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

Post-COVID-19 fatigue is becoming increasingly common as the pandemic evolves. Plenty of so-called alternative medicines (SCAMs) are on offer, including homeopathy. But is homeopathy really helpful?

This trial attempted to identify the preliminary evidence of the efficacy of individualized homeopathic medicines (IHMs) against placebos in the treatment of post-COVID-19 fatigue in adults.

A 3-month, single-blind, randomized, placebo-controlled, parallel-arm trial was conducted at the outpatient department of The Calcutta Homoeopathic Medical College and Hospital, India. Sixty participants were randomized in a 1:1 ratio to receive either IHMs (n = 30) or identical-looking placebos (n = 30). The primary and secondary outcome measures were the Fatigue Assessment Scale (FAS) and Outcome in Relation to Impact on Daily Living (ORIDL), respectively, measured every month, for up to 3 months. Comparative analysis was carried out on the intention-to-treat sample to detect group differences.

Group differences in both the primary (FAS total: F1, 58 = 14.356, p < 0.001) and secondary outcomes (ORIDL: F1, 58 = 210.986, p < 0.001) after 3 months favored IHMs against placebos. Lycopodium clavatum (11.7%), sulfur (11.7%), Arsenicum album (10%), and Thuja occidentalis (10%) were the most frequently indicated medicines. No harm, unintended effects, homeopathic aggravations, or any serious adverse events were reported from either of the groups.

The authors concluded that IHMs produced significantly better effects than placebos in the treatment of post-COVID-19 fatigue in adults. Definitive robust trials may be undertaken to confirm the findings.

A glance at the authors’ affiliations is, I think, revealing:

  • 1Department of Organon of Medicine and Homeopathic Philosophy, D. N. De Homoeopathic Medical College and Hospital, Kolkata, India.
  • 2Department of Pathology and Microbiology, The Calcutta Homoeopathic Medical College and Hospital, Kolkata, India.
  • 3The Calcutta Homoeopathic Medical College and Hospital, Kolkata, India.
  • 4Department of Practice of Medicine, The Calcutta Homoeopathic Medical College and Hospital, Kolkata, India.
  • 5Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Kolkata, India.

We are currently being bombarded with false-positive homeopathy trials from India. Why am I sure that the trial is false-positive? Well, I am not sure, of course. But I have suspicions:

  1. Homeopathy is not a plausible form of SCAM.
  2. The most reliable studies fail to show that is is more than a placebo.
  3. The journal that published this paper is 3rd class; if the findings were valid, they would get published in one of the top science journals.
  4. The authors were clearly biased and even admitted as much; they stated that they wanted “to identify the preliminary evidence of the efficacy” of IHM. But this is not how unbiased researcher conduct clinical trials. Such investigations are for testing hypotheses and not for identifying effects.
  5. Most importantly, the trial design is flawed. Even the authors realize this, and the 1st sentence of the conclusions should therefore have been far less definitive.

And what are the main flaws?

As far as I can see they were:

  • The sample size was to small for a far-reaching conclusion.
  • The study was not double blind. In other words the therapists had the opportunity to exert their influence on the patient to produce the desired outcome. Occam’s Razor demands that we assume this to be the real explanation of the positive effects observed here.

In view of all this, I suggest to change the conclusions as follows:

IHMs produced significantly better effects than placebos in the treatment of post-COVID-19 fatigue in adults which most likely is not due to the efficacy of the treatment applied but to the residual bias not controlled for in this study.

22 Responses to Individualized Homeopathic Medicines in the Treatment of Post-COVID-19 Fatigue

  • May these frauds try their “remedies” when SarsCoV2 enters their brains.

  • Homoeopathy has supposedly been debunked yet there is still so much research being done on it, why is that? Is it possible that Homoeopathy will become mainstream again?

    • “so much research”?
      wrong! it is very little and mostly rubbish.

    • @Mutus Bellator

      … there is still so much research being done on [homeopathy] …

      Nope. PubMed turns up on average about a dozen clinical trials per year, the vast majority of which have negative outcomes, and/or are of dubious quality.

      Is it possible that Homoeopathy will become mainstream again?

      Nope. The overwhelming consensus among real scientists (i.e. not homeopaths or other unscientific quacks) is that the uselessness of homeopathy has been established well enough to just ignore it, and not spend any resources on it any more. The main effort that regular scientists and doctors still spend on homeopathy is educating the general audience that it is no good.

