EBM
Insomnia is a prevalent disorder that is associated with substantial impairment. Homeopathy has been proposed as a complementary treatment for insomnia, but its clinical effects remain uncertain.
This systematic review assessed the efficacy, effectiveness, and safety of homeopathic treatments for insomnia. Prospective comparative studies evaluating any homeopathic preparation for insomnia were included. Searches in MEDLINE, EMBASE, seven additional databases, and three trial registries were conducted through August 2025. Risk of bias, intervention complexity, model validity, and pragmatism were assessed using respectively RoB 2, ROBINS-I, iCAT, MVHT, and RITES. Data were synthesized using random-effects meta-analyses, and certainty of evidence was evaluated using GRADE.
Eight randomized controlled trials (RCTs; n = 364 participants) and four non-randomized studies (NRSIs; n = 517) met the inclusion criteria. In adults, sleep quality (MD = −2.6 points; 95% CI −5.5 to 2.6; low certainty) and insomnia severity (MD = −3.2; 95% CI −5.68 to −0.72, moderate certainty) were reported in one RCT each. For total sleep time, the pooled MD of three RCTs was 0.65 hours (95% CI −0.9 to 2.2; low certainty). In children, one open-label RCT suggested a difference in insomnia severity, but certainty of evidence was very low. Adverse events were rarely reported, resulting in low certainty evidence.
The authors concluded that the current evidence is mainly limited by imprecision and risk of bias. The available evidence does not allow firm conclusions regarding the effects of homeopathy for insomnia. High-quality, replicated trials with systematic adverse event monitoring are needed.
15 years ago, I published a similar review entitled “Homeopathy for insomnia and sleep-related disorders: a systematic review of randomised controlled trials” (Focus on Alternative and Complementary Therapies Volume 16(3) September 2011 195–199)). Here is its abstract:
The aim of this review was the critical evaluation of evidence for the effectiveness of homeopathy for insomnia and sleep-related disorders. A search of MEDLINE, AMED, CINAHL, EMBASE and Cochrane Central Register was conducted to find RCTs using any form of homeopathy for the treatment of insomnia or sleep-related disorders. Data were extracted according to predefined criteria; risk of bias was assessed using Cochrane criteria. Six randomised, placebo-controlled trials met the inclusion criteria. Two studies used individualised homeopathy, and four used standardised homeopathic treatment. All studies had significant flaws; small sample size was the most prevalent limitation. The results of one study suggested that homeopathic remedies were superior to placebo; however, five trials found no significant differences between homeopathy and placebo for any of the main outcomes. Evidence from RCTs does not show homeopathy to be an effective treatment for insomnia and sleep-related disorders.
The findings of the two reviews are remarkably similar. For the following reasons, I find this notable:
- One would have hoped that 15 years are a long enough time for clarifying the issue, particularly as insomnia is not an unimportant condition for homeopathy.
- The new review is authored by well-known proponents. It seems unexpected that they (almost) go as far as admitting that the evidence for homeopathy as a treatment for insomnia is not positive.
- We have here, I think, a textbook example of how proponents of homeopathy prettify results that do not confirm their belief.
SO FAR, SO GOOD.
But now consider this: There are two further reviews of the same subject!
The first is entitled “Homoeopathy for insomnia: A meta-analysis of clinical evidence – Journal of Integrated Standardized Homoeopathy“. Here is its abstract:
Objectives: Insomnia is a prevalent sleep disorder characterised by challenges in initiating, maintaining or achieving restorative sleep, resulting in compromised daytime functionality. Traditional therapeutic modalities frequently encompass pharmacological treatments, which may have adverse effects and potential for dependency. Numerous patients pursue alternative methodologies, such as homoeopathy, which is attributed to its personalised, holistic and non-invasive treatment framework. This thorough examination assesses the effectiveness of homoeopathy in promoting better sleep quality and overall wellness in people with insomnia by analysing randomised controlled trials (RCTs).
Material and Methods: This meta-analysis sought to ascertain whether homoeopathy induces a statistically significant enhancement in the management of insomnia, concentrating on aspects of sleep quality, duration and general well-being. All RCTs addressing insomnia treated with homoeopathic interventions were included in this review. All studies were meticulously documented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three evaluators independently reviewed and compiled the literature, extracting comprehensive details regarding participants, study designs, therapeutic interventions and follow-up pertaining to homoeopathic treatment. The primary outcome of the investigation was disease assessment based on sleep diary scores, with an additional outcome being the enhancement of quality of life.
