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

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Jennifer Jacobs started publishing peer-reviewed papers on homeopathy in the early 1990s. This happens to be around the same time as I did. So, we both have about 30 years of research into homeopathy behind us.

Jennifer just authored a paper entitled “Thirty Years of Homeopathic Research – Lessons Learned“. Here is its abstract:

Conducting double-blind randomized controlled trials is difficult, even in the allopathic medical system. Doing so within the paradigm of classical homeopathy is even more challenging. More than thirty years of experience in carrying out such trials has taught me much about the pitfalls to avoid as well as the factors that can lead to success. The initial steps of putting together a research protocol, securing funding, and obtaining human subjects’ approval can be daunting. After that comes developing questionnaires and surveys, hiring study personnel, and recruitment of subjects. The actual implementation of the research comes with its own set of possible missteps. Sample size determination, entry criteria, as well as type, frequency and duration of treatment are all crucial. Finally, statistical analysis must be performed to a high standard and a manuscript prepared to submit for publication. Even then there can be one or more manuscript revisions to make, based on feedback from reviewers, before a study is actually published. The entire process can take at least two years and is usually much longer.

Mistakes at any one of these steps can damage the outcome, as well as the impact of the study. With examples from my body of research, I will discuss some of the things that I wish I had done differently, as well as those that turned out to be correct. Homeopathic research is held to a much higher standard than conventional trials. Any flaws in study design, implementation, and analysis can be used by critics to negate the results. I am hopeful that the next generation of homeopathic researchers will learn from my experiences and carry on with great success.

Jennifer’s example motivated me to follow suit and contribute some very brief thoughts about my 30 years of homeopathy research and the lessons I have learnt:

  Conducting double-blind randomized controlled trials is difficult in any area of medicine. Yet these types of studies are by far the best way to find out which treatments work and which don’t. Therefore, they need doing, regardless of the obstacles they may pose.

In homeopathy, we now have a large body of such trials. Sadly, not all of them are reliable. Those that are, according to accepted criteria, tend to fail to show that homeopathy works better than a placebo. Understandably, homeopaths are disappointed with this overall result and have made numerous attempts to invalidate it.

The main problem with research into homeopathy is not the research methodology. It is well established for clinical trials and can be easily modified to fit all the demands made by individualised treatment or other pecularities that may apply to homeopathy. The main problem is the homeopath who finds it impossible to accept the truth, namely that highly diluted homeopathic remedies are pure placebos and any observed benefits of homeopathy are due to non-specific effects such as the empathetic encounter or a placebo response.

The lesson to be learned from the past is that, in medicine, even the most obsessive belief, conviction or wishful thinking will eventually have to give way to the scientific evidence. In the case of homeopathy, this process has taken an extraordinary amount of time and effort but, finally, we are almost there and the writing is on the wall for everyone to see.

Two resumes of 30 years of work, research and experience!

And what a difference between them!

Who do you think gets closer to the truth,

Jennifer or I?

Current interventions for posttraumatic stress disorder (PTSD) are efficacious, yet effectiveness may be limited by adverse effects and high withdrawal rates. Acupuncture is an intervention with some positive preliminary but methodologically flawed data for PTSD.  Therefore a new study compared verum acupuncture with sham acupuncture (minimal needling) on clinical and physiological outcomes.

This was a 2-arm, parallel-group, prospective blinded randomized clinical trial hypothesizing superiority of verum to sham acupuncture. The study was conducted at a single outpatient-based site, the Tibor Rubin VA Medical Center in Long Beach, California, with recruitment from April 2018 to May 2022, followed by a 15-week treatment period. Following exclusion for characteristics that are known PTSD treatment confounds, might affect biological assessment, indicate past nonadherence or treatment resistance, or indicate risk of harm, 93 treatment-seeking combat veterans with PTSD aged 18 to 55 years were allocated to group by adaptive randomization and 71 participants completed the intervention protocols.

Verum and sham were provided as 1-hour sessions, twice weekly, and participants were given 15 weeks to complete up to 24 sessions. The primary outcome was pretreatment to posttreatment change in PTSD symptom severity on the Clinician-Administered PTSD Scale-5 (CAPS-5). The secondary outcome was pretreatment to posttreatment change in fear-conditioned extinction, assessed by fear-potentiated startle response. Outcomes were assessed at pretreatment, midtreatment, and posttreatment. General linear models comparing within- and between-group were analyzed in both intention-to-treat (ITT) and treatment-completed models.

