MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

This post is dedicated to all homeopathic character assassins.

Some ardent homeopathy fans have reminded me that, some 25  years ago, I published (OH, WHAT A SCANDAL!!!) a positive trial of homeopathy; I even found a website that proudly announces this fact. Homeopaths seem jubilant about this discovery (not because they now need to revise their allegations that I never did any trials; or the other, equally popular claim, that I have always been squarely against their trade but) because the implication is that even I have to concede that homeopathic remedies are better than placebo. In their view, this seems to beg the following important and embarrassing questions:

  • Why did I change my mind?
  • Am I not contradicting myself?
  • Who has bribed me?
  • Am I in the pocket of Big Pharma?
  • Does this ‘skeleton in my closet’ discredit me for all times?

I remember the trial in question quite well. We conducted it during my time in Vienna, and I am proud of several innovative ideas that went into it. Here is the abstract in full:

The aim of this study was to test the effectiveness of a combined homeopathic medication in primary varicosity. A well-defined population of 61 patients was randomized into active medication (Poikiven®) or placebo. Both were given for 24 d. At the start of the trial, after 12 d medication and at the end of the study, objective and subjective parameters were recorded: venous filling time, leg volume, calf circumference, haemorheological measurements and patients’ symptoms such as cramps, itching, leg heaviness, pain during standing and the need to elevate the legs. The results show that venous filling time is changed by 44% towards normal in the actively-treated group. The average leg volume fell significantly more in this group, but calf circumferences did not change significantly and blood rheology was not altered in any relevant way. None of the patients reported side-effects. Subjective complaints were relieved significantly more by Poikiven than by placebo. These results suggest that the oral treatment of primary varicosity using Poikiven is feasible.

So, there we have it: a homeopathic remedy (as tested by me) is clearly better than placebo normalising important objective parameters as well as subjective symptoms of varicose veins. Is that not a contradiction of what I keep saying today, namely that homeopathy is a placebo therapy?

YES AND NO! (But much more NO than YES)

Yes, because that was clearly our result, and I never tried to deny it.

No, because our verum was far from being a homeopathic, highly diluted remedy. It contained Aesculus D1 12,5 ml, Arnica D1 2,5 ml, Carduus marianus D1 5 ml, Hamamelis D1 10 ml, Lachesis D6 5 ml, Lycopodium D4 5 ml, Melilotus officinalis D1 10 ml. Take just the first of these ingredients, Aesculus or horse chestnut. This is a herbal medicine that has been well documented (even via a Cochrane review) to be effective for the symptoms of varicose veins, and it contains Aesculus in the D1 potency. This means that it is diluted merely by a factor of 1:10. So, for all intents and purposes, our verum was herbal by nature, and there is no surprise at all that we found it to be effective.

[Here is a little ‘aside’: Aesculus is a proven treatment for varicose veins. Homeopathy must always rely on the ‘like cures like’ principle. Therefore, if Aesculus had been used in the homeopathic way, would it not, according to homeopathic dogma, had to worsen the symptoms of our patients rather than alleviating them?]

All of this would be trivial to the extreme, if it did not touch upon an important and confusing point which is often used as an ‘escape route’ by homeopaths when they find themselves between a rock and a hard place. Some trials of homeopathy are positive because they use medications which are homeopathic only by name. This regularly creates considerable confusion. In the recent BMJ debate I tried to address this issue head on by stating at the outset: ” Nobody questions, of course, that some substances used in homeopathy, such as arsenic or strychnine, can be pharmacologically active, but homeopathic medicines are typically far too dilute to have any effect.”

And that’s the point: homeopathic remedies beyond a C12 potency contain nothing, less dilute ones contain little to very little, and D1 potencies are hardy diluted at all and thus contain substantial amounts of active ingredients. Such low potencies are rarely used by homeopaths and should be called PSEUDO-HOMEOPATHIC, in my view. Homeopaths tend to use this confusing complexity to wriggle out of difficult arguments, and often they rely on systematic reviews of homeopathic trials which can generate somewhat confusing overall findings because of such PSEUDO-HOMEOPATHIC remedies.

