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

This review assessed the magnitude of reporting bias in trials assessing homeopathic treatments and its impact on evidence syntheses.

A cross-sectional study and meta-analysis. Two persons independently searched Clinicaltrials.gov, the EU Clinical Trials Register and the International Clinical Trials Registry Platform up to April 2019 to identify registered homeopathy trials. To determine whether registered trials were published and to detect published but unregistered trials, two persons independently searched PubMed, Allied and Complementary Medicine Database, Embase and Google Scholar up to April 2021. For meta-analyses, the authors used random effects models to determine the impact of unregistered studies on meta-analytic results.

The investigators reported the proportion of registered but unpublished trials and the proportion of published but unregistered trials. They also assessed whether primary outcomes were consistent between registration and publication

Since 2002, almost 38% of registered homeopathy trials have remained unpublished, and 53% of published randomised controlled trials (RCTs) have not been registered. Retrospective registration was more common than prospective registration. Furthermore, 25% of primary outcomes were altered or changed compared with the registry. Although we could detect a statistically significant trend toward an increase of registrations of homeopathy trials (p=0.001), almost 30% of RCTs published during the past 5 years had not been registered.

A meta-analysis stratified by registration status of RCTs revealed substantially larger treatment effects of unregistered RCTs (SMD: −0.53, 95% CI −0.87 to −0.20) than registered RCTs (SMD: −0.14, 95% CI −0.35 to 0.07).

The authors concluded that registration of published trials was infrequent, many registered trials were not published and primary outcomes were often altered or changed. This likely affects the validity of the body of evidence of homeopathic literature and may overestimate the true treatment effect of homeopathic remedies.

An obvious investigation to do (why did I not have this idea?)!

And a finding that will surprise few (except fans of homeopathy who will, of course, dispute it).

The authors also mention that reporting biases are likely to have a substantial impact on the estimated treatment effect of homeopathy. Using data from a highly cited meta-analysis of homeopathy RCTs, our example showed that unregistered trials yielded substantially larger treatment effects than registered trials. They also caution that, because of the reporting biases identified in their analysis, effect estimates of meta-analyses of homeopathy trials might substantially overestimate the true treatment effect of homeopathic remedies and need to be interpreted cautiously.

In other words, the few reviews suggesting that homeopathy works beyond placebo (and are thus celebrated by homeopaths) are most likely false-positive. And the many reviews showing that homeopathy does not work would demonstrate this fact even clearer if the reporting bias had been accounted for.

Or, to put it bluntly:

The body of evidence on homeopathy is rotten to the core and therefore not reliable.

104 Responses to The body of evidence on homeopathy is rotten to the core

  • The bluffer Ullman will be dropping by shortly.

  • The damining evidence just keeps coming. I think we need a new up to date definition of homeopathy. My starter for ten and ripping off a well known author and writer is:-

    ‘the inane in full pursuit of the insane’

    We could make the definition more potent by duluting the active ingredients, perhaps removing the vowels would be the first step!!

    • we need a new up to date definition of homeopathy.

      There’s a very old definition that works: Sympathetic magic.
      Homeopathy is a kind of sympathetic magic, and it turns out that “homeopathic magic” is another phrase for sympathetic magic.
      i.e. homeopathy is one kind of homeopathic magic. There are other kinds of homeopathic magic, like sticking pins into a voodoo doll so the person it’s aimed at will feel like they’ve been stuck.
      The believers in homeopathy are modern-day believers in magic.

  • Since 2002, almost 38% of registered homeopathy trials have remained unpublished, and 53% of published randomised controlled trials (RCTs) have not been registered. Retrospective registration was more common than prospective registration. Furthermore, 25% of primary outcomes were altered or changed compared with the registry. Although we could detect a statistically significant trend toward an increase of registrations of homeopathy trials (p=0.001), almost 30% of RCTs published during the past 5 years had not been registered.

    How does this compare with similar statistics for mainstream medicine?

  • We could say the homeopathic trials don’t hold water, which contradicts the 100% constituent of these SCAM meds.

    I suspect strongly that the unregistered trials tortured the data in various ways and finally found stat significance that could be written up. The major science journals promised to not publish unregistered trials, but cannot resist a good story and violate the pledge.

  • Thanx Robin! That is the $64,000 question!

    And it should certainly be noted that the primary reason that scientists have been encouraged to register their trials is due to the serious shenanigans that Big Pharma has played with “science” for decades…all of which have been completely ignored by all but a handful of people. But heck, let’s not investigate the distant past because this “distant” past isn’t very distant anyway.

    In any case, now that I’ve made these simple comments, let’s expect the ad homs to roll out and let’s expect other means to misdirect the narrative away from the HUUUUGE financial conflicts of interest that take place in everyday life of Big Pharma. And the false equivalencies will also be rolled out…and there will be people here who will insist that the “homeopathic doses” of money that homeopathic companies make is so “criminal.” Let’s certainly not bring up the fact that the entire annual RETAIL sales of homeopathic drugs in the USA is considerably less than the common advertising budget for a single Big Pharma drug.

    Marcia Angel, MD, the Harvard professor who previously served as editor of the New England Journal of Medicine noted that in 2001 the ten largest Big Pharma companies in the Fortune 500 made more money than the remaining 490 companies combined.” So, let’s ignore the gorilla in the room…and the many people who suck at her tit (one way or the other).

    What fun…let the fireworks begin…

    • if your neighbor beats up his wife, this does not make it ok for you to be nasty to yours too, Dana!

      • @Edzard
        I think that we should at least have a little understanding for Dana’s point of view: real medicine knows the value of evidence and, most importantly, how that evidence should be obtained and used. Yet they still get it wrong on a far too regular basis, which is not good.

        Homeopaths, on the other hand, are like children: they still live in tinkly fairy land, ruled by sympathetic magic rather than the harsh laws of physics and chemistry, where less is more and medicines are never tested on sick people. And as such, homeopaths may act like selfish, spoiled little brats, but at least they’re innocent little brats, simply because they don’t know any better – and unfortunately, they haven’t yet reached the developmental stage where they are capable of knowing better.
        Which means that we should try to raise and educate homeopaths with patience and compassion, not scorn and derision, just like we raise our children.

