I was alerted to a new book entitled “Handbook of Space Pharmaceuticals“. It contains a chapter on “Homeopathy as a Therapeutic Option in Space” (yes, I am not kidding!). Here is its abstract (the numbers were inserted by me and refer to the short comments below):
Homeopathy is one of the largest used unorthodox medicinal systems having a wide number of principles and logic to treat and cure various diseases . Many successful concepts like severe dilution to high agitation have been applied in the homeopathic system . Though many concepts like different treatment for same diseases and many more are contradictory to the allopathic system , homeopathy has proved its worth in decreasing drug-related side effects in many arenas . Various treatments and researches are carried out on various diseases; mostly homeopathic treatment is used in joint diseases, respiratory diseases, cancer, and gastrointestinal tract diseases . In this chapter, readers will have a brief idea about many meta-analysis results of most common respiratory diseases, i.e., asthma, incurable hypertension condition, rheumatoid arthritis, and diarrhea and a megareview of all the diseases to see their unwanted effects, uses of drugs, concepts, and issues related to homeopathy . Various limitations of homeopathic treatments are also highlighted which can give a clear idea about the future scope of research . Overall, it can be concluded that placebo and homeopathic treatments give almost the same effect , but the less severe side effects of homeopathic drugs in comparison to all other treatment groups catch great attention .
Apart from the very poor English of the text and the fact that it has as good as nothing to do with the subject of ‘Homeopathy as a Therapeutic Option in Space’, I have the following brief comments:
- I did not know that homeopathy has ‘a wide number of logic’ and had alwas assumed that there is only one logic.
- Successful concepts? Really?
- So, homeopaths believe that the ‘allopathic system’ treats the same diseases uniformly? In this case, they should perhaps read up what conventional medicine really does.
- I am not aware of good evidence showing that homeopathy reduces drug related adverse effects.
- No, homeopathy is used for all symptoms – Hahnemann did not believe in treating disease entities – and mostly for those that are self-limiting.
- I love the term ‘incurable hypertension condition’; can somebody please explain what it is?
- The main limitation is that homeopathy is nonsense and, as such, does not really require further research.
- Not ‘almost’ but ‘exactly’! But thanks for pointing it out.
- Wishful thinking and not true. Firstly, the author forgot about ‘homeopathic aggravations’ in which homeopaths so strongly believe. Secondly, I know of many non-homeopathic treatments that are free of adverse effects when done properly.
Altogether, I am as disappointed by this article as you must be: we were probably all hoping to hear about the discovery showing that homeopathy works splendidly in space – not least because we have known for a while that homeopaths seem to be from a different planet.
Congratulations to Joseph Prahlow, MD, who is the winner of the Excellence in Homeopathy Award! Here are the conclusions of his winning essay. Special thanks to Hermeet Singh and Boiron for their prize donation.
Despite the many obstacles and challenges which face homeopathy in the 21st century, the homeopathic community should be emboldened and encouraged by the fact that there are also many opportunities for the advancement of homeopathy as an alternative choice in health care.
Proclaim the Truth: Homeopathy Actually Works
Notwithstanding the challenges involved (especially for a student) in arriving at the correct simillimum for a case, let alone the appropriate follow-up and case management, the truth of the matter is that homeopathy does, in fact, work! Those of us who have been the beneficiaries of homeopathic care, or who have seen the benefits in others, know with no doubt whatsoever that homeopathy represents a truly amazing form of alternative medicine that is able to successfully treat patients having a wide range of health concerns, including some very ill individuals. And it’s not just based on “experience” or “perception,” although such evidence should not be discounted. Numerous studies show the effectiveness of homeopathy.6-9 The fact that homeopathy actually works represents one of the biggest and most important opportunities for homeopathy. The corresponding challenge relates to “getting the word out” into the general community as well as the medical community. Instead of homeopathy being the “last resort,” it should increasingly become the “first choice” amongst patients. Only by “spreading the word” of its success can this become a reality.
What intrigued me here was the evidence that an award-winning homeopath believes might justify the claim that
“Numerous studies show the effectiveness of homeopathy”
6. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of individualized homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2014 Dec 6;3:142. doi: 10.1186/2046-4053-3-142.
As we have discussed previously that meta-analysis is phoney and created a false-positive result by omitting at least two negative studies.
7. Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct in reducing antibiotic usage in children with otitis media. Glob Pediatr Health 2014 Nov 21;1:2333794X14559395. doi: 10.1177/2333794X14559395.
This study had the notorious A+B versus B design and thus was unable to test for specific effects of homeopathy. Moreover, the lead author, Dr Jennifer Jacobs, was a paid consultant to Standard Homeopathic Company.
8. Sorrentino L, Piraneo S, Riggio E, et al. Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy. J Intercult Ethnopharmacol 2017 Jan 3;6(1):1-8. doi: 10.5455/jice.20161229055245.
This study showed no significant result in the intention to treat analysis. The positive conclusion seems to be based on data dredging only.
9. Frass M, Lechleitner P, Grundling C, et al. Homeopathic treatment as an add-on therapy may improve quality of life and prolong survival in patients with non-small cell lung cancer: a randomized, placebo-controlled, double-blind, three-arm, multic0-e1955enter study. Oncologist 2020 Dec 25(12):e1930-e1955. doi: 10.1002/onco.13548.
Perhaps the award winning author should chance the crucial sentence into something like:
Numerous studies have shown how homeopaths try to mislead the public?
In any case, please do not let this stop you from reading the full paper by the award-winning author. I promise you that it will create much hilarity.
What does homeopathy offer our modern ailing world?
“Acute Fulminant Hepatic Failure in 23-Year-Old Female Taking Homeopathic Remedy” is not a title we see often on a scientific paper. Naturally, it attrackted my interest. In the paper, a US team presented a case of a 23-year-old otherwise healthy woman with body mass index 32.3 and a history of polycystic ovarian syndrome who presented with acute liver failure (ALF) ultimately requiring orthotopic liver transplantation. The patient was originally from India where she reported taking homeopathic medications for various indications for several years without known toxicity. She had no history of alcohol, tobacco, or other drug use. At the time of her presentation, she was living and working in the US and reported she was unable to refill her homeopathic product with the primary ingredient of eggshells from India. She was off of all medications and supplements with the exception of Berberis vulgaris for approximately 1 month before obtaining a similarly named homeopathic product with the primary ingredient of eggshells from Amazon. She reported originally taking 4 pills/d for 10 days, and then increased to 10 pills/d for 10 days as she was unsure of the appropriate dose.
She subsequently developed orange discoloration of her urine and nausea, reportedly without any preceding muscle-related effects or symptoms, and she discontinued all of her medications/supplements. Approximately 2 weeks later, she presented to the emergency department for nausea and malaise, where a blood test revealed abnormal liver enzymes. Mononucleosis screen and hepatitis panel were negative. She had no evidence of hepatic encephalopathy at that time. Ultrasound of the abdomen was notable for hypoechoic liver parenchyma only.
She was discharged home with gastroenterology telehealth follow-up. She was seen 1 week later and reported worsening nausea, vomiting, anorexia, jaundice, and fatigue. She presented to a local emergency department where she received intravenous vitamin K and underwent further laboratory evaluation. She was transferred to another hospital for higher level of care and admitted with acute liver injury. There she received intravenous N-acetylcysteine per institutional protocol, ursodiol, albumin, vitamin K, and fresh frozen plasma transfusions given for coagulopathy. Magnetic resonance cholangiopancreatography was performed and demonstrated no evidence of biliary obstruction or chronic liver disease (no ascites, contour nodularity, mass, or lymphadenopathy), though liver size noted to be small (11.5 cm in span). At 21 to 28 days after the onset of symptoms, her lab results were still highly abnormal and her mental status deteriorated. She was intubated for airway protection given severe encephalopathy, “cooling protocols” were initiated, and she was transferred again to a higher level of care at a center for emergent liver transplant evaluation. She was evaluated and listed as status 1A for acute liver failure. Her clinical status continued to decline and her labs continued to worsen.
An appropriate organ became available 28 hours after listing. At the time of her surgery, her explanted liver was noted to have massive parenchymal loss with hemorrhage, and pathology confirmed near complete collapse of the organ’s framework with only small foci of steatotic hepatocytes remaining. After her initial operation, her hospital course was complicated by coagulopathy, hypotension, leukocytosis, kidney failure requiring temporary dialysis, and multiple operations for completion of biliary anastomoses and delayed complex abdominal wall closure with mesh given large donor size. She was discharged from the hospital 2 weeks after transplant and her outpatient course continues to go well over 1 year after liver transplantation.
