MD, PhD, FMedSci, FSB, FRCP, FRCPEd

I get comments of this nature all the time, sometimes by the dozen per day. As the argument is so very common, let me ONCE AGAIN explain what is wrong with it. Here are 10 very simple points for those who find it hard to understand the issue.

  1. My expertise is in alternative medicine and not in pharmacology. I know many pharmacologists who are competent to criticise aspects of pharmacotherapy and do so regularly. I do NOT consider myself competent to comment on pharmacotherapy.
  2. The fact that some things are not perfect in one area of health care (e. g. pharmacotherapy) does certainly not mean that one is not allowed to criticise shortcomings in other areas (e. g. homeopathy).
  3. As far as I can tell, it is not pharmaceuticals that ‘kill 100k a year’, but the issue is more complex: a sizable proportion of this tragic total is due to medical errors, for instance.
  4. The 100k figure seems to refer to the US where the vast majority of the population take pharmaceuticals but only about 2% of the population ever try homeopathy.
  5. Nobody seems to dispute that pharmaceuticals have beneficial effects beyond placebo; the general consensus regarding highly diluted homeopathics is that they have no effects beyond placebo.
  6. To judge the value of a therapy, it is naïve and dangerously misleading to consider just its risks. If we did that, aromatherapy would be preferable to surgery, reflexology would be better than chemotherapy and OF COURSE homeopathy would be better than pharmacotherapy. And if we then implemented this ‘wisdom’ into routine practice, we would hasten the deaths of millions.
  7. Any reasonable judgement of the value of any therapy must account for its documented risks in relation to its documented benefits. In other words, we must always try to weigh the two against each other and do a risk/benefit analysis.
  8. If a therapy is associated with finite risks and no benefits, its risk/benefit balance cannot possibly be positive. Where the benefit is non-existent or doubtful, even relatively small risks will inevitably tilt this balance in to the negative.
  9. This is precisely the situation that applies to homeopathy: its benefits beyond placebo are doubtful and its risks are fairly well documented.
  10. This means that homeopathy cannot be considered to be a therapy that is fit for purpose.

48 Responses to Ernst is slagging off homeopathy, yet pharmaceuticals kill 100k a year

  • Those saucy Homeopathically Prepared (HP) remedies are not pharmaceuticals.
    Making any comparison represents a number of fallacies: straw man; red herring: non sequitur.

    Homeopathy as a belief system is foolish, but so are many belief systems.
    Philosophically, one could say “all are”.
    We have to live with that, constantly think critically and demand the evidence.
    Particularly if we taxpayers are being asked to fund the purchase of irrational whims and fancies.
    (Whatever next? A bottle of Scotch? A ticket for a visit to the grounds of Highgrove House? They’d make many people ‘feel better’.)

    Ernst’s help in the laudible endedeavour to make progress in healthcare is much appreciated.

  • I spotted that someone had replied to Edzard when he Tweeted this post this morning. I’m off to buy a new irony meter:

    another sound bite of uselessness guy obsessed yet ignores huge deaths caused by #harmaceuticals

    ‘Harmaceuticals’ seems to be the new quack buzzword these days.

  • When someone dies because of medical malpractice, there is often an inquiry and possibly consequences for the offender. At the very least the victim gets counted in the stats (and therefore can be cited by hysterical homeopaths).

    When some dies because a homeopath followed “correct” homeopathic procedures, homeopaths say “Oh well” and that’s the end of the matter. Just because they don’t keep records of their failures doesn’t mean that their failures don’t happen.

  • Problems with real medicine validate quackery in precisely the same way that plane crashes validate flying carpets – a fact that I have explained more times than I can count to various assorted homeopathy shills, not one of whom has changed their rhetoric one bit.

  • Edzard,

    In the ‘about’ section, you say that you received hands-on training in acupuncture, herbalism, and massage therapy. How much training would that be? I know MDs who have done 2 day workshops on acupuncture – that would be considered “hands-on” training. Could you elaborate?

