MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Guest post by Richard Rawlins MB BS MBA FRCS

Doctors who are registered medical practitioners (RMPs) must comply with the standards of practice set down by the General Medical Council. ‘Homeopathy’ is a specific system of medical care, devised by Dr Samuel Hahnemann in the nineteenth century, and comprises two distinct dimensions: (i) the establishment of a constructive therapeutic relationship between an empathic homeopath and a patient. This may provide benefit due to the non-specific effects of condolence, counselling, and care – and should be a component of the practice of all doctors in any event; (ii) the homeopathically prepared (HP) remedies that are generally prescribed. To avoid confusion, these two dimensions should not be conflated.

HP remedies may be obtained over the counter, prescribed by lay homeopaths and even given out by dentists and nurses on the grounds that “30C homeopathic arnica helps bruising”. The US Federal Trades Commission has stated that “The Commission will carefully scrutinize the net impression of OTC homeopathic advertising or other marketing employing disclosures to ensure that it adequately conveys the extremely limited nature of the health claim being asserted…accordingly, unqualified disease claims made for homeopathic drugs must be substantiated by competent and reliable scientific evidence.” (FTC Policy statement 2017).

Special focus should be brought to bear on the ethical, intellectual and professional obligations of those doctors registered as medical practitioners by the GMC and practicing homeopathy in the UK. Some homeopaths may intend taking advantage of gullible and vulnerable patients. Here I take it that those practitioners who prescribe homeopathic remedies sincerely do believe they have worthwhile effects, but I contend such practice generally fails to comply with ethical and professional standards as set down by the GMC. That is to be deprecated.

Systems to regulate medical practice in the British Isles have been devised since the middle ages. In 1518, Thomas Linacre founded the College of Physicians – based on systems he had seen in Europe. From 1704, the Society of Apothecaries licensed its members to prescribe and dispense medicines, and developed the profession of general practice. In order to protect the public from charlatans, quacks and fraudsters more effectively, the Medical Act of 1858 established formal statutory regulation of doctors by the General Medical Council. Registrants who are not deemed fit to practice may be struck off the register. They can still practice, but not as registered medical practitioners. They can still use the title ‘doctor’ (as can anyone), but not for fraudulent purposes.

Dr Samuel Hahnemann qualified in Saxony in 1781 and was a good doctor, but he became disillusioned with many of the practices and practitioners of his day. He wrote about his fellow doctors: “Precious and fragile human life, so easily destroyed, was frequently placed in jeopardy at the hands of these perverted people, especially since bleedings, emetics, purges, blistering plaster, fontanels, setons, caustics and cauterisations were used.” In 1796 he wrote to a friend, “I renounced the practice of medicine that I might no longer incur the risk of doing injury, and I engaged in chemistry exclusively and in literary occupations.”

Hahnemann went on to develop his own alternative system of health care, which he styled ‘Homoeopathy’. Published as the Organon of the Healing Arts in 1810, Hahnemann set out an idiosyncratic medical system based on identifying ‘remedies’ which in large doses, could produce symptoms comparable to those suffered by the patient. The remedies he prescribed were prepared with serial dilutions so that no active principle remained. Today’s homeopaths hold that a remedy’s ‘vital force’, ‘healing energy’ or ‘memory’ provides therapeutic benefit. That may be the case, but the consensus of informed scientific and medical opinion is that any effects of ‘homeopathy’ are as a result of contextual placebo effects. The remedies themselves cannot and do not have any effect. England’s Chief Medical Officer has described homeopathy’s principles as ‘rubbish’. The government’s Chief Scientific Adviser, Sir Mark Walport has said he would tell ministers, “My view, scientifically, is absolutely clear: homeopathy is nonsense. The most it can have is a placebo effect.” Simon Stevens, CEO of the NHS, when interviewed on Radio 4 said he agrees with Sir Mark – yet failed to explain why he had not included homeopathic remedies in the 2017 list of NHS proscribed medicines. That stance is being reviewed.

The GMC states, “Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and make sure your practice meets the standards expected.” Those standards are set down in the GMC’s Good Medical Practice which advises, “Serious or persistent failure to follow this guidance will put your registration at risk.” The GMC standards are coherent with those of the American Medical Association’s Principles of Medical Ethics (2016).

In précis, the most relevant and important GMC standards are:

  • Make the care of your patient your first concern.
  • Give patients the information they want or need in a way they can understand.
  • Be honest and open and act with integrity.
  • Never abuse your patients’ trust in you or the public’s trust in the profession.
  • You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.
  • You must  prescribe drugs or treatment only when you are satisfied that the drugs or treatment serve the patient’s needs.                                                                                                                                             
  • You must provide effective treatments based on the best available evidence.
  • You must be satisfied that you have consent or other valid authority before you carry out any examination, investigation or provide treatment.
  • You must make good use of the resources available to you.

I contend that medical practitioners who prescribe homeopathic remedies regularly fail to meet these standards. They know perfectly well that the best available evidence indicates no support for the assertion that homeopathic remedies ‘serve the patient’s needs’, except as placebos; that the treatments have no specific effects; that the remedies are placebos; and that resources are wasted by expenditure on these ineffective remedies. Medical homeopaths invariably do not give patients this information; they fail to obtain properly informed consent; they do not justify their decisions and actions rationally; and they may be obtaining financial advantage by misrepresentation to insurance companies or the NHS. This is an abuse of the public’s trust in the medical profession.

The issue of informed consent is particularly important. GMC guidance states that, “The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice. …Before accepting a patient’s consent, you must consider whether they have been given the information they want or need, and how well they understand the details and implications of what is proposed. This is more important than how their consent is expressed or recorded.”

The GMC states that, “in order to have effective discussions with patients about risk, you must identify the adverse outcomes that may result from the proposed options… risks can take a number of forms, but will usually be: side effects; complications; failure of an intervention to achieve the desired aim.” The risk of wasting money on ineffective remedies, whether NHS or private, and of delaying treatment known to be effective should also be discussed.

Homeopaths acknowledge that after ministration of remedies, some patients experience ‘aggravations’ – a worsening of symptoms, but they advise this is evidence that the remedy is ‘working’. Medical consensus is more likely to suggest ‘aggravations’ are evidence of an underlying psychological component to the patient’s condition. Suggestions that remedies themselves have any effect, good or bad, is misrepresentation and may be fraud. Offering patients sugar pills with a claim the pills have therapeutic effects means lying to them, and is an abuse of trust.

Homeopaths’ system of diagnosis and prescription of remedies requires them to have beliefs for which there is no plausible evidence base. The Oxford Dictionary defines ‘belief’ as “assent to a proposition, statement or fact, especially on the grounds of testimony or authority, or in the absence of proof or conclusive evidence.” It might be acceptable to practice ‘homeopathy’ as a counselling modality, providing the practitioner complies with the GMC standard that, “You must not express your personal beliefs to patients in ways that exploit their vulnerability or are likely to cause them distress.”

Homeopaths are invariably non-compliant in obtaining fully informed consent. Such a failing is an abuse of patients’ trust in the medical profession. Doctors might be determined to be unfit to practice unless they clearly justify their prescriptions, and identify the evidence that supports them. All these issues should also be explored during the doctor’s annual appraisal, without which a registered medical practitioner will not be licensed to practice. Even registration without a licence requires compliance with the standards. Appraisal can be carried out by non-homeopaths, as the issue is not the assessment of the standard of ‘homeopathic practice’, but compliance with GMC standards of good medical practice.

If a medical homeopath wishes to be GMC compliant, they must properly inform patients about contentious issues. I suggest that consent should be obtained along the lines: “I propose prescribing you a remedy comprising sugar pills impregnated with a solution which has been diluted to such an extent that a sphere of water the size of the Earth’s average radius to the Sun would probably contain no more than one molecule of the original substance. Nevertheless, my clinical experience suggests to me that this remedy will improve your condition. You need to understand that colleagues who practise conventional evidence-based scientific medicine regard my belief as implausible and the methods I use as ‘alternative.’ I believe the remedy will help you, but I have no evidence accepted by the majority of doctors that the intervention I propose will achieve the desired effects. I do not believe that taking a homeopathic remedy will delay any other treatment which might reasonably help your condition and I invite you to take this remedy with understanding of the issues I have outlined.” A copy of the consent should be placed in the patient’s records.

Those who defend the right of registered medical practitioners to prescribe HP remedies do so with arguments fatally holed by a myriad of logical fallacies. Some arguments are (with fallacies in parenthesis):

  • “Homeopathy has been used for over two hundred years” (appeal to tradition and argument from ignorance);
  • “It has become very popular and is what patients want (appeal to popularity);
  • “Homeopathy has the capacity to help patients” (red herring, because present consideration is about the value of HP remedies, not relationships);
  • “Remedies are cheap” (red herring);
  • “Homeopathy does not do any harm” (irrelevant and a red herring);
  • “Pharmaceuticals have side effects” (tu quoque and red herring);
  • “The Royal Family use it” (appeal to irrelevant authority);
  • “The remedies enhance the doctor/patient relationship (straw man);
  • “Science does not know everything” (red herring and false dichotomy);
  • “Those who oppose us don’t understand homeopathy” (argumentum ad hominem and ‘poisoning the well’);
  • “I have the evidence of patients’ anecdotes and testimonials” (pseudoscience, confirmation bias and cherry picking);
  • “Homeopathic doctors are caring people” (red herring and straw man);
  • “I’ve got much evidence of  patients taking remedies and getting better” (post hoc ergo propter hoc – ‘after this, therefore because of this’ – confusion of coincidence with causation).

The latter most perverse fallacy is the foundation of homeopathic practice, based on identifying a remedy whereby ‘like cures like’ – a principle based on post hoc fallacy for which there is no scientifically credible evidence.

Unless and until medical homeopaths understand the intellectual environment in which they practice, are prepared to properly inform their patients, and obtain consent for treatment having done so, they should not prescribe homeopathic remedies. Fortunately, there is no evidence that patients who are prescribed HP remedies by empathic GMC registered homeopaths have any different outcomes from those prescribed pure sugar pills – even if they are told they are placebos. However, trust in the medical profession can only be maintained if deceptive practices are set aside and full explanations for proposed interventions are offered. Given the scientific consensus, patients have to face up to the fact that to the highest degree of probability, HP remedies have no value. Regrettably, too many patients and even homeopaths are in denial. Medical homeopaths should continue to serve their patients with care, compassion and intellectual honesty, but if they are to comply with the standards required for GMC registration, they should not prescribe homeopathically prepared remedies.

157 Responses to GMC registered medical practitioners should not prescribe homeopathically prepared remedies

  • There is at least anecdotal evidence of worse outcomes for patients treated by homeopaths, eg:

    https://www.casewatch.org/foreign/viegas/2008.shtml

    The problem is that their patients would quite literally rather die than complain against their doctor. Viegas was shopped to the GMC by another doctor (the patient was dead).

  • ‘A propos’ Les Rose’s comment:

    Lord Betrand Russell opined: “Most people would rather die than think, and many of them do.”

  • Since Homeopaths should not be referred to as doctors or physicians their pseudo treatments should not be referred to as REMEDIES. This insinuates their voodoo tricks and gimmicks are equivalent to actual, logical and science based remedies. A more accurate term is Homeopathic Tricks.

  • Dr Rawlins says that ‘consent should be obtained’ and then states in the same paragraph that ‘too many patients are in denial’. It would be hilarious if his pompous statement had to be read out by Homeopathic Drs to these patients. Many of these patients (in denial of course ) would of course complain to the GMC after listening to such waffle.
    So never in reality would the GMC risk such nonsense.
    You are in Wonderland with Edzard Dr Rawlins.

    • The problem is that many patients misunderstand homeopathy and wrongly believe a/ there is evidence to support its use and b/ there is an actual ingredient in homeopathic remedies. Obtaining consent in this way would make sure these people knew exactly what they were getting into and might prevent a few patients from receiving a bogus treatment which they hadn’t previously understood and had been misled into trying.

      Obviously the patients who already know all this yet still believe, against all the evidence, that homeopathy works will just give a knowing laugh and press on. But it’s not that type of patient who are the reason to insist on informed consent in such circumstances; some might say such patients were already beyond help.

      Excellent article, Richard, thanks.

      Niall

      • Niall Taylor said:

        Obtaining consent in this way would make sure these people knew exactly what they were getting into and might prevent a few patients from receiving a bogus treatment which they hadn’t previously understood and had been misled into trying.

        Indeed. And it’s particularly difficult to see how a homeopath could fulfil the requirements of Montgomery.[1]

        __________
        1. 1 Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland) – The Supreme Court. https://www.supremecourt.uk/cases/uksc-2013-0136.html (accessed 7 Dec 2015).

    • @JK: There appear 5 sentences, made of numerous words and even apparently properly placed punctuation….
      however no sense can I make of what is written.
      Perhaps the actual meaning is so dilute as to be non-existent?

      • Michael Kenny
        You must have understood something otherwise you would not be trying to take the piss. I would offer you a homeopathic remedy to help you learn to read. I have one in mind but first I have to say the following to you…..

        I propose prescribing you a remedy comprising sugar pills impregnated with a solution which has been diluted to such an extent that a sphere of water the size of the Earth’s average radius to the Sun would probably contain no more than one molecule of the original substance. Nevertheless, my clinical experience suggests to me that this remedy will improve your condition. You need to understand that colleagues who practise conventional evidence-based scientific medicine regard my belief as implausible and the methods I use as ‘alternative.’ I believe the remedy will help you, but I have no evidence accepted by the majority of doctors that the intervention I propose will achieve the desired effects. I do not believe that taking a homeopathic remedy will delay any other treatment which might reasonably help your condition and I invite you to take this remedy with understanding of the issues I have outlined.”

    • JK, apart from your posts being anonymous (please have the courage of your conviction and let us know who you are), and ‘ad hominem’ – what exactly is your objection to any practitioner being honest when obtaining consent?

      • I have no concern about any Dr saying to a patient whatever they think about homeopathy.
        I see a problem if the GMC force a statement similar to your one to be read out by homeopathic Drs to patients. This would surely result in complaints to the GMC about the statement from many angry patients. Therefore it will never happen due to patient power.

        • As I asked before JK, on what grounds would such patients complain?

        • JK (why are you fearful of being identified?):
          Why on earth would any patient be concerned about being told a factual statement?
          If, having possession of the facts (consensus of professional opinion), the patient agrees to take a HPP, so be it.

          But you have not said what your objections to honesty are.
          Would you please concoct a statement which would provide patients with the information they need about homeopathy before consenting to treatment.
          Thank you.

  • The GMC sets out clear grounds for a complaint so perhaps you could tell us which ones are relevant here.

    • Please refer to the GMC ‘Good Medical Practice’.
      There is only one ground for complaint: That a practitioner has failed to comply with GMP.
      As to which particular paragraph/injunction – I am going for ‘informed consent’, but you might consider that others apply.

      I am learning from all the responses to my post, and will refine my case before approaching the GMC.
      Many thanks to all for the help – even for the anonymous contributions!

  • Dr Rawlins, as a person that supposedly knows something about law, the blog that you have posted is worthless as a ‘case’ against homeopathy. It is all opinion and speculation without scientific references to back up your assertions.
    Maybe you think by posting your titles that you ARE authority on this topic (expert) and therefore no references required. But you are a medical doctor ands not a homeopath so on what do you base your opinions?

    R: reference required

    I contend that medical practitioners who prescribe homeopathic remedies regularly fail to meet these standards.(R)

    They know perfectly well (R) that the best available evidence indicates no support for the assertion that homeopathic remedies ‘serve the patient’s needs’,(R) except as placebos; that the treatments have no specific effects;(R) that the remedies are placebos; and that resources are wasted by expenditure on these ineffective remedies.(R) Medical homeopaths invariably do not give patients this information (R); they fail to obtain properly informed consent (R); they do not justify their decisions and actions rationally (R); and they may be obtaining financial advantage by misrepresentation to insurance companies or the NHS (R!). This is an abuse of the public’s trust in the medical profession.

    Homeopaths acknowledge that after ministration of remedies, some patients experience ‘aggravations’ – a worsening of symptoms, but they advise this is evidence that the remedy is ‘working’. Medical consensus is more likely to suggest ‘aggravations’ are evidence of an underlying psychological component to the patient’s condition.(R!)

    Homeopaths’ system of diagnosis and prescription of remedies requires them to have beliefs for which there is no plausible evidence base.(R)

    Homeopaths are invariably non-compliant in obtaining fully informed consent.(R!)

    • @Greg:
      It would be very interesting/illuminating to me to see how a homeopathic-defender i.e. an insane person and/or fraud, would ‘defend’ something that ‘their’ limited cognitive skills would suggest is utterly without merit….say Scientology “auditing”?? Or alien invaders??
      Implausible and fraudulent ‘activities’ like homeopathy and Scientology continue to make definitive, positivistic claims regarding utility and mechanism-of-action….yet can NEVER be defended logically or scientifically….yet their proponents vigorously attack those who dare ask for the proof.
      Public denigration of such activities and proponents should be the shibboleth of the reasoned, critical members of the society. Public humiliation IS morally justifiable and should be seen as a moral obligation.
      No one is ‘required’ to prove-their-innocence or prove a negative (in a civilized nation). IF proof exists obfuscation is unnecessary, yet misdirection and obfuscation are all you contribute.

    • Greg, you are correct, I have expressed but an opinion.
      When I have studied the responses (including ad hominem) I will put a ‘case’ together.
      Many thanks for your help.

      • Dr Rawlins, I would be pleased to read your ‘case’ and provide my ‘response’ to it.

        Every debate has ‘for’ and ‘against’ perspectives, and mine is ‘for’ homeopathy but according to the ‘classical’ perspective, and not the medical homeopathy perspective (that is a separate camp and they can advocate their own position).

        • Greg,
          Any case will be a referral to the GMC in connection with a doctor’s performance/ethical failings.
          Neither I nor the GMC will consider a case for or against ‘homeopathy’.
          The issue will be:
          ‘Has the GMC registered homeopath obtained fully informed consent?
          If not, should they prescribe HPP – is it ethical to do so?
          Are they perhaps taking advantage of the vulnerable and gullible?
          Is that ethical?’

