study design
Needle-based acupuncture is used in some detoxification settings. However, its efficacy for illicit drug use disorders remains uncertain because prior reviews often mixed comparator types, co-interventions, or non-needle modalities. This review aimed to evaluate needle-based acupuncture monotherapy using comparator-stratified meta-analysis.
The authors searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM/SinoMed, trial registries, and supplementary sources from inception to September 12, 2025. The quantitative synthesis was restricted to randomized trials of manual acupuncture, electroacupuncture, or needle-insertion auricular acupuncture delivered without concomitant pharmacotherapy or psychotherapy. Although the registered protocol allowed non-randomized comparative studies, none were pooled because of insufficient comparability and a higher risk of confounding. Sensitivity analyses excluded trials with moxibustion co-treatment.
Thirteen randomized trials (n = 1,027) were included in the meta-analysis. For the prespecified primary outcome of withdrawal severity at the end of treatment, acupuncture favored blank/no-acupuncture controls [g = −2.089, 95% confidence interval (CI): −2.869 to −1.309; τ² = 0.712; I² = 82.9%], but the prediction interval (PI) crossed the null (PI: −4.306 to 0.128). Against active non-acupuncture comparators, the pooled effect was imprecise (g = −1.70, 95% CI: −5.43 to 2.02; PI: −23.49 to 20.09). Against sham acupuncture, two comparisons yielded an imprecise estimate (g = −1.45, 95% CI −9.41 to 6.51), and no PI was estimated. Among secondary outcomes, anxiety favored acupuncture over blank/no-acupuncture controls (g = −1.537, 95% CI: −2.047 to −1.026; PI: −2.939 to −0.134), whereas evidence from sham-controlled studies was less certain (g = −0.998, 95% CI: −1.744 to −0.252; PI: −2.828 to 0.832). For depression outcomes, PIs crossed the null in both blank- and sham-controlled analyses. The certainty of the evidence was low to very low.
The authors concluded that acupuncture exhibited favorable average effects on withdrawal severity, but null-crossing PIs limited confidence in the reproducibility of these effects across different settings and treatment protocols. Anxiety was interpreted as a secondary finding. No serious acupuncture-related adverse events were explicitly reported, although surveillance was often passive or insufficiently described.
The review treats acupuncture as “effective” for illicit drug disorders by highlighting short-term improvements in craving or anxiety, while the outcomes that matter for addiction – abstinence, relapse, use frequency, and retention – show no reliable benefit.
This, I think, is a classic case of presenting a negative result as a positive finding!
The review explicitly found no consistent difference between acupuncture and comparators for substance use endpoints, and the apparent positive outcomes were limited by low-quality evidence and publication bias. By foregrounding surrogate outcomes and obscuring the lack of clinically decisive effects, the paper misleads readers into perceiving acupuncture as a viable monotherapy for drug use disorders. Yet the evidence does clearly not support that conclusion.
So-called alternative medicine (SCAM) remains widely used worldwide, yet longstanding concerns persist regarding the balance and reliability of the evidence presented in SCAM journals. This investigation examined long-term trends in publication practices within leading SCAM journals, with particular attention to changes in publication types and the prevalence of positive versus negative study outcomes as indirect indicators of potential publication bias.
The authors conducted a complete census of articles published in four leading SCAM journals at two contemporary time points (2018 and 2023), replicating the design and classification framework of a seminal 2001 analysis covering 1995 and 2000. Articles were categorised by publication type, subject area, and author-reported study outcome (positive, negative, or inconclusive, corresponding to the “open” category used in the original 2001 study). Descriptive analyses were used to compare trends over time and with earlier findings.
The total number of published articles increased substantially between the earlier and contemporary periods. The proportion of empirical studies, particularly clinical trials, rose over time. However, the prevalence of positive outcomes also increased markedly, with positive findings accounting for over 80% of published articles in the contemporary period, compared with 49% in the earlier study. Negative and inconclusive outcomes remained relatively infrequent.
The authors concluded that despite growth in publication volume and a shift toward empirical study designs, SCAM journals continue to exhibit a pronounced predominance of positive outcome reporting. These findings suggest that longstanding concerns regarding publication bias in SCAM publishing have not diminished over time and appear to have intensified, with selective publication and related reporting and dissemination practices plausibly contributing to the observed patterns. This has important implications for research integrity and evidence-based decision-making in medical practice.