    • I worked in Germany’s only homeopathic hospital as a junior doctor for several months; full details in my memoir A SCIENTIST IN WONDERLAND

    • That is two days wasted.

      (Note to jm; it is customary to write numbers as words from zero to nine and use the number thereafter. It is obvious your education in science is sadly lacking, and your writing skills are questionable too.)

      • Frank: “2 day workshops” implies two separate workshops where each is a one-day workshop — as in “2 one-day workshops” — whereas “who have attended a two-day workshop on acupuncture” is probably what was meant.

        • Pete,
          I’m not going to get into an argument about this but your interpretation is wrong.

          This was said, “who have done 2 day workshops on acupuncture”. If jm meant two separate workshops of one day each, s/he should have written, “have done two one-day workshops”, however, if written correctly, it should read, “have done two-day workshops”. jm’s writing is abysmal, as is his/her logic and understanding of science.

          • Frank,
            “have done” tut-tut 🙂

            I don’t think you read my comment correctly because we’re in agreement on using “two-day workshop(s)” and on writing integers less than 10 as words — unless the number is followed by the symbol for its units, e.g., 2 mm.

          • It’s interesting which details you find important, Frank. Two day workshops, one 2-day workshop, etc et. Yet on another thread, you didn’t correct the person who referred to you as “Dr Collins”. Curious.

          • “It’s interesting which details you find important, Frank. Two day workshops, one 2-day workshop, etc et. Yet on another thread, you didn’t correct the person who referred to you as “Dr Collins”. Curious.”

            Strange for you to conflate unrelated matters? That other person is even more deluded than you so I couldn’t see the point. I have not ever used any title and decried its use as Argument from Authority. I have also said several times I am not a doctor, which you would know.

            Is there any point to your post apart from its fatuousness?

    • A simple summary of your training in acupuncture, massage therapy, and herbalism would be great. Amount of time, what tradition?

      • Also what training does Prof. Ernst have in unicorn husbandry?

        • “1. My expertise is in alternative medicine and not in pharmacology.” He doesn’t mention unicorn husbandry, so it’s not really relevant.

          From the ‘about’ section” – “I received hands-on training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation.”
          Again, no mention of unicorn husbandry.

          It’s not a trick question.

          • Jm, acupuncture = Reiki = homeopathy = pick another branch of alt-med = placebo: their claimed mechanisms (other than the placebo reaction itself) = Tooth Fairy Science.

            You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists. — Harriet Hall, MD.

            http://www.csicop.org/specialarticles/show/tooth_fairy_science_part_1

          • Pete,

            It’s not a trick question, and shouldn’t be a very difficult one to answer. I’m not sure what the big deal is here – but apparently it’s enough of a big deal for Guy to invoke unicorn husbandry, you the tooth fairy, and Frank to be Frank. Next, Alan should ask how to measure qi and Bjorn will write a page and a half about his chiropractic experience interspersed with JK Rowling outtakes and Game of Thrones spoilers.

            I didn’t ask about autogenic training, homoeopathy, or spinal manipulation. I don’t know anything about them, and Edzard’s answer wouldn’t really help me understand his perspective. The others (acu, massage, herbalism) would (at least a bit).

          • you are looking for answers and are too lazy to find them yourself; I have explained these things repeatedly; most recently in my book A SCIENTIST IN WONDERLAND [as I mentioned above].
            to save you the money and time [and because I happen to have a spare minute]:
            acupuncture: I went on a course and lecture series offered to medical students many years ago; later used it in several positions.
            massage: I was a clinician at a university rehab dept [later I became head of such a dept in Vienna Uni], and all docs learnt the basics of Swedish massage.
            I first learnt herbalism as a med student and later had more training in various clinical posts [it was what the Germans like to call ‘rational phytotherapy’, the evidence-based use of herbal medicines].

            HAPPY?

          • Jm, The linked article I quoted has 19 occurrences of the word acupuncture — because acupuncture is a prime example of Tooth Fairy Science. Obviously, you were too lazy to read it.