        (Although there are of course always certain hopeless cases …)

    • ‘false equivalencies’

      Indeed. This post isn’t about ‘Big Pharma’. But I know your obfuscating noise prevents you from paying attention.

    • Thanx Robin! That is the $64,000 question!

      Maybe so, but you didn’t answer it.

    • And up goes the entirely predictable Straw Man as Dana engages in another bout of whataboutery in an attempt to deflect attention from the original point.

      Dodge, obfuscate, bluff, bluster. New day, same old Dana.

      We should note that prominent researcher Dr Ben Goldacre began the AllTrials initiative in an attempt to clean this Augean Stables and is making steady ground.

      Dana will of course be able to show us the homeopathy researchers who are working similarly in the field of magic shaken water.

      Oh and whilst you’re here, Dana, are you going to let us know which of the Indian laboratories that you’ve mentioned will be able to distinguish homeopathic water from water. We did the legwork and found a few names but you’ve curiously failed to respond.

      Dodge, obfuscate, bluff, bluster.

    • Dana Ullman wrote “So, let’s ignore the gorilla in the room”.

      Dana, you stomp around in this “room”, off-topic as usual, acting very much like a deranged gorilla, but lacking any ability to either enlighten or entertain your onlookers.

      Homeopathy is a business model, not a medical model.

    • Oh Mr Ullman, I am glad you have looked in!

      If you could spare a moment now to do what you previously said it would be “no problem” to do, and name for this poor “fool or liar” (as you would have it) the laboratory that can distinguish between homeopathic water and other water, why, that would be so much appreciated!

      I know it must simply be pressure of work that has prevented you from supplying this information up till now.

      Twenty-seventh time of asking…..

      • name … the laboratory that can distinguish between homeopathic water and other water

        Whether such a laboratory exists is beside the point. Living creatures can be far more sensitive to tiny quantities than the machinery in a lab. They make use of positive feedback mechanisms that a lab wouldn’t.
        Homeopathy is about effects on living things. Homeopaths claim that living creatures are sensitive to something even when the tiniest possible quantity has been diluted away – that in fact, they become more sensitive as the dilutions continue, so they are somehow sensitive to the process of dilution itself! It’s a paranormal and unproven claim.

        • It is NOT beside the point.

          Mr Ullman said unequivally in here in another thread that “only fools or liars” doubted that it was possible to distinguish homeopathic water from other water.

          I doubt, therefore I am branded a fool or liar.

          I have THIRTY TIMES, politely each time, asked Mr Ullman to name a laboratory that can make such a distinction. He has declinded to do so, despite helpful suggestions and promptings from other contributors here.

          Readers will feel free to draw their own conclusions about fools or liars, and may also contemplate such terms as mountebank, jackanapes, schumck, varlet, poltroon, charlatan, and so forth.

          Readers will feel free to consider whether Mr Ullman knows as little about homeopathy as he does about good manners and about medicine.

          Readers will feel free to ponder whether the best thing Mr Ullman can do for anyone asking him about any health condition, is to refer them to a qualified physician.

          In any case, Mr Ullman is now talking about miracle cures, not nanoparticles, memory of water, or spiritual essence.

          • Mr Ullman said unequivally in here in another thread that “only fools or liars” doubted that it was possible to distinguish homeopathic water from other water.

            Did he say that a lab could distinguish homeopathic water from other water?
            If so, then he is trying to come up with a rationalized version of homeopathy that sounds more sciencey; and you are questioning him about his rationalized version, not about homeopathy per se.
            If not, then he is talking about homeopathy, which makes claims about effects on living organisms, not about what labs can or will do.

          • I’ve already explained the distinguish between homeopathic water and other water to Robin H using two relevant links, but it seems that Robin H is only ever interested in emulating a printer (an output-only device). It’s so damned tedious.

            https://edzardernst.com/2022/02/nothing-much-new-here-about-chucky-windsors-credulity-a-review-of-the-reactions-to-my-biography-of-prince-charles/#comment-137729

          • Robin H: “Did he say that a lab could distinguish homeopathic water from other water?”

            I can’t recall. At one time he provided the name of an institution in India which he claims can tell the difference. It has a number of laboratories, but he never said which one could do the job, nor named anyone in the institution who he thinks is qualified to conduct the test.

            He has also never given any other method that might distinguish a homeopathic cure from water (or whatever other solvent was used). Nor has he said what techniques a laboratory could use to conduct the test, if indeed he thinks that a laboratory test is appropriate.

          • “At one time he provided the name of an institution in India which he claims can tell the difference. It has a number of laboratories,”

            Not quite. He gave the name of a kind of ‘umbrella body’ that represents a chain of universities across India. Two other kind souls on here, ‘has’ and ‘Lenny’ provided information including a list of the universities under the umbrella Mr Ullman referred to, and also suggested possible departments and names for Mr Ullman to confirm or otherwise. He didn’t.

          • What Dana Ullman said was,

            The proof was published in Langmuir (2012). The proof was published in the meta-analyses sponsored by the government of Switzerland…and of Australia (in their original report, not the bastardized junk science review that got 99% of the press…and also in the FINAL report from the Australian government …

            In other words, he gave vague references to articles and reports. “Langmuir 2012” seems to refer to Why Extreme Dilutions Reach Non-zero Asymptotes: A Nanoparticulate Hypothesis Based on Froth Flotation. The abstract of that paper:

            Extreme dilutions, especially homeopathic remedies of 30c, 200c, and higher potencies, are prepared by a process of serial dilution of 1:100 per step. As a result, dilution factors of 1060, 10400, or even greater are achieved. Therefore, both the presence of any active ingredient and the therapeutic efficacy of these medicines have been contentious because the existence of even traces of the starting raw materials in them is inconceivable. However, physicochemical studies of these solutions have unequivocally established the presence of the starting raw materials in nanoparticulate form even in these extreme (super-Avogadro, >1023) dilutions. In this article, we propose and validate a hypothesis to explain how nanoparticles are retained even at such enormous dilution levels. We show that once the bulk concentration is below a threshold level of a few nanograms/milliliter (ng/mL), at the end of each dilution step, all of the nanoparticles levitate to the surface and are accommodated as a monolayer at the top. This dominant population at the air–liquid interface is preserved and carried to the subsequent step, thereby forming an asymptotic concentration. Thus, all dilutions are only apparent and not real in terms of the concentrations of the starting raw materials.

