progress
Today, there is a strong scientific and medical consensus that homeopathy lacks reliable evidence of efficacy. Many of the strongest rejections come, after independent evaluations of the evidence, from national and international scientific bodies of undoubted repute. Here is my list:
- Advertising Standards Authority (UK) The ASA requires that efficacy claims for homeopathic products be supported by robust clinical evidence and has ruled that unsupported claims are misleading.
- American Academy of Pediatrics (USA) Warns that unproven alternative treatments, including homeopathy, should not delay or replace effective medical care, particularly in children.
- American College of Medical Toxicology & American Academy of Clinical Toxicology (USA) Jointly stated “no evidence exists” homeopathy is effective, noting it can be harmful by delaying evidence-based care; they recommended “against using homeopathic treatment for disease or prevention.”
- American Medical Association (USA) Issed statements that there is “no good-quality evidence” homeopathy is effective for any condition and opposed its integration into mainstream practice.
- Argentine Medical Association (AMA, Argentina) The AMA has criticized homeopathy’s inclusion in medical practice, stating it lacks scientific evidence and warning against its promotion as a valid treatment.
- Belgian Health Authority The Belgian Federal Public Service Health halted reimbursement for homeopathy in 2020, following advice from the College of Physicians that it lacks scientific evidence.
- Canadian Health Authorities Health Canada mandates warning labels on unlicensed claims: “This product is neither approved nor authorized for any indication,” aligning with evidence that homeopathy lacks reliable clinical support.
- Canadian Medical Association (CMA) Via editorials in its journal (CMAJ), the CMA has condemned the licensing of homeopathy as a “loophole” that implies efficacy without scientific proof, stating it “makes a joke of the regulatory process.”
- Chief Medical Officer for England (Dame Sally Davies) Publicly called homeopathic preparations “rubbish” that function only as placebos with no therapeutic benefit beyond psychological effects.
- European Academies’ Science Advisory Council (EASAC) Issued a 2017 statement finding “no evidence that homeopathic products are effective” and reiterated that explanations for homeopathy’s efficacy are “scientifically implausible.”
- Federal Trade Commission (USA) Requires that homeopathic products must not claim effectiveness without evidence; otherwise, they must clearly state a lack of scientific support.
- Federation of American Societies for Experimental Biology (FASEB) Asserted “no convincing evidence” for homeopathy’s clinical efficacy, as its mechanisms contradict established chemistry and physics.
- Food and Drug Administration (USA) States “No homeopathic product is FDA-approved”; products are not reviewed for safety or effectiveness. The FDA also warns they may pose risks.
- French Academy of Medicine Rejected homeopathy as scientifically invalid, stating its theoretical basis and clinical evidence are inadequate or absent.
- German Medical Association (Germany) In 2020, removed homeopathy from the model further education curriculum for doctors, declaring it “is not a medical procedure based on scientific findings.”
- House of Commons Science and Technology Committee (UK) In its 2010 report, concluded “the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.”
- Medicines and Healthcare products Regulatory Agency (UK) Followed committee advice by restricting licensing; homeopathic products should not make medical claims without evidence and are no longer endorsed as medicines.
- National Cancer Institute (USA) States homeopathy has “not been shown to be effective” for cancer treatment or symptom relief, with no rigorous studies supporting benefit beyond placebo.
- National Health and Medical Research Council (NHMRC, Australia) After reviewing over 1,800 studies, it concluded “there are no health conditions for which there is reliable evidence that homeopathy is effective.”
- National Health Service (NHS, England) Formally stated “no NHS funding will be spent on homeopathic medicines,” with guidance that homeopathy performs “no better than placebos.”
- National Institute for Health and Care Excellence (UK) NICE does not recommend homeopathy in any clinical guideline and bases its recommendations on the best available evidence.
- Royal Society (UK) Numerous Fellows have publicly criticized homeopathy, and the Society has supported evidence-based medicine principles incompatible with homeopathy’s claims.
- Russian Academy of Sciences Described homeopathy as “pseudoscience” with principles that “contradict known laws of chemistry, physics, and biology.”
- Spanish Medical Associations (Collegiate Medical Organization of Spain) In 2018, rescinded recognition of homeopathy as a “medical procedure,” declaring it “not scientifically sound.”
- Swedish Medical Association The Swedish Medical Association and National Board of Health declared homeopathy scientifically unfounded in 2010, advising against its use in healthcare.
- Swiss Academy of Medical Sciences Concluded homeopathy lacks scientific evidence and should not be reimbursed by health insurance.
- Swiss Federal Office of Public Health After a 2005-2011 review, it rejected renewed inclusion in basic health insurance (though it was later reintroduced in 2017 under specific political conditions).
- World Health Organization (WHO) Explicitly stated homeopathy “should not be used” for serious diseases like HIV, tuberculosis, or malaria, warning reliance “can be dangerous.”
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And what about institutions supporting homeopathy? I am aware of just one:
- Ministry of AYUSH (India) “Homoeopathy is a cost-effective system of medicine and is widely practiced for both acute and chronic conditions.”
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Across decades of systematic reviews and independent evaluations by scientific and medical authorities worldwide, no credible evidence has emerged to support the efficacy of homeopathy. Its principles conflict with well-established scientific laws, and its effects are indistinguishable from those of placebo in rigorous studies. The broad convergence of expert opinion is therefore this: homeopathy has no effects beyond placebo. Its continued use represents a divergence from evidence-based medicine, and reliance on it, particularly as an alternative to effective care, poses a clear risk to public health.
