MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Today, enthusiasts of homeopathy celebrate the start of the HOMEOPATHY AWARENESS WEEK. Let’s join them by re-addressing one of their favourite themes: their personal experience with homeopathy.

Most homeopathy-fans argue that the negative scientific evidence must be wrong because they have had positive experiences. Whenever I give a lecture, for instance, there will be at least one person in the audience who presents such an experience (and I too could contribute a few such stories from my own past). Such ‘case reports’ can, of course, be interesting, illuminating or leading to further research, but they can never be conclusive.

This concept is often profoundly confusing for patients and consumers. They tend to feel that I am doubting their words, but nothing could be further from the truth. Their experience is certainly true – what might be false is their interpretation of it. I think, I better explain this in more detail using a concrete, published example.

After the publication of our 2003 RCT of homeopathic Arnica which showed that two different potencies have effects that do not differ from those of placebo, I received lots of angry responses from people who told me that they had the opposite experience or observed positive outcomes on their pets. In my subsequent publication in the journal ‘Homeopathy‘ entitled ‘The benefits of Arnica: 16 case reports‘, I have tried my best to explain their experiences in the light of our finding that highly diluted homeopathic Arnica is a placebo:

Sixteen case reports of the apparent benefits of Arnica … raise several relevant points. Firstly, topical Arnica preparations are often wrongly equated with homeopathic Arnica, the subject of our trial. The former are herbal preparations (ie not homeopathically diluted), which have undisputed pharmacological activity. Taken orally they would even be toxic. Thus all Arnica for oral administration must be highly diluted and has therefore no pharmacological effects. The case reports show that many lay people seem to be unclear about the difference between herbal and homeopathic Arnica.

Secondly, if animals seem to respond to homeopathic Arnica, as claimed in several of the case reports, this is not necessarily a proof of its effectiveness. Animals are not immune to placebo effects. Think of Pavlov’s experiments and the fact that conditioning is clearly an element in the placebo response.

Thirdly, the natural history of the condition can mimic clinical improvement caused by therapy. Many of the 16 cases summarized can be explained through a placebo response or the natural history of disease or the combination of both phenomena…

Many of the letters I received were outspoken to say the least. The authors stated that they were ‘appalled’, ‘saddened and angry’ by our research. Others implied that I was paid by the pharmaceutical industry to abolish homeopathy in the UK. One person felt that ‘it is highly irresponsible to dismiss a natural healing remedy with no evidence at all’. I believe the case reports … convey an important message about the power of belief, anecdotes, placebos and expectation.

END OF QUOTE

The thing about case reports and personal experiences is quite simply this: they may seem almost overwhelmingly convincing, but they can NEVER serve as a proof that the treatment in question was effective. The reason for this fact could not be more simple. Any therapeutic response is due to a complex combination of factors: placebo effects, natural history of the condition, regression to the mean, etc.

See it this way: you wake up one morning with an enormous hangover. You try to identify the cause of it. Was it the beer you had in the pub? The wine you drank before you went out? Or the whiskey you consumed before you went to bed? Perhaps you think it was the Cognac you enjoyed at a friend’s house? Only one thing is for sure: it was not the glass of shaken water you drank during the night.

 

24 Responses to Sixteen case reports of homeopathic Arnica – never trust what you think!

  • The power of personal experience is so immense, that one only gets to feel it after they are completely distanced from, and become indifferent to, it. It is only after doubting personal experience that one may slowly, but surely, begin to approach reality, truth and objectivity. Until someone has distanced themselves from it and irrevocably decided that personal experience is, and will always be, inconclusive, it is impossible to fully grasp its binding power.

    Under those premises, it is a sad reality that the immense power of personal experience will only surface as prejudice and short-circuited thinking. The worst enemy of science is, unfortunately, the strongest cognitive bias of the human mind.

    Oh science…that desperate attempt to overcome our “strongest weakness” in search of the truth…

  • Take a look at a list of smokers that lived to very old age and see what conclusions to draw:

    Winston Churchill: died aged 90
    Marlene Dietrich: died aged 91
    Loki Schmidt (wife of former German Chancellor Helmut Schmidt): died aged 91
    Charles Aznavour: aged 92
    Helmut Schmidt (former German Chancellor): died aged 96
    Kirk Douglas: aged 100
    Johannes Heesters: died aged 108
    Jeanne Calment: died aged 122, the human that reached the highest officially confirmed age. She started smoking at 21 and had to quit at 119 because she got blind and could not light her cigarettes any more. And note: After quitting she died a mere three years later!

    What do these cases indicate?

