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

Our good friend Dana Ullman commented on my last post that doctors are being unethical by NOT prescribing homeopathic medicines because they are breaking one of the most important medical guidelines: “First, do no harm.” Here I do not want to discuss in-depth the nonsense about homeopathy in his sentence, rather I want to focus on the notion that doctors are obliged to foremost do no harm.

The sentence ‘first do no harm’ is supposed to originate from the Hippocratic oath which allegedly all doctors have to take when finishing medical school. This is twice wrong:

  1. we don’t take this oath – I have read it, and it is something utterly non-applicable to today;
  2. the famous sentence does not appear in the oath.

But never mind the history and all that! Doctors are nevertheless obliged to ‘first do no harm’ because it is an important principle of medical ethics.

This is also not true, I’m afraid.

If it were true, doctors would have to stop practicing much of medicine instantly. Clinicians do harm all the time. Their injections hurt, their diagnostic procedures can be unpleasant and painful, their medications cause adverse effects, their surgical interventions are full of risks, etc., etc. None of this would be remotely acceptable, if it did not also some good.

And that is why the ethical imperative of doing no harm has sensibly been changed to the imperative of doing more good than harm. Of course, doctors must be allowed to do even quite serious harm, as long as their actions can be expected to generate even more good. In more common medical terms, we speak of the risk/benefit balance of an intervention:

  • if the known risks of a treatment are greater than the expected benefits, we cannot ethically prescribe it;
  • if the benefits outweigh the risks, we can consider it as a reasonable option.

That is all very well, but it can only apply to treatments where both the risks and the benefits are well-understood. What about the many treatments where there is uncertainty regarding either or both of these factors? This question is impossible to answer in the abstract. We need to look at the best evidence we have for each specific case and, together with the patient, try to make an informed judgement.

Now, let’s please our good friend Dana and do such an evaluation for homeopathy, as one of many examples of an alternative therapy:

Therefore, one might argue that the balance of risk versus benefit might not look all that bad. Dana and his colleagues would thus feel that it ethically legitimate to routinely use homeopathy. But this line of thought would ignore an important issue: harm can be done not just by the remedy itself. The harm caused by applying an ineffective treatment for conditions that are otherwise effectively treatable (usually referred to as neglect) can be considerable, even fatal. So, for homeopathy the true situation presents itself as follows:

This results in a negative risk/benefit balance which means, as outlined above, we cannot ethically use homeopathy.

… and, of course, Dana’s statement (doctors are being unethical by NOT prescribing homeopathic medicines because they are breaking one of the most important medical guidelines: “First, do no harm.” ) turns out to be wrong on several levels.

58 Responses to First do no harm!!! What does it mean? How does it apply to alternative medicine?

  • My standard example is acute appendicitis. I’d desperately want my doctor to harm me in such a case, I’d beg her/him to plunge her/his scalpel in my abdomen, cut me open, row in my intestines and take out my appendix. Don’t get me wrong, I wouldn’t *like* this one bit. However, the alternative tends to be death, and I’d like that a lot less.

    The medically ethical thing to do here is to inflict major harm, because the patient want to live, instead of to die in agony.

    Homeopathy, then? No thank you very much. I do not want a non-treatment. I prefer life.

  • Dear Prof. Ernst, mathematically speaking, the picture looks very bleak for homeopathy. In selection of a treatment, the risk/benefit ratio should be minimized. Homeopathy has a benefit close to zero, which results in a risk/benefit ratio close to infinity, even with a very low risk.

  • Ah, yes, the good ‘ole fallacy where peddlers of alternative nonsense and their followers exclusively focus on the ‘harm’ caused by regular medicine… Not a day goes by that I don’t come across statements referring to ‘200,000 deaths from medicines annually’ and hospitals being the most dangerous places in the Western world, as that is where the risk of death and injury is highest (although this is of course trumped by the Evil Contraption of Death, present in every home, where we all spend roughly one third of our time: [cue eerie music] ‘The Bed’ — as the vast majority of deaths occur in a bed).

