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

You may have noticed that my patience with homeopathy, homeopaths, and other providers of so-called alternative medicine (SCAM) has diminished. In fact, I do not think much of quacks of all shades and no longer muster much understanding. It is better, so I mean after approximately 30 years of discussions with snake oil salesmen and other charlatans, to offer such people Parole. Facts are facts, and no one should be allowed to ignore that without contradiction.

That was not always the case.

When I began as Chair of Complementary Medicine at Exeter in 1993, I was optimistic. It was clear to me that my task of scrutinizing this field would not be easy and could occasionally bring me into conflict with enthusiasts. But I was determined to build bridges, to remain polite, and to muster as much understanding as necessary.

And so I began to build a multidisciplinary team, conduct research, and publish it. My goal was to do as rigorous science as possible and, if avoidable, not to step on anyone’s toes in the process. Especially with regard to homeopathy, my general attitude was quite positive. Accordingly, my articles were as favorable as the evidence allowed. My goal was to emphasize the good aspects of homeopathy wherever possible.

What, you find that hard to believe?

Then you are in good company!

Homeopaths like to claim that I was out to malign not only homeopathy but all of SCAM from the beginning. That this assumption is not true, I tried to demonstrate in an article entitled ‘Homeopathy and I’. In this paper, I merely extracted typical passages from my publications. From them, you can probably see how my attitude slowly changed over the years. See for yourself (sorry for the length of the list):

  • 1. homeopathic remedies are believed by doctors and patients to be almost totally safe (Ernst E, White A. Br J Gen Pract 1995; 45: 629-30)
  • 2. it might be argued that arnica … is ineffective but homeopathy may still work (Ernst E. BMJ 1995; 311: 510-1)
  • 3. homeopathy, I fear, has soon to come up with … more convincing evidence (Ernst E. Forsch Komplementarmed 1995; 2: 32)
  • 4. future evaluations of homeopathy should be performed to a high scientific standard (Ernst E. Br Homeopath J 1995; 84: 229)
  • 5. the best way forward is clearly to do rigorous research (Ernst E, Kaptchuk TJ. Arch Intern Med 1996; 156: 2162-4)
  • 6. the most pressing question, ‘Is homeopathy clinically more effective than placebo’, needs to be answered conclusively (Ernst E. Br J Clin Pharmacol 1997; 44: 435-7)
  • 7. there is evidence that homeopathic treatment can reduce the duration of ileus (Barnes J, Resch KL, Ernst E. J Clin Gastroenterol 1997; 25: 628-33)
  • 8. the published evidence to date does not support the hypothesis that homeopathic remedies … are more efficacious than placebo (Ernst E, Barnes J. Perfusion 1998; 11: 4-8)
  • 9. the claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials (Ernst E, Pittler MH. Arch Surg 1998; 133: 1187-90)
  • 10. … the trial data … do not suggest that homeopathy is effective (Ernst E. J Pain Sympt Manage 1999; 18: 353-7)
  • 11. … the re-analysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos (Ernst E, Pittler MH.J Clin Epidemiol 2000; 53: 1188)
  • 12. … homeopathy is not different from placebo (Ernst E, Pittler MH. J Clin Epidemiol 2002; 55: 103-4)
  • 13. … the best clinical evidence … does not warrant positive recommendations (Ernst E. Br J Clin Pharmacol 2002; 54: 577-82)
  • 14. the results of this trial do not suggest that homeopathic arnica has an advantage over placebo (Stevinson C, Devaraj VS, Fountain-Barber A, Hawkins S, Ernst E. J R Soc Med 2003; 96: 60-5)
  • 15. this study provides no evidence that adjunctive homeopathic remedies … are superior to placebo (White A, Slade P, Hunt C, Hart A, Ernst E. Thorax 2003; 58: 317-21)
  • 16. … this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists (Grabia S, Ernst E. Homeopathy 2003; 92: 92-8)
  • 17. … the proven benefits of highly dilute homeopathic remedies … do not outweigh the potential for harm (Ernst E.Trends Pharmacol Sci 2005; 26: 547-8)
  • 18 Our analysis … found insufficient evidence to support clinical efficacy of homeopathic therapy (Milazzo S, Russell N, Ernst E. Eur J Cancer 2006; 42: 282-9)
  • 19. … promotion can be regrettably misleading, or their effectiveness? (Ernst E. J Soc Integr Oncol 2006; 4: 113-5)
  • 20. … homeopathy is not based on solid evidence and, over time, this evidence seems to get more negative (Ernst E, Pittler MH, Wider B, Boddy K. Perfusion 2006; 19: 380-2)
  • 21. the evidence from rigorous clinical trials … testing homeopathy for childhood and adolescence ailments is not convincing enough for recommendations in any condition (Altunc U, Pittler MH, Ernst E. Mayo Clin Proc 2007; 82: 69-75)
  • 22. … context effects of homeopathy … are entirely sufficient to explain the benefit many patients experience (Ernst E. Curr Oncol 2007; 14: 128-30)
  • 23. among all the placebos that exist, homeopathy has the potential to be an exceptionally powerful one (Ernst E. Br J Clin Pharmacol 2008; 65: 163-4)
  • 24. … recommendations by professional homeopathic associations are not based on the evidence (Ernst E. Br J Gen Pract 2009; 59: 142-3)