            From the article,

            contrary to the existing
            beliefs that these dilutions would be devoid of any physical
            entities, Chikramane et al. found that homeopathic medicines
            prepared using metal powders as the starting raw materials
            retained them even at extreme potencies of 30c and 200c
            (dilution factors of 1060 and 10400, respectively), much beyond
            Avogadro’s number.

            Nothing about anything other than metal powders. Homeopathic preparations can be made from anything, including non-material “things”.
            So a lab may have detected some metal powders adhering to nanoparticles in extreme dilutions, but that was it.

          • From SBM, a critical article on the idea that homeopathic preparations contain some of the “active ingredient”, via nanoparticles.
            So Dana Ullman was talking about an attempt to scientize homeopathy.

          • Did he say that a lab could distinguish homeopathic water from other water?
            If so, then he is trying to come up with a rationalized version of homeopathy that sounds more sciencey; and you are questioning him about his rationalized version, not about homeopathy per se.
            If not, then he is talking about homeopathy, which makes claims about effects on living organisms, not about what labs can or will do.

            If these effects are detectable, a lab can use them to distinguish between homeopathic remedies and. solvent. If not, they don’t exist.

          • @Mojo

            If these effects are detectable, a lab can use them to distinguish between homeopathic remedies and. solvent. If not, they don’t exist.

            No – what a lab can do depends on what technology they have developed. People’s bodies have different capabilities from a lab.

            In any case – I looked up the Langmuir 2012 reference that Dana Ullman gave, and discussed it in another comment. DavidB’s question seems to have been answered. Dana Ullman was referring to a specific paper in an ACS journal, where someone said they did the homeopathic dilution process with a a couple specific ingredients, some metal powders, and they said the metal powders made it in measurable quantities into the final product.
            So Dana Ullman was talking only about homeopathic dilutions that had been done with a couple of specific ingredients. He was not claiming that a lab – somewhere – could differentiate between a homeopathic preparation and the plain solvent in ALL cases.
            That would be quite a claim, and it would be surprising if he made it. I have only seen hand-waving from him so far. If anyone has a link where he did claim this about homeopathic preparations in general, please give it.

          • If a remedy—metal or not—does anything at all it should be detectable, either by (blinded and randomized) provings and use by patients…or really anything else. You can take whatever it is you need and carry it into a lab. Or not.

          • yes, there have been several challenges where sizable amounts of money would be given to the person who can do this by whatever means. as far as I know, only the German one by the INH was taken up by someone who then failed.

          • @Christine Rose

            If a remedy—metal or not—does anything at all it should be detectable, either by (blinded and randomized) provings and use by patients

            Yes … it comes down to evidence from clinical trials. Not lab technology.
            @Edzard
            Yes, the safety of Randi’s million dollars, that he offered to anyone who could prove a paranormal ability, including being able to tell a homeopathic preparation from placebo, is pretty good evidence too.

          • Here’s what looks like a good detailed critique of the Langmuir 2012 paper, which claimed that repeated homeopathic dilutions of a couple metal powders weren’t actually diluting them.
            It looks like the paper is junk, from the critique.

          • Robin H wrote “it comes down to evidence from clinical trials.”

            No it doesn’t come down to that. If a clinical trail compares A vs B, it is extremely unlikely that zero difference can be detected when A and B are identical; such as homeopathic water vs other water.

            The same is true when attempting to measure the bias in a random number generator or a coin. The probability P of obtaining zero bias in a truly unbiased coin reduces as the number of coin tosses (trials) N increases:
            N=100 P=8% chance of result=0 bias
            N=1000 P=2.5%
            N=10,000 P=0.8%
            N=1 million P=0.08%
            etc.

            In parapsychology, increasing values of N are used to give the impression that the ‘tests’ have increasing power to detect the phenomenon under investigation. Whereas all that’s happening by increasing N is reducing the chance of getting a zero result; an absence of the phenomenon under investigation. Not very clever, yet clever enough to fool those having a desire to believe in the paranormal.

          • @Pete Attkins
            Skeptics certainly aren’t obligated to evaluate the evidence from clinical trials in the way that the true believers do. If they were, they’d be in a pickle indeed. And very confused.

            In parapsychology, increasing values of N are used to give the impression that the ‘tests’ have increasing power to detect the phenomenon under investigation. Whereas all that’s happening by increasing N is reducing the chance of getting a zero result; an absence of the phenomenon under investigation. Not very clever, yet clever enough to fool those having a desire to believe in the paranormal.

            You could never prove that a homeopathic preparation is 100% certain to have zero effect beyond placebo.
            But you could narrow the 95% confidence interval for the effectiveness with larger sample sizes with clinical trials.
            And that’s all that’s needed to show that the homeopathic preparation is a waste of time and money.
            Suppose a homeopath were to tell their pain patients “The best evidence from clinical trials indicates that this homeopathic preparation has no more than a 0.1% chance of decreasing your pain level by 0.01 more than a placebo, on a 1-10 scale “. Or whatever symptom the patient wants help with. Then the patient would say “That isn’t worth my money or time, bye”.

          • Robin H, You are missing the point, as usual.

            RCTs are for estimating the size of an effect (science); not for detecting whether or not the effect actually exists, which is pseudoscience, especially when the A and B being tested are identical.

            However, you seem hell-bent on providing relentless distraction to the issue of Dana Ullman branding certain people “fools or liars”.

    • Oh Dana, is that the best you can do–a rant on Pharma? I am truly disappointed. What is it Ben Goldacre said? “Problems in the aeronautic industry does not mean that magic carpets work”–that’s close enough and my apologies to Dr Goldacre if I misquoted.