    • For references, check out Real Secrets of Alternative Medicine. (Amazon or Kindle).
      Or http://www.placedo.co.uk

  • Rawlins

    In précis, the most relevant and important GMC standards are:

    “Make the care of your patient your first concern.”
    The right way: http://www.bmj.com/content/353/bmj.i2139

    “Give patients the information they want or need in a way they can understand.”
    http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

    Be honest and open and act with integrity.
    https://www.scientificamerican.com/article/how-much-are-drug-companies-paying-your-doctor/

    Never abuse your patients’ trust in you or the public’s trust in the profession.
    http://fortune.com/2016/03/31/big-pharma-fines/
    https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html?mcubz=0

    You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.
    http://edition.cnn.com/2017/07/31/health/opioid-doctors-responsible-overdose/index.html

    You must prescribe drugs or treatment only when you are satisfied that the drugs or treatment serve the patient’s needs.
    https://sciencebasedmedicine.org/most-patients-get-no-benefit-from-most-drugs/

    You must provide effective treatments based on the best available evidence.
    http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

    You must be satisfied that you have consent or other valid authority before you carry out any examination, investigation or provide treatment.
    https://www.rd.com/health/healthcare/50-secrets-your-surgeon-wont-tell-you/
    This is equally valid for physicians.

    You must make good use of the resources available to you.
    Edzard seems to do fairly well for a person without a job.

    This constitutes the substance based upon which you plan running down alternative medicine?

    Chirag taale andhera: Darkness under the lamp: Apt proverb to describe you.

    • Let’s see what fellow Iqbal is pointing at:

      1) http://www.bmj.com/content/353/bmj.i2139

      In the link, the authors state (QUOTE): Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient.5

      Let’s see how homeopathy scores against those definitions:
      Homeopathy acts by OMITTING the active ingredient (or COMITTING fraud because practitioners know there is no active ingredient). It uses a wrong plan (similar cures similar) which has nothing to do with scientific knowledge and doesn’t stem from any sound collection of experimental observations and evidence. It deviates from the process of care (regardless of whether harm is done or not, as defined by the authors) as practitioners at times advise against conventional medical practice.

      That’s right, it is a medical error by ALL definitions. If practiced by non-doctors, this is not relevant to the case. If practiced by doctors, according to the definitions of the paper cited above, its use constitutes a medical error.

      2) http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

      Fellow Iqbal likes the chart at the bottom. How about the statement? (QUOTE) Effectiveness of 3000 treatments as reported in randomised controlled trials selected by Clinical Evidence. This does NOT indicate how often treatments are used in healthcare settings or their effectiveness in individual patients.

      Now I would really like to think it is unnecessary to state ANYTHING as this sentence is as clear as possible. But since fellow Iqbal would like to think that the chart indicates that conventional medicine uses a large number of ineffective treatments, let’s make it clear. It doesn’t! It only shows that a very large number of treatments have been “around”, and conventional medicine was SO open-minded that it put them to the test. The rest is history… usually in the making.

      Also, mind the sentence from the same webpage: (QUOTE) ‘Unknown effectiveness’ is perhaps a hard categorisation to explain. Included within it are many treatments that come under the description of complementary medicine (e.g., acupuncture for low back pain and echinacea for the common cold), but also many psychological, surgical, and medical interventions, such as CBT for depression in children, thermal balloon ablation for fibroids, and corticosteroids for wheezing in infants.

      That’s right, homeopathy coulnd’t even make it into the small parenthesis with examples about complementary medicine. Echinacea won the second place again! Perhaps someone ought to question BMJ Clinical Evidence where they put homeopathy, under “unknown” or “likely to be ineffective”/”unlikely to be effective”.

      3) https://www.scientificamerican.com/article/how-much-are-drug-companies-paying-your-doctor/

      Drug companies approaching doctors! Is anyone surprised to hear? And doctors sometimes respond! Anyone surprised yet? Great. So doctors sometimes prescribe what they are paid to prescribe. Do they prescribe irrelevant stuff? NOPE. They prescribe something that FITS the diagnosis. Competition is competition and, sometimes, money is on the table and a product is preferred over another. Not very ethical, is it? No more than prescribing water or sugar pills of course! Which is why this has NOTHING to do with the matter at hand.

      Oh, and how about prescribing shaken water? Who would approach you? The Ofwat of course… to regulate the price!

      4) http://fortune.com/2016/03/31/big-pharma-fines/
      https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html?mcubz=0

      Scandals in healthcare provide a green card for homeopathy. This is fellow Iqbal’s reasoning! Not even wrong…

      5) http://edition.cnn.com/2017/07/31/health/opioid-doctors-responsible-overdose/index.html

      What is going on in the USA? (QUOTE) The number of doctors penalized by the US Drug Enforcement Administration has grown more than fivefold in recent years. The agency took action against 88 doctors in 2011 and 479 in 2016, according to an analysis of the National Practitioner Data Bank by Tony Yang, an associate professor of health administration and policy at George Mason University. Many other doctors have been sued in civil suits.

      That’s right! 479 doctors were penalized somehow. And many other doctors have been sued in civil suits. If fellow Iqbal would mind making it appear special somehow (which it isn’t), it would be very simple. Just state a profession, the individuals who practice which have a significantly lower rate of wrongdoing than doctors in the USA. Remember, we need something along the lines “(some) agency took action against ## in ####, according to an analysis of (a reliable data bank)…”. And remember… ## has to be less than 88 or 479 and #### has to be after 2010.

      And homeopathy practitioners? They prescribe ineffective treatments, which is textbook wrongdoing. Oh, I forgot… THIS is the matter at hand, not conventional medicine. Seems I got carried away again by fellow Iqbal’s distractions.

      6) https://sciencebasedmedicine.org/most-patients-get-no-benefit-from-most-drugs/

      To comment on that, fellow Iqbal must abstain for a little while from making irrelevant and distracting posts with numerous links, exhibit fair indications that he has a working knowlege of (cf. understand) how drugs work when administered in the human body, a slightly fair understanding of statistics, and then we can get down on talking about NNT. Until then, maybe fellow Iqbal might understand it in a simpler way… from the perspective of the patient:

      (QUOTE from the above website)
      -Blood pressure medications for 5 years:
      -NNT to prevent one death: 125

      Does it serve the patient’s needs to nullify their 1/125 (0.8%) chance of dying? And this is just for the AVERAGE case. For high-risk patients it’s somewhat worse. 5%? 2%? What chance of dying would be small enough to decide that it wouldn’t serve the patient’s needs to prescribe blood pressure medications? Right.

      7) http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

      What? Again? Oh, this time it is about “You must provide effective treatments based on the best available evidence”. Ok, then fellow Iqbal understands that homeopathy is an ineffective treatment, according to the best available evidence. Speaking of the BMJ, I guess the UK NHS is the corresponding regulatory body.
      So, http://www.nhs.uk/Conditions/homeopathy/Pages/Introduction.aspx should make it quite clear:
      (QUOTE): “[…] homeopathic remedies perform no better than placebos […]”.

      8) https://www.rd.com/health/healthcare/50-secrets-your-surgeon-wont-tell-you/

      ## secrets _____ won’t tell you. The almost infallible beginning of any immensely misleading article. The article consists of 50…. APHORISMS. Precisely… this is 50 collected opinions by some 50 doctors.

      “Mistakes are probably more common than you would think…” said… “An orthopedic surgeon”.

      There are so many irrelevant things in there, it would be a waste of time to deal with them.

      What did fellow Iqbal say?
      “You must be satisfied that you have consent or other valid authority before you carry out any examination, investigation or provide treatment.”
      How do homeopathy practitioners get consent? Through testimonials? Yes! By citing impossible research? Maybe! By lying about the effectiveness of the modality? Well, all the time!

      “Edzard seems to do fairly well for a person without a job.”
      It seems fellow Iqbal is a proponent of working past 65 years of age. Until what year of age does fellow Iqbal believe people should work? 100 maybe?

      If fellow Iqbal would stop being schadenfroh with medicine for just a couple of minutes, and would FOCUS on the case, it might occur to him that it is HOMEOPATHY people are discussing here, NOT the rest of medicine.

      • James

        “Let’s see how homeopathy scores against those definitions:”
        How much of homeopathy do you know, other than what is written by the likes of Edzard? His job was to mislead in the name of Chair of complementary medicine…..and this continues. https://www.karger.com/Article/Pdf/355916

        “Homeopathy acts by OMITTING the active ingredient (or COMITTING fraud because practitioners know there is no active ingredient)”
        Who gave you this information? Hahnmann or Edzard? http://www.homeoint.org/books/boericmm/index.htm is one of the general reference book used by homeopath doctors. It also defines dosage. Check and let me know how many remedies are not homeopathic.
        Why would you define “like cures like” a wrong plan? Because you don’t understand it? What has the “unlike cure like” philosophy offered you? http://martinblaser.com/excerpt.html. This is a small summary of outcome of allopathic drugs and treatment processes. This is EXACTLY the outcome observed by homeopaths.

        “nothing to do with scientific knowledge and doesn’t stem from any sound collection of experimental observations and evidence.”
        This is the most stupid argument. Evaluating homeopathic medicines on the basis of laws of Physics and Chemistry is irrelevant. It would have been valid if this approach would have helped allopathic patients. ” Nobel prize was given to scientists confirming H pylori cured ulcers: …physicians everywhere commenced an all-out war against H. pylori by prescribing antibiotics to anyone with gastric discomfort. Their mantra ultimately became “the only good H. pylori is a dead H. pylori.”
        As Dr Blaser writes ” Yes, H. pylori can be very harmful to some adults, but later we found that it may be very beneficial to many of our children. Eliminating it may be causing more harm than good.”
        Physics and Chemistry is great: what about the interface: the human body?

        “In the 1990s there was a great deal of legitimate hope that antioxidant therapy would treat and perhaps even cure a long list of degenerative diseases. Oxygen free radicals damage cells, and antioxidants scavenge those free radicals. It turned out that the system was more complex than we thought, oxygen free radicals are used by cells for immune activity and metabolic signaling, and improving a complex system that evolution has already had millions of years to tinker with is not so easy.
        Also at that time retroviral gene therapy promised to cure a long list of genetic diseases. The idea is clever – use the machinery of viruses to insert bits of DNA into a patient to fix a broken gene. This strategy actually works, however researchers ran into safety problems. The viral vectors can sometimes become replication competent, meaning that they can reproduce and cause a serious infection. Later vectors reduced this risk, but then another risk appeared – activation of oncogenes leading to leukemia. These safety hurdles have kept this treatment from becoming widespread for the last two decades.”

        What is happening to the Science of Physics and Chemistry when used in medicine. When used in low potencies, for temporary relief, homeopathy medicines also behave as allopathic drugs, but offer benefit without side effects.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085232/

        to continue.

        • James

          “How about the statement? (QUOTE) Effectiveness of 3000 treatments as reported in randomised controlled trials selected by Clinical Evidence.”

          Who is the medical system conning with evidence? This is what the doctor who coined the term “evidence based medicine”, has to say: “The goal of this movement is to pierce the fog that envelops the practice of medicine — a state of ignorance for which doctors cannot really be blamed. “The limitation is the human mind,” Eddy says. Without extensive information on the outcomes of treatments, it’s fiendishly difficult to know the best approach for care. The human brain, Eddy explains, needs help to make sense of patients who have combinations of diseases, and of the complex probabilities involved in each.”

          Next time you sit in front of the doctor, defining a chronic ailment, check what changes are made in his brain that take into account your condition and references it for evidence to a similar equivalent case (age, weight, ethnics, test report data, present condition and condition five years ago…………………………..) I believe for diabetes alone, for evidence review there are over 60 attributes.

          “The predictions of success invariably ranged from 0% to 100%, with no clear pattern. “All the doctors were trying to estimate the same thing — and they all gave different numbers,” Eddy says. “I’ve spent 25 years proving that what we lovingly call clinical judgment is woefully outmatched by the complexities of medicine.” Think about the implications for helping patients make decisions, Eddy adds. “Go to one doctor, and get one answer. Go to another, and get a different one.” Or think about expert testimony. “You don’t have to hire an expert to lie. You can just find one who truly believes the number you want.”

          And if you suffer from diabetes and bronchitis, check if the RCT is available for combining 2/3/4 drugs the doctor offers you to be taken together. And if you have blood pressure also, what additional evidence is available for the drug combination? And if the drugs come from different manufacturers does it make a difference? Are there such RCT’s available?

          What about patients who are prescribed to take over 6 drugs during the day for different ailments. Their deaths are attributed to medical error because of combining drugs or they were very sick?.

          ““Our prescription drugs are the third leading cause of death after heart disease and cancer in the United States and Europe. Around half of those who die have taken their drugs correctly; the other half die because of errors, such as too high a dose or use of a drug despite contraindications. Our drug agencies are not particularly helpful, as they rely on fake fixes, which are a long list of warnings, precautions, and contraindications for each drug, although they know that no doctor can possibly master all of these.”
          Professor Peter C Gøtzsche: Big Pharma and Organized Crime

          Merck cheated with Vioxx (I doubt). But is this the ONLY drug clearing RCT and killing patients? What did the manufacturer do when testing Actos, for example? Patients continued with diabetes and added cancer of the bladder. Now they would require Actos and chemotherapy. When they die, is it cancer or medical error the reason for their death?

          What evidence are you talking about?

          • Iqbal, ladies and gentlemen! The man! The Myth… the Legend!

            A) Is fellow Iqbal impervious to reason? Does fellow Iqbal even exist? Let’s see what he has to say:

            1) “As Dr Blaser writes [long quote precedes and follows]”
            2) [goes on to quote what Steven Novella writes… out of context of course]
            3) “I am aware of a doctor […] He commented to me in a discussion”
            4) “This is what the doctor who coined the term “evidence based medicine”, has to say:…”
            5) “[a large quote from] Professor Peter C Gøtzsche: Big Pharma and Organized Crime”

            Fellow Iqbal boldly asks: “What evidence are you talking about?”

            Well, for the moment, I am talking about EVIDENCE that fellow Iqbal does not have an opinion of himself. He has to rely on opinions of other people. Can fellow Iqbal not express any piece of his knowledge? Does fellow Iqbal have ANYTHING to say? The evidence above favor the negative answer, unfortunately. He does not know, so he cites what OTHER PEOPLE “have to say”. And when knowledge is in abundant shortage, opinion prevails. But is it possible that fellow Iqbal does not even have an opinion of himself?

            Apparently, once again, not. His opinion is a patchwork of opinions with a strong element of criticism against conventional medicine. Fellow Iqbal’s brain retains the sieve functionality though. Whatever falls within this category is to his liking. Everything else seems to be irrelevant. Say hello to opinion-based medicine!

            B) Some special points, just for the sake of the legendary fellow Iqbal.

            First of all, fellow Iqbal only quotes the miserable parts from the report he seems to be reading. Let’s put this straight: he is quote-mining. Let’s check a few other quotes later on, from the same piece:

            “Of course, there are plenty of areas of medicine, from antibiotics and vaccines to early detection of certain tumors, where the benefits are huge and incontrovertible.”

            “The best way to go from intuition to evidence is the randomized clinical trial.”

            “[…] “The popular version of evidence-based medicine is about proving things,” says Kaiser’s Wallace, “but it is really about transparency — being clear about what we know and don’t know.” […] ”
            (That one is what, among other things, the present article of Dr. Rawlins is also about, coincidentally).

            That’s right. Fellow Iqbal should understand that we know his sources. We can easily check to see that he is quote-mining. If the texts are followed carefully, the overall picture becomes clear again, and in support of evidence-based medicine.

            C) Fellow Iqbal makes a suggestion:

            “Next time you sit in front of the doctor, defining a chronic ailment, check what changes are made in his brain that take into account your condition and references it for evidence to a similar equivalent case (age, weight, ethnics, test report data, present condition and condition five years ago…………………………..) I believe for diabetes alone, for evidence review there are over 60 attributes.”

            What is included in those “over 60 attributes” that fellow Iqbal believes in? Dreams? Tingling of the tongue? Time spent in traffic?

            Fellow Iqbal must understand that this is not how “the doctor” makes attempts to diagnose. This is empirical or opinion-based medicine. “The doctor” does not just reference for evidence to a similar earlier case. “The doctor” follows protocols that are established by fellow Iqbal’s worst nightmare, “evidence”. To the extent available, of course, evidence may include aggregations of similar case characteristics. But “the doctor” does not only look for similar symptoms (in packs of thousands, no less). This is, actually, how homeopathic practitioners make their diagnoses. Fellow Iqbal makes fair attempts to formulate partially rational points, but homeopathic principles and practice have so deeply permeated his brain that he confuses aspects of reality with aspects of homeopathy.

            Because fellow Iqbal does not know more, all he can do is look at the symptoms. And fellow Iqbal can, as such, project himself as a doctor. And fellow Iqbal can be pleased with his life! By his reasoning, he is playing doctor and he can compare himself to conventional well-educated doctors (having studied for years on end), and annihilate all of their causes, all by his entirely own reasoning. Ah, the ever self-righteous fellow Iqbal! Does fellow Iqbal even believe that he can homeopathically treat Type 1 diabetes? He likes the word, but what does he know about the condition?

            All this may not be fellow Iqbal’s own mistake. Maybe he grew up this way. It is hard to dispel fellow Iqbal’s dangerously misconstrued perception of reality. Fellow Iqbal is standing before a crossroad, fighting with his own delusions, and he needs to choose between improvement or belief perseverance.

            At this point, before he can begin improving himself, he needs to understand that incomplete knowledge is even worse than total lack of knowledge. Fellow Iqbal should take many steps back and start from scratch, the right way. Should he take this decision, this would definitely amaze me. Until then, fellow Iqbal’s attempts at argumentation by citing fascinating (only to him) stuff that some people said at some points are entirely not-amazing, let alone highly irrelevant to the subject of the current post.

      • James

        The end result is of paramount importance. Killing and maiming 43 million patients every year around the world in the name of evidence and medicine, by error or other wise, cannot be a medical system. If this is not understood, how can good medicine be understood?

        “If practiced by doctors, according to the definitions of the paper cited above, its use constitutes a medical error.”
        Homeopathy IS defined to be practiced by doctors in most countries. I am aware of a doctor, (MBBS, MD) who, after 18 years of conventional practice, took a course and started homeopathic practice. He commented to me in a discussion, “when I get carried away with the investigation reports, I miss the patient and most often, reach the wrong conclusion for the choice of medicines and get no result. When I focus on the patient, use reports as additional information, I always get result.”

