clinical trial
The Spanish Agency for Medicines and Medical Products (AEMPS) has just published a comprehensive technical report entitled “Homeopathy and Homeopathic Products: Evaluation of Evidence on Their Efficacy and Safety”, which categorically concludes that there is no scientific evidence supporting the efficacy of homeopathy as a therapeutic tool. After a systematic review of scientific literature and evaluations by state agencies internationally, the report states that the observed effects are comparable to placebo.
The report, which analyzed 64 systematic reviews published since 2009, highlights that most studies suggesting benefits from homeopathy have low methodological quality, often invalidated by small samples, short follow-up periods, or biases in randomization. Furthermore, it notes that as the quality and rigor of clinical trials increase, the supposed effect of homeopathy diminishes until it disappears entirely.
From a scientific standpoint, the principles of homeopathy clash with the laws of physics and current pharmacology. In typical dilutions like 12 CH—where one part of the original substance is mixed with 100 parts of solvent twelve times consecutively—it is mathematically impossible for a single molecule of the original ingredient to remain in the preparation, breaking any cause-and-effect relationship between the product and the therapeutic effect.
To illustrate this disproportion, the report points out that a dilution of just 6 CH (far less extreme than 12 CH) equates to dissolving a packet of sugar in the entire Mediterranean Sea. For this reason, the AEMPS classifies theories like “water memory”—the belief that the liquid retains the properties of a substance even without its molecules—as empirically baseless postulates that challenge scientific and rational thinking.
In compliance with European and national regulations, the AEMPS has completed a regularization process that has resulted in the market withdrawal of numerous products. As of the report’s publication date, no homeopathic product with authorized therapeutic indications exists in Spain. The 976 that remain registered did so via a simplified procedure, based on extreme dilutions ensuring the preparation’s innocuousness, which does not require proof of therapeutic effect and legally prohibits any therapeutic claims on labeling.
Spain aligns with a global trend of health institutions adopting critical stances:
- United Kingdom: The Science and Technology Committee recommended halting public funding and requiring labeling warnings about lack of efficacy.
- Australia: The National Health and Medical Research Council concluded that homeopathy should not be used for chronic or serious diseases.
- France: The Haute Autorité de Santé eliminated public reimbursement for these products in 2021 due to lack of demonstrated efficacy.
- Germany: Approval is expected in 2026 for the definitive removal of homeopathy coverage from statutory health insurance.
- United States: The Food and Drug Administration (FDA) considers these products “unapproved new drugs,” and the Federal Trade Commission requires warnings that there is no scientific evidence of their functioning.
Although there is a popular belief that these preparations are innocuous because they are “natural,” serious adverse reactions have been reported, including poisonings from poor dosing and infant deaths linked to teething products in other countries.
However, the AEMPS warns that the main associated risk is the abandonment or delay of proven effective medical treatments. Citizens opting for homeopathy to treat serious or chronic conditions may endanger their health by replacing evidence-based therapies with products lacking such evidence.
The AEMPS report reaffirms the Ministry’s commitment to public health protection and evidence-based medicine. In line with other international agencies, it emphasizes the need for transparent information so citizens can make safe health decisions. The conclusion of the report is firm:
Given the lack of evidence of efficacy, homeopathy cannot be considered a valid therapeutic alternative, and its use must not lead to delaying or abandoning treatments proven to be effective.
The Nazi’s endorsement of homeopathy during the Third Reich was a complex fusion of pseudo-science, ideology and pragmatic policy. Homeopathy was deemed to align ideologically with National Socialism’s völkisch worldview and, foremost, it was considered to be practical:
- It had pure German (“Aryan”) origins.
- It was considered to be natural.
- It was inexpensive.
- It was abundantly available.
- It was deemed to be harmless.
Several top Nazis also promoted “New German Healing” (Neue Deutsche Heilkunde), which integrated natural therapies like homeopathy into healthcare emphasizing racial purity, folk traditions, and self-reliance. Conventional medicine (“Schulmedizin”) was derided as “Jewish medicine” (verjudete Medizin), tainted by Jewish physicians who were disproportionately represented in German academia and practice. By purging Jews – over 5,000 doctors were expelled by 1935 – the Nazis created a vacuum which they filled with “Aryan” alternatives, e.g. the “Heilpraktiker” framing homeopathy as a proud German invention free from “internationalist” or capitalist pharmaceutical dependencies.