  • Of course the evidence is rotten. In Germany this is a billion dollar industry.
    Since 1976 this industry is allowed by law to assess the effect of their “medication” by “alternative standards”.
    Source: https://www.gesetze-im-internet.de/amg_1976/__38.html

  • Hmmmm…I was waiting for SOMEONE (!) here to acknowledge that this problem in “publication bias” is a major problem in ALL areas of medical research…but alas, no one has mentioned this. My comments here are not just about “what-about-ism,” but actually how this problem is much worse in conventional medical research.

    I was hoping that SOMEONE (!) here would show some real objectivity by acknowledging that the authors of the BMJ article admitted that reporting bias is “not a phenomenon that is limited to homeopathy” but that it occurs in all areas of clinical research.

    According to previous studies published in the BMJ which looked at reporting bias in all medical fields:

    Half of all registered clinical trials(1) in conventional medicine fail to report their results within a 12 month period; whereas 62% of all registered homeopathy trials reach publication.

    Inconsistencies in reporting of primary outcome(2) occur in 43% of conventional medical studies; whilst this occurs in only 25% of published homeopathy trials.

    The potential impact of unregistered/unpublished results on estimates of treatment effects is well documented, yet for homeopathy, according to the authors of this BMJ article, the impact may be minimal, or nothing at all: “the difference in effect sizes between registered and unregistered studies did not reach statistical significance”.

    Isn’t it INTERESTING that Eddie choose to NOT mention this fact of the article!? One must therefore ask if Eddie Ernst may himself be proving his own publication bias…AND reporting bias!

    Dr Alexander Tournier, HRI Executive Director explains, “Reporting bias is a well-recognised issue in all areas of medical research, so it is unsurprising that it occurs in homeopathy research. The most interesting finding from this new study, published in ‘BMJ Evidence Based Medicine’, is that we now know homeopathy is out-performing conventional medicine in this respect, with lower levels of reporting bias.”

    References:
    (1) Goldacre B et al. Compliance with requirement to report results on the EU Clinical Trials Register: cohort study and web resource. BMJ, 2018;362:k3218
    (2) Shah K et al. Outcome reporting bias in Cochrane systematic reviews: a cross-sectional analysis. BMJ Open, 2020;16;10:e032497.

    Slam dunk…

    • “I was waiting for SOMEONE (!) here to acknowledge that this problem in “publication bias” is a major problem in ALL areas of medical research…but alas, no one has mentioned this.”
      It seems they are all smart enough to stay on the subject of the article
      … EXCEPT YOU, OF COURSE!

    • Mr Ullman, I would so much value it if you could supply the name of a laboratory that can distinguish between homeopathic water and other water, a feat which you said “only fools or liars” doubt.

      Many thanks.

      Twenty-eighth time of asking…..

      • You do not need a laboratory. Only a carefully structured double blind.

        If a homeopath can tell a real remedy from a blank, or even tell two remedies apart, by any means at all, that would be significant.

        They can “prove” them. Or give them to sick people. Or sense their energy. Whatever they like, so long as the samples are properly blinded and randomized.

  • Criticism of studies of homeopathy miss the point. Following the homeopathic principle that dilution increases potency can’t you see that the weaker the evidence for its effectiveness the more effective it becomes?

    How else can you explain its popularity?

  • The body of medical research in general is rotten to its core:

    “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, ‘poor methods get results’.”
    Dr. Richard Horton, editor-in-chiefLancet, Apr 11, 2015 editorial

    That is why I recommend personal experience over second hand experience or reading about it in journals and Wikipedia.

    • Personal experience is a sample size of one with no control group or blinding.

      Maybe not the most reliable.

    • The body of medical research in general is rotten to its core

      Yet medicine has undeniably made tremendous progress in the past 150 years. Child mortality has dropped from 25% to 0.4%, our lifespan has increased from less than 60 to almost 80 years on average, and the number of years spent in good health has also increased dramatically. And a lot of what were once a life-threatening conditions (infections, heart disease and lots of other health problems) can now be cured, treated, or at least made into a chronic but quite bearable condition. We even managed to halve cancer mortality in the past half-century or so. And please note that homeopathy and other forms of quackery have NOT contributed to these developments in any way.

      So how do you reconcile this with your viewpoint that medical research in general is ‘rotten to the core’?

      That is why I recommend personal experience …

      We tried ‘personal experience’ for the better part of the last 50,000 years or so. It didn’t work.

    • ‘That is why I recommend personal experience… ‘

      And there your entire fallacious argument comes crashing down.

      We are all aware of the long-standing issues with clinical trials. Yet when the homeopathy apologist is asked whether they support the ‘AllTrials’ initiative, the response is silence. You’re coming close to claiming that homeopathy is (no less) valid (than medicine) because all trials are crap. And you expect to be taken seriously?!

  • “IN MY EXPERIENCE”

    What else matters ?
    Should I care what is effective for the collective (the study group) ?

    If taking my personal remedy is effective every time, why would I care if it has been proven to be effective for somebody else with different DNA ?

  • “IN MY EXPERIENCE”

    What else matters ?
    Should I care what is effective for the collective (the study group) ?

    If taking my personal remedy is effective every time, why would I care if it has been proven to be effective for somebody else with different DNA ?
    As an MD prescribing for somebody else yes, but as an individual…. I’ll stick with what have proven to be effective or not effective for me as an individual.

    • If taking my personal remedy is effective every time, why would I care if it has been proven to be effective for somebody else with different DNA ?

      What personal remedy do you mean? For what?
      A person has about 999/1000 of the same genes as a random other person. It’s very unlikely that something would be effective for you personally, and not effective for others.
      Also, it often happens that someone thinks something is effective when it’s not. If so, they’re wasting time, money and effort on the remedy.
      And they might not get some treatment that IS effective.
      Or in the future, if they become seriously ill they might think that their serious illness could similarly be fixed by some unproven treatment. People give all their money to cancer clinics selling bogus but expensive cures, and if they avoid getting mainstream cancer treatment, they may die before they have to.