          • Pete,

            In the link you sent, the section of acupunture starts with “In acupuncture fairy science, the hypothesis is that sticking needles in specific acupuncture points along acupuncture meridians affects the flow of qi, which improves health.”

            Her hypothesis is wrong – so it’s kind of a tooth fairy analysis, predictably leading to an irrational conclusion.

          • Just pointing out that expertise in unicorns, as in, studying the mythology, does not require one to train as a unicorn handler. Same for fantasy-based medicine. No amount of study will make qi exist, but it will reinforce the false belief that it does exist.

          • Jm, Congratulations on spotting that the hypothesis Dr Hall used is wrong. There is only one hypothesis that is correct: the null hypothesis. The same applies to homeopathy, Reiki, et al. Everyone who claims otherwise is using Tooth Fairy Science because they have not bothered to firstly establish whether or not the efficacy of the modality really exists beyond a sham version of the modality.

            All of your arguments boil down to a claim that is as silly as claiming that it rains because The Rain God makes it rain. When challenged, you reply that we are talking about a westernized version of The Rain God instead of The One True Rain God. The only correct hypothesis for The Rain God, and for rain gods in general, is the null hypothesis.

          • “Just pointing out that expertise in unicorns, as in, studying the mythology, does not require one to train as a unicorn handler.”
            I see. I’m glad that mystery got cleared up.

            “No amount of study will make qi exist, but it will reinforce the false belief that it does exist.”
            As it turns out, even western MDs measure qi. My wife went for a physical, and they measured her breath (qi). I think they did it by counting how many per minute or something. Someone else told me that you could even measure the volume. Who knew? I don’t know about you, but I think we should reinforce the belief in respiration.

            Two ways to measure qi, and we haven’t even started counting the ways you can measure moving blood (also considered qi). Well, blood usually moves. With some injuries…some of it can leave the channels, get stuck(ish) and die. That would be a form of qi stagnation (to use a fancy dany Chinese med term).

            There ya go, Guy. Breath & moving blood. You can measure it, you could study it if you want, you can feel it (put your hand in front of you mouth/nose…or take your pulse). Most people believe in them, and most consider them vital.

            But I think you’re right about the unicorn thing.

          • So-to tidy this up, because -lucid though your explanation was, I think it may be a bit too ‘sciencey’ for most people- your wife had her qi counted and there’s quite a large volume of it and it’s a good job they did it before her blood died and that? Or something?
            Did you and your wife get your science education off the Telegoons?

          • No, MDs do not measure qi (incidentally, “Western MD” is a tautology, there is no “Eastern meicine” or “Western medicine”, there is only medicine, as distinct from pseudomedicine like homeopathy).

            Measuring breath is not “qi”. Qi, as referenced by believers in acupuncture, is a mythical life-force that flows along mythical meridians whose blockage causes disorders that can be cured by sticking needles in mythical acupoints. Even if the acupoints were not inconsistent between traditions studies clearly demonstrate that it makes no difference where you stick the needle, so either everything is an acupoint or nothing is. No objective test has ever identified the existence of either qi or meridians. These are religious, not medical, constructs.

          • Pete,

            “When challenged, you reply that we are talking about a westernized version of The Rain God instead of The One True Rain God.” I hope you’re kidding about that.

            And thanks for the acupuncture fairy science link – that’s an absolutely hilarious writeup of acupuncture! I may have to print it out and put it on the work fridge. I’m afraid that trying to paraphrase it wouldn’t do it justice.

          • @jm
             
            “My wife went for a physical, and they measured her breath (qi). I think they did it by counting how many per minute or something. Someone else told me that you could even measure the volume. Who knew?” Clearly not you. What you’re talking about is two aspects of pulmonary function tests. They reveal different types of disorder of lung function.

            If you want to call breath ‘qi’ that’s your business. But to go on and call blood ‘qi’ as well is senseless obfuscation. The measurements that can be done on and in blood are many and varied. If everything gets called ‘qi’ we learn exactly nothing. The reason why progress in knowledge always seems to lead to the invention of new terms is precisely to avoid confusion in understanding. Your comment reveals (a) that you know zilch about the human body (and revel in your ignorance) and (b) you know zilch about how reason advances and care even less.