        This is a DOCTOR’S definition of the medical error. And he did not kill or maim a patient.

        • Iqbal Krishna,

          It seems to be far beyond your ability to comprehend that, out of the circa 7.5 billion people currently alive on planet Earth, each and every one of us will die. Procreation is, in and of itself, the only incurable sexually-transmitted death sentence.

          The birth rate is circa 18.5 per 1,000 people per year; the net population growth is circa 1 percent, therefore the death rate is circa 137 million people per year. Attempting to assign 43 million of these deaths per year to medical incompetence, while at the same time promoting homeopathy as the solution to the problem, is nothing other than committing and promoting medical fraud. I guess you operate under a jurisdiction which either tolerates or promotes quackery.

          • Careful.
            The UK jurisdiction tolerates quackery, and the Head of State endorses it (giving homeopathic shops a Royal Warrant).
            Her heir actively promotes it!

            Best to avoid tu quoque.

          • Richard, It wasn’t a tu quoque, it was a sideswipe at the Head of State and her heir. I can imagine him sitting on the throne (Royal Doulton).

        • @Iqbal
          What is your education and training? Please provide full details so that we can confirm you are an authority/scholar whose extraordinarily strange and unrealistic ideas regarding modern medicine and health care are worth discussing. Untill then you can be dismissed as an amateur with a religiously confused agenda promoting make-believe medicine.

        • Ah, if it isn’t the original fellow Iqbal! It is a pleasure to discover the “content” behind the name.

          Fellow Iqbal seems to love TEH INTERNET! Let’s see what he is pointing at now:

          1) https://www.karger.com/Article/Pdf/355916

          Dear readers, beyond the fact that this is a Robert Hahn paper and it is an OPINION in a complementary medicine journal, a few extra problems appear striking through. A first-pass reality check reveals a citation:
          (QUOTE)
          Ullman D, Frass M: A review of homeopathic research in the treatment of respiratory allergies. Altern Med Rev 2010;15:48–58.
          (/QUOTE)

          If one has to cite Ullman reviews, they probably don’t know too much about homeopathy. All this is enough for me to disbelieve Robert Hahn’s critique and discussed information. There is too much to be said about this but I suspect it has already been dealt with elsewhere, so I shall put all these observations to the side.

          I will only ask a very simple question. Robert Hahn’s paper ends with a note, stating:
          (QUOTE)
          “The author has never practiced, received, or studied homeopathy, but has worked in clinical medicine and performed traditional medical research in anesthesiology and surgery for the past 30 years.”
          (/QUOTE)

          Fellow Iqbal has asked me:
          “How much of homeopathy do you know, other than what is written by the likes of Edzard?”

          So, Robert G. Hahn has never studied homeopathy either. But fellow Iqbal seems to believe HIS opinions. So, the favorite question of fellow Iqbal and Co. that goes around the lines: “have you studied homeopathy” or “what do you know about homeopathy” etc. is only addressed to people that express an opinion that is conflicting to their own beliefs. When Robert Hahn’s opinion supports their beliefs, they never resort to that theme, DESPITE the clear statement that Robert Hahn, at least at the time of this publication, is fairly ignorant of what homeopathy is about*. So, the question for fellow Iqbal is, how much of homeopathy does Robert G. Hahn know? Apparently “[he] has never practiced, received, or studied homeopathy […]”.

          *See, according to the lines of Iqbal & Co. Homeopathy Apologists, if one hasn’t STUDIED homeopathy, he knows nothing about homeopathy…

          The homework for readers is a far simpler question: Does fellow Iqbal use double standards to promote homeopathy?

          2) http://www.homeoint.org/books/boericmm/index.htm

          I have to admit that few things are more dangerous than this pre-scientific thinking type of medicine. Anyway, let’s check some really dangerous stuff in there. I shall quote the links with dosages:

          http://www.homeoint.org/books/boericmm/b/botul.htm – BOTULINUM toxin
          Dose.–Higher potencies. (Yeah, RIGHT!)

          http://www.homeoint.org/books/boericmm/a/acon.htm
          Dose.–Sixth potency for sensory affections; first to third for congestive conditions. Must be repeated frequently in acute diseases. Acon is a rapid worker. In Neuralgias tincture of the root often preferable, one drop doses (poisonous), or again, the 30th according to susceptibility of patient.
          (KEEP THAT INFO IN MIND FOR A MOMENT)

          According to the WHO report (http://www.who.int/medicines/areas/traditional/Homeopathy.pdf, page 4), the German Homeopathic Pharmacopoeia (GHP) provides an alkaloid content (in the form of aconitine) of 0.016–0.032% in products of 1X = 1DH. I will be mean and choose a number close to the upper bound, i.e. 0.03%. So this means that the solution contains ~0.3g/L, or 0.3 mg/mL aconitine. Fair stuff. According to https://en.wikipedia.org/wiki/Aconitine, which states a fairly reliable source ([21]), the lowest observed lethal dose of aconitine in human is reported to be 0.028 mg/kg, i.e. ~2 mg for a 70kg individual. This is little more than 6 mL of the first potency of Aconitum Napellus 1X.

          Fellow Iqbal’s “manual” (the materia medica) suggests “first to third [potency] for congestive conditions”. So, this has the potenctial to cause hard symptoms on people. Imagine how things fare when applied on children (left as homework for the readers). However, I understand fellow Iqbal’s skepticism with respect to science, so I have an extra report for him.

          Those guys: http://www.sciencedirect.com/science/article/pii/S0099542808604244 report using mother tinctures of Nux Vomica that contain 0.224% alkaloids. I would go with a 0.2% content of strychnine equivalent, just to be on the unsafe side. This means that there are about 2 mg/mL of strychnine in the mother tincture. People here: https://www.ncbi.nlm.nih.gov/pubmed/9365429 mention a reported lethal dose at about 100 grams but I would cut that down on 50g to once again be on the unsafe side. They also report a half-life of strychnine equal to 16 hours, although typical literature reports 10 hours as a t-1/2 for strychnine. I will also use 16 hours as a half life, just to be on the unsafe side. Worst-case scenarios lead to stricter safety measures anyway.

          So, the case is here: http://abchomeopathy.com/forum2.php/360980/0#p0
          The poor guy was prescribed mother tincture of Nux Vomica, 15 drops, three times a day. If we are to make the typical assumption that 20 drops make an mL, 45 drops per day are definitely equal to 2 mL, if not more. This contains 4 mg of strychnine per day. I will abuse a few mathematics and oversimplify for the moment, but let’s assume a course of therapy equal to 30 days. I have seen homeopathy advocating immensely large treatment periods quite often.

          By the end of each 24 hour day, strychnine in the body should have been metabolised and only a content of about 20% of the original dose will remain (10 hours for half, and then another 10 hours for half of half, i.e. 25% and I cut it down a bit more to account for the rest 4 hours in the day). I could do better than that, but I doubt fellow Iqbal would follow.

          Therefore, of the 4 mg received daily, a bit less than 1 mg appears to accumulate. I shall use this value to account for the cut-down from the 45 drops being cut-down to 40 and the 0.224% value being cut-down to 0.2%. So, I calculate an approximate value of 1 mg accumulation per day. Guess how many days you need to cause accumulation of a lethal dose in a person. Exactly! Anywhere between 50-100 days (equal to the reported lethal dosage), although significant symptoms are bound to emerge far earlier. What could be seen as an “initial aggravation” of symptoms is, merely, a steady-state trip towards strychnine poisoning.

          Does fellow Iqbal follow the case? Had the patient continued the treatment for more than a month, his/her life would be at risk.

          3) “Check and let me know how many remedies are not homeopathic.”
          A proposition for fellow Iqbal: This is a fair article, from what I have seen after a few glances.
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760822/

          Check, and let me know why people disguise allopathic preparations as homeopathic. The rest (the higher potencies) are definitely homeopathic. And they contain nothing. So, don’t hijack low potencies as homeopathic. It’s toxicology and the effects are clear, as are the dose-response rates. Huge efforts have been put into chemistry and toxicology and now, fellow Iqbal & Co. appear and try to hijack the results.

          4) http://martinblaser.com/excerpt.html

          Really? The unlike cures like philosophy is totally described by some Dr. Blaser? What about the rest of TEH INTERNETS fellow Iqbal seems to love so much?

          Let’s make a quick search: http://www.who.int/csr/disease/smallpox/en/
          Oh, smallpox was eradicated due to vaccines! Cool, allopathy at its greatest! I hope fellow Iqbal does not dare hijack vaccination and claim it is a form of homeopathy. This has been discussed extensively elsewhere. It is not.

          Fellow Iqbal questions: “Why would you define “like cures like” a wrong plan?”

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771618/
          (QUOTE FROM ABSTRACT)
          “Analyses of covariance indicated that individuals who had been physically abused in the first 5 years of life were at greater risk for being arrested as juveniles for violent, nonviolent, and status offenses.”

          https://www.ncbi.nlm.nih.gov/pubmed/12055156
          (QUOTE FROM ABSTRACT)
          CONCLUSIONS:
          “These findings from northern India are congruent with those from other geographical/cultural settings in suggesting that witnessing violence between one’s parents while growing up is an important risk factor for the perpetration of partner violence in adulthood.”

          This and SO MUCH MORE provides reasons why I believe like cures like is a wrong plan. (But, in any case, anything without evidence would be a tentative plan, at best). Perhaps fellow Iqbal may begin to understand that Like CAUSES Like more often than it cures it (if ever). Does fellow Iqbal refer to “like cures like” as an alternative phraseology for “tough love”?

          5) Clarification for the readers

          Fellow Iqbal appears to have NO IDEA about chemistry or medicine, and science in general. This is why he is amazed by the not-so-amazing ideas and evidence Dr. Blaser provides in his book. Fellow Iqbal should know we have millions of bacteria within our bodies (they are everywhere on the planet actually), and multiple species no less. What did he expect? That we could kill large numbers of them without destabilizing some manifestations of the complicated interactions with out various systems? Yet he finds it amazing.

          How would a knowledgeable person call the fact that some of these species of lifeforms living within us interact with out bodies in multiple complex ways? Entirely NOT-AMAZING.

          So I fail to see why fellow Iqbal is so much amazed by all this stuff, which is, merely, popularized science, other than the reason that he totally lacks scientific knowledge on the subject. And, of course, whenever a scientists writes about antibiotic overuse, another entirely non-scientist gets the point “antibiotics are harmful”. It happens everyday. Fellow Iqbal is just another case.

          6) Quote-Mining from Steven Novella’s articles? I think fellow Iqbal believes that like cures like can also be used to cure rationality. Well, the paragraph beginning with antioxidants etc. stems from:
          https://sciencebasedmedicine.org/the-promise-of-crispr/

          If fellow Iqbal likes quote mining, I can use “like cures like” on him by quote mining the following from the same article:

          “The point of reviewing this recent history is not to denigrate these important advances or the quality of the science. These are all cutting edge scientific advancements that do contain significant promise for curing diseases. The feature they share in common is that the initial hype when they first come to public attention dramatically overestimates current progress while ignoring or underestimating the difficulty and unpredictability of such cutting edge technology. These are advances that are likely to take 30-50 years to develop, and it is highly likely that we will run into obstacles that need to be solved prior to implementation.”

          I would add another feature they share in common: The increasing tendency of laypeople with deep religious beliefs in alternative medicine to misinterpret them and misuse them in attempts to make void and completely invalid points.

          7) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085232/

          Now THIS is an example of a VERY bad article. Only 3 RCTs are referenced to strengthen the results, of which 2 are old and one in German. The 2 old studies have already been dealt with elsewhere. They have been sponsored by the manufacturer of Traumeel and… I don’t really know what fellow Iqbal’s point was by citing this link anyway. Maybe he likes to divert the attention. He has been proven time and time again that this is one of his favorite strategies.

          http://spotlight.vitals.com/2009/12/alexa-ray-joels-suicide-attempt-with-traumeel-harmless-says-dr-lewis-nelson/

          Is this link good enough for fellow Iqbal to understand that these products don’t cause anything?

          8) The Science of Physics and Chemistry

          As fellow Iqbal so claims:
          “Evaluating homeopathic medicines on the basis of laws of Physics and Chemistry is irrelevant. It would have been valid if this approach would have helped allopathic patients.”

          Fellow Iqbal seems to not understand the LEAST bit of Physics and Chemistry. But he seems to understand and implement DOUBLE STANDARDS perfectly. Apart from the obvious nonsense in the above sentences, what exactly are allopathic patients and how do they differ to homeopathic patients? Are they created unequal? Homeopathy only helps homeopathic patients? Interesting (futile) points raised by fellow Iqbal.

          9) Second reply

          Yes, the end result is of paramount importance. Homeopathy does not keep people alive, whereas conventional medicine does. Fellow Iqbal does not mention how many people die in the name of alternative medicine because nobody keeps a good track. That’s how good alternative doctors are at being honest.

          The doctor fellow Iqbal is aware of (MBBS, MD) was enlightened after 18 years. Great! This doctor should have followed a patient-centered approach from the beginning. Investigation reports are there to serve the patient, not the doctor. So this doctor’s opinion means little in this context. There is no significant information contained in fellow Iqbal’s attempt-at-a-point.

          However, the “DOCTOR’S definition of the medical error” expression of fellow Iqbal serves to strengthen a central point here. Fellow Iqbal is amazed by EXTREMELY NOT-AMAZING things and cites them fervently to make (void) points. But, guess what. People in here are educated and knowledgeable and have NO AMAZEMENT AT ALL from things they have dealt with all their lives. Fellow Iqbal’s “I know a doctor” attitude seems to pervade his entire thinking machinery (cf. brain), so fellow Iqbal first needs to understand that popularized science aims to entertain people more than to educate them.

          And if fellow Iqbal is so persistent with the opinion that people who despise homeopathy should first get to know about it, he should know that this is even more important for conventional medicine. Prior to making void points about it (conventional medicine), fellow Iqbal should get to learn a few basics (fundamental knowledge, really) about chemistry, physics and medicine, and then, discussions in here might begin to be much more productive, including fellow Iqbal.

          I never lose my hope that some people can improve after understanding where they went wrong along the way.

          • In my first pass, I did not get further than the methodology section in Robert G. Hahn’s paper before I lost faith in his scientific diligence (the emphases are mine):

            Methodology
            Evidence-based medicine initiated a decade of struggle
            between believers and non-believers in which meta-analyses
            were used as the tool of analysis. All of them were based on
            virtually the same material, but authors arrived at different
            conclusions. The aim of the present re-appraisal of this period
            was to scrutinize the arguments used and to illustrate what
            non-believers rely on to advocate abandoning homeopathy in
            the evidence-based era.

            Dr. Hahn MD, PhD is an undoubtedly renowned scholar within his field of intensive care and fluid replacement therapy, but when it comes to religion, namely homeopathy, he is totally off his rockers. Those interested can look him up and find his several books on spiritism and reincarnation, for which he claims to have found evidence in his own rebirth from a medieval person.
            A scientific paper with a “Methodology” section that elaborates on belief and non-belief instead of outlining the methodology of the work being presented, can safely be ignored.

            As to the rest of James’s analysis, I don’t think the problem with our friend Iqbal’s attempts at argumenting could be put any clearer than this:

            And if fellow Iqbal is so persistent with the opinion that people who despise homeopathy should first get to know about it, he should know that this is even more important for conventional medicine. Prior to making void points about it (conventional medicine), fellow Iqbal should get to learn a few basics (fundamental knowledge, really) about chemistry, physics and medicine, and then, discussions in here might begin to be much more productive, including fellow Iqbal.

          • James

            “So, Robert G. Hahn has never studied homeopathy either. ”
            Dr Hahn’s review is about studies on homeopathy, not homeopathy itself. Unlike Edzard, Dr Hahn makes no qualms about his lack of knowledge of homeopathy. Dr Hahn has questioned Edzard’s fudging of data (to discredit homeopathy) that no one, including Edzard will rebut. For obvious reasons.

            Glad that you picked up Aconite and Nux Vomica. These are 2 medicines that I use very routinely in the family.
            Aconite: If my child was to return home from school/play with light fever (<101F), I would choose between Aconite and Belladona in 30c. (Ask Edzard if he can differentiate symptoms between these 2 remedies. This is taught to first year students of homeopathy) If the fever has already crossed 101F, I will use both with a time gap of 15 minutes and watch fever cross 102F in no time -exactly opposite to the action of paracetamol. My younger son is susceptible to delirium at 103F. With these 2 remedies, his temperature crosses 104F every time and crossed 105F once. With no issues. We would switch off fan even if it is summer and cover him with a blanket. Most often, by next morning, the fever is gone. During this period, he would have had 4 doses of each medicine: 2/3 drops of medicine in alcohol.
            This is valid for a child of 3kg and an adult of 70 kg and above. I would also give Aconite 6/30 to a person exposed to severe cold weather.
            Aconite is only for starting treatment and short term outcome. To finish, additional remedy is used. This is defined. Its sphere is in the beginning of an acute disease and not to be continued after pathological change comes.

            Nux Vomica Q: I would explain with an example. I normally eat a light dinner at home. In case I would end up eating a heavy dinner, a steak or something similar, it would interfere with my sleep. Heaviness in stomach, eructations would awaken me. To avoid this outcome, I would ensure taking 3/5 drops of of mother tincture of Nux Vom in half a cup of water before going to sleep. No stomach issues. Or if anyone was to complain of continuous stomach ache followed by many visits to the toilet due to over eating of meat, 2 doses of Nux Vomica mother tincture would be sufficient.
            No doctor in his senses would prescribe 15 drops of Nux Vomica Q 3 times a day and indefinitely. It is not required. So, either the guy who writes it misrepresents information, or the doctor was trained on the INTERNET. This constitutes material dose and is defined. (ECHINACEA A, Berberis A etc.)
            I am not a doctor and know limited uses of different homeopathic medicines. A good doctor knows wide use of each. A case could be stated: The patient, a transporter by profession, complained of head ache that would appear anytime and would be severe enough for him to become redundant for days together. This had continued for years. His history revealed that it started sometime after he and his colleagues ate a contaminated (for lack of a better description) chicken at a road side eatery. They all had diarrhea few hours after their food. One dose of Nux Vomica 1m resolved the problem for all times to come. His family and his friends became regular patients of the doctor.
            This is the reality of homeopathy.