A total of 85 male and 8 female veterans (mean [SD] age, 39.2 [8.5] years) were randomized. There was a large treatment effect of verum (Cohen d, 1.17), a moderate effect of sham (d, 0.67), and a moderate between-group effect favoring verum (mean [SD] Δ, 7.1 [11.8]; t90 = 2.87, d, 0.63; P = .005) in the intention-to-treat analysis. The effect pattern was similar in the treatment-completed analysis: verum d, 1.53; sham d, 0.86; between-group mean (SD) Δ, 7.4 (11.7); t69 = 2.64; d, 0.63; P = .01). There was a significant pretreatment to posttreatment reduction of fear-potentiated startle during extinction (ie, better fear extinction) in the verum but not the sham group and a significant correlation (r = 0.31) between symptom reduction and fear extinction. Withdrawal rates were low.

The authors concluded that the acupuncture intervention used in this study was clinically efficacious and favorably affected the psychobiology of PTSD in combat veterans. These data build on extant literature and suggest that clinical implementation of acupuncture for PTSD, along with further research about comparative efficacy, durability, and mechanisms of effects, is warranted.

I am not sure that the authors’ enthusiastic verdict is correct. Its lead author was even quoted stating that his study, which used improved controls, was needed to “definitively” support acupuncture for PTSD. He noted that “acupuncture ought to be considered a potential first-line treatment for PTSD.”

While the study is an improvement on the previous research in this area, it is by no means compelling. My main point of criticism is the nature of the sham acupuncture. Such controls are used to account for placebo effects which, of course, can be considerable in the case of acupuncture.

For this concept to work adequately, the patient and the therapist need to be blinded. In the case of acupuncture, therapist blinding is difficult (but not impossible). In this study, therepists were not blinded. Thus they could have influenced the outcome by verbal and non-verbal clues given to the patient. As acupuncturists inevitably have an interest in the positive result of their study, this effect seems inevitable to me.

More important, however, is the adequate blinding of the patient. In this study, it was attempted by using shallow needling as a sham intervention. Yet, shallow needling can easily distinguished from real acupuncture by the patient. At the very least, patients should be asked what treatment – sham or real – they thought they had received. This did not happen, and we therefore might assume that the effect of patient de-blinding – combined with the confounder described above – was sufficient to bring about the relatively small effect sizes observed by the authors.

One might argue that this does not really matter; all that counts is to alleviate the suffering of the patients, never mind by what mechanism. I think, this would be erroneous. It matters because, if acupuncture itself is ineffective (which I suggest), settling for acupuncture as a first line therapy for PTSD is in nobody’s interest and a disservice to severely suffering patients. It would inhibit meaningful research aimed at finding an optimal therapy (one that works beyond placebo) and be a waste of resources.

 

The aim of this systematic review and network meta-analysis was to identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.

The screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. All randomised trials with exercise arms for participants meeting clinical cut-offs for major depression were included.

A total of 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for

  • walking or jogging,
  • strength training,
  • mixed aerobic exercises,
  • and tai chi or qigong.

The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

The authors concluded that exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

As far as I can see, there are two main problems with these findings:

  1. Because too many of the studies are less than rigorous, the results are not quite as certain as the conclusions would seem to imply.
  2. Patients suffering from a major depressive disorder are often unable (too fatigued, demotivated, etc.) to do and/or keep up vigorous excerise over any length of time.

What I find furthermore puzzling is that, on the one hand, the results show that – as one might expect – the effects are proportional to the intensity of the excercise but, on the other hand tai chi and qugong which are both distinctly low-intensity turn out to be effective.

Nonetheless, this excellent paper is undoubtedly good news and offers hope for patients who are in desperate need of effective, safe and economical treatments.

The French ‘National Assembly’ has yesterday adopted a major law aimed at reinforcing the prevention and combat against sectarian aberrations in France. This marks a significant step forward in strengthening the protection of citizens against abuse and manipulation by charlatans, gurus and other sectarian movements.

This bill, the result of particularly fruitful work and debate in both chambers, reflects the Government’s commitment to meeting the expectations of the victims of these sectarian movements.