    I wonder why those woomeisters keep coming up with utterly childish ‘arguments’ like this — are they really that stupid? Unfortunately, things like this suggest that, yes, they really are that stupid — and worse:

    Note: Drowning is a life-threatening emergency. Call an ambulance immediately if someone is drowning so they may be assessed by an emergency professional. After you call an ambulance, you may administer the remedy below.

    OK, granted: calling the emergency services is Good. But subsequently tipping sugar pills in the mouth of a victim who is choking, coughing and spluttering is Not Good At All. It is Very, Very, VERY Stupid, and may well kill someone who would otherwise have survived the drowning incident. (And also no word about resuscitation and/or first aid — the single most important thing you can do as a bystander.)

    I therefore suggest a slight modification to the ‘first and foremost do no harm’ mantra of homeopaths:
    “First and foremost, do not use brains”

  • Excellent and most reasonable insight….as always.
    However these farking icehole alternative-fraudsters like Ullman cannot make adult arguments.
    It’s been asked of these reprobates many times, but always left unanswered: why won’t ‘they’ critically assess “other” unorthodox treatments and beliefs e.g Scientology auditing and health-treatment claims, Chiropractic Activator technique, NUCCA upper-cervical claims, Christian-evangelical faith-healers, reflexology etc, etc, etc. Reprobate sCAMers are all the same, they are world-class experts on all manner of medical care and pharmacology and their risks yet are utterly silent and ignorant regarding other sCAMs. Why? Obviously criticizing other frauds can’t garner the verisimilitude and pecuniary rewards of criticizing the “real” common enemy: science and modern medicine.
    They abhor revealing the fact that they actually do understand logic and evidence (albeit more like children do) and don’t want to be left with their pants around their ankles criticizing other-people’s SCAMs…as it may tend to brake a window in their own glass outhouse.

    • MK, you forgot (as usual) to mention “Hands on Homeopathy” AKA, physiotherapy. The shake, bake and fake of physiotherapy must rate a mention in this post, as nothing that they do works for low back pain. i.e. TENS, prescriptive exercises, short-wave diathermy, core exercises, ultrasound etc. If physiotherapy doesn’t work for low back pain, then it is not going to work for any other condition of Neuro-Musculo-Skeletal origin, e.g. knee pain, hip problems, cervical strains (just to name a few).

  • Wow…I didn’t realize that Hippocrates actually did not say, “First, do no harm.” According to Ernst, he really didn’t mean it. He meant to say, “First, do some serious harm and don’t ever consider any treatments expect those from Big Pharma.”

    Further, I didn’t realize Ernst is so blatant in his double standard: There are virtually no randomized double-blind and placebo controlled trials testing surgical procedures…but every “alternative medicine” must be tested using these type of study or it is considered “quackery.” OR…perhaps there are other ways to evaluate efficacy other than randomized double-blind and placebo controlled trials. Which is it? Is surgery quackery?

    OR…don’t answer these questions and concerns and instead continue with the ad hom attacks…

    • “Wow…I didn’t realize that Hippocrates actually did not say, “First, do no harm.””
      there are many other things you haven’t realised, I fear.
      [a Medline search for ‘surgery RCT’ returns almost 4 000 hits]

    • There are virtually no randomized double-blind and placebo controlled trials testing surgical procedures

      This is probably because you, like all homeopaths, are a randomized(*) double-blind(**) placebo-biased person.

      I can easily locate several dozen RCT’s just for appendectomy alone. Mitral valve surgery: over a hundred RCT’s. Postoperative abdominal adhesions: dozens of RCT’s. Etcetera …

      *: Consult three homeopaths with the exact same complaints, and you will likely receive three radically different diagnoses-plus-remedies (even though those ‘remedies’ are in fact 100% identical — but that again is of course denied by homeopaths…).