This landmark study, often called the “Nürnberger Kochsalzversuch”, is historically significant as probably the first recorded instances of a randomized, double-blind, placebo-controlled trial. It was conducted to test a specific claim made by a leading practitioner of the time. By the mid-1830s, homeopathy had gained significant popularity among the upper classes in Nuremberg, then part of the Kingdom of Bavaria (Stolberg, 2006). This success frustrated the city’s medical establishment Thus, in 1834, Friedrich Wilhelm von Hoven, the city’s highest-ranking public health official, published a scathing critique of homeopathy using the pseudonym “E.F. Wahrhold” (Cukaci et al., 2020). Johann Jacob Reuter, a prominent local homeopath, responded by challenging von Hoven to a test which became the now famous Nürnberger Kochsalzversuch. Reuter claimed that even a healthy person would experience “extraordinary sensations” if they ingested a dilution of ordinary table salt (Sodium Chloride, or Natrum Muriaticum, as homeopaths like to call it) (Stolberg, 2006).
The trial was organized by a “Society of Truth-loving Men,” supported by George Löhner, a local newspaper editor who also wrote the final report (Cukaci et al., 2020). To ensure impartiality, they implemented a – for the time revolutionary – study design:
- 100 identical glass vials were prepared.
- 50 were filled with pure distilled snow water (the placebo),
- 50 were filled with a salt dilution prepared exactly as Reuter had instructed (one grain of salt diluted 29 times at a 1:100 ratio.
- The vials were numbered, shuffled, and divided into two lots at random in front of a public audience.
- A sealed list recorded which vial/number contained which substance.
- Neither the distributors/trialists nor the participants knew the contents of the vials.
- The vials were distributed to volunteers.
- They were asked to record any unusual symptoms over the following three weeks.
The results could not have been clearer. Of the participants who reported back (approx. 50–54 individuals), the vast majority experienced no symptoms at all. Moreover, there was no difference between the verum and the control group.
The organizers concluded that, as the “symptoms” were evenly distributed between the salt and water groups, Reuter’s claim was discredited. They attributed any reported symptoms to imagination, self-deception, or preconceived opinion (Stolberg, 2006).
The study has historical importance. It is now celebrated by as a pioneering moment in clinical methodology. It could have established the importance of double-blinding, placebo-controls, and randomisation to eliminate bias. I say “it could have” because, in fact, it did nothing of the sort.
- It took until the 1930s that blinding started appearing in more formal academic settings; and only after 1948 (see below), became blinding accepted widely a “best practice”.
- In 1955, Henry Beecher published his landmark paper claiming that roughly 35% of patients improved on placebo alone. The Kefauver-Harris Amendment of 1962 finally legally mandated that manufacturers prove a drug is “effective” compared to a control, usually a placebo.
- Sir Ronald A. Fisher, a statistician working at an agricultural research station in England, realized that if you test two different fertilizers on two different patches of land, the soil quality might be better in one patch than the other, which would ruin the data. He proposed that only by randomly assigning treatments could you “cancel out” unknown variables (like soil acidity or moisture). His 1925 book, Statistical Methods for Research Workers, provided the mathematical proof that randomization was the only way to eliminate this form of bias.
- The MRC Streptomycin Trial of 1948 finally marked the official birth of the randomized clinical trial (RCT).
But – most importantly in the context of this blog – the trial could have established that highly diluted homeopathic remedies are pure placebos. Sadly, this fact is still being ignored by all homeopaths, most healthcare systems, and far too many consumers across the world.
References
Beecher, H. K. (1955). The Powerful Placebo. Journal of the American Medical Association, 159(17), 1602–1606. https://doi.org/10.1001/jama.1955.02960340022006
Cukaci, C., Freissmuth, M., Mann, C., Marti, J., & Sperl, V. (2020). Against all odds—the persistent popularity of homeopathy. Wiener klinische Wochenschrift, 132(9-10), 232–242. https://doi.org/10.1007/s00508-020-01624-x Cited by: 99
Fisher, R. A. (1925). Statistical Methods for Research Workers. Oliver & Boyd. (Bodmer, 2003; Larson, 2008).
Jamison, J. C. (2016). The Entry of Randomized Assignment into the Social Sciences. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2739005 Cited by: 29
Stolberg, M. (2006). Inventing the randomized double-blind trial: the Nuremberg salt test of 1835. Journal of the Royal Society of Medicine, 99(12), 642–643. https://doi.org/10.1177/014107680609901216
The regualtion of so-called alternative medicine (SCAM) differs from country to country which can and does cause a lot of confusion. Here are very brief summaries of some of the countries that I know best:
UK Policy
The UK government adopts a cautious, evidence-based stance on SCAM, with the Medicines and Healthcare products Regulatory Agency (MHRA) regulating herbal and homeopathic products for safety and quality, requiring accurate labelling without efficacy claims. Practitioner oversight is largely voluntary through bodies like the Complementary and Natural Healthcare Council (CNHC), while the NHS tends to fund mainly therapies demonstrating clinical efficacy, cost-effectiveness, and safety per NICE guidelines. This approach, shaped by responses to inquiries like the 2000 House of Lords report, prioritizes patient protection, clinician discretion, and avoidance of unproven treatments to safeguard public resources, without mandating statutory registration for most SCAM practitioners.
US Policy
In the US, much of SCAM falls under the FDA’s oversight as dietary supplements via the 1994 Dietary Supplement Health and Education Act (DSHEA), mandating pre-market safety notification but exempting efficacy proof, with strict rules against disease-treatment claims. The National Center for Complementary and Integrative Health (NCCIH) at NIH funds some research into SCAM but does not regulate practice; Medicare and Medicaid offer no routine reimbursement, except for acupuncture as a treatment of chronic low back pain. Licensing varies by state—e.g., naturopaths are regulated in 25 states, without federal endorsement of unproven therapies to balance innovation and safety.