It is great to see that our past research [the 2001 study mentioned above is one of my team] is being continued. It is less great, of course, to learn that the SCAM-bias continues and might even be on the increase. The reasons why there are so few negative results in SCAM journals might be complex. Two possible clues are:
- The quality of SCAM research tends to be low, and poor quality research tends to generate positive findings, particularly if it is conducted by pseudo-researchers who abuse science for confirming their beliefs rather than for testing hypotheses (see also the ALTERNATIVE HALL OF FAME on this blog).
- If nonetheless a high quality study emerges in SCAM – which, of course, does happen every now and then – it tends to produce a negative result and is likely to get published in a good quality journal rather than in one of the dodgy SCAM journals.
As I have often noted, the end-effect is bad for all concerned: SCAM and SCAM journals are slowly becoming the laughing stock of science. Consequently, nobody takes them seriously. If one day an effective therapy should emerge, we all might faile to notice. In a nutshell: publication bias harms us all!
Dr. Toby Rogers, a political economist and fellow at the libertarian Brownstone Institute, ignited a firestorm in March 2026 when he declared the current childhood vaccination program “one of the greatest crimes in human history” (“libertarian” refers to someone who advocates for extreme individual liberty—particularly freedom from government mandates and regulations—believing that the state should be minimized and that individuals should have absolute autonomy over their own bodies, property, and choices without state coercion).
Rogers’ 2026 statement is not an isolated outburst but the culmination of years of vaccine skepticism. After his partner’s son was diagnosed with autism in 2015, Rogers abandoned his original doctoral focus to study autism’s causes, reviewing nearly 1,000 studies over four years. He concluded that vaccines are the primary driver of the autism epidemic. The overwhelming scientific consensus, however, is that vaccines are safe and that autism’s rise stems from improved diagnosis, broader criteria, and complex genetic and environmental factors unrelated to immunization (see the plethora of previous posts on this subject). His PhD thesis, The Political Economy of Autism, and subsequent publications have been widely criticized by the scientific community. Its methodological flaws include:
- selection bias,
- cherry-picking,
- inclusion of weak studies,
- dismissing robust epidemiological research.
Rogers’ 2026 statement elevates personal conviction and contested research over scientific rigor and public health reality. Rogers argues that children receive too many vaccines too early, warning of “cumulative effects” on developing immune systems. Yet the Institute of Medicine has found no evidence of major safety concerns with the current childhood immunization schedule, and the National Academy of Sciences has repeatedly affirmed that vaccines are safe and effective. Rogers dismisses the 22 major studies confirming vaccine safety as “worthless” because they lacked a true unvaccinated control group—a standard that is both ethically impossible and scientifically unnecessary given the massive population data demonstrating vaccine safety over decades.
Rogers’ evidence relies heavily on a handful of independent studies to support his claims. These studies have been criticized for small sample sizes, selection bias, failure to control for confounders, and methodological flaws so severe that some of Rogers’ co-authored papers, such as “Autism Tsunami,” were retracted from peer-reviewed journals. His claim that vaccinated children have dramatically higher rates of autism and chronic disease rests on research that has not withstood independent replication or scrutiny by mainstream scientists. By contrast, the scientific community’s confidence in vaccine safety derives from massive, longitudinal studies involving millions of children, rigorous clinical trials, and decades of population surveillance.
Rogers’ credibility is compromised not least because he is a regular contributor to Children’s Health Defense, an anti-vaccine organization founded by Robert F. Kennedy Jr. that has a long history of spreading debunked claims. Roger’s testimony before the US Senate Subcommittee on Investigations in September 2025, titled “How the Corruption of Science has Impacted Public Perception and Policies Regarding Vaccines,” tried to position him as a whistleblower exposing “flawed science.” In reality, it relied on the same flawed studies and conspiracy narratives that have been repeatedly discredited by the scientific community.
Rogers receives funding from several anti-vaccine and libertarian organizations, though specific salary figures are not publicly disclosed :
- Brownstone Institute is a libertarian think tank founded by economist Jeffrey Tucker that promotes vaccine skepticism, “medical freedom,” and opposition to public health mandates. The institute is funded by libertarian donors and provides fellowships to researchers who align with its ideology.