These quotes speak for themselves, I think. But what was the reason for the change? As far as I can judge in retrospect, there were three main reasons.

1. The data became clearer and clearer

When I started researching homeopathy, at least the clinical evidence was not clearly negative. In 1991, Jos Kleinjen had published his much-noted systematic review in the BMJ. Here is its conclusion:

At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials.

Subsequently, more and better clinical trials were published, and the overall picture became increasingly negative. Kleinjen, who had become somewhat of a hero in the realm of homeopathy, re-reviewed the evidence in 2000 and concluded that there are currently insufficient data to either recommend homoeopathy as a treatment for any specific condition or to warrant significant changes in the provision of homoeopathy.

The 24 citations above reflect this development quite nicely. Today, there is no longer much doubt that highly-diluted homeopathic remedies are pure placebos. This is perhaps most clearly expressed in the now numerous statements of high-ranking international bodies.

2. The lack of understanding on the part of homeopaths

So the evidence is now clear. But it may not fully explain why my patience with homeopaths diminished. To understand this better, one must consider the utter lack of insight of today’s homeopaths (think, for example, of the incredible Ebola story).
It is of course understandable that a homeopath would be less than enthusiastic about the increasingly negative evidence. But homeopaths are also physicians or at least medically untrained practitioners (lay homeopaths). As such, they have an obligation to acknowledge the overwhelming evidence and act accordingly. That they quite obviously do not do so, is not only regrettable but also highly unethical and shameful. In any case, I find it difficult to have much patience for such people.

3. Personal attacks

In the many years that I have now been scrutinizing SCAM, I have become used to being attacked. The attacks and insults I have received, especially from homeopaths, are legion. For example, when we published our arnica study, we were threatened with letter bombs. However, one should keep one thing in mind: ad hominem attacks are a victory of reason over unreason. If one is personally attacked by one’s opponent, it only shows that he has run out of rational arguments.

Perhaps the most impressive example of an attack was not directed against me personally, but across the board against all who dare to doubt homeopathy. Christian Boiron is the boss of the world’s largest homeopathic manufacturer, Boiron. In an interview he was once asked what he thought of homeopathy critics; his answer: “Il y a un Ku Klux Klan contre l’homéopathie” (There is a Ku Klux Klan against homeopathy).

Yes, many of these attacks even have something comical about them; nevertheless, they are not likely to increase my patience with homeopaths. This does not mean, however, that I will soon hang my opponents from the nearest tree in the old KKK tradition. I’ll gladly leave such tasteless ideas to Christian Boiron.

 

 

19 Responses to Why my patience with homeopaths (and other SCAM providers) is wearing thin

  • My amateur take on this is that homeopaths don’t respond well to criticism because they don’t really know what criticism is or how it works. They can imitate it, just like they try to imitate science without know what that is or how it works either. And to be fair to them, it’s genuinely difficult for them to comprehend it. Nothing in their training teaches them prepares them for it, and the criticism they get from scientists is extremely simplistic and blatant — of course unavoidably so.