      **: Homeopaths on one hand tend to see things that aren’t really there, due to post hoc ergo propter hoc and other well-known pitfalls of the human mind, yet on the other hand fail to see things that are there, i.e. simple scientifically viable mechanisms for what they think they think are the effects of homeopathy (placebo effect, regression to the mean, etcetera).

      • Homeopaths on one hand tend to see things that aren’t really there, due to post hoc ergo propter hoc and other well-known pitfalls of the human mind, yet on the other hand fail to see things that are there, i.e. simple scientifically viable mechanisms for what they think they think are the effects of homeopathy (placebo effect, regression to the mean, etcetera).

        I can’t help but recite this opinion, it is terrifying how strong this fallacy affects homeopaths’ minds. Homeopathy fails Occam’s razor miserably.

    • Dana, if you think the homeopathic and/or naturopathic industry works one little bit otherwise than Big Pharma, you are either naive or completely ignorant. The mechanism is exactly the same.

      The problem with homeopathy is not so only the lack of clinical studies, there are several severe problems:

      (1) the way it was conceived is based on a faulty conclusion from results of an experiment carried out by a very bad scientist. The original experiments of Hahnemann have nothing to do with homeopathy and gave wrong results . which already contemporaries noted.

      (2) It runs against almost all known science (and I am talking of theories), which already Hahnemanns contemporaries noted

      (3) The first known RCTs and epidemiologic studies proved Hahnemann wrong.

      Do you really think that this cocktail leads to something useful ? If so, you have never really worked in research.

    • Oh dear Dana. Are you still trotting out this pathetic attempt at argument? It’s been eviscerated repeatedly elsewhere so many times. Do you not read replies to your posts or is your memory defective? Just in case, let me remind you.

      As Edzard says, there are many RCTs of surgical procedures and when they have demonstrated a surgical procedure to be ineffective, that procedure is discarded. You know, like homeopaths do when their research shows a homeopathic treatment to be ineffective. Except they don’t, do they?

      Other surgical procedures are not tested by RCT because it would be unethical to do so. The parachute analogy applies. There are no RCTs demonstrating the effectiveness of parachutes. And yet we still use them because we know they save lives. Placebo arm of an emergency ruptured aortic aneurism repair study, Dana? I think not.

      Homeopathy is eminently testable by RCT, as are all proper medicines. Those proper medicines which are shown not to work are discarded. Like homeopaths don’t.

      You know all this, Dana. Anyone with the faintest iota of methodological analysis will know this. And yet you persist with your spluttering indignation, handwaving, stamping and foolishness. And we continue to point and laugh.

      Time to pick your crayons up and flounce off, Dana. You’re done here.

    • Stop talking about ad hominem attacks please. The straightforward and clean-cut argumentation that you are willfully ignorant about anything relevant to medicine is very well formulated and you have proven it time and again. You are plain wrong.

      Oh, and your deviation from the subject at hand, coming up with surgery, is not fooling anyone here. That’s right, every alternative medicine must be tested using RCTs. As has ultramolecular homeopathy over some hundreds of years, and was proven to be totally ineffective, if not for the ritual, that is.

  • According to present and former editors of THE LANCET and the NEW ENGLAND JOURNAL OF MEDICINE, “evidence based medicine” can no longer be trusted. There is obviously no irony in Ernst and his ilk “banking” on “evidence” that has no firm footing except their personal belief systems: https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

    Ernst is a fundamentalist whose God is reductionistic science, a 20th century model that has little real meaning today…but this won’t stop the new attacks on me personally…

    • WHEN A HOMEOPATH HAS RUN OUT OF AGUMENTS (which happens very quickly), HE USES LIES AND/OR AD HOMINEMS

    • Really?! Are you actually saying or even suggesting that you are NOT a strong strong proponent of “evidence based medicine” and the usage of randomized double-blind and placebo controlled trials? Please clarify what is incorrect about this assertion?