To make it perfectly clear: the typical homeopathic remedy is far too dilute to have any effect. When scientists or the public at large speak of homeopathic remedies, we don’t mean extracts of Aesculus or potent poisons like Arsenic D1 (has anyone heard of someone claiming to have killed rats with homeopathy?); we refer to the vast majority of remedies which are highly dilute and contain no or very few active molecules – even when we do not explain this somewhat complicated and rather tedious circumstance each and every time. I therefore declare once and for all that, unless I indicate otherwise, I do NOT mean potencies below C6 when I speak of a ‘homeopathic remedy’ (sorry homeopathy fans, perhaps I should have done this when I started this blog).

What if our Vienna study all those years ago had tested not the pseudo-homeopathic ‘Poikiven’ but a highly dilute, real homeopathic remedy and had still come up with a positive finding? Would that make me inconsistent, dishonest, untrustworthy or corrupt? Certainly not!

I have always urged people to not go by the results of single trials. There are numerous reasons why a single study can produce a misleading result. We should therefore, wherever possible, rely on systematic reviews that critically evaluate the totality of the evidence (I would always mistrust even my own trial data, if it contradicted the totality of the reliable evidence) – and such analyses clearly fail to show that homeopathy is more than a placebo.

And even, if none of this had happened, and I had just changed my mind about homeopathy because

  • the evidence changed,
  • I had become wiser,
  • I had learnt how to think like a scientist,
  • I had managed to see behind the smokescreen many homeopaths put up to hide the truth?

Would that discredit me? I don’t think so! As someone once said, being able to change one’s mind is a sign of intelligence.

I am sure that the weird world of homeopathic character assassination will soon find something else to discredit me – but for now…

I REST MY CASE.

17 Responses to Professor Ernst’s very own POSITIVE trial of homeopathy (oh dear, have I been found out?)

  • Einstein was wrong about the universal constant in the first iteration of relativity but he recognised his mistake, acknowledged it, and corrected it. So Prof, even if it was a mistake (putting aside it wasn’t), it isn’t as if you wouldn’t be in good company.

    Let’s see who crawls from under a rock to attack you for this.

  • Since I don’t have access to the original article, and since I would have to defer reading it until I had time to actually do that thoroughly, I can’t comment on the article.

    That said, any homeopath who claims that this is homeopathy, should be aware that he/she is committing high treason against just about everything homeopathy is.

    Merely because Hennig Brand was an alchemist when he discovered phosphorus, a discovery that has withstood – so far – the test of time (something, not a single homeopath has ever been able to do, as far as I know), does not mean that any chemist who is using phosphorus today is proving the validity of alchemy (and these people, while wrong, were at least honest searchers, something homeopaths do not seem to be).

    As for the rest, all this article proves, in my view, is that Prof. Ernst has been honest all along. Results were not withheld or manipulated to fit an agenda. They were reported, regardless of whether or not they were convenient. I also see no mistake here, unless mistakes would become apparent from the complete article. Even if the results are a fluke, that does not indicate a mistake. It’s just how reality is, which is precisely why we insist so much on replicability by independent teams.

    I think we can all agree that we would be delighted if homeopathy worked. It would be fantastic. But it doesn’t.

    The X-ray machine I created when I was 9 years old didn’t work either, because I had been utterly misinformed by the “scientific books” I was given. I was deeply disappointed, but I have always accepted that I was wrong, left it at that and moved on. Why can’t adult homeopaths do what a misled nine year old with no scientific background could?

  • I do have one question I can’t help but asking, however:

    I had managed to see behind the smokescreen many homeopaths put up to hide the truth?

    How is this compatible with the idea that homeopaths believe what they say? Does this not remind one of “Lying for Jesus” where we can prove that the Christian is lying, unless we accept some form of psychiatric insanity?

    Sorry I am still going on about this. I just have a big problem accepting that someone can be intelligent enough to learn how to read and write and go through life as an independent adult, yet be too dim to understand that they are lying, and – how convenient – in a manner that favours their particular fantasy.

    It is a big problem for me.

    • my test says MANY HOMEOPATHS!
      there are all sorts, of course.

      • my test says MANY HOMEOPATHS!
        there are all sorts, of course.

        Don’t worry, I did not overlook that. It is also what you have said in the past, when I asked the question for the gazillionth time (and you are not the only person I am terrorising with this question).