    • @James Joromat

      What else matters ?
      Should I care what is effective for the collective (the study group) ?

      Of course, nothing else matters but your own experience. I take it that you have a lab in your basement where you have already tested all possible remedies on yourself and know which one to use for a host of diseases and conditions that afflicts mankind. Next time, when you are very ill and incapacitated you or your loved one knows what remedy to use without needing to consult a MD or alt-med practitioner.

  • They said some things about the state of reporting bias in mainstream medicine, in the paper, to put the problems with homeopathy research in perspective.

    To reduce reporting bias, public trial registries such as ClinicalTrials.gov in the USA and ClinicalTrialsRegister.eu in the European Union have been founded to promote the prospective registration of all trials. Since an amendment of the Declaration of Helsinki in 2008, prospective trial registration and publication of results are regarded as an ethical obligation of investigators. In 2005, the International Committee of Medical Journal Editors (ICMJE) adopted a policy that the journals they oversee would only publish results of clinical trials which have been prospectively recorded in a public registry. These measures have led to an increase in the number of clinical trials that are prospectively registered; however, researchers are not obligated to publish results of such trials and the proportion of non-publication remains high. …
    Over the past years, numerous studies reported that, despite registration, large proportions of completed trials
    remained unpublished. For example, an assessment of 2132 registered clinical trials in Germany between 2009 and 2013 showed that 33% remained unpublished after 5 years. Likewise, of 4347 clinical trials conducted in academic centres in the USA, 34% remained unpublished.

    The point of prospectively registering trials is to avoid the hidden reporting bias that happens when this is not done. Registering the trial before it’s done tells the world that it will be done, before the researchers know if they will like the results.
    From a 2018 review of trial registrations analyzing papers published 2013 or shortly before,

    In analyses of more than 8000 RCTs published in medical journals, half of the RCTs … had not been registered, and 4 in 5 published RCTs had not been registered prospectively.

    This has likely improved in the last 10 years, since registration was trending upwards in the decade before that.
    It seems in 2013, the frequency of registering/publishing trials in mainstream medicine was apparently similar what it’s like in homeopathy research today.
    They say about homeopathy research

    25% of primary outcomes were altered or changed compared with the registry.

    This can also create bias. If you are doing a trial and what you’re measuring based on what’s happening in the trial, a new trial should be done. Feynman made a <a href="https://thejeshgn.com/wiki/great-speeches/cargo-cult-science-by-richard-feynman/&quot; good speech on avoiding bias in science.

    Because regulatory agencies do not require proof of effectiveness for homeopathic products, little attention has been paid to the non-publication of homeopathy trials and its consequences.

    It sounds like regulators need to require proof of effectiveness for homeopathic products. Not requiring proof leads to shoddy research.

    • But also,

      regulatory agencies do not require proof of effectiveness for homeopathic products.

      This means that clinical trials on homeopathic products are different from clinical trials of pharmaceuticals, so comparing prospective registration rates for them is an apples and oranges comparison.
      When a clinical trial of a pharmaceutical is done, they would surely have to inform the regulatory agency about it beforehand, and not change the primary outcome during the trial.

  • Dr Ullman, I was unfamiliar with the letters after your name so looked them up on Acronym Finder. I guessed they must have a medical significance. Fascinated to discover that MPH stands for Male Pseudo-Hermaphroditism and CCH for Certified Crystal Healer.
    It’s always nice to meet someone who has elected to serve such a specialized field.

    • Yes, that MPH is the good ole masters in public health from UC Berkeley. This prestigious university’s alumni magazine conducted one of their five-page interviews with me back in 1999. ‘Tis a special honor that this university chose to show some love to me and to homeopathy. The link that accesses this article is in this bio:
      https://homeopathic.com/about/

      Never been more proud of my training in public health.

      And CCH is certified in classical homeopathy…where I literally see a miracle every day of my practice. There are GOOD reasons that homeopathy’s founder, Samuel Hahnemann, MD, challenged skeptics to AUDE SAPERE, dare of taste, to experience…and then, see for yourself. Until and unless you chose this, you’re simply mentally masterbating.

      • Mr Ullman, if you could take a minute to name a laboratory that can distinguish between homeopathic water and other water, that would be much appreciated.

        Twnety-ninth time of asking.

      • I understand the certified bit – that seems entirely appropriate.

      • “And CCH is certified in classical homeopathy…where I literally see a miracle every day of my practice”.

        This seems a little confusing – are you literally talking of miracles, Mr Ullman? Does this mean that you do not claim there is any scientific basis for homeopathic medicines and that cures attributed to them are due to miracles, not nanoparticles, memory of water, or spiritual essence? And that therefore the selection of ‘remedy’ is irrelevant?

        What do you take to be the source of the miracles?

        May I ask please where you studied for your Certificate in Classical Homeopathy? How much of that training and certification do you now consider meaningless, in view of your current opinion that cures are literal miracles?

        Where do you now stand regarding your former claim that a laboratory can tell the difference between homeopathic water and other water – is that claim now withdrawn?

      • There are GOOD reasons that homeopathy’s founder, Samuel Hahnemann, MD, challenged skeptics to AUDE SAPERE, dare of taste, to experience…and then, see for yourself.

        Yes, he lived too early to know much about the scientific method.

      • So Dana…what exactly does “mentally masterbating” involve? Is it the act of mentally masturbating over the fact that you have a Masters Degree in Public Health?

      • … where I literally see a miracle every day of my practice …

        … which, with all due respect, is more consistent with someone who lives in tinkly fairy land and believes in magic than with someone who critically searches for and examines evidence for the things they believe.

      • Except “sapere aude” translates as “dare to be wise”…That was the motto of my old school.

        Try again.

      • Did the person claiming to be a health professional (with an MPH from UCB no less!!) really misspell “masturbating” ?

        “Never been more proud of my training in public health.”

        I guess not a lot of hours were spent on sexual health. Or spelling. Or critical thinking. Rather than be proud, I’d ask UCB for a refund.

