualities essential to become a successful homeopath. He failed as a homeopath, and then turned a skeptic. His failure is only his failure- it does not disprove homeopathy by any way. Once he failed in putting a mark as a successful homeopath or CAM practitioner, he just tried the other way to become famous and respectable- he converted himself into a skeptic, which provided him with ample opportunities to appear on ‘anti-homeopathy’ platforms’ as an ‘authority’, ‘expert’ and ‘ex-homeopath’! Some went even further claiming that I had also lied about my medical qualifications.
These notions has been going around the internet for several years now and conveniently served as a reason to re-categorise me into the camp of the homeopathically unqualified pseudo-experts: ‘We believe that it is time to recognise that opposition to homeopathy is largely based on the opinions of individuals who are unqualified or unwilling to judge the evidence fairly’. I, by contrast, believe it is time that I disclose the full truth about ‘my double-life as a homeopath’. What exactly is my background in this area? Have I really been found out to be a confidence-trickster?
THE HOMEOPATHIC CLINICIAN
I graduated from medical school in Munich in the late 1970s and, looking for a job, I realised that there weren’t any. At the time, Germany had a surplus of doctors and all the posts I wanted were taken. Eventually, I found one in the only hospital that was run almost entirely homoeopathically, the KRANKENHAUS FUER NATURHEILWEISEN in Munich. Within about half a year, I learned how to think like a homeopath, diagnose like a homeopath and treat patients like a homeopath. I never attended formal courses or aspired to get a certificate; as far as I remember, none of the junior doctors working in the homeopathic hospital did that either. We were expected to learn on the job, and so we did.
Our teachers at medical school had hardly ever mentioned homeopathy, but one thing they had nevertheless made abundantly clear to us: homeopathy cannot possibly work; there is nothing in these pills and potions! To my surprise, however, my patients improved, their symptoms subsided and, in general, they were very happy with the treatment we provided. My professors had told me that homeopathy was rubbish, but they had forgotten to teach me a much more important lesson: critical thinking. Therefore, I might be forgiven for proudly assuming that my patients’ improvement was due to my skilful homeopathic prescriptions.
But then came another surprise: the boss of the homeopathic hospital, Dr Zimmermann, took me under his wings, and we had occasional discussions about this and that and, of course, about homeopathy. When I shyly mentioned what I had been told at medical school ( about homeopathy being entirely implausible), he agreed! I was speechless. Crucially, he considered that there were other explanations: “Our patients might improve because we look after them well and we discontinue all the unnecessary medication they come in with; perhaps the homeopathic remedies play only a small part”, he said.
THE INVESTIGATOR OF HOMEOPATHY
This may well have been the first time I started looking critically at homeopathy and my own clinical practice – and this is roughly where I left things as far as homeopathy is concerned until, in 1993, it became my job to research alternative therapies systematically and rigorously. Meanwhile I had done a PhD and tried my best to learn the skills of critical analysis. As I began to investigate homeopathy scientifically, I found that my former boss had been right: patients do indeed improve because of a multitude of factors: placebo-effects, natural history of the disease, regression towards the mean, to mention just three of a multitude of phenomena. At the same time, he had not been entirely correct: homeopathic remedies are pure placebos; they do not play a ‘small part’ in patients’ improvement, they play no part in this process.
As I began to state this more and more clearly, all sorts of ad hominem attacks were hauled in my direction, and recently I was even fired from the editorial board of the journal ‘HOMEOPATHY’ because allegedly I “…smeared homeopathy and other forms of complementary medicine…” I don’t mind any of that – but I do think that the truth about ‘my double-life as a homeopath’ should not be diluted like a homeopathic remedy until it suits those who think they can defame me by claiming I am a liar and do not know what I am talking about.
This rather depressing story shows, I think, that some homeopaths, rather than admitting they are in the wrong, are prepared to dilute the truth until it might be hard for third parties to tell who is right and who is wrong. But however they may deny it, the truth is still the truth: I have been trained as a homeopath.
Even I you had no training as homeopath or never worked with dilutions it must be possible to criticise homeopathy.
According to Maxim Gorki (1886-1936)
“Man muss nicht in der Bratpfanne gelegen haben, um über ein Schnitzel zu schreiben”.
Or–you do not have to murder someone to know it is wrong to do so. Did I get the gist of the quote?
Thanks for the history–I was a bit vague on how you came to practice homeopathy in the first place. I read T or T years ago but no longer have a copy and had forgotten the details (if they were in the book).
I came to practice homeopathy mainly because I got this job and could not easily get another [but I had also been treated by a homeopath as a boy].
Another truly interesting post! I am currently a psychology student, hoping to eventually persue a PhD. I’ve been following you on twitter and reading every single one of your posts on this website and find each one equally inspiring. Thank you for the inspiration.
