MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

homeopathy

Homotoxicology is sometimes praised as the ‘best kept detox secret‘, often equated with homeopathy, and even more often not understood at all.

But what is it really?

Homotoxicology is the science of toxins and their removal from the human body. It offers a theory of disease which describes the severity and duration of an illness or disorder based on toxin-loading relative to our body’s ability to detoxify. In other words, it tells you how sick you’ll get when what stays inside progressively overwhelms our ability to get the garbage out. It explains what you can expect to see as you start removing toxins.

And yes, there is a hierarchy of toxic substances. Homotoxicology says you should remove the gentler ones first. As the body strengthens, it will be able to handle the really bad stuff (i.e., heavy metals). This explains why some people do really well on the same detox treatments that take others out at the knees.

Yes, I know!

This sounds very much like promotional BS!!!

So, what is it really, and what evidence is there to support it?

Homotoxicolgy is a therapy developed by the German physician and homeopath Hans Reckeweg. It is strongly influenced by (but not identical with) homoeopathy. Proponents of homotoxicology understand it as a modern extension of homoeopathy developed partly in response to the effects of the Industrial Revolution, which imposed chemical pollutants on the human body.

„Ich möchte einmal die Homöopathie mit der Schulmedizin verschmelzen H.-H. Reckeweg Küstermann/Auriculotherapie_2008.

According to the assumptions of homotoxicology, any human disease is the result of toxins, which originate either from within the body or from its environment. Allegedly, each disease process runs through six specific phases and is the expression of the body’s attempt to cope with these toxins. Diseases are thus viewed  as biologically useful defence mechanisms. Health, on the other hand, is the expression of the absence of toxins in our body. It seems obvious that these assumptions are not based on science and bear no relationship to accepted principles of toxicology or therapeutics. In other words, homotoxicology is not plausible.
The therapeutic strategies of homotoxicology are essentially threefold:

• prevention of further homotoxicological challenges,
• elimination of homotoxins,
• treatment of existing ‘homotoxicoses’.

Frequently used homotoxicological remedies are fixed combinations of homeopathically prepared remedies such as nosodes, suis-organ preparations and conventional drugs. All these remedies are diluted and potentised according to the rules of homoeopathy. Proponents of homotoxicology claim that they activate what Reckeweg called the ‘greater defence system’— a concerted neurological, endocrine, immunological, metabolic and connective tissue response that can give rise to symptoms and thus excretes homotoxins. Homotoxicological remedies are produced by Heel, Germany and are sold in over 60 countries. The crucial difference between homotoxicology and homoeopathy is that the latter follows the ‘like cures like’ principle, while the former does not. As this is the defining principle of homeopathy, it would be clearly wrong to assume that homotoxicology is a form of homeopathy.

Several clinical trials of homotoxicology are available. They are usually sponsored or conducted by the manufacturer. Independent research is very rare. In most major reviews, these studies are reviewed together with trials of homeopathic remedies which is obviously not correct. Our systematic review purely of studies of homotoxicology included 7 studies, all of which had major flaws. We concluded that the placebo-controlled, randomised clinical trials of homotoxicology fail to demonstrate the efficacy of this therapeutic approach.

So, I ask again: what is homotoxicology?

It is little more than homeopathic nonsense + detox nonsense + some more nonsense.

My advice is to say well clear of it.

Dr Alok Pareek has been elected as the World President of the International Homeopathic Medical league (LMHI – Liga Medicorum Homoeopathica Internationalis), the largest, oldest and only association of Medical Homeopaths in the World. He is the first Asian in 4 decades to bring this honour to India. Dr Alok Pareek was elected at the 71st World Congress of the LMHI held in Buenos Aires, Argentina on 23rd August 2016. He was elected unopposed by over 70 member countries. He has been elected for a three year tenure from 2016 to 2019

