The researcher who proves that highly diluted homeopathics work beyond placebo might be in for a Nobel Prize. The scientist who finds a cure for addictions probably also deserves one. The investigator who does both might get two Nobels. The question is, do these Brazilian homeopaths fulfil these criteria?

Their study investigated the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting. A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence. The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group). The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were recorded in both groups.

The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% compared to 29.8% in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients’ appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group.

The authors concluded that a psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.

I am glad that the authors mention the high dropout rate which clearly is a serious limitation of this fascinating trial. Had they analysed the data according to an intention to treat analysis – which, I think, would have been a better statistical approach – the results would almost certainly have been negative.

But there are other puzzling issues about this study:

  • The authors say they used homeopathic remedies. I think, however, that this is not the case. Homeopathy is defined as a therapy that follows the ‘like cures like’ principle. If the remedy is based on the causative agent, as in the case of the present study, it follows a different principle (identical cures identical) and is not called homeopathy but isopathy (here an explanation from my book: “Isopathy is the use of potentised remedies which are derived from the causative agent of the disease that is being treated. It thus does not follow the supreme law of homeopathy; instead of ‘like cures like’, instead it postulates that identical cures identical. An example of isopathy is the use of potentised grass pollen to treat patients suffering from hay fever. Some of the methodologically best trials that generated a positive result were done using isopathy; they therefore did not test homeopathy and its principal assumption, the ‘like cures like’ theory. They are nevertheless regularly used by proponents of homeopathy to argue that homeopathy is effective”). This means that the above trial does, in fact, NOT test the defining principle of homeopathy.
  • Moreover, I fail to understand why the authors called their trial a PILOT study. It does not explore the feasibility of a more definitive trial, but tests the effectiveness of the intervention. It is thus NOT a pilot study.
  • I cannot help being suspicious of authors who, based on an extremely implausible, such as homeopathy, publish one paper after the next with positive or encouraging results.
  • I am also puzzled by the fact that, in 2012 and 2013, the authors have published two previous studies along the same lines that produced encouraging results. Surely 6/5 years are a long enough period for INDEPENDENT replications to be carried out and published. And surely, a finding like this would have been replicated several times by now.
  • I furthermore find it odd that the authors chose to publish their findings in the JOURNAL OF INTEGRATIVE MEDICINE. This is a 3rd class journal read only by those who promote alternative therapies. The notion that a treatment of addiction has finally be found should appear in journals like SCIENCE, NATURE, NEJM, etc.
  • Considering the extremely low prior probability of their hypothesis, the authors should perhaps have not used the conventional 5% probability threshold, but one two dimensions lower.
  • I have not found a statement regarding informed consent of the study participants.

So, are these Brazilian homeopaths likely to be on the next list of Nobel laureates?

I have my doubts.

What do you think?

8 Responses to Brazilian homeopaths in line for a Nobel Prize?

  • Dear Dr. Ernst,

    Wasn´t clear for me if you are using irony, but I hope so.
    Indeed, something that shame us Brazilians is that even Colombia and Argentina have Nobel laureates, while we still waiting for.
    But, god forbid our first one being an.. homeopathy professional!
    It would be even worst of giving the Peace Nobel to our former president Lula, now serving a 12 years sentence doe to the robbery of billions of dollars from public owned companies. That almost happened few years ago.
    Nevertheless, would be also a blow on the credibility of the sciences Nobel Prizes as all. The Peace Nobel Prizes already have being depraved after being given to terrorists and murders like Yasser Arafat, product of the leftism dominant on Norway.
    By the way, how the Scandinavians deal with homeopathy and other forms of chemophobia and neo alchemy?

  • The supreme irony of life is that hardly anyone gets out of it alive.
    Robert A. Heinlein

  • Dear Prof. Doctor Edzard Ernst:

    I am a doctor, retired professor at the Federal University of Rio Grande do Norte- Natal-RN (Brazil) and equivalent to PHD by the University of Porto with the thesis “Ethical indefensibility of the practice of alternative medical systems.”,
    where you are often quoted because of his extensive knowledge of the subject. I commend him for his extensive work in favor of the best practice in medicine. I am writing to the Federal Medical Council (Brazil) urging to review the inexplicable recognition of Homeopathy and Acupuncture as medical specialties.
    Munir Massud

      • A text of a certain antiquity, to your knowledge:

        Reese MR. Humbugs of New-York: being a remonstrance against popular delusion; whether in science, philosophy, or religion. 2nd e. New York: JS Taylor, 1839. p. 109.

        “Such, then, is homeopathia; a greater humbug than witchcraft, or any other form of imposture, by which mankind have ever been gulled; and a more impudent and shameless form of quackery than was ever concocted by any charlatan practitioner in “roots and yarbs,” with whom our world was ever cursed. That it should assume the garb of science, and, still worse, that of piety, is among the secrets of its gullibility. And the fact that men of sense and character should become its dupes, is one of the most striking exhibitions of intellectual stupidity and moral obliquity which the history of fanaticism itself can furnish.”

  • I think you are wrong. I am myself being treated for homoeopathy for a rare bone cancer which is not treatable anywhere. I see improvements in my MRI scans.
    Being skeptical is good. But people are blindly against Homoeopathy which is so frustrating

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