The product in this case has not been previously reported to be toxic. Its primary ingredient is calcium from “toasted eggshells,” which is also not generally known to cause liver failure or disease. However, the authors point out that it is not uncommon for supplements such as this one to contain other potentially toxic agents that are not specifically listed on the bottles’ label. For example, toxic metals including lead, mercury, and arsenic have reportedly been discovered in many (almost 20%) naturopathic medicines manufactured in India, particularly those sold by US websites. As such, the authors hypothesize that this patient’s ALF was likely caused by a contaminant (also consumed in higher quantities than intended) in her homeopathic product with the primary ingredient of eggshells.
The authors of this paper repeatedly state that the product was a homeopathic remedy; however, on other occasions they claim that it was a herbal supplement. In their Figure 1, they name the product as ‘OVA TOSTA’; on Amazon USA, I did indeed find a remedy by that name. Sadly, I was unable to obtain any information about its exact ingredients or composition.
Regardless whether the product was herbal or homeopathic, this case report is a poignant reminder that, in so-called alternative medicine (SCAM) many dangerous remedies are offered for sale. Therefore, it is advisible to be cautious and insist on sound information about the quality, safety, and efficacy before trying any such therapy.
On the occasion of a talk that I recently gave in Italy, I was interviewed by VANITY FAIR ITALY. I gave it in English and it was published in Italian. As I don’t expect many readers to be fluent in Italian and since it was a good interview, in my view, I thought I give you here the English original:
1.How can we exactly define «alternative medicine»?
There is much confusion and a plethora of definitions, none of which is fully satisfactory. In fact, the term “alternative medicine” itself is nonsensical: if a therapy works, it belongs to evidence-based medicine; and if it doesn’t work, it cannot possibly be an alternative. I therefore have long been calling it “so-called alternative medicine” (SCAM). The definition I use for SCAM with lay audiences is simple: SCAM is an umbrella term for a diverse range of therapeutic and diagnostic methods that have little in common, other than being excluded from mainstream medicine.
2.Who uses it and why?
Predominantly women! Statistics say about 30-70% of the general population use SCAM. And with patient populations, the percentage can be close to 100%. They use it because they are told over and over again that SCAM is natural and thus safe, as well as effective for all sorts of conditions.
3.Focusing on terminology, is there a difference between «complementary» and «alternative» medicine?
Theoretically, there is a big difference between «complementary» and «alternative» medicine. The former is supposed to be used as an add-on to, while the latter is a replacement of mainstream medicine. In practice, this dividing line is very blurred; most SCAMs are used in both ways, depending on the actual situation and circumstance.
4.Are users different from non-users?
Yes, there has been much research on this and my reading of it is that SCAM users tend to be less intelligent, more religious, more superstitious, less trusting in science, and more prone to conspiracy theories, for instance.
5.Which forms of alternative medicine are the most popular?
There are certain national differences, but in most European countries herbal medicine, acupuncture, chiropractic, osteopathy, homeopathy, aromatherapy, and reflexology are amongst the most popular SCAMs.
6.Does it work?
With such a wide range – someone once counted over 400 modalities and my last book evaluated 202 of them (Alternative Medicine: A Critical Assessment of 202 Modalities (Copernicus Books): Amazon.co.uk: Ernst, Edzard: 9783031107092: Books) – it is impossible to answer with yes or no. In addition we need to consider the conditions that are being treated. Acupuncture, for example, is touted as a panacea, but might just work for pain. If you take all this into account, I estimate that less than 3% of the therapeutic claims that are being made for SCAM are supported by sound evidence.
Is it safe?
Again, impossible to say. Some treatments are outright dangerous; for instance, chiropractic neck manipulations can injure an artery and the patient suffers a stroke of which she can even die. Other treatments are assumed to be entirely harmless; for example homeopathy. But even that is untrue: if a cancer patient relies exclusively on homeopathy for a cure, she might easily hasten her death. Sadly, such things happen not even rarely.
Do its benefits outweigh its risks?
That depends very much on the treatment, the disease, and the precise situation. Generally speaking, there are very few SCAMs that fulfill this condition.
You said that these were the research questions that occupied all your life in Exeter. Did you find the answers?
We published more on SCAM than any other research group, and we found mostly disappointing answers. But still, I am proud of having found at least some of the most pressing answers. Even negative answers can make an important contribution to our knowledge.