Results: The analysis revealed that homoeopathic remedies exhibited statistically significant improvement over placebo in the management of insomnia. The overall pooled effect size, standardised mean difference (random), was −0.60, standard error (random) was 0.42 and confidence interval (random) at 95% ranged from −0.93 to −0.26. The risk of bias was assessed for all studies.
Conclusion: This meta-analysis shows that homoeopathic remedies are effective in treating insomnia, but more studies are required for accuracy.
The last review is entitled “Effectiveness of Homeopathic Interventions for Insomnia and Sleep Disorders: A Systematic Review and Meta-Analysis“. Here is its abstract:
Insomnia is a common sleep disorder, and many individuals seek alternative treatments like homeopathy. However, evidence for its effectiveness remains controversial. This systematic review and meta-analysis evaluated the effectiveness of homeopathic interventions for insomnia and sleep-wake disorders. A comprehensive search of PubMed, MEDLINE, CINAHL, and the Cochrane Library was conducted for studies published between 2010 and 2025. We included randomized controlled trials (RCTs) and non-randomized studies involving adults (≥18 years) with primary insomnia receiving any homeopathic intervention compared to placebo, no treatment, or active care. Primary outcomes included validated sleep quality measures (e.g., Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI). Four reviewers independently performed study selection, data extraction, and risk of bias assessment using RoB 2.0 and ROBINS-I. A random-effects meta-analysis was conducted for controlled trials, and a narrative synthesis for non-randomized studies. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The search yielded 1304 records; 12 studies (nine RCTs and three non-randomized) met inclusion criteria. Meta-analysis showed a large, statistically significant positive effect of homeopathy on sleep outcomes (SMD = 0.81, 95% CI [0.24, 1.38], p = 0.0055), with substantial heterogeneity (I² = 86.04%) and publication bias (Egger’s test, p = 0.0079). Most studies had high or critical risk of bias, and overall certainty was low. Homeopathic interventions showed a large positive effect on sleep outcomes, but due to high bias, heterogeneity, and publication bias, evidence remains low-certainty and insufficient to support effectiveness. High-quality RCTs are needed.
What should we make of this?
We now have two reviews concluding that there is no good evidence and two implying that homeopathy is effective for insomnia! This clearly demonstrates how easy it is to mislead the public with seemingly rigorous reviews.
I must say, I pity all the interested lay people who are trying to make sense of this mess.
How can they arrive at the best available, most reliable evidence?
We have here, I think, another textbook example; one of how important it is to run reality checks. But surely, we cannot possible ask of a lay person to understand why the last two reviews are badly misleading. What we need is an accessible tool for differentiating the science from the pseudoscience, the reliable from the unreliable.
Unfortunately, such a tool does not exist. But there are a few indicators:
- Is the journal that published the review reputable?
- Are the authors affiliated to reputable institutions?
- Do the authors have a history of critical analysis or one of uncritical promotion?
- Do they explain clearly and provide the essential details of their work?
These are issues that lay people might be able to check relatively easily. The above 4 reviews demonstrate that using them does not always provided an entirely clear cut-off. However, it might give some valuable pointers into the right direction.
Spinal manipulative therapies, including chiropractic and osteopathic maneuvers, are widely practiced for musculoskeletal complaints. However, serious complications such as cerebrospinal fluid (CSF) leak with subsequent intracranial hypotension (IH) have been described. The pathophysiological mechanism is presumed to involve mechanical stress on the spinal dura during high-velocity movements, leading to dural tears, particularly in the cervicothoracic region.
A team of Italian neuroscientists conducted a scoping review in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines, through a comprehensive search of PubMed and Scopus. They complemented the review with an illustrative case from their own institution.
The researchers identified 21 eligible papers, including 21 patients with IH following spinal manipulation. Most patients were women (81%), aged 29-54 years, and the majority underwent cervical maneuvers.
SMT techniques vary, most often involving high-velocity cervical maneuvers. The most frequent were axial tension with rotation in seven cases (33.3%), unspecified cervical manipulation in four cases (19%), and thoracic spinal manipulation in two cases (9.5%). Less common single-case techniques included rotation with hyperextension, combined cervical and thoracic mobilization, axial tension with lateral flexion, and occipital/shoulder tension technique (n = 1 case each).