- Children’s Health Defense is explicitly an anti-vaccine organization led by Mary Holland (CEO) and founded by Robert F. Kennedy Jr. The organization has illuminated funding sources through IRS 990 filings, showing it raised millions of dollars and pays researchers, speakers, and staff. In Rogers’ Senate testimony, he explicitly stated: “Since then I’ve continued my research with Children’s Health Defense, as an independent journalist, and as a Fellow at Brownstone Institute”.
- Rogers also appears at MAHA Institute conferences (Make America Healthy Again), which is aligned with HHS Secretary Robert F. Kennedy Jr.’s movement and features speakers from anti-vaccine organizations including Children’s Health Defense.
Rogers’s financial ties to anti-vaccine organizations create clear conflicts of interest. His research supports the organizational mission of Children’s Health Defense and Brownstone Institute, and his income appears tied to producing content that aligns with these organizations’ anti-vaccine advocacy. The political economy of Rogers’ work is thus ironic: while he critiques the “political economy of autism” and government response, his own research is funded by private organizations with clear ideological and financial incentives to promote vaccine skepticism.
Rogers is not a medical doctor. He has a doctorate in political economy from the University of Sydney and a Master’s in public policy. He holds no medical degree or formal training in medicine, immunology, epidemiology, or vaccine science. His expertise is in political economy, not medical or vaccine research, which means his claims about vaccine safety and autism lack the scientific credentials required to make authoritative medical assertions.
Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.
This multicenter, randomized, sham-controlled clinical trial determined whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluated its safety in patients with PHN. It took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial. Patients received 20 sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up. The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.
Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (−1.52) than the sham electroacupuncture group (−0.99) with an adjusted mean difference of −0.53 (95% CI, −0.61 to −0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.
The authors concluded that, among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.
Here are a few points of concern and criticism:
- The authors state that the study was funded by the Evidence-Based Capacity Building Project for Traditional Chinese Medicine from National Administration of Traditional Chinese Medicine, the National Natural Science Foundation of China, the Natural Science Foundation of Jiangsu Province, Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine, Youth Talent Project of Jiangsu Province Administration of Traditional Chinese Medicine, and Nanjing University of Chinese Medicine Double-Hundred Talent Program. Yet, they insist they had no conflict of interest.
- Acupuncture studies from China are as good as never negative. As frequently noted on this blog, the vast majority of Chinese studies seem to rely on falsified data.
- The authors imply that their study was patient-blind; yet there is no way that this is true: 1) The verum was administered to elicit ‘de-qi’, while the sham was not. 2) The electrical current in the verum group induced mild muscle twitching, while the sham group had no such experience. This means the verum patients knew the were receiving verum and thus were expecting an effective therapy. By contrast, the control group would have comprehended that they were given a placebo and were disappointed. These effects inevitably contribute to the outcome. In fact, I would agruge that they suffice in bringing them about without any contribution of a specific acupuncture effect. At the very minimum, the authors should have discussed these issues fully and critically.
- The acupuncturists of this study were also not blind. It is possible – I would argue, even likely – that they influenced patients to report or experience more positive results. Again, I would suggest that such effects suffice to generate a false-positive outcome.
- Even if there was a true effect of the verum beyond placebo, the question is, was it caused by acupuncture or the electrical current? There is a sizable body of evidence suggestion that electrotherapy might be effective for PHN!
In conclusion, the assertion that “electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes” is uncritical, promotional and unjustified. I am once again dismayed that a reputable journal publishes such overt rubbish.
This study was conducted to determine the effect of Reiki performed on children with leukemia between the ages of 5-7 years on pain, vital signs, oxygen saturation, and quality of life. It was a double-blind, pre-test-post-test randomized controlled experimental study. The research sample consisted of 66 children with leukemia aged 5-7 years who were hospitalized in pediatric oncology wards of a university hospital between December 2020 and November 2021. The balanced block randomization method was used for randomization. The data were collected using Information Form, Wong-Baker FACES Pain Scale (W-BPS), Vital Signs Follow-up Form, The Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module. Reiki was performed to the Reiki group for 20-30 min once per day, for 3 consecutive days and pseudo-Reiki was applied to the pseudo-Reiki group by an independent nurse during the same application period.