  • None (!) of the 19th century infectious disease epidemics were stopped due to any vaccines or any drugs, except if you want to call “soap” a drug! It is good old-fashion public health improvements and increased sources of foods and nutrients that have led to the greatest reductions of mortality.

    • Mr Ullman, if you could take a moment to name a laboratory that can distinguish homeopathic water from other water, that would be much appreciated.

      THIRTIETH time of asking……

    • @Dana Ullman

      None (!) of the 19th century infectious disease epidemics were stopped due to any vaccines or any drugs …

      That is because none of the 19th century infectious disease epidemics were stopped period. Until the late 1800’s, the average life expectancy in the US still hadn’t progressed much beyond 40 years of age. The same goes for child mortality, that only began to drop from 1875 onwards. Which of course is logical, as the average life expectancy is intimately coupled with child mortality.

      Yes, sanitation and hygiene (the latter especially in hospitals) were instrumental in preventing infectious disease, but please realize that these improvements were based on the same scientific principle that provided us with antibiotics and safe vaccines, i.e. the germ theory of disease. Note that it was NOT ‘life force’, and most certainly NOT ‘miasmas’.
      (From what I know, food was less of an issue, as most people had enough to eat for most of the time.)

      It is absolutely modern science and modern (real) medicine based on that science that have given us our current life span and health, and if our modern-day healthcare would be completely abandoned, we would be thrown back in time for at least a century or so health-wise.
      Homeopathy has contributed exactly one important thing to these developments: the insight that it is often better to do nothing than to always intervene at all cost(*). Ironically, this lesson is taken to heart first and foremost by real medicine, not homeopaths – because accepting this insight would mean that they would have to concede that what they do is indeed nothing more than a placebo treatment. For all the rest, homeopathy has not contributed to human health or longevity in any way.

      *: Which is why homeopathy was so ‘successful’ in its early days: not because it was so effective, but because regular medicine around 1800 was so appallingly bad that it tended to cause more harm than good. Hospitals were places where people got infected and died, and doctors performed all sorts of very harmful treatments such as bloodletting and dressing wounds with infective materials.
      Which also demonstrates why it is not a good idea stick to personal experience and tradition and ignore newer insights, because that is exactly what all those regular doctors did – and what homeopaths do now.

      • #LOL!

        Yeah, sure. I’m amazed that you believe that cholera, yellow fever, scarlet fever, and typhoid are widespread. What is additionally amazing is that your colleagues here, who seemingly believe in “evidence,” haven’t yet corrected your gross errors in fact.

        As for real medical history, homeopathy achieved its greatest popularity in Europe and America in large part due to its compelling results in treating infectious disease epidemics of the 19th century. In fact, FOUR different Popes gave the highest awards that a Pope can give to non-clergy to homeopathic physicians due to their heroic and successful treatment of people suffering from these pandemics in the 19th century.

        Conventional medicine may not be using bloodletting anymore, but it continues to use dangerous and questionably effective treatments. This is why, with rare exceptions, most conventional drugs are only in use for 10 or 20 years because eventually good science shows that they are more dangerous than effective.

        History is a better measure of effectiveness than short-term “scientific” inquiry…and that is why homeopathy persists throughout the world despite the significant opposition to it.

        • “History is a better measure of effectiveness than short-term “scientific” inquiry”
          Bravo!
          May I quote you when citing major misunderstandings in medicine?

        • Mr Ullman,

          If you could take a moment to name a laboratory that can distinguish between homeopathic water and other water, that would be much appreciated.

          Thirty-first time of asking…..

          • Once again, I will simply encourage you to read and re-read this article:
            https://journals.sagepub.com/doi/full/10.1177/15593258211022983

            You might learn a thing or two (finally)…

          • Yes, Mr Ullman, we read it and we discussed it here:
            https://edzardernst.com/2021/07/dana-ullman-has-just-published-two-papers-in-real-science-journals/

            The very post on which you wrote:
            In any case, no one, except liars and fools, can now say that homeopathic water is “the same” as “water.”

            I suggest that you reread the post, and all the comments.

          • Dana

            Rather than posting a link to one of your own laughable pieces of tendentious, tiresome and vapid bumwash explaining how angels on pinheads might best be counted, how about – as David has repeatedly and politely requested – telling us which laboratory would be able to tell homeopathic from non-homeopathic water. Should be easy. You could shut us all up once and for all. Imagine how triumphantly you’ll be able to strut and crow when it is unarguably demonstrated that homeopathic water is so different to ordinary water.

            You haven’t done so, though.

            Could it be that you know you’ll be shown – again – to be wrong?

            TBH I’m not sure why we bother asking. You’re already proved yourself repeatedly to be an ignorant, irrelevant and pompous blowhard who exists only as a laughable figure of scorn. Providing us with another rhetorical nail to bang into the lid of the coffin which holds your reputation as a commentator on matters scientific isn’t going to prove anything.

          • I cannot but agree with Lenny, with a sad, but not unamused little shake of the head (having re-read the paper, as requested).

            I respectfully repeat my request, Mr Ullman, to name a laboratory that can distinguish homeopathic water from other water.

            Thirty-third time of asking.

            If you could also now answer my additional previously-posted questions, please explain the role of the miracles you said you see every day, and whether for you these replace theories of homeopathic modalities.

            I would point out, respecting the paper cited, that the Simple Past tense of the verb “to shake” is “shook”, not “shaked” and the Past Participle is “shaken”. Thus, “We shook the flask after dilution” or “The flask was shaken after dilution” not “We shaked the flask” or “The flask was shaked”.

            Also, as far as I know, in American English (which I like and respect) as in British English, the Simple Past tense of the verb “to grind” is “ground”, not “grinded”.

            Also, as has been discussed in this Forum, and beautifully elucidated by Dr. Money-Kyrle, it’s “different FROM”, not “different THAN”.

            I was inclined to suggest that these observations if taken up, might help to polish your paper. But then I reflected that “You cannot polish a……….”.