Pragmatic motives amplified this support. Homeopathy was inexpensive, used mostly locally available materials and promised self-sufficiency amid wartime shortages of synthetic drugs. Heinrich Himmler championed it personally, funding research and integrating it into SS clinics; Rudolf Hess, the “Deputy of the Führer”, was also a vocal advocate. The regime licensed homeopathic training, established research institutes, and started a most comprehensive research program of homeopathy. In one of the darkest chapters, the SS conducted experiments at the Dachau concentration camp to test homeopathic treatments for various conditions. Authors from the era celebrated homeopathy as compatible with Nazi racial hygiene, linking it to family doctors fostering generational health.
However, the outcomes were far from what homeopaths had hoped for. The Donner Report on the Nazi’s large research program of 1941–1943 revealed “wholly negative” findings: homeopathic remedies failed catastrophically. Official evaluations deemed it ineffective for epidemics, leading to its sidelining in military hospitals by 1943. After the war, German homeopaths suppressed these findings by making the documents disappear.
Yet the Nazi legacy endures. Nazi promotion entrenched homeopathy in German culture, at least partly explaining its persistence today. This contributed to vaccine hesitancy during COVID-19, as historical distrust of “allopathic” medicine (like “Schulmedizin, a derogatory term created by Hahnemann) lingered.
The Third Reich history of homeopathy highlights how pseudo-science tends to thrive under authoritarianism, masking inefficacy with nationalism, dogma or untruths. While the Nazis tolerated homeopathy for ideological purity, its empirical failure exposed the regime’s bankruptcy.
The parallels to what is currently happening to healthcare in the US are difficult to overlook.
The suppression of scientific data within US federal agencies represents a fundamental tension between independent public health expertise and political ideology. This conflict seems to have now reached a boiling point at the ‘Centers for Disease Control and Prevention’ (CDC), where the Trump administration’s political leadership has indefinitely delayed the publication of an important report demonstrating the continued benefits of the COVID-19 vaccine. This action marks a pivotal shift in how the US manages public health information, signalling an era where data is scrutinized not just for its accuracy, but for its alignment with a specific political narrative.
The controversy centres on a study conducted by career scientists within the CDC’s ‘National Center for Immunization and Respiratory Diseases’. It analyzed data from the winter of 2025 and showed that COVID-19 vaccinations reduced the risk of hospitalization by 55% and emergency room visits by 50% among healthy adults. These figures provide a compelling argument for the vaccine’s role in mitigating the burden on the US healthcare system. However, despite being scheduled for release in the agency’s Morbidity and Mortality Weekly Report (MMWR) in mid-March, the study remains unpublished.
The primary figure behind this delay is the Acting CDC Director, Dr. Jay Bhattacharya. Appointed by the Trump administration and a vocal advocate for the “Great Barrington Declaration,” Bhattacharya has challenged the report’s methodology, specifically the “test-negative design”. This is an observational study design often used to estimate vaccine effectiveness. It compares people who seek care and are test-positive for the target infection with similar people who seek care but are test-negative. The key idea is simple:
- Recruit people with similar symptoms who come for testing.
- Split them into cases, who test positive, and controls, who test negative.
- Compare the odds of prior vaccination or another exposure between the two groups.
If vaccinated people are less common among the test-positive group than among the test-negative group, that suggests the vaccine is effective. This design is efficient because both cases and controls come from the same care-seeking population which reduces confounding. It is also practical during outbreaks, since cases and controls can be identified quickly from testing records.
While Bhattacharya frames his criticism as a commitment to rigorous quality control, the scientific community begs to differ and stress that the test-negative design has been the gold standard for assessing vaccine effectiveness for over twenty years. Indeed, a flu vaccine study using the exact same methodology was approved for publication by the same leadership just days prior, suggesting a double standard applied specifically to COVID-19 data.
This scandalous incident does not exist in a vacuum; it is a manifestation of a broader overhaul of US public health spearheaded by Health Secretary Robert F. Kennedy Jr. Under this leadership, the administration has sought to deprioritize standard immunization schedules and has integrated vaccine skeptics into the Advisory Committee on Immunization Practices (ACIP). By suppressing data that proves vaccine efficacy, the administration creates a vacuum of information that can be filled by more skeptical, politically convenient narratives.
The consequences of all this are profound. When political appointees act as gatekeepers for scientific data, it erodes the public’s trust in the CDC as a neutral, evidence-based institution. High-profile resignations, such as that of Dr. Fiona Havers, suggest a demoralized workforce of career scientists who feel their objective research is being censored. Furthermore, by withholding data that quantifies the protection offered by vaccines, the government limits the ability of healthcare providers and citizens to make informed decisions about their own health risks.