      I do find it very interesting that you have not yet responded to my concern that the vast (!) majority of surgical procedures have NO randomized double-bind and placebo controlled trials…and as such, are you recognizing that there ARE plenty of medical practices for which randomized double-blind and placebo controlled trials are NOT necessary and can and should be integrated within modern medical care?

      OR…are you going to ignore this question/concern again?!?

      • “Ernst is a fundamentalist whose God is reductionistic science, a 20th century model that has little real meaning today…but this won’t stop the new attacks on me personally…”
        SAY NO MORE!

      • “I do find it very interesting that you have not yet responded to my concern that the vast (!) majority of surgical procedures have NO randomized double-bind and placebo controlled trials…and as such, are you recognizing that there ARE plenty of medical practices for which randomized double-blind and placebo controlled trials are NOT necessary and can and should be integrated within modern medical care? ”

        Already answered above, Dana. That you so willingly and repeatedly demonstrate your foolishness on a public forum for all to see is quite gratifying. You can’t block and run here, sunshine.

        • If you honestly think that ANYONE has adequately or accurately responded to my concerns, that’s remarkable…my personal condolences to you.

          Please note that there are virtually no placebo controlled trials in surgical procedures, and you KNOW this. And yet, when an alternative therapy has similar but different ethical and procedural issues about conducting a placebo controlled trial, skeptics typically ignore these challenges and simply return to their mantra asserted there is no “real” evidence that a special alternative treatment is effective.

          If Ernst or anyone insists that a treatment provide “evidence” via randomized double-blind and placebo controlled trials, you cannot make “exceptions” for certain conventional treatments. For the record, no one here has admitted to this hypocrisy or inconsistency…and therefore recognize that there ARE other means to evaluated efficacy of treatment. It may be a little humbling to do so…but without doing so, you are admitting to your double-standard…

          • YOU ARE DEAF OR WHAT?
            I have told you that for surgery [and most other treatments] there is evidence

          • Let me help you Dana.

            Go get a cup of coffee and sit down at your computer. When you are ready, click the link below and pay very close attention. You can repeat the exercise as often as you like if you do not understand it right away. Make sure you click the “Search”-link at the end.

            http://bfy.tw/IRWh

            When you are finished you can go and play with your homeopathy set.

          • Already answered comprehensively above, Dana. You seem to have missed this. We know your powers of comprehension are limited so please read the posts carefully, say the words out loud as you do so if this helps and if you are struggling with any of the big words we’ll be delighted to explain them to you.

            You are currently sitting on the floor with your fingers in your ears going “LALALACAN’THEARYOULALALA” priniciply because, as ever, your argument has been reduced to tatters and you have been shown to be demonstrably wrong. Again.

          • yes, but he is such good fun!

          • Dana, this is not about placebo controlled studies. This is about science based medicine. Aside that, that is not the topic. The topic here is homeopathy and the unproven claims about it’s efficacy. This – and only this – is the topic.

          • don’t be so harsh on my friend Dana; he just cannot resit his little diversion, delusions and confusions.

        • Actually, in my experience many surgeons are quite resistant to the idea of subjecting their preferred treatment to randomised controlled trials.

          One example of this was the SPARE trial in the UK, which was conceived as a nationally-co-ordinated, multi-centre trial exploring the question of whether radiotherapy or surgery might be the most suitable treatment for muscle-invasive bladder cancer (not superficial bladder cancer, which is quite common, and which is very effectively treated by minor surgery). At the time, the standard treatment was surgical removal of the bladder (cystectomy), usually resulting in a stoma in the abdominal wall to collect the urine in a bag. Undoubtedly this mutilating procedure has saved a great many lives, but for patients unwilling or unfit for surgery, radiotherapy was an alternative. Historical series in the published literature had not shown such good outcomes for radiotherapy, but in the context of older, frailer patients with additional pathologies, this is not surprising.