7.What is the problem with the placebo effect?
All therapies can prompt a placebo effect. Thus an ineffective treatment can easily appear to be effective through generating a placebo effect. This is why we need to rely on properly conducted, if possible placebo-controlled trials, if we want to know what works and what not.
8.Is it true that some alternative medicines can cause significant harm?
9.What about herbal remedies? What do studies show about them?
Many of our modern drugs originate from plants, Therefore, it is not surprising that we find herbal remedies that are effective. But careful! This also means that plants can kill you – think of hemlock, for instance. In addition herbal medicine can interact powerfully with synthetic drugs. So, it is wise to be cautious and get responsible advice.
10.Which alternative therapies are overrated and why?
In my view, almost all SCAMs are over-rated. If you go on the Internet, you find ~5 000 000 websites on SCAM. 99% of them try to sell you something and are unreliable or even dangerous. We need to be aware of the fact that SCAM has grown into a huge business and many entrepreneurs are out to get your money based on bogus claims.
11.On the contrary, which therapies could be seen as an integration in routine care?
The best evidence can be found in the realm of herbal medicine, for instance St John’s Wort. Some mind-body interventions can be helpful; also a few massage techniques might be worth a try. Not a lot, I’m afraid.
12.Would you tell us what happened in 2005 with Prince Charles?
He complained about my actions via his private secretary to my University. A 13 month investigation followed. At the end, I was found not guilty but my funding, my team, my infrastructure had been dismantled. So, in effect, Charles managed to close down what was the only research group that looked critically and systematically into SCAM. A sad story – not so much for me but for progress and science, I think.
3.Why is alternative medicine still a controversial subject?
Mainly because the gap between the claims and the evidence is so very wide – and getting wider all the time.
14.Would you suggest the «right way» to approach it?
I often recommend this: if it sounds too good to be true, it probably is! I might add that, if you want reliable advice, don’t listen to those who profit from giving it.
We have discussed the homeopathic obscession with bovine mastitis before. For instance, we have looked at this systematic review which did exactly that. Its authors are highly respected and come from institutions that are not likely to promote bogus claims:
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
- Canadian Bovine Mastitis and Milk Quality Research Network, Canada
- Canadian Bovine Mastitis and Milk Quality Research Network, Canada
- Sherbrooke Research and Development Centre, Agriculture and Agri-Food Canada
- Canadian Bovine Mastitis and Milk Quality Research Network, Canada
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montreal, Canada.
A total of 2,451 manuscripts were first identified and 39 manuscripts corresponding to 41 studies were included. Among these, 22 were clinical trials, 18 were experimental studies, and one was an observational study. The treatments evaluated were conventional anti-inflammatory drugs (n = 14), oxytocin with or without frequent milk out (n = 5), biologics (n = 9), homeopathy (n = 5), botanicals (n = 4), probiotics (n = 2), and other alternative products (n = 2). All trials had at least one unclear or high risk of bias. Most trials (n = 13) did not observe significant differences in clinical or bacteriological cure rates in comparison with negative or positive controls. Few studies evaluated the effect of treatment on milk yield. In general, the power of the different studies was very low, thus precluding conclusions on non-inferiority or non-superiority of the treatments investigated. No evidence-based recommendations could be given for the use of an alternative or non-antimicrobial conventional treatment for clinical mastitis. The authors concluded that homeopathic treatments are not efficient for management of clinical mastitis.
Did this finally stop homeopaths from claiming that their placebos work for mastitis?
I would not count on it!
Will it stop homeopaths to conduct trials of the subject?
Recently a new study has emerged. Its aim was to assess the potential of a novel homeopathic complex medicine in managing bovine mastitis. Twenty-four lactating Holstein cows with mastitis were divided into two groups: the homeopathic complex group received a homeopathic complex daily for 60 days at a dose of 20 g/d; the placebo group received the calcium carbonate vehicle without homeopathic medicines at the same dose and repetition. The main outcome measure was somatic cell count (SCC; cells/mL), with additional outcome measures including milk production (kg/d), milk constituents (percentage of protein, fat, lactose and total milk solids), and serum levels of cortisol, glucose, ammonia and lactic acid. All outcomes were measured at the beginning of the study and after 30 and 60 days. Milk samples were also collected from all animals at the beginning of the study, confirming a high (>0.2) MAR index for isolated bacterial cultures.