          • Frank,

            “If you want to call breath ‘qi’ that’s your business. But to go on and call blood ‘qi’ as well is senseless obfuscation.”

            You know full well that the dicitonary definition of qi is “breath, respiration”. So when you or whoever says “qi doesn’t exist, can’t be measured” – plug in the dictionary definition and read it again.

            “Respiration doesn’t exist. Respiration can’t be measured.”

            After that, we can talk about the difference between blood, and the movement of blood. I didn’t say that qi was blood – and you know that. You’re fully capable of understanding the difference between blood, and the movement of blood.

            And you clearly know what obfuscation means. You’re quite skilled at it.

          • Well his wife had all her qi’s measured, and she had more of them than they’d expected. But it’s good they did it before her blood ‘died’. I think they got their science from the Telegoons. That or Karl Pilkington.

          • @jm

            “we haven’t even started counting the ways you can measure moving blood (also considered qi)”

            “I didn’t say that qi was blood – and you know that. ”

            Sorry. You said that qi is moving blood. Silly of me not to appreciate the difference. Insert ‘moving’. My earlier post still stands. I don’t obfuscate.

          • Frank,

            “My earlier post still stands. I don’t obfuscate.”

            Except for ignoring or changing definitions of commonly used terms, of course. Then you have quite the obfuscation habit. Gotta give you some credit though – it really takes some balls when even the dictionary plainly defines qi as “breath, respiration”.

          • Guy

            “No, MDs do not measure qi” I’m betting that docs in the UK measure respiration. Bet they measure it in some way, too.

            As far as the second paragraph goes, where are you getting your information? You managed to muck up every sentence in one way or another. It’s as if some weird game of ‘telephone’ went horribly (but humorously) awry.

          • You assert that qi is respiration. Qi is supposed by believers to flow along meridians and be released by sticking needles in acupoints, it is fair to say that this is not respiration as observed by reality-based doctors.

            While qi may literally translate as breath (or air, or possibly gas generally), the term as used by TCM means, as you are perfectly well aware, the empirically unverified “life force” – prana in Indian culture, ki in Japanese and so on.

            Wikipedia has an article that will settle your evident confusion: https://en.wikipedia.org/wiki/Qi

          • @jm

            As ever, this thread and its indentations have extended to the point where responses don’t clearly relate to previous comments. You quote me here as saying “Respiration doesn’t exist. Respiration can’t be measured.” When the heck did I ever write that??! Just search on this page: the quote doesn’t exist!

            “You know full well that the dicitonary definition of qi is “breath, respiration”.” That’s indeed the translation of the word from some Chinese dialects (depending on source it can also mean ‘energy’). In English dictionaries, which define the language I use and understand…

            chi or ch’i or qi: “noun (sometimes capital) (in Oriental medicine, martial arts, etc) vital energy believed to circulate round the body in currents.” [Collins English Dictionary]

            qi (also chi or ki): “[noun] The circulating life force whose existence and properties are the basis of much Chinese philosophy and medicine.” [Oxford dictionary of American English]

            qi, variant of chi: “vital energy that is held to animate the body internally and is of central importance in some Eastern systems of medical treatment (as acupuncture) and of exercise or self-defense (as tai chi).” [Merriam Webster]

            “Qi” in British English: “in ​Chinese ​traditional ​medicine, the ​life ​force”. [Cambridge English Dictionary]

            In other words; in English, qi is some nebulous entity that makes zero sense in the context of what we now know about physiology. If you want to say ‘qi’ means breath, that’s perfectly reasonable, but very unhelpful because we normally use ‘breath’ (related to, but definitely not the same as, ‘respiration’) when speaking English. (Or do you not understand the difference between ‘breath’ [noun] and ‘breathe’ [verb]?)

            And, I repeat, you state quite plainly here “Two ways to measure qi, and we haven’t even started counting the ways you can measure moving blood (also considered qi).” You are defining qi in multiple ways, which can serve only to create confusion and obfuscation. Then you have the brass cheek to accuse me of obfuscation.