Germany Policy
Germany integrates SCAM into its statutory health insurance system, reimbursing popular therapies like homeopathy, herbalism, acupuncture, and anthroposophic medicine when prescribed by doctors, often via the “IGeL” self-pay catalog for non-standard uses. Non-physician practitioners require Heilpraktiker certification under federal law, while products follow the Medicines Act (AMG) with simplified registration for SCAM remedies. This tradition-rooted policy, supported by major insurers like TK and AOK, fosters a hybrid model that aims at combining some regulatory rigor with broad access for patient choice in primary care settings.
France Policy
France regulatesSCAM through the National Agency for the Safety of Medicines (ANSM), requiring marketing authorization for homeopathy and herbal products based on safety dossiers, though simplified for traditional use. Assurance Maladie reimburses select therapies at reduced rates, phasing out full coverage amid efficacy critiques, with practitioners either physicians or under voluntary syndicates like the Syndicat des Médecins Homéopathes. Post-2021 policy shifts emphasize evidence-based medicine, restricting public funding to proven interventions while allowing private practice, reflecting a tension between cultural acceptance and demands for evidence to justify taxpayer expense.
Austria Policy
Austria’s policy mirrors Germany’s, with social health insurers reimbursing SCAM therapies like acupuncture, homeopathy, osteopathy, and herbal medicine when delivered by licensed physicians under the Ärztegesetz, or voluntarily via the Austrian Umbrella Organization for Quality in Complementary Medicine (ÖZK). Austria does not allow ‘Heilpraktiker’ to practice. Products align with EU standards, including simplified authorizations for SCAM remedies through the Austrian Agency for Health and Food Safety (AGES). This integrative approach aims at prioritizing evidence from clinical studies for coverage decisions, supporting patient-centred care within universal healthcare while mandating professional qualifications to ensure safety, with ongoing evaluations balancing tradition and scientific validation.
What ever the regulatory details are, we should, I think, bear in mind something that I state whenever SCAM regulation is being discussed:
Even the most rigorous regulation of nonsense must result in nonsense.
I have long felt that Cureus is a very strange journal:
- It publishes an incredilby high volume of papers: ~50,000 in 2025.
- An unusual high percentage of these articles are on so-called alternative medicine (SCAM).
- Its article retraction rate seems one dimension higher than the average.
- It charges hefty fees for submissions needing language, formatting, or reference corrections.
- Estimates of its profits vary hugely: $3.5M revenue (Growjo), $1.4M (SignalHire), or $25-50M (Cience).
Now RETRACTION WATCH (RW) have reported that Clarivate has removed Cureus from its Master Journal List. The move means Cureus will no longer be indexed in Web of Science or receive an impact factor. Thus, researchers are less likely to submit to the journal.
Clarivate put indexing for the journal on hold last September for concerns about article quality, which the journal has been criticized for in the past. Cureus has retracted about 125 papers since Springer Nature acquired the title in late 2022. Last year, the journal closed six of its academic channels critics described as dressed-up paper mills, and has had to repeatedly retract plagiarized articles, as we’ve previously reported.
In August, Cureus eliminated author suggestions for peer reviewers in an attempt to decrease potential conflicts of interest. The journal has had authorship issues in the past, as RW previously reported. In 2021, a medical resident in New Jersey invited his wife to review his papers without disclosing their relationship, resulting in five retractions. In 2019, another author faked reviewer accounts for two well-known neurosurgeons and was discovered only after a routine editorial audit.
Rebecca Krahenbuhl, a communications manager at Clarivate, told RW a journal is removed from the Master Journals List when it “no longer meets” 24 quality criteria. These criteria include appropriate citations, adequate and effective peer review, and primarily original scholarly content, according to the company’s website. Krahenbuhl also told RW journals are typically on hold for an average of around six weeks, but in cases where publishers “engage” with Clarivate, the company allows journals to remain on hold for longer “to allow time for publishers to conduct their own investigations and take corrective action should they decide to do so.”
Graham Parker-Finger, the publishing director at Cureus, told us the journal was “very disappointed” in Clarivate’s decision and noted the journal would continue “to offer fast, affordable, trusted and quality-assured publishing for the global medical community.”
Debates on researching SCAM frequently hinge on the tension between theoretical plausibility and empirical testing. The central question is this: should interventions that contradict well-established scientific principles nonetheless be subjected to clinical trials? This issue raises fundamental concerns about the allocation of research resources, the epistemology of medical science, and the boundary between scientific openness and credulity.
In medical research, plausibility refers to the compatibility of a treatment’s purported mechanism of action with established biochemical and physiological knowledge. Treatments such as homeopathy, reiki, bioresonance, etc., etc. are typically judged to be implausible because their mechanisms violate basic physical principles (Ernst, 2010; Offit, 2013). One could argue that conducting randomized clinical trials (RCTs) on such interventions is methodologically and ethically questionable, as the prior probability of efficacy is exceedingly low (Goodman, 1999) and the probability of a positive result obtained with a rigorous trial approaches zero. Framed in Bayesian terms, if a hypothesis begins with a negligible prior probability, even seemingly positive trial outcomes are unlikely to meaningfully change its posterior credibility (Spiegelhalter, 2019).
But insisting that only theoretically plausible hypotheses merit empirical testing risks scientific conservatism. Medical history includes numerous examples – such as the discovery of the antipyretic and antithrombotic effects of aspirin – where therapeutic value was demonstrated before mechanisms were fully understood (Vane, 2000). Advocates of broader testing argue that empirical methods should retain the capacity to surprise theory and that excluding “implausible” ideas a priori risks reinforcing disciplinary dogma (Ioannidis, 2012). This appeal to epistemic humility emphasizes observation as a safeguard against the overreach of theoretical reasoning.