In conclusion, the suppression of the 2026 CDC vaccine report is a watershed moment for scientific integrity in government. It illustrates the danger of a system where data is viewed through a lens of political utility rather than public safety. As the administration continues to reshape federal health policy, the ongoing struggle between career researchers and political leadership will likely define the future of public health transparency in the US. The losers, no doubt, will be the people – primarily in the US but likely also globally.
The Indian Ministry of Ayush was established in 2014 with a vision of reviving the profound knowledge of India’s ancient systems of medicine and ensuring the optimal development and propagation of the Ayush systems of healthcare. Earlier, the Department of Indian System of Medicine and Homoeopathy (ISM&H) formed in 1995, was responsible for the development of these systems. It was then renamed as the Department of Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy (Ayush) in November 2003 with focused attention towards education and research in these therapies.
In the global landscape of public health, India’s Ministry of AYUSH stands as a profound anomaly. While most middle‑ and high‑income countries have converged around evidence‑based, scientifically grounded medicine, India has instead expanded this large, state‑run administrative apparatus where cultural nationalism and traditionalist narratives dominates over clinical efficacy and scientific rigor. The Ministry’s current trajectory reveals a troubling pattern: the systematic promotion of unproven therapies, flawed research, and notorious breaches of ethical principles, particularly with respect to the treatment of India’s most vulnerable populations.
The Homeopathy Anomaly
The most glaring anomaly must be the Ministry’s continued, high‑level support for homoeopathy. India is currently the only country in the world that maintains a dedicated national ministry and a statutory regulatory framework – via the National Commission for Homoeopathy – specifically to promote a system widely regarded as implausible, ineffective and harmful. Global assessments, including those by no less than 28 independent organisations worldwide, have concluded that there is no reliable evidence that homeopathic remedies work beyond placebo. Yet the AYUSH Ministry funds and publicizes a central research council (the Central Council for Research in Homoeopathy, CCRH) as well as a network of homoeopathic hospitals and teaching institutions, with annual budget allocations now exceeding ₹4,400 crore (roughly 470–480 million US dollars at current exchange rates). By directing substantial taxpayer funds to homoeopathic research and infrastructure, the state effectively endorses a “placebo‑as‑medicine” model, elevating it to the status of a national health strategy. This is not merely an academic dispute; it is a policy outlier that places India’s healthcare posture at odds with well‑established chemical and physical principles, as well as with the recommendations of leading international scientific bodies.
The Facade of Rigor
The Ministry tends to defend its approach by claiming a pivot toward “evidence‑based” or “scientific” AYUSH medicine, but an examination of its research output suggests a facade of rigor rather than its substance. Much of the work produced by bodies such as the Central Council for Research in Ayurveda (CCRA) and their counterparts in Unani and Siddha consists of investigations that are methodologically weak and wide open to bias. Key methodological flaws recur:
- Small sample sizes: Many trials involve fewer than 50–100 participants, rendering them statistically underpowered.
- Lack of blinding: A large proportion of studies is open‑label, where both clinicians and patients know the assigned intervention, amplifying placebo effects and observational bias.
- Selective reporting and publication bias: Negative findings – where AYUSH interventions fail to demonstrate benefit – are rarely published.
By branding such useless studies as “scientific proof,” the Ministry engages in a form of “science‑washing.” This practice misleads the public, uncritical clinicians, and policymakers into believing that AYUSH therapies have undergone the same rigorous, independent scrutiny as conventional therapies.
The Ethical Violations
In my view, the most serious concern is ethical. Under the banner of “Self‑Reliant India” (Atmanirbhar Bharat), the Ministry has aggressively promoted AYUSH products, for instance, during the COVID‑19 pandemic. This push could be viewed as an exercise in cultural pride and national self‑reliance but, in fact, it carries serious risks.
Medical ethics rely on two core principles: informed consent and non‑maleficence. When a state body, backed by cabinet‑level authority, “flogs” unproven and potentially dangerous treatments to a largely rural population with limited health literacy, it undermines both. Many patients are not able to distinguish between an ancient tradition and a clinically validated drug, yet they may be led by government‑sponsored messaging to defer or abandon evidence‑based treatments.
This is particularly dangerous in chronic conditions such as diabetes mellitus and hypertension, where effective pharmacological control and regular monitoring are both available and potentially life‑saving. If patients substitute proven allopathic regimens with state‑endorsed AYUSH alternatives of uncertain efficacy, the consequences can be dire. They include uncontrolled blood glucose, stroke‑risk elevation, organ damage, and avoidable mortality. The Ministry’s conduct, in effect, offloads these risks onto the most vulnerable while shielding itself behind appeals to tradition and national identity.