Dr. Alok Pareek runs a homeopathic hospital together with his father R.S. Pareek in Agra, India with fifty beds, treating around two hundred patients daily. His clinical practice spans thirty years. This extensive experience has given him a wealth of opportunity to carry out and refine homeopathic treatment in a wide range of acute and emergency situations…  Dr. Pareek demonstrates that homeopathy has much to offer in acute and emergency settings. He aims to increase the confidence of practitioners, to improve results and encourage them to offer safe and effective treatment in this important field, enabling homeopathy to take its place alongside conventional approaches within mainstream medicine. “As an Emergency Medicine physician who deals with life threatening diseases on a daily basis, I found Dr. Pareek’s homeopathic approach to be full of well-rounded clinical criteria and plenty of wise advice to the homeopathic doctor. I truly hope to be in medicine long enough to see us practice ‘hand in hand’ and enjoy the great benefits of this marvelous ‘scientific marriage’ in my emergency medicine patients.” Gladys H. Lopez M.D., M.P.H. USA Board Certified in Emergency ­Medicine

These two quotes might give you a fairly good impression of Dr Alok Pareek.

But why do I dedicate an entire post to him?

The reason is that I was alerted to one of his books entitled ‘Cancer is curable with homeopathy’. Even though it is obviously a translation from English, I could not find the original; so you have to bear with me as I translate for you the German abstract copied below:

75 years of homeopathic experience by father and son from India are expressed in this book about the homeopathic cure of cancers. Based on excellently documented cases, it demonstrates how homeopathy is clearly superior to chemotherapy and radiotherapy. We experience how a cure is possible even for such a serious disease as cancer in advanced stages. Dr D. Spinedi (Switzeralnd) estimates the immense experience of the doctors Pareek as ‘essential basic knowledge that should be accessible to all homeopaths’. It is a book that gives courage to both patients and therapists.

Zusammen 75 Jahre homöopathischer Erfahrung von Vater und Sohn Pareek aus Indien mit Tausenden von Patienten finden in diesem Buch ihren Niederschlag in der homöopathischen Heilung von Krebserkrankungen. Anhand exzellent dokumentierter Fallbeispiele wird gezeigt, wie in klassischer Arbeitsweise die Homöopathie der Chemotherapie und der Strahlentherapie deutlich überlegen ist. Wir erleben mit, wie Heilung bei einer so schweren Krankheit wie Krebs auch noch in fortgeschrittenen Stadien durch Homöopathie möglich ist. Dr. D. Spinedi (Schweiz) wertet die immense Erfahrung der Dres. Pareek als “unverzichtbares Grundlagenwissen, das allen Homöopathen zugänglich sein sollte.” Ein Buch, das Patienten wie Therapeuten Mut macht!

It is by Jove not often that I am speechless, but today, that’s exactly what I am.

Doubtlessly, you will have noted that homeopathy missed out yet again at this year’s Nobels. Personally, I am convinced that this is all due to the evil propaganda put about by malicious sceptics (paid lavishly by BIG PHARMA, of course). But all is not lost! Down under, ‘CHOICE’ do know what is truly prize-worthy!

The Australian Consumers’ Association ‘CHOICE’ reviews everyday items like aspirin, detergents and instant coffee – but also major purchases like cars and washing machines. Each year, CHOICE awards ‘SHONKIES’ (from ‘shonky‘ = dishonest, unreliable, or illegal, especially in a devious way). CHOICE receive hundreds of nominations for Shonky products and services from CHOICE members and staff. While some Shonky nominees may not be breaking laws or breaching regulations – though sometimes they are – they believe that consumers deserve better products and services.

And how do they decide which nominations make the cut?

First and foremost, a nomination has to meet one or more of the following Shonky criteria:

  • Fails a standard
  • Poor performance on CHOICE tests
  • Hidden charges
  • Lack of transparency
  • False claims or broken promises
  • Consumers are worse off because of it
  • Consumer confusion
  • Poor value for money
  • Consumer frustration, or just plain outrage

Products that meet one or more of these criteria make it to the short list. From there CHOICE look at how the issue will resonate with consumers, as well as government authorities and the media, which have the power to prod companies to pick up their act.

This year, CHOICE awarded 7 shonkies. My favourite, of course, is the award for trickery that leaves people sleepless – here is what CHOICE tell us about it:

Big pharmaceutical companies, or ‘big pharma’, are synonymous with big medical production, big money and a big impact on the type of healthcare products we can access. One thing that’s rarely expected from big pharma is homeopathic cures, which are more typically found in the domain of alternative therapies.