          The design of the trial was quite complex, with an initial randomisation between cystectomy and chemotherapy, then (if there had been a response to chemotherapy) a second randomisation between cystectomy and radiotherapy; if there was no response to initial chemotherapy then the patient would have surgery anyway. This protocol was agreed after much negotiation nationally between oncologists and urologists (i.e. urological surgeons), and does seem rather skewed towards most participants having surgery. However, that was what was agreed.

          Once the trial opened, recruitment was very poor. It seemed that on making a diagnosis of bladder cancer, many urologists would decide that, while the trial was a good idea in principle, this particular patient would be better off with surgery. In the end the trial collapsed and so the question of surgery vs. radiotherapy was never addressed.

          Participating oncologists were both angry and perplexed by this. It is strongly in the culture of oncology that treatment should be based on trial-based evidence, and indeed we feel slightly uncomfortable about recent technical advances in radiotherapy (which enable treatment to be given very precisely) when they are adopted without a robust comparison against older techniques, even though such trials would take decades of follow-up to assess long-term toxicity and disease-free survival, and the new techniques (such as intensity-modulate radiotherapy) are clearly able to deliver higher tumour doses while sparing normal tissue.

          By comparison, the urologists seemed perfectly happy. Their view seemed to be that they already knew how to treat bladder cancer effectively and didn’t see any reason for a trial.

          I think in the end this is due to the personality of many surgeons. In order to perform any kind of cancer operation, which is of necessity extensive and technically demanding, and physically tiring, too, generally requiring the removal not only of the tumour itself, but also all or most of the organ it is involving, together with the lymph nodes into which it could spread, the surgeon has to have a strong belief in himself, in his competance and in the correctness of his decisions. Without that he would be unable to do his job. Unfortunately this seems to result in the feeling that any clinical trial is bringing his expertise as a surgeon into question, and indeed any result in favour of a different treatment would bring the inevitable conclusion that the patients he has operated on so far might have been better off having something else (even if the surgery was the best treatment given the evidence available at the time). Self-doubt in surgeons rapidly leads to burn-out and early retirement.

          Happily in cancer care in the UK we now have a system of multidisciplinary review of all cases at the time of diagnosis and (hopefully) at the time of significant changes in the course of the disease, so that each patient is discussed in detail by the pathologist examining the biopsies and surgical specimens, the radiologist reporting the scans (or more often, a specialist radiologist revieweing scans reported by their colleagues) the surgeon or physician responsible for the diagnosis, a surgeon and an oncologist who would be involved in subsequent treatment, not to mention specialist nurses, physiotherapists, dieticians etc. All relevant clinical trials are considered at this point, with an MDT recommendation that the trials should be offered to the patient as part of the agreed management. For various reasons the recommendations of the MDT are not always followed (on meeting the patient new factors often come to light) but if not, the clinician must be able to defend his decision.

          I am an oncologist, so I have no direct experience of how and to what extent surgical treatment is assessed in trials in non-cancer cases, though it would not surprise me to find that many operative techniques have not been assessed as robustly as we would ideally like.

      • Mr. Ullman,
        you are insisting that homeopathy is very effective. Could you please explain why you have not put your money where your mouth is and accepted the 50.000 € challenge from the GWUP?
        https://www.gwup.org/challenge-home
        Why do you not use this great opportunity to defeat all of your enemies, including Prof. Ernst, once and for all?!

    • Well, Dana, your argument is called a “tu quoque” and is an attempt to drag homeopathy out of the light of scrutiny and refocus an shortcomings of evidence based medicine. The old tactics of naturopaths.Pointing out shortcomings while offering something that is not likely to work.

      Yes EBM has it’s shortcomings. As for the shortcomings of homeopathy, view my previous post. In the meantime even the “star” of homeopathy research, Mathie, admits that there might be only a small effect. Personally I doubt that if you look at the studies included and more importantly excluded in his 2014 metaanalysis. The honduran study on diarrhea, f.i. potentially includes major confounding factors.