Assessment of SCC showed a statistically significant difference favoring the homeopathic complex versus placebo group at day 60. A reduction in serum cortisol levels and an increase in fat, lactose and total milk solids in animals treated with the homeopathic complex at day 60 were also seen. Other outcome measures did not show statistically significant inter-group differences.
The authors from the Paranaense University-Praça Mascarenhas de Moraes, Umuarama, Paraná, Brazil, concluded that the results of this non-randomized, open-label, placebo-controlled trial suggest the potential for a novel homeopathic complex medicine in management of multiple antibiotic-resistant bovine mastitis, thus offering dairy farmers an additional option to antibiotics and making dairy products safer for consumer health and milk production more sustainable.
Here are just some of the most obvious points of concern:
- The trial was supported by the manufacturer of the homeopathic product, yet the authors declare no conflicts of interest.
- The exact nature of the product remains unknown to anyone like me who tried to obtain the information by searching the websites of the manufacturer, etc.
- The trial was non-ramdomized and open label, i.e. wide open to bias, yet the authors do not shy away from drawing firm conclusions.
- There is no plausible rationale for homeopathy in this (or any other) indication.
- Homeopathy for animals contradicts the gospel of Hahnemann, its inventor.
- Overwhelmingly, the evidence fails to show that homeopathy is effective for bovine mastitis.
I do understand that manufacturers smell a lucrative market, but I still think that, for serious veterianarians, scientists, journal editors, etc., the subject should be closed.
Robert Jütte, a German medical historian, has long been a defender of homeopathy and other forms of so-called alternative medicine (SCAM). His latest paper refers to the situation in Switzerland where the public was given the chance to vote for or against the reimbursement of several SCAMs, including homeopathy. I reported previously about this unusual situation, e.g.:
- More about homeopathy in Switzerland: “Globuli only cause unnecessary healthcare costs”
- More on the situation of homeopathy in Switzerland
- SCAM in Switzerland: paediatricians couldn’t care less
- It’s official: Switzerland is going holistically round the bend
Unsurprisingly, Prof Jütte’s views are quite different from mine. Here is the abstract of his recent paper:
Behind the principle of involving users and voters directly in decision-making about the health care system are ideas relating to empowerment. This implies a challenge to the traditional view that scientific knowledge is generally believed to be of higher value than tried and tested experience, as it is the case with CAM. The aim of this review is to show how a perspective of the history of medicine and science as well as direct democracy mechanisms such as stipulated in the Swiss constitution can be used to achieve the acceptance of CAM in a modern medical health care system. A public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism (provided that therapeutical alternatives are not risky). Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine.
I think that Jütte’s statement that “a public health care system financed by levies from the population should also reflect the widely documented desire in the population for medical pluralism provided that therapeutical alternatives are not risky. Otherwise, the problem of social inequality arises because only people with a good financial background can afford this medicine” is untenable. Here are my reasons:
- Lay people are not normally sufficiently informed to decide which treatments are effective and which are not. If we leave these decisions to the public, we will end up with all manner of nonsense diluting the effectiveness of our health services and wasting our scarce public funds.
- Jütte seems to assume that SCAMs that are not risky do no harm. He fails to consider that ineffective treatments inevitably do harm by not adequately treating symptoms and diseases. In serious conditions this will even hasten the death of patients!
- Jütte seems concerned about inequity, yet I think this concern is misplaced. Not paying from the public purse for nonsensical therapies is hardly a disadvantage. Arguably, those who cannot affort ineffective SCAMs are even likely to benefit in terms of their health.
I do realize that there might be conflicting ethical principles at play here. I am, however, convinced that the ethical concern of doing more good than harm to as many consumers as possible is best realized by implementing the principles of evidence-based medicine. Or – to put it bluntly – a healthcare system is not a supermarket where consumers can pick and chose any rubbish they fancy.
I wonder who you think is correct, Jütte or I?
Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals.
In this study, an international team of researchers analyzed the relationship between endorsement of so-called alternative medicine (SCAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries:
In total the sample amounted to 2,787 physicians.
The results suggest that, in all the participating countries, SCAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average SCAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another:
- 24% in Germany,
- 18% in France,
- 10% in Finland,
- 6% in Portugal.