    Effective criticism is of course essential to scientific progress, and pseudo-science can’t progress. Thus homeopathy hasn’t progressed, and homeopathic trainings see it only as a body of knowledge to be expanded but not improved. So that aspect of criticism is entirely foreign to them too.

    In fact the mere *hypothetical possibility* of progress would be a threat to all homeopaths, who would face the danger of, for example, better diagnostic techniques making their current methods redundant, or, even worse, being themselves revealed to be individually poor at diagnosis, or verifiably not as good as their competitor down the road.

    Really, if there ever were studies that showed up clear positive results for some homeopathic treatment, it would be a disaster for for homeopaths. It wouldn’t automatically mean that all treatments work equally well (as they always assume it would), but rather that some treatments work better than others, and some don’t work at all. Worse still, it would suddenly become possible to test the diagnostic skills and prescribed treatments of each homeopath, for any kind of illness they worked with. Their individual performances would suddenly come under intense and objective scrutiny. They’d find that even more baffling and inflammatory than the current politely worded criticism they encounter.

    (Sorry for the rant!)

  • My patience with WHO scam pandemic is also wearing thin, the trouble is everyone lies or exaggerates for some effect, especially the media ,who are under the directive of the G7..and tell me now that “science ” cant be bought, and manipulated by Governments who have their own agendas.
    Vaccine companies stand to make over a trillion dollars this year, because you think that all alternative medicine is a scam would you also put your your total trust in the WHO?

    • are you sure?
      sounds like a spell of paranoia to me.

    • So it’s the G7 who are calling the shots. This is very confusing. I thought it was George Soros and Bill Gates.

      • Because no doubt you only digest mainstream media you will not have noticed much except that everyone says that vaccines are truly wonderful and we all need to have more of them…..and that anyone who doesnt agree with that probably believes in Q anon or some equally silly conspiracy theory, when i mention G7 im just referring to their meet up next week as they will be discussing how their wonderful vaccines are going to save the world from any dangerous new mutant strains of a talked up nasty flu…and in the process make a trillion dollars for big pharma …. and here a little old man is constantly whinging on about dishonest homeopaths

        • Vaccines actually make very little money for pharma co’s.
          It’s the drugs for lifestyle diseases that make them the $$$, because people take those drugs every day for the rest of their life, often.
          You could ask why so many people get these lifestyle diseases, like obesity, type 2 diabetes, high blood pressure, atherosclerosis. Since they’re largely avoidable, why aren’t they avoided? That would be a more fruitful place to look for societal and systemic problems.
          People demonize pharma co’s, but they don’t seem to demonize Big Food nearly enough – even while it’s training them to eat in a way that ends up causing these diseases and making them die too young.

          • Vaccines actually make very little money for pharma co’s

            Indeed. I often ask antivaccine people who complain about Bad Big Pharma making gazillions of dollars with vaccines if they use supplements and store-bought ‘natural’ medicines.
            And when I explain that all those products are also made by Big Pharma – and that these generate far more turnover (some $75bn annually) than vaccines (some $25bn), silence ensues …

            OK, I think that the current pandemic may well have doubled or even tripled vaccine makers’ annual revenues – but that isn’t strange of course, considering that we are now vaccinating several billion people instead of ~200 million annually under normal circumstances.

  • Patience wearing thin? Time to move on to some other field.

  • There is a real danger in solutions labeled homeopathic that are not super diluted.
    A few years back there was a a solution touted for colds based on zinc that caused loss of taste.
    Recently a man was taken to emergency for consumption of something 600 times above standard dosage.

    Poorly diluted homeopathic pills are really dangerous for consumers who believe in it.

    • @JimR
      Some years ago, badly manufactured ‘homeopathic’ teething tablets from a quack company by the name of Hyland killed at least eight infants and injured hundreds: https://www.scientificamerican.com/article/hundreds-of-babies-harmed-by-homeopathic-remedies-families-say/
      This article also shows the astonishing level of arrogance and refusal to admit any wrongdoing that I have since come to associate with the alternative universe in general and homeopathy in particular.

      • In fact this was never proven, and remains nothing but innuendo (as you can see from the FDA website). With added innuendo that some batches had concentrations that varied from well-below ‘trace’ to well-below ‘trace’, and a supposition that such a ‘trace’ could be toxic despite a lack of any such evidence.

