clinical trial
“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.
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.
This double-blind, three-arm randomised trial evaluated the efficacy of homeopathic medication in patients with seasonal allergic rhinitis (SAR). Patients at eleven outpatient clinics and two medical centres were randomised to receive:
- (1) individualised homeopathic case taking (IHCT) and standardised homeopathic medication with Galphimia Glauca (GG),
- (2) IHCT and individualised homeopathic treatment (IHG),
- (3) IHCT and placebo (PG).
The primary outcome was disease-specific quality of life, assessed using the Rhinitis Quality of Life Questionnaire (RQLQ) after three and four weeks. Secondary outcomes included response rate (≥0.5-point change in RQLQ), rescue medication use, and total nasal and non-nasal symptom scores (TNSS, TNNSS).
Sixty-two SAR patients (mean age ± SD: 46.9 ± 14.9; 43.5% female) were recruited, approximately 25% of the planned sample size. After weeks three and four, there were no significant differences in RQLQ (p=0.244) between GG (adjusted mean, 1.2, 95% CI 0.7-1.7), IHG (1.7, 1.2-2.3), and PG (1.4, 0.8-2.0). High response rates were observed (GG: 86.4%, IHG: 66.7%, PG: 81.3%), while RM use was 21.7%, 55.6%, and 29.4%, respectively. There were no relevant differences in RM score, TNSS and TNNSS between the three groups. Eight adverse events but no serious adverse events were reported.
The authors concluded that standardised and individualised homeopathic drugs were not superior compared to placebo suggesting that treatment response was not based on study medication. The validity of the study and its conclusions are limited by the fact that the recruitment target was not achieved.
Multicentre studies like this one are useful for recruiting large numbers of patients. SAR is a common condition; the recruitment of a large sample should therefore have been fairly straight forward. So, why was this study so woefully under-powered? An average of 6 patients per centre is dismal, to put it mildly!
This leaves us with a failed study of a failed (implausible) hypothesis; its negative findings cannot be properly interpreted (other than showing the incompetence of the trialists).
Why publish such a waste of resorces at all?
Search me!
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.
Religiosity has been linked to a wide range of health outcomes, with evidence for both benefits and harms.
Alleged positive effects
Many studies have found positive associations between religious involvement and physical and mental health, including lower mortality, better self-rated health and greater psychological well‑being. However, most of this literature is methodologically weak, with selection bias, poor control for confounders and selective reporting, so firm causal conclusions are difficult.
Religiosity and spirituality have frequently been associated with positive effects on mental health, such as higher levels of life satisfaction, meaning in life, hope, optimism and lower rates of depression, substance misuse and some forms of suicidal behaviour. Proposed mechanisms include social support from religious communities, promotion of coping resources, encouragement of health‑promoting behaviours and cognitive frameworks that help some people make sense of adversity.
In addition, observational studies have linked religious participation with positive effects on physical endpoints, such as reduced smoking, more moderate alcohol use and in some cases better cardiovascular outcomes and lower all‑cause mortality, though effect sizes are usually modest. Cross‑national analyses show that religious people sometimes report better self‑rated health, but these associations vary widely by country and are sensitive to socioeconomic and cultural context.onlinelibrary.
Alleged negative effects
Some aspects of religiosity might be harmful: religious struggles—such as feeling punished by God, spiritual discontent or conflict with religious communities—are consistently associated with higher levels of depression, anxiety and distress. Some studies also suggest that rigid or punitive religious beliefs can exacerbate guilt, internalized stigma (for example around sexuality) and delay help‑seeking for mental illness.
In highly secular societies, belonging to a religious minority may correlate with poorer health, possibly via discrimination, lower social integration or economic disadvantage. A critical economic analysis even reports a negative relationship between religious background and some health indicators once socioeconomic factors are carefully controlled, challenging simple “religion is good for you” narratives.
Methodological problems
Much of the evidence relies on observational studies, making it difficult to be sure about causality: healthier or more socially integrated people may be more likely to be religiously active. Measures of religiosity and spirituality are heterogeneous, ranging from attendance to private practices to diffuse “spiritual well‑being”, which complicates comparisons and may inflate positive findings. In other words, the effects of religiosity on health are less that certain or clear.
You wake up with a headache on a rainy day.
Did the rain cause your headache?
Or was it perhaps the late-night coffee?
You then take a homeopathic remedy, and an hour later the pain is gone.
Did the remedy cause this?
Or was it the shower you took, the placebo effect, or something else entirely?
