homeopathy
It has been reported, at the German Medical Congress (DÄT) a year ago, that it was decided to delete the additional title of homeopathy from the model further training regulations of the German Medical Association. And Federal Health Minister Karl Lauterbach (SPD) tweeted applause: “Homeopathy has no place in modern medicine.”
Now the ‘ Bundesverband der Pharmaziestudierenden in Deutschland’ (BPhD), the German Pharmacists Organization, even goes a few steps further. The position paper distinguishes between evidence-based medicine (EBM) and unproven therapeutic methods. According to the BPhD, these include homeopathy, but also anthroposophy, traditional Chinese medicine, and traditional medicines.
Among other things, the BPhD is disturbed by the way homeopathy presents itself as an alternative, because an alternative means “a choice between two equally suitable possibilities” to achieve a goal, and this is not the case. Compared to evidence-based medicine (EBM), homeopathy is a “constructed, illusory concept” and “the principles of homeopathic teachings and principles” are to be rejected as “unscientific”. According to the BPhD, a designation as “alternative” for advertising purposes should no longer be allowed.
They would also like to see a demarcation from naturopathy; the clear distinction between homeopathy and phytopharmacy has been lacking up to now. The advertising attribute “natural” should therefore also be banned in order to prevent equalization in advertising, the position paper states.
Like doctors, pharmacy students point to the lack of proof of efficacy beyond the placebo effect. According to the BPhD, the dogma WER HEILT HAT RECHT, “he who heals is right” would “disregard all processes that work towards healing and glorify the result”. The “gold standard” of EBM – randomized, double-blind studies with placebo control – should in future also have to be fulfilled by homeopathic medicines, experience reports are not sufficient, it continues.
Homeopathic medicines are only registered as medicinal products without indication, which requires neither proof of efficacy nor clinical studies. The BPhD, therefore, demands that a warning be placed on the preparations that they have “no proven efficacy beyond the placebo effect”. Up to now, without this warning, patients have been “deceived about the efficacy”, and there is an “urgent need for detailed public information and counseling on homeopathy since its unjustified reputation poses a danger of not seeking treatment”. The BPhD also demands that the status of homeopathic medicines is withdrawn and that the pharmacy obligation for the preparations is abolished…
“In the health professions, no trivialization of unproven therapeutic procedures should be tolerated, as inadequate counseling or ignorance poses a danger to patients,” the BPhD said.
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When I first read this article – I translated and shortened it for those who cannot read German- I was truly dazzled. These are the suggestions that I have been making for around 20 years now, not specifically for Germany but for pharmacists in general. For many years, the Germans seemed the least likely to agree with me. But now they seem to be ahead of everyone else in Europe!
How come?
I suspect and hope that our recent initiative might have something to do with it.
Let’s hope that the pharmacists of other countries follow the German example.
A team of French researchers assessed whether a conflict of interest (COI) might be associated with the direction of the results of meta-analyses of homoeopathy trials. Their analysis (published as a ‘letter to the editor) is complex, therefore, I present here only their main finding.
The team conducted a literature search until July 2022 on PubMed and Embase to identify meta-analyses of randomized clinical trials assessing the efficacy of homoeopathy. They then assessed the existence of potential COI, defined by the presence of at least one of the following criteria:
- affiliation of one or more authors to an academic homoeopathy research or care facility, or to the homoeopathy industry;
- research sponsored or funded by the homoeopathy industry;
- COI declared by the authors.
The researchers also evaluated and classified any spin in meta-analyses conclusions into three categories (misleading reporting, misleading interpretation and inappropriate extrapolation). Two reviewers assessed the quality of meta-analyses and the risk of bias based. Publication bias was evaluated by the funnel plot method. For all the studies included in these meta-analyses, the researchers checked whether they reported a statistically significant result in favour of homoeopathy. Further details about the methods are provided on OSF (https://osf.io/nqw7r/) and in the preregistered protocol (CRD42020206242).
Twenty meta-analyses were included in the analysis (list of references available at https://osf.io/nqw7r/).
- Among the 13 meta-analyses with COI, a significantly positive effect of homoeopathy emerged (OR=0.60 (95% CI 0.50 to 0.70)).
- There was no such effect for meta-analyses without COI (OR=0.96 (95% CI 0.75 to 1.23)).
The authors concluded that in the presence of COI, meta-analyses of homoeopathy trials are more likely
to have favourable results. This is consistent with recent research suggesting that systematic reviews with financial COI are associated with more positive outcomes.