However, at least one big pharma company in Australia is selling homeopathic products on a very large scale. Pharmacare, which boasts on LinkedIn that it’s “the largest private, Australian-owned consumer health, fitness and consumer goods company in the country”, currently operates 23 brands, including Bioglan. According to their website, their products are available in “5200 pharmacies, 3000 supermarket outlets, department and variety stores nationwide, and hundreds of overseas outlets in Asia, America and Europe.”

In 2017, we awarded Bioglan and another Pharmacare brand, Nature’s Way, a Shonky for its outrageous claims that sticky, sugary lollies are in fact good for teeth. This year, Pharmacare and Bioglan receive another dubious honour for its over-the-counter Melatonin Homeopathic Sleep Formula. While melatonin (currently a prescription-only medicine in Australia) is known to promote sleep and is used to help people suffering jet lag or sleep disorders, there’s no reliable evidence that homeopathic melatonin (or homeopathic products in general) has any effect other than as a placebo. Despite this, the company makes the claim that Bioglan Melatonin helps “relieve mild temporary insomnia and symptoms of mild nervous tension”.

Bioglan’s Melatonin Homeopathic Sleep Formula is also available in chewable tablet form or spray and both products promise to “relieve mild temporary insomnia”.

On the product’s web page, we’re told “results depend on how often the homeopathic remedy is taken, not on the quantity used”, because in homeopathy, “the amount consumed is not relevant, children are treated in the same way as adults”.

However, directions for the tablet version state, “To aid sleep: Chew 3-5 tablets half an hour before bedtime”, while the spray is “rapidly absorbed to start working quickly”.

To be fair to Bioglan, consuming more does support the primary reason for this product’s existence – the more tablets people chew, the sooner they’ll potentially cough up another $24.50 (RRP).

Melatonin Homeopathic Sleep Formula is packaged like medication and sold in a pharmacy. But with murky claims that are not supported with evidence, wasting money is the only area where this product is proven to be effective. Not only does Bioglan Melatonin not help you sleep, it’s Shonky enough that you might lose sleep worrying about the brazen trickery this company gets away with.

END OF QUOTE

As I said, it’s not a Nobel, but it’s certainly a start.

My heart-felt congratulations to homeopaths across the world!

In Germany, homeopathic firms are – as I recently mentioned – starting to panic. Sales figures have, for the first time since decades, declined. This is undoubtedly the work of all those evil sceptics (including, or perhaps foremost?, my evil self!) who are well-organised and even better-funded.

At least, this is what their new PR-man seems to think.

Christian J Becker has been exceedingly active on Twitter provoking everyone who said a word against homeopathy. He is without any doubt the fiercest PR-defender of German homeopathy since Claus Fritzsche. But just like with the late Fritzsche, all those years ago, I am beginning to worry. Is Mr Becker feeling alright? I see increasingly worrying signs and parallels. Might he be drifting into some sort of a psychopathologic episode?