These results constitute a call to consider health care professionals’ attitudes toward SCAM as a factor that could hinder the implementation of immunization campaigns.
The authors also point out that the link between SCAM endorsement and negative attitudes toward vaccines has been documented in previous research among the general public. A systematic review, which categorized arguments against vaccines retrieved from peer-reviewed articles and debunking texts published by international fact checking agencies, identified a category of arguments largely based on alternative health beliefs related to SCAM. This category was the third most common in the scientific and fact-checking literature. Furthermore, in a British study, anti-vaccination arguments related to SCAM were also among the most endorsed arguments by individuals. These results suggest that SCAM beliefs play an important role in individuals’ justification of their hesitant attitudes toward vaccines for both adults and children. Analyses of samples from the Australian, Finnish, American, and Spanish general populations found that positive attitudes toward SCAM were related to negative attitudes toward vaccines. In a recent large-scale study in 18 European countries, parental consultation with homeopaths was associated with higher vaccine hesitancy than consultation with pediatricians or nurses. Moreover, a systematic review found that SCAM use tended to be positively associated with lower childhood immunization. Similar findings were reported also from the US and Australia.
There are several potential causes for the observed relationship between vaccine hesitancy and SCAM. Since SCAM use occurs more frequently at the poles of the disease spectrum (i.e., in cases of minor or life-threatening illness), SCAM use has been identified as a marker of both misperception of risk and frustration with regular healthcare (e.g., negative prognosis or lack of remission of symptoms). Accordingly, SCAM-related health conceptions could be motivating healthcare practitioners (HCPs) to be more reluctant to recommend and receive vaccinations both for illnesses that are perceived as minor and in cases of severe clinical pictures. There are also reasons related to the potential alignment between SCAM and the ideology or worldview of the HCP, such as their distrust in “Big Pharma” or a general disregard for scientific knowledge. Along the same lines, it has been shown that the main reasons for their preference for SCAM included a greater affinity between SCAM, their do-it-yourself approach to health care, and their sympathy for natural and allegedly harm-free products in contrast to medications marketed by pharmaceutical companies, which were perceived as ineffective, “toxic” and “adulterating.”
Besides these implicit reasons, some SCAM traditions are theoretically incompatible with vaccination and portrayed as a valid, or even superior, alternative to scientific knowledge. A quantitative study found that pro-SCAM and anti-vaccination attitudes both reflect beliefs contrary to basic scientific knowledge, such as “an imbalance between energy currents lies behind many illnesses” and “an illness should be treated with a medicine that has properties similar to those of the illness.” An example of these SCAM-related beliefs that contradict the theoretical basis of vaccinations is “homeopathic immunization” through so-called “nosodes” – orally administered extreme dilutions of infectious agents. Similarly, Rudolf Steiner and Ryke Geerd Hamer, promoters of anthroposophic medicine and ‘German New Medicine’, respectively, have sown doubts about vaccinations based on their conceptions of the etiology and treatment of diseases. Consequently, strong science denial and vaccine hesitancy can be found within these communities, and outbreaks of vaccine-preventable diseases, such as measles and whooping cough, have been reported in educational centers linked to anthroposophy.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme.
Many people believe in and use so-called alternative medicine (SCAM) to address health issues or prevent diseases. Empirical evidence for those treatments is either lacking or controversial due to methodological weaknesses. Thus, practitioners and patients primarily rely on subjective references rather than credible empirical evidence from systematic research.
This study investigated whether cognitive and personality factors explain differences in belief in SCAM and homeopathy. The researchers, German psychologists, investigated the robustness of 21 predictors when examined together to obtain insights into key determinants of such beliefs in a sample of 599 participants (60% female, 18-81 years). A combination of predictors explained 20% of the variance in SCAM belief:
- ontological confusions,
- spiritual epistemology,
- death anxiety,
Approximately 21% of the variance in belief in homeopathy was explained by the following predictors:
- ontological confusions,
- illusory pattern perception,
- need for cognitive closure,
- need for cognition,
- death anxiety,
The autors concluded that individuals believing in SCAM and homeopathy have cognitive biases and certain individual differences which make them perceive the world differently.
The authors argue that a key characteristic of many SCAM treatments is the spiritual orientation to knowledge and decision-making. For medical decisions, individuals who agree that important knowledge results from religious or spiritual experiences might not rely on evidence as a proof of efficiency but rather explain it in terms of personal experiences. One primary reason for the use of homeopathy is having had good experiences in the past. Own experiences have a high value and persuasive power but are meaningless from a scientific point of view.
