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

This randomized, double-blind, placebo-controlled trial investigated whether homeopathic Hypericum leads to a reduction in postoperative pain and a decrease in pain medication compared with placebo. Inpatients undergoing lumbar sequestrectomy surgery were given the homeopathic treatment Hypericum C200 or a placebo in addition to usual pain management. The primary endpoint was pain relief measured with a visual analog scale. Secondary endpoints were the reduction of inpatient postoperative analgesic medication and change in sensory and affective pain perception.

The baseline characteristics were comparable between the two groups. Pain perception between baseline and day 3 did not significantly differ between the study arms. With respect to pain medication, total morphine equivalent doses did not differ significantly. However, a statistical trend and a moderate effect (d = 0.432) in the decrease of pain medication consumption in favor of the Hypericum group was observed.

The authors concluded that this is the first trial of homeopathy that evaluated the efficacy of Hypericum C200 after lumbar monosegmental spinal sequestrectomy. Although no significant differences between the groups could be shown, we found that patients who took potentiated Hypericum in addition to usual pain management showed lower consumption of analgesics. Further investigations, especially with regard to pain medication, should follow to better classify the described analgesic reduction.

I applaud the authors from the Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany (not an institution known for its objectivity in SCAM) to have published this negative study in a journal that is so clearly pro-SCAM that it very rarely contains anything in its pages that is not positive about SCAM. Yet, I am baffled by two things:

  1. The plant Hypericum is used in SCAM as a painkiller. According to the ‘like cures like’ axiom of homeopathy, it should thus INCREASE the pain of post-op patients.
  2. The researchers used a C 200 potency. I ask myself, how can anyone assume that such a dilution has any effect at all? C200 means that the plant tincture is diluted at a ratio of 1: 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000 00000000000000000000. Less than one molecule of the plant per several universes!

To believe that such a dilution might work, one really needs to be a convinced disciple of Hahnemann. Yet, to disregard the ‘like cures like’ axiom, one needs to be what he called ‘a traitor’ to his true art of healing.

36 Responses to Surprise, surprise: Homeopathy is not an effective painkiller! Another negative trial of homeopathy

  • The title of the paper is misleading. The test article did not contain any Hypericum. As usual, we get the “more research is needed” statement. No it isn’t, and this study was a waste of time and resources.

    • Well, indeed, no actual Hypericum. We are in the minefield of the names of homorpathic ‘remedies’.

      Professor Ernst has previously in this Forum, I seem to recall, humorously raised this matter in relation to homeopathic Mercury. There are government controls on the handling and use of mercury in the UK. But homeopathic mercury remedies don’t not seem to be subject to those controls. Why? Because they are admitted not to actually contain any mercury. But if it’s labelled Mercury but isn’t mercury, where does Consumer Law fit in?

      • “Well, indeed, no actual Hypericum.”

        There couldn’t be any actual Hypericum because Hypericum is not a tangible object; it is an ontological concept (a category, a class, or a type).

        Hypericum is a class or type identifier; specifically, the principal taxonomy category genus, which ranks below family and above species.

        The genus Hypericum contains approximately 500 species which are divided into 36 sections as described by botanist Norman Robson.
        — Wikipedia

        This common ontological error is frequently encountered in homeopathy and its ‘remedies’. It is a category error caused by a failure to understand the type–token distinction.

        Simple example:
        • I cannot ride bicycle because bicycle is a concept class or type;
        • I can ride my bicycle because my bicycle is a particular instance of the class/type bicycle.

        https://en.m.wikipedia.org/wiki/Type%E2%80%93token_distinction

        • But in America, you can play piano, as in the UK you can play football or tennis….. I will give this more thought….

          • @ DavidB

            “But in America, you can play piano, as in the UK you can play football or tennis…”

            That was mentioned in the Wikipedia article:

            “The word ‘letters’ is one of many words having “type–token ambiguity”.

            football [noun]
            1. any of various forms of team game involving kicking (and in some cases also handling) a ball, in particular (in the UK) soccer or (in the US) American football.
            “a football club”

            2. a ball used in football, either round (as in soccer) or oval (as in rugby and American football) and typically made of leather or plastic and filled with compressed air.

            So, yes, one can play football using definition 1: play a team game involving kicking a ball. I disagree with you that one can play piano without bastardizing the English language.
            https://www.merriam-webster.com/dictionary/piano#examples

            However, you are missing my point. Homeopaths and their congregations are quick to remind us that homeopathy is a precise healing art. It must be individualized to the client using the correct ‘remedy’, at the correct ‘potency’, at the correct ‘dosing’. Therefore, it’s ludicrous to administer the ‘remedy’ Hypericum, the mother tincture of which could have been made from any combination of approximately 500 species of plants.
            https://en.m.wikipedia.org/wiki/List_of_Hypericum_species

          • “However, you are missing my point.”