        It is just truly a problem for me, because I can’t “fit it in”. The three explanations I can find, “lack of intelligence”, “intention to mislead”, “insanity” or combinations thereof are all so grim, not to mention vague and rather meaningless. I am often inclined to favour “intention”, because I think I see similar behaviour in (mainly American) Christians, where – short of an explicit declaration to that effect – intentional dishonesty is essentially proven.

        Maybe I need to learn to declare this an unexplainable conundrum beyond my reach and leave it at that.

        • Bart, I think that believing a lie to be truth is not an uncommon psychological situation. Clergymen do it all the time, so why not practitioners of Big Snakeoil?

          • I like that, FrankO. Our way of thinking seems to be the same, just the starting point/bias may be different. Could it be an educational matter? I have always been to Catholic schools (not by choice, mind you, on the contrary, I was quite young when I started annoying my parents about it, they just didn’t budge). As a consequence, I am certainly no stranger to lies, the refusal to accept the undeniable, even the idea that it was not educationally responsible to admit that a student was right and a teacher wrong, even if that was irrefutably the case (which, unsurprisingly, has led me to profoundly distrust teachers and school books). The one we talked about before, the foundational statement of Biola “University”, is the most unequivocal and demonstrable lie I know of.

            Although I cannot comprehend it, I think I am still flexible enough to accept that someone believes in talking snakes that stopped hopping around when Yahweh condemned them to crawl through the dust. I can convince myself that Christians are being honest when they explain away God’s fundamental lie in Genesis and call it an allegory or whatever, but my buck stops when they claim to believe what they must know to be utterly untrue, no matter how intellectually limited one is while still being able to read.

            The Biola statement is untrue and they do not need me or anyone else to make that clear to them. They are lying because that is their intention, not because they are dimwitted or delusional. They are lying because they are, at a fundamental level, dishonest, just as Bernie Madoff was dishonest. Their goal is to deceive.

            While he used other arguments, that is exactly what Lawrence Krauss has demonstrated beyond the reasonable doubt about William Lane Craig. We know that Craig is dishonest, and we know that he knows it himself. In fact, Craig has hinted at that himself by pointing out that what he said was merely a *possible* explanation (talking about children being exterminated at the command of the all-loving God). This was a relatively dangerous thing to do for him. If he was not such a star in American religionist circles, it could well have terminated his employment, because he came dangerously close to violating the terms of his contract.

            In other words, I do not believe that they believe (at least some of) their lies, and taking that experience to the homeopaths and other quacks and alternologists, I have trouble believing that they believe at least some of their own lies. I can certainly accept that the more ignorant or less educated ones truly believe homeopathy has positive effects. Even my own personal experience has shown, at least to my (dis)satisfaction, that this is an undeniable fact.

            One of the persons I always have in mind, is Andrew Weil. I think there are enough known elements of his past to figure out that it did not matter to him in any way what he learned at university. He set out to make antiscience claims and that is what he has been doing ever since.

            I do not know Peter Fisher’s past, and his arguments do sound retarded, but he is able to read and write and to get through life. Is that not an indication that he is intelligent enough to know that at least some of what he claims is untrue?

            I will never forget Cees Baas, an MD and homeopath who is active here in Toronto. He claimed that homeopathy is not nonsense, that it really works, and then sends people to actual doctors “because there is a medical reality behind their question”. That would seem to indicate that he thinks homeopathy is only good in cases where there is no medical reality. The point is, of course, that this would also seem to indicate that he knows homeopathy is bunk, even when he claims otherwise.

        • Bart, it is simple cognitive dissonance. This is a well-understood human condition to which we all succumb at one time or another. It happens when we believe two things that contradict each other, and typically we don’t recognise the contradiction because it happens at the subconscious level. It produces a psychological pain that discourages us from addressing the conflict.

          What you’re trying to do, I think, is to understand the possible motives of a practitioner, but you’re doing so with two assumptions: that they are logical, and that they fully understand their motivations. I put it to you that they (and indeed we) are not naturally logical (fast vs slow thinking, Daniel Kahneman) because logical thinking is difficult – especially if you already know the answer!

          Furthermore, human reasoning is often not sequential as we like to imagine. Instead what often happens is that we unconsciously “feel” the conclusion, and then we consciously try to explain it to ourselves. This is demonstrated in experiments conducted by Gazzinga on split-brain patients (http://www.scientificamerican.com/article/true-stories-of-trauma-and-madness-and-why-portrait-sitters-tend-to-face-left-excerpt/).