Conclusion
The Ministry of AYUSH has become the institutional vehicle for a “pluralistic” health model that, in practice, functions as a state‑funded rejection of the scientific method. This constitutes a regression in public‑health governance rather than a progressive pluralism. Until the Ministry subjects its therapies to the same scrutiny as any other medicine, and until it accepts transparent, independent evaluations without recourse to political or cultural vindication, it will remain less a health body and more a department of cultural preservation and doctrine.
Aaron Siri is an American lawyer and anti‑vaccine activist. He has become a key figure in contemporary US vaccine‑policy debates, largely through his legal challenges and close ties to health‑policy critics such as Robert F. Kennedy Jr. His following five central claims about vaccines are a mix of selective quoting, misrepresentation of studies, and appeal to legal‑style rhetoric:
- Vaccines cause chronic illness
Siri’s central “smoking‑gun” claim rests on an unpublished Henry Ford Health‑system analysis allegedly showing that vaccinated children have far higher rates of chronic illness than unvaccinated children. Vaccinated children in this dataset had far more health‑care visits than unvaccinated children, so more conditions were diagnosed in them regardless of whether vaccines caused them. This is a textbook example of detection bias, but not evidence of causation. Moreover, the study has not passed peer review; its reported disease prevalences are inconsistent with known epidemiology. It is therefore widely seen as methodologically unsound.
- Vaccines were never properly tested against proper controls
Siri argues that many childhood vaccines have not been tested in inadequately-powered, placebo‑controlled trials. When an effective vaccine exists, medical ethics oppose using placebos in new trials, as that would deny protection to a control group. Moreover, his claim that older vaccines (e.g., tetanus–diphtheria–pertussis) “lack adequate controlled trials” is misleading because earlier trials were designed for different standards and later observational data, post‑licensure surveillance, and large‑scale cohort studies have filled the gaps. In other words, he exploits technical‑sounding language to imply a hiatus of evidence, when in reality the evidence base is broader and more heterogeneous than he portrays.
- The CDC/WHO inflates how many lives vaccines have saved
Siri has attacked the WHO’s estimate that vaccines have saved around 154 million lives, calling it “corruption of science”. The 154‑million figure comes from a modelling exercise [like most “lives‑saved” statements in public health]. It depends on assumptions but is based on vaccine‑coverage and mortality‑trend data, but it is not fabricated. Siri’s rebuttals focus on rhetorically dismissing the exercise as “advertising” rather than engaging its assumptions or proposing alternative, better‑validated models. His claim that this number is “corrupt” thus rests polemic than but not on a coherent technical critique of the underlying epidemiological models.
- Exploiting the 1986 Vaccine Injury Act and “lack of liability”
Siri blames the 1986 National Childhood Vaccine Injury Act for reducing oversight and downplaying risk, arguing that liability protection “corrupts” safety monitoring. Yet the law was designed to protect manufacturers from financially ruinous litigation and to create a dedicated federal compensation program for proven injuries, not to forbid safety monitoring. The US has multiple surveillance systems (VAERS, VSD, CISA) and expert advisory bodies (ACIP, NVAC) that continuously review vaccine safety. Siri’s critique thus conflates legal strategy with scientific oversight, implying that the absence of mass torts proves lax monitoring.
In conclusion, Siri’s vaccine claims are mostly built on:
- one deeply flawed, unpublished observational study,
- selective readings of older vaccine‑trial designs,
- unwarranted dismissal of WHO‑level modelling, and
- a legal framing that conflates liability shields with absence of safety science.
Epidemiologists, infectious‑disease specialists and other experts rightly regard Siri’s arguments as misrepresenting or misapplying biostatistics and failing to meet standards for causal inference. It would be a serious mistake to follow them!
I am sure that many of my readers have no idea what ‘Slinding Cupping Therapy’ is. It is a TCM therapy that, according to the authors of this paper, receives much appreciation for treating plaque psoriasis. This study was designed to test the hypothesis that sliding cupping therapy is non-inferior to narrowband ultraviolet B (NBUVB) therapy in improving disease severity in patients with plaque psoriasis.