            "Check, and let me know why people disguise allopathic preparations as homeopathic."
            A good idea would be to check which came first: the homeopathic remedy or the allopathic equivalent. This would also define that Hahnemann was not the only contributor to homeopathy 200 years ago.

            Vaccination: Small pox: Dr. Hahenamann supposedly found the idea of vaccination supporting his logic of treatment through low doses. This is where similarity ends. Homeopaths consider disease as part of health. Eradication of disease is not part of homeopathy. Each disease has a lesson for the human body. Was small pox eradication the reason why HIV AIDS became a epidemic thereafter?
            http://news.bbc.co.uk/1/hi/health/8686750.stm
            There are many such examples coming up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841828/

            to continue

          • “Dr Hahn has questioned Edzard’s fudging of data (to discredit homeopathy) that no one, including Edzard will rebut”
            NOT TRUE!
            THIS HAS BEEN REBUTTED SEVERAL TIMES ON THIS BLOG

          • @Iqbal Krishna:

            I would choose between Aconite and Belladona in 30c. (Ask Edzard if he can differentiate symptoms between these 2 remedies. This is taught to first year students of homeopathy)

            Ask a homoeopath if they can distinguish between these two remedies without looking at the labels.

          • I have tried this with leading homeopaths – they did not want to do it.
            I WONDER WHY!!!

          • Dr Hahn’s review is about studies on homeopathy, not homeopathy itself

            Dr. Hahn writes about his beliefs, not about science. See my comment above.

          • Wow, indeed! Fellow Iqbal appears to have crashed on planet Earth. This is the closest Iqbal has come to a rational exchange of opinions and/or knowledge without being too ironic or sarcastic about science. I am slowly approaching amazement, honestly. I think it is now possible to engage in an actual discussion.

            Dear Iqbal,

            (A) — Homeopathic preparations and symptoms —
            Aconite and Poison nut (Strychnos Nux Vomica) do appear to be very typical plants for homeopathic preparations. There is actually no need to ask Edzard if he can differentiate symptoms between these two remedies for two reasons:

            a) in 30c, the homeopathic preparations cause no symptoms anyway. Anything you appear to “observe” or “watch” is the effects of the small quantities of alcohol. Alcohol generally lowers body temperature.

            b) the original (strong) stuff causes symptoms because of the specific alkaloids, which comprise the primary active substances. These are aconitine and strychnine, correspondingly. You don’t need any course in homeopathy to learn the symptoms. It’s toxicology:

            Aconite: https://www.ncbi.nlm.nih.gov/pubmed/19514874 (just read the clinical features)
            Strychnine: https://en.wikipedia.org/wiki/Strychnine_poisoning (provides a fair description of the clinical presentation).

            (B) — Dr. Hahn —
            Dr. Hahn is a shelter for your wrong beliefs, unfortunately, but because Dr. Hahn has been extensively discussed in other places of this blog, it would not be useful to make any further point about that issue. Dr. Hahn presents his opinion and shuffles around research findings to build a case about, as Björn aptly noted, believers and nonbelievers. I agree that this paper has no importance whatsoever with respect to evidence.

            (C) — Personal observation bias and belief perseverance —
            It only serves to make me feel more sad that you entrust matters of health of your children to homeopathic preparations. But I will set that aside for the moment. I will ask you clearly…

            -You really believe that Aconite and Belladonna 30C contain anything other than water or ethanol in them (or maybe contaminants such as silica nanoparticles, leaking from the glass vials because of the succussion process, they don’t do anything for the body anyway)?

            -You seem to have observed the fact that paracetamol counters the increased temperature effect of fever. Do you have any idea how it succeeds in doing that?

            -Do you believe that this action of paracetamol (lowering the fever) is unwanted? If yes, why do you believe they sell the product then?

            -You actually believe that a fever on its onset (i.e. while temperature is increasing) crosses 101F because of the 30C preparations and not because it is the natural course of any fever? If yes, have you ever tried simply not giving anything to your children when temperature is 101F and also watch the temperature increase (it’s quite simply the natural course of fevers)?

            -Your son is susceptible to delirium at 103F? Other young children are not? Have you made this diagnosis yourself?

            -You state: “With these 2 remedies, his temperature crosses 104F every time and crossed 105F once”. You really believe that this is a special effect of the homeopathic preparations you administer? And you don’t believe this is anyway the natural course of a fever?

            -You state: “Most often, by next morning, the fever is gone”. Still, you don’t believe that this is what happens anyway with most fevers? You think that the homeopathic preparations do that to the children? If yes, what do you believe would happen if you did not administer the homeopathic preparations?

            -You keep a bottle with mother tincture of Poison nut in your house and you are teaching your children (through your actions of course) that these things help cure ailments? Can your children understand the difference between mother tinctures and 30C? If yes, make sure you are as clear as possible about that. If not, keep that VERY FAR AWAY from your children, because if they are not old enough to fully comprehend, I can’t imagine what might happen if they get access to it, believing that these things can “lower their fever” or whatnot. Thankfully, 30C does nothing whatsoever.

            I could keep up with the questions, but these are enough to enlighten me with respect to what you really believe, and how much you really know, and how/whether you justify your beliefs through knowledge or through hope. You can always provide a direct answer to that. You can always ask questions in the same manner, provided you are just as kind and not sarcastic, especially about things you do not know (I don’t use the word “understand” here, because I still harbor a fair level of hope that you can eventually understand and even learn some things from these discussions here).

            (D) — Science-based Medicine, hypotheses, plausibility and home-made DIY research —
            In the meantime, I will be kind enough to devote some time to help you understand one of the potentially-more-than-one ways, in which the mother tincture of poison nut (your nux vomica, although we are not talking in Latin here) provides some relief to your stomach troubles. While doing that, I will demonstrate a slightly more proper use of your home-made research, because you appear to be misusing the internet to stick only to whatever pleases your beliefs. As an added bonus, I will try to demonstrate proper reasoning.

            Strychnine is a glycine-competing antagonist for receptors of the central nervous system. It binds strychnine-sensitive glycine receptors. So much is clear!

            I will make the hypothesis: Small doses of mother tincture of poison nut can aid with digestion in some cases. Does it sound plausible? Even homeopathy opponents may say “not so much”, and rightly so. Therefore, I have a case to support, the burden is on me to prove my hypothesis. Let’s go.

            -The mother tincture of poison nut contains fair amounts of strychnine, as stated in one of my earlier comments. This is definitively known.

            -You seem to be explicit in your example about meat. This is very important, because it is a strong argument FOR the case (although you wouldn’t know at the time). Let’s fill you in at this point. Meat consists of large amounts of protein, which is digested primarily in the stomach, because the involved enzymes require a highly acidic pH to start functioning and the stomach is a great place for that. So, too much meat burdens the stomach and the rest of your gastrointestinal tract and increases the chances that undigested food components may reach your colon and begin fermenting and I assume you know what happens next…

            -The stomach maintains a highly acidic environment that enables protein digestion by secreting gastric acid. So, if it can do that more efficiently, protein digestion can take place more efficiently and make you feel better while your stomach’s at it.

            So, by now, the hypothesis can be reformulated to something more plausible: Strychnine, contained in mother tinctures of poison nut, can aid with digestion by causing the stomach to secrete more gastric acid. Any more plausible? Somewhat, becaues it is more rationally stated by now, in terms of science. It is definitely much clearer!

            And now, the rest is the proper use of research I promised, and some things you probably don’t know, but you are going to learn at this point.

            -Did you know that our bodies have taste receptors, which are not located in the mouth (extraoral)? Yes, we do!

            -One of them (many) is the TAS2R10 (just as a convenient example) protein. This is a bitter taste receptor, and it is located in multiple places, such as our gastrointestinal and respiratory systems. A brief provision for that can readily be found, for example, in the article:
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509062/

            -Caffeine induces gastric acid secretion via bitter taste signaling in gastric parietal cells. One of the bitter taste receptors involved is TAS2R10 (and multiple others). This has been observed and can be found here:
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544304/

            -Strychnine provokes a response from the TAS2R10 bitter taste receptor protein. This has been elaborated upon here:
            https://www.ncbi.nlm.nih.gov/pubmed/23283334

            Thus, if caffeine appears to increase gastric acid secretion by modulating TAS2R10 (and other bitter taste receptors), then strychnine also has the potential to increase gastric acid secretions through parts of the same mechanism. All that is left, is to test it in a clinical setting.

            There is no homeopathy involved in the process. Only chemistry (especially biochemistry), biology, and a large bit of physiology. There is nothing homeopathic about mother tinctures at all.

            As I stated above, in an earlier comment, the mother tincture of poison nut (nux vomica) contains maybe around 2 mg/mL of strychnine, maybe a bit less. A few drops of mother tincture, say 5, are 1/4th of an mL (approximately), so it is 0.5 mg. I believe this is enough of an amount to provoke a response, but I will let you do the research about the pharmacokinetics and dose-response relationships.

            In exchange for my kindness, you can (firstly) simply be just as kind and (secondly) try to make an effort to begin understanding that those things, which you believe have magical powers, simply do nothing when diluted to the point of non-existence and, even more importantly, when playing around with mother tinctures, “like-cures-like” is not what helps your organism, it is the active substances that do. And these substances don’t help your organism… they simply do what they are chemically structured to do, wherever there is a biochemical structure to interact with them that is (in simple words, this is not homeopathy, or any other fancy word for that matter).

            (E) — Miscellaneous fallacies —
            As for the rest of your comment, it is COMPLETELY irrelevant whether homeopathic remedies were concocted before allopathic equivalents. What did you expect? It takes a microscope to understand how to make drugs. I mean, excrement also came long before “allopathic drugs”… should they be preferred over them (according to your rationale, yes)?

            And regarding the hygiene hypothesis and your strong concern about AIDS becoming an epidemic because small pox was eradicated, I will once again resort to urging you… Until you have some solid foundations of scientific medical knowledge, so that you can interpret findings soundly and without an absurd level of ignorant subjectiveness, you are at a constant danger of drawing wrong and unrealistic conclusions by reading whichever kind of scientific articles online. You appear to be especially prone to that, unfortunately, but I still hope you can learn some things from now on. If you have that much time to write to this post, you can use it to study a bit instead!

            My kind regards to the more pleasant and human version of fellow Iqbal!

            (F) — Apology (not as in “apologist”) —
            I apologize for my lengthy comment and for digressing. Fellow Iqbal exhibits a provocative level of ignorance and I have fallen prey to that because I feel that the endangerment of the health of children is involved in the process and becaues I never give up hope that any person can begin approaching reality with respect to some matters, even after having gone excessively wrong for a very long time. I can only hope that these posts bring some insight to fellow Iqbal, while amusing the rest of the readers. However, in view of abusing blog space, I can only acknowledge my verbosity and apologize for that from everyone reading this.

          • Mojo

            “Ask a homoeopath if they can distinguish between these two remedies without looking at the labels.”

            No need to be a joker. This is not a doctor’s responsibility.
            http://pubs.acs.org/doi/abs/10.1021/la303477s
            https://www.ncbi.nlm.nih.gov/pubmed/20970092

          • Edzard

            “THIS HAS BEEN REBUTTED SEVERAL TIMES ON THIS BLOG”

            Specific allegations:

            1. For example, Ernst [7] makes conclusions based on assumed data [6] when the true data are at hand [3].

            2. Ernst [7] invalidates a study by Jonas et al. [18] that shows an odds ratio of 2.19 (1.55–3.11) in favor of homeopathy for rheumatic conditions, using the notion that there are not sufficient data for the treatment of any specific condition [6]. However, his review deals with the overall efficacy of homeopathy and not with specific conditions. Ernst [7] still adds this statistically significant result in favor of homeothy over placebo to his list of arguments of why homeopathy does not work.3

            3. Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB: Impact of study quality on out-come in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999;52:631–636.
            6. Ernst E, Pittler MH: Re-analysis of previous meta-analysis of clinical trials of homeopathy. J Clin Epidemiol 2000;53:1188.
            7.Ernst E: A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002; 54:577–582.
            18. Jonas WB, Linde K, Ramirez G: Homeopathy and rheumatic disease. Rheum Dis Clin North Am 2000; 26:117–123

            …require specific response. Just copy and paste the reason for changing data to suit your requirement.

            Dr Hahn’s comment about you: “Such argumentation must be reviewed carefully before being accepted by the reader.”

          • Hehe, The Iqbal (on Sunday 10 September 2017 at 10:32) drags in Chikramane and his fantasy-findings as evidence. How hilarious can homeopaths become? We have dealt with that pseudo-evidence before.
            There are so many who have shown Chikramane’s theories results to be nothing but fantasies and wishful thinking. Try Google-ing the name. Here is one of many overviews of the nonsense Chikramane has produced:
            https://sciencebasedmedicine.org/homeopathy-as-nanoparticles/

          • Iqbal, do you understand that the Chikramane study you cited is a very bad piece of (non-)science?

            The analysis can also be found here (same author as the one Björn stated above)
            http://scienceblogs.com/insolence/2010/11/18/measuring-contaminants-and-concluding-th/

            I can say it is a fairly accurate analysis that shows how extravagantly optimistic the paper’s conclusions are. Why do you still believe this Chikramane et al. paper?

            Its title is: Extreme homeopathic dilutions retain starting materials… Bump! No, extreme homeopathic dilutions do not retain starting materials, at least not without the chance for that being an inconceivably small number. Even if they analyzed tap water, they would probably find (whatever it is they saw, which they call) nanoparticles in it as well…

          • Edzard

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874503/

            “Conflict of interest: The author is a trained homeopath; he has no financial interests in this area.”

            In April 2010 the German National Association of Homeopathic Physicians published an interview with Professor Edzard Ernst in its newsletter where he claimed he “acquired the prerequisites” to be able to add ‘homeopathy’ to his medical title “but never applied for the title.”

            In Germany, where homeopathy is regulated, it is a prerequisite to have passed an exam by a governing medical council, which Ernst did not do.

            GNAHP: “So is it correct that you did not acquire the additional medical title ‘Homeopathy’ but took further medical education courses in homeopathy? If yes, which ones?”

            ERNST: “I never completed any courses.”

            Began his career at a homeopathic HOSPITAL but never completed any courses in homeopathy in a country that regulates its use?

            REALLY. OH DEAR. Have you heard of the Trojan horse?

          • learn English, Iqbal!
            I am a trained homeopath; I do not need qualifications for that.
            “In Germany, where homeopathy is regulated, it is a prerequisite to have passed an exam by a governing medical council, which Ernst did not do.”
            YOU ARE WRONG!
            any doctor can practice homeopathy in Germany, regardless of qualifications in homeopathy.

          • Bjorn/James

            It is the same writer posting under different names. David Gorski. This paper is not worth to be used as toilet paper either.

            This idiot is still debating that medical errors are NOT the 3rd largest killers in USA. This is when top doctors are agreeing to the fact and trying to put together a plan to reduce these problems.

            And none of these guys :Chikramane PS1, Suresh AK, Bellare JR, Kane SG., is a homeopath out to prove a point. And they found the particles of base materials: not some new compounds.

          • James

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760822/

            Check, and let me know why people disguise allopathic preparations as homeopathic. The rest (the higher potencies) are definitely homeopathic. And they contain nothing. So, don’t hijack low potencies as homeopathic.

            This is interesting. Regret I had no information on this earlier. The homeopathic preparation “Two tablets of Mastodynon (daily dosage) contain the dry matter of 324 mg Vitex agnus castus mother tincture, 162 mg Caulophyllum thalictroides D4, 162 mg Cyclamen europaeum D4, 162 mg Strychnos ignatii D6, 324 mg Iris versicolor D2, 162 mg Lilium lancifolium D3”.
            http://www.homeoint.org/books/boericmm/a/agn.htm
            http://www.homeoint.org/books/boericmm/c/caul.htm
            http://www.homeoint.org/books/boericmm/c/cycl.htm
            http://www.homeoint.org/books/boericmm/i/ign.htm
            http://www.homeoint.org/books/boericmm/i/iris.htm
            The medicine offered, is based upon “like cures like” and covers the entire range of symptoms. The result would be immediate.

            The allopathic equivalent would be limited in action. But the question is: on what basis is the allopathic drug prescribed?
            “The exact mechanism of action and the active constituents of Vitex are unknown, however, some of its effects demonstrated in vitro and in vivo may play a role in the clinical efficacy. Premenstrual symptoms, particularly mastodynia, are often accompanied by latent hyperprolactinemia. Mild D2-receptor-agonistic properties of Vitex agnus-castus have been demonstrated, resulting in suppressed prolactin release from cultivated lactotrophs as well as in animal experiments. In line with this observation, serum prolactin levels were indeed reduced in patients treated with this extract. An agonistic action on µ- and potentially κ-opioid receptors may also be of relevance to the use of Vitex for menopause-related symptoms such as hot flushes and mood symptoms. Extracts were demonstrated to displace ligands from human opioid receptor binding . A relatively potent binding inhibition was observed for opioid receptors (µ and κ subtypes) with IC50 values of the native extract between 20 and 70 mg/ml. The results of an in vitro study suggested that Vitex acts as an agonist at the µ-opioid receptor, supporting its beneficial action in PMS . A 90% methanol extract of chasteberry was found to bind to and activate μ- and δ-, but not κ-opioid receptor subtypes. Several flavonoids isolated from Vitex were found to bind to both μ- and δ-opioid receptors in a dose-dependent manner; however only casticin was found to have an agonistic activity selective for δ receptors at high concentrations.

            So it is not the homeopaths taking a drug from allopaths, but allopaths taking a medicine and converting it into a drug.

            So much for evidence based medicine. And ensuring that exact action is known.

          • Edzard

            “I am a trained homeopath; I do not need qualifications for that.”

            Let us check your homeopathic training in simple English.

            How long did it take you to understand Materia Medica during training?
            In simple English, can you state the difference between Aconite and Belladona when used for fever? This I stated earlier is taught in the first 6 months of homeopathic training.
            In simple English, What could be an important symptom of Lachesis that would allow you to prescribe the remedy with no further question.

            You have no clue about homeopathic p

          • you are priceless!

          • Iqbal Krishna said:

            Let us check your homeopathic training in simple English.

            How long did it take you to understand Materia Medica during training?

            I’m sure Edzard will have understood it in its original German. You?