          I can fully understand how a human can believe that homeopathy works, while also believing the reasons why it can’t, and simply not want to decide which belief to discard. This is particularly true when one has invested (financially and/or emotionally) so much in a belief, and it’s why I have immense respect for people such as Edzard, and Britt Hermes, who fought their natural instincts, wrote-off their investments, and confronted the fact that one of their beliefs was wrong.

  • Jezzaaaa: I am indeed aware of those principles. A now-retired Manitoba professor, Robert Altemeyer, wrote quite convincingly about it in his book “The Authoritarians”. I forgot if it was Christopher Hitchens or someone else who gave the example of the oil magnate who believed in an old earth when evaluating oil drilling sites and in a 6,000 year young earth while pretending to be a Christian.

    Even though I personally know people with such (un-)thinking patterns who seem to confirm these ideas, I just have trouble accepting it and leave it at that. To me, these people have a mental disorder, and should – if at all possible – be helped in some way. If that is not possible, I am not sure they should be allowed to occupy positions of authority/responsibility. They scare me silly.

    Not being a psychiatrist, I fully accept the possibility that I may be wrong, but it seems highly likely to me that this is the type of mental disorder that leads people to sacrifice themselves in suicide bombings, rape innocent women to make it legally possible to execute them, practice genital mutilation on something like a quarter of the American population, and so on.

    Seeming perfectly sane people are capable of inflicting great deals of harm, but I like to think that these can be reasoned out of their bad manners. I don’t really see how we can assume that the compartmentalising ones can be made equally harmless by letting them loose on the public.

    This Hahn character seems largely harmless, but creeps like Dr. Oz. are abusing their positions of authority to mislead and harm numberless people (and some of his (ex-)colleagues have indeed tried to get him removed from at least his professorship). If they are incapable of understanding the dissonance between what they should know is likely to be false and what they should know is (far) more likely to be correct, is that not a reason to protect the public from them?

    I am very much against legislating what is true and what is not, which seems to be on the rise in industrialised countries, but must this automatically mean that delusionals should be allowed to make decisions that affect us all or a great many of us?

    When someone like Peter Fisher advises a patient, are we not becoming accomplices if we don’t at least denounce that he is a quack, and because of his influential position, a very dangerous one? Or do I get this completely wrong? Or are we just letting it all be because the problem is so formidable that nothing significant can be done and that it is better not to waste any valuable time on it?

    • Bart, you have left out one (or actually two) possible explanations why grown up and by all means intelligent people believe in something they surely must know to be untrue. One is some People are such great con artists they even manage to deceive themselves. The other is that in most people early educational influences are so strong they can not overcome them but at very high psychological costs. I’d even go so far as to say that we all have some personal convictions that have their Basis in our early childhood which we hold on to even though we know or should know that they’re based on false premises. Unfortunately and fortunately at the same time, we are a species that just isn’t entirely rational. In fact we aren’t even mainly rational. And of course, there’s always your cognitive dissonance. If your investements into something are substantial enough and you’re confronted with evidence you have been misled/made a mistake you tend to block it out and go into denial, even to the point of severing your ties with your previous environment.

  • Isn’t the “like cures like”-principle slightly less understandable than the often used trope “if A cures B wouldn’t homeopathically used A cause B” or the easy inverse? Even if we disregard the fact that homeopathy lack any evidence for relying on cause-and-effect at all…
    The usefulness of a homeopathic product for treating symptoms are determined in the very strange process of provings, where healthy (and supposedly specially trained) persons take (“Ernstian” non-homeopathic doses of) the ingredient under study and keeps a book of ALL perceived symptoms (including dreams and feelings in the name of holism); out of which a number makes it into the homeopathic repertories after evaluation to discard the symptoms perceived that for some reason really was not caused by the ingredient. Not exactly a very transparent process…

  • “if A cures B wouldn’t homeopathically used A cause B”

    No.

