bias
One of the perks of running a busy blog like this one is the fact that the most original insults come your way. One of the best in this genre is probably comparing me to Donald Trump. Our “friend” Dana Ulman is not the only one, but he does that with some regularity. For example, he recently commented this little gem: “It seems that you are now emulating America’s liar-in-chief, Donald Trump. Should I now call you Edzard Trump?! Yep, he has adopted you…OR you have adopted him!”.
As this comparison is not an isolated occurrence, I better deal with it properly. Allow me therefore to attempt my own comparison between Edzard Ernst and Donald Trump. I find the comparison intriguing, if only as a study in how thoroughly opposites can be confused.
Trump’s relationship with the truth is famously transactional: facts are useful when they flatter and dispensable when they do not. In contrast, I have spent my career demonstrating that facts and truth have the habit of existing independently of one’s preferences. Where Trump manufactures certainty, I try to interrogate it.
Both Trump and I are accused of promoting “untruths”. In Trump’s case, the accusation reflects a well-documented indifference to reality. In my case, it typically signals that a proponent of so-called alternative medicine (SCAM) is displeased with the conclusions of my research.
Our rhetorical styles further widen the gulf, I hope. Trump’s language inflates, while mine tries to deflate. Trump deals in selfishly exaggerated declarations (e.g. “the best,” “the greatest,” “nobody knows more”). I usually prefer the quieter approach of citing and explaining the data, allowing the evidence to dismantle cherished beliefs without raising its voice.
Criticism, too, is handled differently, I think. Trump counters it with more lies, denial or insult; I normally try to respond with evidence and rational arguments, an approach that is arguably more irritating, as it leaves less room for theatrical rebuttal. After all, it is difficult to argue with a meta-analysis without first reading and understanding it.
If there is a shared trait, it is our ability to provoke. Yet even here, the symmetry is illusory. Trump provokes by disregarding evidence; I often try to provoke by insisting on it. The former invites belief without proof; the latter demands proof before belief.
It therefore appears that likening me to Trump (or vice versa) serves less as an argument than as an all too transparent attempt to avoid one. Still, I must confess a certain appreciation for its unintended comedy. In that spirit, I am tempted to thank Dana – and to encourage him to continue, if only in the hope that his future contributions might prove even more entertaining.
Keep up the good work, Dana!
And feel free to call me whatever you like.
“Popularity takes the place of plausibility, tradition replaces validity, and individual experience is positioned above objective efficacy.”
This sentence (my translaation of the German original) comes from a book by Udo Endruscheit that I have been reading. It is entitled “Vom Zweifel zur Haltung: Eine Reise durch die Geschichte der Erkenntnis” (From Doubt to Conviction: A Journey Through the History of Knowledge) and outlines the epistemological development of truth from the early thinkers of antiquity to the postmodern voices of today. It traces how the concept of truth has changed, how it has been criticized, relativized, and deconstructed, and how these changes have shaped us and our thinking.
The statement was no necessarily meant to me applied to medicine, but it does aply capture a recurring epistemological pattern within large segments of so-called alternative medicine (SCAM). It describes a shift away from the truth towards criteria that are socially and psychologically compelling but scientifically nonsensical.
The substitution of popularity for plausibility is evident in the way many SCAMs have gained traction. Treatments such as homeopathy, naturopathic detox regimens, or paranormal energy-based healing have achieved global followings despite the fact that there can hardly be a mechanism of action that does not fly in the face of science. Their popularity is often driven by anecdotal endorsements, celebrity advocacy, and market forces rather than by convergence of experimental and theoretical support. Opinion counts more than truth, and the absence of plausibility in a SCAM is frequent and frequently ignored.
The elevation of tradition over validity is a defining feature of most SCAMs. Historical longevity is often presented as implicit evidence of effectiveness. “It would not have survived, if it were ineffective!” Yet, from a scientific perspective, tradition is a most unreliable indicator: ineffective or even harmful practices can persist for centuries in the absence of effectiveness and even safety. Bloodletting in pre-modern Western medicine offers a cautionary example. The critical issue is not whether a therapy is old, but whether it has been subjected to rigorous evaluation and shown to produce reproducible benefits that exceed placebo and other non-specific effects.