However, defenders of plausibility-based research prioritization contend that such humility must be balanced against the always finite resources for research and the ethical responsibility of researchers. Health research funding is limited, and prioritizing the study of implausible treatments may divert attention from interventions with rational mechanistic foundations and higher expected utility (Sampson, 2005). Additionally, the evidentiary record of clinical trials in SCAM demonstrates a consistent pattern: small, underpowered studies occasionally produce marginally positive results that fail replication, while systematic reviews of rigorous studies yield null or inconclusive conclusions (Shang et al., 2005; Ernst et al., 2011). In such cases, further testing is more likely to perpetuate public misunderstanding than to advance medical knowledge.
So, what is the solution? An epistemologically coherent approach, frequently advocated in evidence-based medicine, is to calibrate evidential standards to plausibility. Highly improbable claims should first demonstrate compelling preclinical signals – biochemical, mechanistic, or reproducible physiological effects – before human trials are considered (Goodman, 1999; Howick, 2011). This proportionality upholds methodological rigor without foreclosing the possibility of genuine empirical discovery. It respects Bayesian reasoning: extraordinary claims require extraordinary evidence.
Science must remain open to the unexpected yet disciplined in method and theory. Medical research is usually at its most productive when it operates between the two extremes—dogmatism that refuses to test unconventional claims, and indiscriminate empiricism that tests everything without theoretical guidance. The prudent path lies in aligning the scope of empirical investigation with scientific plausibility, ensuring openness tempered by rational constraint.
References
- Ernst, E. (2010). “A systematic review of systematic reviews of homeopathy.” British Journal of Clinical Pharmacology, 69(5), 577–582.
- Ernst, E., Pittler, M. H., Wider, B., & Boddy, K. (2011). The Desktop Guide to Complementary and Alternative Medicine. Elsevier.
- Goodman, S. N. (1999). “Toward evidence-based medical statistics. 1: The P value fallacy.” Annals of Internal Medicine, 130(12), 995–1004.
- Howick, J. (2011). The Philosophy of Evidence-Based Medicine. Oxford University Press.
- Ioannidis, J. P. A. (2012). “Scientific inbreeding and same-team replication: Type D personality as an example.” Journal of Psychosomatic Research, 72(6), 408–410.
- Offit, P. A. (2013). Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. HarperCollins.
- Sampson, W. (2005). “Antiscience trends in the rise of the ‘alternative medicine’ movement.” Annals of the New York Academy of Sciences, 775(1), 188–197.
- Shang, A., et al. (2005). “Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy.” The Lancet, 366(9487), 726–732.
- Spiegelhalter, D. (2019). The Art of Statistics. Pelican Books.
This prospective cohort study investigated associations of coffee and tea intake with dementia risk and cognitive function. It included female participants from the Nurses’ Health Study (NHS; n = 86 606 with data from 1980-2023) and male participants from the Health Professionals Follow-up Study (HPFS; n = 45 215 with data from 1986-2023) who did not have cancer, Parkinson disease, or dementia at study entry (baseline) in the US.
The primary exposures were intakes of caffeinated coffee, decaffeinated coffee, and tea. Dietary intake was collected every 2 to 4 years using validated food frequency questionnaires. The primary outcome was dementia, which was identified via death records and physician diagnoses. The secondary outcomes included subjective cognitive decline assessed by a questionnaire-based score (range, 0-7; higher scores indicate greater perceived decline; cases defined as those with a score ≥3) and objective cognitive function assessed only in the NHS cohort using telephone-based neuropsychological tests such as the Telephone Interview for Cognitive Status (TICS) score (range, 0-41) and a measure of global cognition (a standardized mean z score for all 6 administered cognitive tests).
Among 131 821 participants (mean age at baseline, 46.2 [SD, 7.2] years in the NHS cohort and 53.8 [SD, 9.7] years in the HPFS cohort; 65.7% were female) during up to 43 years of follow-up (median, 36.8 years; IQR, 28-42 years), there were 11 033 cases of incident dementia. After adjusting for potential confounders and pooling results across cohorts, higher caffeinated coffee intake was significantly associated with lower dementia risk (141 vs 330 cases per 100 000 person-years comparing the fourth [highest] quartile of consumption with the first [lowest] quartile; hazard ratio, 0.82 [95% CI, 0.76 to 0.89]) and lower prevalence of subjective cognitive decline (7.8% vs 9.5%, respectively; prevalence ratio, 0.85 [95% CI, 0.78 to 0.93]). In the NHS cohort, higher caffeinated coffee intake was also associated with better objective cognitive performance. Compared with participants in the lowest quartile, those in the highest quartile had a higher mean TICS score (mean difference, 0.11 [95% CI, 0.01 to 0.21]) and a higher mean global cognition score (mean difference, 0.02 [95% CI, −0.01 to 0.04]); however, the association with global cognition was not statistically significant (P = .06). Higher intake of tea showed similar associations with these cognitive outcomes, whereas decaffeinated coffee intake was not associated with lower dementia risk or better cognitive performance. A dose-response analysis showed nonlinear inverse associations of caffeinated coffee and tea intake levels with dementia risk and subjective cognitive decline. The most pronounced associated differences were observed with intake of approximately 2 to 3 cups per day of caffeinated coffee or 1 to 2 cups per day of tea.
The authors concluded that “greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels”.
I asked the AI platform “Google Gemeni” to run a few analyses of my blog. Here is what I go:
FREQUENCY OF SPECIFIC SUBJECTS
While Edzard Ernst does not provide a live “leaderboard” of therapies by exact post count on his blog, his activity across over 3,000 posts (dating back to 2012) follows a very clear hierarchy. Based on his frequent “tags,” book focuses, and recent blog archives, here is a breakdown of the therapies he discusses most often:
- Homeopathy (Extremely Frequent)
This is arguably his most discussed topic. He frequently analyzes new homeopathic “studies,” criticizes the sale of these remedies in pharmacies, and documents his personal history as a former practitioner.
Common Themes: The “memory of water,” the lack of active molecules in high dilutions, and the unethical nature of using placebos for serious conditions like cancer.
- Acupuncture (High Frequency)
Ernst frequently reviews systematic reviews and meta-analyses of acupuncture.
Common Themes: He often points out that while acupuncture might show a tiny benefit for certain types of pain (like chronic low back pain), this benefit is usually clinically insignificant and likely due to the “theatrical” placebo effect of the needles.
- Chiropractic & Spinal Manipulation (High Frequency)
He dedicated an entire book to this (Chiropractic: Not All It’s Cracked Up to Be) and posts about it regularly.
Common Themes: The risk of vertebral artery dissection (stroke) from neck manipulation, the lack of evidence for “subluxations,” and the promotion of chiropractic for non-musculoskeletal issues like infant colic or asthma.
- Herbal Medicine / Phytotherapy (Frequent)
Because some herbal remedies actually have pharmacological effects, his tone here is often more nuanced, though still highly critical of “natural” marketing.
Common Themes: Adulteration of supplements with heavy metals or prescription drugs, the efficacy of St. John’s Wort for depression (one of the few he views more favorably), and the dangers of detox teas.
- Anthroposophic Medicine (Frequent)
Given his German background, he often critiques the “spiritual-cosmological” medicine founded by Rudolf Steiner.
Common Themes: Mistletoe therapy for cancer (Iscador), the lack of scientific basis for anthroposophic “rhythmical massage,” and its links to vaccine hesitancy.
- Energy Healing & Reiki (Moderate Frequency)
He often groups these under “Spirit Healing” or “Biofield therapies.”
Common Themes: The lack of any measurable biological “energy,” and how these therapies rely entirely on the patient’s belief and the practitioner’s bedside manner.
- Naturopathy & “Integrative” Medicine (Moderate Frequency)
He frequently critiques the “branding” of alternative medicine as “Integrative,” arguing that it is often a way to smuggle unproven treatments into mainstream hospitals.
Summary of Frequency: If you were to look at his tag cloud, Homeopathy, Acupuncture, and Chiropractic would be the largest, followed closely by general categories like Evidence-Based Medicine (EBM), Medical Ethics, and Pseudo-science.
THE COMMENTS
These sections are often quite active and serve as a “battleground” between skeptics, science-based medicine proponents, and supporters of alternative therapies.
Here are the key characteristics of the comments on his site:
- High Engagement and Debate
The blog has a dedicated “Recent Comments” widget (and page) because it is one of the most active parts of the site. Ernst himself is a frequent participant; he often replies to commenters to challenge their logic, ask for peer-reviewed evidence, or clarify his position.
- The “regulars”
There is a consistent community of regular commenters, including:
Scientific Skeptics: Who often help Ernst debunk specific claims made by other commenters.
Proponents of SCAM (So-Called Alternative Medicine): People like Dana Ullman (a well-known homeopathy advocate) frequently post long defenses of homeopathy, leading to “marathon” debates that can span hundreds of comments.
- Comment Moderation and Rules
Ernst has a specific set of “Privacy & Rules” for his comments to keep the discussion civil. He generally allows dissent as long as it isn’t abusive, though he frequently mocks what he calls “trolls” or “quack-defenders” who use logical fallacies.
- Common Tropes in the Comments
If you read the sections, you will notice recurring themes:
The “It worked for me” argument: Users sharing anecdotes, which Ernst and others then explain via the placebo effect or natural regression to the mean.
Big Pharma conspiracies: Proponents often accuse Ernst of being “in the pocket” of the pharmaceutical industry (a claim he frequently lampoons).
Calls for “Medical Freedom”: Debates about whether the government should regulate what people are allowed to buy or what doctors are allowed to recommend.
- Most Commented Topics
Posts about Homeopathy and King Charles tend to generate the highest volume of comments, sometimes reaching 50–100+ replies as people debate the “fine print” of specific studies or the ethics of royal influence on healthcare.
RISKS OF SCAM
In Edzard Ernst’s view, the risk of a therapy is not just about the “poison” or the “needle”—it is calculated by the risk-benefit balance. Because he argues most alternative therapies have near-zero proven benefit, he considers even a small risk to be “too high.”
Based on his writings and systematic reviews, he classifies the most risky therapies into two categories: Direct Risks (physical harm) and Indirect Risks (harm from the choice itself).
- The Most Dangerous “Direct” Risks
These therapies are deemed risky because they can cause immediate, physical injury or death:
Chiropractic Neck Manipulation:
The Risk: Vertebral Artery Dissection (VAD), which leads to stroke or death.
The “Why”: Ernst has documented dozens of cases where high-velocity thrusts to the upper spine damaged the arteries supplying the brain. He is particularly critical here because he argues there is “no good evidence” that neck manipulation is effective for any medical condition, making even a remote risk of stroke unjustifiable.
Acupuncture:
The Risk: Pneumothorax (collapsed lung), organ puncture, and serious infections.
The “Why”: While often called “safe,” Ernst’s reviews of the literature have found hundreds of serious adverse events, including needles piercing the heart or lungs, and cases of hepatitis or MRSA from poor hygiene.