So we must assume that ALL these cited studies on animals are wrong. There is no placebo effect there ..
http://www.facultyofhomeopathy.org/research/veterinary-research/ Idid not include the link sorry.
Maybe not a placebo effect from the animal, but a double-blind placebo controlled trial controls for more than just the placebo effect. See, for example, Conforti et al. Rat models of acute inflammation: a randomized controlled study on the effects of homeopathic remedies BMC Complement Altern Med. 2007; 7: 1, noting the “discrepancies between single-blind and double-blind methods”.
I also suspect that producing that list of studies may have involved some degree of cherry-picking of positive results: “we have highlighted the 15 (42% of the total) that report positive findings for homeopathy”. Presumably you are assuming that the 20 trials that failed to report positive findings are false negatives (or maybe just that they are “statistically non-conclusive”).
I see they cite the famous “itchy dogs” study, which contained what is probably the first published report in the scientific literature of clairvoyance in a dog (dog number 16, reported in table 2).
I know one of those studies quite well, the one on diarrhoea in neonatal piglets. It’s deeply flawed and it is almost too funny that it got rewarded by Vithoulkas as the ‘best peer scientific article on homeopathy’ in the 2011 edition of his IACH Research Award. See http://www.pepijnvanerp.nl/articles/iach-research-award-for-study-on-homeopathic-prevention-of-piglet-diarrhoea/
That one has also been discussed by Kausik Datta.
George: Placebo effect is not the entirety of the null hypothesis (though it’s a significant part of it). Other elements are mentioned above including regression to the mean, natural history of disease and so on.
The idea that SCAM works in animals is debunked here: http://www.rationalinquiry.org.uk/it-works-in-animals.php
Debunked ? They say that the all researchers who test homeopathy in animals convince the owners that there is a real effect —–But when conventional medicine is used on animals this effect magically disappears….
How rational is that … !!!?
I wonder how often homeopathy will need to get disproven before the people who practice it will say that it doesn’t work. An open mind is one that can change its beliefs when shown evidence. A closed mind is one that will hold onto its beliefs in spite of the evidence. Which one are you?
The trouble is that it will never actually be “disproven” to the standards demanded by homoeopaths, because a clinical trial can never actually prove that a treatment doesn’t work.
A clinical trial will do one of two things: either it will find a statistically significant effect, or it will fail to find a statistically significant effect. While the latter is, of course, exactly what would be expected for a completely ineffective therapy, homoeopaths can define these results as “statistically non-conclusive” and (because very few trials of homoeopathy actually show it performing significantly worse than placebo) say that more trials are positive than negative.
Yes, debunked. It’s bunk, the bunk has been debunked. And what you are doing? That’s called rebunking 🙂
No, the effect does not “magically disappear” in medicine. That is precisely why we demand randomised controlled trials, to isolate real effects from placebo and other inferential errors. Nobody active in medical research is in any doubt about the need to isolate and control for nonspecific effects.
I should have called this reply “My double-life as a psychiatrist”.
For five years I worked long hours on a mental health unit dealing with patients suffering from a wide range of complex mental health issues. There were some patients who were detained there under section 3 of the Mental Health Act so reasoning with them alone was a futile exercise. Conventional medicines were the only treatment used.
Some days I would marvel at how a patient’s volatile, and unpredictable, behaviour would transform, often in a matter of minutes, after being given medication. As their anguish, distress or even violent behaviour changed every detail would be noted and subsequently discussed in “Ward Round”. In discussions with the consultant psychiatrist the multidisciplinary team would collaborate to amend medication doses and work out the care strategies needed to return the patient to daily life.
At that time I was one of the care staff. I too had ‘on the job training’ for all those years on the unit but it obviously doesn’t give me the right to use the title earned by the person who actually trained, and qualified, as a psychiatrist. Working with, or alongside, Homeopaths and having ‘some’ training does not make YOU (Dr Ernst) a homeopath yet the title of your blog post intentionally misleads people into thinking that you are/were one in an attempt to give credibility, and authority, to your views.
‘psychiatrist’ is a protected, regulated title; ‘homeopath’ isn’t. you and I and anyone else can call themselves ‘homeopath’ in the UK.
Professor Ernst protection of title aside it is quite unacceptable for a regulated profession such as yourself to claim to be a homeopath when you have had no formal training particularly as I understand that this was required in Germany at the time. This is not to say that you are not qualified to comment on homeopathy but given that your previous posts were on misinformation I am frankly astonished.
who says it is “unacceptable”? you? not the GMC or any other professional body, as far as I can see.
my claim is/was:
1) tongue in cheek
2) made well after I left Germany and made in the UK context
at no stage is it required for a doctor to have formal training in homeopathy to practice homeopathy in Germany or anywhere else, as far as I know.
I am astonished that you are astonished!