Perhaps you don’t care? But, if we want to make progress, we ought to care and find the answers. Sorting out coincidence from actual cause is crucial for making progress. Causality is one of the most important concepts in research, because humans are naturally prone to seeing patterns where none exist. We are all easily fooled, and regularly even by ourselves. Mistaking a correlation (two things coicidentally happening in sequence) for a cause (one thing creating the other) can lead to wrong decisions, useless treatments, wasted resources, and often to significant harm. To prevent this, scientists have long relied on structured frameworks to prove when one event truly triggers another.
In the late 19th century, the German physician Robert Koch wanted a foolproof way to prove that a specific microbe caused a specific disease. He developed the “Koch’s Postulates”, a four-step checklist that transformed medicine:
- The microbe must be present in every case of the disease.
- The microbe must be isolated from the sick host and grown in a lab.
- The lab-grown microbe must cause the same disease when introduced to a healthy host.
- The microbe must be isolated again from the newly infected host.
While these rules worked beautifully for many infectious diseases, they have limits. Some viruses cannot be grown easily in a lab, and some people carry bacteria without ever getting sick. And, of course, there are many diseases that are not due to microbes.
As medicine evolved to tackle chronic, non-infectious conditions like heart disease or cancer, Koch’s checklist thus fell short. For instance, smoking causes lung cancer, but you cannot easily “isolate” smoking in a lab, nor does every smoker get cancer. To solve this riddle, the UK epidemiologist Austin Bradford Hill introduced a broader toolkit in 1965, today known as the “Bradford Hill Criteria”. Instead of a strict pass or fail test, it uses several simple viewpoints to weigh the evidence:
- Strength: Is the connection large or powerful?
- Consistency: Do different studies produce the same result?
- Temporality: Did the cause occur before the effect?
- Biological Gradient: Does more exposure lead to more severe outcomes?
- Biological plausibility: Does the connection make sense with what we already know?
Without the guardrails of causality, medicine would still be based mostly on guesswork. Koch’s postulates gave us the clarity to cure deadly infections, and the Bradford Hill criteria allowed us to take on different public health threats like tobacco. By forcing us to ask how and why things happen, these criteria allow us to ensure that medical science is built on truth rather than mere coincidence.
In the realm of so-called alternative medicine (SCAM), causality has a particularly improtant role. This is because proponents often claim causality, while science rejects it:
Homeopathy:
Proponent claim: The fact that many patients get better after taking a homeopathic remedy proves that homeopathy works.
Reality: There are many other, more convincing explanations for this outcome.
Applied Kinesiology
Proponent claim: Muscle response strength proves nutrient deficiencies, toxin exposure, or food allergies.
Reality: No consistent relationship between muscle testing results and actual health status. The practice fails basic reliability tests; different practitioners get different results from the same patient.
Reiki
Proponent claim: Practitioners channel “healing energy” from assumed sources that improves health and prompts recovery.
Reality: No such energy exists. Well-controlled studies show Reiki performs no better than placebo. The claimed energy has no basis in physics or biology.
Acupuncture
Proponent claim: Inserting needles at specific points along “meridians” releases blocked qi and cures various conditions.
Reality: Most ot the patient-blind acupuncture trials show no difference from placebo acupuncture (needles placed randomly or not penetrating skin). Cochrane Reviews find acupuncture does no better than placebo. The meridian system has no anatomical basis.
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These 4 examples illustrate the fundamental problem: SCAM proponents routinely mistake correlation for causation, or propose causal mechanisms that have no basis in established physics, chemistry, or biology. Without satisfying the above-mentioned criteria, these claims remain unproven speculation rather than scientific fact.
To put it bluntly:
CAUSALITY MATTERS!
Evidence‑based medicine (EBM) was developed to make clinical decisions more reliable by grounding them more solidly in good research. Thus, randomised clinical trials, systematic reviews, and meta-analysis became crucial for healthcare. That development brought undeniable progress, but it also created a problem: if we focus exclusively on such evidence, we might neglect an important question:
IS THE TREATMENT IN QUESTION BIOLOGICALLY PLAUSIBLE?
Put simply, EBM asks “Does it work in this study?” without first asking “Could it reasonably work at all?”
The neglect of biological plausibility can lead to wasted resources, misleading conclusions and, in some cases, the promotion of nonsense. The issue is, of course, particularly relevant in so-called alternative medicine (SCAM) known for its frequent lack of plausibility. A simple example might explain this more clearly: in homeopathy, we see an abundance of poor-quality studies with a positive result. This could easily lead to the overall impression that homeopathy works, while in fact it cannot reasonably work at all.
So, how can we reasonably take account of this complication? It turns out there are several options:
Option 1 Gatekeeping
One way to account for plausibility within EBM is to use it to decide what we test in the first place. Before launching an expensive clinical trial, we can ask for a clear explanation of how the proposed intervention might reasonably work. If no such rationale can be articulated without contradicting science, it is reasonable to conclude that the intervention lacks sufficient plausibility to justify the time, money and ethical burden involved in testing it on patients. In practice, this kind of gatekeeping often happens informally, but making it explicit and mandatory could help keep overtly implausible interventions from consuming scarce resources.