Symptom onset was typically within the first week, and all presented with orthostatic headache, often accompanied by nausea, neck pain, tinnitus, or visual disturbances. Neuroimaging consistently revealed features of IH, with pachymeningeal enhancement and subdural collections as the most frequent findings; spinal imaging frequently demonstrated extradural CSF collections. Management was conservative in about one-third of cases, but most required epidural blood patching, which was effective in the majority. Surgical repair was necessary in rare, refractory cases, particularly in the presence of structural spinal abnormalities. Overall prognosis was favorable, with 95% of patients achieving full recovery.
The authors’ illustrative case highlights the potential for severe complications such as subdural hematomas and recurrence if the underlying leak is not addressed:
A 65-year-old patient without a previous history of headache presented with a progressively worsening headache, with orthostatic features, poorly responsive to medical therapy, that has lasted for the past 20 days. The patient denied any recent trauma. He reported having undergone cervical osteopathic manipulations within the past 3 months for recurrent cervicalgia. A brain MRI without contrast was performed, showing a large bilateral subdural hematoma with significant mass effect on the cortical gyri. The patient was admitted to the emergency department and underwent neurosurgical evacuation of a bilateral chronic subdural hematoma via burr holes. Subsequently, endovascular embolization of the middle meningeal arteries was performed as an adjunctive treatment to reduce the risk of recurrence. The surgical procedure was performed without complications. A cranial CT scan showed a reduction in the volume of the hematoma. Therefore, the patient was discharged. However, after a transient improvement in the symptoms, the patient continued to present a fluctuating headache without positional features, with four to five episodes per month. He was readmitted to our clinic and, upon arrival at the ER, a head CT scan showed an increase in pneumocephalus and a recurrence of the hematoma. The following day, an MRI of the neuraxis with contrast was performed, which revealed radiological findings suggestive of IH: pachimeningeal enhancement, subdural fluid collection, dural venous engorgement, cervical spinal longitudinal extradural collection, and effacement of the suprasellar cistern. The Bern score was 7. Given these findings, a surgical revision of the previous burr holes was performed without periprocedural complications. After the first day, a non-targeted epidural blood patch (EBP) was performed under local anesthesia by injecting 16 mL of autologous blood into the L3–L4 epidural space. The procedure was uneventful. A cranial CT scan showed satisfactory surgical outcomes, highlighting a reduction in the volume of the hematoma and of the pneumoencephalus. The patient was subsequently discharged with complete resolution of the headache.
The authors concluded that clinicians should recognize the possibility of CSF leaks after spinal manipulation, especially in patients with new-onset orthostatic headache.
I feel compelled to point out that, considering the multiple risks of upper spinal manipulations and the almost total lack of evidence of benefit from such treatments, the risk/benefit balance of spinal manipulation is clearly not positive. It follows, I think, that it would be wise for patients not to allow such therapies being carried out, and for healthcare professionals to discourage them.
Following my post about the decline in homeopathy-use in Europe, several people dismissed it by saying something like this: Who cares about Europe? Across the globe, homeopathy is state-funded in a majority of countries!!!
This is NOT correct. A correct description of the situation would be that homeopathy is currently state-funded or reimbursed in a minority of countries. In most other countries, it is paid out of pocket or covered only by private insurance. Yes, homeopathy is integrated into national health systems in some countries, explicitly listing Brazil, Chile, India, Mexico, Pakistan, and Switzerland, but this is NOT the global norm.
The counter-argument by homeopathy-fans is this: The states that support homeopathy tend to be very large (e.g. India and Brazil). Therefore, the majority of the world population has access to state-sponsored homeopathy.
This statement seems to be false as well. It is true, of course, that India alone accounts for about 18% of the world’s population, and India does publicly support homeopathy through its health system and the Ministry of AYUSH. But the claim that, for the majority of the world population, homeopathy is state-funded is not based on good evidence. Most of the world’s population lives outside the small number of countries where homeopathy is publicly reimbursed or embedded in state systems.
Even with India included, the evidence available here does not justify a world-population majority claim. The publicly supported/reimbursed countries are still a rather small group, and, as far as I can see, they constitute neither most countries nor most of humanity. In several large countries homeopathy-use exists without state funding or with only private coverage, which weakens any global majority argument. Should someone nevertheless claim that “the majority of the world population has access to state-sponsored homeopathy”, I would ask him or her to show me the evidence for the claim. As far as I can see, it does not exist.
A more accurate statement would therefore be the following:
A substantial share of the world’s population lives in countries where homeopathy has some level of state support, mainly because of India, but there is no good evidence to prove that this amounts to a majority of the world population.