I understand that the GMC “duties of a doctor” require you to:
1)Keep your professional knowledge and skills up to date.
2) Recognise and work within the limits of your competence
To practice in an area in which you have no formal qualifications or training would I believe be unacceptable.
I am sorry that you have a problem with this.
I think you might have a problem or two understanding things:
there is no title-requirement for homeopathy, it is just another tool in the bag and doctors do not seek a title for every type of intervention they use; and working within the limits of competence does not mean accumulating useless diplomas.
“‘psychiatrist’ is a protected, regulated title”
In Mexico, India and Brasil, medical homeopathic doctor is a regulated title. You loose.
except I was writing from a UK perspective.
E. Vanwijk s said:
I hope that dire situation is remedied quickly for the sake of the health of the people.
I too am fully qualified to call myself a homeopath, as are you and everyone else.
I too am from the ‘other side’ in that I grew up in an environment of natural healing in my teens and homeopathic remedies were commonly used in my home. But I was never really a believer, I will not use the word instinct, but I just felt that it couldn’t be right and have accepted conventional medicine and treatment for many ailments and illnesses (including cancer).
I always feel that the quality of ones convictions can be measured through ones response to criticism. That homeopaths close ranks and become incredibly defensive comes as no surprise. The exact same response comes from faith healers, psychics etc. One’s lack of belief in their system is the problem. Well, when I was having chemotherapy I KNEW that it was going to work as well as it will whether or not I believe in it!
In response to George: ‘Within the limits of the power of this trial there was no evidence to show that the homoeopathic nosode tested had any effect on the cows’ SCCs’ = is a little piece of evidence I gathered when looking at homeopathy on animals
Excellent article, Sir, and very insightful. I have argued against homeopathic ‘medicine for the last two decades simply because unbiased scientific evidence does not support it. Indeed though, your boss Dr.Zimmerman was correct, other factors, such as the placebo effect play an important part in healing, but which of course has little to do with the product administered.
Dr Zimmerman’s observation reminds me of this comment by Mark Twain, in Christian Science:
Since “training” in homeopathy involves nothing but how to determine which vial of water or which sugar pill to administer, the issue of who is “qualified” is rather moot, no? It’s like arguing about whether the tooth fairy should bring a quarter or a dollar.
Professor Ernst I do not have a problem understanding the concept of protection of title, however, taking your logic is it ok for a GP to practice acupuncture without receiving any training? I suspect the British Medical Acupuncture Society would not endorse this approach and neither would your indemnity insurers. However, since acupuncturist is also not a protected title you may be happy to claim this also.
glad to hear that YOU DO NOT HAVE A PROBLEM …[in your opinion]
It is not acceptable for a doctor to practice acupuncture, or any nonsense whose purported mechanisms of action are mutually incompatible with the findings of medical science, whether trained or not.
Is disease caused by pathogens or imbalance in yin and yang? Is illness caused by biological effects or by a disturbance in qi? Science permits only one answer to either of these questions, and no doctor should succumb to superstition-based medicine in any form.
I suggest you look at this link:
It explains medical acupuncture are practiced by many physiotherapists and GPs
I have extensive training and clinical experience in Traditional Chinese Medicine. Years of colleges, including studying directly under prominent Chinese doctors who are internationally recognized authors of TCM. Training in China, Taiwan, and top schools in North America. I also spent a lot of time in Naturopathic libraries and studying Naturopathy, Yoga, etc. with college professors and clinical practitioners (chiropractors, naturopaths, acupuncturists…).
And, thankfully, today was my last day of acupuncture clinic. I’m taking an extended sabbatical, which will likely be permanent. This is because I have done years of research and concluded that TCM theory is mostly prescientific pseudoscience, with a few prescientific lucky hits regarding nutritional deficiencies and potent herbs (mostly analgesics) for conditions which are rarely encountered today and have more appropriate science-based treatments.
I have many dedicated patients who are sorry to see me take a sabbatical. I suspect for them the benefits have mostly come from my caring attitude and conversational abilities, combined with the placebo effects of putting needles in (somewhere, anywhere), and telling them to rest a while with the (often unspoken) suggestion that they will feel better afterwards. If I continue to do research and am interested and able to present an acupuncture practice which doesn’t involve superstition or deception, I may resume. It seems that that would involve telling patients “it doesn’t matter where I put the needles or how deep I put them, but our therapeutic relationship should help you feel better. Please pay attention to my lifestyle advice to make real changes in your long-term health conditions.”