  • Despite being a novice to this field, he seems to think that a substance which had no therapeutic effect to start with – think of Berlin wall – becomes highly active, if you dilute it at a rate of 1:1000000000000000000000000000000000000000000000000000000000000, for instance. Could this be the first sign of a deeper problem developing?
  • He hints at his suspicion that poor old Fritzsche did, in fact, not commit suicide as generally believed and well-documented. No, he seems to think that he was murdered! By whom? Not the evil sceptics, surely?!
  • He seems persuaded that I am some sort of master mind of the growing German opposition to homeopathy. As I obviously know better, I find his persuasion worrying.
  • A further concern, in my view, is Becker‘s assumption about the huge amounts of money that are behind the criticism of homeopathy. As the big money is demonstrably on the other side, i. e. the homeopathic industry, this loss of reality might be an ominous sign.
  • Similarly, Becker believes that the German government has decided to go against homeopathy. As the opposite is (and always has been) the case, one might ask: do his opinions indicate some type of a paranoid trait?
  • Becker thinks, as already mentioned, that those who speak out against homeopathy are all paid by some sinister source. We all receive big cheques and live a life of Reilly because of this lavish support? This theory supposes that we all act against better knowledge and, deep down, we all know that homeopathics diluted at a rate of 1:1000000000000000000000000000000000000000000000000000000000000 are effective. More loss of reality?, I ask myself.
  • Becker has a strategy that he proudly admits to: he provokes people on Twitter to a point where they lose their nerve and reply something offensive. Armed with this statement, he then recruits a lawyer* and sues them for libel. He tried his trick recently likening several homeopathy-critics to Roland Freisler, the infamous judge of the Nazi era. Such actionable behaviour could be seen as a sign of a man in serious trouble – has Becker lost so much contact with reality that he does not realise that, in court, his insults would harm him and not his opponent?
  • Or perhaps he misunderstood the prime dogma of homeopathy? ‘Like cures like’ does not mean one can cure criticism with aggression. I am sure that Hahnemann, who knew a fair bit about aggression, never said so.
  • One of the most concerning features of homeopathy’s new defender is that Becker thinks anyone might believe him when he implies that, as a professional PR-man, he does a time-consuming PR-job for free. Yes, he did indicate that he conducts PR for homeopathy for a hobby. Would you find such behaviour normal?

So, should we be worried about the state of mind of homeopathy’s staunch defender? It might be too early to issue a final judgement on this question. But I am the first to admit that the signs are somewhat ominous. The man might need our help! Therefore, let me emphatically and empathetically stress this:

Mr Becker, if you read this – and I suspect you will – please stay calm. I know several good physicians who might be able to help you. And I promise, they will not prescribe a single homeopathic remedy!

*if you are one, please note this article is pure satire!

Endocrine therapy (ET) is often used to reduce the risk of recurrence in hormone receptor-expressing disease. It is associated with worsening of climacteric symptoms can therefore have a negative impact on the quality of life (QoL) of those affected. Homeopathy is sometimes recommended for management of hot flushes (HF), and a new study aimed to test whether it is effective.

In this multi-centre, double-blind, placebo-controlled RCT, women were included suffering from histologically proven non-metastatic localized breast cancer, with Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) ≤ 1, treated for at least 1 month with adjuvant ET, and complaining about moderate to severe HF. Patients scheduled for chemotherapy, or radiotherapy, or those with associated pathology known to induce HF were excluded. After a 2- to 4-week placebo administration, patients were randomly assigned to receiving the homeopathic medicine complex Actheane® (arm A) or placebo (arm P). Randomization was stratified by adjuvant ET (taxoxifen/aromatase inhibitor) and recruiting site. HF scores (HFS) were calculated as the mean of HF frequencies before randomization, at 4, and at 8 weeks post-randomization (pre-, 4w,- and 8w-) weighted by a 4-level intensity scale. The primary endpoint was the variation between pre- and 4week-HFS. Secondary endpoints included HFS variation between pre- and 8week-HFS. Compliance and tolerance were assessed 8 weeks after randomization, and QoL and satisfaction were assessed at 4- and 8-week post-randomization.

In total, 138 patients were randomized (A, 65; P, 73). Median 4week-HFS absolute variation (A, - 2.9; P, - 2.5 points, p = 0.756) and relative decrease (A, - 17%; P, - 15%, p = 0.629) were not statistically different between the two arms. However, 4week-HFS decreased for 46 (75%) in A vs 48 (68%) patients in P arm. 4week-QoL was stable or improved for respectively 43 (72%) vs 51 (74%) patients (p = 0.470).

The authors concluded that the efficacy endpoint was not reached, and BRN-01 administration was not demonstrated as an efficient treatment to alleviate HF symptoms due to adjuvant ET in breast cancer patients. However, the study drug administration led to decreased HFS with a positive impact on QoL. Without any recommended treatment to treat or alleviate the HF-related disabling symptoms, Actheane® could be a promising option, providing an interesting support for better adherence to ET, thereby reducing the risk of recurrence with a good tolerance profile.

At the start of their abstract, the authors state that homeopathy might allow a better management of hot flushes (HF). Frankly, I fail to see the evidence for this statement. The only study I know of (by a known advocate of homeopathy) showed no effect of homeopathy.