          • It does not come as a surprise that Mr. (Ms.?) Krishna does not like Professor David Gorski. Prof. Gorski, is a genuine, washproof Professor of Surgery and Oncology at the Wayne State University School of Medicine and he is one of the most active Quack-busters known. That Prof. Gorski blogs under the pen-name “Orac” has never been a secret, least of all from his side.

            The link I gave is not to a “paper” but a blog post where a respected cancer surgeon and scientist writes an overview over why we can safely ignore (as evidence for any activity in homeopathic preparations) Chikramane’s findings of impurities in the samples he was looking at with expensive instruments and imagined being support for something of importance being found in homeopathic delus.. eh, dilutions. The post cites mutiple sources (many of them indirectly), which corroborate Professor Gorski’s analysis and if anyone doubts Professor Gorski it is easy to Google the name Chikramane, the first pages of hits include multiple critical analyses of Chikramane’s incompetent attempts at over-interpreting the existence of contaminants in homeopathic preparations.

            Now the question remains whether we need to take the person behind the name “Iqbal Krishna” seriously? Does this self professed savant know anything besides citing homeopathic incantations?

          • “Now the question remains whether we need to take the person behind the name “Iqbal Krishna” seriously?”
            CERTAINLY NOT!
            but he/she is such good fun.

          • Edzard

            “Now the question remains whether we need to take the person behind the name “Iqbal Krishna” seriously?”

            Taking seriously means what?
            You have continued to avoid specific answer to specific allegation of Dr Hahn about fudging data.

            You have zero knowledge of Materia Medica. This is 50% of homeopathy. What was the hands on training in homeopathy?
            “I received hands-on training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation.”
            I am positive you have zero knowledge of other disciplines also.
            You can say so: this statement was only to help become a Trojan horse and try to run down complementary medicines. Every second interview started with this statement.

            It seems you took Claus Fritzsche quite seriously and put Esowatch after him. The poor guy ended up committing suicide. “”With deep consternation, I have heard from the Internet that the Internet journalist Claus Fritzsche took his life in January this year.

            Everyone who is personally affected or followed by the large-scale cyber bullying, which is based on the anonymous Internet pranger Esowatch, knows Claus Fritzsche as the most serious and most brutally mistreated victim among the about 2000 people who are denounced by these abominable people. The horrific agitation against his person over the years by Esowatch and friendly websites reveals abysses, which one can not consider possible.”

            ““Mit tiefer Bestürzung habe ich aus dem Internet die Nachricht wahrgenommen, dass der Internet-Journalist Claus Fritzsche sich im Januar dieses Jahres das Leben genommen hat.

            Jeder, der vom großangelegten Cyber-Mobbing persönlich betroffen ist oder mitverfolgt, das vom anonymen Internet-Pranger Esowatch ausgeht, kennt Claus Fritzsche als das schwerste und am brutalsten misshandelte Opfer unter den ca. 2000 Personen, die von diesen abscheulichen Leuten angeprangert werden. Die entsetzliche Hetze gegen seine Person über Jahre hinweg durch Esowatch und befreundete Webseiten offenbart Abgründe, die man nicht für möglich halten kann.

            Als ein weiteres Opfer dieses Internet­prangers (wegen meiner Vorstellung der Kritik der Relativitäts­theorie und meinem Einsatz für den Tierschutz) kam ich in den letzten Jahren zu persönlichen E-Mail-Austauschen mit Claus Fritzsche, der mehrere Jahre seines Lebens dazu gewidmet hat, sich gegen Esowatch zu wehren und verzweifelten anderen Esowatch-Geschädigten durch eine Art informelle Selbsthilfe-Organisation bei diesen zum Teil schweren Straftaten zu helfen. Ich war nicht nur beeindruckt von der Sorgfalt und der Ausgewogenheit seiner privaten Ermittlungen zur Aufdeckung der Verantwortliche dieses kriminellen Wirkens, sondern auch von seinem hohen moralischen Denken und seiner Empathie. Er hatte Würde und er hatte Niveau, in allem was er schrieb.
            Nicht zuletzt Claus Fritzsche hat mir durch seinen mutigen Kampf gegen kriminelle Energie aus dem Internet die Kraft gegeben, die Aus­sicht­losig­keit der rechtlichen Lage von Cybermobbing-Opfern zu verarbeiten und persönlich zu verkraften. Dass am Ende die Kraft für sich selbst nicht mehr ausreichte, empfinde ich mit tiefer Traurigkeit. Ich trauere um ihn und kann mich nur bei seinem tragischen Schicksal den Worten anschließen, die Freunde in einer seiner Selbsthilfe-Webseiten als Nachruf geschrieben haben: Ruhe in Friede, lieber Claus.”

            Is this your idea of taking people seriously. If it is so, then you can take me seriously.

          • Iqbal Krishna,

            I have circa 50 years experience in homeopathy. I have the same number of years experience in various fields of applied science and applied mathematics.

            Homeopathy does not work; it is most definitely NOT medicine; its materia medica serves only one useful purpose: teaching students of applied science and applied mathematics the dire consequences of failing to learn critical thinking skills and failing to learn science and mathematics from first principles.

            I always enjoy your comments: they serve as solid empirical evidence of the aforesaid dire consequences.

          • Tut-tut Iqbal!
            It is not nice to dump the same turds over and again, especially when you do not understand the meaning of them yourself. You have already cut-pasted this fable from some homeopathy site several months ago and had your confused attempt sternly responded to:
            http://edzardernst.com/2017/04/a-chat-with-a-homeopath/#comment-89905
            This abject fabrication about poor Mr. Fritzsche having taken his life as a consequence of unfair net-criticism has been going the rounds on, mostly German, homeopathy sites for quite a while. The truth is far from what you have cut-pasted, as can be understood from this post for example: http://edzardernst.com/2014/03/thoughts-about-claus-fritzsches-suicide/

            Why don’t you try something original Iqbal, something of your own production for once? It should provide good fun, not sadness and disgust as this one.
            And try not to get yourself evicted from this blog for a childishly dishonest cut-and-pasted allegation that you didn’t even construct yourself. You are much more fun when you try on your own.

          • Björn Geir

            “It does not come as a surprise that Mr. Krishna does not like Professor David Gorski. Prof. Gorski, is a genuine, washproof Professor of Surgery and Oncology at the Wayne State University School of Medicine and he is one of the most active Quack-busters known.”

            Gorski is just a technician, with a thought process equivalent of maybe a plumber. You are probably in the same league. Have you at any time tried to think like a doctor? A technician would open up a machine, remove the non-required/defective component, close the machine and wait for the problem to come back. Do you do any thing different? Is that what a doctor supposed to do?

            This is what Gorski writes: ” I don’t believe that reproducibility in science is in “crisis,” as so many are claiming, but I do believe it’s a significant problem that needs to be addressed in a thoughtful way. I also have to concede that it’s scientists’ fault that we’re in the mess we’re in and that we haven’t addressed problems with reproducibility more robustly before now, given that this problem has been festering for a while. If it takes labeling the problem as a “crisis” to get some action, I suppose I can live with that.”
            The idiot has no clue that reproducibility is impossible with human body interface.
            “Pharmaceuticals company Bayer, for example, recently revealed that it fails to replicate about two-thirds of published studies identifying possible drug targets.”
            “Amgen reported an even higher rate of failure – over the past decade its oncology and haematology researchers could not replicate 47 of 53 highly promising results they examined.”
            These figures are lies. Now the definition of “Reproducibility” will be changed so that the figures can be justified.

            Gorski is a quack doctor. The only problem is that he has some degrees that help him point fingers at others.

            “That Prof. Gorski blogs under the pen-name “Orac” has never been a secret, least of all from his side.”
            There was no need to put this up as a second source.

          • Björn Geir/Pete

            I am sure Edzard can read English and German and reply for himself.

          • Pete Attkins

            “I have circa 50 years experience in homeopathy.”

            Great. This is similar to what Edzard write.

            Doing what in homeopathy?

          • ” This is similar to what Edzard write.”
            HILARIOUS!
            where did I ever write this?
            you are the proof that homeopathy does nor help against delusions.

          • Fellow Iqbal boldly states:

            “The idiot has no clue that reproducibility is impossible with human body interface”.

            Good for fellow Iqbal. Let me suggest a perfectly reproducible experiment. Dear Iqbal… Take two tablespoons of mother tincture of Nux Vomica. Record what happens. Next day, take another two tablespoons. Record what happens. Repeat for a couple of days. See? Perfectly reproducible! But since you only live once, the last record of symptoms will contain one extra symptom there (not much of a difference though).

            Fellow Iqbal, now I am positive. You have NO idea about the human body “interface” (all fancy talk). Have you ever seen what the inside of a body looks like? You judge and criticize surgeons when the CLOSEST you have been to the inside of a human body is barely past the epidermis, and so far ONLY by accident (literally, cf. cut).

            So, what is this magical, super-special defensive mechanism of the body that homeopathy stimulates? How would you know, of course, when there is no such thing as you would like it to exist.

            Ah… fellow Iqbal! An ever-increasingly-delusional mentality built upon a patchwork of opinions against medicine. What else? Well, basically a smartass, so it seems. Because you will probably end up causing harm due to neglect to your loved ones in the end, AND because you have gone TOO far insulting and denigrating respected scientists that do their best to make this world a better place, I have a suggestion for you fellow Iqbal:

            Stick with investments and business models… there just might be a chance that you are more competent in that area. Better put people’s wallets at risk… not their health.

          • James

            “Let me suggest a perfectly reproducible experiment. Dear Iqbal… Take two tablespoons of mother tincture of Nux Vomica. Record what happens. Next day, take another two tablespoons. Record what happens.”

            If you do not even understand reproducibility, time for you to jump ship. Take a new boat.

          • @Iqbal
            Are you willfully writing silly comments or are you really trying to make a
            point? If you think ‘reproducibility’ is erroneously defined in dictionaries and scientific literature, then please explain.

  • Dear Mr Krishna,

    Thank you for setting out the GMC standards to which I had already referred in my piece.

    I hope you understand that ‘tu quoque’ comments – that much conventional medicine leaves a lot to be desired – does not blind you to the fact that all registered medical practitioners have ethical obligations, and IMHO, any that do not comply with GMC’s GMP should be arraigned.
    On that basis, unless they do comply as I have suggested, RMPs should not prescribe homeopathic remedies (homeopathically prepared products).
    That is the subject of this theme.

    I have not planned to, and do not, ‘run down alternative medicine’ as you suggest.
    I don’t know where you got that idea from.
    I am concerned about doctors who act unethically by failing to obtain fully informed consent.
    Are you not concerned? Do you endorse dishonesty?

    Comments about other poster’s employment status are ‘ad hominem’, unworthy, irrelevant, and should not be made.

  • No one at the GMC will take you seriously Dr Rawlins. They must get a few wacky proposals from retired members. They might advise you that they haven’t had any complaints from all of the masses of gullible and duped members of the public you believe are out there. No doubt they will thank you for your letter, wish you well before binning your letter.

  • I think that there is no evidence for your statement that patients are being duped.
    My point is that if you do advise the GMC of this then you need to back this up with evidence that patients are being duped. Otherwise how could they possibly take this forward?
    Look at what happened to those trying to restrict veterinary homeopathy with chang.org in 2016. 7000 signatures for homeopathy quickly countered 1000 signatures against. The against homeopathy petition quickly vanished!

    The RCVS reply (Opening sentence) to the petition might be simliar to how the GMC will reply to you.
    ‘Whatever views there may be within the veterinary profession it is clear that there is a demand from some clients for complementary and alternative therapies.’

    Dr Rawlins wrote:
    ‘Most patients who use homeopathic preparations (HP) do not realise they have been duped.’

    • “I think that there is no evidence for your statement that patients are being duped.”
      perhaps you should have a look at this [or indeed many other posts on this blog]
      http://edzardernst.com/2017/08/oh-that-glorious-and-ubiquitous-bs-about-homeopathy/

    • JK,
      Argumentun ad populum is a logical fallacy – and a red herring (also a logical fallacy).
      This thread is about patients giving fully informed consent.
      That is an ethical obligation for doctors, if not for lay homeopaths.

      We all know that many patients are duped into thinking homeopathic preparations have an effect on specific ailments. Whilst that just might be true (I don’t think so, but will concede for this post), it certainly is the case that the consensus of medical and scientific opinion shares Chief Medical Officer Dame Sally Davies’ that: “Homeopathy is rubbish.”

      That is what patients should be told if they are to give fully informed consent.
      They are not obliged to agree, but if they not fully informed, they are duped.
      QED.

  • i am asking for evidence Edzard for Dr Rawlins to present to the GMC to justify that UK patients are being duped.
    You provide a series of slides from Indian and US sites with just one slide from a UK Dr who states that homeopathy is safe.
    You also refer to other posts on your blog. Nothing specific though.
    This does not justify the GMC to take action against UK homeopathic Drs does it?

  • Thank you for your opinion Edzard. I hope that Dr Rawlins posts the reply from the GMC on here.

  • Edzard: You are now assuming that I am assuming that I know what the GMC thinks and does. This is a logical fallacy argumentum confusinum.
    Dr Rawlins: Why the interest in me? Why don’t you want to know who James and Greg are?

    • I want to know who all posters are, in order to assess their knowledge, experience, and esteemed wisdom.

      It could be that posters are trolls; base evil folk with malign intent; determined to harm gullible patients; desirous of gaining commercial advantage for the HPP manufacturers they represent (or may even be); practical jokers; seriously mentally deranged; criminals etc.

      I say, ‘could be’.
      Unless we can identify the poster, how do any of us know?

      What is the problem which you (and others) have which is solved by you remaining anonymous?

      • I agree with RR. We cannot take extraordinary claims from incognito persons seriously until we know what these persons have to corroborate their incredible assertions. Until then we have to take their writings at face value, which is plain and simple RUBBISH in this and many other cases.

        • Richard Rawlins wrote: “I want to know who all posters are, in order to assess their knowledge, experience, and esteemed wisdom…What is the problem which you (and others) have which is solved by you remaining anonymous?”

          As far as skeptics go, it’s often this:
          http://scienceblogs.com/insolence/2011/08/22/the-consequences-of-blogging-under-ones/

          Consequence example (long version)
          http://www.internationalskeptics.com/forums/showthread.php?t=121214

          Consequence example (short version)
          http://crispian-jago.blogspot.co.uk/2009/12/ladybird-book-of-chiropractic-treatment.html

          • Thank you for referencing the concerns held by some bloggers – but it is for them to explain what their reasons for anonyminity are. Until they do explain, how can we know whether their reasons are valid (in our eyes) or not?
            They might be crooks, fraudsters, scamists, in the pay of homeopathic product manufacturers. How are we to know?

          • But we have no way of verifying who anyone is! Giving what might sound like a plausible real name – say, John Smith – tells us precisely zero about whether that is their real name, what their occupation is or whether they fall into any of the categories you mentioned.

          • [Richard Rawlins to Blue Wode] Thank you for referencing the concerns held by some bloggers – but it is for them to explain what their reasons for anonyminity [sic] are. Until they do explain, how can we know whether their reasons are valid (in our eyes) or not?

            They might be crooks, fraudsters, scamists, in the pay of homeopathic product manufacturers. How are we to know?

            That is a hilarious reply in light of the fact that it was written by a magician 🙂

            BTW, Richard, There are only three books that I think should be compulsory reading during high school education:

            The Demon-Haunted World: Science as a Candle in the Dark, by Carl Sagan;
            Trick or Treatment? Alternative Medicine on Trial, by Simon Singh and Edzard Ernst;
            Real Secrets of Alternative Medicine: An Exposé, by Richard Rawlins.

            I’ve written the above using my real name. I would’ve written exactly the same had I been hiding behind a pseudonym! I sincerely thank you for sharing your in-depth knowledge with current and future generations.

      • I personally wouldn’t have much of a problem revealing my identity (not that it would matter so much) and educational experience (that would probably matter more). I choose, however, not to do so in a public blog for a multitude of reasons, but most importantly because I simply don’t want to. Because I understand that this behavior on my account might raise concerns of dispute, I will supply two provisions to excuse this choice of mine.

        1) I have very strong faith in privacy and this is why I usually have not so much of a problem with other people being unidentified too. To my eyes, this is a placebo control that helps eliminate pretense bias, so that people will expose the true contents of their brains. This way, it is safer to assume that quacky comments correspond to quacky individuals, than if people had to fit their expressed opinions to their real-life identities, which, more often than not, are based on a fair degree of pretending and/or assuming roles with social limitations. With all that in mind, knowing that I am someone unidentified on this blog, I try to abstain from making grandiose claims or presenting novel or controversial/exaggerated information. I simply write comments, with respect to the discussed issues or the content of other comments of course, for the sake of entertaining the readers and providing info and excerpts from my personal thought processes as “processed food” for thought. If anyone in here might get even the slightest ray of an idea, enlightening, interesting, or just plain amusing, because of something they read from my comments, that much concludes my drawing pleasure from the process. To say that I would expect people in here to take me really seriously on whatever I write would naturally be quite beyond my circumstantial realistic expectations.

        2) Despite all that, should any of the gentlemen who are posting in here under their full real-life identities have an expressly stated reason to wish to procure information about my identity (wouldn’t matter much, honestly) and my education (that would be more relevant), they may feel free to ask me and, judging by the circumstances, I shall retrieve an email address of theirs myself (you can find everything on the internet these days, right?) and send them the information they requested, assuming the good faith that they will fulfill my wish to not reproduce that information in here.

        There! As clear as it could have been, I hope!

  • if JK Rowling had written Harry Potter 200 hundred years ago I can imagine JK, Greg & Krishna would be dutifully extracting all the science and research available from Hogwarts.

  • I would like to know who ‘James’ is, and on what medical register Bjorn Geir is registered as a medical practitioner and surgeon.

    This site may well be a fraud, the site owner is ‘hidden’ by WHOIS.

    And you want to know who the anonymous commenters are?

  • @Greg

    I would like to know who ‘James’ is, and on what medical register Bjorn Geir is registered as a medical practitioner and surgeon.

    What is the problem?
    You already found my name in the British registry where I was temporarily registered many years ago when I was teaching an advanced surgical procedure in the UK. They would not have let me in if I was no good, don’t you think?
    In a recent comment I listed three different national medical authorities where I am currently registered as a medical practitioner and surgeon and more.
    I have given you clear and simple instructions on how to find my current information where my whole CV including education and publications can be found. I am actually wondering why on earth you haven’t figured out how to follow the hint. There you can even read about my new job. I am since a week back a Senior Medical Officer in the national authority that registers and monitors health care practitioners of all sorts. One of the three links I recently gave you is to that authority. They would hardly have hired me if I was an impostor 🙂

    What more do you need Greg?