Some of the key measures voted through by parliamentarians include:

  • The enshrinement in law of the powers of MIVILUDES (Interministerial Mission of Vigilance and Combat against Sectarian Aberrations);
  • The reinforcement of the penal response with the creation of the offence of placing or maintaining in a state of psychological or physical subjection;
  • The creation of an offence of incitement to abandon or refrain from treatment, or to adopt practices which clearly expose the person concerned to a serious health risk;
  • Support for victims, with the extension of the categories of associations that can bring civil action;
  • Information for the judiciary, with the introduction of an “amicus curiae” role for certain government departments in legal cases relating to cults.

Despite sometimes heated debates, particularly around article 4, fuelled by the opinion of the Conseil d’Etat, the adoption of this law by the National Assembly bears witness to a shared desire to protect the rights and freedoms of individuals while providing better protection for our fellow citizens against sectarian aberrations.

This bill is part of a multi-annual national strategy for 2023-2027 resulting from the conference on sectarian aberrations held in spring 2023. It is a major step towards strengthening the penal arsenal and protecting victims.

_______________

Sabrina Agresti-Roubache, Secretary of State for Citizenship and Urban Affairs, commented:

“Long-awaited by victim support associations, this text aims to strengthen our legal arsenal in the fight against sectarian aberrations. I’m delighted that all the articles have been adopted, particularly Article 4, which creates an offence of incitement to abandon or abstain from treatment. There have been some passionate debates in the Chamber, but I’d like to reiterate the basis of this bill: the State is not fighting against beliefs, opinions or religions, but against all forms of sectarian aberrations, these dangerous behaviors which represent a threat to our social cohesion and put lives at risk.”

_______________

Obviously, we shall have to see how the new law will be applied. But, in any case, it is an important step into the right direction and could put an end to much of so-called alternative medicine that endangers the health of French consumers.

Other nations should consicer following the Franch example.

Mercury is a highly toxic chemical that threatens the health of humans and the environment. When it is released into the environment, it enters the food chain where it accumulates, particularly in fish. Exposure to high levels of mercury can cause harm to the brain, lungs, kidneys and the immune system. For these reasons, dental amalgam fillings which contain mercury have long been criticized. This is particularly true in the realm of so-called alternative medicine (SCAM) where, as discussed repeatedly, amalgam has long been a subject of both concern and misinformation, e.g.:

In the EU, dental amalgam might soon be merely of historical interest.

It has been announced that the EU Parliament and Council reached a provisional political agreement on the Commission’s proposal to address the remaining uses of mercury in products in the EU in line with commitments set out in the EU’s Zero Pollution Ambition.

In spite of viable mercury-free alternatives, around 40 tonnes of mercury are still used in the EU annually for dental amalgam as current rules only forbid the use of dental amalgam for treating teeth in children under 15 years old as well as pregnant and breastfeeding women.

Negotiators agreed to phase out the use of dental amalgam in the EU by 1 January 2025 except if deemed strictly necessary by the dental practitioner based on the duly justified specific medical needs of the patient.

EU countries that have not yet adjusted their reimbursement system to cover alternatives, may postpone the phase-out up until 30 June 2026, to avoid negative repercussions for low-income individuals that would otherwise be socio-economically disproportionally affected by the phase-out.

The export of dental amalgam will also be prohibited from 1 January 2025, whereas the manufacturing and import into the EU will be banned from 1 July 2026.

After the agreement, rapporteur Marlene Mortler (EPP, Germany) said: “After an intensive week of negotiations, we were able to reach an agreement today to ban dental amalgam containing mercury. This is an important step towards a mercury-free future. I am very pleased with the result – because we have ensured that such dental amalgam may only be used in medically necessary cases. Some Member States have been granted an exemption in order to mitigate the socio-economic consequences of the amalgam phase-out. After all, the ban on dental amalgam must not mean that low-income EU citizens can no longer afford adequate dental treatment in these countries. Another key point of this agreement is the decision that lamps containing mercury may only be exported to countries outside the EU until 30 June 2026. This will ensure that products that are already banned in the EU are not sold to third countries and have environmentally harmful consequences there.”

The deal still has to be adopted by the EU Parliament and Council, after which the new law will be published in the EU Official Journal and enter into force 20 days later.