For decades, European health systems have maintained an uneasy coexistence between evidence-based medicine and a range of so-called alternative medicines (SCAMs). Among the most prominent has been homeopathy. That evidence free ride seems now coming to an end. Driven to some degree by budget pressure and by a much larger extend by a stronger emphasis on clinical evidence, many governments have reduced or ended public reimbursement for homeopathy, prompting an important question: which European countries will follow next?
The early movers: the UK and France
As we have discussed ad nauseam on this blog, the UK was among the first major European systems to move away from public funding of homeopathy. In 2017, NHS England recommended that general practitioners stop prescribing homeopathic remedies because of the lack of evidence for clinical effectiveness, and NHS guidance now states that the NHS no longer funds homeopathy. France followed a similar path. After a review by the French National Authority for Health (HAS), the government gradually reduced reimbursement from 30 percent to 15 percent in 2020 and then to zero in 2021.
Germany’s contested turn
As I frequently reported, Germany, the country of Samuel Hahnemann’s birth, became the next major and somewhat convoluted battleground. In 2022, Health Minister Karl Lauterbach publicly argued that homeopathy had no place in a science-based statutory health insurance system, and in 2024 there was a serious political push to end coverage. But the story did not end there: by 2025, that effort had been reversed, and homeopathy and anthroposophic medicine remained covered under statutory health insurance. The most recent turn in this saga is that the days of reimbursement of homeopathy in Germany are counted.
Spain
Spain has taken a particularly forceful stance against SCAM. Its Ministry of Health has pursued a plan aimed at restricting misleading promotion, excluding SCAM from health centres and universities, and improving consumer warnings; however, Spain has not simply “banned” homeopathy, and the products remain available under regulatory controls.
Belgium
Belgium is also restrictive: homeopathy may be practised only by doctors, dentists, and midwives, and the Belgian health-technology authorities advised against compulsory insurance reimbursement.
Switzerland
Switzerland is the clearest exception to the broader European trend. Following the 2009 referendum, several forms of were incorporated into basic insurance, and homeopathy has been covered under mandatory health insurance for services provided by qualified physicians. Recently, it was decided to halt the renewed evaluation of homeopathy.
Italy
Italy is different again: homeopathic products are regulated as medicines, but they are not normally funded through the national health service, so public reimbursement has never been central to their use.
Other countries
In much of Scandinavia and in many central and eastern European states, public reimbursement of homeopathy is generally absent or minimal, even when homeopathy is legally permitted. The Baltic states and several Balkan countries are typically more restrictive in practice, with homeopathy either outside the public system or allowed only under limited professional regulation. Slovenia and Croatia are notable for tighter professional restrictions, with homeopathy not generally open to medical doctors in the way it is in some western European systems.
The future
Across much of Europe, the trend clearly is towards tighter regulation of homeopathy, reduced reimbursement, and greater insistence on sound evidence of benefit. Thus homeopathy is increasingly being pushed out of the public sphere and into private purchase or supplementary insurance. In other words, European public healthcare systems are increasingly treating homeopathy in one of the following ways:
- obsolete because of lack of evidence,
- low-priority,
- non-essential expense.
PS
An interesting ‘aside’ is the fact that the “European Committee for Homeopathy” ignores much of the evidence by falsely stating the following:
“In some areas of the United Kingdom homeopathic treatment by doctors is covered by the National Health System. In Belgium and Latvia the fees for homeopathic treatment are partially covered by the statutory health insurance. In Austria, Belgium, Bulgaria, Germany, Hungary, Italy, Netherlands, Switzerland and the United Kingdom by private insurance companies. The costs for homeopathic medicines are covered by the statutory health insurance in Belgium (partially), France (partially), Portugal (only magistral formula) and Switzerland, by additional private insurance companies in Belgium, Germany, Hungary, the Netherlands and the United Kingdom.”
PPS
In case you happen to be in Vienna during the next week, please come to my lecture:
Gesellschaft der Ärzte, Wien, 13.5.2026, 19:00 – 19:45 Uhr, „Sogenannte Alternativmedizin – Nutzen und Risiken am Beispiel Homöopathie“
Dame Shirley Porter died on May 2. She passed away in Herzliya, Israel, where she had spent much of her time since the early 2000s. Dame Shirley had been the former leader of Westminster City Council and a dominant figure in 1980s UK municipal politics. Once hailed as the “Iron Lady of the town halls,” her career was ultimately defined by the “homes for votes” scandal, which led to her being labeled by the district auditor as the “most corrupt” politician of her era.