There was no statistically significant difference in vital signs (heart rate, respiratory rate, body temperature) and SpO2 values among the groups (p > 0.05). However, both children’s and mothers’ evaluations on days 1, 2, and 3 after the intervention showed that pain scores in the Reiki group were significantly lower than in the pseudo-Reiki and control groups (p < 0.001), and quality of life was significantly higher (child:p < 0.001; mother:p < 0.01) compared to the pseudo-Reiki and control groups.
The authors concluded that Reiki did not affect the vital signs of the children but was effective in reducing pain and increasing the quality of life compared with the pseudo Reiki and control groups. It is recommended that Reiki therapy be used in addition to medical treatment to reduce pain and improve quality of life in children with leukemia aged 5-7 years.
The whole point of having a control group receiving pseudo-Reiki is to control for placebo effects. For this purpose, it is necessary to fool the patients well and make sure that they are unable to tell Reiki from pseudo-Reiki. I would guess – I have no aceess to the full paper – that this was not the case in this study. If I am correct, the positive outcome is likely to be due to expectation of a positive healing effect and unrelated to any specific effect of Reiki.
In any case, it is irresponsible nonsense to recommend Reiki – or any therapy – on the basis of just one positive study. For that one would need several independent confirmations with high quality studies that firmly establish a cause effect relationship. The current study does not fall into that category, and I am not aware of a single trial that does.
Insomnia is a prevalent disorder that is associated with substantial impairment. Homeopathy has been proposed as a complementary treatment for insomnia, but its clinical effects remain uncertain.
This systematic review assessed the efficacy, effectiveness, and safety of homeopathic treatments for insomnia. Prospective comparative studies evaluating any homeopathic preparation for insomnia were included. Searches in MEDLINE, EMBASE, seven additional databases, and three trial registries were conducted through August 2025. Risk of bias, intervention complexity, model validity, and pragmatism were assessed using respectively RoB 2, ROBINS-I, iCAT, MVHT, and RITES. Data were synthesized using random-effects meta-analyses, and certainty of evidence was evaluated using GRADE.
Eight randomized controlled trials (RCTs; n = 364 participants) and four non-randomized studies (NRSIs; n = 517) met the inclusion criteria. In adults, sleep quality (MD = −2.6 points; 95% CI −5.5 to 2.6; low certainty) and insomnia severity (MD = −3.2; 95% CI −5.68 to −0.72, moderate certainty) were reported in one RCT each. For total sleep time, the pooled MD of three RCTs was 0.65 hours (95% CI −0.9 to 2.2; low certainty). In children, one open-label RCT suggested a difference in insomnia severity, but certainty of evidence was very low. Adverse events were rarely reported, resulting in low certainty evidence.
The authors concluded that the current evidence is mainly limited by imprecision and risk of bias. The available evidence does not allow firm conclusions regarding the effects of homeopathy for insomnia. High-quality, replicated trials with systematic adverse event monitoring are needed.
15 years ago, I published a similar review entitled “Homeopathy for insomnia and sleep-related disorders: a systematic review of randomised controlled trials” (Focus on Alternative and Complementary Therapies Volume 16(3) September 2011 195–199)). Here is its abstract:
The aim of this review was the critical evaluation of evidence for the effectiveness of homeopathy for insomnia and sleep-related disorders. A search of MEDLINE, AMED, CINAHL, EMBASE and Cochrane Central Register was conducted to find RCTs using any form of homeopathy for the treatment of insomnia or sleep-related disorders. Data were extracted according to predefined criteria; risk of bias was assessed using Cochrane criteria. Six randomised, placebo-controlled trials met the inclusion criteria. Two studies used individualised homeopathy, and four used standardised homeopathic treatment. All studies had significant flaws; small sample size was the most prevalent limitation. The results of one study suggested that homeopathic remedies were superior to placebo; however, five trials found no significant differences between homeopathy and placebo for any of the main outcomes. Evidence from RCTs does not show homeopathy to be an effective treatment for insomnia and sleep-related disorders.
The findings of the two reviews are remarkably similar. For the following reasons, I find this notable:
- One would have hoped that 15 years are a long enough time for clarifying the issue, particularly as insomnia is not an unimportant condition for homeopathy.
- The new review is authored by well-known proponents. It seems unexpected that they (almost) go as far as admitting that the evidence for homeopathy as a treatment for insomnia is not positive.
- We have here, I think, a textbook example of how proponents of homeopathy prettify results that do not confirm their belief.
SO FAR, SO GOOD.
But now consider this: There are two further reviews of the same subject!