            You might be surprised by the alacrity and celerity with which I can miss points!

            Not to drag this august Forum into the territory of subtle semantical sophistry and badinage, however, I shall devote myself to private study and reflection upon the grammatical aspects you raise.

            The point is well-taken regarding the labelling of homeopathic ‘remedies’ (and above 12C, of course, the label is the ONLY way to tell one ‘remedy’ from another – unless Mr D. Ullman makes good on his “no problem” offer to name a laboratory…..). As far as I can see, the homeopathic remedy “Hypericum” specifically means Hypericum Perforatum, St. John’s Wort and as your argument suggests, the label really ought to say so!

          • “Not to drag this august Forum into the territory of subtle semantical sophistry and badinage…”

            Normally, I’d agree, but I think it is important to know how to differentiate genuinely knowledgeable persons from numpties, quacks, and woomeisters.

            This isn’t aimed at you, David, it is a useful tool to have in our baloney detection toolbox…

            The botanical identifier Hypericum perforatum is written in italics and:
            • the first word is the genus, which is capitalized;
            • the second word is the species, which is not capitalized.

            https://en.m.wikipedia.org/wiki/Botanical_nomenclature
            https://en.m.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Organisms#Scientific_names

            Clearly, “Hypericum C200” is a strong indication of quackery.

          • You know, I actually knew that the genus should be capitalised, but not the species, because a Fellow of the Institute of Biology (who had worked with Alexander Fleming no less, and wrote an excellent paper on myths surrounding the discovery of Penicillin) explained this to me years ago concerning Staphylococcus aureus (sorry no italics). In a moment of self-doubt however, I looked online and saw that loads of listings have a capital P for perforatum! Biological illiteracy is not confined to me, it seemeth.

          • And incidentally, I stopped off at a café/resturant on the way home today, and took a photo of a sign they have up which says “Face coverings must be wore when walking around the venue at all times”.

            Fortunately I had my face mask with me and I weared it while walking around the venue at all times…..

          • above 12C, of course, the label is the ONLY way to tell one ‘remedy’ from another – unless Mr D. Ullman makes good on his “no problem” offer to name a laboratory

            Mr. Ullman was referring to the paper 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”.
            According to a detailed critique, this paper has a lot of issues.

          • Was it Neitsche, or Wittgenstein – I forget – who said “We should speak whereof we know; whereof we know not, we should keep silent”.

            Or words to that effect.

          • David,

            It is the provider, not the recipient, of a product, a service, or information — especially an entity who’s making a claim — who needs to demonstrate expertise, due diligence, and intellectual integrity.

            So, it should not matter to anyone that you wrote “Penicillin” instead of “penicillin”. However, if I was writing a technical comment or a technical paper (being a provider of information) then such a mistake should indeed reduce my credibility.

            Two translations of Ludwig Wittgenstein’s Tractatus Logico-Philosophicus have:
            • Whereof one cannot speak, thereof one must be silent.
            • About what one can not speak, one must remain silent.

            Wittgenstein’s friend and colleague Frank Ramsey put it:
            • What we can’t say we can’t say, and we can’t whistle it either.

          • DavidB:

            Was it Neitsche, or Wittgenstein

            Wittgenstein.

            Or words to that effect.

            “Whereof one cannot speak, thereof one must be silent.” Or, as he originally wrote: “Wovon man nicht sprechen kann, darüber muß man schweigen.” From Tractatus Logico-Philosophicus.

        • There couldn’t be any actual Hypericum because Hypericum is not a tangible object; it is an ontological concept (a category, a class, or a type).

          Hypericum is a class or type identifier

          It’s common to use abbreviations in science articles, and this seems to be what the authors were doing.

          • Rubbish. If the author(s) of a scientific paper wrote, say, Homo as an abbreviations for Homo sapiens then we would know that the author was an incompetent ass, an ignoramus; the same applies to the peer reviewers and the journal editor.

          • @Pete Attkins

            They’re obviously aware of the species name, since they use it in the title. So the meaning of the abbreviation is clear. It doesn’t mean they think any plant in that genus could be used.

            Although it could 🙂

          • Good grief! I know the correct name was used in the title of the paper.