Saying that Professor Ernst isn’t a “real” homeopath is a perfect example of the “no true Scotsman” fallacy. If there were good evidence that homeopaths with a certain type of training (i.e. classical homeopaths, etc.) had actual better clinical results than others, that may be something. But all evidence points to the caring, attentive intake used by homeopaths as being the primary factor in the positive reports from patients later. Giving the idea that “I’ve listened to you, I’ve asked questions to learn more, I care about you, and based on all of my knowledge and experience, I believe this pill will cause a change and enable you to heal and progress in your life” is where the therapeutic ‘magic’ happens. But given that homeopathic pills are, according to all known scientific testing and good clinical research, all identical and not identifiable as to purported ‘ingredients,’ giving that clinical recommendation is based on either ignorance or deception. Same with doing ‘special’ acupuncture points to fix addictions, internal diseases, or emotional problems. There isn’t an “anxiety point,” “blood sugar” point, “tobacco addiction” point, or “5 needle protocol NADA treatment” for cocaine and heroin addiction which have been conclusively shown to be better than doing other points with fake needles that don’t penetrate the skin.
Practitioners of homeopathy and acupuncture often have positive intentions to help people. They have often investing huge amounts of time and money in learning their trade and becoming certified/licensed. They often need to be convincing and “effective” to pay their bills (and student loans). Many of them aren’t aware of the best quality research which shows their modality is no better than a credible placebo. Many choose to be anti-science and criticize the double-blind placebo controlled study instead of accept evidence that their system is no more effective than a convincing fake.
For me, this has become a line between science and religion. Yes, I mean to say this is the same as between science and pseudoscience. Many people hold superstitious beliefs, and feel less anxiety and depression when someone confidently performs a ritual to assuage their superstition-based angst. When one pseudoscientific ritualist quits, even if she tells her “patients” that she has discovered that her belief system was just fantasy and myth, many of her patients will say “do you know anyone else I can go to who will continue pretending this fantasy is real?” It is a sad commentary on humans and their attachment to belief systems. People who align themselves with the actual scientific process, where they are willing to change their beliefs and practices based on the best evidence and improved understanding of plausibility and causation, are often demonized by those who prefer fantasy and religion.
I am willing to say “I was wrong. I was too credulous. I was gullible.” I can only hope that my long process of learning about medicine, science, history, pseudoscience, and ethics help me make a better contribution to the world in the future. I believe Edzard has done that through his similarly twisted journey through the “Complementary and Alternative Medicine” world.
Congratulations on having such an open mind and being willing to change it when confronted with evidence. If only there were more like you.
You may have already read this, but this is a similar story: Escaping the Cult of Homeopathy.
Best wishes to you in whatever new career (retirement?) you choose.
Thank you very much for your comments here, ex-acupuncturist. I wish you all the best in whatever you do next.
Bloody hell that’s brave. Actually opening up to the challenge of your own quite deeply vested preconceptions, that is incredibly hard to do.
A rare bird indeed
Re the discussion about the possibility of a placebo effect in animals.
There is the well established phenomenon of “placebo by proxy”, discussed in this article (among several others). http://www.sciencebasedmedicine.org/is-there-a-placebo-effect-for-animals/
congratulations to those brave enough to admit they have changed their minds after examining the evidence. I wish them well in the future.
To those who are so closed in their mindset that they can only offer insults to people who have done them no harm, I ask – please think again.
Homeopathy works only with the right remedy and right potency. What you are talking about is what happens when someone is given not the right remedy. Then of course homeopathy does not work. But if you never learnt homeopathy why do you give opinion?
If only you could provide good, robust, independent evidence that homeopathy is any more than a placebo.
When and why did the practice of medicine change from being a healing modality to becoming the scientific application of pharmaceuticals? All this to do about one is right and the other is wrong….what a waste of time. You are speaking different languages, the language of healing and the language of science. They both have their place and the public should have a free choice as to which language they understand and want to live with. It is a question of philosophy of medicine, not a question of one is false and one is true. That the status quo doesn’t support homeopathy financially is a great pity and totally the result of pharma lobbyists and sceptics. The NHS and the population in general would be so much better off if they did encompos other healing modalities apart from the scientific ones. There will obviously be charlatans out there, but these are not confined to alterative medicine as the alarmingly high number of struck off conventional medical practioners on record highlights.
Medicine has always been about trying to heal things. It’s just that modern, science-based medicine has got much better at it. I agree there are two different languages: the one spoken by promoters of so-called alternative medicine being the language of BS.
It certainly isn’t a shame if homeopathy doesn’t receive public funding; there are more important things to spend our money on that pre-science cult therapies. If you want it you can buy it for yourself, but you can’t have it at the expense of other people’s lives. Big pharma doesn’t give a stuff about homeopathy because homeopathy is nonsense. If it wasn’t nonsense then Big pharma would happily cash in on it a lot more than it already does.
Mainstream doctors do get struck off from time to time but not usually for providing ineffective treatments where effective ones would save lives – with the odd rare exception like Dr Marisa Viegas who advised Lady Victoria Waymouth to stop taking her heart meds and use only homeopathy. Waymouth died only a few days after taking this advice, at the age of 57.