The first is entitled “Homoeopathy for insomnia: A meta-analysis of clinical evidence – Journal of Integrated Standardized Homoeopathy“. Here is its abstract:
Objectives: Insomnia is a prevalent sleep disorder characterised by challenges in initiating, maintaining or achieving restorative sleep, resulting in compromised daytime functionality. Traditional therapeutic modalities frequently encompass pharmacological treatments, which may have adverse effects and potential for dependency. Numerous patients pursue alternative methodologies, such as homoeopathy, which is attributed to its personalised, holistic and non-invasive treatment framework. This thorough examination assesses the effectiveness of homoeopathy in promoting better sleep quality and overall wellness in people with insomnia by analysing randomised controlled trials (RCTs).
Material and Methods: This meta-analysis sought to ascertain whether homoeopathy induces a statistically significant enhancement in the management of insomnia, concentrating on aspects of sleep quality, duration and general well-being. All RCTs addressing insomnia treated with homoeopathic interventions were included in this review. All studies were meticulously documented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three evaluators independently reviewed and compiled the literature, extracting comprehensive details regarding participants, study designs, therapeutic interventions and follow-up pertaining to homoeopathic treatment. The primary outcome of the investigation was disease assessment based on sleep diary scores, with an additional outcome being the enhancement of quality of life.
Results: The analysis revealed that homoeopathic remedies exhibited statistically significant improvement over placebo in the management of insomnia. The overall pooled effect size, standardised mean difference (random), was −0.60, standard error (random) was 0.42 and confidence interval (random) at 95% ranged from −0.93 to −0.26. The risk of bias was assessed for all studies.
Conclusion: This meta-analysis shows that homoeopathic remedies are effective in treating insomnia, but more studies are required for accuracy.
The last review is entitled “Effectiveness of Homeopathic Interventions for Insomnia and Sleep Disorders: A Systematic Review and Meta-Analysis“. Here is its abstract:
Insomnia is a common sleep disorder, and many individuals seek alternative treatments like homeopathy. However, evidence for its effectiveness remains controversial. This systematic review and meta-analysis evaluated the effectiveness of homeopathic interventions for insomnia and sleep-wake disorders. A comprehensive search of PubMed, MEDLINE, CINAHL, and the Cochrane Library was conducted for studies published between 2010 and 2025. We included randomized controlled trials (RCTs) and non-randomized studies involving adults (≥18 years) with primary insomnia receiving any homeopathic intervention compared to placebo, no treatment, or active care. Primary outcomes included validated sleep quality measures (e.g., Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI). Four reviewers independently performed study selection, data extraction, and risk of bias assessment using RoB 2.0 and ROBINS-I. A random-effects meta-analysis was conducted for controlled trials, and a narrative synthesis for non-randomized studies. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). The search yielded 1304 records; 12 studies (nine RCTs and three non-randomized) met inclusion criteria. Meta-analysis showed a large, statistically significant positive effect of homeopathy on sleep outcomes (SMD = 0.81, 95% CI [0.24, 1.38], p = 0.0055), with substantial heterogeneity (I² = 86.04%) and publication bias (Egger’s test, p = 0.0079). Most studies had high or critical risk of bias, and overall certainty was low. Homeopathic interventions showed a large positive effect on sleep outcomes, but due to high bias, heterogeneity, and publication bias, evidence remains low-certainty and insufficient to support effectiveness. High-quality RCTs are needed.
What should we make of this?
We now have two reviews concluding that there is no good evidence and two implying that homeopathy is effective for insomnia! This clearly demonstrates how easy it is to mislead the public with seemingly rigorous reviews.
I must say, I pity all the interested lay people who are trying to make sense of this mess.
How can they arrive at the best available, most reliable evidence?
We have here, I think, another textbook example; one of how important it is to run reality checks. But surely, we cannot possible ask of a lay person to understand why the last two reviews are badly misleading. What we need is an accessible tool for differentiating the science from the pseudoscience, the reliable from the unreliable.
Unfortunately, such a tool does not exist. But there are a few indicators:
- Is the journal that published the review reputable?
- Are the authors affiliated to reputable institutions?
- Do the authors have a history of critical analysis or one of uncritical promotion?
- Do they explain clearly and provide the essential details of their work?