Paranormal beliefs and SCAM belief do not only share ontological confusions as a predictor, paranormal beliefs are typically the best predictor of CAM belief. However, comparing those belief forms, it becomes clear that they share many concepts and approaches to explain reality in an unscientific way. Therefore, both belief forms, paranormal beliefs and SCAM beliefs, could also be seen as a result of a world view in which scientific evidence is valued less and, instead, emotional and spiritual explanations are consulted.
I think that anyone who has followed the discussions on this blog must agree wholeheartedly.
Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment.
The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023.
The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference.
Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943–2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs.
Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM).
The authors concluded that the quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems.
Reading this SR, I got the impression that it was designed to generate a positive result. The 6 included MAs are marginally positive (mainly due to publication bias and other artefacts) and thus very well known to fans of homeopathy. The authors of this paper must therefore have expected that combining them in a review would generate an overall positive finding.
The first question I asked myself while studying this paper was: who would want to do an SR of MAs (a most peculiar exercise); why not at least an SR of SRs which is already an unusual project but would make at least some sense. (An SR is a review that includes all studies that match a set of pre-definied criteria. A MA is a special form of SR where statistical pooling was possible.) The answer is, I fear, simple: this would not have generated a positive result: here are now dozens of SRs of homeopathy and most are not positive (as discussed regularly on this blog)
The authors themselves provide no real justification for their bizarre approach. All they tell us about it is this:
One approach is to focus on a specifc indication (e.g., depression , acute respiratory tract infections in children ) while often including open-label trials and observational studies. In this approach, data synthesis is grouped by design, thus yielding information about homoeopathy in patient care. Te opposite approach is to include all indications while restricting study designs to placebo-controlled trials and aggregating results in an MAs, thus yielding information about the specifc efects of homoeopathy beyond those of placebo. A major reason for using this approach has been the claim that ‘homoeopathy violates natural laws and thus any efect must be a placebo efect’ .
Since 1997, at least six MAs of placebo-controlled homoeopathy trials for any condition have been published [6–11]. These MAs have difered in their methods for trial inclusion, data synthesis and assessment of risk of bias; furthermore, their results and conclusions have been inconsistent. During this period, there have been substantial advancements in methodology and quality standards for MAs and other SRs [12–15], including SRs of SRs (also called overviews or umbrella reviews) [16–18]. To our knowledge, a formal SR of MAs of randomised placebo-controlled homoeopathy trials for any condition has not been performed. Herein, we report such an SR.
What the authors actually did is this: they knew of the 6 MA; they also knew that they arrived at cautiously positive conclusions; finally they also were aware of the fact that, obviously, the 6 MA included more or less almost the same primary studies. So, by pooling the MAs, they generated a positive result which was no longer marginally positive but strongly. Anyone looking through this strategy (which in effect multiplies the results of many primary studies by factor 6) must realize that this methods creates a false-positive impression.
My suspicion that this paper is a deliberate attempt at misleading us about the ‘efficacy’ (actually it should be effectiveness) is strengthened by further facts:
- One of the two MAs by Mathie et al excluded primary studies that reported positive findings (i.e. mine and the one by Walach et al)
- Funding: Open Access funding enabled and organized by Projekt DEAL. Funding specifcally for this SR was provided by Christophorus-Stiftung (No. 393 CST), Stiftung Marion Meyenburg (Date 24.09.2020), Dr. Hauschka Stiftung (Date 16.11.2020) and Gesellschaft für Pluralität im Gesundheitswesen (Dates 11.06.2021, 22.06.2021). General funding for IFAEMM was provided by the Software-AG Stiftung (SE-P 13544). The funders had no infuence on the writing of the protocol or on the planning, conduct and publication of this SR.
- Competing interests: In the past 3 years, HJH has received research grants from two manufacturers of anthroposophic medicinal products (Wala Heilmittel GmbH, Bad Boll/ Eckwälden, Germany; Weleda AG, Arlesheim Switzerland). Anthroposophic medicine is not based on the homoeopathic simile principle or on drug provings, but some anthroposophic medicinal products are potentized. The two manufacturers had no involvement with the present SR. Anthroposophic medicinal products were not part of the intervention in any of the trials evaluated in the MAs of this SR (Suppl. Table 15). DSR has received a development grant from Heel GmbH (manufacturer of homoeopathic products) for online training in case report writing. AG, KvA and HK declare that they have no competing interests.