Meta-analyses are systematic reviews (critical assessments of the totality of the available evidence) where the data from the included studies are pooled. For a range of reasons, this may not always be possible. Therefore the number of meta-analyses (20) is substantially lower than that of the existing systematic reviews (>50).
Both systematic reviews and meta-analyses are theoretically the most reliable evidence regarding the value of any intervention. I said ‘theoretically’ because, like any human endeavour, they need to be done in an unbiased fashion to produce reliable results. People with a conflict of interest by definition struggle to be free of bias. As we have seen many times, this would include homoeopaths.
This new analysis confirms what many of us have feared. If proponents of homeopathy with an overt conflict of interest conduct a meta-analysis of studies of homeopathy, the results tend to be more positive than when independent researchers do it. The question that emerges from this is the following:
Are the findings of those researchers who have an interest in producing a positive result closer to the truth than the findings of researchers who have no such conflict?
I let you decide.
In response to yesterday’s post, I received a lengthy comment from ‘Stan’. Several readers have already commented on it. Therefore, I can make my arguments short. In this post, will repeat Stan’s points each followed by my comments (in bold). Here we go:
Seven Reasons Homœopathy is Not Placebo Effect
Sorry, Stan, but your heading is not proper English; I have therefore changed it for the title of this post.
1. Homeopathic remedies work on babies, animals, plants and people in a coma. Biodynamic farmers use homeopathic remedies to repel pests and treat plant diseases. Some organic ranchers rely on homeopathic remedies to treat their herds. Some “placebo by proxy” effect has been shown for children but its doubtful that it could be shown for a herd of cattle or crops in a field. Farmers can’t rely on wishful thinking to stay in business.
As discussed ad nauseam on this blog, homeopathic remedies do not work on babies or animals better than placebos. I don’t know of any studies with “people in a coma” (if you do, Stan, please let me know). The fact that ranchers rely on homeopathy is hilarious but does not prove anything.
2. The correct curative remedy will initially cause a worsening of the condition being cured if it is given in too strong (i.e. too dilute) a dose. A placebo might only cause a temporary improvement of the condition being treated; certainly not an aggravation.
The ‘homeopathic aggravation’ is a myth created by homeopaths. It disappears if we try to systematically research it; see here, for instance.
3. One can do a “proving” of an unknown homeopathic remedy by taking it repeatedly over several days and it will temporarily cause symptoms that one has never experienced previously – symptoms it will cure in a sick person. This is a repeatable scientific experiment used to determine the scope of a new remedy, or confirm the effects of an already proven remedy. A placebo might possibly have an effect if the individual taking it has been “prepared” by being told what they are taking but it likely wouldnt match previously recorded symptoms in the literature.
Homeopathic provings are rubbish and not reproducible when done rigorously; see here.
4. One can treat simple acute (self-limiting) conditions (e.g. minor burns, minor injuries, insect bites, etc.) and see unusually rapid cures with homeopathic remedies. A placebo might only cause a temporary improvement of the condition being treated while taken. Placebos have been found mostly effective in conditions with a strong psychological component like pain.
You mean like using Arnica for cuts and bruises? Sadly, it does not work.
5. One can get homeopathic treatment for long term chronic (non self-limiting) conditions and see a deep lasting cure, as has been documented clinically for a couple centuries. A placebo might only cause a temporary partial improvement of the condition being treated while the placebo is being taken.
You mean like asthma, eczema, or insomnia?
6. There is over 200 years worth of extensive documentation from around the world, of the clinical successes of homeopathy for both acute and chronic conditions of all types. As Dr Hahn has said you have throw out 90% of the evidence to conclude that homeopathy doesnt work. The Sheng et al meta-analysis in 2005 Lancet that was supposedly the death knell of homeopathy used only 8 studies, excluding hundreds of others. Unsurprisingly homeopathy was found wanting. So-called Skeptics see what they want to see in the science. There is relatively little documentation of placebo usage. A few recent studies have been done showing the limited temporary benefits of placebos.
What Hahn wrote is understandably liked by homeopaths but it nevertheless is BS. If you don’t trust me, please rely on independent bodies from across the world.