These are issues that lay people might be able to check relatively easily. The above 4 reviews demonstrate that using them does not always provided an entirely clear cut-off. However, it might give some valuable pointers into the right direction.
Guest post by Udo Endruscheit
Two years ago, in a guest post on this blog, I described the long and winding history of homeopathy in Switzerland — a story marked by political expectations, institutional entanglements, and repeated attempts to reconcile a lack of evidence with a desire for legitimacy. I ended that article with the hope that the country would not embark on yet another “honour lap” around the same unresolved questions.
In 2024, however, Switzerland initiated a new evaluation of homeopathy — a renewed attempt to clarify its role within the national health insurance system. It was, in many ways, the beginning of yet another loop in the same story.
Now, in 2026, that loop has come to an unexpected end. The evaluation was halted.
Not postponed, not softened, not watered down — simply stopped.
And this stop is not merely a political gesture. It marks the structural endpoint of a system that has exhausted its internal possibilities.
A system designed to avoid the evidence question
To understand why Switzerland has arrived at this point, one must look beyond the political headlines and examine the institutional landscape that has shaped the country’s approach to homeopathy for more than a decade.
Three elements are central:
- The political mandate created by the 2009 referendum, which placed homeopathy and other CAM modalities into the basic health insurance package.
- The professional environment, in which thousands of Swiss physicians hold CAM qualifications and the national medical association (FMH) views integrative medicine positively.
- The academic anchor, the Institute for Complementary and Integrative Medicine (IKIM) at the University of Bern, which provides an appearance of scientific legitimacy without producing evidence capable of resolving the core question of efficacy.
This combination created a system in which homeopathy became institutionally normalised — not because of evidence, but because of political and professional expectations.
The HTA as a detour — and the beginning of the dead end
When the Federal Office of Public Health (BAG) was tasked with evaluating homeopathy after the referendum, it faced an impossible dilemma:
- The clinical evidence was weak to non‑existent.
- The political expectation was strong.
- A direct assessment of the evidence would have produced a negative result.
The solution was a detour: a Health Technology Assessment (HTA). But HTAs are not designed to determine efficacy. They assume efficacy has already been established through robust clinical research. Their purpose is to assess cost‑effectiveness, safety, and system impact.
The Swiss HTA did the opposite. In its conclusion, it stated:
“The effectiveness of homeopathy can be considered as proven when internal and external validity criteria are taken into account.”
This is a remarkable inversion of the HTA principle. The report asserted efficacy — without the evidence required to do so — while simultaneously admitting that the actual HTA questions (such as cost‑effectiveness) could not be answered reliably.
In retrospect, this HTA was not the beginning of a solution. It was the beginning of a dead end. A system that asserts efficacy without evidence cannot move forward. It can only circle around itself.
The IKIM: an academic structure without academic function
The IKIM at the University of Bern has played a central role in stabilising this circular logic. Its research output is broad in appearance but narrow in substance. It avoids the central question of efficacy and instead focuses on:
- sociological aspects,
- patient satisfaction,
- model validity,
- and experimental approaches that are not independently reproducible.
The IKIM does not produce evidence. It produces normality — the impression that homeopathy is a legitimate academic field simply because it is housed within a university.
This normality has been crucial for maintaining the political and professional acceptance of homeopathy in Switzerland. But it has also contributed to the structural dead end: an academic institution that cannot resolve the evidence question because it is not designed to ask it.
The 2026 decision: not a surprise, but a consequence
Against this background, the 2026 decision to halt the renewed evaluation of homeopathy is not really surprising. It is the logical endpoint of a system that has exhausted its internal possibilities.
- The evidence has not improved.
- The HTA detour has failed to provide a foundation.
- The institutional structures have stabilised expectations but not knowledge.
- The political mandate cannot be fulfilled without contradicting scientific standards.
The result is a dead end. Not because anyone wanted it, but because the system was built in such a way that no other outcome was possible.
A lesson beyond Switzerland
The Swiss case is often cited by proponents of homeopathy as a model of political and professional acceptance. But the 2026 decision reveals a different lesson:
A system that tries to reconcile political expectations with a lack of evidence will eventually reach a point where it can neither move forward nor turn back.
Switzerland has reached that point. The “endless story” of homeopathy in the Swiss health system has not been resolved — but it has reached its structural conclusion.