    A homeopath-like conclusion would be that smoking is the remedy to live to old age.
    A scientific conclusion would be that there are individuals out there, that live to old age instead (!) of smoking, and those people that failed to reach old age are out in the graveyards and will not be presented as case studies.

    • Norbert Aust

      “A homeopath-like conclusion would be that smoking is the remedy to live to old age.”

      Only if he was to reason like you. Errors are part of the evolutionary system.

      Homeopaths would observe closely and put on record their findings: the ill effects of tobacco on different parts of the body. http://www.homeoint.org/clarke/t/tab.htm

      Homeopaths are mostly aware that life expectancy and being sick may not be inversely proportional in all cases and life expectancy alone, is not the measure of being healthy. This can, at best, be one parameter for reference. You can be bed ridden at 50 and stay there for the next 40 years to die at 90. An allopath would define this as power of his medication: keeping a person in bed for 40 years. (Was the treatment not for the patient to get up from bed and walk or run?).

      Look at the Americans in general: a perennially sick society based upon the quantity and value of prescription drugs they eat every year. They have added a 11.8 years between 1960 and 2012.

      “From 1960 through 2013, health spending rose from $147 per person to $ 9,255 per person,(63 times) an average annual increase of 8.1 percent. In comparison, per capita adjusted personal income was $2,267 in 1960, and in 2013 it reached $42,266, (19 times) reflecting an average annual growth rate of 5.7 percent. As overall health spending increased at a faster rate than personal income, household expenditures on health as a share of adjusted personal income grew from 4 percent in 1960 to 6 percent (50% extra) in 2013.

      Theoretically, if the scientific medicine was really effective, the average cost should have stayed at earlier level or at least the averages would have moved in the lower direction. Americans using less medication and still living longer? And the problem is, that this equation is the same for every part of the world. America is used as an example as it is considered the Mecca of medical research.

      • oh dear!
        your logic is unique!

        • Edzard

          “your logic is unique”.

          Really. You are unable to keep pace? So we use another reference: What would you say about Dr Martin Blaser? He is NOT a homeopath.

          “Yet recently, just within the past few decades, amid all of these medical advances, something has gone terribly wrong. In many different ways we appear to be getting sicker. You can see the headlines every day. We are suffering from a mysterious array of what I call “modern plagues”: obesity, childhood diabetes, asthma, hay fever, food allergies, esophageal reflux and cancer, celiac disease, Crohn’s disease, ulcerative colitis, autism, eczema. In all likelihood you or someone in your family or someone you know is afflicted. Unlike most lethal plagues of the past that struck relatively fast and hard, these are chronic conditions that diminish and degrade their victims’ quality of life for decades.

          The most visible of these plagues is obesity, defined in terms of the body mass index (BMI), which expresses the relationship between a person’s height and weight.

          In 1990, about 12 percent of Americans were obese. By 2010, the national average was above 30 percent. Next time you go to an airport terminal, supermarket, or mall, look around and see for yourself. The obesity epidemic is not just a U.S. problem; it’s global. As of 2008, according to the World Health Organization (WHO), 1.5 billion adults were overweight; of these, over 200 million men and nearly 300 million women qualified as obese. Many of these people live in developing countries that we associate more with famine than with overeating.

          These figures are alarming, but the really shocking fact is that this accumulation of global human body fat has been accelerating not over the course of a few centuries but in a mere two decades. Yet fat- and sugar-rich foods, so often blamed for all the extra pounds, have been ubiquitous for a good deal longer than that, at least in the developed world, and the new generations of overweight people in the third world have not suddenly adopted a Kentucky-fried American-style diet. Epidemiologic studies have shown that high caloric intake, while definitely not helpful, is not sufficient to explain the distribution or course of the worldwide obesity epidemic.

          At the same time, the autoimmune form of diabetes that begins in childhood and requires insulin injections (juvenile or Type 1 diabetes) has been doubling in incidence about every twenty years across the industrialized world. In Finland, where record keeping is meticulous, the incidence has risen 550 percent since 1950. This increase is not because we are detecting Type 1 diabetes more readily. Before insulin was discovered in the 1920s, the disease was always fatal. Nowadays, with adequate treatment, most children survive. But the disease itself has not changed; something in us has changed. Type 1 diabetes is also striking younger children. The average age of diagnosis used to be about nine. Now it is around six, and some children are becoming diabetic when they are three.