            The ‘remedy’ mentioned in the paper, and by some homeopathic ‘remedy’ manufacturers, is:
            Hypericum [potency]

            Here’s an example from a supplier’s website:
            HYPERICUM HOMEOPATHIC / HOMEOPATHY REMEDY Potencies 3c, 6c, 12c, 30c, 200c, 1M

            So tell us, Robin H, as you’ve read the paper that is the subject of the article on which we’re commenting, what was the exact ‘remedy’ used in the trial? Because without knowing the manufacturer, the product identifier, its specification and that of its mother tincture, and its batch number, the trial cannot be replicated and its methods are not traceable/auditable — one of the red flags of pseudoscience posing as science.

            Is there a reason that you’re arguing against things that I didn’t write?

          • Robin H wrote “So the meaning of the abbreviation is clear”.

            The abbreviation for Hypericum perforatum is neither Hypericum nor Hypericum, it is H. perforatum.

            That, Robin H, is a shining example of how one differentiates genuinely knowledgeable persons from numpties, quacks, and woomeisters.

          • Also, Hypericum is used as abbreviation for Hypericum perforatum in non-homeopathy papers. For example, Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. They mention the species name only once, in the introduction.

          • Robin H wrote “Also, Hypericum is used as abbreviation for Hypericum perforatum in non-homeopathy papers. For example, Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. They mention the species name only once, in the introduction.”

            They did not use “Hypericum” as the abbreviation, they used the uncapitalized word (except at the beginning of a sentence. I don’t give a damn who wrote it, it’s incorrect, as shown in the taxonomy articles I linked to in a previous comment. Your logical fallacy is: appeal to false authority.
            https://en.m.wikipedia.org/wiki/Argument_from_authority#Appeal_to_false_authority

            As to your “They mention the species name only once, in the introduction.”: the specific product name, WS 5570, occurs in the paper thirteen times.

            After your distraction, perhaps you will now answer my question:
            So tell us, Robin H, as you’ve read the paper that is the subject of the article on which we’re commenting, what was the exact ‘remedy’ used in the trial?

            I echo what Professor Ernst said to you on 2022‑03‑15: “you don’t have to turn every trivial idea that comes to your mind into a comment.”

          • Yes, the authors can abbreviate scientific names. But there are rules on how it is done.

            When authors are talking about a specific species, they cannot use genus name as abbreviation, esp. when there are several other species in that genus. The authors should have abbreviated it as H. perforatum.

            If it is a monotypic genus, maybe one can get away with using just the genus name, but Hypericum is not monotypic.

            Reputable science journals are particular about how the scientific names are used and abbreviated. Apparently, quacks and quackery promoting journals don’t really care.

            https://www.biosciencewriters.com/Species-Taxonomy-Nomenclature.aspx

          • The abbreviation for Hypericum perforatum is neither Hypericum nor Hypericum, it is H. perforatum.

            That, Robin H, is a shining example of how one differentiates genuinely knowledgeable persons from numpties, quacks, and woomeisters.

            Your point in bringing up their use of the genus name instead of the species name seems to be that it’s a red flag for pseudoscience. But, it isn’t.
            Using “Hypericum” as an abbreviation for the species is done in many such non-homeopathy, non-pseudoscience papers.
            It might be something that’s done in pharmacology papers, as opposed to papers on evolution, say. There are many papers that discuss “Hypericum extract”, and I also came across a paper using Hypericum directly when discussing H. perforatum.
            Also, in this particular case, other species in the Hypericum genus may have similar medicinal activity. The active compounds may be conserved in the genus. There are many papers investigating the medicinal activity of other Hypericum species.
            In that case, it would make sense to talk of “Hypericum extract”, not “H. perforatum extract”.
            And the paper at hand, that Dr. Ernst blogged about, does not seem to be pseudoscience. It was, after all, a double-blind randomized placebo-controlled trial of homeopathy.
            And it turned out negative. If it were pseudoscience, it would have turned out positive.
            One might object to the authors mentioning a non-significant positive result, but authors of non-homeopathy, non-pseudoscience papers often do likewise, and say more-research-is-needed.
            Some very good scientists use English incorrectly in various ways (like they have hoaribel spelling). That doesn’t make them bad scientists, or pseudo-scientists.

          • So tell us, Robin H, as you’ve read the paper that is the subject of the article on which we’re commenting, what was the exact ‘remedy’ used in the trial? Because without knowing the manufacturer, the product identifier, its specification and that of its mother tincture, and its batch number, the trial cannot be replicated and its methods are not traceable/auditable — one of the red flags of pseudoscience posing as science.

            Is there a reason that you persist with arguing against things that I didn’t write? It is beyond tedious, but not unexpected from you.

          • Robin H wrote “If it were pseudoscience, it would have turned out positive.”