And unfortunately that conclusion is not a triumph of evidence. It is the recognition that evidence cannot be replaced by institutional normality. But one thing it certainly isn’t: an endorsement of homeopathy, even if its advocates will once again try to interpret it that way.
When a top journal like PNAS (Procedings of the Nationsl Academy of Science) publishes an article entitled “What’s the science behind acupuncture?“, I must take notice. Here is my take on the (sadly disappointing) effort:
My very short summary of the paper (I do encourange my readers to read it in full)
The article starts from the premise that acupuncture is proven to work, an assumption that – as we will see in a minute – is not based on sound evidence. It describes the evolution of acupuncture from a traditional practice rooted in ancient concepts like “qi” and “meridians” to a modern medical treatment increasingly validated by science. It argues that practitioners like Min Chen are today able to provide evidence-based explanations for their work. While early clinical trials were plagued by the “sham” acupuncture paradox, the text argues that more recent, rigorous studies and technological projects are bridging the gap between Eastern philosophy and evidence-based medicine, suggesting that acupuncture’s effects are physiological realities rather than mere placebo.
My concerns of the paper
The article attempts to bridge the gap between Traditional Chinese Medicine (TCM) and conventional medicine suggesting that several anatomical discoveries “correspond” to ancient meridians. This, however, is a post hoc ergo propter hoc fallacy. Finding a morphological structure (e.g. fascia) and claiming it represents the meridian system ignores that meridians were conceptualized as functional energetic conduits, not anatomical vessels. Citing an 80% overlap between acupoints and connective tissue planes lacks specificity. Given the ubiquity of connective tissue in the human frame, any randomized point on the body would likely “overlap” with a tissue plane, rendering the “meridian” map a possible exercise in pattern-seeking rather than anatomical discovery.
The paper acknowledges the “most puzzling” finding that sham acupuncture often produces results comparable to “true” acupuncture. This, it would seem to me, invalidates the foundational TCM theory of specific “acupoints” and “meridians” is invalidated. Yet, the article suggests that sham acupuncture is “not a true placebo” because it also triggers biological pathways. If needling anywhere produces an effect, acupuncture is merely a generalized, non-specific neuro-modulatory stimulus.
The article quotes Chen on “harmonizing organ functions” and “regulating qi” as well as researchers referring to “fibroblast activation” and “vagus nerve stimulation”. The author seems to consider both to be true; yet they seem mutually exclusive. Translating metaphysical concepts into physical phenomena does not “validate” the original theory but merely replaces it.
The article employs the opioid crisis to justify the rise of acupuncture. Yes, the need for non-pharmacological pain management is urgent, but clinical necessity does not equate to scientific validity. The text quotes the “lasting benefits” observed in some meta-analyses without discussing the often fatal flaws in these papers. Furthermore, it fails to cite the substantial body of evidence suggesting that acupuncture is not effective. Moreover, it hardly mentions the small effect sizes and hence limited clinical usefulness found in the positive studies.
The final section of the paper essentially rebrands acupuncture as “bioelectronic medicine”. If its mechanism of action is purely the electrical stimulation of the vagus nerve or the release of endogenous opioids, then the TCM concepts are all but superfluous. If a cheap and wearable TENS unit is more or less equivalent, the “meridian” and “qi” myths are obsolete.
In summary, the paper reads, I fear, only marginally better than a Chinese government promotional text – most disappointing for an article published in a journal of high standing. It attempts to preserve the cultural prestige of TCM while stripping it of its internal logic in order to make it compatible with science. For acupuncture to gain a true “scientific footing”, research must, in my view, move beyond finding “tantalizing” correlations. It should address fundamental problems, e.g.:
- As long as we have no convincing proof that acupuncture works beyond placebo, discussions about its mechanisms are futile.
- If qi, acupoints and meridians are illusions and irrelevant for the clinical outcome, then the science is not validating acupuncture but merely re-discovering a well-known non-specific form of peripheral nerve stimulation.
The defence of anthroposophical medicine – or of any other unproven modality – as articulated, for example, by figures like Weleda CEO Tina Müller, presents a vision of patient-centred care and economic pragmatism. However, when held against the light of current clinical standards and the principles of evidence-based medicine (EBM), it reveals significant cracks.