I have to admit that I came across the ‘ARCIM’ (Academic Research in Complementary and Integrative Medicine) Institute only yesterday when writing the post about Buteyko. Naturally, the institution interested me, and I tried to find out more about it. As pointed out previously, the aim of the ARCIM research institute, founded in 2010, is to research complementary and integrative medicine, in particular anthroposophic medicine, on a scientific basis according to rigorous scientific standards established by the Equator Network criteria (http://www.equator-network.org/).

On the ARCIM’s website we furthermore learn that:

  • ARCIM exists since 2010.
  • Consists of a team of 8 co-workers.
  • Its director is the physician Jan Vagedes.
  • Who have published a sizable amount of papers.
  • Is funded by the following sponsors: Federal Ministry of Education and Research (BMBF), Mahle-Foundation (Mahle Stiftung), Software AG (Software AG), DAMUS-DONATA e.V.
  • Is located in the buildings of the ‘Filderclinic’.

This begs, I think, several questions:

Why is the Federal Ministry of Education and Research sponsoring the ARCIM?

As anthroposophical medicine is based on concepts that fly in the face of science, this seems a legitimate question. Sadly, I have no answer to it.

What is the ‘Filderclinic’?

The Filderklinik in Filderstadt-Bonlanden is one of six anthroposophically orientated hospitals in Germany. It is operated by the non-profit organisation Filderklinik gGmbH. The main founders of the Filderklinik, which has existed since 1975, were Hermann and Ernst Mahle, the founders of the Mahle Group. The Mahle-Stiftung GmbH is the main shareholder and also the largest sponsor of Filderklinik gGmbH. The hospital employs around 915 staff and has 300 beds.

Who is Jan Vagedes?

Jan Vagedes is a specialist for paediatrics and adolescent medicine, neonatology and a doctor for anthroposophic medicine. He studied in and graduated from the LMU in Munich (my alma mater) in 1997. He is the Founder and Scientific Director of the ARCIM Institute, a research associate at the University Children’s Hospital Tübingen, and Head of paediatrics and adolescent medicine at the Filderclinic.

He has no ‘habilitation’ (PhD and in Germany precondition for a professorship). Medline currently lists 42 articles in his name most of which are in 3rd class journals. His first Medline-listed article is dated 2012. As the ARCIM was established in 2010, this means that, when he was appointed as its ‘scientific director’, he had exactly zero published science to his name.

Why did he get the job?

I have absolutely no idea?

(If you know more than I do, I’d be grateful to hear about it.)

 

 

Guest post by Udo Endruscheit

Switzerland is probably the European country with the strangest complementary and alternative medicine (CAM) regulations in the health insurance system. A total of five different CAM methods have been included in the benefits catalogue of basic insurance for several years. However, this is subject to a strange proviso. How did this come about?

As almost everywhere in Europe, there was a desire in Switzerland in the 1990s to include CAM in the public healthcare system, with homeopathy naturally once again taking pole position. Initially, the urge to include five CAM modalities in basic care was granted, but only provisionally. A major project called the “Complementary Medicine Evaluation Programme” (PEK) was launched in 1999 to evaluate the procedures. Even back then, the criteria of efficacy, appropriateness and cost-effectiveness were prerequisites for reimbursement in health insurance. PEK was intended to create clarity here.

One part of PEK has been the well-known Shang/Egger (2005) study on homeopathy “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy”, which was to become a bone of contention without precedent. However, this did not change the negative result for homeopathy.

In any case, clear conclusions were drawn in Switzerland not only from this study, but also from the results of the other evaluations: the provisional inclusion of the methods in statutory basic insurance was terminated.

This in turn enraged the supporters of CAM methods, who thought they had already reached their goal with the provisional decision in their favour. Apparently, they had not even considered the possibility that scientific evaluations could actually lead to a sudden end to their wishes, which they believed had already been fulfilled.

In fact, in 2009, the friends of ineffective methods succeeded in bringing about one of the referendums for which Switzerland is known under the catchphrase “direct democracy”. And they prevailed – around two thirds of the votes cast were in favour of CAM and its inclusion in the Swiss Federal Constitution. However, it should be borne in mind that the two-thirds figure is put into perspective if the approval, including the low voter turnout, is converted to the proportion of the total electorate. This leaves just 17 per cent who voted for the CAM. And a closer look at the issue of the constitution also reveals that no unconditional protection space has been created for CAM. This is more or less a kind of good behaviour clause for CAM methods, but not rules that could render laws null and void.