This prospective trial recruited 60 patients with plaque psoriasis who were randomized to receive either sliding cupping intervention or NBUVB treatment. The cup was moved 30 times for each skin lesion until the target skin area turned purple. The initial dose (mJ/cm2) of ultraviolet radiation b (UVB) was determined based on sun-reactive skin types I through VI, which ranged from 300 mJ/cm2 to 800 mJ/cm2. Both treatments were performed 3 times per week for 8 weeks. The primary endpoint was the percentage reduction in Psoriasis Area and Severity Index (PASI) score at week 8, with secondary endpoints, including Physician’s Global Assessment (PGA), body surface area, visual analogue scale scores, and quality of life measures.
The total response rates were 69% (18/26) and 79% (19/24) for patients receiving sliding cupping intervention and those receiving NBUVB treatment, respectively, which showed no significant difference (P = .526). The PASI scores, body surface area, and PGA were reduced in patients with plaque psoriasis at W0, W4 and W8 after either sliding cupping intervention or NBUVB treatment (P <.001), and these reductions were not significantly different between the patients receiving sliding cupping intervention and those receiving NBUVB treatment at W0, W4, W8, and W12. At W8, the mean percentage reduction in PASI was 62.4% (95% CI, 54.9–69.8) in the sliding cupping group and 66.9% (95% CI, 59.6–74.2) in the NBUVB group, with no significant difference between groups. The total response rates were 69.23% (18/26) and 79.17% (19/24), respectively (P = .526). Patients receiving sliding cupping intervention and those receiving NBUVB treatment did not show statistically significant differences in these outcomes at W0, W4, W8, and W12 (P >.05).
The authors concluded that the overall results suggest that sliding cupping therapy exhibits statistically similar efficacy and safety profiles as NBUVB treatment, especially at 8 weeks after treatment.
Sliding cupping therapy is a form of cupping in which cups producing mild suction are placed on oiled skin and then moved along the body surface, generating a “reverse massage” that lifts rather than compresses the subcutaneous tissues. The negative pressure is thought to increase local blood flow and lymphatic drainage, reduce perceived muscle tension, and temporarily improve range of motion, though high‑quality clinical evidence for most claimed benefits remains limited.
The treatment is used mainly by massage therapists, physiotherapists, and TCM practitioners in musculoskeletal and sports‑rehab settings, as well as in wellness and spa‑oriented clinics; it is commonly applied to the back, shoulders, neck, limbs, and along fascial lines or acupuncture meridians, often for pain, stiffness, “trigger‑point”‑type tension, and post‑exercise recovery. The popularity of this therapy is best characterised as a niche within broader cupping and fascial‑release practice rather than a mainstream standard treatment.
The new study is a text-book example of how to mislead people with seemingly reliable research. The fact that it was grossly under-powered – and not the effectiveness of the sliding cupping therapy – is obviously the cause of the lack of a difference between the effective therapy (NBUVB) and the sliding quackery.
Let me give you an example: say, we compare antibiotics (A) to homeopathy (H) as treatments for bacterial pneumonia. We treat 10 patientsin each group, and 8 of them recover in group A within a week, while in the H-group the amount is 6 (many patients recover even without an effective treatment). We run statistical tests which tell us that the difference is not significant. Thus we falsely conclude that homeopathy is as effective as antibiotics in the treatment of pneumonia. The 2 treatments were, in fact, not equal but the lack of power of the small study failed to detect the existing difference.
It seems rather obvious to me that a similar thing has happened with the above study. Its authors are to be congratulated for cheating so slyly that neither the editors nor the reviewers of the journal ‘Medicine’ managed to see through their simple litte trick.
Some homeopathy-fans claim that tiny “nanoparticles” survive even in remedies diluted a trillion trillion times (i.e. the process of manufacturing a high-potency homeopathic remedy). They furthermore assume that this phenomenon can explain how homeopathy works. This argument sounds ever so modern and sciency but – unless you are a bit of a dim-wit – it falls apart for several fairly straightforward reasons that almost anyone should be able to grasp.
Too Dilute
Imagine starting with a single drop of medicine and diluting it by adding 99 drops of water, shaking it up, then repeating that hundreds of times. By the 12C stage (about 1 part in 10^24), there’s statistically zero original molecules left – way before most remedies hit 30C or higher. Even if some nanoparticles somehow cling on from the mixing process or glass vials, they’d be so rare (fewer than one per bottle) that they couldn’t reliably affect your body like a real drug.
Breaks the Main Rule
Homeopathy’s main axiom is “like cures like” assumption: a substance that causes a headache in a healthy person should cure headaches when you’re sick. But nanoparticles would just deliver a tiny dose of the ingredient itself, acting like an extremely weak remedy – not following homeopathy’s main axiom. This would turn homeopathy back into normal medicine and miss the basis of its own theory.