Acthéane is a mixture marketed by Boiron of 5 ingredients:
– Actaea racemosa 4 CH : 0,5 mg
– Arnica montana 4 CH : 0,5 mg
– Glonoinum 4 CH : 0,5 mg
– Lachesis mutus 5 CH : 0,5 mg
– Sanguinaria canadensis 4 CH : 0,5 mg

I am not aware of evidence that this remedy might work.

If there is no plausible rationale for conducting a study, does that not mean it is ethically questionable to do it?

Apart from that, the study seems well-designed. It is not very well presented, but the paper is clear enough. Its results are as one would expect from a rigorous trial of homeopathy. The fact that the authors try to squeeze out some positive messages from this squarely negative study is, of course, pathetic. To mention in the abstract that 4week-HFS decreased for 46 (75%) in A vs 48 (68%) patients (not the primary outcome measure) in P arm is little more than an embarrassing tribute to the sponsor, in my view.

Boiron Canada state on their website that Acteane® is a homeopathic medicine used for the relief of perimenopause and menopause symptoms such as hot flashes, night sweats, sleep disorders, headache, irritability and mood swings.

The benefits of Acteane, a new solution for women:

• Hormone-free
• Soy-free
• Can be associated with other treatments used during perimenopause
• Non-drowsy
• Chewable tablets
• Does not require water

WILL THEY NOW ADD ‘EFFECT-FREE’ TO THEIR LIST?

The AMERICAN INSTITUTE OF HOMEOPATHY (AIH) is the oldest national medical association in the United States. The AIH’s mission is “to promote the science and art of homeopathic medicine, to safeguard the interests of the homeopathic medical profession, to improve the standards of homeopathic medical education, to educate the medical and scientific communities about the scientific basis for homeopathic medicine, and to increase public knowledge and acceptance of homeopathy as a medical specialty.”

The AIH is about to hold its annual conference. This year’s theme is “Tackling Patients with Severe Pathology”. The announcement reads as follows:

Homeopathy has been found to be effective in the great majority of patients suffering from infectious and autoimmune diseases. The limits of homeopathic treatment are encountered in the treatment of patients with Parkinson’s disease, ALS and late-stage cancers. After finding a way to treat patients with Parkinson’s disease with homeopathy, Dr. Saine began to apply this approach to cancer patients in stages III and IV. In this seminar, he will review case analysis, posology and case management for this cohort of patients.

We are fortunate to have the opportunity to learn from Dr. Saine in this seminar. He is recognized as one of the foremost homeopathic teachers and clinicians in the world, with special expertise in extremely difficult cases of severe and advanced pathology.

Who, for heaven sake, is this foremost homeopathic teachers and clinicians in the world, Dr Saine?, I asked myself after reading this (and even more so after listening to the rather spectacular video provided with the announcement). Here is what I found out about him:

Dr. Saine is a 1982 graduate of the National College of Naturopathic Medicine in Portland, Oregon. He is board-certified in homeopathy (1988) by the Homeopathic Academy of Naturopathic Physicians and has been teaching and lecturing on homeopathy since 1985. He is considered one of the world’s foremost experts on the subject of homeopathy.

And this is what non-doctor* Saine writes about medicine etc.:

The Organon of Medicine is a blueprint on how to practice medicine rationally and wisely through an integration of all the fundamental principles of medicine into a comprehensive whole. Unfortunately, to the detriment of the sick, very few homeopaths have delved, as Hahnemann did, into the practice of lifestyle medicine and the use of complementary care to homeopathy.

With rare exceptions, patients will present with a portion of their disease that ensues from an unhealthy environment or ways of living. The role of the physician is to determine in the equation of disease what is primarily due to an untuned vital force versus a causa occasionalis, as both will have to be addressed in due time.

After reading and listening to all this I am mildly shocked.

It does not seem to me that the AIH is fit for purpose. Neither am I convinced that non-doctor Saine should be let near any patient, let alone one with cancer or another severe pathology.

There should be a law protecting patients from this sort of thing!