            OK, jm. You win. At one time I thought you might be worth talking to. But you’re a troll and I shan’t respond to you again.

          • Guy

            Yes, if you want to stick with a Wikipedia overview – ‘life force’ works. This is also from Wikipedia:

            “Vital signs (often shortened to just vitals) are a group of the 4 to 6 most important signs that indicate the status of the body’s vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.”

            In the next paragraph:
            “There are four primary vital signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate)”

            In Chinese medicine, these four (as well as other things like nerve conduction, muscle movement, etc) are shorthanded to just ‘qi’. But there are specific terms for each function, just like western med. These things are not mythological – and they can be measured.

            You said “While qi may literally translate as breath (or air, or possibly gas generally), the term as used by TCM means, as you are perfectly well aware, the empirically unverified “life force” – prana in Indian culture, ki in Japanese and so on.”

            Not just literally, it’s primary. If you don’t breathe, you die. Qi, prana, lüng, all the other terms for the same thing – they are all used as blanket terms for many functions, and all get measured. But all consider the breath as the primary example. It’s vital for life.

          • Frank

            I wasn’t directly quoting you. Let me re=phrase. If anyone says that qi doesn’t exist or can’t be measured, they are saying that breathing doesn’t exist, that breathing can’t be measured. Is that clearer?

            Yes, English dictionaries use that definition. If you’re going to discuss qi as it’s used in Chinese medicine, you’re going to have abandon your English dictionary and look to a Chinese to English dictionary. Wikipedia did that for you, about a third of the way down the page on qi:

            n. ① air; gas ② smell ③ spirit; vigor; morale ④ vital/material energy (in Chinese metaphysics) ⑤ tone; atmosphere; attitude ⑥ anger ⑦ breath; respiration

            As far as your problem with the words breath and respiration – I should have been clearer and used “the breath” rather than just “breath”. Yes, I understand the difference between breath and breathe. “The breath” encompasses both, and is used as an example to illustrate qi/prana/lüng/etc – taking in raw materials we need for life and eliminating the waste.

            “You are defining qi in multiple ways, which can serve only to create confusion and obfuscation.” Qi is used as a blanket term. If you don’t acknowledge that, you’re muddying things up. You’re obfuscating.

            “In English dictionaries, which define the language I use and understand…” If you want to talk about Chinese medicine, you need to try to understand the terms as they are used in that system. You should understand that. And I’m pretty sure you do. So it doesn’t take a lot of “brass cheek” to accuse you of obfuscation. It’s pretty obvious.

          • But it’s still nonsense though, isn’t it. However much you try to split hairs. As has been pointed out, there is not ‘Western medicine’ and ‘Chinese medicine’. There is, in the modern world, ‘medicine’. If it works, it’s ‘medicine’. If it doesn’t it’s what we call ‘not medicine’. Very similar to the homeopathy argument really. The only way that fans of this claptrap can appear-not very successfully- to claim any validity for their essentially religious beliefs is by inventing things like ‘qi’ and ‘meridians’. Or, in the case of homeopathy, by waving around words like ‘somehow’, or-in one book review I took the piss out of on Amazon- by using hysterically funny phrases like ‘It’s a bit too difficult for science to understand just yet’. If the law found me in possession of 10 million unexplained banknotes, I wouldn’t really expect to get away with ‘Well it’s a bit too difficult for you coppers to understand just yet’.

  • I got this email today and take the liberty to publish and answer it here:
    Dr. Ernst,

    I read with interest your article on homeopathy in the Boston Globe today. I am a practicing veterinarian who is also a certified veterinary homeopath. I also attended the Baylight School of Homeopathy in Portland, Maine and graduated from the 4 year program ay Baylight.

    I can assure you, after treating many animals as well as family members with homeopathy, it DOES indeed work. There may be no scientific explanation to explain it, but there are many things in the world that can’t be explained scientifically but just ARE. If homeopathy does not work at all how did it survive over 200 years all over the globe, especially with all the advances in modern pharmaceuticals?