      Only when homeopaths manage to come up with a homeopathic preparation that actually shows any effects(*) in a clear, consistent and independently repeatable way may it be justified to look into it once again. But as homeopaths have utterly failed to produce such a preparation in all 228 years of homeopathy’s existence, no-one is holding their breath.

      *: I’d say that homeopaths are becoming increasingly desperate, as quite a few of their more recent research efforts attempt to show that their homeopathic dilutions 12C+ still exhibit signs of the diluted substance, and that this means that there is something to ‘ultra high dilutions’ after all.
      A far more likely and mundane explanation is that the dilution process was simply screwed up. But this possibility is of course never addressed in their ‘research’.

      • “ *: I’d say that homeopaths are becoming increasingly desperate, as quite a few of their more recent research efforts attempt to show that their homeopathic dilutions 12C+ still exhibit signs of the diluted substance…”

        I hope you don’t mind my renovation:

        *: I’d say that homeopaths are becoming increasingly desperate, as quite a few of their more recent research efforts attempt to show that their homeopathic dilutions faffing around with insoluble metallic gold to 12C+ potencies — but clearly not 12C+ dilutions — still exhibit signs of the diluted original insoluble metallic gold…

        • No, I don’t mind, but this horsing around with ‘potentizing’ insoluble gold is just the latest homeopathic foolishness (pardon the pleonasm).
          Some months ago we had >a href=”https://www.nature.com/articles/s41598-024-51319-w”>another bunch of water-shaking clowns from India messing up in an identical way: when they found that their homeopathic arsenic trioxide dilution still contained measurable amounts of arsenic trioxide, they didn’t hide their faces in shame as they should, nosiree – they triumphantly declared that they found that nanoparticles of arsenic trioxide were responsible for effects on immune cells, and that this somehow ‘proved’ the efficacy of homeopathy.
          All it proved is that you can’t even trust homeopaths to properly dilute stuff, much like this later example with gold.
          Of course Mr Ullman was absolutely elated, and waved this piece of nonsense around on at least half a dozen occasions.

          • Alchemists attempted, unsuccessfully, to turn inexpensive materials into valuable gold.

            Conversely and perversely:

            Homeopathists have, successfully, turned valuable gold into useless waste. And they boast about it!

          • Perhaps there is a simple solution to all of this. Do we just tell the Homoeopathic pharmacies to stop diluting substances beyond Avogadro’s number and only make medicines in the low decimal scale eg from 1X to 6X where active ingredient is still present, provided that what they make isn’t poisonous eg Arsenic Trioxide.

          • @Mutus Bellator
            I have an even simpler solution: homeopaths should only be allowed to sell preparations as ‘medicines’ after they have shown those preparations to be effective in high-quality clinical trials.

            As I mentioned before, PubMed registers on average less than a dozen homeopathic trials annually – a ridiculously low number, especially for what homeopaths claim is a complete ‘system of medicine’, supposedly suitable for treating many thousands of conditions. And only one or two of those dozen or so trials come up positive – mostly the lower-quality trials, and with small effect sizes, at that.

            Ideally, homeopaths should show us the viability of their founding principles:
            – The similia principle, or “Like Cures Like”: So far, not a single homeopathic substance was ever identified that consistently a) causes certain symptoms in healthy people, and b) cures sick people who suffer from those symptoms.
            – The law of infinitesimals, or “Higher Dilution = More Potent Medicine”: So far, not a single substance was ever identified that consistently produced stronger effects at increasing dilutions.
            – The concept of Proving, or “Identifying Medicines by Given them to Healthy People”: This may well be the dumbest concept in all of homeopathy: to establish if something has therapeutic properties, it is given to healthy people, who then write down anything they think they experience out of the ordinary. No actual medical conditions or patients are involved at all. If the pharmaceutical industry would ‘test’ their products this way, they would be forcibly shut down immediately, and given serious fines to boot.

            But again, I won’t be holding my breath.

          • In the UK most homeopaths refer to ‘remedies’ and not medicines. I know in other parts of the world this is different and we get references to homeopathic medicines and drugs, however, I think that this is wrong. We should not conflate conventional drugs with homeopathic remedies.
            However, the EU decided to do this back in 92.
            Those ‘remedies’ licensed in the UK as medicines to be sold retail are not used by homeopaths but are bought by members of the public who after years of media exposure are fully aware of the dilutions involved. So we even have informed choice and I thank you all so much for this.

            Great campaign by the sceptics at the time though so thank you all for telling us. Tough luck that so many just didnt believe you and it all somehow back fired. It was not ‘the end of homeopathy’ as once declared by some who havent been around for a while now.
            Credit to Edzard though as at least he battles on true to himself and no doubt right to the end.