7. Homeopathic remedies have been shown to have a very weak electromagnetic signature and contain some nano-particles. Some believe this explains their mechanism. An exciting new potential field of research is the subtle cell signalling that has been found to direct the development of stem cells. Scientists have created double-headed planeria worms and this trait has been found to be inherited by their offspring without any change in the genes or epigenetics. Until now we had no idea how a single fertilized ovum could evolve into a complex creature that is bilateral and has multiple cell types. It is possible that the very subtle electromagnetic signature or some other unknown effect of homeopathic remedies is effecting this subtle cell signalling.
The homeopathic nano-myth is nonsense. And so is the rest of your assumptions.
Every conventional drug has “side effects” that match the symptoms for which it is indicated! Aspirin can cause headaches and fever, ritalin can cause hyperactive effects, radiation can cause cancer. Conventional doctors are just practicing bad homeopathy. They are prescribing Partially similar medicines. If their drugs were homeopathic (i.e. similar) to the patients symptoms on all levels they would be curative. Radiation sometimes does cure cancer instead of just suppressing it per usual.
Even if this were true, what would it prove? Certainly not that homeopathy works!
Dr Hahneman did forbid mixing homeopathy and conventional medicine. In his day doctors commonly used extensive blood letting and extreme doses of mercury. Its not Quite as bad now.
You evidently did not read Hahnemann’s writings.
Just because we dont know how extremely dilute homeopathic remedies work, doesn’t discount that they Do work. Homeopathy seems to fly in the face of Known science. In no way is it irrational or unscientific. There are lots of phenomena in the universe that cant be explained yet, like dark energy and dark matter effects and even consciousness!
Not knowing how a treatment works has not stopped science to test whether it works (e.g. Aspirin). In the case of homeopathy, the results of these endeavors were not positive.
The assumption that the moon is made of cheese also flies in the face of science; do you perhaps think that this makes it true?
The actions of homeopathy can and have been well-explained: they are due to placebo effects.
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Stan, thank you for this entertaining exercise. But, next time, please remember to supply evidence for your statements.
After all these years, I am still fascinated by what proponents of homeopathy try to tell others about their trade. Recently I found a long article in this vein. It is aimed at an audience of HEILPRAKTIKER and their patients. It should therefore be responsible, thorough, and evidence-based (yes, I am an optimist).
“With this article”, the authors state, “we aim to provide a comprehensive overview of homeopathy and help people make informed decisions about their health. Whether you already have experience with homeopathy or simply want to inform yourself, we hope that this article will provide you with valuable insights and information” (my translation).
Here I present to you just the relatively short section dedicated to the ‘pros and cons’ of homeopathy. Here we go:
Advantages of homeopathy:
- Holistic approach: homeopathy considers the human being as a whole and takes into account both physical and emotional aspects. It aims to support individual balance and the body’s self-healing powers.
- Gentle and non-invasive treatment: Homeopathic remedies are usually taken as globules, drops, or tablets and are therefore easy and convenient to use. They rarely cause side effects and are generally well tolerated.
- Individualized treatment: In homeopathy, each patient is considered unique and treatment is based on individual symptoms and characteristics. There is no “one-size-fits-all” solution, but a personalized approach.
- Support for chronic diseases: Homeopathy can be an alternative or complementary treatment for chronic conditions where conventional medicines offer limited relief. It can help improve quality of life and promote overall well-being.
Limitations of homeopathy:
- Placebo effect: Much of the effect of homeopathy is attributed to the placebo effect. It is argued that the improvements patients experience occur because of belief in the efficacy of the remedies and positive expectations, rather than due to a specific effect of the diluted substances.
- Lack of scientific evidence: The scientific evidence for the efficacy of homeopathy is limited and controversial. Many studies have failed to demonstrate benefits beyond the placebo effect. There is a lack of well-conducted randomized controlled trials that clearly show the effectiveness of homeopathy.
- Delay or rejection of conventional treatments: In some cases, the choice of homeopathy as the sole method of treatment may lead to delays in the diagnosis and timely treatment of serious or acute illnesses. It is important that serious illnesses are examined by a doctor and treated appropriately.
- Difficulties in standardization: Homeopathy involves a variety of remedies used in different potencies and dilutions. This makes standardization and the conduct of reproducible studies difficult. There are also controversial debates about whether the dilutions go beyond the extent to which molecules of the original substance are still present.
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I am sure that you have heard the BS about the alleged advantages of homeopathy often enough. Therefore, I will here not bother to comment on them again. More interesting, in my view, are the limitations of homeopathy, as seen by its proponents. Please allow me, therefore, to discuss them briefly.