Herbal Medicine:
The Risk: Liver/kidney failure and dangerous drug interactions.
The “Why”: Ernst warns that “natural” does not mean safe.
Toxicity: Herbs like Kava (liver) or Aristolochia (kidney/cancer) are directly toxic.
Interactions: St. John’s Wort is a major “red flag” for him because it can interfere with birth control, blood thinners (Warfarin), and transplant medications, potentially making them fail.
Adulteration: Many products (especially those from unregulated sources) are found to be “spiked” with actual prescription drugs or heavy metals like lead and arsenic.
- The Most Dangerous “Indirect” Risks (The “Biggest Danger”)
Ernst frequently states that indirect harm is the greater threat. This applies most heavily to Homeopathy and Healing/Spirituality:
Delay of Effective Treatment:
The Risk: Death from treatable diseases (especially cancer).
The “Why”: Because homeopathic remedies are just “sugar pills” (placebos), they have zero side effects. However, if a patient with a curable cancer chooses homeopathy instead of chemotherapy, the “risk” is 100% mortality. He views practitioners who encourage patients to “abandon” conventional medicine as the most dangerous elements in healthcare.
Anti-Vaccination Influence:
The Risk: Outbreaks of preventable diseases (Measles, Polio).
The “Why”: Ernst has published studies showing that certain alternative practitioners (especially homeopaths and naturopaths) are significantly more likely to advise parents against vaccinating their children, leading to a “public health disaster.”
Financial Exploitation:
The Risk: “Financial toxicity.”
The “Why”: Desperate patients (especially those with terminal illnesses) are often charged thousands of dollars for “alternative cures” that have no scientific basis, leaving families in debt and without medical results.
Summary of the “Ernst Logic” on Risk:
| Therapy | Primary Danger | Severity | Why it’s “Riskier” than Drugs |
| Chiropractic | Stroke/Death | High | Drugs have risks, but they also have benefits; this has (in his view) no benefit for neck pain. |
| Homeopathy | Delay of Care | Fatal | It seems “safe” because it’s just water, but that safety is a “trap” for people with serious illness. |
| Herbalism | Organ Failure | Medium/High | Lack of regulation means you don’t always know what’s in the bottle. |
Ernst’s mantra is: “A treatment that has no proven benefit but carries even a tiny risk is, by definition, dangerous.”
OBJECTIVE/EVIDENCE-BASED OR BIASED/UNFAIR?
Whether Edzard Ernst’s blog is “objective” or “biased” is a subject of intense debate, and the answer largely depends on which “side” of the scientific fence you sit on.
To provide a fair assessment, we have to look at how he defines his work versus how his critics see it.
The Case for It Being Evidence-Based & Objective
Ernst is widely considered the world’s leading researcher in the scientific study of CAM. Proponents of his blog argue it is the “gold standard” for objectivity for several reasons:
Reliance on Systematic Reviews: Ernst rarely relies on single studies. He focuses on systematic reviews and meta-analyses (the highest level of evidence), which aggregate data from multiple trials to see if a treatment actually works beyond a placebo effect.
The “Same Yardstick” Principle: His core philosophy is that alternative medicine should not get a “free pass.” He applies the exact same rigorous clinical trial standards to a homeopathic pill as a pharmaceutical company must apply to a new heart medication.
Scientific Background: As the first-ever Chair in Complementary Medicine (at the University of Exeter), his methodology is rooted in Evidence-Based Medicine (EBM). He has published over 1,000 peer-reviewed papers, making his blog essentially a translation of high-level science for the public.
Transparency: He frequently links directly to the studies he critiques, allowing readers to verify his claims.
The Case for It Being Biased or Unfair
Critics (practitioners and supporters of alternative medicine) often view him as a “crusader” with an axe to grind. Their arguments include:
Scientism/Reductionism: Critics argue he ignores “holistic” benefits that are hard to measure in a lab, such as the patient-practitioner relationship or the “subjective” improvement in quality of life that doesn’t show up in a blood test.
Tone and Wit: Ernst’s writing style is often sharp, dry, and highly critical. He uses words like “quackery,” “bogus,” and “nonsense.” While his data may be objective, his tone is undeniably polemical, which can feel “unfair” to those who find value in these therapies.
Selection Bias: Some argue he focuses heavily on the most “absurd” claims of alternative medicine to make the entire field look bad, rather than engaging with the more plausible “integrative” approaches.
Personal History: Because he was once a homeopath and “converted” to a skeptic, critics sometimes claim he is over-compensating or has a personal vendetta against his former profession.
The Verdict: A “Biased” Commitment to Objectivity
In the world of science, “objectivity” doesn’t mean giving equal weight to both sides; it means giving weight to the side with the most evidence.
If you define Objectivity as “neutrality” (giving both homeopathy and conventional medicine a 50/50 chance), then you will find him biased.
If you define Objectivity as “adherence to the scientific method,” then he is highly evidence-based.
Ernst himself would argue that he isn’t biased against alternative medicine, but rather biased in favor of evidence. As he often says: “There is no such thing as alternative medicine. There is only medicine that has been proven to work and medicine that has not.”
GOOD SOURCE?
BETTER BLOGS?
Edzard Ernst’s blog is widely considered a high-quality, evidence-based source, but its value depends on whether you are looking for a neutral overview or a skeptical analysis.
Is it a good source?
Yes, primarily because Ernst is not just a blogger; he is a peer-reviewed researcher who founded the first academic department for the study of Complementary and Alternative Medicine (CAM).
Pros: He uses “Evidence-Based Medicine” (EBM) standards. If a therapy fails a randomized controlled trial (RCT), he reports it as such. He is excellent for understanding the history and plausibility of treatments.