          • @Dana Ullman
            This is just Tooth Fairy Science. It is very silly to invent elaborate, highly speculative explanations as to how something might work without any credible evidence that it works in the first place. And no, personal anecdotes of how you witness ‘miracles on a daily basis’ are not good evidence. And no, the fairy tales of other believers in magic that you refer to are not good evidence either.

            Not to mention that there are holes the size of barn doors in your tale about ‘nanoparticles’. E.g. how does magically diluted table salt (natrum muriaticum in homeopathy’s dog Latin) fit into this? Salt does not form nanoparticles in water, it completely dissociates into sodium and chloride ions, which are subsequently washed away by serial dilution. Also note that your average adult already has some 200 grams of sodium chloride in their body. One must be a complete idiot to believe that adding the non-existing ghost of a nano-grain of salt can make any difference whatsoever. Yet I still have to come across the first homeopath to admit that there is indeed a huge problem there. And their fairy tale book still lists well over a hundred ‘symptoms’ that they believe are associated with non-existent salt.

            Anyway, I wasted time enough already, back to work!

        • You forgot to mention smallpox, Dana. Why? And the great pox – syphilis. The former eradicated by vaccines, the latter now extremely rare and extremely curable with antibiotics to which it has never become resistant. Why weren’t they wiped out by homeopaths?

          I know why.

          Persist in your little world of fatuous self-delusion, Dana. You remain the insignificant and pig-ignorant figure of ridicule that you always have been.

          • Lenny…my bad. Smallpox was eliminated by a vaccine. And syphilis is cured with good ole antibiotics. Distinct from every person at this website, I admit when I have erred. However, the vast majority of infectious diseases that created epidemics were neither prevented or cured with any medical intervention.

          • Mr Ullman, having branded me as among “fools or liars” elsewhere in this Forum, I would appreciate it if you would name a place that can distinguish between homeopathic water and other water.

            Thirty-first or thirty-second time of asking (I am losing count).

        • @Dana Ullman

          I’m amazed that you believe that cholera, yellow fever, scarlet fever, and typhoid are widespread.

          ?? They WERE widespread in the 19th century and earlier. Nowhere do I say that I believe that they are widespread now.
          And no matter if some religious leaders believed in homeopathy (after all, they also believe in other things that don’t exist), simple statistics show that the real progress in medicine only started when medical science really took off.

          History is a better measure of effectiveness than short-term “scientific” inquiry…and that is why homeopathy persists throughout the world despite the significant opposition to it.

          Um, no. Science is by far the best and most accurate way to understand our world. And if we’re making an appeal to ancient wisdom, then why are many homeopaths opposed to vaccination? Vaccination is at least as old as homeopathy (Jenner made his famous cowpox discovery in 1796, the exact same year that Hahnemann dreamed up his shaken water treatment), and has saved many hundreds of millions of lives since then. Yet countless water-shaking imbecile colleagues of yours are very explicitly anti-vaccine.

          Anyway, homeopathy persists because a couple of naive believers in magic keep claiming that shaken water is a highly effective yet totally harmless medicine, and a lot of people with all sorts of ailments want to believe that this kind of magic medicine indeed does exist. It’s just like faith healing or any other system of quackery that promises painless and effective relief from disease: they’re all banking on the fact that over 80% of ailments resolve naturally, and then take the credit when indeed that is what happens.

        • … homeopathy persists throughout the world despite the significant opposition to it.

          No, the myth of homeopathy persists because of gullibility and ignorance exploited by the likes of grifting bluffers like you. You are analogous to Brexit big mouthpieces, in that you know it has always been nonsense, but you have deceived people for your own benefit. And it’s too difficult to come clean, isn’t it? You don’t have the integrity. That, or you are simply an utter fool, unable to see that your reiterated nonsense has been debunked countless times.

  • Also Mr Ullman, please answer my questions about the ‘miracle cures’ you say you see every day.

  • lol

    You simply can’t stand it when a person exercises freedom to choose their own medicine, freedom to think differently, freedom to think for themselves. You want to make everyone else fit neatly into your box.
    It’s all good Mr. Daneel …. live and let live.

    My experience with MD’s during my life is about fifty/fifty. That is to say that some benefited me, and others did not. That is also not far from the efficacy of most medication I was prescribed. Should I be impressed ?

    Therefore, if something benefited me, then great, I might be open to using it again if needed for myself or a family member. It I found the treatment ineffective, and something else beneficial, I’ll continue using that also, and no amount of statistics from test trials will change my thinking. We simply don’t all react to treatments the same. If we did, test trials would come in with higher than 95% efficacy…but they don’t.

    • @James Joromat

      You simply can’t stand it when a person exercises freedom to choose their own medicine, freedom to think differently

      Interesting thought process James! I never implied anything of that sort. In fact, I agreed with you in my last post, and pointed out a few loopholes in your plan. Here is what I said:

      Of course, nothing else matters but your own experience. I take it that you have a lab in your basement where you have already tested all possible remedies on yourself and know which one to use for a host of diseases and conditions that afflicts mankind. Next time, when you are very ill and incapacitated you or your loved one knows what remedy to use without needing to consult a MD or alt-med practitioner.

      But hey! You are free to twist my words and make stuff up in your delusional mind! Freedumbs! Amirite?

      As one famous Doctor said: It’s my life!, it is your life James, you are free to exercise your freedoms as you choose and say whatever comes to you mind. However, do not forget that others have the same freedoms. They can choose to exercise their freedoms by pointing out the innate idiocy in your posts and laugh at you.

      • R Daneel

        If you re-read my post, you will notice that I laugh at you also…. first.

        • If you re-read my post, you will notice that I laugh at you also…. first

          Of course. That is the least you could do when someone points out your idiocy. Or you could go on a tangential bullshit of a tirade about individual freedoms, which you also did.

    • Seems an odd conclusion to draw. The research has clearly demonstrated that homeopathy is clinically ineffective. So how can “does bugger-all” be an overstatement?