The daughter of Tesco founder Sir Jack Cohen, Porter used her wealth to influence both politics and public policy. Beyond the well-documented legal battles over her misuse of council powers – which eventually saw her pay a £12.3m settlement in 2004 – Porter was a prolific, if often controversial, philanthropist. Notably, she was the primary financial backer of the Smallwood Report (2005). Entitled The Role of Complementary and Alternative Medicine in the NHS, the report was commissioned by the then Prince of Wales and written by economist Christopher Smallwood. The study was heavily criticized by myself and several others for advocating that so-called alternative medicine (SCAM) to be funded by the UK taxpayer. The editor of The Lancet, dismissed the findings as “dangerous nonsense” and I suggested the report’s pro-SCAM conclusions were written befor anyone had even looked at the evidence.
Dame Shirely was also a trustee of the London Institute for Mathematical Sciences and as a co-founder of the Porter Foundation. Through these organizations, she funded major capital projects including the Porter School of Environmental Studies at Tel Aviv University and various galleries at the V&A and the National Portrait Gallery.
She is survived by her daughter, Linda.
Despite overwhelming evidence proving that homeopathics are pure placebos, a faction of German healthcare professionals – predominantly people who profit from homeopathy – continues to argue against their removal from statutory insurance. They claim that defunding homeopathy would eliminate vital treatment options, ultimately driving patients toward more expensive conventional interventions. However, from a health economics perspective, this argument is fundamentally flawed; subsidizing treatments that lack proven efficacy is not a cost-saving measure, but rather a misallocation of limited healthcare resources.
Recognizing this inconsistency, German policymakers have finally shifted towards a more evidence-based approach. The federal cabinet recently approved a draft law to reform the statutory health insurance system, which includes a pivotal provision: homeopathic and anthroposophic medicines, along with their associated services, will no longer be eligible for reimbursement as optional benefits (Satzungsleistungen) by public insurers.
This legislative move serves as a long-overdue correction to a historically irrational policy that was initiated by the Nazis during the Third Reich. Excluding these treatments, the government is now finally acknowledging that public healthcare contributions should not fund therapies devoid of scientific backing. This decision brings Germany in line with other European countries like France and the UK, and marks a significant alignment of national policy with the dual principles of evidence-based medicine and responsible fiscal management.
At its core, this reform addresses a long-standing critique of how so-called alternative medicine (SCAM) has been integrated into the German healthcare system. For many decades, institutional tolerance allowed ineffective treatments to gain a veneer of legitimacy and public financing. Consequently, this shift is more than a mere technical adjustment; it represents a symbolic turning point in the relationship between science, medicine, and public policy.
The removal of homeopathy from insurance coverage is undoubtedly both scientifically justified and economically imperative. It signals a decisive transition of German medicine towards a more rational, evidence-based healthcare system that prioritizes proven outcomes over tradition.
Zack Polanski the current Leader of the Green Party of England and Wales, previously worked as a professional “cognitive hypnotherapist”.
My own assessment of hypnotherapy states that is the use of a trance-like state (hypnosis) for therapeutic purposes. It can be traced back to ancient cultures, but more recently Anton Mesmer (1734–1815) introduced hypnotherapy into medicine. Initially Mesmer was highly successful—until a Royal Commission investigated his method of ‘animal magnetism’ and concluded its effects were entirely due to imagination. Hypnotherapy induces in many but not all individuals a state of deep relaxation that is potentially helpful in a range of conditions. Today, there are different schools of hypnotherapy, e.g. Ericksonian hypnotherapy, cognitive behavioural hypnotherapy, curative hypnotherapy. Various different healthcare professionals practise hypnotherapy, including doctors, dentists, psychologists and nurses. Hypnotherapy is used to treat many conditions or symptoms, from pain and stress to irritable bowel syndrome and drug dependency. The evidence from clinical trials is mixed. Most systematic reviews emphasise the often poor-quality of the primary studies, e.g.:
“Hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature.”
“Due to exploratory designs and high risk of bias, the effectiveness of hypnosis or hypnotherapy in stress reduction remains still unclear.”
“There are still only a relatively small number of studies assessing the use of hypnosis for labour and childbirth. Hypnosis may reduce the overall use of analgesia during labour, but not epidural use. No clear differences were found between women in the hypnosis group and those in the control groups for satisfaction with pain relief, sense of coping with labour or spontaneous vaginal birth. Not enough evidence currently exists regarding satisfaction with pain relief or sense of coping with labour and we would encourage any future research to prioritise the measurement of these outcomes. The evidence for the main comparison was assessed using GRADE as being of low quality for all the primary outcomes with downgrading decisions due to concerns regarding inconsistency of the evidence, limitations in design and imprecision.”