Option 2 Prior probability
Plausibility can also be integrated into how we interpret trial results. Some trialists treat a statistically significant result as an infallible signal that the therapy was effective. When a trial result is “statistically significant”, it means the data we observed would be unlikely if the treatment had no effect. Prior probability is another way of expressing plausibility. If a hypothesis is highly plausible given existing scientific knowledge, a positive trial fits into a broader, coherent picture. If a hypothesis is highly implausible, a positive trial is more likely to be a false positive, an artefact of bias, chance, methodological flaws, or fraud. In other words, for low‑plausibility claims, we need stronger and more consistent evidence before accepting them as true. The less plausible a claim is, the more extraordinary the evidence must be.
Option 3 Guidelines
Guideline development offers another opportunity to embed plausibility into EBM. When expert panels prepare recommendations, they typically grade the strength of evidence according to study design, risk of bias, and consistency of results. They might also add a distinct step in which they rate the plausibility of the intervention. This rating could be justified explaining how well the intervention fits with established knowledge. Guideline writers could then let this plausibility rating influence the strength of their recommendations.
Health technology assessments have been moving in this direction for some time. It makes guideline documents more transparent: clinicians could see not only what the trials showed, but also how the intervention was judged to fit into or contradict broader scientific understanding.
Option 4 Causation
Finally, causation frameworks are being used to bring plausibility into EBM. When we decide whether an association is causal, we often rely on criteria such as consistency, temporality and strength of association. Biological plausibility is another of these criteria. Using it systematically means asking whether there is a logical pathway from intervention to outcome that passes through known mechanisms and observed effects. If such a pathway can be sketched in a way that accords with science, plausibility is high. If not, plausibility is low, and we should be more cautious about drawing causal conclusions from statistical associations alone.
EBM has revolutionized healthcare, but evaluating evidence in a vacuum can carry the risk of validating the absurd. To minimise this risk, we might consider integrating biological plausibility into EBM, a possibility that has long been discussed by many experts in the field. This approach is not a rejection of EBM, but a vital safeguard for it which ensures that the evidence aligns with and strengthened by fundamental science and existing knowledge. By demanding extraordinary evidence for extraordinary claims, medicine can better protect its resources, maintain intellectual integrity, and ensure that clinical practice rests on a foundation that is both statistically sound and scientifically reasonable.
An article entitled “Beyond the Appearance of Rigor: Trustworthiness, Integration, and Standardization in Traditional, Complementary, and Integrative Medicine” caught my eye. The name “Traditional, Complementary, and Integrative Medicine” is, I think, impressive as it demonstrates the seemingly infinite ability of SCAM-promoters to come up endlessly with new and ridiculous terms! Please allow me nonetheless to continue calling it so-called alternative medicine (SCAM).
The paper itself might be summarised as follows:
SCAMs struggles to fit into mainstream science. Trustworthiness isn’t just about flashy, individual study results; it requires a reliable system of transparent data and independent replication. However, forcing SCAM into mainstream healthcare via scientific scrutiny, standardisation and integration is a double-edged sword. It strips away the personalized, holistic essence of these therapies. Instead of abandoning science or changing the therapies, researchers need to use creative, flexible scientific methods that document the real-world complexity of SCAM without trying to force it into an artificial mold.
I have heard this argument often, particularly early on when I started applying science to SCAM. SCAM proponents were initially taken by the idea; later, when the results were often not what they expected, they were less impressed and argued that, because science failed to produce positive results, something must be wrong with it and in need of improvement. Specifically, the arguments were:
- SCAM is individualised,
- SCAM is holistic,
- SCAM is complex,
- SCAM is subtle,
- SCAM depends on the skill of the practitioner.
And therefore, SCAM cannot be fitted into the straitjacket of science, particularly not in the one imposed by the randomised clinical trial.
It took many years to convince some SCAM proponents that these notions were erroneous, that science is not always perfect but that no better method for testing exists, that many mainstream interventions (e.g. physiotherapy, psychotherapy) are just as complex, holistic, etc. as is SCAM. Eventually the argument that SCAM defies scientific evaluation disappeared – not totally, but almost.
Now, 30 years later, it is back!
One cannot even blame the SCAM enthusiasts for reviving it. Thirty years of research and very little of SCAM has been proven to work – unless one gives SCAM a huge ‘benefit of the doubt’ and pretends poor science constitutes proof. Even the treatments that SCAM proponents celebrate as evidence-based fall apart once we scratch the surface and discover how poor and irreproducible the evidence mostly is.