[*in the context of healthcare, a doctor is for me someone who has studied medicine]

Samuel Hahnemann invented homeopathy about 200 years ago. His placebos were better than (or not as bad as) the ‘heroic’ medicine of his time which frequently was more dangerous than the disease it aimed to cure. Thus, homeopathy took Germany by storm. When, about 100 years ago, medicine finally became scientific and was able to offer more and more effective treatments, the popularity of homeopathy began to wane. Yet, before its natural demise, during the Third Reich, it received a significant boost from Nazi-greats such as Hess and Himmler. After this nightmare was over, German homeopathy went into another slow decline. But when the New Age movement and the current boom in alternative medicine reached Germany, homeopathy seemed to thrive once again.

In the 1990s evidence-based medicine (EBM) grew into one of the central concepts of medicine. In Germany, however, EBM had a relatively hard time to get established. This might be one of the reasons why homeopathy continued to prosper, despite the arrival of ever clearer evidence that highly diluted homeopathic remedies are pure placebos. While, in the UK, we had an increasingly lively debate about the uselessness of homeopathy, Germany remained the promised land of homeopathy. Sales figures of homeopathics continued to increase steadily and reached a level of about half a billion Euros per annum.

The golden age of German homeopathy had dawned:

  • The media, often sponsored by homeopathic interest groups, kept on promoting homeopathy largely unopposed.
  • The mighty Carstens Stiftung worked tirelessly to promote it.
  • Homeopathy became established in many medical schools.
  • Homeopathy was available and often advertised in almost all pharmacies.
  • The public was convinced that homeopathy worked.
  • The Heilpraktiker adopted homeopathy fully.
  • The medical and other conventional healthcare professions embraced it to a large degree.
  • The adult education institutes (Volkshochschulen) offered courses.
  • Politicians were squarely on the side of homeopathy,
  • Health insurances, paid for it.

Of course, there were also some (and always had been) opposing voiced and organisations, such as the GWUP (the German sceptic organisation), for example. But somehow, they remained relatively low-key. When, every now and then, courageous journalists dared to think of a critical take on homeopathy, they had to search far and wide to find a German-speaking expert who was willing or able to tell them the truth: that homeopathy is neither biologically plausible nor evidence-based and therefore an expensive, potentially harmful waste of money that makes a mockery of EBM. During this period, journalists (far too) often asked me for some critical comments. I hardly ever published my research in German, but they nevertheless would find me via my Medline-listed papers. I often felt like a very lone voice in a German desert.

For the German homeopathic industry, I evidently was more than just a lone voice. Unbeknown to me, they clubbed together and financed a PR-man/journalist (at the tune of Euro 30 000/year) to write as many defamatory articles about me as he could muster. First, I was bewildered by his activity, then I tried to communicate with him (only to get mis-quoted), and eventually I ignored his writings. Yet, a German investigative journalist found Fritzsche’s one-sided activities offensive and started investigating. His research and subsequent article disclosed the fact that he was being paid by the homeopathic industry. Once I learn about this scandal, I wrote to some of the financiers directly and asked for an explanation. As a result, they discontinued their sponsorship. Shortly afterwards, Fritzsche committed suicide.

At heart, I have always been an optimist and strongly believe that in medicine the truth, in this case the evidence, will always prevail, no matter what obstacles others might put in its way. Recent developments seem to suggest that I might be right.

In the last few years, several individuals in Germany have, from entirely different angles, taken a fresh look at the evidence on homeopathy and found it to be desperately wanting. Independent of each other, they published articles and books about their research and insights. Here are 5 examples:

Die Homöopathie-Lüge: So gefährlich ist die Lehre von den weißen KügelchenChristian Weymayr, Nicole Heißmann, 2012

In Sachen Homöopathie: Eine Beweisaufnahme, Norbert Aust, 2013

Homöopathie neu gedacht: Was Patienten wirklich hilft, Natalie Grams, 2015

Der Glaube an die Globuli: Die Verheißungen der HomöopathieNorbert Schmacke, Bernd Hontschik, 2015

Der wahrscheinlich teuerste Zucker der Welt: Was Sie über Homöopathie und Alternativmedizin wissen sollten, Oliver Grunau, 2017

Inevitably, these individuals came into contact with each other and subsequently founded several working-groups to discuss their concerns and coordinate their activities. Thus the INH and the Muensteraner Kreis were born. So, now we have at least three overlapping groups of enthusiastic, multidisciplinary experts who voluntarily work towards informing the German public that paying for homeopathy out of public funds is unethical, nonsensical and not in the interest of progress:

  • the GWUP,
  • the INH
  • and the Muensteraner Kreis.