Cons: He has a high “snark rating.” If you are looking for a sympathetic view of how a therapy feels or its cultural significance, his blog will feel biased. He focuses almost exclusively on clinical efficacy and safety.
Blogs and Resources That Might Be “Better”
Depending on what you need, these alternatives offer different strengths:
- For In-Depth Medical Analysis: Science-Based Medicine (SBM)
Run by Steven Novella and David Gorski, this is the “gold standard” for skeptical medical blogging.
Why it might be better: It covers a broader range of medical topics (not just SCAM) and dives deeper into the physiology of why certain treatments are impossible.
- For a Massive Database of Claims: Quackwatch
Operated by Dr. Stephen Barrett, this is more of an encyclopedia than a blog.
Why it might be better: It is incredibly thorough on specific “health frauds” and historical quackery. If you want to look up a specific obscure supplement or a specific practitioner’s legal history, this is the place.
URL: quackwatch.org
- For the “Purest” Evidence: The Cochrane Library
This is not a blog, but a global independent network.
Why it might be better: If you want zero “snark” and purely clinical data, search Cochrane for systematic reviews on any therapy (e.g., “Acupuncture for back pain”). It is the most objective source in the world for whether a treatment works.
URL: cochrane.org
- For Cancer-Specific Information: Memorial Sloan Kettering (AboutHerbs)
Why it might be better: If you are a patient looking for safety information on herbs or supplements, this database is managed by pharmacists and oncologists. It provides a balanced view of “What it is,” “Does it work,” and “Is it safe.”
URL: mskcc.org/aboutherbs
- For an Insider’s Perspective: Naturopathic Diaries
Why it might be better: Written by Britt Hermes, a former naturopath who left the profession. It provides a unique “from the inside” look at the training and logic of alternative practitioners that Ernst (who was a MD first) doesn’t always capture.
The aim of this study was to determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for adults with increased risk of chronic disabling LBP.
This 2 × 2 factorial randomized clinical trial enrolled participants in 3 research clinics at the Universities of Minnesota and Pittsburgh from November 2018 to May 2023; final follow-up was in June 2024. Adults with acute or subacute LBP at moderate to high risk of chronicity based on the STarT Back tool were randomized to 1 of 4 groups, with interventions lasting up to 8 weeks. Statistical analysis was conducted from November 2024 to June 2025.
These interventions were:
- Spinal manipulation therapy (n = 201),
- supported self-management (n = 305),
- combined supported self-management with spinal manipulation (n = 193),
- guideline-based medical care (n = 301).
Physical therapists and chiropractors provided spinal manipulation and supported self-management.
The 2 primary outcomes averaged over a follow-up of 1 year were monthly low back disability (Roland-Morris Disability Questionnaire) and weekly pain intensity (numerical rating scale). Secondary analysis examined the proportion of participants achieving a 50% or higher reduction in the primary outcome measures.
Among the 1000 participants randomized (mean [SD] age, 47 [16] years; 58% female), 93% completed the trial. The omnibus test for differences across the 4 treatment groups was statistically significant for disability (P = .001; supported self-management, 4.7; spinal manipulation, 5.5; combined supported self-management with spinal manipulation, 4.8; medical care, 5.9) but not pain intensity (P = .16; supported self-management, 2.8; spinal manipulation, 3.0; combined supported self-management with spinal manipulation, 2.8; medical care, 3.0). Averaged over 12 months, LBP disability was significantly lower compared with medical care for supported self-management (mean difference, −1.2 [95% CI, −1.9 to −0.5]) and supported self-management with spinal manipulation (mean difference, −1.1 [95% CI, −1.9 to −0.3]) but not spinal manipulation alone (mean difference, −0.4 [95% CI, −1.2 to 0.4]). Group differences in pain intensity were not statistically significant; point estimates ranged from −0.2 to 0. Both supported self-management groups had higher proportions of patients achieving a 50% or greater reduction in disability (supported self-management, 67%; spinal manipulation, 54%; combined supported self-management with spinal manipulation, 65%; medical care, 54%).
The authors concluded that for patients with acute or subacute LBP at increased risk of chronic disabling LBP, clinician-supported biopsychosocial self-management showed statistically significant but small reductions in disability, but not pain, vs medical care over 1-year follow-up, and spinal manipulation alone showed no significant difference for either outcome.
These findings are very bad news for chiropractors (the profession that uses spinal manipulations more than any other): spinal manipulation does not generate effects that are in the least convincing. This is particularly remarkable, since the study was not blinded. It means that, even the undoubtedly powerful placebo effect associated with spinal manipulation did not render the outcome more favourable.
I said it many times, and I will say it again: For LBP, many therapies generate similarly marginally positive effects but no treatment is truly convincing. In this situation, we should choose one that is at least inexpensive and free of severe adverse effects. And that evidently cannot be spinal manipulation!
On this blog, some people insist that homeopathy goes from strength to strength. Here I counter this notion by pointing out that several contries have stopped reimbursing homeopathy and that loss of trust in homeopathy has grown significantly.
Several converging factors explain the erosion of confidence:
- Lack of evidence of effectiveness: Large reviews by national and international bodies (for example the Australian NHMRC and the European Academies’ Science Advisory Council) concluded there is no reliable evidence that homeopathic remedies are effective for any health condition beyond placebo.
- Scientific implausibility: Homeopathy’s principles (high dilutions, “water memory”) conflict with established chemistry and physics, which weakens its credibility among scientists and the informed publics.
- Placebo and expectation effects: Empirical work suggests any benefits are best explained by non-sepecific effects such as placebo responses, contextual care, and patient expectations rather than pharmacological action of the remedies.