“We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomised controlled trials.”
“Current research concerning the efficacy of hypnosis to relieve insomnia is lacking in key methodological elements”
Contrary to what is often claimed, hypnotherapy is not entirely free of adverse effects. It has been associated with the ‘false memory syndrome’ where unpleasant recollections that have never occurred are implanted into the patient’s brain. Hypnotherapy should not be used by patients who suffer from psychoses or personality disorders.
Polanski’s practice was based at a clinic on Harley Street, a London district renowned for private healthcare. His work focused on personal development, confidence building, and body-image issues. Polanski’s hypnotherapy career became a subject of public scrutiny due to a 2013 report by The Sun newspaper, in which it was claimed that during a consultation, Polanski offered to use hypnosis to facilitate breast enlargement. While Polanski later stated the piece was a “misleading” representation of his methods and intended as an experiment in internal self-image, recent investigative reporting has cast doubt on his subsequent narrative.
Although Polanski has frequently asserted that he apologized for the article “the day after” its publication in a BBC radio interview. This claim is, however, contested. In a 2013 interview with BBC Radio Humberside, Polanski reportedly discussed the technique and stated that “the evidence is growing” regarding its efficacy. Independent analysis of the clinical evidence-base for hypnotherapy fails to find good evidence regarding physical outcomes. Similarly, the evidence regarding the efficacy of hypnotherapy for personal development and confidence building is at best varied, with outcomes often depending on the specific application and individual context. My own assessment does not arrive at a positive conclusion.
Polanski has claimed he was misrepresented in the Sun article. Yet, he also wrote in a 2019 blog post that he did not believe the journalist had done a “bad job” or misrepresented him. In that same post, he noted that the coverage led to numerous inquiries from men seeking similar hypnotic treatments for other physical augmentations, all of which he stated he declined.
The “breast enlargement” claim has been frequently cited by political opponents and the media to question Polanski’s judgment and credibility. The story has resurfaced repeatedly during his political campaigns, including through confrontations from members of the public and intense scrutiny during his time as leader.
Polanski maintains that his background in hypnotherapy provides him with unique insights into mental health and communication, which he views as assets in his political role. I would add that, for many of the conditions for which it is promoted, hypnotherapy is not an evidence-based treatment.
Polanski has expressed regret for the “distraction” the story has caused his party, even as critics continue to challenge the consistency of his account regarding the original 2013 events.
Guest post by Udo Endruscheit
Two years ago, in a guest post on this blog, I described the long and winding history of homeopathy in Switzerland — a story marked by political expectations, institutional entanglements, and repeated attempts to reconcile a lack of evidence with a desire for legitimacy. I ended that article with the hope that the country would not embark on yet another “honour lap” around the same unresolved questions.
In 2024, however, Switzerland initiated a new evaluation of homeopathy — a renewed attempt to clarify its role within the national health insurance system. It was, in many ways, the beginning of yet another loop in the same story.
Now, in 2026, that loop has come to an unexpected end. The evaluation was halted.
Not postponed, not softened, not watered down — simply stopped.
And this stop is not merely a political gesture. It marks the structural endpoint of a system that has exhausted its internal possibilities.
A system designed to avoid the evidence question
To understand why Switzerland has arrived at this point, one must look beyond the political headlines and examine the institutional landscape that has shaped the country’s approach to homeopathy for more than a decade.
Three elements are central:
- The political mandate created by the 2009 referendum, which placed homeopathy and other CAM modalities into the basic health insurance package.
- The professional environment, in which thousands of Swiss physicians hold CAM qualifications and the national medical association (FMH) views integrative medicine positively.
- The academic anchor, the Institute for Complementary and Integrative Medicine (IKIM) at the University of Bern, which provides an appearance of scientific legitimacy without producing evidence capable of resolving the core question of efficacy.
This combination created a system in which homeopathy became institutionally normalised — not because of evidence, but because of political and professional expectations.
The HTA as a detour — and the beginning of the dead end
When the Federal Office of Public Health (BAG) was tasked with evaluating homeopathy after the referendum, it faced an impossible dilemma:
- The clinical evidence was weak to non‑existent.
- The political expectation was strong.