- The authors state that “it is argued that the improvements patients experience occur because of belief in the efficacy of the remedies and positive expectations”. This sounds as though this is a mere aberrant opinion or at least an ongoing debate amongst scientists. In fact, it is the scientific consensus supported by tons of evidence.
- This is the same point expressed differently.
- The admission that “the choice of homeopathy as the sole method of treatment may lead to delays in the diagnosis and timely treatment” is yet another way of stating that homeopathy is not effective. What is, however, not expressed clearly enough, in my view, is the fact that homeopathic treatment usually amounts to medical neglect which is unethical and can cause serious harm, in extreme cases even death.
- It is not true that the range of potencies renders “the conduct of reproducible studies difficult”. There are plenty of examples to demonstrate this, for instance, this study. “There are also controversial debates about whether the dilutions go beyond the extent to which molecules of the original substance are still present.” Yes, I did translate this correctly. I am sorry to say that this sentence does make no sense in German or in English.
What I find particularly interesting is that the authors do not mention disadvantages that non-homeopaths would rate as quite important, e.g.:
- The assumptions of homeopathy fly in the face of science.
- Hahnemann strictly forbade homeopathy to be combined with ‘allopathy’ (yet proponents now claim this option to be an advantage).
- Treating a patient with homeopathy violates even the most basic rules of medical ethics.
- Homeopaths have no choice but to lie to their patients on a daily basis.
- Many homeopaths have the nasty habit of advising their patients against using effective treatments, e.g. vaccinations.
- Homeopathy undermines rational thinking in a general way.
In summary, the authors’ “aim to provide a comprehensive overview of homeopathy and help people make informed decisions about their health” has not been reached.
Last September, THE GUARDIAN published an article about the HEAD OF THE ROYAL MEDICAL HOUSEHOLD. I did not know much about this position, so I informed myself:
The royal household has its own team of medics, who are on call 24 hours a day. They are led by Prof Sir Huw Thomas (a consultant at King Edward VII’s hospital [the private hospital in Marylebone often used by members of the royal family, including the late Prince Philip] and St Mary’s hospital in Paddington, and professor of gastrointestinal genetics at Imperial College London), head of the medical household and physician to the Queen – a title dating back to 1557. Thomas has been part of the team of royal physicians for 16 years and became the Queen’s personal physician in 2014. The role is not full-time and does not have fixed hours or sessions but Thomas is available whenever he is needed. Thomas received a knighthood in the 2021 new year honours, and was made Knight Commander of the Royal Victorian Order (KCVO) – a personal gift of the monarch. At the time of the honour, in an interview with Imperial College London, he said it had been a “busy couple of years in this role,” adding that he felt “very grateful to have been recognised for my service to date”. Thomas added that being the Queen’s personal physician was a “great honour” and “a very enjoyable and rewarding role”. He said: “The nature of the work is interesting because you see how a whole different organisation, the royal household, operates. You very much become part of that organisation and become the personal doctor to the principal people in it, who are patients just like other patients.” …
In previous generations the royal doctor has caused controversy. When the Queen’s grandfather King George V was in his final hours, Lord Dawson, the royal doctor with personal responsibility for the 70-year-old monarch issued a bulletin, declaring: “The King’s life is moving peacefully towards its close.”
In 1986, four decades after Lord Dawson’s death, his diaries were made public – revealing that he had administered a lethal dose of morphine and cocaine to relieve the King’s pain, but also to ensure that the death could be announced in the morning edition of the Times, rather than “less appropriate evening journals”.
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During the last few days, it was difficult to escape all the hoo-hah related to the coronation, and I wondered whether Charles has replaced Prof Thomas in his role as HEAD OF THE ROYAL MEDICAL HOUSEHOLD. It did not take long to find out. There even is a Wiki page on the subject! It provides a list of the recent heads:
List of Heads of the Medical Household
The Head of the Medical Household was first appointed in 1973.