Not Based on Materials
Not all homeopathic remedies start with physical ingredients. Some are “imponderables” like “X-ray” (sugar pills exposed to X-ray radiation, then diluted), “vacuum” (made by evacuating air from water), or even “moonlight.” There’s no material at all to leave nanoparticles behind, so this explanation can’t cover those products.
Useless Ingredients
Most homeopathic remedies are based on mother tinctures that have no heath effects, like sepia (ink from cuttlefish), cantharis (Spanish fly blister beetle), or even bits of the Berlin Wall. These aren’t bioactive – they don’t fight infections or reduce pain or do anything else in normal doses. Nanoparticles from such useless junk wouldn’t magically gain healing powers; they’d still do nothing useful for health.
Lack of Convincing Clinical Evidence
As discussed ad nauseam on my blog, there simply is no sound evidence to show that homeopathy works better than a placebo. Any benefits people feel are thus likely from expectation, natural recovery, or doctor attention – and not from nanoparticles. If homeopathy had any real effects to explain, nanoparticles might be worth debating; without them, it’s a dead end.
I do sympathise with the desperation of homeopaths. They feel they must identify a plausible mode of action for their remedies. Their 200 year old struggle to find anything at all is in many ways remarkable. Here are some of the main explanatory ideas homeopaths (or homeopathy-friendly authors) have previously proposed for how homeopathy might work:
- Vital force / life energy – the remedy is said to act on a non-physical “vital force” or life energy that supposedly governs health and disease.
- Water memory – water is claimed to “remember” substances once dissolved in it, even after dilution beyond any remaining molecules, via changes in water structure or hydrogen bonds.
- Electromagnetic signatures – remedies are said to carry subtle electromagnetic patterns or “information” of the original substance, sometimes claimed to be recordable, transmitted electronically, and imprinted on new water.
- Quantum coherence domains – models suggest water forms coherent quantum domains storing drug “information” as electromagnetic frequencies, inspired by Del Giudice and Preparata’s ideas, though lacking solid experimental support.
- Stable water clusters / clathrates – hypotheses that long-lived clusters or cage-like structures (clathrates) in water somehow encode the properties of the starting substance.
- Nanobubbles and interfaces – suggestions that gas nanobubbles or interfaces in the solution store and transmit information about the starting material.
- Hormesis-based explanations – the idea that ultra-low doses act via hormesis (beneficial effects of mild stress or toxins), extended to the extreme dilutions used in homeopathy.
- Resonance with the body – proposals that remedies resonate with biological systems (cells, tissues, or “vital force”) through frequency matching or electric resonance, rather than via chemistry.
- Quantum entanglement / non-locality – claims that patient, practitioner, and remedy become “entangled,” so healing occurs via non-local quantum effects rather than molecules or doses.
- Information medicine / encoding – framing remedies as carriers of abstract “information” rather than substance, supposedly acting like a software signal on the body’s “hardware.”
Is it not time for homeopaths to accept the only well-proven, plausible explanations as to why their patients feel better after taking their remedies?
- The empathetic therapeutic encounter.
- The natural history of the condition.
- Regression towards the mean.
- Concommittant conventional treatments.
- The placebo effect.
Immunisation and homeopathy are often assumed to be similar; some even claim that the efficacy of the former proves the latter. They both are said to “stimulate the body’s natural defences” and they both allegedly use “tiny does”. Yet they are fundamentally different, not just in their methods, but in their scientific validity and biological mechanisms.
Immunisation (or vaccination) is grounded in the well-understood biological principles of immunology. Simply put, when a pathogen enters the body, the immune system identifies foreign proteins (antigens) and produces antibodies to fight them. Immunization mimics this process without causing the actual disease. By introducing a weakened, inactivated, or recombinant part of a virus or bacteria, the vaccine “trains” the immune system. If the person is later exposed to the real pathogen, their body recognizes it and is capable of launching a rapid defence. This process is quantifiable; doctors can measure “titer levels” in the blood to confirm the presence of antibodies.
Homeopathy operates on two primary axioms:
- The Law of Similars: The belief that a substance that causes symptoms in a healthy person can cure those same symptoms in a sick person.
- The Law of Infinitesimals: The belief that the more a substance is diluted, the more potent it becomes.
Homeopathic remedies are typically diluted to such an extent that not a single molecule of the original substance remains in the final dose. Proponents claim the water “remembers” the substance, a concept known as water memory, which has no empirical support in the scientific community. The confusion between immunisation and homeopathy usually stems from the superficial similarity that both allegedly involve “small doses” to trigger a response. However, the “small dose” in a vaccine is a calculated, detectable amount of biological material designed to trigger a specific cellular reaction. In contrast, the “dose” in homeopathy is non-existent in remedies beyond the C12 potency. While the resopnse to an immunisation is quantifiable, this is not the case with homeopathy.