      Anyways, by using tu quoques instead of real arguments, Dana, you guess it – you have lost.

      • Thomas, shouldn’t you be in the kitchen?

        My understanding of Dana’s argument is that Professor Ernst practices double standards, and therefore tu quoque arguments against his ‘positions’ are acceptable arguments to use.

        Professor Ernst states that conventional medicine is based/should be based on RCT evidence yet much of medical practice is at the discretion of what the Dr. thinks is in the best interests of the patient (NICE may be looked at but the Dr. makes their own judgement). So, the day to day practice of conventional medicine is not iron clad evidence based, is it Tom?

        Professor Ernst also argues that the rationale for conventional medicine is that it does ‘more good’ than ‘harm’. This is the scary zone for patients because have RCT’s done to prove that all the medicines that are prescribed are doing more harm than good? Take statins for example: what studies have been done to show that patients who decline statins are better or worse off than patients that are on lifetime statins? Who knows whether statins are doing more good than harm? My doctor was peeved when I refused to take his prescription for statins as I do not take ANY conventional medicine and I was not about to let him ‘get me started’.

        That was over 10 YEARS ago.

        With you back on this blog, at least my daily laugh rate with increase.

        Thanks Tom.

        • No Greg. The position of Prof. Ernst is – as I understand it – that evidence based medicine should be based on solid evidence which ideally is a placebo controlled RCT. In many instances it is unethical to conduct such studies (e.g. if a working treatment exists). In any case, medicine should be based on scientific knowledge. However, RCTs are only one aspect of the problem. Another aspect is the prior probability of homeopathy. As I have outlined homeopathy is

          (1) based on a faulty interpretation of an experiment (Chinchona bark) and
          (2) violating not only one, but several theories.

          The scientific definition of theory is that of a model that is that well confirmed by data that a falsification is extremely unlikely. This means that the prior probability of homeopathy is close to zero, which means in turn that even a few positive studies (meaning a p-value below 0.05) are likely false positives. In the meantime even the big shots of homeopathy, e.g. Mathie write of a “small” effect beyond placebo.

          • correct!

          • The devil is in the detail…

            Even 0.05 is quite large for such a claim. I woud not be convinced by anything more than 0.001, with such an extraordinary claim. Still, caution is necessary.

            And, also, homeopaths’ big shots tend to wishfully overestimate things.

          • Given that the prior probability of homeopathy is so much lower compared to the other hypotheses of an RCT (False Positive, some overlooked factor) etc. even a p-value of 0.001 doesn’t help a lot.

          • Well done, my jab did not ‘get you started’.

            Homeopathy is a scientific conundrum, but 200 years of human experience in using it has , so far, not produced the result of its termination.

            Why is this Mr Mohr?

          • and why has blood letting survived thousands of years in so many different cultures?

          • Blood letting is still “a thing” in many countries:

            https://www.youtube.com/watch?v=708dfprS_bQ

          • I’m not sure that the term “theory” as used by scientists is as well-defined as that. Nor is it safe to say that falsification is extremely unlikely. For instance, quantum theory and the theory of general relativity contradict each other, even though they are both very strongly supported by evidence and and make precisely quantifiable predictions which continue to be verified experimentally (and used every day by engineers). My understanding is that physicists regard them both as the best that we have for the moment until a deeper explanation of reality is found that can reconcile the two. In the meantime scientists continue to do what they always do with theories, which is to try as hard as they can to prove them wrong, the only way that progress can be made. So I would regard a theory as being an explanation of observed phenomena that hasn’t been falsified yet, with the corollary that any worthwhile theory has to make testable predictions.

            I should add at this point that I am a physician, not a physicist.