    • An notarised copy of your birth certificate, your current passport(s). a letter from your parents and grandparents. And a blood sample…

      • Don’t forget your shoe size, too!

      • Good grief. Mr Henness (Director: Nightingale Collaboration), are you personally vouching that Bjorn Geir is a registered medical doctor and surgeon?

        • LOL! Now you’re getting even sillier.

        • I could ask for a forwarded letter of good standing from all three authorities but I guess the effort would be wasted. Greg does not seem to even understand his own questions let alone all the answers we have given..

          • Please can we revert to the this thread’s concern:
            ‘GMC registered medical practitioners should not prescribe homeopathically prepared remedies.’

            All this ‘ad hominem’ bitching by some posters, many of whom are not only anonymous, but play silly games when asked who they are, serves no purpose.
            If you want a playground spat – start your own blog, or ask Professor Ernst to let you guest post on his.
            But please do not mess up my post which the professor was kind enough to host.

            It’s called courtesy.

            Mr Krishna, tell me, should GMC registered medical practitioners prescribe homeopathically prepared remedies without obtaining fully informed consent from their patients? And that means without telling patients what the consensus of scientific and medical opinion is about such preparations – namely that they do not work any better than placebos.

            I know you think they do, but do you agree patients should be informed as to the consensus of others in the field of healthcare? Or do you think homeopaths should fool gullible and vulnerable patients on the grounds, “It’s what they want.”?

            Thank you.

          • @ Richard Rawlins
            I beg forgiveness for my part in feeding the trolls. Your post is a landmark contribution to the fight against the waste of resources and threat to public health inherent in homeopathy. Not to speak of the element of fraud in the sale of homeopathy as goods.
            You “contend that medical practitioners who prescribe homeopathic remedies regularly fail to meet these standards.”
            They certainly fail to meet any standards whether scientific, medical or commercial.
            A doctor who falls into the trap of applying this nonsense in their practice is by definition a homeopath and should be reprimanded for failing to meet standards of practice and other requirements for health care providers.

            Further you say “They [homeopaths] know perfectly well that the best available evidence indicates no support for… ” etc.
            The notion that homeopaths, be they MD’s or not, know what they are doing implies fraud, i.e. willful deception in commerce, right? I am not sure this is correct and therefore an applicable angle of attack so to speak. I would contend that homeopaths of any caliber should know that their nostrums are useless but psychological/mental obtundation prevents them from applying such knowledge. Therefore their act is not wilful albeit deceitful.
            I have come to look upon homeopathy as based on a disorder of cognition and analytical ability.

            Out of context and off-topic comments directed at me or my contributions here will not be responded to in the future.

          • I also have to apologize, especially for my contribution to making this comments section a few “kilometers” longer, probably for no good reason. I am really sorry for that, honestly! I will make sure to behave from this point on.

            First of all, I agree that GMC registered medical practitioners definitely should NOT prescribe homeopathically prepared remedies. In fact, I would use MUST NOT instead of should. I believe that prescribing a placebo can only be justified if patients are fully informed about this. Even so, this is still unjustifiable the way it is used in everyday homeopathic practice.

            Unfortunately, prescribing homeopathic products is also intimately tied to this annoying homeopathic examination process, which fools more people into buying into homeopathy and all. To my eyes, this tiresome and exhausting procedure is the primary culprit for converting gullibility into money. The remedy nonsense is just the cookies in the dough. There is a climax in the mind of a patient taking place during this process. I believe that the most important step to cash in gullibility is exactly this step, which can also be described as “holistic”, as it appears to take into account dozens of aspects of the patient’s everyday life. A whole propaganda can then be woven on those lines, regardless of whether patients are actually prescribed anything or not. If the patients obtain informed consent through the proposed explanation (i.e. that it is a placebo without active ingredients), this should effectively invalidate this exhaustive examination process as well.

            I believe that this fake examination process that questions about countless unnecessary aspects of the patient’s life, character, personality, etc. (including recurring dreams, which hand you use to tie your shoelaces and lots of other utterly needless themes) is also a violation of the patient’s personality and comprises an act of ridicule upon the patient when performed under a lack-of-efficacy consensus. I use the word “believe” because I don’t know at this point whether I could generalize this conclusion or not, but I, for one, would definitely feel exploited if I had undergone such an extensive questionnaire just for the sake of it. I would feel having been made fun of.

            In view of this, I would opine that it is unethical to expose the naive and, hence, vulnerable patients to such an inquiry, asking them questions that have nothing to do with healthcare provision at all, and making them believe it does. This is outright lying and an exploitation of the relationship of trust between patients and doctors.

  • Gorski is just a technician, with a thought process equivalent of maybe a plumber

    …and what does that make you, dear Iqbal? To what should we compare your thought processes? I come to think of several fitting analogies 😀

    It must be difficult living in a constantly dysphoric dislike of all those more clever and knowledgeable than yourself.

  • Dr Rawlins:
    The main question is: should GMC registered medical practitioners prescribe medicines or treatments that they are not fully cognizant with?

    Dr Rawlins:
    1. Do you actually believe that medical practitioners understand the pharmacology and biochemistry of all the drugs that they prescribe for patients?
    2. Do you actually think that when the NHS is hard pressed to meet patient demand and complete 10 minute appointments that this is enough time to do a full assessment, reassuring the patient, and discussing the medicines and treatment to obtain ‘fully informed consent’? In other words, do you actually believe that medical practitioners obtain ‘fully informed consent’ for every patient that they consult with?

    As for homeopathic treatment: Do I think that patients receiving homeopathic remedies should be given fully informed question? YES, of course they should. Now, please explain what is really your issue?

    • Greg (who ever you are),
      Your numerated points are of course red herrings and can be ignored.

      Thank you for answering the question posed.

      With respect to the prescription of the drugs which GP’s prescribe :
      All come with detailed data sheets covering indications, doses, side effects etc.

      I should have thought my ‘issue’ was obvious:
      To ensure (in so far as is possible) that vulnerable and gullible patients are not taken advantage of.
      Do you heve an ‘issue’ with that?

  • Richard Rawlins

    “….should GMC registered medical practitioners prescribe homeopathically prepared remedies without obtaining fully informed consent from their patients?”

    No. They should not. But my opposition is from the point of mind set. Your training in allopathic system will not allow you to even comprehend the homeopathic system of medicine. And if you cannot, reading a small paper written by a company producing a remedy does not qualify you to start dispensing the medicine to the patient sitting across the desk. This approach can offer a short term mitigation of symptoms, and this even a dispensing chemist can do. This is not a doctor’s approach to the healing a patient.

    “With respect to the prescription of the drugs which GP’s prescribe : All come with detailed data sheets covering indications, doses, side effects etc.” You forgot to Add the TV commercial and the company’s representative.
    This is the bane of allopathic treatment.

    ” And that means without telling patients what the consensus of scientific and medical opinion is about such preparations – namely that they do not work any better than placebos.”
    If this is the thought process, created by paid shills, how can the doctor trained in allopathy even think of prescribing a homeopathic remedy? Based upon his training, he is surely entitled to prescribe homeopathic combination remedies that contain low potencies and offer short term alleviation of symptoms.
    This off course is very similar to a chemist’s approach with long experience. A sleeping pill for insomnia. What is the doctor’s approach: treat the patient so he can sleep with out the requirement of the pill.
    Do YOU understand the difference?

    • Please stick to the point.
      IMHO (and in due course I hope the GMC will agree) – doctors who want to prescribe HP preparations should tell patients what the consensus of scientific and medical opinion is, and why. Using a data sheet if they wish.
      But to prescribe HP products without properly informing patients is, IMHO, unethical.

      That’s it!

      • Morning Dr Rawlins

        Perhaps you will answer this question, and not cite ‘red herring’, tu quoque, or maybe even the 5th for declining to answer the question.

        Is it possible that you conceived your post above in order to continue driving the wedge between conventional and homeopathic medicine prescribing by GMC registered doctors? GMC registered doctors have to obtain informed consent in regard to any treatment/therapy that they prescribe so why single out homeopathic prescribing only in this regard?

        My ‘red herring’ question above addresses the issue of fully informed consent as part of the total practice of a medical doctor so it is a valid question

        • As Chairman of the BMA’s Clinical Audit Committee I did indeed become very disenchanted with standards of medical, and especially, surgical practice, and I have promoted the principles of ‘TQM’, ‘CQI’ and patient safety vigorously.
          I contributed to the foundation of the National Joint Register, and was Chairman of the European Standards Committee of the British Standards Institution, and of the Health Quality Service’s Advisory Council.
          I also sat as a BMA representative on the committee which reviewed the GMC’s stance on informed consent.
          ‘Montgomery’ is of particular current concern.

          As a former chairman of the Junior Hospital Doctors Association I was asked to help with the BMA junior doctors committee’s policy development – to see they were no longer expected to do modules at the Glasgow Homeopathic Hospital during training.

          As a magician, I am well versed in many techniques for fooling people and taking advantage of their gullibility – but even magicians (with a few exeptions) draw the line at claiming that the ‘powers’ they demonstrate are real. Lying is not fooling, or entertaining! Too easy!

          I do not know why some doctors practice as homeopaths – but I simply ask that they properly inform their patients.
          I am trying to help patients who clearly are troubled, worried, suffering (<Pateo , I suffer).
          That is what doctors want to do, and are supposed to do.
          Simple.

          Frankly, my motives are irrelevant, and those who question them are indeed dragging red herrings into the debate, using tu quoque and <ad hominem , all of which are logical fallacies.
          So please, don’t concern yourself about me. Focus on patients and the information they need if they are to give properly informed consent to treatment by registered medical practitioners.
          Why would anyone not want that?

          • The issue Dr Rawlins is that you are suggesting that properly qualified GMC registered practitioners are not obtaining informed consent and are exploiting vulnerable and gullible patients. You also imply that the GMC are turning a blind eye towards this state of affairs.

            I would say that you need EVIDENCE to support this contention.

            What evidence do you have that this is the case?

          • Greg:
            This blog is providing much evidence.
            Thank you for your contributions.

  • James

    “They have been sponsored by the manufacturer of Traumeel and… I don’t really know what fellow Iqbal’s point was by citing this link anyway.”

    And the Vioxx study was done by FDA.

    “http://spotlight.vitals.com/2009/12/alexa-ray-joels-suicide-attempt-with-traumeel-harmless-says-dr-lewis-nelson/
    Is this link good enough for fellow Iqbal to understand that these products don’t cause anything?”

    This is where I first came across Traumeel:
    https://sciencebasedpharmacy.wordpress.com/2010/04/16/slipping-through-the-cracks-health-canada-traumeel-and-homeopathy/
    And after reading the few hundred patient responses, I suggested it to my son for his knee injury. The result was excellent. The operation suggested by the doctor in Denver was not required to be done.

  • James

    “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760822/” Check, and let me know why people disguise allopathic preparations as homeopathic.”
    You know nothing about potencies and off course nothing about homeopathy and allopathy either. But this reference is interesting. Since when have herbal extracts been used as allopathic medicines? Quality control? How to ensure that the active compound in all samples remain the same? And off course the double blind RCT”s?

    And have you tried to find out a little more of this company? It seems to specialize in locating homeopathic remedies for specific conditions, putting them all together in low potency and creating a short term symptom alleviation drug. This is perfect strategy for replacing allopathic drugs: takes care of the symptoms and no adverse effects. Allopaths with no training in homeopathy can read and prescribe with abandon.

    The rest (the higher potencies) are definitely homeopathic. And they contain nothing. So, don’t hijack low potencies as homeopathic. It’s toxicology and the effects are clear, as are the dose-response rates. Huge efforts have been put into chemistry and toxicology and now, fellow Iqbal & Co. appear and try to hijack the results.

    • James

      “The rest (the higher potencies) are definitely homeopathic. And they contain nothing. So, don’t hijack low potencies as homeopathic. It’s toxicology and the effects are clear, as are the dose-response rates. Huge efforts have been put into chemistry and toxicology and now, fellow Iqbal & Co. appear and try to hijack the results.”

      If the patient gets completely cured, the required remedy for her was one of the higher potency remedy. But I do not see high potencies here.
      Toxicology and effects are chemistry and should not be confused with medicine.

      • Iqbal:

        Statement: “If the patient gets completely cured, the required remedy for her was one of the higher potency remedy.”
        -Right. And if the patient does not get cured, just try some other remedy. There are a few thousands of them. Keep trying until the patient is healed all by himself. Then claim victory because of the remedies! Easy-to-follow instructions, really!

        Statement: “You know nothing about potencies and off course nothing about homeopathy and allopathy either.”
        You are half right there. I don’t know anything about “allopathy” indeed. What is this thing? Do you like this word?
        Because it means NOTHING to me. Are you using it to mean “medicine”? I hope not. As for potencies and homeopathy, these are in the sphere of delusion, of course. Do you know what grief your perpetuation of this vanity causes to people? I have friends that constantly argue with their families about how and why they should follow the “homeopath’s” orders. Take these pills, wrap them in foil. Then another foil. Then another foil. Ten layers of foil so that the pills don’t lose their potency. They have to try too hard not to feel sad about their parents when they watch these religious ceremonials.

        And then, no coffee of course! After so many years, still, no coffee. Do you know why my friends are being scolded by their parents when they drink coffee? Because the HOMEOPATH has convinced them parents that coffee can antidote the effects of the remedies RETROACTIVELY (unbelievable, I know!). So now, one of my friends has to hide when drinking coffee at home, because his parents still STRONGLY believe that his health is strong because of the past administration of “remedies” and coffee can REVERSE this well-being. And what do the guys themselves do? Well, most are scientists with a fair background in engineering, mathematics, physics, etc. so, thankfully, they don’t have any trouble dismissing homeopathy by both observing that it does nothing to them (after having been “force fed” the stuff all the way through to adulthood, to no avail) and by observing that its theories are based on, as I have recounted elsewhere in this blog, the scientific equivalent of quicksand.

        Homeopathy and potencies that I have so meticulously wasted time to learn about, and that you so meticulously defend in the name of nothing, bring nothing but misery to families and friends of mine. Patients going to doctors are misinformed or completely ignorant about what homeopathy is about and it is so easy to be fooled into it by false evidence and coincidental events that everyday people with no experience or education in any discipline of science are desperately fall victims to this fancy talk all the time. The most profound misrepresentation of homeopathy that goes around is that people know it’s about “like-cures-like”. Most patients don’t even know how the remedies are prepared. How many people do you think you can fool by telling them that you dilute and shake water, and it somehow gets stronger? But nobody knows that. They are only told that it uses like to cure like. Potency is the CHOSEN word conveyed by doctors who prescribe, whereas DILUTION should be the key word. Misrepresentation, to your heart’s content.

        As for Traumeel… Nobody really knows what and how much it contains. It definitely contains alcohol however, which is quite soothing all by itself, both inside and outside the body 😉

        I am glad about Dr. Rawlins’ initiative, and I need to express my fear, that patients most often don’t even know whether the doctors they are visiting are GMC-registered or not. If the initiative ends up establishing the desired outcome, measures should also be provided to cater for patient facilities to report whether doctors do adhere to the newly established guidelines. Homeopathy is the longest tentacle of the Big Placebo octopus I’m afraid, so it’s not like new guidelines will be widely applied quite soon.

        • Any one can style themselves ‘Dr’, whether or not they are registered by the GMC, so caveat emptor.

          Check the GMC web site to see if a ‘doctor’ is registered or not.
          This post is about the ethics of RMPs.

          • And your ethics Richard Rawlins?

            “……..about informing a patient as to what the consensus of mainstream opinion is.” Is this ethics or advertising? Like writing here on a subject that you have no knowledge about?

            And off course, do you tell your patients that most surgical operations done have no evidence and most often later audits show zero benefit and mostly adverse results?

            https://www.bloomberg.com/news/articles/2005-07-17/is-heart-surgery-worth-it

            “A large study of 18,151 patients who underwent bypass surgery immediately after a heart attack or following an attack of crescendo angina (unstable angina) showed that they were nearly four times more likely to have a subsequent stroke than those who did not have bypass surgery. (1)
            Death in these stroke patients following bypass surgery was much higher! This study showed, in addition, that bypass surgery was the most important predictor of stroke followed by past history of stroke, diabetes, and older age group. Most glaring finding of this study is that the existence of an onsite catheterization laboratory facility was also a risk factor for subsequent stroke in those hapless patients with a heart attack admitted to such hospitals.
            This study did not show statistically increased stroke following angioplasty. Those wanting to sell angioplasty could use this as their marketing strategy. They cannot, however, escape the findings of another study that showed that “angioplasty may lead to greater reduction in anginal pain compared to medical treatment but at a cost of more coronary artery bypass grafting, although all the randomized controlled trials done all over the world and published between 1979 and 1998 do not give enough data about death and subsequent revascularization, the trends so far DO NOT FAVOUR ANGIOPLASTY.” 2
            Curiously, another study has shown that “initial angioplasty may complicate the bypass operation and may increase postoperative mortality and morbidity.3
            An audit on an earlier study of bypass surgeries did show that in those without symptoms a large majority of 84% recipients of bypass surgery did not get any life expectancy benefit from their interventions. Only 16% did get some small benefit. This study had audited a large number of such procedures running to nearly 60,000.4
            Other studies in the past have also thrown light on the side effects of bypass surgery on the brain.5
            These studies showed the incidence of stroke following bypass surgery to be anywhere between 1.5 to 5.2%, postoperative delirium to be 10-30%, and cognitive decline to be ranging from 53% on discharge to 42% on a long term basis.6
            1. Joesefson D. Early bypass surgery increases the risk of stroke. BMJ 2001; 323: 185
            2. Bucher HC, Hengstler P, Schindler C, and Guyatt GH. PTCA verses Medical treatment for non-acute coronary heart disease. BMJ 2000; 321: 73-77
            3. Kalaycioglu S, Sinci V, and Oktar L. CABG after successful PTCA. Is PTCA a risk for CABG? Int. Surg 1998; 83: 190-193
            4. Yusuf S, Zucker D, Peduzzi P. et.al. Effect of CABG on survival.. Lancet 1994; 344: 565-568
            5. Hornick P, Smith PL, Taylor KM. Cerebral complication following coronary bypass grafting. Curr. Opin. Cardiol 1994; 9: 670-679
            6. Selens OA and McKhann GM. Coronary Artery Bypass and the Brain. N. Engl.J.Med 2001; 344: 451-453”

            What ethics are you talking about:

          • Mr Krishna asks me “What ethics are you talking about?”.