But the most important difference between immunisation and homeopathy is, of course, this: the former is effective beyond placebo and the latter isn’t.
In short, immunisation is a biological “training manual” for the immune system, backed by centuries of sound evidence and the near-elimination of diseases like polio and smallpox. By contrast, homeopathy is a so-called alternative medicine (SCAM) that relies on implausible assumptions and at best works via a placebo effect.
This landmark study, often called the “Nürnberger Kochsalzversuch”, is historically significant as probably the first recorded instances of a randomized, double-blind, placebo-controlled trial. It was conducted to test a specific claim made by a leading practitioner of the time. By the mid-1830s, homeopathy had gained significant popularity among the upper classes in Nuremberg, then part of the Kingdom of Bavaria (Stolberg, 2006). This success frustrated the city’s medical establishment Thus, in 1834, Friedrich Wilhelm von Hoven, the city’s highest-ranking public health official, published a scathing critique of homeopathy using the pseudonym “E.F. Wahrhold” (Cukaci et al., 2020). Johann Jacob Reuter, a prominent local homeopath, responded by challenging von Hoven to a test which became the now famous Nürnberger Kochsalzversuch. Reuter claimed that even a healthy person would experience “extraordinary sensations” if they ingested a dilution of ordinary table salt (Sodium Chloride, or Natrum Muriaticum, as homeopaths like to call it) (Stolberg, 2006).
The trial was organized by a “Society of Truth-loving Men,” supported by George Löhner, a local newspaper editor who also wrote the final report (Cukaci et al., 2020). To ensure impartiality, they implemented a – for the time revolutionary – study design:
- 100 identical glass vials were prepared.
- 50 were filled with pure distilled snow water (the placebo),
- 50 were filled with a salt dilution prepared exactly as Reuter had instructed (one grain of salt diluted 29 times at a 1:100 ratio.
- The vials were numbered, shuffled, and divided into two lots at random in front of a public audience.
- A sealed list recorded which vial/number contained which substance.
- Neither the distributors/trialists nor the participants knew the contents of the vials.
- The vials were distributed to volunteers.
- They were asked to record any unusual symptoms over the following three weeks.
The results could not have been clearer. Of the participants who reported back (approx. 50–54 individuals), the vast majority experienced no symptoms at all. Moreover, there was no difference between the verum and the control group.
The organizers concluded that, as the “symptoms” were evenly distributed between the salt and water groups, Reuter’s claim was discredited. They attributed any reported symptoms to imagination, self-deception, or preconceived opinion (Stolberg, 2006).
The study has historical importance. It is now celebrated by as a pioneering moment in clinical methodology. It could have established the importance of double-blinding, placebo-controls, and randomisation to eliminate bias. I say “it could have” because, in fact, it did nothing of the sort.
- It took until the 1930s that blinding started appearing in more formal academic settings; and only after 1948 (see below), became blinding accepted widely a “best practice”.
- In 1955, Henry Beecher published his landmark paper claiming that roughly 35% of patients improved on placebo alone. The Kefauver-Harris Amendment of 1962 finally legally mandated that manufacturers prove a drug is “effective” compared to a control, usually a placebo.
- Sir Ronald A. Fisher, a statistician working at an agricultural research station in England, realized that if you test two different fertilizers on two different patches of land, the soil quality might be better in one patch than the other, which would ruin the data. He proposed that only by randomly assigning treatments could you “cancel out” unknown variables (like soil acidity or moisture). His 1925 book, Statistical Methods for Research Workers, provided the mathematical proof that randomization was the only way to eliminate this form of bias.
- The MRC Streptomycin Trial of 1948 finally marked the official birth of the randomized clinical trial (RCT).
But – most importantly in the context of this blog – the trial could have established that highly diluted homeopathic remedies are pure placebos. Sadly, this fact is still being ignored by all homeopaths, most healthcare systems, and far too many consumers across the world.
References
Beecher, H. K. (1955). The Powerful Placebo. Journal of the American Medical Association, 159(17), 1602–1606. https://doi.org/10.1001/jama.1955.02960340022006
Cukaci, C., Freissmuth, M., Mann, C., Marti, J., & Sperl, V. (2020). Against all odds—the persistent popularity of homeopathy. Wiener klinische Wochenschrift, 132(9-10), 232–242. https://doi.org/10.1007/s00508-020-01624-x Cited by: 99
Fisher, R. A. (1925). Statistical Methods for Research Workers. Oliver & Boyd. (Bodmer, 2003; Larson, 2008).