        The FDA made a complete mess of investigating this, advising parents to discard evidence rather than collecting any and actually analyzing it.

        And – what an interesting thing – this has only happened in the USA, whereas the product is sold (in slightly different formulations) worldwide.

        Could it be that someone deliberately adulterated the product, for their own ends? Thanks to FDA incompetence, we shall probably never know. Meanwhile, they are happy with their innuendo and their commercially-inspired “crackdowns” on the likes of IV vitamin C, HCQ and such.

  • I have become more angry with alt-med providers over time, too. They seem like people who exploit others’ foolishness.
    And they exploit people’s wish for an easy answer.
    I realized this in the case of chiropractors when discussing it recently. The alternative to seeing a chiro is to see a physical therapist. But physical therapists give you a lot of boring and time-consuming exercises. Chiropractors allow you to be passive about it. Just lie there & get your back cracked (or your neck cracked, or whatever).
    But alt-med providers often fool themselves too, and are the truest of true believers in what they do. They aren’t deliberate charlatans a lot of the time, so they can’t be described as genuinely evil. Just foolish and deluded. A lot of them go into it because they genuinely want to help others, to be healers.
    Again, it’s taking the easy way. Much easier than going through 8 years of difficult training to be a doctor. “The road to hell is paved with good intentions”.

  • I have also been scammed by an MD practice, though. Going to a supposedly evidence-based, reputable practitioner is not an absolute protection against being scammed. Again, they probably sincerely believed what they were doing was helpful.

    • I am sorry, but not surprised to hear of Laura’s experience.
      But that is why doctors have extensive training with peers at university based medical schools, post-graduate apprenticeships, and are required to maintain continuous professional development (CPD).

      Perfect? No – but so very much better than the camists have arranged for their practices.

      And there are extensive systems for clinical audit which do much to improve care offered.
      Are all scam MD’s identified?
      No.
      But there are systems to find them out and deal with them.
      Not least, the expectation that critical thinking and scientific methods will be employed to provide evidence-based care.

      Take care, and be wise!

      • >But there are systems to find them out and deal with them.

        Unfortunately, those systems don’t necessarily help to eliminate scamming MD’s. They can charge a lot for a treatment that isn’t evidence-based, but is made to seem plausible.

      • >Are all scam MD’s identified?
        >No.
        >But there are systems to find them out and deal with them.
        >Not least, the expectation that critical thinking and scientific methods will be employed to provide evidence-based care.

        That’s the belief system I had at the time. This is an MD practice I’m going to, so I can trust them not to offer a dodgy treatment. Right? Riiiggghht???

        The trust that people have in mainstream medicine also enables scammers.

        And it enables the scammers to sincerely believe that they are being helpful.

  • 3. homeopathy, I fear, has soon to come up with … more convincing evidence

    Should that read “is yet to come up with” rather than “has soon to come up with”? The latter reads like you expected that the evidence would be available soon.

  • Kleijnen published in 1991 his review concluding that overall homeopathy has a greater effect than placebo even in some trials of higher methodological quality, its update to the year 200 does not change this, only says that the evidence for specific clinical conditions is “insufficient”. This is the same conclusion as Linde, Mathie and the Australian report, after the correction of the CEO, Ana Kelso.

    And what about the “official verdicts” you brag about?You say they are: “are independent, employed a thorough assessment of the evidence, have a reputation of being beyond reproach, and represent scientific consensus”

    You quote the conclusion of the “Russian Academy of Sciences”, but you do not say that the conclusion is not of the Russian Academy of Science, but of a parallel Commission to “combat pseudosciences” led, among others, by Alexander Panchin, a GMO-Monsanto proponent. The Russian memorandum is not a literature review, it is a copy of the EASAC report divided into five documents.

    “These products are not supported by scientific evidence, Health Canada, Canada” Why doesn’t Health Canada have that appointment on its website?

    It will be of interest that you can demonstrate that the “Hungarian Academy of Sciences, Hungary”, the “Swedish Academy of Sciences, Sweden”, the “Food and Drug Administration, USA” and the National Centre for Complementary and Integrative Health, USA published an “assessmenent of the evidence”. Why lie, Ernst?

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