- 1973–1981: Sir Richard Bayliss, KCVO MD FRCP MRCS
- 1981–1989: Sir John Batten, KCVO MD FRCP
- 1989–1993: Sir Anthony Dawson, KCVO MD FRCP[1]
- 1993–2005: Sir Richard Thompson, KCVO DM PRCP
- 2005–2014: Professor Sir John Cunningham, KCVO BM BCh MA DM FRCP
- 2014–2022: Professor Sir Huw Thomas, KCVO MBBS MA PhD
- 2022 – to present: Dr Michael Dixon, LVO, OBE, MA, FRCGP, FRCP
Yes, Michael Dixon! I am sure this will be of interest. Michael Dixon used to be a friend and an occasional collaborator of mine. He has featured prominently in my memoir as well as in my biography of Charles. In addition, he has been the subject of numerous blog posts, e.g.:
- Today, integrative medicine is about to make history, says Dr. Michael Dixon
- My (most forgettable) paper with Dr Michael Dixon
- Boosting immunity against coronavirus? Dr Michael Dixon’s infinite wisdom on the pandemic
- Dr Michael Dixon seems to support homeopathy as a treatment for cancer
- Should homeopathy be blacklisted in general practice? Dr Michael Dixon’s profoundly misleading comments
- Johrei healing and the amazing Dr Dixon (presidential candidate for the RCGP)
- Dr Dixon’s safe herbal medicine
- Remember the ‘Foundation for Integrated Health’? Here is a good summary of its infamous history
- Prince Charles becomes patron of the ‘College of Medicine and Integrated Health’
- Uncharitable charities? The example of ‘YES TO LIFE’
- A treasure trove of fallacies, falsehoods and deceptions
I am sure that many of my readers would like to join me in wishing both Michael and Charles all the best in their new roles.
Assigning shelf life for homeopathic medicine is – according to the authors of this new, ground-breaking study – an important yet debatable issue. Therefore, the present article is aimed at investigating the problem from a Quantum Electrodynamics point of view and suggests ten years to be a moderate estimate of shelf life.
Data were obtained by the following methods:
- dynamic light scattering,
- atomic force microscopy,
- anomalous dielectric dispersion,
- UV,
- electron spin resonance spectrometry.
The results show the formation of nanosized molecular assemblies. These water clusters containing millions to billions of water molecules, which are created by repeated dilution of aqueous solutions, have been photographed.
The authors draw the following conclusions:
- Ultra-high dilutions (UHD) contain dissipative structures.
- These structures are solute specific
- These structures are tremendously persistent
- Therapeutic values of UHDs are found to continue for a very long time (20-25 years)
Summarizing, we can say that the solute, which in this case is the starting material of homeopathic medicine, leaves its highly stable foot prints in the dissipative structure formed in the UHD solution of polar solvent. Unfortunately, no targeted experiments are done yet to find the exact shelf life. Hence, we wish to suggest that as the shelf life (with proper precautionary measures) of the homeopathic medicine are theoretically expected to be very prolonged and supported by clinical experience, let it be accepted as ten years till future targeted experiments give the exact value, which is expected to be higher than this suggested value.
Were these sensational findings published in a journal like NATURE or SCIENCE? No, they emerged in ‘HPATHY‘ (“the World’s No. 1 Homeopathy Website: Since 2001”). That is a great shame, I think, because they might thus not be awarded the Noble Prize that they clearly deserve.
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Joking apart, the self life issue is evidently of some concern to homeopaths. Take this ‘study‘, for instance:
Background: Assignment of expiry date to homeopathic medicines is a subject of important concern to its pharmacists and practitioners. This study compares the regulatory framework for the expiry of homeopathic medicines in four countries: Brazil, Germany, India and the United States.
Findings: Different or no expiry periods are variously followed. Whereas Germany, with some exceptions, employs a maximum expiry of 5 years for both potencies and finished products, Brazil adopts a 5-year expiry for finished products only, potencies used in manufacture being exempted from an assigned expiry date. In India, all homeopathic medicines except dilutions and back potencies have a maximum of 5 years’ shelf-life, including those supplied to consumers. In the United States, homeopathic medicines are exempted from expiry dates.
Comments: There is neither a rational basis nor scientific evidence for assigning a short (3-5 years) expiry period for homeopathic medicines as followed in some of the countries, particularly in light of the fact that some studies have shown homeopathic medications to be effective even after 25 years. Homeopathic ultra-dilutions seem to contain non-material activity that is maintained over time and, since these exhibit different chemical properties compared to the original starting material, it is quite possible they possess properties of longer activity than conventional medicines. Regulators should acknowledge this feature and differentiate expiry of homeopathic medicinal products from that of conventional drugs.
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For once, I almost agree with my homeopathic colleagues:
The activity of homeopathic ultra-dilutions is maintained over time.
However, we need to add just a little explanation to this statement:
This activity is zero.
According to a German court ruling, the homeopathic remedy Meditonsin for colds may no longer be advertised with certain statements. The Higher Regional Court in Hamm, Germany made it clear that it shares the opinion of the Regional Court in Dortmund, which had sentenced the marketing company to desist from making statements such as “rapid and reliable reduction of the intensity of the typical cold symptoms”. Such statements falsely generate the impression that therapeutic success can be expected with certainty. The court made it clear that the company’s appeal against the previous ruling was unlikely to be successful. The company subsequently withdrew its appeal today – and the judgment is now legally binding.
The lawsuit filed by a consumer organization was thus successful. It had criticized several statements as unfair and inadmissible advertising. The Dortmund court shared this view in September 2022 – and according to the spokesman, the Higher Regional Court in Hamm now followed the argumentation of the lower court.
The statements that
- “good efficacy and tolerability were once again impressively confirmed by a pharmacy-based observational study”,
- and “all cold complaints showed a clear improvement in the course of the disease”,
were deemed to be misleading advertising. They must therefore be omitted, the ruling stated.
Meditonsin is currently being advertised as follows:
For support of the immune system at the first signs of a cold to help the body build up the defense against pathogens effectively.
In addition, conditions are made more difficult for the intruders – through an effective medicine: the well-known Meditonsin® supports your defenses and naturally fights the onset of inflammation of the ears, nose and throat with pure homeopathic ingredients.
If applied early and correctly, Meditonsin® helps to ensure that the typical unpleasant symptoms have no chance to develop. Because Meditonsin® is particularly well tolerated and protects the organism, it is for both adults and children alike – a family medicine in the best sense.
Meditonsin contains two homeopathic ingredients in the D5 and one in the D8 dilution. To the best of my knowledge, there is no sound evidence that the remedy is effective for anything.
The claim that homeopathy has a role in oncology does not seem to go away. Some enthusiasts say it can be used as a causal therapy, while others insist it might be a helpful symptomatic adjuvant. Almost all oncologists agree that homeopathy has no place at all in cancer care.
Who is right?
This systematic review included clinical studies from 1800 until 2020 to evaluate evidence of the effectiveness of homeopathy on physical and mental conditions in patients during oncological treatment.
In February 2021 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning use, effectiveness, and potential harm of homeopathy in cancer patients.
From all 1352 search results, 18 studies with 2016 patients were included in this SR. The patients treated with homeopathy were mainly diagnosed with breast cancer. The therapy concepts included single and combination homeopathic remedies (used systemically or as mouth rinses) of various dilutions. The outcomes assessed were:
- the influence on toxicity of cancer treatment (mostly hot flashes and menopausal symptoms),
- the time to drain removal in breast cancer patients after mastectomy,
- survival,
- quality of life,
- global health,
- subjective well-being,
- anxiety and depression,
- safety and tolerance.
The included studies reported heterogeneous results: some studies described significant differences in quality of life or toxicity of cancer treatment favoring homeopathy, whereas others did not find an effect or reported significant differences to the disadvantage of homeopathy or side effects caused by homeopathy. The majority of the studies had low methodological quality.
The authors concluded that, the results for the effectiveness of homeopathy in cancer patients are heterogeneous, mostly not significant and fail to show an advantage of homeopathy over other active or passive comparison groups. No evidence can be provided that homeopathy exceeds the placebo effect. Furthermore, the majority of the included studies shows numerous and severe methodological weaknesses leading to a high level of bias and are consequently hardly reliable. Therefore, based on the findings of this SR, no evidence for positive effectiveness of homeopathy can be verified.
This could not be clearer. Some might argue that, of course, homeopathy cannot change the natural history of cancer, but it might improve the quality of life of those patients who believe in it via a placebo response. I would still oppose this notion: there are many effective treatments in the supportive treatment of cancer, and it seems much better to use those options and tell patients the truth about homeopathy.
A “null field” is a scientific field where there is nothing to discover and where observed associations are thus expected to simply reflect the magnitude of bias.
This analysis aimed to characterize a null field using a known example, homeopathy (a pseudoscientific medical approach based on using highly diluted substances), as a prototype. The researchers identified 50 randomized placebo-controlled trials of homeopathy interventions from highly cited meta-analyses. The primary outcome variable was the observed effect size in the studies. Variables related to study quality or impact were also extracted.