No wonder then, that the German homeopathic industry and other interested parties got worried. When they realised that (presumably due to the work of these altruistic enthusiasts) the sales figures of homeopathics in Germany had, for the first time since many years, started declining, they panicked.

Their reaction was, as far as I can see, similar to their previous response to criticism: they started a media campaign in an attempt to sway public opinion. And just like before, they have taken to employing PR-people who currently spend their time defaming all individuals voicing criticism of homeopathy in Germany. Their prime targets are those experts who are most exposed to activities of responsibly informing the public about homeopathy via lectures, publications social media, etc. All of us currently receive floods of attack, insults and libellous defamations. As before (innovation does not seem to be a hallmark of homeopathy), these attacks relate to claims that:

  • we are incompetent,
  • we do not care about the welfare of patients,
  • we are habitual liars,
  • we are on the payroll of the pharmaceutical industry,
  • we aim at limiting patient choice,
  • we do what we do because we crave the limelight.

So, what is going to happen?

I cannot read tea leaves but am nevertheless sure of a few things:

  • The German homeopathy lobby will not easily give up; after all, they have half a billion Euros per year to lose.
  • They will not argue on the basis of science or evidence, because they know that neither are in their favour.
  • They will fight dirty and try to defame everyone who stands in their way.
  • They will use their political influence and their considerable financial power.

AND YET THEY WILL LOSE!

Not because we are so well organised or have great resources – in fact, as far as I can see, we have none – but because, in medicine, the evidence is invincible and will eventually prevail. Progress might be delayed, but it cannot be halted by those who cling to an obsolete dogma.

The UK Royal Pharmaceutical Society have published a quick reference guide on homeopathy. In it, they make the following 5 ‘key points’:

  • The Royal Pharmaceutical Society (RPS) does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect.
  • The RPS does not support the prescribing of homeopathic products on the NHS.
  • Pharmacists should ensure, wherever possible, that patients do not stop taking their prescribed conventional medication, if they are taking or are considering taking a homeopathic product.
  • Pharmacists must be aware that patients requesting homeopathic products may have serious underlying undiagnosed medical conditions which may require referral to another healthcare professional.
  • Pharmacists must advise patients considering a homeopathic product about their lack of efficacy beyond that of a placebo.

This publication is a few months old, but I only saw it recently. It could not be clearer and it is much more to the point than the General Pharmaceutical Council’s ‘Standards for Pharmacy Professionals‘ which state:

People receive safe and effective care when pharmacy professionals reflect on the application of their knowledge and skills and keep them up-to-date, including using evidence in their decision making. A pharmacy professional’s knowledge and skills must develop over the course of their career to reflect the changing nature of healthcare, the population they provide care to and the roles they carry out. There are a number of ways to meet this standard and below are examples of the attitudes and behaviours expected.

People receive safe and effective care when pharmacy professionals:

  • recognise and work within the limits of their knowledge and skills, and refer to others when needed
  • use their skills and knowledge, including up-to-date evidence, to deliver care and improve the quality of care they provide
  • carry out a range of continuing professional development (CPD) activities relevant to their practice
  • record their development activities to demonstrate that their knowledge and skills are up to date
  • use a variety of methods to regularly monitor and reflect on their practice, skills and knowledge

The two statements together should suffice to finally get some sense into UK pharmacies when it comes to the sale of homeopathic remedies. What is needed now, I think, is an (under-cover?) investigation to see how many UK community pharmacists abide by this guidance.

If anyone has the means to conduct it, I would be delighted to advise them on the best methodology.

Some homeopaths claim that there is anecdotal support for the use of the homeopathic medicine Arsenicum album in preventing post-vaccination fever. As far as I know, the claim has not been tested in clinical trials. This study was aimed at evaluating the efficacy of this approach in preventing febrile episodes following vaccination.