            🤣🤣🤣

            Please remember: if you make a claim in a comment, support it with evidence.

            So, if everyone stopped publishing positive trials, there would be no more pseudoscience. I wonder why Professor Ernst never thought of this.

            Thank you, Robin, for adding this incredible gem of wisdom to the toolbox of critical thinking skills. I have a few suggestions for what you could do with it.

          • other species in the Hypericum genus may have similar medicinal activity. The active compounds may be conserved in the genus.

            For example, from Hypericin and Pseudohypericin Contents in Some Hypericum
            Species Growing in Turkey
            ,

            Hypericin and pseudohypericin content in stems, leaves, and flowers of some Hypericum species growing in Turkey, namely, H. heterophyllum Vent, H. hyssopifolium L., H. linarioides Bosse, H. monbretii Spach, H. orientale L., H. origanifolium Willd., H. perforatum L., H. scabrum L., and H. triquetrifolium Turra, was determined by HPLC. Hypericin and pseudohypericin were detected in all species tested except for H. heterophyllum, and the presence in H. orientale and H. scabrum was reported by us for the first time in the current study. … H. montbretti and H. triquetrifolium were found to be superior over H. perforatum with regard to hypericin and pseudohypericin content.

            So hypericin and pseudohypericin, both of which are thought to have medicinal activity, are conserved across a lot of Hypericum species.
            That, and other conserved medicinal compounds in the Hypericum genus, may be why many authors describe it as “Hypericum extract” and not “H. perforatum extract” in pharmacology articles.

          • @ Robin H

            From your pseudohypericin link: ”
            Description
            Pseudohypericin is a predominant naphthodianthrone from St. John’s wort (Hypericum perforatum L.) phytomedicinal drug.”

            Yes “Hypericum perforatum L.”, which is the taxonomical binomial nomenclature, where the appended “L.” is the standard abbreviation used for “Linnaeus”: the taxonomical naming convention derived by Carl Linnaeus[1].

            The above description omits italics, but the species to which it is referring is nonetheless unambiguous. Obviously, the producers of that description are within the realm of genuinely knowledgeable persons, not within the realm of numpties, quacks, and woomeisters.

            1. https://en.m.wikipedia.org/wiki/Carl_Linnaeus

            After yet another of your tedious distractions, will you please answer my question:
            https://edzardernst.com/2022/04/surprise-surprise-homeopathy-is-not-an-effective-painkiller-another-negative-trial-of-homeopathy/#comment-138905

    • And the “trend” statement too.

  • Although no significant differences between the groups could be shown, we found that patients who took potentiated Hypericum in addition to usual pain management showed lower consumption of analgesics.

    How come these trials by hopeful believers all show a non-significant effect in favor of homeopathy? At least, the ones that I’ve seen on this blog do.
    Do they just not publish the ones that don’t? Are they p-hacking?

  • Oh dear! Those pesky homeopaths got lucky again with a Cohen d moderate effect for the reduction of medication in the Hypericum group.
    It is a good thing that the researchers didn’t use the MM potency. With two million zeros to paste on your blogpost this would have caused us readers immense problems as we scrolled down to your last paragraph of infinite wisdom.

  • The dilution ratio for the preparation is given as 1:0, though in a rather long-winded form. It should be 1:10000000….

  • A student playing cricket at IIT Delhi threw a ball and broke his arm. In 2 pieces. Between shoulder and elbow. Quite extraordinary.

    2 days earlier, while playing badminton, he had slipped and hurt his arm. He had used pain killers provided by his mother (medicine box containing many other drugs) as he had an examination the next day. After examination, he went out to play cricket, threw a ball and broke his arm.
    Now has a steel plate screwed into his arm.

    The real benefit of a pain killer!

    • Krishna,

      I think you hit a sixer with your keen sense of observation. Who would have thought pain killers would make one want to play cricket so badly that they break their arms while playing?

    • A student playing cricket at IIT Delhi threw a ball and broke his arm. In 2 pieces. Between shoulder and elbow. Quite extraordinary.

      Maybe he has rickets, or some other disease that causes brittle bones.

  • “Was it Neitsche, or Wittgenstein – I forget – who said “We should speak whereof we know; whereof we know not, we should keep silent”.

    Or words to that effect.”

    (DavidB on Thursday 21 April 2022 at 07:10)

    It was Wittgenstein: “Whereof one cannot speak, thereof one must be silent.” (Tractatus 7 in the Tractatus Logico-Philosophicus)

    • There is also, of course, the variously attributed “It is better to keep silent and be thought a fool, than to open one’s mouth and remove all doubt”……

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories