Psoriasis is a chronic inflammatory skin disorder, affecting the trunk and extensor surfaces of limbs and scalp predominantly. Its prevalence ranges between 0.1 and 11.4% and in India between 0.4 and 2.8%. Psoriasis remains a frequently encountered condition in homeopathy practice, but there is a dearth of evidence supporting its use. 
This 6-month, double-blind, randomized trial was conducted on 51 patients suffering from psoriasis at the National Institute of Homoeopathy, India. Patients were randomized to receive either individualized homeopathic medicines (IHMs; n = 25) in LM potencies or identical-looking placebos (n=26). Psoriasis area and severity index (PASI; primary), psoriasis disability index (PDI), and dermatological life quality index (DLQI; secondary) were measured at baseline, and every 2 months, up to 6 months. The intention-to-treat sample was analyzed using a two-way repeated measure analysis of variance.
Although intra-group changes were significant in both groups, improvements were significantly greater in the IHMs group than in the placebo group regarding the PASI scores after 6 months (F1, 49 = 10.448, P = 0.002). DLQI daily activity subscale scores also yielded similar significant results favoring IHMs against placebos after 6 months (F1, 49 = 5.480, P = 0.023). Improvement in PDI total (F1, 49 = 0.063, P = 0.803), DLQI total (F1, 49 = 1.371, P = 0.247), and all remaining subscales were higher in the IHMs group than placebos after 6 months, but non-significant statistically. Calcarea carbonica, Mercurius solubilis, Arsenicum album, and Petroleum were the most frequently prescribed medicines.
The authors concluded that IHMs exhibited better results than placebos in the treatment of psoriasis. Further research is warranted.
I am unable to access the full text of this paper [in case someone can, please send it to me for further scrutiny]. Judging from just the abstract, I see the following problems with this trial:
- Psoriasis is a genetically determined condition, and I find it hard to believe that homeopathy can change its natural history.
- The symptoms of psoriasis fluctuate and can be influenced by a range of factors, including stress.
- We learn nothing about any concomitant interventions which are always necessary, e.g. creams, or compliance with them.
- It is conceivable that patients in the verum group received inadvertent reassurance which, in turn, reduced stress and improved compliance with external treatments.
- It is unclear whether patients were successfully blinded or whether inadvertent de-blinding occurred.
In any case, I would caution that this trial needs independent replications before we can take its findings seriously.
__________________________
Thanks to several readers, I now have the full text and can add the following points:
- The authors report adverse events as follows: ” No adverse events were reported during the treatment period from either group that could be attributed causally to either IHMs or placebos. Some minor events unrelated to study medications, like common cold and injury occurring in both groups were treated with acute homeopathic medicines irrespective of allocated codes, and once those acute phases were over, the patients were returned to originally allocated groups again.” This is odd because homeopaths would expect aggravations in a high percentage of cases.
- I am not sure that I understand the blinding procedure; it is described as follows: “Double-blinding method was adopted by masking the trial participants, investigators, outcome assessors, pharmacists, and data entry operators throughout the trial. Identical-looking vials were coded as either “1” or “2” and contained either medicines or placebos. The codes remained the same for all the randomized participants. Codes were assigned randomly and confidentially by another independent third party. Both medicines and placebos were repacked in identical glass bottles and labeled with code, name of medicine, and potency, and were dispensed according to the random number list. The vials were destined for each patient by the random number chart. The participants got the medicines dispensed personally at the hospital pharmacy. Codes were broken at the end of the trial after the dataset was frozen.”
- The affiliations of the authors are interesting:1 Dept. of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Block GE, Sector 3, Salt Lake, Kolkata 700106, West Bengal, India; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, India
2 Dept. of Repertory, National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India, Block GE,
Sector 3, Salt Lake, Kolkata 700106, West Bengal, India; affiliated to The West Bengal University of
Health Sciences, Govt. of West Bengal, India 3 Dept. of Repertory, The Calcutta Homoeopathic Medical College and Hospital, Govt. of West Bengal, 265, 266, Acharya Prafulla Chandra Road, Kolkata 700009, West Bengal; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, India
4 East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre,
Village and Post Office: Dakshin Gouripur, Police Station Bishnupur, South 24 Parganas 743503, West
Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, India 5 Dept. of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, 12, Gobinda Khatick Road, Tangra, Kolkata 700046, West Bengal; affiliated to The West Bengal University
of Health Sciences, Govt. of West Bengal, India.
I think it is safe to repeat that independent replications would be essential.
15 Responses to Individualized homeopathy for psoriasis: a double-blind, randomized, placebo-controlled trial
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Some data (supplementary files) are here:
https://figshare.com/articles/dataset/Supplementary_Material_for_Individualized_homeopathic_medicines_in_the_treatment_of_psoriasis_vulgaris_Double-blind_randomized_placebo-controlled_trial/23276315
Supplementary file 8 is a table detailing the treatments for both the verum and the placebo groups.
I am not able to grasp how the treatments are different; perhaps you could help me.
The placebo vials were packaged and labelled as if they contained the genuine product rather than the placebo product. The tables you mentioned contain this label information.
[The most frequently prescribed medicines:]
This is pig Latin for calcium carbonate, the primary ingredient of limestone, chalk and marble. Upon ingestion, it immediately reacts with stomach acid (hydrochloric acid) to produce calcium ions and carbon dioxide. And as we already have lots of calcium ions as well as calcium compounds in our body, it is chemically and biologically impossible that the homeopathic ghost of a bit of limestone diluted into oblivion has any effects at all.
This is pig Latin for mercury (II) nitrate, diluted into oblivion. As it is water soluble, it is impossible that there are any molecules of this compound left after homeopathic dilution (which in fact is a Very Good Thing, as the stuff is extremely neurotoxic in several different ways). Which in turn means that it is chemically and biologically impossible that this ‘remedy’ has any effects at all.
… which is NOT a song collection by a death metal group, but pig Latin for arsenic trioxide, another soluble poison. See the explanation about mercury nitrate why this stuff can’t possibly have any effects in homeopathic dilutions.
… which is crude oil, diluted into oblivion with the help of sulfuric acid. Like any other homeopathic dilution, this one too has an extremely low plausibility that it does anything at all. Do NOT confuse with petroleum jelly (brand name Vaseline), which is in fact an undiluted mixture of larger hydrocarbons, and is somewhat effective in ameliorating skin conditions (including psoriasis) as a topical ointment.
And oh, in dreaded anticipation of Mr Ullman’s nanoblather: apart from the fact that his nanoparticle ‘theory’ has holes in it the size of barn doors, none of the above compounds can form persistent nanoparticles upon dilution. The same goes for lots of other homeopathic ‘remedies’ described in the
biblemateria medica.So I guess we can already toss out most of those homeopathic preparations à priori, simply because it is chemically and biologically impossible that they have any effects at all – making homeopathy as a whole extremely implausible, even when accepting Mr Ullman’s nanoblather as an explanation of its mechanism of action.
Sorry if this sounds like a pedantic question but is it really impossible that a homeopathic preparation contains no molecules of the ‘active’ substance? Extreme dilution makes it highly improbable that a particular sample contains even one molecule but surely not impossible? Or is there some other mechanism going on which makes it impossible?
Not that it matters so far as the absurdity of homeopathy is concerned. Presumably most of the ‘active’ stuff gets poured down the drain during the dilution where it eventually ends up in our tap water, further diluted and therefore more potent.
@Socrates
This is not a pedantic question at all, and the answer is that it is in fact by definition possible that molecules of the original ‘active’ substance are still found. I can think of at least three ways for this to happen:
– By chance. When a substance is properly diluted to the point that Avogadro’s number is reached (roughly 1:10^24 ~=12C in homeospeak), there is a fair chance that there is still one molecule left. At the next 1:100 dilution, this chance decreases to 1/100, or 1%. So with a 13C dilution, there is still a one percent chance that there is one molecule present etcetera. And at 30C (a dilution of 10^60), this chance is astronomically small – 10^-36 to be precise, which is way, way smaller even than the chance to win the lottery jackpot 10 times in a row – but still not zero.
So when I say that it is impossible that there are any molecules left, I am in fact lying. It is still possible, but extremely improbable.
– By homeopaths messing up. The most likely reason why some traces of the original material can still be found in homeopathic preparations is simply because their dilution procedure somehow fails. This can happen when the original material sticks to the walls of the container used to perform the dilutions, or because of other contamination pathways, causing detectable amounts of the substance to be inadvertently added again at each dilution step. The resulting dilution of course is then not e.g. the intended 30C, but only 3C or 4C. This is also what Mr Ullman based his nanobabble on: some researchers still found minute aggregations (‘nanodoses’) of the original substances (mostly metals, IIRC) after diluting and shaking.
– By natural contamination. Many substances used in homeopathy are naturally found in our environment and in the materials we use. For instance glassware and metalware used for diluting substances inevitably contains traces of arsenic and lots of other elements. If you set out to make e.g. arsenicum album 30C, you will never reach that dilution – the arsenic leaching from the equipment you use will ensure that there will always be thousands or even millions of arsenic ions present in the resulting dilution. (I also describe this problem in my recent book.)
Yep, that’s one old and still quite valid point of criticism. Apart from freshly collected rainwater, all the water we drink has contained as well as passed through all sorts of substances and organisms. So it must be a true panacea, in fact making all of homeopathy obsolete.
BTW I really hope that they don’t toss any of that mercury nitrate I mentioned down the drain … Then again, if they’re smart, they just need 1 milligram of the stuff, which they can then dilute to more ‘medicine’ than there is water in all the oceans.
Oops, correction:
I screwed up here: assuming that you have a 1 in 100 million (1:10^8) chance of winning the lottery jackpot, then you have a 1:10^16 chance of winning it twice in a row, 1:10^24 of winning it three times etcetera.
Which means that this 10^-36 probability of finding one molecule in fact equals winning the lottery jackpot 5 times in a row. So homeopaths aren’t the only ones messing up with extremely small numbers and probabilities 🙂
Not that it matters to the biological effect, but I think you will find that the number of ions or number of molecules that remain, can be approximated by a Poisson distribution.
E.g., if the expected number of ions in the final dilution is 1 then the probability of actually getting k ions in the final dilution is as follows:
k P(k)
0 0.368
1 0.368
2 0.184
3 0.061
4 0.015
5 0.003
≥6 0.001
Σ P(k=0..∞) = 1
For lower dilutions, which have many ions/molecules remaining:
• arithmetic mean ≈ the expected number;
• standard deviation ≈ √ (expected number).
I love it when seemingly high quality randomized placebo-controlled and double blind trials show a significant effect from homeopathic treatment, and people at this website do ALL they can to purposefully misunderstand scientific inquiry.
First stage: DENIAL: Ernst writes: “Psoriasis is a genetically determined condition, and I find it hard to believe that homeopathy can change its natural history.” Isn’t the whole purpose of randomized placebo-controlled and double blind trials to evaluate if and when a treatment provides a significant difference between it and a placebo?
Second stage: MISINFORMATION: Ernst writes: “This is odd because homeopaths would expect aggravations in a high percentage of cases.” Please show me hard evidence that “aggravations” from homeopathic treatment are experienced in a “high percentage of cases.” The experience of an “aggravation” of symptoms (a temporary worsening of symptoms prior to an experience of heightened benefits) is always been in a small minority of cases, not a majority (and Ernst KNOWS this!).
Third stage: PRETEND CONFUSION: Ernst writes: “I am not sure that I understand the blinding procedure.” Did anyone notice that he didn’t explain what you didn’t understand…thankfully, in the comments section, Peter Attkins makes it clear that there is no reason for confusion, pretend or not.
Fourth stage: Make-believe evidence: Ernst writes: “It is conceivable that patients in the verum group received inadvertent reassurance which, in turn, reduced stress and improved compliance with external treatments.” Yes, anything and everything is “conceivable,” but aren’t people HERE believers in “evidence.” What is your evidence here, sir?