Yes, I do sympathise with the frustration of SCAM proponents as they gradually realise all this. Many of them know only too well that their most solid evidence can be taken apart by any first-year medical student with rudimentary skills of critical evaluation. Many of them therefore have long moved away from hypothesis testing research and prefer the type of investigation that never generates a negative finding (e.g. surveys, qualitative studies, sociological approaches). Others, including the two authors of the above-mentioned paper, prefer to go full circle and revive the notions we dealt with decades ago claiming we need different standards for SCAM than for the rest of medicine.
Perhaps someone should tell them that double standards are never a good idea?
Homeopaths tend to voice a standard set of arguments when confronted with irrefutable evidence against homeopathy. In the discussion sections of this blog, we heard them all:
- “The negative trials are flawed designed.” They claim these trials were done by ungifted therapists or used the wrong remedies, wrong potencies, wrong dosing schedules, etc. Therefore, they do not reflect true homeopathic practice.
- “Homeopathy is individualised, RCTs can’t capture it.” They argue that randomised clinical trials are inherently unsuitable because homeopathic treatment must be tailored to each patient, rendering RCTs “unfair” or even “unscientific.”
- “Only a fraction of the evidence has been considered.” They assert that critics cherry-pick negative evidence and ignore positive small trials, case series, or observational data that they regard as equally valid.
- “There is much positive evidence.” They point to older or methodologically weak positive studies and claim these outweigh or at least balance the otherwise negative body of evidence.
- “Meta-analyses and systematic reviews are biased and/or politically motivated.” They allege that negative evaluations are driven by ideological hostility to homeopathy, Big Pharma influence, or institutional bias.
- “Statistical significance is not the same as clinical reality.” They argue that statistics miss “real-world” benefits observed in practice and that evidence-based medicine is too narrow.
- “Evidence-based medicine overvalues RCTs and undervalues experience.” They insist that long clinical experience, case reports, patient testimonies, etc. should count as strong evidence and that their accumulated practice is itself proof of efficacy.
- “Patient demand and satisfaction are evidence.” They use high patient satisfaction, repeat consultations, and word-of-mouth popularity as a proxy for effectiveness.
- “Millions use it worldwide.” They argue that longstanding, global usage implies that it must work; otherwise it would have disappeared.
- “Conventional medicine is not perfect either.” They respond to criticism by highlighting harms, errors, and historical reversals in conventional medicine, implying that science-based critics lack moral authority.
- “If it were only placebo, it wouldn’t work on XY.” They claim efficacy in infants, animals, or unconscious patients as evidence that placebo cannot fully explain the effects.
- “Mechanisms aren’t fully known, but that doesn’t matter.” They liken homeopathy to earlier medical advances whose mechanisms were unknown at the time (e.g. aspirin), arguing that lack of a plausible mechanism is not a valid reason to reject positive clinical observations.
- “Physics and chemistry are incomplete; future science will explain it.” They invoke concepts like quantum physics, nanostructures, or complex systems to argue that current science is still too limited to explain homeopathy.
- “Regulatory / institutional conspiracies.” They suggest that powerful pharmaceutical or medical lobbies seek to suppress homeopathy to protect their financial interests.
- “Homeopathy is cheap and safe; risk–benefit favours it.” They argue that even if evidence is thin, the very low risk and low cost justify its use.
- “The therapeutic encounter itself is part of the effect.” They turn criticisms about placebo and context effects into a strength: the long consultation, empathy, and attention are claimed to be legitimate and central components of homeopathy.
- “Freedom of choice / patient autonomy.” They shift from scientific to ethical/political ground, insisting that patients should be free to choose homeopathy regardless of scientific consensus.
- “Skeptics misunderstand what homeopathy really is.” They claim that people conflate homeopathy with herbalism, confuse potencies, or misunderstand Hahnemann’s principles, so their critiques do not address true homeopathy.
- “Critics don’t see the individual ‘miracle’ cases.” They counter population-level data with vivid anecdotes of dramatic improvements which they regard as decisive.
- “Negative evidence is ‘absence of evidence’, not ‘evidence of absence’.” They argue that failed trials or negative reviews merely show that efficacy hasn’t been proved yet, not that homeopathy does not work.
- “Science evolves; today’s ‘overwhelming evidence’ may be overturned.” They claim that scientific consensus has been wrong before and that homeopathy will eventually be vindicated when paradigms shift.
In discussions with homeopaths, these points are repeated endlessly. One could easily get the impression of a broken record. All of the above arguments have in common that – even as some of then contain a kernel of truth – they are erroneous. In theory it could be easy to point this out to the stereotypical homeopathy promoter; in practice, however, it often is impossible, since the broken record continues turning senselessly.