            The concepts behind homeopathy are in conflict with existing theories of chemistry and physics. I doubt whether any scientists would take them seriously enough to want to design an experiment to test their predictions, though I would be interested to know if that has been done (I am not talking about clinical trials, where the end point concerns the outcome for the patient rather than insights into mechanism of action). Having said that, I do remember being taught at medical school the concept of “biological plausibility” when assessing the value of a treatment, a mechanism or an aetiology.

            When you talk about prior probabilities I’m not sure how you are applying Bayesian statistics here. Are you talking about the probability of the underlying theory of homeopathy being true, or the probability of homeopathic treatment having a clinical effect (which isn’t the same thing, although I would expect them both to be close to zero). In any case neither of these are relevant to the statistical analysis of a properly designed clinical trial, which assumes the null hypothesis (that any difference in outcome between the two arms is entirely due to chance, with no consideration of prior probabilities) the p-value then being the probability of obtaining the observed results if the null hypothesis is true. This is quite different from the probability that a positive result is true. Though I certainly agree with you that extraordinary claims require extraordinary evidence.

            Whether any effect found in a trial is actually relevant to clinical practice is a different question entirely. A small effect beyond placebo is not enough to base treatment on, but if it is real then it would revolutionise our understanding of physics, chemistry and biology.

        • The crude death rate world average is systematically decreasing in the last 50+ years.

          That must be because of homeopathy, huh?

    • Dear Mr. Ullman,

      I don’t know what you think you’re doing here, but these highly concentrated bouts of criticism addressed at Prof. Dr. Ernst run contrary to everything your profession has taught you.

      As you of all people should know, your criticism of Prof. Dr. Ernst should become far more potent if diluted to, say, 30C. So I propose you reduce the frequency of your attempts at scathing ad hominems to perhaps once per century for starters — and don’t forget to give your computer keyboard a vigorous shake beforehand (or just bang it on the edge of your desk, there is a plentiful supply of example videos of this on YouTube).
      This should produce far better results than your current approach, if only because it provides you with sufficient time to think up a really nasty, hurtful retort.

      No, no need to thank me, really. It’s my pleasure. I’ll be looking forward to not hearing from you any time soon with keen interest.

      • Thanx RichardR for proving that you still don’t understand homeopathy and your sense of humor makes no sense.

        Still, I like it when stupid people embarrass themselves…

        • is that why you do it all the time?

        • You really don’t help your case by resorting to insults. It makes you seem petty and less credible. I’m relatively new to this debate and while my view is that you are losing the argument based on science and logic these insults of yours really put you a category of person not worth listening to.

          • If you think Dana is not credible, you are definitely new to this debate!

            Dana’s belief perseverance goes beyond what you could possibly imagine.

        • Studied Harry Potter extensively… still can’t get the spells to work. Better study harder…

        • Thanx RichardR for proving

          Hahahaha! Yes, now that is a good sense of homeopathic humour! Thank you for brightening my day!

          that you still don’t understand homeopathy…

          Sorry old chap, but I understand homeopathy perfectly fine, thank you very much, and far better than you do. You’re still stuck in the 18th-century belief that it actually does something, whereas I know that it is merely an elaborate, ritualized placebo treatment, based on sympathetic magic and numerous fallacies and shortcomings in human observation and reasoning. These insights are of course in large part based on the work of Prof. Dr. Ernst and others, but in the end it is simply based on the diligent application of scientific principles, and weeding out aforementioned human fallacies.

          and your sense of humor makes no sense.

          Hahaha, another pun! Well, OK, a rather feeble one this time, but you’re definitely on a roll! Keep up the good work!
          But I’m happy that you at least appreciate my ‘advice’ for what it is — a joke. Unfortunately, lots of your fellow homeopaths make far worse jokes, yet appear to be totally serious about it for all I can see. Like this foolish lady, claiming that diluted(?) shipwreck can cure a ‘sense of being stuck’, or these clowns, who claim to have captured and diluted the light of Saturn, and turned it into a ‘remedy’, among other things for mental trauma. And then there’s this buffoon, with this immortal quote: “I experienced strong symptoms from the remedy even though I did not take it”. Thank you, mr. Andrews, for confirming that homeopathy is all about the imagination, and that the actual sugar pills or shaken water are merely props for the ritual. And, of course, there’s the idiot I mentioned earlier, with the horrendously stupid advice that one could help a drowning victim by popping sugar pellets in their mouth instead of administering resuscitation and other proven lifesaving treatments. And there are many, many more, and far worse than these. My suggestion to dilute and shake your comments to make them more potent sounds quite sane in comparison.