The mean effect size for homeopathy was 0.36 standard deviations (Hedges’ g; 95% confidence interval: 0.21, 0.51) better than placebo, which corresponds to an odds ratio of 1.94 (95% CI: 1.69, 2.23) in favor of homeopathy. 80% of studies had positive effect sizes (favoring homeopathy). The effect size was significantly correlated with citation counts from journals in the directory of open-access journals and CiteWatch. We identified common statistical errors in 25 studies.
The authors concluded that a null field like homeopathy can exhibit large effect sizes, high rates of favorable results, and high citation impact in the published scientific literature. Null fields may represent a useful negative control for the scientific process.
The paper is perhaps not the easiest to comprehend but once you got the idea, you will agree with me that it is BRILLIANT. I warmly recommend it to all fans of homeopathy – in fact, if I could I’d offer it to King Charles as a present for the coronation.
Its authors are among the most prominent medical epidemiologist of our time with affiliations that speak for themselves:
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
- 2Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
- 3Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Department of Statistics, Stanford University, Stanford, CA, USA.
It is, of course, a pity that the article is behind a paywall – but fortunately, the senior author, John Ioannidis, published his email address together with the abstract: [email protected]. So, if you have trouble understanding the point of the analysis, I suggest you ask for a reprint to get your head around it. I promise it’s worth it.
During the coronavirus disease 2019 pandemic, Ayurvedic herbal supplements and homeopathic remedies were promoted as immune boosters (IBs) and disease-preventive agents. This happened in most parts of the world but nowhere more intensely than in India.
The present study examined the clinical outcomes among patients with chronic liver disease who presented with complications of portal hypertension or liver dysfunction temporally associated with the use of IBs in the absence of other competing causes. This Indian single-center retrospective observational cohort study included patients with chronic liver disease admitted for the evaluation and management of jaundice, ascites, or hepatic encephalopathy temporally associated with the consumption of IBs and followed up for 180 days. Chemical analysis was performed on the retrieved IBs.
From April 2020 to May 2021, 1022 patients with cirrhosis were screened, and 178 (19.8%) were found to have consumed complementary and alternative medicines. Nineteen patients with cirrhosis (10.7%), jaundice, ascites, hepatic encephalopathy, or their combination related to IBs use were included. The patients were predominantly male (89.5%). At admission, 14 (73.75%) patients had jaundice, 9 (47.4%) had ascites, 2 (10.5%) presented with acute kidney injury, and 1 (5.3%) had overt encephalopathy. Eight patients (42.1%) died at the end of the follow-up period. Hepatic necrosis and portal-based neutrophilic inflammation were the predominant features of liver biopsies.
Ten samples of IBs, including locally made ashwagandha powder, giloy juice, Indian gooseberry extracts, pure giloy tablets, multiherbal immune-boosting powder, other multiherbal tablets, and the homeopathic remedy, Arsenicum album 30C, were retrieved from our study patients. Samples were analyzed for potential hepatotoxic prescription drugs, known hepatotoxic adulterants, pesticides, and insecticides, which were not present in any of the samples. Detectable levels of arsenic (40%), lead (60%), and mercury (60%) were found in the samples analyzed. A host of other plant-derived compounds, industrial solvents, chemicals, and anticoagulants was identified using GC–MS/MS. These include glycosides, terpenoids, phytosteroids, and sterols, such as sitosterol, lupeol, trilinolein, hydroxy menthol, methoxyphenol, butyl alcohol, and coumaran derivatives.
The authors concluded that Ayurvedic and Homeopathic supplements sold as IBs potentially cause the worsening of preexisting liver disease. Responsible dissemination of scientifically validated, evidence-based medical health information from regulatory bodies and media may help ameliorate this modifiable liver health burden.
The authors comment that Ayurvedic herbal supplements and homeopathic remedies sold as IBs, potentially induce idiosyncratic liver injury in patients with preexisting liver disease. Using such untested advertised products can lead to the worsening of CLD in the form of liver failure or portal hypertension events, which are associated with a high risk of mortality compared to those with severe AH-related liver decompensation in the absence of timely liver transplantation. Severe mixed portal inflammation and varying levels of hepatic necrosis are common findings on liver histopathology in IB-related liver injury. Health regulatory authorities and print and visual media must ensure the dissemination of responsible and factual scientific evidence-based information on herbal and homeopathic “immune boosters” and health supplements to the public, specifically to the at-risk patient population.