The dominance of individual experience over objective effectiveness is perhaps the most pervasive and psychologically persuasive cause of SCAM’s popularity. Patients’ testimonials, often sincere and seemingly compelling, are being touted as sufficient evidence of effectiveness. Yet individual experience is highly susceptible to regression to the mean, natural disease fluctuation, placebo effects, confirmation and other biases and confounders. Without proper comparisons, it is impossible to distinguish specific therapeutic effects from non-specific ones. Evidence-based medicine does not dismiss patient experience; rather, it contextualizes it with external evidence to avoid misleading us all.
The above statement by Udo Endruscheit was meant as a general characterisation of the way we currently handle and mishandle truth. As such it applies to much more than just SCAM. Yet, it also provides an apt critique of dominant tendencies within SCAM. Popularity, tradition, and personal experience are, of course, not inherently without value, but when they displace plausibility, validity, and objective effectiveness, they create a situation that is wide open to error, exploitation and often also harm.
In a nutshell: the truth matters; watering it down – as we all currently tend to do – carries serious risks in medicine as much as in life.
PS
I almost forgot!
Yes, I do recommend reading Udo’s most fascinating book.
The Journal of Evidence Based Homeopathy (JEBH)?
Yes, it does exist!
It was launched in 2023 by Willmar Schwabe India, as a twice yearly publication that presents itself as a peer-reviewed outlet for research, clinical trials, case studies, reviews, and theoretical pieces about homeopathy. Its own site describes it as a “groundbreaking” journal meant to promote the “evidence-based practice and understanding of homeopathy,” and lists the editor-in-chief as Dr. Ramachandran Valavan who seems to be on the payroll of Schwabe India. As far as I can see, the editorial board consist exclusively of Indian homeopathy supporters.
The publisher is Dr. Willmar Schwabe India Pvt. Ltd., with a Noida/Ghaziabad address in Uttar Pradesh, India. The firm is a branch of the well-known German manufacturer of homeopathic products. JEBH is a specialty homeopathy journal rather than a mainstream medical journal. Its language is strongly promotional, emphasizing “rigorous investigation,” “scientific exploration,” and “solid evidence,” but those claims are made by the journal itself rather than independently demonstrated in the material available here.
JEBH claims it is peer-reviewed. However, its articles often read like advocacy: they present homeopathy as being refined by “modern scientific exploration” and “real-world data,” and frequently treat positive case reports or reviews as confirmation of homeopathy’s validity. That style is, of course, not unusual in homeopathy publications, but from an evidence-based medicine perspective it is a ridiculous substitute for reproducible controlled data.
To give you a taster, here is the first section of a recent editorial published in the JEMH:
The Journal of Evidence-Based Homeopathy (JEBH) continues to strengthen its mission of uniting classical homeopathy with modern scientific exploration. This issue exemplifies how research, provings, and clinical observations converge to validate and refine homeopathic practice. The original articles section presents a diverse set of contributions from clinical case management to digital tools aiding repertorization. The featured case on Natrum muriaticum exemplifies the precision of individualized prescribing in addressing emotional and mental health concerns , while an insightful review on repertory software underscores the evolving integration of technology in clinical decision-making …
I wonder: does anyone know of another so-called “evidence-based” medical journal that is fully controlled, financed and run by a BIG PHARMA firm?
I don’t!
The JEBH confirms what we all suspected:
HOMEOPATHY IS UNIQUE.
Because homeopathic remedies are usually diluted to the point where none of the original substance remains (often beyond Avogadro’s number), the ethical concerns with this treatment must focus on veracity (truth-telling), patient autonomy, beneficence, and justice. Here are some of the problems that ensue**:
Violations of Veracity and Informed Consent
Informed consent is an essential element of medical ethics and dictates that a patient must be given full, accurate, and evidence-based information regarding a treatment’s nature, mechanisms, risks, and efficacy to make an autonomous decision.
Homeopathy operates on two main principles: “like cures like” (Law of Similars) and the “law of minimum dose” (the more diluted a substance, the more potent it becomes). Scientifically, these principles contradict established kowledge of chemistry, physics, and pharmacology. Presenting these concepts nevertheless as scientifically valid violates veracity.
When a practitioner administers or sells a homeopathic remedy without explicitly stating that it contains no active ingredients and performs no better than a placebo in clinical trials, the patient’s autonomy is compromised. In other words, patients are making a healthcare choice based on deception or omission.
Maleficence
While homeopathics are physically inert and thus unlikely to cause direct harm, homeopathy poses a severe threat via indirect harm.
The most critical ethical issue occurs when patients use homeopathy for severe, progressive, or life-threatening conditions (such as cancer, severe infections, or chronic diseases like diabetes). Delaying or entirely replacing evidence-based medicine with placebo treatments (i.e. homeopathy) violates the duty of non-maleficence (do no harm). It can lead to preventable suffering, worsening of the condition, or even death in extreme cases.
Homeopathic “Vaccines” (Homeoprophylaxis) is an apt example. Some homeopaths offer all sorts of homeopathic vaccinations as alternatives to standard immunizations. Marketing these as effective protection against potentially deadly diseases like measles, polio, or pertussis erodes public herd immunity, leaves individuals entirely unprotected, and can endanger us all. This is a massive failure of both individual and public health ethics.
Beneficence
Beneficence requires healthcare providers to act in the best interest of the patient by offering treatments that provide a tangible, therapeutic benefit.
While the empathetic, unhurried nature of a homeopathic consultation can provide psychological comfort, homeopaths cannot ethically justify charging high fees for what is essentially a placebo wrapped in pseudo-medicine. Relying on a mechanism that depends on the patient remaining ignorant of the treatment’s true nature is fundamentally paternalistic and violates modern standards of beneficence.
Justice and the Exploitation of Vulnerability
The ethical principle of justice involves fairness, equity, and the responsible distribution of healthcare resources. It is regularly violated in the realm of homeopathy.
Homeopathic remedies are cheap to manufacture, yet they are marketed at unjustifiably inflated prices. Targeting vulnerable populations, such as the chronically ill, parents anxious about medication side effects in their children, or low-income individuals seeking cheap alternatives, is an ethical violation of justice.
When public the health insurance programs of certain countries, or mainstream pharmacies fund or promote homeopathic products alongside effective medicines, they misallocate resources and mislead the public. In other words, they give a false stamp of authority to quackery, draining resources that could support evidence-based public health initiatives.
So, how unethical is homeopathy? My short answer is: VERY!
** for a more detailed discussion, please have a look at our book.
I was reminded of a paper that I published a long time ago – 23 years to be precise. It is entitled THE LECTURE FROM HELL. As it is not available online, let me give you a slightly revised version of it here:
When it comes to giving lectures, I have certainly made every mistake there is, and therefore I consider myself qualified to write this personal account on how to deliver THE LECTURE FROM HELL. I do this in the hope that others might learn from my imperfections.
In preparing for a lecture, it is best to be cool and leave things to the last minute. You are so gifted and competent that a few scribbles made on the way to the venue will easily suffice for fascinating your audience. Don’t bother enquiring who they are; what you have to say will capture the attention of a lay audience as much as that of a highly specialised one.
The kind people who have invited you will certainly have suggested a topic. Don’t get irritated by that; you know best what you can and want to talk about and, after all, it is always best to stick to what you know. If your subject is palliative cancer care, for instance, it should not be too difficult, after a few introductory sentences, to shift the attention to the most revealing survey you conducted on 10 back pain patients 25 years ago – cancer patients suffer from back pain too!
From the outset, you need to show the audience that you are better than they are. A good way of achieving this aim is to display your knowledge of as many acronyms as possible. Making abundant use of abbreviations has the added advantage that it could hide a few glitches in your arguments (or spelling). People might even think you are talking about palliative care after all.
Another golden rule is never produce evidence for your statements. Some people use visual aids to produce the evidence, but this is both tiring and confusing (and it would, of course, require much more preparation than you allowed for). If you want to use visual aids, use photographs of your kids (pets if you are childless) or your last holiday in Corfu. This will add the personal touch that people crave. Surely, if they had wanted evidence they would have gone to a library, not to your lecture.
It is advisable to spend as much time as possible with lengthy preliminaries, particularly if you are not really covering the subject as printed in the programme. Mention that you first met Cathy (who just introduced you) when you were both in nursery and give a full and colourful account of your relationship since then. If you haven’t actually been to nursery with Cathy, perhaps you could talk about the car accident you saw en route and what it made you think of. Or you could take the holistic approach, ask everyone to stand up, do a few relaxation exercises and feel the flow of energy in the body, room or universe. The obvious aim is to leave as little time as possible for the proper lecture. Thus, you can pretend to know much more about your subject than you had time to disclose and you can end your unfinished lecture with the upbeat exclamation ‘‘yeah! perhaps another time’’.
Most lecturers find the ensuing discussion period the most challenging part of their task. Not you! First, you have wisely ensured that there is no time left. Thus, the discussion slot will either be completely cancelled or it will be refreshingly brief. When the first difficult question comes your way, remember the important principle: you are so much cleverer than anyone else in this room! Make sure you show it. Arrogance has always been a perfect shield for hiding incompetence.
Another good strategy is to ridicule the person who dared ask the awkward question. Thus, they end up with egg on their face instead of you. If all else fails and you really don’t know how to answer, the best approach is to say: ‘‘this is a bit too complex right now; perhaps I could explain this to you later over coffee’’. Just ensure that you are safely on the way home when the coffee break starts.
Generally speaking, the overriding principles of a truly diabolically bad talk are quite simple. Lectures are neither the time nor place for transmitting knowledge to those who came to listen. Their predominant purpose is to massage the lecturer’s ego and increase their income. If you keep this in mind, you will stop worrying about things like evidence, structure and delivery and simply enjoy the outing.
I was reminded of this article because I saw the title of a recently published paper: HOW TO GIVE A BAD TALK. It starts as follows: “It is crucial to know how to communicate your work by delivering an effective talk, but our training for doing so is limited, so it is a skill often learned by watching others — who sometimes do it badly”.
Sadly, I could not read on; the journal asked almost 30 Euros for the privilege! So, I will never know what else I can do to give a truly poor lecture. Yet, I did learn something important: the knowledge of how to give a bad talk does not always come cheap!
The long-standing consensus surrounding moderate alcohol consumption has recently been disrupted by a landmark review. Initiated under a US congressional mandate to evaluate the evidence base for the US Dietary Guidelines for Americans, the study—convened by the National Academies of Sciences, Engineering, and Medicine (NASEM) alongside the Department of Health and Human Services (HHS)—concluded that even a single alcoholic beverage per day significantly elevates the risks of serious chronic illness and premature death. After unexplained bureaucratic delays, the release of this taxpayer-funded research delivers a sobering truth: there is no net health benefit derived from alcohol consumption at any level.
For decades, public perception was shaped by data suggesting that a daily glass of wine or beer could act as a cardiovascular shield. This new review systematically dismantles that notion by identifying significant methodological biases in the previous evidence. Chief among these is the “sick quitter” effect, wherein baseline categories of non-drinkers inadvertently included individuals who had abstained precisely because of pre-existing, severe health conditions. By correcting for these distortions, the review demonstrated that health risks accumulate linearly. Alcohol acts as a dose-dependent toxin with no safe lower threshold, and even minimal daily intake accelerates linear risk trajectories for:
- liver cirrhosis,
- severe hypertension,
- various malignancies, including esophageal, colorectal, and breast cancers.
Beyond chronic pathology, low-level consumption also:
- impairs cognitive architecture,
- accelerating brain aging,
- elevates the immediate probability of physical injury.
The friction surrounding the report’s delayed release has exposed systemic vulnerabilities at the intersection of federal policy and corporate lobbying. Historically, US dietary guidelines defined moderate drinking as up to two drinks per day for men and one for women. The new scientific consensus exposes these thresholds as dangerously obsolete, highlighting a stark disconnect between federal health advice and contemporary medical data.
This friction might underscore the impact of the commercial determinants of health, exposing how multi-billion-dollar alcohol conglomerates employ aggressive public relations campaigns and sophisticated scientific interference to preserve market shares. By aggressively marketing alcohol as a benign staple of a healthy lifestyle, the industry had successfully obscured its intrinsic risks. The new evidence shifts the conversation from personal indulgence to an important public health issue.
Update (July 2026): a US government–commissioned analysis of alcohol-related risk was published. Here is its abstract:
The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health.
Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health.
At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury.
Alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
Public health significance statement: The Alcohol Intake and Health Study shows that for Americans, even what is socially considered “moderate drinking” increases the risk of dying or developing health problems, helping people better understand the net health impact of alcohol. Furthermore, by identifying the levels of alcohol use that raise the risk of cancer, cardiovascular disease, and injury, these findings can guide individuals, families, and communities in making safer choices about drinking patterns. The results also support changing the U.S. Dietary Guidelines on alcohol to recommend that current adult drinkers consume 1 drink or less in a day.
Authors and independent observers have described the report as having been sidelined during the Trump administration, citing conflicts with industry interests and existing “moderate drinking is safe” messaging.
I spent the last 2 months in France where it happened to be hot. Too hot for my taste! I could not do much during the day and, at night, I was unable to sleep well. As the heatwave carried on, it began to impact on my mood and health. I may be particularly sensitive to heat, but I am by no means the only one who suffered. Record-breaking temperatures and unprecedented ocean warming have triggered a global health emergency. Driven by climate change, modern heatwaves are predicted to strike with greater frequency, intensity, and duration, pushing human physiology to (and sometimes past) its limits.
Extreme heat operates as a silent killer by severely exacerbating pre-existing cardiovascular and respiratory conditions. It can also cause acute medical issues like severe dehydration, kidney damage, heatstroke, and even death. Extreme heat disproportionately impacts highly vulnerable groups, including older adults, children, outdoor laborers, and individuals who are unhealthy to start with. Urban populations face magnified dangers due to the urban heat island effect, which traps dense pockets of heat in city environments.
The consequences are already devastating. The recent heatwaves in Europe caused over 1,300 excess deaths within just a few weeks. Extreme heat contributes to a global toll of hundreds of thousands of heat-related fatalities each year. It also ripples through societal infrastructure. Extreme heat heavily strains our healthcare systems, disrupts local economies, worsens food and water insecurity worldwide, endangers local transport and other infrastructure. Here in France, for instance, we had prolonged cuts first of electricity and then on the Internet/telephone; many people and shops had to throw away the content of their fridges and freezers. Even more alarming: one of France’s largest rivers, the Loire, went completely dry.
An analysis of nearly 2,500 UK media articles covering the June heatwave found that most reports failed to connect the event to climate change, despite strong scientific evidence that global heating intensifies extreme weather. Approximately three-quarters of the articles made no reference to climate change or global warming, highlighting a significant gap between scientific consensus and public communication. Such omissions are problematic because they leave audiences without crucial context. Attribution science now allows researchers to quantify how much more likely or intense specific heatwaves have become due to greenhouse gas emissions, primarily from fossil fuel use. Without this information, heatwaves may be perceived as isolated or purely natural events rather than manifestations of a broader, human-driven trend. Failing to link extreme weather to climate change undermines public understanding and may weaken support for mitigation and adaptation policies.
The most worrying thing is that we are rapidly approaching irreversible thresholds. To mitigate this mounting catastrophe, immediate international cooperation is required. We must deploy both short-term adaptation strategies, such as robust local heat action plans and early warning weather networks, as well as aggressive, long-term global emissions reductions. And we also should vote out politicians who still:
- pretend that climate change is a hoax,
- blame their neighouring country, despite being huge polluters themselves,
- shout “drill baby, drill”,
- pretend that summers have always been hot,
- claim (against all medical knowledge) that humans will somehow manage to adapt to extreme heat.
Without urgent measures, the human and economic toll will escalate uncontrollably.
Drugging soldiers seems to be an odd idea. Yet, it is not without precedent, e.g.:
- Nazi Germany (WWII): The Wehrmacht and Luftwaffe were systematically supplied with Pervitin (methamphetamine), with tens of millions of tablets issued to keep soldiers and pilots awake, alert and aggressive during the war.
- Britain/US (WWII air operations): Allied air forces issued amphetamine and caffeine tablets to bomber crews and other soldiers to counter fatigue on long missions, representing a state‑sanctioned stimulant program for performance enhancement.
- US (Vietnam War): soldiers were routinely given Dexedrine (dextroamphetamine) and other psychoactive drugs to sustain long patrols and suppress combat stress; hundreds of millions of tablets were thus distributed with official approval.
- Soviet Union (Cold War): State‑run sports programmes, closely tied to military and security structures, systematically administered anabolic steroids and testosterone derivatives to elite athletes to boost strength and recovery, normalising pharmacological enhancement in a militarised setting.
Now, the US Defence Secretary Pete Hegseth’s recent “High-T” initiative mandates annual testosterone screening for US troops aged 30 and older, coupled with optional hormone replacement therapy (TRT). This is a striking case of policy outrunning clinical evidence. While announced as a readiness initiative to keep the joint force on the “leading edge of lethality,” the proposal glosses over critical medical, ethical, and operational realities.
First, the medical rationale for mass screening is weak, to put it mildly. Established clinical guidelines recommend testing only men presenting with specific symptoms and risk factors, not broad, asymptomatic populations. Screening hundreds of thousands of personnel annually risks over-diagnosis and over-treatment, particularly in a young force where borderline-low values are common, highly fluctuating, and often transient. In a word: the “High-T initiative” is nonsense.
Second, oral testosterone undecanoate (TU) shares general testosterone risks, e.g. erythrocytosis, prostate effects (worsening BPH symptoms, small PSA rises, contraindication in prostate cancer), suppression of spermatogenesis and infertility, acne, fluid retention, mood changes, and possible lipid alterations. Compared with transdermal or injectable formulations, oral TU offers convenience but requires strict baseline and ongoing monitoring of blood pressure, haematocrit, PSA, and testosterone levels, and is best reserved for men without uncontrolled hypertension, high cardiovascular risk, or near-term fertility plans, and only after considering safer first-line options. In particular, TRT-induced suppression of spermatogenesis presents a serious threat to fertility for service members of reproductive age, introducing severe clinical trade-offs without clear medical indications. In a word: the “High-T initiative” is likely to do more harm than good.
Third, the policy dangerously blurs the line between therapeutic medicine and performance enhancement. Mass-screening healthy soldiers and offering TRT to asymptomatic individuals normalizes the pharmacological optimization of the force. This sets a dangerous precedent: once hormonal levels are treated as adjustable parameters for “readiness,” the boundary between standard healthcare and state-sponsored enhancement dissolves. In a word: the “High-T initiative” is unethical.
Fourth, the operational logistics remain unresolved. Mandating annual blood draws will strain military medical systems, must generate an influx of equivocal results, and will create a massive administrative trail of counselling, monitoring, and liability. In a word: the “High-T initiative” is unpractical.
Fifth, the policy’s ambiguity regarding female service members exposes a glaring double standard: the Pentagon has not clarified whether women will be screened for sex-hormone deficiencies, or if this “restorative” care is reserved strictly for men. In a word: the “High-T initiative” is sexist.
Sixth, the political optics are highly suspect. The initiative directly mirrors broader administration efforts to liberalize testosterone prescribing, raising concerns that ideology, rather than rigorous military medicine, is driving policy. In a word: the “High-T initiative” is ideological.
Unsurprisingly, many experts have criticised the initiative sharply, e.g.:
- Stuart Phillips, a medical professor at McMaster University, told The Washington Post: “A blanket policy like we’re going to screen everybody over the age of 30 is kind of a ridiculous notion.”
- Adriane Fugh-Berman, a Georgetown University professor of pharmacology and physiology, warned: Hegseth’s claims are “non‑evidence‑based and could cause harm.”
Overall, Hegseth’s policy is out-running clinical evidence, and his stupidity is out-doing common sense. There is no doubt in my mind that his testosterone obsession is extremely ill-advised and – if not urgently stopped – will do an abundance of harm.
Hypothyroidism is a prevalent hormonal disorder symptoms often persist despite levothyroxine therapy. Adjunctive individualized homeopathic medicines (IHMs) may improve clinical outcomes, biochemical markers, and quality of life, robust evidence of efficacy remains limited.
The objective of this study was to evaluate the efficacy of add-on IHMs alongside standard levothyroxine therapy in the treatment of hypothyroidism in children and adults.
A 3-month, double-blind, randomized, placebo-controlled trial was conducted in a homeopathic hospital involving 64 trial subjects with hypothyroidism undergoing levothyroxine therapy. The participants received either IHMs plus levothyroxine (verum; n = 32) or placebo plus levothyroxine (control; n = 32) for 3 consecutive months. Patients, study investigators, outcome evaluators, and data entry staff were all kept blinded about the allocation concealment according to a double-blinded approach. The codes were not disclosed to the principal investigator, and unblinding occurred only in cases of clear medication-related risk, substantial benefit, or futility. The primary outcome was the Zulewski’s Clinical Scoring (ZCS); secondary outcomes included thyroid-stimulating hormone (TSH), T3, T4, and ThyroPRO-39 scores.
Both groups showed significant improvement in symptoms and thyroid indices. Between-group difference in ZCS was nonsignificant (mean diff: 0.1, 95% confidence interval [CI] −0.3–0.6, P = 0.567), but significant in T3 (mean diff: −0.2, 95% CI −0.4 to −0.1, P = 0.002), T4 (mean diff: 1.6, 95% CI 1.2–2.0, P < 0.001), and TSH (mean diff: −3.0, 95% CI −5.8 to −0.3, P = 0.033), favoring homeopathy against placebo. Quality-of-life changes were minimal, though some ThyroPRO-39 domains improved significantly with IHMs (e.g., symptoms, P < 0.001; tiredness, P = 0.012; nervousness and tension, P = 0.001; and daily activity, P = 0.001).
The authors concluded that adjunctive IHMs did not improve symptoms or quality-of-life outcomes over placebo conclusively, but revealed favorable biochemical changes, meriting further long-term studies.
I must admit: I am puzzled by this paper:
- According to the primary endpoint, the result is squarely negative.
- Yet, the article itself is presented as though the findings were positive.
- This is because the some secondary endpoints yielded positive results.
- But how can this be?
- I find the power justification unconvincing; perhaps the study was under-powered?
- The authors report that “Neither group experienced any adverse effects.”
- How can this be?
- Even placebo therapy generates adverse effects!
- And common problems of levothyroxine therapy are palpitations, tremor, nervousness, insomnia, sweating, heat intolerance, headache, diarrhoea, weight loss, and increased appetite.
As I said, I am puzzled. Perhaps the authors’ affiliations might explain?
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Affiliated to the West Bengal University of Health Sciences, Kolkata – 700 046, West Bengal, India
- Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health and Family Welfare, Govt. of West Bengal, India
The Medical Journalists’ Association (MJA) has outlined six practical tips to help scrutinise health claims responsibly and accurately. They are primarily meant for journalists but, I think, they are also usefull for the general public, particularly when dealing with health claims in the realm of so-called alternative medicine (SCAM):
Check the source
Assess whether the claim originates from credible, peer-reviewed research and a reputable institution. Be wary of press releases, anecdotal reports, or media outlets known for sensationalism. Specifically for claims about SCAM, we might also add caution regarding the many third class SCAM journals.
Look for conflicts of interest
Investigate who funded the research and whether any authors or organisations stand to profit from the findings. Industry sponsorship can introduce bias, even in otherwise well-conducted studies. For claims about SCAM, we should remember that financial interest might be secondary to ideological ones.
Examine the study design
Consider whether the research used appropriate methods – such as randomisation, control groups, and adequate sample sizes – to support its conclusions. Observational studies, or case reports, or trials with the often-discussed ‘A+B versus B’ design, for example, cannot prove causation.
Consider the magnitude and relevance of effects
Distinguish between statistical significance and clinical importance. A tiny effect may be statistically significant in a large trial but meaningless in practice. Also ask whether the study population is representative and the outcome can be generalised.
Look for independent replication
Single studies should be treated cautiously until confirmed by other researchers. Consistent findings across multiple studies increase confidence in a claim.
Beware of over-interpretations
Scrutinise whether the authors or media coverage extrapolate beyond what the data support. For instance, generalising from animal studies to humans, or implying benefits without evidence of improved health outcomes.
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If I may, I will add an 7th to the six by the MJA. It is one that I have issued many times previously and that is, I think, essential in SCAM:
If it sounds too good to be true, it probably is!
Exaggerated or false health claims are endemic in SCAM. These 7 tips might be useful in disclosing them and in minimising the harm they can do.