The Swiss government was faced with the question of how to avoid simply ignoring the result of the referendum, while at the same time complying with the still valid requirements for reimbursement in basic insurance. So the representatives of the five CAM directions were actually asked to come to the Federal Office of Public Health with their proof of efficacy and economic efficiency. This was done in 2011.

Of course, this was a little bizarre at this stage – and of course nothing came of it. Or actually it did: once again, no proof could be provided. Meanwhile, a lot of time had passed again and a new Federal Council was forced to take up the matter.

The latter, Alain Berset, came up with the plan that the necessary proof of efficacy could actually be postponed until after the methods had been included in the catalogue of basic insurance benefits. In other words, he gave the methods a governmental leap of faith (which, in view of the long-year history of the case, meant closing several eyes) and postulated that this should be the matter until someone applied for an evaluation of one of the methods.

This is what happened in the year of our Lord 2017. Apparently everyone was able to make their peace with it, which is hardly surprising after ten years of moving around and around. Only the umbrella organisation of health insurers, Santesuisse, grumbled about it and predicted that the announced cost neutrality of such a measure could hardly be expected. Which Santesuisse did indeed prove in a dossier two years later.

The exhausted Swiss have so far left it at that. Homeopathy remained untouched. This was also unfortunate for the reason that the fairy tale of the clever and innovative Switzerland, which knew how important the wishes and preferences of its patients were, was propagated in Germany. The rather strange result of more than ten years of struggle was even passed around by German homeopaths under the name “Swiss model”. Even the leading Swiss press was embarrassed by this and published a clarifying article. And unfortunately, the Swiss began to get used to the existence of hocus-pocus in their basic insurance and to take it for granted.

Until now. Even in Switzerland, the fact that homeopathy is coming under increasing criticism everywhere has probably not gone unnoticed. And the Swiss are actually a rather critical and resistant people. And so it happened that a single brave inhabitant of the country recently decided to exercise his right to demand a new evaluation of homeopathy. The Federal Office of Public Health must have been surprised – or perhaps they were desperately waiting for it? Perhaps. In any case, the application was accepted without hesitation. Meanwhile, a notification has been issued that the hearing procedure for the evaluation has been initiated. The representatives of homeopathy (the service providers), the representatives of the Swiss medical profession and the representatives of the health insurance companies – the aforementioned Santesuisse – will be heard. The final decision will then be made by the Swiss government’s Department of Home Affairs.

How many attempts at an evaluation has this actually been – the third? The fourth? We can’t keep up … We have seen the consequences of scientific questions being decided by majorities. It is to be hoped that Switzerland will not add another chapter to the drama that has been going on since 2005. Mr Berset’s successor, who has been in office since the beginning of the year, should only be given a brief reminder: in Switzerland, too, homeopathy has no effect beyond contextual effects. And that is not enough to prove efficacy, appropriateness and cost-effectiveness.

But cheers to the courageous descendant of William Tell, who is about to single-handedly bring down homeopathy in the Swiss healthcare system!

The Austrian ‘Initiative für Wissenschaftliche Medizin‘ (Initiative for Scientific Medicine) did a great job by summarizing the non-scientific training events dedicated to pseudomedicine organized, supported or promoted by the ‘Österreichische Akademie der Ärzte‘ (Austrian Academy of Physicians), a partner of the Austrian Medical Association. They sorted them by date in descending order, listing the DFP points (points required for postgraduate education) awarded and the link to each specific event. The content of the programme of such events, if available, is also often “interesting”. The pseudomedicine methods are provided with links to psiram.com, where these methods are described in more detail.

So, restricting ourselves to the period of 20 years (2003-2023) and merely looking at a selection of all possible so-called alternative medicine (SCAM), we find in this treasure trove of quackery the following:

  • Anthroposophic medicine – 218 events
  • Homeopathy – 1 708 events
  • Orthomolecular medicine – 645 events
  • Neural therapy – 864 events
  • TCM diagnostics – 1214 events

In total, thousands SCAM events were organized, supported or promoted by the Academy, and I am not aware of any national physicians’ organization that has done anywhere near as much for quackery.

