MD, PhD, FMedSci, FSB, FRCP, FRCPEd

WHAT IS THE WORST THAT COULD HAPPEN TO HOMEOPATHS?

This might seem like a strange question, but I think it is quite interesting… bear with me.

The worse, you might think, is that the we all agree that highly diluted homeopathic remedies are pure placebos. Apart from the fact that this already is a broad consensus shared by virtually everyone in healthcare (except the homeopaths, of course), I think this is not the worst that could happen to homeopaths. They simply ignore the consensus, continue much as before and carry on earning a living by fooling the public (and often themselves as well).

No, the worse is the opposite of the above. The worse is that we all accept the homeopaths’ view. The worse is to say: Very well, we agree for the moment that your remedies are highly effective. And therefore we need to regulate them just as any other medicine.

In our yesterday’s response to the German homeopaths’ statement affirming the effectiveness of homeopathy, we tried to express exactly that. Here is the passage I am referring to:

Wenn dies für Homöopathen also so eindeutig ist, dann können die zuständigen Institutionen in den Arzneimittel-Gesellschaften (BfArM, AMG) Homöopathika genau so bewerten wie normale Medikamente…  die Politik sollte die Homöopathen bei ihrem eigenen Wort nehmen und sie denselben Prüfverfahren unterwerfen wie alle anderen Behandlungsverfahren auch.

And this is my (somewhat liberal) translation:

If homeopathy’s effectiveness is so crystal clear, the regulators should assess homeopathic remedies just like normal drugs…  politicians and regulators should take homeopaths by their own word and should apply the same standards as for all other medicines.

In the past, homeopaths have always wanted the cake and eat it; they pleaded that their remedies are so special and therefore they need special regulations and extra considerations. Because of these, they were sheltered and escaped any legal or ethical obligations to demonstrate effectiveness. This introduced an unjustified and regressive double standard with was detrimental to good healthcare, medical ethics and scientific progress.

Now that homeopaths (the Germans are merely an example, other countries’ homeopaths are much the same) have agreed on what they think is solid scientific proof, it is right and necessary to remove the special protection which homeopathy used to enjoy. Let’s for the moment accept the homeopaths’ argument (‘homeopathy is effective just like other medicines) and then force them to deliver the proof of their opinion according to the standards all medicines must be judged by!

That would surely be the end of all this nonsense, and homeopaths would find themselves hoisted by their own petard.

32 Responses to Homeopaths could be hoisted by their own petard

  • Yes — they know that that gray zone is the only safe place for them. If they really started showing the results they claim they do, authorities would have immediately take their products off the market. “Holy heck, there are indeed active ingredients in this stuff! What’s in it? Pus? Dog shit? Wolf’s milk? And it’s really active? Banned until we can figure out how it works!”

    I’ve noticed that here in Germany, the way my medical insurer deals with it is by insisting that it can only be used for non-serious illnesses and in combination with proper medicine. It’s always struck me that homeopathy, which “really works” suddenly only “works” for minor problems and in combinaiton with other medicines as soon as it’s clear who would have to pay for the consequences.

    The rest of the time it “heals the underlying cause of the illness not just the symptoms so that you will never be sick again”.

    But it can’t be tested. But we know it works.

    • The requirement of German insurers for non serious or as an adjunctive treatment is fascinating. Do you know if this is true in France or Holland and can you point to a document that area this, it would be extremely useful.

      • I don’t know about France or Netherlands. France is probably worse.

        In Germany it’s all quite complicated with blurred lines of responsibility, so no single link would explain the whole situation. I only found out that my own insurer will pay for homeopathy “as a complimentary treatment” from a newsletter they sent out. I asked them about it and one person started screaming at me that it works, and the second person shamefacedly “Yes, I know, I know, I can’t do anything about it.”

        Legally, parliament decided that what counts as medicine is to be determined by a particular committee of doctors. These doctors decided that homeopathy and Anthroposophical medicine are expemt from the normal testing that other micines have to go through — so all I can say to lunatics like Dana Ullman who say homeopathy has been clinically proven, is “Don’t convince me, convince those guys that their exemption is not needed.”

        Both homeopathy and Anthroposophy of course have some “unfortunate” incidents in their history, and the medical profession in general has a mixed record of admitting or denying their complicity with the Nazis. It would not surprise me if some of the underground connections in this regard are still present in selecting the medical committee that holds the door open for such dangerous and corrupt pseudo-medicine.

        It should be noted, however, that alt med in general is ridiculously popular in Germany, and acupuncture and TCM are also paid for by some insurers — it’s all highly popular with the Green voting middle & upper middle classes.

  • In countries where anyone can set themselves up as a homeopath with their minimalist educational standards it will also mean they will have to qualify as real doctors, not a prospect they will look forward to.