    This concept goes right back to the start of homeopathy, namely the cinchona-trial of Hahnemann himself from 1796: If A (=cinchona) cures B (= malaria) in a sick person, then A would cause B when a healthy person takes it. Thats how Hahnemann found his like cures like idea

    As to homeopathic provings: Usually a homeopathic proving contains ‘Ernstian’ homeopathics. Hahnemann himself recommended to use C30 to perform them. (see §128 in the Organon e. g. http://homeopathybulgaria.org/todormed/SAMUEL%20HAHNEMANN-ORGANON.pdf)

    • Your comment is somewhat strange and only supports the non-scientific base for homeopathy. Malaria can’t be caused by ingestion of cinchona bark in any concentration as this is a parasitic disease proven by the 1880’s. I also have trouble with the application of cinchona according to Boericke’s Materia Medica: “Debility from exhausting discharges, from loss of vital fluids, together with a Nervous erethism, calls for this remedy. Periodicity is most marked. Sensitive to drafts. Seldom indicated in the earlier stages of acute disease. Chronic gout. Chronic suppurative pyelitis. Post operative gas pains, no relief from passing it.”
      Besides the periodicity it is hard to see a close correlation to malaria; nor caludicatio or palpitations – for which alkaloids isolated from cinchona bark has convetnional uses.

    • This may seem a trifling point, but Hahnemann was not referring to dilutions that would cure malaria, but that he believed would be effective in treating symptoms typical of malaria.

      More importantly, the following statement of Ernst’s post above needs to be emphasized:

      “. . . homeopathic remedies beyond a C12 potency contain nothing, less dilute ones contain little to very little, and D1 potencies are hardy diluted at all and thus contain substantial amounts of active ingredients. Such low potencies are rarely used by homeopaths and should be called PSEUDO-HOMEOPATHIC, in my view. Homeopaths tend to use this confusing complexity to wriggle out of difficult arguments, and often they rely on systematic reviews of homeopathic trials which can generate somewhat confusing overall findings because of such PSEUDO-HOMEOPATHIC remedies.”

      I would argue that concentrations greater than those in C12 preparations are not pseudo-homeopathic, but non-homeopathic and open to regulation outside of homeopathic preparations.

      • This may seem a trifling point, but Hahnemann was not referring to dilutions that would cure malaria, but that he believed would be effective in treating symptoms typical of malaria.

        There is nothing trivial about it, I think. Granted, it has been a few years since last I read the Organon, but what I remember is that my interpretation of Hahnemann’s Organon is indeed that he was all about “symptoms” and that, somehow, addressing the symptoms would tell the rather dumb vital force to find its way back to behaving as it should.

        As for the difference between pseudo and non homeopathic, I think you are right that they are non-homeopathic (if I am not mistaken, there is only one dilution in the Organon, C30, but my memory may be failing me), but I also think that Prof. Ernst is correct in calling them pseudo-homeopathic, because homeoquacks like to call them homeopathic anyway, even though they should know their holy book doesn’t mention them.

      • @Lighthorse
        Not a trifling poiint at all. The ‘like cures like’ concept is indeed purely aimed at symptoms. Therefore, for all diseases where we now have definitive evidence of cause (infections, cardiovascular disorders, congenital disease… the list is long), homeopathy by definition cannot possibly cure disease. Yet homeopaths and other Big Snakeoil merchants try to say the exact opposite: that medicine treats only symptoms whereas witchcraft cures the causes. Do atlmed supporters ever get anything right?!

  • @FrankO: In Canada and the U.S., as in and other countries, homeopathic preparations represent ‘grandfathered’ remedies, whether they are sold OTC or by prescription. Like many other OTC remedies, they have been allowed for sale without sufficiently conclusive evidence for their efficacy. Inconceivable as it may seem, on the basis of medications allowed on the market, what constitutes sufficient evidence varies from one country to the next.

    As you may know, the question of continuing to allow the sale of homeopathic preparations is currently under scrutiny by the Federal Trade Commission in the U.S. Whatever their final decision on the matter, one might expect that Canadian regulation will follow suit. In 1994, when the U.S. passed the Dietary Supplement Health and Education Act (DSHEA), Canadian regulations also changed, although they have since become comparatively more lax.

    http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2015/06/will-ftc-kill-homeopathic-products-or-will-fda.html

    http://mjlh.mcgill.ca/blog.php?blog_id=144

    Concerning altmed proponents and their claim of being unlike conventional medicine in that they cure causes rather than treat symptoms, when the etiology of a disease or medical condition has yet to be established, their boast is at best, fanciful.

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