On their website, the Austrian Academy of Physicians state that they were founded by the Austrian Medical Association as a non-profit organisation with the aim of promoting and further developing medical education in Austria… The aim is to lead the way in medical education issues in order to achieve continuous improvement in the medical profession. For the Academy, continuing medical education is an essential component of medical quality improvement…

This may sound alright but, in my view, it raises several questions, e,g,:

  • Does the Academy believe that continuous improvement in the medical profession can be achieved by promoting, organizing or conducting such a huge amount of courses in quackery?
  • Do they not know that this is the exact opposite of medical quality improvement?
  • Are they aware of their ethical responsibility?
  • Do they know that the promotion of quackery puts patients at risk?
  • Have they heard of evidence-based education?

It is easy to criticize but less obvious to improve. In case the people responsible for postgraduate education at the Academy want to discuss these issues with me, I would therefore be delighted to do so, for instance, via a series of evidence-based lectures on SCAM.

 

 

Proponents of so-called alternative medicine (SCAM) are often – as we had many opportunities to observe here on this blog – not impressed with the safety and efficacy of COVID vaccinations. This is despite the fact that several studies have demonstrated the huge number of lives saved by them, both at national and multi-country level in the earlier stages of the pandemic. I wonder whether the doubters will be convinced by new evidence.

This analysis estimates how many lives were directly saved by vaccinating adults against COVID in the Region, from December 2020 through March 2023.

The researchers estimated the number of lives directly saved by age-group, vaccine dose and circulating Variant of Concern (VOC) period, both regionally and nationally, using weekly data on COVID-19 mortality and COVID-19 vaccine uptake reported by 34 European areas and territories (CAT), and vaccine effectiveness (VE) data from the literature. They calculated the percentage reduction in the number of expected and reported deaths.

The authors found that vaccines reduced deaths by 57% overall (CAT range: 15% to 75%), representing ∼1.4 million lives saved in those aged ≥25 years (range: 0.7 million to 2.6 million): 96% of lives saved were aged ≥60 years and 52% were aged ≥80 years; first boosters saved 51%, and 67% were saved during the Omicron period.

The authors concluded that over nearly 2.5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among these most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures.

The authors feel that their results reinforce the importance of up-to-date COVID-19 vaccination, particularly among older age-groups. Communication campaigns supporting COVID-19 vaccination should stress the value of COVID-19 vaccination in saving lives to ensure vulnerable groups are up-to-date with vaccination ahead of periods of potential increased transmission.

Those SCAM proponents who are not convinced of the merits of COVID and other vaccinations will undoubtedly claim that this new analysis was biased and thus unreliable. Therefore, it seems worth stating that this work was supported by a US Centers for Disease Control cooperative agreement, who had no role in data analysis or interpretation. The authors affiliated with the World Health Organization (WHO) are alone responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO.

I had the rare pleasure to give an interview for the ‘Frankfurter Allgemeine’. As it was, of course, in German, I took the liberty to translate it for my non-German speaking readers:

You have researched so-called alternative medicine over several decades, including homeopathy. What is your conclusion?

We are talking about far more than 400 methods – to draw one conclusion about all of them
is completely impossible. Except perhaps for this one: if something sounds too good to be true, it probably is.

Does this apply to homeopathy?

Highly diluted homeopathic remedies are popular because they have no side-effects. But there is also no effect. They are touted as a panacea. This is certainly not the case, on the contrary, they are
ineffective. And any therapy that is ineffective and promoted as a panacea is also dangerous.

How do you explain the fact that so many people swear by homeopathy?

There are several reasons for this. In Germany, homeopathy has an unbroken tradition, it was, for instance, promoted by the Nazis and later in the Federal Republic of Germany. It has a reputation for being gentle and effective. It might be gentle, but it is certainly not effective. It is also supported by lobby groups such as the manufacturers. And most people who use it don’t even understand what it actually is.

In any case, the placebo effect helps. What’s so bad about that??

Nothing at all, on the contrary: it is to be advocated. When we talk about placebo effects, we subsume many things under this umbrella that do not actually belong to it, such as the extensive, empathetic conversation that homeopaths often have with their patients. Besides, a common cold goes away whether you treat it or not. If you then use homeopathy, you can easily get the impression that it worked. Every good, empathetic doctor tries to maximize the placebo effect. To put it bluntly: you don’t need a placebo to generate a placebo effect. Patients also benefit from it when I give an effective remedy with empathy. In addition they benefit from the specific effect of my therapy, which should make up the lion’s share of the therapeutic response. If I withhold the most important thing I mistreat my patient.