- A direct assessment of the evidence would have produced a negative result.
The solution was a detour: a Health Technology Assessment (HTA). But HTAs are not designed to determine efficacy. They assume efficacy has already been established through robust clinical research. Their purpose is to assess cost‑effectiveness, safety, and system impact.
The Swiss HTA did the opposite. In its conclusion, it stated:
“The effectiveness of homeopathy can be considered as proven when internal and external validity criteria are taken into account.”
This is a remarkable inversion of the HTA principle. The report asserted efficacy — without the evidence required to do so — while simultaneously admitting that the actual HTA questions (such as cost‑effectiveness) could not be answered reliably.
In retrospect, this HTA was not the beginning of a solution. It was the beginning of a dead end. A system that asserts efficacy without evidence cannot move forward. It can only circle around itself.
The IKIM: an academic structure without academic function
The IKIM at the University of Bern has played a central role in stabilising this circular logic. Its research output is broad in appearance but narrow in substance. It avoids the central question of efficacy and instead focuses on:
- sociological aspects,
- patient satisfaction,
- model validity,
- and experimental approaches that are not independently reproducible.
The IKIM does not produce evidence. It produces normality — the impression that homeopathy is a legitimate academic field simply because it is housed within a university.
This normality has been crucial for maintaining the political and professional acceptance of homeopathy in Switzerland. But it has also contributed to the structural dead end: an academic institution that cannot resolve the evidence question because it is not designed to ask it.
The 2026 decision: not a surprise, but a consequence
Against this background, the 2026 decision to halt the renewed evaluation of homeopathy is not really surprising. It is the logical endpoint of a system that has exhausted its internal possibilities.
- The evidence has not improved.
- The HTA detour has failed to provide a foundation.
- The institutional structures have stabilised expectations but not knowledge.
- The political mandate cannot be fulfilled without contradicting scientific standards.
The result is a dead end. Not because anyone wanted it, but because the system was built in such a way that no other outcome was possible.
A lesson beyond Switzerland
The Swiss case is often cited by proponents of homeopathy as a model of political and professional acceptance. But the 2026 decision reveals a different lesson:
A system that tries to reconcile political expectations with a lack of evidence will eventually reach a point where it can neither move forward nor turn back.
Switzerland has reached that point. The “endless story” of homeopathy in the Swiss health system has not been resolved — but it has reached its structural conclusion.
And unfortunately that conclusion is not a triumph of evidence. It is the recognition that evidence cannot be replaced by institutional normality. But one thing it certainly isn’t: an endorsement of homeopathy, even if its advocates will once again try to interpret it that way.
When a top journal like PNAS (Procedings of the Nationsl Academy of Science) publishes an article entitled “What’s the science behind acupuncture?“, I must take notice. Here is my take on the (sadly disappointing) effort:
My very short summary of the paper (I do encourange my readers to read it in full)
The article starts from the premise that acupuncture is proven to work, an assumption that – as we will see in a minute – is not based on sound evidence. It describes the evolution of acupuncture from a traditional practice rooted in ancient concepts like “qi” and “meridians” to a modern medical treatment increasingly validated by science. It argues that practitioners like Min Chen are today able to provide evidence-based explanations for their work. While early clinical trials were plagued by the “sham” acupuncture paradox, the text argues that more recent, rigorous studies and technological projects are bridging the gap between Eastern philosophy and evidence-based medicine, suggesting that acupuncture’s effects are physiological realities rather than mere placebo.
My concerns of the paper
The article attempts to bridge the gap between Traditional Chinese Medicine (TCM) and conventional medicine suggesting that several anatomical discoveries “correspond” to ancient meridians. This, however, is a post hoc ergo propter hoc fallacy. Finding a morphological structure (e.g. fascia) and claiming it represents the meridian system ignores that meridians were conceptualized as functional energetic conduits, not anatomical vessels. Citing an 80% overlap between acupoints and connective tissue planes lacks specificity. Given the ubiquity of connective tissue in the human frame, any randomized point on the body would likely “overlap” with a tissue plane, rendering the “meridian” map a possible exercise in pattern-seeking rather than anatomical discovery.
The paper acknowledges the “most puzzling” finding that sham acupuncture often produces results comparable to “true” acupuncture. This, it would seem to me, invalidates the foundational TCM theory of specific “acupoints” and “meridians” is invalidated. Yet, the article suggests that sham acupuncture is “not a true placebo” because it also triggers biological pathways. If needling anywhere produces an effect, acupuncture is merely a generalized, non-specific neuro-modulatory stimulus.