    Their products would have to be produced to good manufacturing practice standard, I wish them well in devising tests to identify 30C products.

    However, before we get carried away, what will happen is a messy compromise that allows them to continue to defraud but gives them legitimacy.

    • Just to let you know that all homeopathy remedies are manufactured under strict FDA standards now. And are regulated by the FDA. So what are you talking about???
      Jill Elliot, DVM (homeopathic veterinarian, USA)

      • Jill Elliot said:

        Just to let you know that all homeopathy remedies are manufactured under strict FDA standards now. And are regulated by the FDA. So what are you talking about???

        What do you mean by ‘regulated’?

      • Good manufacturing practice involves the determination of dosage in the final product. This is not done in the US or anywhere else for homeopathic preparations of 5C or greater. Beyond 12C it is impossible. The recent FDA discussion was about enforcing the regulations so it is hard to see how homeopathy preparations are manufactured to strict FDA standards.

        That clear enough for you?

      • Show me a reliable method to find out that some 30C (or even not so dilute) “remedy” really is what it is claimed to be! And in case of the real meds it is also possible to measure what is happening with the active substances in the bodies of the patients. Nothing like that in the case of homeopathy. No way to check whether “remedy” had any effect at all (well, even a tiny bit of water/sugar have a tiny effect), but it is not the one we have in the mind. So, ok, “remedies” are manufactured according to standards, but why should this fact concern me? I will not be poisoned? Yes, that’s a good thing, but I will not be poisoned by so many things (at least if I eat them in reasonable quantities), however, this property is not enough to cure diseases.

  • When considering ‘homeopathy’, I strongly urge we all distinguish between Type I effects due to a constructive therapeutic encounter with an empathic practitioner (the TLC, context effects, placebo effects, often ‘work’ to give a number of patients the benefit of ‘feeling better’) and Type II effects resulting from the use of a specific ‘homeopathically prepared’ (HP) remedy – the sugar pills or what have you.

    I know of no evidence whatsoever that the HPs themselves have any identifiable effect on any specic disease, condition or pathological process. No effects when shorn of placebo effects from personal relationships.

    With this distinction, we can work with ‘homeopath’ colleagues and supprt their work to help patients feel better.
    The regulatory, legal and political authorities should urgently deal with any practitioner who advertises, sells or even recommends the purchase of HPs which have no effect whatsoever. Might that not be fraudulent misrepresentation?

    Additionally, the position of manufacturers who claim their products have an effect they do not have has surely to be considered fraudulent.
    If not, why not?

    Concentrate on the practice, not the practitioner; the therapeutic agent, not the therapist; the substance, not the style.

    More in my book, ‘Real Secrets of Alternative Medicine’ (Amazon and Kindle).

    • Once the case that zero concentration produces zero effects is made then others who are not entranced by fantastical notions can take the minor effects and reproduce them with evidence based medicine. What we don’t need are overly expensive charlatans anywhere near a healthcare situation. Their lack of any real training plus their inbuilt inimical attitude to medicine precludes them.

      If, and this has only been suggested not proven by research, the cup of tea approach is beneficial, we have properly trained professionals who can administer it. We don’t need untrained delusionists.

  • for those who can read German; this is how the pro-homeopathy ‘Carstens Stiftung’ summarised the current best evidence on homeopathy [http://www.carstens-stiftung.de/artikel/stand-der-homoeopathieforschung.html]:
    Dabei ist ein Forschungsreader entstanden… dessen zentralen Ergebnisse sich in fünf Punkten zusammenfassen lassen:
    1. Homöopathische Behandlung ist unter ärztlichen Alltagsbedingungen (Praxis) klinisch nützlich (Perspektive Versorgungsforschung).
    2. Auch hochwertige randomisierte klinische Studien zeigen spezifische Effekte, in denen Homöopathie dem Placebo überlegen ist (Perspektive Randomisierte Klinische Studien).
    3. Vier von fünf Metaanalysen zeigen eine statistische Überlegenheit der homöopathischen Arznei im Vergleich zu Placebo. Die Anzahl hochwertiger Studien wird von den Autoren jeweils unterschiedlich bewertet. Die verbleibende Arbeit mit negativem Ergebnis ist aus methodologisch-wissenschaftlicher Sicht fragwürdig zu nennen (Perspektive Metaanalysen).
    4. Auch in Experimenten mit Zellkulturen, Tieren und Pflanzen gibt es mittlerweile stabil reproduzierbare, Effekte, die eine spezifische Wirkung von Hochpotenzen zeigen (Perspektive Grundlagenforschung).
    5. Eine zusammenfassende Betrachtung klinischer Forschungsdaten belegt hinreichend einen therapeutischen Nutzen (effectiveness) der homöopathischen Behandlung. Die Ergebnisse zahlreicher placebokontrollierter Studien sowie Experimente aus der Grundlagenforschung sprechen darüber hinaus für eine spezifische Wirkung (efficacy) potenzierter Arzneimittel.