- Health literacy: Studies indicate that higher health literacy is associated with greater perceived credibility of conventional medicine and relatively lower credibility of homeopathy, which means better-informed patients tend to trust it less.
- Safety and opportunity costs: Critics emphasize that relying on ineffective remedies can delay effective treatment, prolong illness, and in some cases contribute to preventable harm or death.
A range of actors has shaped this loss of trust:
- Scientific bodies and advisory councils: Organizations such as the NHMRC in Australia and EASAC in Europe have issued high‑profile reports stating that homeopathy lacks robust evidence of efficacy and should not be claimed to treat health conditions.
- National health systems and regulators: NHS England, for instance, has advised against prescribing homeopathy, describing it as unsafe or ineffective where better, cost‑effective options exist, and warning that giving it institutional endorsement risks misleading patients.
- Skeptical and consumer‑protection movements: Skeptics’ groups and consumer advocates have campaigned against public funding of homeopathy and organized public “overdose” demonstrations to highlight the extreme dilutions and question the idea that the products contain active ingredients.
- Critical scientists and physicians: Numerous clinicians and researchers have published analyses arguing that homeopathy violates basic scientific and ethical principles, has no explanatory power, and undermines science‑based medicine.
The loss of trust has produced several consequences across healthcare systems and societies:
- Several public health systems have reduced or eliminated reimbursement and institutional support for homeopathy, reallocating funds towards treatments backed by compelleing evidence.
- Market contraction and repositioning: Declining official endorsement and critical media coverage have contributed to shrinking markets in some countries.
- Manufacturers and practitioners increasingly market homeopathy as “wellness” or “complementary” rather than curative medicine, a notion that would make Hahnemann turn in his grave.
- Homeopathy has become a touchstone in broader debates about scientific literacy, misinformation, and the role of the state in regulating ineffective therapies.
Taken together, these dynamics show how rigorous research, scientific critique, regulatory action, and changing public expectations will gradually strip a once‑popular therapy of its medical legitimacy. Or, to put it bluntly: in medicine, evidence will aways win against belief, even if it takes several decades.
While hiring remains the cornerstone of university excellence, the priorities and mechanics of recruitment vary significantly across borders. Drawing from the systems I am most familiar with, here is a breakdown of how academic careers are forged in the US, UK, Germany, France and Austria.
United States: The High-Stakes Tournament
Academic hiring in the U.S. functions as a high-stakes “tournament” where prestige and productivity are the primary currencies.
Key Drivers: Success hinges on a robust publication record in top-tier journals, a pedigree from elite institutions, and a proven ability to secure substantial external funding.
The Ritual: The process is exhaustive. After a meticulous committee review, finalists undergo a grueling “fly-out,” consisting of formal job talks, teaching demonstrations, and a series of faculty interviews.
The Paradox: While teaching loads can be demanding (often 4–5 courses per year), tenure is almost exclusively determined by research output, a model that rigorously rewards early-career hyper-productivity.
United Kingdom: Streamlined Excellence
In the UK, research excellence is the undisputed priority, though the recruitment process is notably more compressed than its American counterpart.
The REF Factor: Candidates are primarily evaluated on their “REF potential”—their ability to contribute high-impact publications to the Research Excellence Framework.
Efficiency: Recruitment is streamlined; committees often shortlist from massive pools and conduct relatively brief interviews, frequently forgoing the extended “job talk” common elsewhere.
Culture: While the system highly values international mobility, its specific metrics and institutional hierarchies can occasionally feel opaque to those outside the Commonwealth circuit.
Germany: Tradition Meets Bureaucracy
The German model is a blend of rigorous academic tradition and formal transparency.
The Gatekeeper: The Habilitation (a secondary, post-PhD qualification) remains the standard prerequisite for a full professorship.
The Process: Hiring is characterized by public job announcements and a formal “Berufungsverfahren,” which includes trial lectures and committee pre-selection.
Balance: In DFG-funded environments, high research expectations are balanced against intensive teaching duties (typically 9 Semesterwochenstunden, or roughly 4 courses per year). While the process is highly transparent, heavy bureaucracy can lead to lengthy recruitment timelines.
France: The National Gatekeeper
France employs a unique, centralized gatekeeping system that prioritizes institutional equilibrium over raw competitive output.
The CNU: Before applying for “teacher-researcher” positions, candidates must first pass a national qualification exam administered by the Conseil National des Universités.
Internal Focus: The system is known for “endo-recruitment”—a tendency to favor internal promotions. This is reflected in the fact that only about 17% of hires are foreign nationals.
Structure: Recruitment focuses on a stable balance between teaching and research, with teaching loads varying significantly depending on the specific type of institution.
Austria: The Search for Consensus
Austria’s academic hiring system closely mirrors the German model, emphasizing a formal, legally structured process combined with rigorous committee-led evaluation.
Metric of Success: Research excellence is the primary currency. Candidates are judged on their publication record in reputable journals, their success in securing third-party funding, and their integration into global academic networks.
The Procedure: The “Berufungsverfahren” (appointment process) is highly regulated. It involves public advertisements, a formal search committee, and a series of external reviews of the candidate’s research dossier.
The Audition: Finalists are invited for public job talks that include both research presentations and teaching demonstrations. The process concludes with a delicate sequence of faculty votes and final approval by the university rectorate.
Academic Balance: While teaching is essential—candidates are expected to plug into existing curricula—it generally remains secondary to research prestige during the selection phase.
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I have experience with several of these systems, both as a academic candidate as well as a member of hiring panels. In my view, no system is faultless. Which is the best? I am honestly not sure.