But there are diseases for which there are no good remedies.

I often hear that argument. But there is practically always something we can do that at least
improves symptoms. Otherwise you should also say that instead of lying and recommending homeopathy – and thinking that, although there is nothing in it and it doesn’t work, but the patient, being an idiot, should take it nevertheless. It is unethical to use placebos as much as it is to use homeopathy.

Neurophysiologically, the placebo effect is becoming better and better understood.

The Italian neuroscientist Fabrizio Benedetti in particular has done very good work.  But he also warns that this does not justify the use of homeopathy, for example.

Are there any studies on whether the placebo effect of homeopathy with its esoteric superstructure is greater than that giving just a piece of sugar?

There are analyses of what makes a particularly effective placebo. From this, we can learn that effective therapies in evidence-based medicine must be applied with empathy and sufficient time in order to maximize the ever-present placebo effect. So-called alternative medicine often does this quite well, and we can learn something from it. But the reason is that it often has nothing else. Homeopaths are a serious danger because they see homeopathy as a panacea. If someone has homeopathically treated their cold “successfully” for years and then gets cancer, they might think of turning to homeopathy for their cancer. It sounds crazy, but many homeopaths do offer cancer treatments on the internet, for instance. That sends shivers down my spine.

How should doctors and pharmacists react to the demand for homeopathic remedies?

Pharmacists are not primarily salespeople, they are a medical profession – they have to adhere to ethical guidelines. In this respect, evidence-based information of their clients/patients is very important.

Thomas Benkert, President of the German Federal Chamber of Pharmacists, has stated that he would not be able to stop giving advice if he always had to explain the lack of proof of efficacy.

He should perhaps read up on what his ethical duty to patients is.

What if doctors or pharmacists themselves believe in the effect?

Belief should not play a role, but evidence should.

Are you pleased with Lauterbach’s plan to no longer reimburse homeopathy?

I think it’s a shame that he justifies it by saying it’s ineffective. That is true. But the justification should be that it’s esoteric nonsense and therefore ineffective – and dangerous.

In the end, the Bundestag will decide.

I think Lauterbach has a good chance because things have started to move. Medical associations in Germany have spoken out against the additional designation of homeopathy, for example, and overall the wind has changed considerably.

What is it like in the UK, where you live?

The UK healthcare system, NHS, said goodbye to reimbursement of homeopathy about five years ago, even before France. The pharmacists’ association has distanced itself very clearly from homeopathy. However, most pharmacists still sell the remedies and many continue to support them.

You have also had disputes with the current head of state, King Charles. How did that come about?

A few years ago, he commissioned a paper claiming that so-called alternative medicine could save the British health service a lot of money. I protested against this – Charles accused me of leaking it to The Times before it was published. My university launched an investigation, which eventually found me innocent, but it led to the demise of my department. That caused me to retire two years early.

So Charles managed to close down the only research unit in the world that conducted critical and systematic research into so-called alternative medicine. Most researchers in this field only want to confirm their own prejudices and not disprove hypotheses. This is a serious misunderstanding of how science works. If someone reports only positive results for their favorite therapy in all conditions, something is wrong.

Some people say that homeopathy should not be researched because nothing positive can come out of it anyway.

There are certainly some SCAMs that are so nonsensical that they should not be researched, as is currently the case with homeopathy. I put it this way because I have researched homeopathy myself and, from my point of view, the situation was not so crystal clear 30 years ago.

Would you say that you have approached the matter with a sufficiently open mind?

No one can be completely unbiased. That’s why it’s important to do science properly, then you minimize bias as much as possible. When I took up my position at Exeter in 1993, I was perhaps somewhat biased towards homeopathy in a positive sense, because I had learned and used it myself, as well as other alternative medicine methods. The fact that the results then turned out to be negative in the vast majority of cases initially depressed me. But I have to live with that.

Every researcher prefers positive results, also because they are easier to publish. It was clear to me that, if I had succeeded in proving homeopathy right, I wouldn’t get one Nobel Prize, but two. Who wouldn’t want that?

(The interview was conducted by Hinnerk Feldwisch-Drentrup.)

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