            The clue is in the title of this ‘guest blog’ – the ethics of registered medical practitioners who prescribe homeopathically prepared products (‘remedies’) without properly informing their patients about the status of conventional scientific and medical opinion on these products.

            That’s it. Simple. I do not dispute that manufacturers of pharmaceutical products may leave a lot to be desired, nor that some surgeons fail to obtain informed consent (beware ‘Montgomery’), but that is not the subject of this post and tu quoque is a logical fallacy to be disregarded.

            Now you know what ethics I am talking about, please comment on registered medical practitioners’ ethics and avoid your other favourite logical fallacy of dragging red herrings into the debate.

            Please. I implore you.
            And I repeat – my post was not about the value or otherwise of homeopathy, but the ethics of doctors who do not inform their patients of the nature of the treatments they propose, and fail to comply with the injunction of the GMC.
            In this post, non-registered practitioners are of no concern to me.

            OK? Clear now?
            Please do not abuse the facility of Professor Ernst’s site by advancing your own opinions unless they are relevant to the specifics of the post, or you are invited to be a guest blogger!

            Thank you.

          • Please, fellow Iqbal, try to focus on your attempts to defend homeopathy… or businesses and investments if you prefer, of course. I am afraid you are reaching too far when using words such as “angioplasty” and “grafting” in your comments…

            You have any suggestions on how to treat serious coronary artery stenosis homeopathically?

          • Richard Rawlins

            “…….the ethics of registered medical practitioners who prescribe homeopathically prepared products (‘remedies’) without properly informing their patients about the status of conventional scientific and medical opinion on these products.”

            If an allopath prescribes a homeopathic remedy, he is bound to know something about it. Your irrelevant logic does not work. If he offers a combination remedy (many remedies mixed in low potency, then your statement is patently false as active compounds can be found and “With respect to the prescription of such remedies which GP’s prescribe : All come with detailed data sheets covering indications, doses, and side effects etc.”
            James came up with the information showing low potency homeopathic remedy being used as allopathic remedy with great result: test and actual. What would you expect the doctor to comment to his patient in such case? I would expect most allopathic doctors prescribe combination remedies only. It is easy. Even chemists are able to help customers save consultation fees.

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760822/

            “…that is not the subject of this post and tu quoque is a logical fallacy to be disregarded.”
            Just because you are allowed to write a post, you gain moral authority to point fingers at others?

            What about the four fingers that get pointed at you and your ilk: What do YOU ALL tell your patients when prescribing allopathic drugs?

            “I do not dispute that manufacturers of pharmaceutical products may leave a lot to be desired…..,”
            Do you say this to your patient? OR,
            “Most patients do not benefit from most drugs. Doctors know this, but that doesn’t stop them from prescribing. Some patients do benefit from most drugs; after all, pharmaceuticals have to demonstrate benefit before the FDA will approve them for marketing. Doctors tend not to think in terms of NNT. They think in terms of who will benefit, not in terms of who won’t. They have to act without having all the information. There is no way of knowing which patients will benefit, so we are stuck treating the many to benefit the few.”
            ” If the treatment has no evidence, what would you tell your patient”?
            ” …that some surgeons fail to obtain informed consent …” Consent for what? If the surgeon has no idea what he is up to himself: most often you have a very broad idea what you will find when you cut open the patient: this is also same as you have generally no idea what you will find when you cut open a patient.”
            These are the facts.

            The purpose of your post was ““I propose prescribing you a remedy comprising sugar pills impregnated with a solution which has been diluted to such an extent that a sphere of water the size of the Earth’s average radius to the Sun would probably contain no more than one molecule of the original substance. Nevertheless, my clinical experience suggests to me that this remedy will improve your condition. You need to understand that colleagues who practise conventional evidence-based scientific medicine regard my belief as implausible and the methods I use as ‘alternative.’ I believe the remedy will help you, but I have no evidence accepted by the majority of doctors that the intervention I propose will achieve the desired effects. I do not believe that taking a homeopathic remedy will delay any other treatment which might reasonably help your condition and I invite you to take this remedy with understanding of the issues I have outlined.”
            At the end of all this, the patient would at least be alive: what do you tell your patient’s relatives when the patient dies: the drug was good, the reports were right, the operation was successful and still the patient died. Or get ready to pay for the new complication?

            Frankly, if a similar statement was designed for the allopathic treatment, no patient would ever set foot in the hospitals that put to shame five star delux hotels in cost and service.

            https://www.thequint.com/fit/if-homeopathy-is-hogwash-why-are-millions-still-buying-it

            It is important for you to get your OWN ETHICS REALIGNED suitably first.

  • Dr Rawlins

    Greg (whoever you are): Dr Rawlins you have been fixated on this matter of identities for some time (but not James). You may consider going to talk with someone about this issue and explain that you have been blogging on Edzard’s site for some years now but recently you have developed some concerns about the identities of some commenters.

    I answered your question: informed consent of the patient MUST be obtained for homeopathic treatment.

    You labelled my questions: ‘red herrings’. You served society for many years as a medical practitioner so I am not inclined towards disrespecting you but you should know that my questions are not red herrings as your article is about GMC practitioners prescribing practice and obtaining informed consent. What your answer suggests is when highly active chemical drugs are prescribed then providing a leaflet to the patient constitutes ‘fully informed consent’ but you expect that when GMC doctors prescribe a homeopathic remedy that more than a leaflet is required.

    In terms of ‘taking advantage’ of patients, you should know that the general public have been the experimental subjects of Medicine for years. Once initial trials have passed the drug for patient use, the long term study on the general patient population commences and data on the drugs is then gathered on the drug. This ends up in the NICE database that enables the Guidelines to be updated regularly.

    The issue of the effectiveness and side effects continues for many drugs: eg statins. One day they are good for almost everyone, the next day they are seen as over prescribed due to the threshold for prescribing being too low.

    Is this explained to patients? Patients would need A levels in physics, biology and chemistry to understand enough about the medicines that they are given in order for them to provide FULLY INFORMED CONSENT.

    The truth is that the relationship of trust that exists between doctor and patient means that most of the time patients trust their doctor is doing what is best for them and accept the prescribed medicine/treatment. If, as you suggest, leaflets constitute the complete fulfillment of the legal requirement for ‘informed consent’ then GMC doctors could also provide their patients with leaflets on the homeopathic treatment to ensure consent is obtained.

    Thank you for your article and comments Dr Rawlins. In my view, you were the most serious and credible person on this site.

    • I will take up JK’s suggestion. I only hope the patients’ group are as open minded as I am.
      One problem is that this is not a group for patients interested in homeopathy, but for those who support a specific institution (The Royal London Hospital – for integrated medicine), which had to change its name from the Royal London Homeopathic Hospital, to use a name which could be confused with the long established Royal London Hospital in Whitechapel – and which has the mission of integrating implausible pseudo-scientific camistry with regular conventional medicine.

      Quite why anyone wants such integration I do not know, but IM is harmful to the development and progress of orthodox medicine, as IM/camistry requires an alternative mindset and understanding of science in order to function at all.
      (Regular medicine’s orthodoxy constantly changes in the light of experience – and evidence!)

      Please note, I am not concerned about camistry in this thread, but about the honesty and integrity of camists, and any failure to properly inform NHS patients of the nature of their remedies.

      Re Greg and informed consent:
      How doctors inform patients is up to them (as long as the GMC is happy that they do so).
      If data sheets are OK for pharmaceutical products, that’ll be fine for HP products.

      Has anyone got an example of a data sheet for a homeopathically prepared product?

      • “Has anyone got an example of a data sheet for a homeopathically prepared product?”

        Of course: the “data sheets” are contained within its “Materia Medica”. E.g.:
        http://edzardernst.com/2014/06/berlin-wall-homeopathy-at-its-finest/

        See also:
        https://rationalwiki.org/wiki/Unusual_homeopathic_remedies

      • My favourite “datasheet” and proving protocol: http://nyhomeopathy.com/provings/musca-domestica/
        It takes a special kind of stupidity to grind up a housefly, dissolve it in water or alcohol or whatever, then rinse the pulverised housefly cadaver completely out of the solution, drip ordinary water on sugar tablets, let it evaporate and think the spirit of the housefly must be left in there and can work miracles 😀
        A physician (MD) who takes up such games should be considered out of its mind and made to find another job.

        • If this procedure were described adequately to patients, I don’t think the same amount of them would fall prey to that kind of gibberish. And then homeopathy proponents get into discussions about ethics. This is preposterous in every morbid way imaginable. Upon visiting the linked website, I stumbled upon the following sentences:

          “Needless to say, some provers took more of the remedy than they needed, and perhaps some took less. One prover took the remedy in the midst of a terrible cold, and so we eliminated her from the proving as it would have been difficult to know which symptoms to attribute to the remedy. Another prover discovered she was pregnant shortly before remedy distribution, so we only allowed her to put the vial under her pillow”.

          What kind of insanity dwells at the minds of these people…

          • One feature which bedevils rational discussion of homeopathy in English has been lost in translation.

            Hahnemann tested potential remedies on himself and other healthy (albeit, male) associates. This method continues today, but the German word pruefung used by Hahnemann (meaning ‘testing’ or ‘examination’) has been translated into English as ‘proving’. Both languages derive their words from the Latin probare , to test. The Professor will correct me if I am wrong.

            In modern English usage ‘probability’ means ‘likelihood’ – ‘proving’ today caries a connotation of certainty which Hahnemann did not intend. The British Homeopathic Association states: ‘Hahnemann deduced that an illness could be treated with a very small amount of a substance that, in larger quantities, could cause that illness. These experiments were called proving and led him to observe and describe the basic principles of homeopathic medicine.’ But the procedure was not called ‘proving’ by Hahnemann.

            Some folk may be misled into thinking there is an element of scientific truth in the procedure of ‘proving’ that is not merited (OED: to prove – to demonstrate the truth or existence of something by evidence). Any claims that Hahnemann ‘proved’ anything are deliberately misleading. The German for ‘to prove’ is beweisen , and that is not the word Hahnemann used. There is no reason why homeopathic writings in English should not refer to the investigations as ‘testing’, ‘experiments’ or even ‘research’, as the German pruefung translates, but invariably homeopaths use the terms ‘proof’, ‘proving’ and ‘provers’ with the misleading certainty that implies. Moreover, as Anthony Campbell has pointed out: ‘Hahnemann’s method of conducting his proving, though extremely meticulous and painstaking, did nothing to eliminate the effects of suggestion. The subjects knew what medicines they were taking and what effects they might experience.’

  • Why don’t you Dr Rawlins contact a homeopathic patient group with your concerns ? ie
    http://www.friendsrlhim.org/our-patients/what-the-patients-say-2/

    Maybe turn up at a meeting and talk to all these vunerable and gullible patients. Write to the President Peter Hain and also let him know of your concerns. He knows a thing or two about standing up for vunerable and exploited people.

    Just make sure that it isn’t you who is vunerable and gullible.

  • Statement requires evidence:
    ‘Please note, I am not concerned about camistry in this thread, but about the honesty and integrity of camists, and any failure to properly inform NHS patients of the nature of their remedies.’

    Good grief, Dr Rawlins, you have a lot of concerns on your mind. Holiday?

  • The fact that you are prepared to speak on behalf of all the ‘gullible’ homeopathic patients without even communicating with any homeopathic patients or any patient groups sure does make you the ‘amazing’ Dr Rawlins.
    As a one time homeopathic patient i think that you are gullible as you only seem to listen to one side. My view of course but I think that quite a few homeopathic patients would agree with me.

    I can’t wait for the GMC reply to your letter! I am sure that you have the integrity to post the reply even if it doesn’t quite go your way.

    • Please do not be silly (is there a ‘remedy’ for that?).
      I have never suggested I ‘speak on behalf of patients’, homeopathic or otherwise.
      I am asking a question about how all patients are treated and cared for.
      I am not sure what a ‘homeopathic patient’ is and will resist attempts at satire.

      As for the ‘sides’ in this debate – are you (or anyone else posting here) seriously suggesting that patients should not be properly informed about treatements that are proposed?

      I have already indicated I will keep this blog informed about progress with the GMC.
      You could help.
      Did you, JK, ever received a data/information sheet from your homeopath informing you of the consensus of scientific and medical opinion about the HPP they were recommending?
      Thank you.

      • Dr Rawlins:If any homeopathic Dr tried to present a data sheet to me about ‘scientific’ opinion about an HHP then I would consider that Dr to be unethical. I have my personal anecdotes which have led to my beliefs. If I make an unsolicited appointment with a homeopathic Dr then I don’t expect to have to hear statements about HPP I think are BS. However, if the GMC ever did adopt your policy then it would be very interesting. Up to now the homeopathic community collectively do very little against the likes of the GTS. That is so long as they can get their HPPs and see their homeopaths. Sooner or later this community will arise and take action. Humiliating patients with data sheets should provoke enough anger for a mass campaign for homeopathy. So on reflection it maybe best if you did get your way asap. I fear that you won’t though.

        • There is nothing unethical about informing a patient as to what the consensus of mainstream opinion is.
          By all means, a homeopath could add, “…but I think and believe….”.

          Is that too much to expect?

          What is ‘humiliating’ about that?

          Why would informing patients about mainstream opinion make patients angry?

          Has integrity left homeopaths’ consulting rooms?

          • Also, UK Supreme Court case, Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland), [2015] UKSC 11

          • ‘Why would informing patients about mainstream opinion make patients angry?’

            It would because it is not their opinion!

            Anyway if you get some time try checking out some people who have actually seen homeopaths and ask them who they think is unethical in all of this.

          • The fact that homeopathy advocates, practitioners and a great deal of all-purpose alternativists have, at times successfully, campaigned against conventional medicine, bringing forward a non-negligible mentality shift to the average “patient”, imparting the belief that conventional medicine is only to blame and utterly no good does not mean that the patients’ opinions should be weighed more than the doctors’ opinions. Homeopaths are wrong and so are patients that believe in this nonsense. The fact that patients are naturally entitled to have an opinion is intimately tied to the fact that patients are often wrong. When patients visit doctors, they go to get expert opinion, or, even better, evidence-based treatment advice. Promoting the idea that patients will get angry when given an expert opinion is a fallacy. The point is that they must be taught to trust this opinion MORE than their own. Sadly, alternativists promote the idea that patients should trust their own opinions and beliefs (along with whatever the alternativists peddle of course, homeopathy and whatnot).

            This “protect-the-right-to-choose-your-medicine” campaign causes more harm than good in the end. It imparts a false level of importance to the patient’s OPINION, when it is the doctor’s opinion that should matter the most. Does anyone in here disagree with that?

            Truth be told, it does seem that patients “carry” their opinions along with them when visiting doctors and the teachings of alternative medicine to defend their opinions and often reject the established standards of care are strong on this one. I argue that it is more often a bad thing. Registered medical practitioners operate under the conventional mainstream evidence-based protocols. These have nothing to do with homeopathy. It’s only reasonable that patients visiting REGISTERED medical practitioners are given access to full information about the conventional perspective with respect to whichever treatment is to be provided and along this line of reasoning, I totally agree with the initiative of Dr. Rawlins. If patients are going to be given homeopathically prepared products, the least REGISTERED medical practitioners must do is provide patients with the conventional evidence-based medical opinion on the subject.

          • Richard Rawlins

            “Has integrity left homeopaths’ consulting rooms?”
            A homeopath does not accept mainstream opinion. Mainstream opinions have most often been proved wrong.

            1.”take off the labels and no one can identify identify the homeopathic medicine” This was main stream message: Outcome?
            http://ccrhindia.org/pdf/ijrh/5(1)/1.pdf
            http://pubmedcentralcanada.ca/pmcc/articles/PMC2822343/

            2. Ultra dilute solutions cannot have any effect on organism: against principle of chemistry!
            https://www.hindawi.com/journals/ecam/2011/696298/
            https://www.ncbi.nlm.nih.gov/pubmed/21057725
            https://www.theguardian.com/science/2001/mar/15/technology2

            3. Shaken water is water only:
            https://link.springer.com/article/10.1007/s10953-007-9215-5

            Now to allopaths like you: What do you tell your patients about the efficacy of the drug offered?

            “Most patients do not benefit from most drugs. Doctors know this, but that doesn’t stop them from prescribing. Some patients do benefit from most drugs; after all, pharmaceuticals have to demonstrate benefit before the FDA will approve them for marketing. Doctors tend not to think in terms of NNT. They think in terms of who will benefit, not in terms of who won’t. They have to act without having all the information. There is no way of knowing which patients will benefit, so we are stuck treating the many to benefit the few.”

            Do you say anything even close to this to your patient while prescribing a drug?

            Shall we say: “PITCH DARK UNDER THE LAMP?”

          • JK on 14th September:

            As a one time homeopathic patient i think that you are gullible as you only seem to listen to one side.

            JK on 16th September:

            If any homeopathic Dr tried to present a data sheet to me about ‘scientific’ opinion about an HHP then I would consider that Dr to be unethical. I have my personal anecdotes which have led to my beliefs.

            JK on 16th September:

            ‘Why would informing patients about mainstream opinion make patients angry?’

            It would because it is not their opinion!

            Are you sure that it was a good idea to post the last two comments on the same page as the first one?

          • Fellow Iqbal is truly magnificent! I can’t even begin to describe the multiplicity of facepalms induced by going through the cited “studies”. I suggest visiting [https://rationalwiki.org/wiki/Point_refuted_a_thousand_times] instead.

            Is it so hard to focus fellow Iqbal? The point of the current post is simple:

            Registered Medical Practitioners should warn that homeopathically prepared products don’t do what proponents claim they do prior to prescribing any of this stuff. If they don’t, they should not be registered. If they are not registered, this is not a concern of the current post.

            In my opinion, it would be unethical on behalf of the GMC to not at least seriously consider Dr. Rawlins’ proposition.

            P.S.: Mainstream opinions have NOT been proven wrong as often as you wish they would have fellow Iqbal. Why are you so persistent with conspiracy-driven attempts at argumentation anyway?