          • I know in other parts of the world this is different and we get references to homeopathic medicines and drugs, however, I think that this is wrong.

            You never state that you think this is wrong to Dana Ullman when he refers to homeopathic medicines and drugs. Why is that; if there is a reason that is separable from your hypocrisy.

            members of the public who after years of media exposure are fully aware of the dilutions involved

            Wrong.

          • I did say that in other parts of the world they reference ‘medicines’ for homeopathic products.
            I dont think they are medicines but if everyone starts calling them medicines then I might have to just put up with it. Worse things can happen.
            Please carry on with your opinion that members of the public are not aware of the dilutions involved in homeopathic medicines – er I mean remedies.
            It is though a pity that you cant get any publicity these days pushing this delusion in the media.

          • [‘JK’ wrote:] Please carry on with your opinion that members of the public are not aware of the dilutions involved in homeopathic medicines – er I mean remedies.

            Are you not a member of the public?

            You have more than adequately demonstrated your ignorance of “the dilutions involved”. On this occasion, you were in error by 3½ orders of magnitude:

            https://edzardernst.com/2024/04/neurodoron-the-anthroposophic-remedy-for-neurasthenia-is-unsurprisingly-useless/#comment-151231

            No wonder you’re anonymous. 😂

          • I am pleased that you have at last found some joy.
            It won’t last though.

          • I am pleased that you have at last found some joy.
            It won’t last though.

            Your command of temporal logic is as exiguous as your command of numeracy and English.

            I’m sorry the state education system failed you so badly.

          • Your assumptions are wrong.
            Maybe you should give critical thinking a go.

          • I stated “Your command of temporal logic is as exiguous as your command of numeracy and English.”

            That was not an assumption; you provided the evidence.

            Education services are available for the purpose of raising you above your current level of coming across as a barely-literate halfwit.

            Grow up, FFS. But if you continue to present yourself as a goading halfwit then I shall respond in the same manner in which Lenny responds to your ilk.

            The readers may have forgotten that troll ‘JK’ got itself banned on 19 May 2018 at 14:30 for making false accusations.
            https://edzardernst.com/2018/05/are-you-a-homeopath-this-is-how-you-can-get-rich-quickly/#comment-102045

          • Lots more coming your way PA.
            Enjoy

  • The sample size is n = 30 in each arm and the p-value is extremely small. I do not have access to the paper but from the stats in the abstract, this would be a Cohen’s d of about 1. This is just not plausible, even if for a single-blind study.

  • From the abstract:
    “Comparative analysis was carried out on the intention-to-treat sample to detect group differences.

    In medicine an intention-to-treat (ITT) analysis of the results of a randomized controlled trial is based on the initial treatment assignment and not on the treatment eventually received.

    ITT analysis is intended to avoid various misleading artifacts that can arise in intervention research such as non-random attrition of participants from the study or crossover.

    ITT is also simpler than other forms of study design and analysis, because it does not require observation of compliance status for units assigned to different treatments or incorporation of compliance into the analysis.

    Although ITT analysis is widely employed in published clinical trials, it can be incorrectly described and there are some issues with its application.[1] Furthermore, there is no consensus on how to carry out an ITT analysis in the presence of missing outcome data.

    continued…

    https://en.m.wikipedia.org/wiki/Intention-to-treat_analysis

    [my formatting for clarity]

    In the IHM treatment group, 4 were lost to follow-up, which is missing outcome data. I don’t know how many were lost to follow-up in the placebo control group.

    continuing…

    Issues
    Medical investigators often have difficulties in completing ITT analysis because of clinical trial issues like missing data or poor treatment protocol adherence.

    To address some of these issues, many clinical trials have excluded participants after the random assignment in their analysis, which is often referred to as modified intention-to-treat analysis or mITT. Trials employing mITT have been linked to industry sponsorship and conflicts of interest by the authors.

  • Interesting.

    Patients with ME argued for years that the model adopted in this country and around the world was based on flawed evidence.

    Some of us indeed said that the trial designs, if used for homeopathy would find the same sort of results.

    The main flaw, as we kept pointing out, was that subjective measures were used in completely unblinded trials. Both patients and therapists knew who was getting the interventions.

    And indeed when the same design was used for the Lightning Process. it did find some subjective improvement.

    When we kept saying this, we were subjected to an appalling campaign depicting us as dangerous, anti-science activists.

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