  • The underlying problem with homeopathy research seems to be that almost all of it is done by true believers, or people who badly want it to work.
    Hardly any of it is done by skeptics. Even Dr. Ernst doesn’t seem to have done any clinical trials on homeopathy – just various reviews and articles.
    It would probably be hard to for a skeptic to get funding for a clinical trial; and a skeptic might not have much interest anyway, since they’d be pretty sure how it will turn out.
    But the believers would get funding from other believers – e.g. some of the money that believers pay for visits to a homeopath and for homeopathic preparations ends up being used in homeopathy research.

    • “Even Dr. Ernst doesn’t seem to have done any clinical trials on homeopathy.”
      NOT TRUE!

      • What homeopathy clinical trials did you do? I looked you up on Medline and didn’t see any.

          • Interesting, thanks! What inspired you to do clinical trials on super-diluted homeopathic preparations?
            Probably it was NOT the hope that you’d find out they actually were better than placebo 🙂 So what was it, then?

            Some trials of homeopathy are positive because they use medications which are homeopathic only by name. This regularly creates considerable confusion.

            Yes, and it helps sell the super-diluted homeopathic preparations. People may use some treatment that is sold as homeopathic, but it’s actually some kind of herbal or natural treatment, such as Zicam, which has Zincum aceticum 2x, Zincum gluconicum 1x, i.e. a lot of zinc. And maybe it really does have the advertised effect.
            This is apparently illegal in the EU, which seems like a really good idea.

          • Robin H, are you not aware of Professor Ernst’s role as the world’s first Professor of Complementary Medicine at Exeter University, a Professorial Chair set up in 1993?

            Have you not read Professor Ernst’s book “Homeopathy, the Undiluted Facts” or his book co-authored with Dr Simon Singh, “Trick or Treatment”? Or any of his other books?

            I believe that it would help you to make more relevant contributions here if you were to more thoroughly familiarise yourself with Professor Ernst’s career.

          • And where and how did you get funding for the clinical trials on super-diluted homeopathic preparations?

          • various sources

          • And where and how did you get funding for the clinical trials on super-diluted homeopathic preparations?

            If you read the papers you can find out where the funding came from.

          • @Mojo

            If you read the papers you can find out where the funding came from.

            That got me to look again:

            Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial:
            The Prince of Wales’s Foundation for Integrated Health, London
            provided a grant for the trial

            and for

            Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery:
            Funding was provided by the Dr Susil Kumar and Jamila Mitra Charitable Trust (UK)

            How much money is there around for research by skeptics on alt-med? How many foundations are willing to fund such research?
            And what would motivate a skeptic to do research for which they already know what the answer will be?

          • How much money is there around for research by skeptics on alt-med? How many foundations are willing to fund such research?
            I AM OUT OF THIS FOR 10 YEARS; DURING MY DAYS, WE HAD TO FIGHT EXTREMELY HARD FOR EVERY PENNY OF RESEARCH FUNDS
            And what would motivate a skeptic to do research for which they already know what the answer will be?
            I WAS NOT A SKEPTIC; JUST A SCIENTIST TRYING TO CONDUCT FAIR TESTS OF SCAM.

          • And what would motivate a skeptic to do research for which they already know what the answer will be?

            That is contrary to being a skeptic. A skeptic has doubts, not answers.

            a person who doubts the truth or value of an idea or belief. (Cambridge)

            A skeptic is always willing to consider new evidence and with sufficient evidence will re-evaluate their doubt.

          • Robin H, You wrote: “How much money is there around for research by skeptics on alt-med? … what would motivate a skeptic to do research …”

            In a placebo-controlled trial, the default hypothesis is that the null hypothesis is true; and that the alternative hypothesis (that the treatment under test is better than the placebo treatment) is false. This is the skeptical position that all researchers must adopt in order to minimize bias, especially confirmation bias.

            I echo DavidB’s remark to you: “I believe that it would help you to make more relevant contributions here if you were to more thoroughly familiarise yourself with Professor Ernst’s career.

          • @DC

            And what would motivate a skeptic to do research for which they already know what the answer will be?

            First, a sceptic does not know what the answer will be, but may consider a particular outcome highly likely, based on prior plausibility and earlier research
            One major reason for doing research is to see if preconceived notions may be wrong after all (falsification). Another important reason is to gather and present evidence for a hypothesis in a formal manner. This way, a hypothesis is no longer just a matter of one sceptic’s opinion, but shows to anyone in a transparent way what outcome was reached and how this was done.

            That is contrary to being a skeptic. A skeptic has doubts, not answers.

            There are degrees of doubt. I have very little doubt that homeopaths’ claims are wrong, simply because they contradict many basic principles of chemistry, physics and biology.

            A skeptic is always willing to consider new evidence and with sufficient evidence will re-evaluate their doubt.

            Absolutely. And please note your qualifier sufficient evidence: for something with an extremely low prior plausibility such as homeopathy, this evidence must not only be plentiful, but also strong in a qualitative sense, and it must be replicated multiple times by independent researchers. Up until this day, there is not even a shred of credible evidence for the viability of the basic principles of homeopathy (‘like cures like’, ‘dilution makes it stronger’, and ‘testing is done with healthy people’). All and any effects observed so far can be safely attributed to placebo/nocebo effects; also note that any effects that are observed are weaker with increasing research quality, and that successful replication is rare in the extreme. And even our resident homeopaths here such as one Mr. Ullman only come up with highly convoluted speculations about possible mechanisms how homeopathy might work, without ever providing evidence that it works in the first place (a.k.a. Tooth Fairy Science). And even then their ‘explanations’ completely fail to explain why only homeopathically diluted water should have those effects, but not water that is diluted in any other way or by any other party than homeopaths.

            So I think that any sensible sceptic/scientist might as well stop the search for the body of evidence on homeopathy – simply because there is no body to be found, just elusive ghosts.

          • @DC

            A skeptic is always willing to consider new evidence and with sufficient evidence will re-evaluate their doubt.

            That is called the “Scientific Method”.

            https://en.wikipedia.org/wiki/Scientific_method

            The fact that you doubt this method or do not seem to know it does not say anything good about you , but only speaks of a quite enormous portion of wilfull ignorance.

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