The article quotes Chen on “harmonizing organ functions” and “regulating qi” as well as researchers referring to “fibroblast activation” and “vagus nerve stimulation”. The author seems to consider both to be true; yet they seem mutually exclusive. Translating metaphysical concepts into physical phenomena does not “validate” the original theory but merely replaces it.
The article employs the opioid crisis to justify the rise of acupuncture. Yes, the need for non-pharmacological pain management is urgent, but clinical necessity does not equate to scientific validity. The text quotes the “lasting benefits” observed in some meta-analyses without discussing the often fatal flaws in these papers. Furthermore, it fails to cite the substantial body of evidence suggesting that acupuncture is not effective. Moreover, it hardly mentions the small effect sizes and hence limited clinical usefulness found in the positive studies.
The final section of the paper essentially rebrands acupuncture as “bioelectronic medicine”. If its mechanism of action is purely the electrical stimulation of the vagus nerve or the release of endogenous opioids, then the TCM concepts are all but superfluous. If a cheap and wearable TENS unit is more or less equivalent, the “meridian” and “qi” myths are obsolete.
In summary, the paper reads, I fear, only marginally better than a Chinese government promotional text – most disappointing for an article published in a journal of high standing. It attempts to preserve the cultural prestige of TCM while stripping it of its internal logic in order to make it compatible with science. For acupuncture to gain a true “scientific footing”, research must, in my view, move beyond finding “tantalizing” correlations. It should address fundamental problems, e.g.:
- As long as we have no convincing proof that acupuncture works beyond placebo, discussions about its mechanisms are futile.
- If qi, acupoints and meridians are illusions and irrelevant for the clinical outcome, then the science is not validating acupuncture but merely re-discovering a well-known non-specific form of peripheral nerve stimulation.
I am quite fond of garlic, but not as a cancer therapy. Dr. Mohsen Ali, a former doctor whose UK medical license was revoked by the General Medical Council (GMC) in January 2015, has been permanently struck off the medical register following a Medical Practitioners Tribunal Service (MPTS) investigation into his running of an illegal clinic. The tribunal, which began proceedings on December 1, 2025, reconvened on January 14 and concluded from April 22 to 24, 2026, found Ali guilty of serious professional misconduct for preying on vulnerable cancer patients with unproven and dangerous treatments.
In 2018, Ali treated two patients from a semi-detached Leicester property described as a “squalid council house.” Patient A had stage three prostate cancer, while Patient B suffered from terminal ovarian cancer. Referred to Ali by word-of-mouth, both were told he could cure their cancers with a claimed 90% success rate. He charged Patient A up to £15,000 and Patient B between £10,000 and £12,000 for sessions involving intravenous vitamin C, garlic oil, ozone therapy, oxygenated water, and sodium bicarbonate injections.
Ali disparaged conventional medicine, asserting that the NHS was “killing them” through ineffective chemotherapy and radiotherapy, while “big pharma companies were making money.” During a phone call, he laughed off Patient A’s diagnosis, calling prostate cancer “easy to cure.” For Patient B, he overrode the NHS’s prognosis that nothing more could be done, promising her husband a full recovery. Patient B died shortly after stopping treatment, before police and Public Health England (PHE) probes began.
The case surfaced when Patient A emailed Leicestershire Police, prompting a GMC referral. A police raid uncovered a flyer at Ali’s address, advertising him as a “qualified doctor” who left the NHS because standard treatments “did not work.” It invoked “Allah the best healer” and boasted over 90% cure rates for cancers and other severe illnesses.
MPTS evidence revealed grave hygiene failures. PHE inspections described the property as a “dirty and unhygienic” shared residential-clinical space with visibly contaminated surfaces, reused equipment without decontamination, and no basic infection prevention measures. Ali reused intravenous bags, exposing patients to serious infection risks. The tribunal deemed his actions dishonest, as he knew these were not evidence-based cancer cures.
An expert witness confirmed no clinical studies support these so-called alternative medicines (SCAMs) for curing any cancer. Ali also failed to obtain informed consent, particularly from Patient B. Absent from the hearing, he emailed the GMC denying claims of cure, but the flyer and patient testimonies contradicted him.
Ali, who graduated from Cairo University in 1994 and practiced in the UK from 2001 was erased him from the register, underscoring the dangers of unqualified SCAM practitioners – even (or perhaps especially) when they have a doctor title.