In the community medicine out-patient of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, West Bengal, a double-blind, randomized, placebo-controlled trial was conducted on 120 children. All of them presented for the 2nd and 3rd dose of DPT-HepB-Polio vaccination and reported febrile episodes following the 1st dose. They were treated with Arsenicum album 30cH 6 doses or placebo (indistinguishable from verum), thrice daily for two subsequent days. Parents were advised to report any event of febrile attacks within 48h of vaccination.

The groups were comparable at baseline. Children reporting fever after the 2nd dose was 29.8% and 30.4% respectively for the homeopathy group and control group respectively [Relative Risk (RR)=1.008] with no significant difference (P=0.951) between groups. After the 3rd dose, children reporting fever were 31.5% and 28.3% respectively for the homeopathy group and control group respectively (RR=0.956) with no significant difference (P=0.719) between groups.

The authors concluded that empirically selected Arsenicum album 30cH could not produce differentiable effect from placebo in preventing febrile episodes following DPT-HepB-Polio vaccination.

I can hear it now, the chorus of homeopaths:

  • this is part of a conspiracy against homeopathy,
  • the authors of this study display an anti-homeopathy bias,
  • this study did not closely follow the principles of homeopathy,
  • it lacked the input by experience homeopaths,
  • no homeopath worth his money would use Arsenicum album 30cH for this purpose,
  • no homeopath in his right mind would employ 6 doses thrice daily for two subsequent days,
  • etc., etc.

Well guys, I have to disappoint you: the authors of this paper have the following affiliations:

  • Dept. of Pathology and Microbiology, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Govt. of West Bengal
  • Dept. of Community Medicine, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Govt. of West Bengal
  • Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Govt. of West Bengal
  • National Institute of Homoeopathy, Ministry of AYUSH, Govt. of India
  • Central Council of Homoeopathy, Vill, Champsara

So, perhaps it’s true: highly diluted homeopathic remedies are pure placebos.

 

It has been reported that the faculty of medicine of Lille unversity in France has suspended its degree in homeopathy for the 2018-19 academic year. The university announced its decision on Twitter, and the faculty of medicine’s dean, Didier Gosset, confirmed it to the AFP news agency: “It has to be said that we teach medicine based on proof – we insist on absolute scientific rigour – and it has to be said that homeopathy has not evolved in the same direction, that it is a doctrine that has remained on the margins of the scientific movement, that studies on homeopathy are rare, that they are not very substantial,” he explained. “Continuing to teach it would be to endorse it.”

The decision is, of course, long overdue and must be welcomed. Personally, however, I wonder why defenders of reason like Prof Gosset often employ such unclear lines of argument. Would it not be clearer to make (some of) these simple points?

  1. The assumptions on which homeopathy is based are obsolete and implausible.
  2. It is not that we do not understand homeopathy’s mode of action, but we understand that there cannot be one that does not fly in the face of science.
  3. The clinical evidence fails to show that highly diluted homeopathic remedies are more than placebos.
  4. Homeopathy can cause significant harm, e. g. through neglect.
  5. Homeopathy costs millions which would be much better used for evidence-based treatments.
  6. The practice of homeopathy hinders progress and does not provide benefit for the public.
  7. Teaching homeopathy at university-level is unscientific, unethical and nonsensical.

The French are among the world’s largest consumers of homeopathic remedies. The French social security system does normally reimburse homeopathic therapy. A group of doctors challenged this situation in an open letter in Le Figaro newspaper in March 2018. They called practitioners of homeopathy and other alternative medicines “charlatans”, pointing to a 2017 report by the European Academies Science Advisory Council that stressed, like a plethora of previous reports, the “absence of proof of homeopathy’s efficacy”. They challenged the French medical council to stop allowing doctors to practice homeopathy and asked the social security system to stop paying for it. Subsequently, a group of French homeopaths filed a formal complaint with the medical council against the signatories of this letter.

France’s health ministry has asked France’s National Health Authority to prepare and publish a report on whether homeopathy works and should be paid for by the public purse. It is due to be delivered in February 2019.

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