Jamison, J. C. (2016). The Entry of Randomized Assignment into the Social Sciences. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2739005 Cited by: 29
Stolberg, M. (2006). Inventing the randomized double-blind trial: the Nuremberg salt test of 1835. Journal of the Royal Society of Medicine, 99(12), 642–643. https://doi.org/10.1177/014107680609901216
Large-scale randomized trials have found that multivitamin–multimineral (MVM) supplements and cocoa flavanols may benefit several age-related chronic conditions among older adults, but it remains unclear whether these two supplements directly slow the biological aging process. This prespecified ancillary study evaluated the 2-year effect of a daily MVM (Centrum Silver) and cocoa extract (500 mg cocoa flavanols per day, including 80 mg (−)-epicatechin) on five DNA methylation measures of biological aging (PCHannum, PCHorvath, PCPhenoAge, PCGrimAge and DunedinPACE) among 958 participants (482 women and 476 men) in the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS).
Compared with placebo, daily MVM supplementation modestly reduced the rate of increase of second-generation epigenetic clocks, with a between-group difference in yearly change of −0.113 years (95% confidence interval (CI) −0.205 to −0.020; P = 0.017) for PCGrimAge and −0.214 years (−0.410 to −0.019; P = 0.032) for PCPhenoAge. MVM had a stronger effect on PCGrimAge among those with accelerated biological aging at baseline (−0.236 [−0.380 to −0.091]).
Compared with those with normal or decelerated biological aging (−0.013 [−0.130 to 0.104]; P = 0.018 for interaction). Cocoa extract did not have an effect on the five epigenetic clocks tested. Although the statistically significant but small effects of daily MVM supplementation on slowing biological aging are encouraging, additional studies are needed to determine the clinical relevance of daily MVM supplementation on epigenetic clocks and whether such effects can help explain the beneficial effects of MVM supplementation on aging-related chronic conditions.
Experts who were not involved in the new study urged caution. While the researchers saw an effect with two epigenetic clocks, three other epigenetic clocks included in the study showed no statistically significant change to their speed. “The multivitamin produced small favorable changes in two epigenetic aging markers, but not across all the clocks that were measured,” says José Ordovás, a professor of nutrition and genetics at Tufts University. “That makes the finding interesting, but it is still far from showing that multivitamins broadly slow aging or improve longevity.”
One of the study’s strengths is that the researchers carefully matched the characteristics of people in the vitamin group to those in the placebo group, says Zachary Clayton, an assistant professor of medicine at the University of Colorado Anschutz, who was also not involved with the research. “However, the magnitude of the observed differences was modest, and their clinical significance remains uncertain,” he says. The study doesn’t take a person’s exact diet or physical activity during the two-year period into account, and those factors can’t be ruled out as having an effect on biological aging, he adds.
Still, in nutrition science, randomized clinical trials of this kind are rare. They aren’t generally required to sell supplements like multivitamins, even if the makers claim specific health benefits. Additional trials, the authors note, “are needed to confirm these findings and determine the role of [multivitamins] in extending healthy aging not only among older adults, but also across the lifespan.”
In addition to these criticisms, I would add a few further points:
- Scientists emphasize that “biological age” as measured by DNA methylation is a biomarker, a surrogate endpoint, but not a direct health outcome. It is currently unknown if a 2-month reduction in an epigenetic clock actually translates into a lower risk of disease, disability, or a longer life.
- The 2-year duration of the study is a great achievement for such a trial; yet it still is considered relatively short for assessing biological aging, which is a process that accumulates over decades. Longer-term data is needed to see if these small changes persist or lead to meaningful health differences.
- The fact that those study participants who started “biologically older” saw the most benefit could be a statistical artifact known as “regression to the mean” rather than a true systemic effect of the supplements.
- The study participants were primarily of Caucasian descent and over the age of 60. This limits the ability to generalize the findings to younger populations or diverse ethnic groups.
- Epigenetic alterations are only one of several “hallmarks of aging.” Because the study did not measure other factors like DNA damage, protein stability, or cellular communication, it provides only a very narrow “snapshot” of the aging process.
- The multivitamin might not have “slowed aging” in a general sense, but could have corrected minor, undiagnosed nutrient deficiencies in some participants, which then reflected positively on their biomarkers. If that were true, supplementation of non-deficient volunteers would have no effect.