  • don’t you just love it!?!
    the German Homeopathic Doctors’ Association just tweeted:
    Falschaussage in der FAZ von Prof Ernst. Er hat keine Ausbildung in #Homöopathie. Etikettenschwindel! http://www.faz.net/-gwz-8hkwk#GEPC;s3 … via @faznet
    essentially, they claim I lied in my FAZ interview when I said that I once was a homeopath. they fail to appreciate the Oxford dictionary definition: homeopaths = practitioner of homeopathy
    nobody can doubt that this applied to me.

  • That’s an example of the “No true Scotsman” fallacy

  • Brilliant David:

    “No true homeopath puts any active substance on their homeopathically prepared remedies.”

    “But I’m a homeopath and I do – the remedies have an effect on pathology – they do, they really do!”

    “Then you’re no true homeopath.”

  • Given Ernst’s “logic” (that’s a very liberal use of the word because of the paucity of real logic here)…

    How about requiring that vaccines undergo randomized double-blind and placebo controlled trials?

    How about requiring ALL surgical procedures to undergo randomized double-blind and placebo controlled trials?

    Oh…you say that it is unethical to conducted placebo controlled surgical trials…I don’t remember any skeptics saying that it is impossible to conduct placebo controlled trials on many alternative treatment disciples…

    Somehow, Ernst and his ilk will make exceptions for THEIR favorite treatments…just as Big Pharma and his promoters minimize the various side effects of conventional treatments and maximize the assumed benefits. “How convenient”…and yet, how many medical treatments today have been around for just 30 years, seemingly forgetting that the vast majority of drugs are ultimately found to be a lot more dangerous than previously realized and are not nearly as effective as originally assumed. Why do skeptics ignore and deny this pattern. It’s fun to watch the spin cycle in action!

    • WHO SAYS I WOULD MAKE EXCEPTIONS?
      I would advocate RCTs for all those therapeutic interventions; for disease prevention, things can be a little different because of the logistics of doing RCTs. but when they are relatively easy to do, I would advocate them [but surgery etc. is not my field, as you know].

      • So, first, you choose to make an exception for vaccines? Why?

        And if you still think that preventive treatment are exceptions, are you therefore supportive of using homeopathic medicines for PREVENTION?

        • with your superior logic, Dana, you should be able to quote me correctly; what I did state was the following: “I would advocate RCTs for all those therapeutic interventions; for disease prevention, things can be a little different because of the logistics of doing RCTs.” [there is the reason you asked for(reasons are often preluded by the word BECAUSE; a thing to remember, Dana)] but this does not necessarily mean I would make an exception for vaccines.
          with immunizations, one could, for instance, measure the immune response rather than infection rates [which would be ethically impossible and logistically difficult, I imagine]. and if you search Medline for ‘vaccines, RCT’ you get 108 hits – ~3 x more than for ‘homeopathy, RCT’. what does that tell you, Dana?
          of course, one could do the same for homeopathy. years ago, while still in Exeter, I tried to find homeopaths to collaborate in such a study on ‘homeoprophylaxis’. guess what – they did not want to! perhaps they knew the result already?

          • It tells you that there is a shit-load more money being spent by Big Pharma due to the high PROFITS they make than the “homeopathic” doses of profits made by homeopathic manufacturers who commonly sells their medicines for $5 to $20! I wonder why you couldn’t figure out this simple explanation.

          • no, it tells me that both you notions – surgery, vaccinations – were mistaken or deliberately misleading. feel free to apologise Dana.

          • Even Dullman’s strawmen don’t contain any actual straw.

          • has said:

            Even Dullman’s strawmen don’t contain any actual straw.

            Wrong. Ullman’s straw men contain straw diluted to 200C: they are the most powerful arguments in the Universe – well, only to him anyway.

        • So first there is no exemption for vaccines. Plenty of DBRCTs are performed for vaccines for new disease indications. After a vaccine has been shown, to the satisfaction of real experts, to be effective then new vaccines are compared with existing ones. How on earth did an MPH get a qualification without knowing this?

    • and guess what – I just searched Medline for RCTs in surgery and in homeopathy: 2700 versus 31!

      • Ernst, did you ever treat your wife with homeopathy?

        • yes, did you not read my memoir A SCIENTIST IN WONDERLAND? [https://www.amazon.co.uk/Scientist-Wonderland-Searching-Finding-Trouble/dp/1845407776?ie=UTF8&*Version*=1&*entries*=0] you should, if you are so interested in this aspect of my life!

    • Let the games begin! D.Ullman’s in town.

      How about an RCT comparing parachutes (verum) with umbrellas (placebo)? Would that count as research in your eyes Dana?

      (This comment intentionally contains frivolous sarcasm)

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