  • JK, Dr Rawlins should have now realised that he has work to do before sending his Letter to the GMC. His opinion piece needs to be backed up with evidence.

    The other thing is that he could consider that by the very act of writing to the GMC to inform them of this issue, it suggests that he may consider them as gullible and unaware of matters within their remit.

    How funny is that?

    • The GMC knows perfectly well what the score is, but is prepared to leave these patients to their own devices, and in the hands of doctors who (IMHO) are unethical.
      Because nobody (apparently) dies – the GMC is content.
      IMHO, that should read, complacent.

      Sir Michael Rawlins (no relation), when head of NICE, was asked why NICE would not report on the value to the NHS of homeopathic products. He replied, “Because persons of influence wouldn’t like it.”

      I’m afraid patients who believe ‘nothing’ (in the form of HPP) can help them are abandoned by the mainstream.
      Frankly, I’m uncomfortable with that.
      Aren’t you?

      • Dr Rawlins: the GMC knows the score and will be aware of the letter that you intend to put in the post soon. Your statement above suggests that you do not expect a GMC Commission to be set up to investigate GMC practitioner homeopathy prescribing in regard to obtaining informed consent.

        As you stated: these matters depend on patient complaints and if all the patients are satisfied with their treatment, well that is that then, isn’t it?

        Dr Rawlins you might think that people who believe in Jesus are gullible, but there are hundreds of millions of happy Jesus believers. Do you think you would have an impact if you wrote to the Pope and told him that he is misleading and exploiting vulnerable and gullible people?

        Please post your GMC letter here and their reply.

        I look forward to reading them.

        • This post is about the ethical responsibilities of registered medical practitioners – not persons of religious faith.
          I have already confirmed I will convey any decision of the GMC.

  • I believe in the US homeopathic ‘manufacturers’ are NOT required to put the (albeit farcical, understated and patently useless) “warning” seen on all scam nutritional & non-medicine products: “these statements have not been evaluated by the FDA, not meant to treat, cure…blah, blah, blah”.
    Is that the same throughout Europe as well?
    THAT was a real coup for homeopathy (much like Chiropractors getting to use the term Doctor and get Medicare payments). At the least such labeling could potentially raise the discussion of efficacy between scammer and scammee and then set the stage for their false and misleading treatment hyperbole to be dealt with legally.

    In the US the FTC can’t prevent homeopathic marketers from selling their products; only the FDA could do that. But supposedly starting very soon, they will require that homeopathic products include statements that:
    “There is no scientific evidence backing homeopathic health claims
    Homeopathic claims are based only on theories from the 1700s that are not accepted by modern medical experts”.

  • James

    “Personal observation bias and belief perseverance.”
    I agree. That is the reason I refer to the homeopathic Materia Medica. This is not result of personal experience. The outcomes confirm the defined possibility in the materia medica.

    “It only serves,,….. to homeopathic preparations. -You really believe that Aconite and Belladonna 30C contain anything other than water or ethanol in them (or maybe contaminants such as silica nanoparticles, leaking from the glass vials because of the succussion process, they don’t do anything for the body anyway)?”
    It is not a matter of belief. The outcome is important and now, with new technology, it is possible to confirm actual remedy as also its potency. Further trials are ongoing.
    http://ccrhindia.org/pdf/ijrh/5(1)/1.pdf
    Send this to ORAC or was it Gorski for comments.

    “You seem to have observed the fact that paracetamol counters the increased temperature effect of fever. Do you have any idea how it succeeds in doing that?”
    Paracetamol does NOT counter the EFFECTS of fever. It only reduces the temperatures for ~ 4 hours.

    “Do you believe that this action of paracetamol (lowering the fever) is unwanted?”
    Unwanted!!! This is a wrong term. Paracetamol is dangerous for children. Gives zero benefit and kills few hundred children every year in the western world and a few hundred thousand children every where else every year. And it has been around for over 50 years. That would add up to over a few million children killed for no benefit.
    And this is not a homeopath or me saying so (we always knew this) This is WHO.
    http://www.who.int/bulletin/volumes/81/5/Russell0503.pdf and toxicity:
    http://uk.cochrane.org/news/paracetamol-widely-used-and-largely-ineffective

    “Many studies suggest that fever is a beneficial response to bacterial infection. Fever has been reported to be associated with increased survival in patients with spontaneous bacterial peritonitis and polymicrobial sepsis . A prospective study of 748 children with severe pneumonia in Papua New Guinea found mortality rates of 29% in afebrile malnourished children and 12% in febrile malnourished children; no such difference was found in well-nourished children with severe pneumonia (Go into detail and you will find this study rigged.). In three other prospective studies of sepsis, hypothermia was present in about 10% of adults surveyed and was associated with a greater than two-fold higher mortality than the presence of fever. Several retrospective studies confirmed that human survival after serious infection is reduced in patients with hypothermia or in those who fail to generate a fever.

    “If yes, why do you believe they sell the product then?”
    Stupid customers are available every where and making money from symptom alleviation is common practice in the allopathic system. You can come up with a better suggestion. Incidentally, this useless practice is stopped? NOOOO.

    “You actually believe that a fever on its onset …temperature increase (it’s quite simply the natural course of fevers)”
    It could increase.

    “Your son is susceptible to delirium at 103F? Other young children are not? Have you made this diagnosis yourself?”
    My younger son is. The elder son has no effect until 104.6 -his highest measured temperature.

    “With these 2 remedies, his temperature crosses 104F every time and crossed 105F once”. You really believe that this is a special effect of the homeopathic preparations you administer? And you don’t believe this is anyway the natural course of a fever?”
    I have never waited to find out the outcome without medicine. Without Belladona, he had delirium. After using Belladona, never.

    “Most often, by next morning, the fever is gone”. Still, you don’t believe that this is what happens anyway with most fevers? You think that the homeopathic preparations do that to the children?
    I have never waited to find out. People of your ilk, do not even wait for 2 hours and start pushing paracetamol. Read the outcome above. With homeopathy, temperature increase is normal process, and doctors caution patients.

    “If yes, what do you believe would happen if you did not administer the homeopathic preparations?”
    The result is known to you, Rawlins, Edzard et al. Diseases start curing themselves during homeopathic treatment, which refuses to happen in allopathy, and drugs are mandatory, even if the prescription drugs like Crocin, are ineffective and end up killing patients.
    http://uk.cochrane.org/news/paracetamol-widely-used-and-largely-ineffective

    • It would be very interesting and illuminating to me to see how a homeopathic-defender i.e. an insane person and/or fraud, would ‘defend’ something that ‘their’ albeit limited cognitive skills would suggest is utterly without merit….say Scientology “auditing”?? Network-Chiropractic?? Alien invaders?? Or astrology? (Oops sorry we all know that IS real…).
      Implausible and fraudulent ‘activities’ like homeopathy, Scientology and the like continue to make definitive, positivistic claims regarding utility and mechanism-of-action….yet can NEVER be defended by their adherents logically or scientifically….however they vigorously attack those who dare ask for the proof.
      IF proof exists obfuscation is unnecessary, yet misdirection and obfuscation are all they ever offer.
      Perhaps IF you would have your Engrams audited-to-Clear you could see the world rightly…..unless you have “cleared” your Engrams with a homeopathic preparation?

      • Michael Kenny
        If you understood what you read then you would know that your comment is not related to Dr Rawlins’ post.

        Dr Rawlins refused to get drawn into answering my two questions above as he regarded them as ‘red herrings’

        Then he would not contemplate extending the discussion of the exploitation of the ‘vulnerable and gullible’ due to this being a religious topic, and he also did not respond to whether he thought the GMC was vulnerable and gullible as not to know about the ethics of GMC doctor homeopathic prescribing.

        Then you come along with your comment.

        I think the answer to your comment is best provided by Dr Rawlins:
        ‘Please. I implore you.
        And I repeat – my post was not about the value or otherwise of homeopathy, but the ethics of doctors who do not inform their patients of the nature of the treatments they propose, and fail to comply with the injunction of the GMC.
        In this post, non-registered practitioners are of no concern to me.

        OK? Clear now?
        Please do not abuse the facility of Professor Ernst’s site by advancing your own opinions unless they are relevant to the specifics of the post, or you are invited to be a guest blogger!’

    • Fellow Iqbal quotes:
      “I agree. That is the reason I refer to the homeopathic Materia Medica. This is not result of personal experience. The outcomes confirm the defined possibility in the materia medica.”

      I really don’t want to be harsh to the scrupulousness and care, energy, efforts and persistence that have been put to compiling such a large volume of information. I respect the effort itself, but I can’t help but quote a gymnastics coach with respect to the quality over quantity aspect of training: “If you pile crap upon crap upon crap… it doesn’t suddenly turn into a diamond… It’s just a big pile of crap”. “Crap” here is an even stronger reference to the statement “The outcomes confirm the defined possibility in the materia medica”. These “outcomes” fancied by fellow Iqbal are fully coherent with a no-treatment regimen of course.

      http://ccrhindia.org/pdf/ijrh/5(1)/1.pdf ???
      This merits laughter of course! Seriously? Do you understand what a supercontinuum even is? I wouldn’t waste Dr. Gorski’s time with this piece of fantasy. The only part of the document that one can trust is the sentence:
      “The gas chromatography tests carried out indicated that all the samples contained water and ethanol only, and in similar portions”. The rest information are concoctions of WILD IMAGINATION and an abuse of data artifacts.

      Statement of fellow Iqbal:
      “Paracetamol does NOT counter the EFFECTS of fever. It only reduces the temperatures for ~ 4 hours.”
      -Fellow Iqbal, that’s COOL (literally)! So the increased body temperature is not a physiological response or a manifestation of fever. Good to know…

      Quotation of fellow Iqbal:
      “…… and so […] Several retrospective studies confirmed that human survival after serious infection is reduced in patients with hypothermia or in those who fail to generate a fever”.
      -Nothing too amazing here. Fever is a natural response. When its symptoms are sometimes unbearable, you WANT a lower temperature. When thermoregulation malfunctions, you WANT a lower temperature.

      Statement of fellow Iqbal:
      “I have never waited to find out the outcome without medicine. Without Belladona, he had delirium. After using Belladona, never”.
      -Without Belladonna he had delirium? Like… once? After using Belladonna, never? And it is not likely that he simply got older and stronger, right? Why do you always have to choose the complicated over the simple explanations? Fellow Iqbal, firemen being present at all fires does NOT mean that firemen CAUSE the fires.

      Statement of fellow Iqbal:
      “My younger son is. The elder son has no effect until 104.6 -his highest measured temperature”.
      -Right. As I said above, it is very simple. The young son had delirium. Then he got older and stronger. And you continue to believe it was Belladonna 30C.

      Statements of fellow Iqbal:
      “People of your ilk, do not even wait for 2 hours and start pushing paracetamol. Read the outcome above. With homeopathy, temperature increase is normal process, and doctors caution patients”.
      “Diseases start curing themselves during homeopathic treatment, which refuses to happen in allopathy […]”.
      -Yes, we are evil! We want to perpetuate disease and so we hide the only solution out there. HOMEOPATHY!!! Listen, fellow Iqbal. Our ilk is not so incompetent. In full contrast to you and homeopathy lovers in general, we get things right! If we wanted to kill people, we wouldn’t be 3rd on your FAVOURITE LIST… we would be the 1st. Now focus for a while and repeat after me: “Conventional Medicine does not aim to kill people”!

      Dear Michael Kenny, this is the fabulous world of cognitive dissonance! Fellow Iqbal:
      -Chooses extremely complicated explanations over simple and realistic facts.
      -Chooses to believe that correlation implies causation.
      -Justifies his beliefs by citing all kinds of utterly wrong research findings.
      -Ignores the correct findings.
      -ADAPTs reality to his beliefs and not the other way around.

      His last comment provides, of course, ample evidence for these observations, so I believe the diagnosis is trivial to reach.

      I hope the necessary conceptual changes will come to fellow Iqbal when he watches a serious condition failing to improve after trying all homeopathic tricks that crowd his head. Until then, his entire life will revolve around fitting evidence to his beliefs, when it should be the other way around. Total recall might be the only solution, unfortunately…

      • “I hope the necessary conceptual changes will come to fellow Iqbal when he watches a serious condition failing to improve after trying all homeopathic tricks that crowd his head.”

        You just raised a thought: sugar pills are probably good for treating an episode of acute hypoglycaemia. Score +1 for homeopathy!

        On the other hand, lactose is not the best sugar for the job, so maybe the score is +0.5.

      • James

        “This merits laughter of course! Seriously?”
        Seriously: the trial was done at Tata Institute of Fundamental Research: Check this out.

        Wasting Gorski’s time? This is a laugh. You will provide him a very valuable topic to write about. What do you believe his 10 hours every day are spent on?

        “Nothing too amazing here. Fever is a natural response. When its symptoms are sometimes unbearable, you WANT a lower temperature. When thermoregulation malfunctions, you WANT a lower temperature.”
        The WHO report clearly states that under NO condition of fever, paracetamol provides any benefit. And how do doctors find out ” thermo regulation malfunctions”?” Which test?

        ” If we wanted to kill people, we wouldn’t be 3rd on your FAVOURITE LIST… we would be the 1st. Now focus for a while and repeat after me: “Conventional Medicine does not aim to kill people”!
        This is correct. Still allopathy kills people:

        “It has been 15 years since the landmark report by the Institute of Medicine (IOM), To Err is Human, which found that as many as 100,000 people die every year in the United States as a result of preventable medical errors.”
        “As a physician, I took the oath to “first, do no harm” and yet, To Err is Human revealed to me and to doctors, nurses, and patients a simple truth: we do a staggering amount of harm every day.” (This is one stupid doctor: recalls the oath : first do no harm! your message for him?)
        ” A recent study led by Dr. John James found that between 200,000 and 400,000 Americans die each year from unsafe medical care, which makes it the third leading killer in the US…,(the figure in BMJ is 251,000: and not 391,000.).
        “Finally, in an eye – opening November 2011 report on adverse events in hospitals, the Office of the Inspector General (OIG) in the Department of Health and Human Services found that 13.5 percent of Medicare patients suffered an injury in the hospital that prolonged their stay or caused permanent harm or death.
        “An additional 13.5 percent of Medicare patients suffered temporary harm such as an allergic reaction or hypoglycemia. Together, the data suggest that more than one in four hospitalized Medicare beneficiaries suffer some sort of injury during their inpatient stay, much higher than previous rates.
        The OIG report also found that unsafe care contributes to 180,000 deaths of Medicare beneficiaries each year.” (From the testimony of Dr Jha to US Senate Committee on health).

        The world wide figure is 43 million. That is equivalent of the population of Argentina wiped out once every year! If that does not qualify for no. 1 position of killing, removing Chinese population once every year will?

        If you start to total up, in the name of scientific medicine, medical world is already the biggest killer. No. 1 on the list. And the reason is simple: the complex human body is treated as a “simple and realistic fact”. Outcome: death and disability. Fever is considered thermo regulation malfunction and paracetamol kills fever and the child!
        When a cancer patient dies of pneumonia during chemotherapy, is it medical error of death due to pneumonia ?
        Or a child dies with liver failure due to paracetamol, is it liver failure or drug over dose?
        Or a diabetic treated with Actos develops bladder cancer, is it error of the pharma company or the doctor/

        End result in all cases: the patient dies!!!!!!!!!!!!!!!!!!!! Great medicine:

        In India, homeopathy has support from government and the benefits:
        https://www.thequint.com/fit/if-homeopathy-is-hogwash-why-are-millions-still-buying-it

        • Ok. I get it. You don’t like medicine at all. You propose that people should be left alone to suffer then. Let’s see if you can confirm your suggestion with a very brief example:

          https://www.ncbi.nlm.nih.gov/pubmed/9215816/
          During the trial, doxorubicin and cyclophosphamide were administered (scary names, eh Iqbal?). The result was that:

          “Breast tumor size was reduced in 80% of patients after preoperative therapy; 36% had a cCR.”. So, about 80% of the time, the effect was favorable. And in 36% of the time, response was complete

          -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915699/
          —About NeoAdjuvant Chemotherapy—
          The authors state that: “In our institution, fluorouracil, epirubicin and cyclophosphamide (FEC) followed by weekly paclitaxel is the standard NAC regimen for operable breast cancer cases. In the present study, 95 patients with breast cancer were treated with this regimen, 5 of whom (5.3%) developed IP during NAC”.
          IP stands for interstitial pneumonia.

          So, about 80% of patients improve, and often very much. About 5% of patients (in one study at least) may suffer from complications, such as pneumonia. The percentages may not represent the exact cases, but they are estimates relatively close to reality. So, fellow Iqbal, do you suggest that to avoid the 5% of cases where pneumonia may develop through neoadjuvant chemotherapy in breast cancer, we should also avoid the 80% of cases that will improve, right?

          This is the nirvana fallacy fellow Iqbal! You score again!

          So, what do you suggest so that people with cancer will not die of complications or medical error? Homeopathy?

  • Dr Rawlins, the only ‘evidence’ that I can see accumulating on this blog are your views on the GMC, and GMC registered doctors in regard to the topic of your post.

    Thank you for your post and comments, I learned something.

    • Other evidence is confidential at this stage.

      • Can’t wait to see this evidence when it is ok with you Dr Rawlins.

        • The reference to the GMC will include:
          “There is no evidence that registered medical practitioners who practice homeopathy comply with GMC guidance and provide patients with the information they will need to decide whether or not to accept recommendations to take homeopathically prepared products. Specifically, patients are not told (either verbally or by data sheet), that the consensus of conventional medical and scientific opinion is that such products are placebos, and have no ailment specific effect. Attempts have been made to identify relevant information/data sheets, to no avail.”

          OK?

          Please correct me if I am wrong.

          • My comment at 08:43 was posted while your 08:38 comment was being moderated. Even so, what is ‘confidential’ about this issue, given that you have stated what the matter is?

            Don’t you think that it is an easy problem to fix: provide a leaflet to the patients as is normally done with the prescribed medicines?

          • Greg:
            The evidence I am amassing is being worked on and is not yet readied for submission to the GMC.
            Yes, it would be an easy problem to solve as you say. But I have no evidence that any homeopathic doctor provides such information.
            That is the point!

      • Morning Dr Rawlins,

        Edzard’s latest post is ‘you got to be kidding’; is this the case with your latest comment?

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