    Your main argument is that there is a placebo effect which people who claim they are healed with homeopathy don’t realize. If this is the case, then how do you explain animals and babies/small children who improve quickly and dramatically when treated homeopathically? I can provide many instances in which seriously ill animals as well as children responded and were cured with a remedy. I actually have a video of a paralyzed dog who I treated with ONE remedy and who went from total paralysis to full recovery in 14 days. This dog was paralyzed for 5 days prior to the owner bringing it to me and after one dose the dog was able to raise it’s body up off the floor. This is unrefutable proof that homeopathy DOES work.

    I am happy to provide you a link to the video I mentioned above, as well as other cases who were cured with homeopathy.

    MY ANSWER:
    the question whether homeopathy works for animals has been answered [see my bog post on the subject]. the rest of your comments is, as far as I can see, a bonanza in fallacies all of which have also addressed repeatedly on this blog.

    • Edzard, your comment that the fallacy bonanza in this mail has been addressed repeatedly on this blog says it all. Forgive me, therefore, for honing in on one point. I’m moved to do so because I’ve been following the comments on this thread and on the one about the case of stroke following chiropractic cervical manipulation all at the same time.
       
      From the mail… “I actually have a video of a paralyzed dog who I treated with ONE remedy and who went from total paralysis to full recovery in 14 days. This dog was paralyzed for 5 days prior to the owner bringing it to me and after one dose the dog was able to raise it’s body up off the floor. This is unrefutable proof that homeopathy DOES work.” No, it’s not irrefutable proof, it’s the post-hoc fallacy. At first glance, the same is true of the stroke case: it’s anecdotal, it’s the post hoc fallacy.
       
      But there’s a difference. My usual response to people who claim that something worked because a change happened after some therapy or other is to ask them a question. How would you design an experiment to confirm that it was the result of the therapy and not some other coincidental factor you may not have noticed (including, most importantly, the tendency of illnesses to cure themselves)? The best answer is, of course, a prospective, randomized, properly blinded trial.
       
      For chiropractors, in the absence of any effective adverse effect reporting system, the best we can hope for is to compile anecdotes from multiple posts, examine case descriptions in detail, and evaluate mechanistic probabilities. That has happened in massive detail on your chiropractic/stroke thread.
       
      For your veterinary homeopath, we could perhaps see similar, moderate quality evidence by soliciting paralysis cure stories from other vets. But first we need to know why the dog was paralysed for 5 days: surely the least we might expect of a certified veterinary practitioner is that they make proper diagnoses of their sick animals? We also need to know what the vet and owner did in addition to giving the dog a sip of water.
       
      From this terrific blog of Edzard’s, the post hoc fallacy comes over as by far the most common and important reason why people believe in therapies that have no basis in reason. It also accounts for belief in other forms of magic (psychic phenomena, ghosts, astrology, UFOs as visiting alien spacecraft and many more), as well as all forms of religious belief. Psychologists have proved over and over that humans are supreme masters of self delusion, yet most people flatly refuse to imagine that they might have misinterpreted or misunderstood something they have experienced.

    • I’m intrigued-not very, but I am- by the idea that longevity by itself confers validity, on homeopathy or anything else.
      Voodoo and witchcraft have also been around a long time-much longer than homeopathy -and are deeply poular ‘all over the globe’, despite advances in modern thinking. Are we then to clamour for these also to be available on the NHS?
      As long as we don’t succeed in blowing the planet up, we’ll eventually get to the point where ‘brearharianism’ will also have been around for 200 years. Would the veterinarian claim that this practice had therefore been validated?
      How on EARTH do these people manage to obtain their qualifications?
      I wouldn’t leave my shoes to be mended by such a charlatan, let alone my horse.

  • I just finished the ‘Scientist In Wonderland’ book.
    Tell you what -Prince Charles and his sycophants are a malign piece of work, aren’t they?
    Not quite the harmless eccentric he appears.

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