And yeah, I can go on…but please stop pretending that this trial is the only good study in history to show a significant benefit from homeopathic medicine. There have also been similar such high quality trials published in the Lancet and BMJ (multiple times!), Pediatrics, Chest, Rheumatology, Cancer, The Oncologist, Plos One, and Pediatrics Infectious Disease Journal…and on and on.
“purposefully misunderstand scientific inquiry”
No, it’s called critical analysis, Dana – you should learn it!
@Dana Ullman
Sorry to burst your balloon, but those homeopathic ‘medicines’ they used cannot possibly have any effects, as I explained at length. Your water-shaking brethren most likely messed up their trial one way or another, or perhaps they simply made up the outcome. Homeopathy has been adopted by certain foolish politicians as a highly prestigious part of Indian culture, and just like with TCM in China, negative outcomes are therefore extremely undesirable.
Don’t ya HATE it when your personal beliefs are disproven by science?
It is no wonder that you hate homeopathy because there are way too many times that your personal beliefs have been disproven. You may call this “cherry-picking” evidence…but there are now just way too many cherries.
And of course, there is no irony to the fact that you choose to ignore what the science says by simply believing more in your own theories and assumptions than the evidence.
Indeed, Dana. As your faith in magic shaken water has been. You just can’t accept it. Because you’re an ideologically-blinded fool.
And you just HATE that the only attention your fatuous, demented spoutings get is us laughing at them.
Show us when homeopathy becomes the gold standard treatment for psoriasis. Won’t happen. Ever. Dermatologists will pay this no heed whatsoever.
The boat sailed years ago, Dana. Shame you weren’t on it. You’re shouting at the empty ocean.
As ever, the soldiers march by and Private Ullman is very happy that he’s the only one marching in time.
@Dana Ullman
Well, you certainly do …
The thing here is that you really appear to believe that homeopathy has anything to do with science – even when 99.9% of actual scientists reject that notion. Please note that you are not the one who gets to decide what is science and what isn’t. According to the overwhelming majority of scientists, homeopathy is not science, but pseudoscience, a system of belief that doesn’t actually work. It is safe to say that homeopaths think of science the same way that they think of medicines: dilute the actual substance completely away, and then proudly claim that you’ve produced the Real Thing.
Also, I can’t help but notice that once again,you fail to address the real scientific arguments that show that homeopathy’s preparations can’t possibly work. What exactly is wrong with what I explain about calcium carbonate and mercury nitrate etcetera? They certainly don’t fit into this nanodrivel system of yours, so either admit that they don’t work, or present another plausible(!) explanation.
Or to put it like this: homeopathy is so extremely implausible(*) that we can safely employ Occam’s Razor here: it is a far more reasonable explanation that your water-shaking brethren in India messed up or even made up their results than that their ‘treatments’ are indeed effective. Because we see people screw up and deceive and defraud other people every single day, but we NEVER saw plain water turn into an effective medicine.
*: A strong susceptibility to (self-)deception may be considered the primary job requirement for homeopaths. You are a good example of this mindset: you never actually engage with what I think is valid criticism, but instead insult and denigrate the ones who do not share your silly beliefs, completely ignoring what they actually have to say. At best, you once again dump your pseudoscientific nanobabble ‘paper’ as a response.
Nobody is pretending that it’s the only good study. However, it is the ONLY study of this particular type thus far, hence Professor Ernst concluding:
I think it is safe to repeat that independent replications would be essential. [my emphasis]
The necessity of independent replication has been pointed out countless times on this blog, Mr Ullman, e.g.:
https://edzardernst.com/2018/07/non-reproducible-single-occurrences-are-of-no-significance-to-science-the-example-of-the-homeopathic-diarrhoea-trials/
Here are two instance of my reminders to you, Mr Ullman:
https://edzardernst.com/2022/08/diaralia-40-cp-acute-diarrhea-homeopathie-boiron/#comment-140612
https://edzardernst.com/2022/11/homeopathy-kills-vulnerable-patients/#comment-142276
“The quality of an unreplicated trial is irrelevant.”
Homeopathic medicines? No thank you!
I think that references of homeopathic remedies to medicines risks the end of homeopathy.
‘Homeopathic magic shaken water’ though sounds good and regular usage of this term should help keep us on the up.