          The recent rise in asthma, a chronic inflammation of the airways, is similarly alarming. One in twelve people (about 25 million or 8 percent of the U.S. population) had asthma in 2009, compared with one in fourteen a decade earlier. Ten percent of American children suffer wheezing, breathlessness, chest tightness, and coughing; black children have it worst: one in six has the disease. Their rate increased by 50 percent from 2001 through 2009. But the rise in asthma has not spared any ethnicity; the rates were initially different in various groups, and all have been rising.

          Asthma is often triggered by something in the environment such as tobacco smoke, mold, air pollution, cockroach leavings, colds, and flu. Once an attack begins, asthmatics gasp for air and, without quick medication, are rushed to emergency rooms. Even with the best care, they can die, as did the son of a physician colleague. No economic or social class has been spared.

          Food allergies are everywhere. A generation ago, peanut allergies were extremely rare. Now, if you stroll through any preschool, you will see walls plastered with “nut-free zone” bulletins. More and more children suffer immune responses to proteins in foods, not just in nuts but in milk, eggs, soy, fish, fruits—you name it, someone is allergic to it. Celiac disease, an allergy to gluten, the main protein in wheat flour, is rampant. Ten percent of children suffer from hay fever. Eczema, a chronic skin inflammation, affects more than 15 percent of children and 2 percent of adults in the United States. In industrialized nations, the number of kids with eczema has tripled in the past thirty years.

          These disorders suggest that our children are experiencing levels of immune dysfunction never seen before, as well as conditions such as autism, a much discussed and debated modern plague that is a focus of my laboratory. Nor are adults escaping their own share of modern plagues. The incidence of inflammatory bowel disease, including Crohn’s and ulcerative colitis, is rising, wherever we look.

          When I was a medical student, esophageal reflux, which causes heartburn, was uncommon. But the ailment has exploded in these past forty years, and the cancer it leads to, adenocarcinoma of the esophagus, is the most rapidly increasing cancer in the United States and everywhere else it has been tracked, and is a particularly nasty problem for Caucasian men.

          Why are all of these maladies rapidly rising at the same time across the developed world and spilling over into the developing world as it becomes more Westernized? Can it be a mere coincidence? If there are ten of these modern plagues, are there ten separate causes? That seems unlikely.

          Or could there be one underlying cause fueling all these parallel increases? A single cause is easier to grasp; it is simpler, more parsimonious. But what cause could be grand enough to encompass asthma, obesity, esophageal reflux, juvenile diabetes, and allergies to specific foods, among all of the others? Eating too many calories could explain obesity but not asthma; many of the children who suffer from asthma are slim. Air pollution could explain asthma but not food allergies.

          Many theories have been proposed to explain each disorder: lack of sleep makes you fat; vaccines lead to autism; genetically engineered wheat strains are toxic to the human gut; and so on.

          The most popular explanation for the rise in childhood illness is the so-called hygiene hypothesis. The idea is that modern plagues are happening because we have made our world too clean. The result is that our children’s immune systems have become quiescent and are therefore prone to false alarms and friendly fire. A lot of parents these days try to ramp up their kids’ immune systems by exposing them to pets, farm animals, and barnyards or better still by allowing them to eat dirt.

          I beg to differ. To me, such exposures are largely irrelevant to our health. The microbes present in dirt have evolved for soil, not for us. The microbes in our pets and farm animals also are not deeply rooted in our human evolution. The hygiene hypothesis, as I will show you, has been misinterpreted.

          Rather we need to look closely at the microorganisms that make a living in and on our bodies, massive assemblages of competing and cooperating microbes known collectively as the microbiome. In ecology, biome refers to the sets of plants and animals in a community such as a jungle, forest, or coral reef. An enormous diversity of species, large and small, interact to form complex webs of mutual support. When a keystone species disappears or goes extinct the ecology suffers. It can even collapse.

          Each of us hosts a similarly diverse ecology of microbes that has coevolved with our species over millennia. They thrive in the mouth, gut, nasal passages, ear canal, and on the skin. In women, they coat the vagina. The microbes that constitute your microbiome are generally acquired early in life; surprisingly, by the age of three, the populations within children resemble those of adults. Together, they play a critical role in your immunity as well as your ability to combat disease. In short, it is your microbiome that keeps you healthy. And parts of it are disappearing.

          The reasons for this disaster are all around you, including overuse of antibiotics in humans and animals, Cesarian sections, and the widespread use of sanitizers and antiseptics, to name just a few. While antibiotic resistance is a huge problem—old killers like tuberculosis are increasingly resistant and making a comeback—there now seem to be separate ones, affecting people with such scourges as Clostridium difficile (C. diff), bacteria of the digestive tract resistant to multiple antibiotics, a potential danger in the hospital, and a spreading pathogen, methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired anywhere. The selective pressure of antibiotic use is clearly increasing their presence.