- Author details: 1) Institute for Applied Epistemology and Medical Methodology at Witten/ Herdecke University (IFAEMM), Freiburg, Germany. 2) Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany. 3) Maryland University of Integrative Health (MUIH), Laurel, MD, USA. 4) Homeopathic Pharmacopoeia Convention of the United States (HPCUS), Southeastern, PA, USA.
Personally, I do not find it surprising that these authors bend over backwards to publish something positive about homeopathy (such things happen in homeopathy all the time). However, I do find it astonishing that an allegedly decent journal passes such pseudoscience for publication as though it is serious science.
The history of so-called alternative medicine (SCAM) is rich with ‘discoveries’ that are widely believed to be true events but that, in fact, never happened. Here are 10 examples:
- DD Palmer is believed to have cured the deafness of a janitor by manipulating his neck. This, many claim, was the birth of chiropractic. BUT IT NEVER HAPPENED! How can I be so sure? Because the nerve responsible for hearing does not run through the neck.
- Samuel Hahnemann swallowed some Cinchona officinalis, a quinine-containing treatment for malaria, and experienced the symptoms of malaria. This was the discovery of the ‘like cures like’ assumption that forms the basis of homeopathy. BUT IT NEVER HAPPENED! How can I be so sure? Because Hahnemann merely had an intolerance to quinine, and like does certainly not cure like.
- Edward Bach, for the discovery of each of his flower remedies, suffered from the state of mind for which a particular remedy was required; according to his companion, Nora Weeks, he suffered it “to such an intensified degree that those with him marvelled that it was possible for a human being to suffer so and retain his sanity.” This is how Bach discovered the ‘Bach Flower Remedies‘. BUT IT NEVER HAPPENED! How can I be so sure? His experience was not caused by by the remedy, which contain no active ingredients, but by his imagination.
- William Fitzgerald found that pressure on specific areas on the soles of a patient’s feet would positively affect a specific organ of that patient. This was the birth of reflexology. BUT IT NEVER HAPPENED! How can I be so sure? Because there are no nerve connections from the sole of our feet to our inner organs.
- Max Gerson observed that his special diet with added liver juice, vitamin B3, coffee enemas, etc. cures cancer. This is how Gerson found the Gerson therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because he never could demonstrate this effect and others never were able to replicate his alleged finfings.
- George Goodheart was convinced that the strength of a muscle group provides information about the health of inner organs. This formed the basis for applied kinesiology. BUT IT NEVER HAPPENED! How can I be so sure? Because applied kinesiology has been disclosed as a simple party trick.
- Paul Nogier thought that the function of inner organs can be influenced by stimulating points on the outer ear. This was the discovery that became auricular therapy. BUT IT NEVER HAPPENED! How can I be so sure? Because Nogier’s assumptions fly in the face of anatomy and physiology.
- Antom Mesmer discovered that by moving a magnet over a patient, he would move her vital fluid and affect her health. This discovery became the basis for Mesmer’s ‘animal magnetism‘. BUT IT NEVER HAPPENED! How can I be so sure? Because there is no vital fluid and neither real nor animal magnetism have specific therapeutic effects.
- Reinhold Voll observed that the electric resistance over acupuncture points provides diagnostic information about the function of the corresponding organs. He thus invented his ‘electroacupuncture according to Voll‘ (EAV). BUT IT NEVER HAPPENED! How can I be so sure? Because EAV and the various methods derived from it are not valid and fail to produce reproducible results.
- Ignatz von Peczely discovered that discolorations on the iris provide valuable information about the health of inner organs. This was the birth of iridology. BUT IT NEVER HAPPENED! How can I be so sure? Because discolorations develop spontaneously and Peczely’s assumptions about nerval connections between the iris and the organs of the body are pure fantasy.
I hope that you can think of further SCAM discoveries that never happened. If so, please elaborate in the comments section below; you will see, it is good fun!
By sating ‘IT NEVER HAPPENED’, I mean to say that it never happened as reported/imagined by the inventor of the respective SCAM and that the explanations perpetuated by the enthusiasts of the SCAM regarding cause and effect are based on misunderstandings.