          But let’s face it, even if you would distance yourself from these über-nitwits, you would still be a nitwit yourself, as long as you believe in homeopathy. And therein lies the whole problem: if homeopaths would accept a science-based assessment of their craft, they wouldn’t be homeopaths any more.

          I like it when stupid people embarrass themselves…

          I think that an explicit comment on my behalf is quite unnecessary at this point.

      • Richard, with all due respect, you don’t understand homeopathy. Please, allow me to enlighten you:

        -If it works, it’s homeopathy.
        -If it doesn’t work, the homeopath is incompetent or the remedy is not correct.
        -Adverse effects with homeopathy mean the remedy is working, or conventional medicine will kill someone soon is to blame.

        Wrap these principles in a couple ~1000-page books and you get homeopathy!

        Well, you could get practically any type of religion through this recipe…

  • Dana Ullman,

    I just want to make sure that I understand correctly. Are you saying that because some surgical procedures have not been tested using randomized controlled trials (but are known to work) then that means homeopathic remedies don’t need to be tested using RCTs?

    Something I have been curious about, are there examples of homeopathic remedies that have been taken out of use because they were found to be ineffective?

    • The homeopathic remedy ‘BERLIN WALL’ (edzardernst.com/2014/06/berlin-wall-homeopathy-at-its-finest/) might become obsolete one day [because of the non-existence of the raw material].

    • Actually there are none because homeopathic treatment is a purely symptom based treatment. If a remedy does not work it is not well enough matched to the symptoms.

  • To Prof. Ernst and the other allies in the discussion: Dana Ullman uses a tactics often used by naturopaths, namely criticizing state-of-the art medicine via tu-quoque arguments. The *only* thing a tu quoque serves is to put the target into a defensive position with the aim to change the focus on the target’s weaknesses. The only working counter tactics is simply not to leave *any* room for distraction.

    A prime example is the argument that there are no RCTs in surgery. The counter argument is *not* that there are (with all respect Prof Ernst, it is a big temptation but here we are already on the path of shifting attention) but that this is *completely irrelevant* for the topic that homeopathy is not effective under conditions of science based medicine.

  • “Primum non nocere” – literally – first, to do no harm was popularised in Anglophone medicine by Worthington Hooker, who is an important 19th century figure in the development of medical ethics. “Physician and Patient” is considered one of his most important works. References to the Latin phrase can be traced to the 17th century but no further back. The Hippocratic Oath, which was originally in Greek, does not use that kind of phraseology.

    From the Corpus (which was written by multiple authors – and possibly with no direct contribution from Hipporrates – and is somewhat contradictory) what can be read is “The physician must … have two special objects in view with regard to disease, namely, to do good or to do no harm”. Whilst the Ancient/Classical Greeks had many good ideas, statistical evaulation of risk is a relatively modern invention and it’s still a huge societal issue – qv benefits of cancer screening.

    Hooker’s promotion of “Primum non nocere” can be understood in a historical context. US medicine was, in part, the “Wild West” in terms of being almost totally unregulated. Quacks and mountebanks abounded. Medical professionals qualified from Ivy League universities on the East Coast stayed there largely. The American Civil War made that situation worse in many ways in terms of the huge disruption it caused to the South. It took decades but the Flexner Report lead to huge reforms (which have been constantly eroded).

    “Primum non nocere” must also be understood in a public health context, a more utilitarian context. Infectious diseases are the most obvious example.

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