          But as terrible as these resistant pathogens are, the loss of diversity within our microbiome is far more pernicious. Its loss changes development itself, affecting our metabolism, immunity, and cognition.

          http://martinblaser.com/excerpt.html

          Is this logic better understood?

          • Yet another megaclipping from our resident master of cut and paste.

            Dear Iqbal. Why can you not understand that a simple link would have sufficed along with a few words as to the relevance you think your reference to the speculative musings of Doctor Blaser has to the merits of imitation medicine?
            It is very trying to read your extended clippings and we often simply scroll past them.

            Of course, studies of the microbiome and its possible implications are certainly an exciting field and Dr. Blaser’s book is said to be very interesting but it has nothing whatsoever to do with playing doctor using shaken water and sugar pills and for that matter, the text you borrowed is part of the marketing of his book, not the most balanced and neutral discussion of this interesting subject.

            What you are totally missing dear Iqbal is the simple fact that you cannot substantiate homeopathy by demonstrating the well known and incontrovertible shortcomings of modern medicine.
            Homeopathy is a game of make-believe. It is very like the popular pastime of playing air-guitar. There is nothing in it but an act of pretending to administer medicine. The subject, the patient if you will, may get a short lived impression of being helped by the attention and promise of help. And the homeopath selects the cases that can be perceived to be positive as confirmation of his fantasy. Or, as is evident from many stories on that risible repository of homeopathic anecdotes hpathy.com, the result of severe delusional thinking.
            Your animosity towards modern medicine is severely misguided. You obviously have very limited isight into modern health care and you do not seem to understand the nature of evidence and what is required to substantiate a method or medication. You cannot just go by personal experience and much less by personal preference.
            I especially liked our friend Norbert Aust’s recent comment where he likened homeopathic logic to believing that tobacco use caused longevity from the simple enumeration of centenarians who happened to have survived the risk of smoking.

            Next time you want to contribute something Iqbal, please remember that you do not have to clip and paste a shitload of text. Just give us a link and try to explain what the message is (in your own words, not another clipping) you are trying to convey.

          • Edzard

            Logic not understood? I expected so. Please read slowly and carefully. Dr Blaser has written in simple English. This has suddenly become an important new research area. The implications are looking bad for your trade.

            It would be good idea to start reading more of new scientific medical research. Many earlier scientific medical theories that you would have studied and keep on writing about are being thrown in the dust bin. But this should be normal for you: part of improvement.

            The issue is only with those who lost a dear one because of the wrong science or were at the wrong place at the wrong time.

          • Björn Geir

            “Next time you want to contribute something Iqbal, please remember that you do not have to clip and paste a shitload of text. Just give us a link and try to explain what the message is (in your own words, not another clipping) you are trying to convey.”

            You find it difficult to read half page of a Doctor’s message and you want to read a book? And why do you want it to be written in “my own words”? The doctor has written in simple English. I avoid articles with a lot of scientific terms: difficult to get across to you all.
            I want you make it clear to you all what Edzard and you try to pass off as scientific medicine is not scientific nor medicine. Numerous audits and research papers by scientific community shows it to be so. Outcomes exactly opposite to the expected scientific theory. If you all cannot understand what you all do day-in-day-out, going around in circles like zombies, repeating exactly the same activity that has continued to fail in the past, how can you understand any thing about homeopathy?

            You have been killing patients in the name of malaria treatment: now you have malaria and drug resistant malaria. What change have you made in the approach to malaria treatment other than changing the drug for which resistance is already noticed.
            Repeat this for TB. MDR TB and now XDR TB.
            Repeat for: I am sure you can continue to fill some pages.

            You can help allopathy by observing closely, and try and clear the cess pool it has become. As Dr Blaser comments: most if not all chronic diseases are created by allopathic doctors by misuse of antibiotics and other “scientific medical activities”. An issue that has been observed by commented upon by homeopaths for past 200 years.
            First learn to understand a bit of medicine, then we discuss homeopathy.

          • Are you feeling alright Iqbal? Your last comment is totally incoherent. Maybe you should see a doctor?
            I am starting to be genuinely worried about your health, seriously!

          • Björn Geir

            “Your last comment is totally incoherent”.

            Is that correct? I just summarized Dr. Blaser’s conclusion. Read it as HE writes: It is only one small paragraph.

            “Together, they play a critical role in your immunity as well as your ability to combat disease. In short, it is your microbiome that keeps you healthy. And parts of it are disappearing.”

            “The reasons for this disaster are all around you, including overuse of antibiotics in humans and animals, Cesarian sections, and the widespread use of sanitizers and antiseptics, to name just a few. While antibiotic resistance is a huge problem—old killers like tuberculosis are increasingly resistant and making a comeback—there now seem to be separate ones, affecting people with such scourges as Clostridium difficile (C. diff), bacteria of the digestive tract resistant to multiple antibiotics, a potential danger in the hospital, and a spreading pathogen, methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired anywhere. The selective pressure of antibiotic use is clearly increasing their presence.”

            So who is made responsible for the problem of chronic diseases like asthma, diabetes, and resurgence of old easily treatable disease like TB, Scarlet fever etc. by Dr Blaser?
            Doctors from the allopathic system!!!!!

          • Well, among an ever-exponentially-increasing amount of excrement, finally, a diamond shines

            The issue is only with those who lost a dear one because of the wrong science or were at the wrong place at the wrong time.

            That is right. And since homeopathy is the wrong science, you understand how many dears have been, are and will be lost with it.

            What change have you made in the approach to malaria treatment other than changing the drug for which resistance is already noticed.

            Well, people have also tried to supply shaken water as a first-line treatment. This kills more patients faster, gets rid of the bad genes quicklier. Improved evolution through homeopathy. You have a point there, fellow Iqbal!

            As for Dr. Blaser, he overly exaggerates, as needed to sell his book. Who doesn’t? Now, go on and blindly trust someone who has their full name as a website domain name.

      • ” And the problem is, that this equation is the same for every part of the world. America is used as an example as it is considered the Mecca of medical research.”

        The USA are actually well known to have really expensive healthcare and not-so-great health outcomes for the general populace.

        Here’s a nifty chart to see the compared healthcare spend:
        https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcompareinternationally/2016-11-01

        Impressive strawman attempt though.

        • The Vodka Diet Guru

          “The USA are actually well known to have really expensive healthcare and not-so-great health outcomes for the general populace. ”

          Then my statement “America is the Mecca of medical research” is incorrect?

          Great research cannot co-exist with “not-so-great health outcomes.” Other wise it is one extra paradox.

      • @ Iqbal Krishna: What are you talking about? This was about the conclusions to draw from case reports. Not from homeopathic provings. Not from the state of health of the US-American population. Not from the expenditure on the health system in the US. Or is all this the same to you?

        “And the problem is, that this equation is the same for every part of the world.”
        Do you have any proof for this?

        • Norbert Aust

          “This was about the conclusions to draw from case reports”
          This was about the conclusions YOU drew from case reports. Homeopaths are not such idiots.

          “Not from homeopathic provings.”:
          This information was provided to you to inform you that homeopaths are aware of the health issues resulting from tobacco use: in any form. There fore they CANNOT make a statement, as you thought up on their behalf. This was purely your thought process.

          ” Not from the state of health of the US-American population. Not from the expenditure on the health system in the US. Or is all this the same to you?”

          You were praising the scientific system. I therefore provided you with additional information on benefits and cost. If benefits are there and the cost is too high, a large part of the population cannot use it. From the American health care outcome you can see while the cost is too high, there are no real benefits. What is your equation?

          If the American medical research is world class, with real benefits, then you can explain why are Americans are being made to eat increased quantity of medication to stay alive? Research should help make the Americans healthy, with less requirement of medication or is it the other way round?

          Eating a lot of medication is not a sign of illness?

          • Still I do not know why you are talking about the things you are talking about.

            Professor posted an article about how misleading case reports could be in that they put personal experience over evidence. To suppurt this I gave a set of “case reports” that would lead to wrong conclusions if you would deploy this “experience over evidence” approach. I thought everybody on this blog, mostly being from medical or scientific background, would understand this and would easily recognise the misunderstanding this led to.

            Please note: I do not want to discuss the results of homeopathic provings of tobacco, nor its use in homeopathy, nor the cost of the health system nor the state of the health in the US nor what signs of illness are. Simply for the reason, that this would be off topic here and my post was not meant to divert the thread.

          • I have made a habit of ignoring the ineducable Iqbal. He was good for homeopathic curiosity for a short while but lately his rantings have regressed into platitudinous head banging.

            I wonder if blog-admin can activate a feature for us to collapse/hide comments from depreciated contributors?

          • I wonder, was it like that all along?

            Doesn’t he ever get bored of repeating the same things?

  • One (standard) glass of beer, wine, whiskey & Cognac should result in an enormous hangover?!
    This is a quite unbelievable example that I have to disagree with…

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