The most profound problem lies in the definition of scientific evidence. Proponents often point to decades of “positive experience” and high patient satisfaction as proof of effectiveness. Yet, in the hierarchy of science, anecdotal success sits at the very bottom. Anthroposophical treatments lack biological plausibility. Their perceived benefits are largely indistinguishable from context effects (such as placebo). Anthroposophical medicine might provide more time, empathy, and personal attention – factors that undoubtedly improve a patient’s well-being but do not validate the effectiveness of the specific remedies used. When independent bodies subject these treatments to rigorous, high-quality trials, the purported effects usually vanishe.
Anthroposophical medicine represents merely a tiny percentage of our healthcare expenditures. Therefore, proponents argue, little money would be saved by getting rid of it. This argument is a calculated distraction from the ethical core of the issue. While the fiscal burden may be marginal, the scientific cost is immense. A statutory health insurance system is built on a social contract of solidarity; it functions under the premise that public funds are reserved for treatments of proven value and effectiveness. To fund therapies that lack plausibility as well as reproducible results is to erode the credibility of medicine and rational thought. It is not a question of the amount of money, but the principle of integrity: every Euro, £ and $ spent on unproven treatments is a euro, £, and $ diverted from underfunded and often life-saving healthcare.
The regularly made appeal to the Swiss Model as a beacon of success also requires a more critical reading. The integration of so-called alternative medicine (SCAM) in Switzerland was, at its heart, a result of direct democracy rather than evidence. While the Swiss public voted for inclusion, the majority of the medical community remains deeply sceptical. To cite Switzerland as “proof” that anthroposophical medicine has fulfilled the criteria of EBM is to conflate political popularity with scientific validation. Democracy can decide how a nation spends its money, but it cannot vote a reliable evidence-base into existence.
Finally, we must consider the human risk of legitimizing non-evidenced-based practices. When a state-sanctioned insurance system places such therapies on the same pedestal as EBM, it risks misleading vulnerable individuals. For patients facing chronic or life-threatening illnesses, the “integrative” path can lead to a dangerous delay in seeking conventional, life-saving interventions. By treating subjective belief and peer-reviewed science as equal peers, we risk entering a “post-truth” medical era where the desire for a “natural” or “holistic” experience outweighs the necessity for proof.
In conclusion, while the call for a more “human” and “holistic” medical system might be noble, it must not come at the expense of scientific rigor. It is deeply misleading to imply that this is an ‘either or’; good medicine will always be based on both. A healthcare system that prioritizes popularity over proof risks becoming a system of expensive comfort rather than one of effective healing. True patient appreciation lies not in offering unproven choices, but in ensuring that every treatment covered by the public purse is supported by sound evidence. Not following this strategy is a disservice to patients and to progress.
So, the next time you hear people defending anthroposophical medicine or any other unproven modality, please look behind the smoke screen and find out why they do it. More often than not, you will then identify a massive conflict of interest. My advice is to listen to independent experts and to dismiss the people with an axe to grind.
Tonsillitis is a common condition predominantly affecting children and adolescents, presenting as acute, recurrent, or chronic infection. This review evaluated the effectiveness of homeopathy for clinical improvement and recurrence prevention across all tonsillitis presentations.
A team of scientists searched nine databases and four trial registries for randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) involving patients of all ages with diagnosed tonsillitis. Studies examining individualised homeopathy (IH) and non-individualised homeopathy (non-IH) were included, compared with an inactive or active control group. Primary outcomes were clinical improvement (symptoms and signs) and recurrence. Secondary outcomes were antibiotic consumption, healthcare utilisation, quality of life, costs, and adverse events. Data extraction, Risk of Bias assessment, and certainty of evidence evaluation (GRADE) followed established methodology.
Five RCTs compared homeopathy with placebo (n=4) or standard care (n=1): one used IH, one used both IH and non-IH, and three used non-IH. Two RCTs examined acute tonsillitis, two examined recurrent tonsillitis, and one examined chronic tonsillitis. Three trials enrolled children, one enrolled adults, and one enrolled a mixed population. Sample sizes ranged from 30 to 256. Substantial heterogeneity across populations, interventions, and outcomes precluded meta-analysis. Individual RCTs showed that, in acute tonsillitis, non-IH achieved short-term symptom improvement. In recurrent tonsillitis, both IH and non-IH were associated with reduced infection recurrence, lower antibiotic consumption, and improved quality of life, with the strongest evidence for a standardised non-IH complex (SilAtro-5-90). In chronic tonsillitis, IH showed delayed but consistent improvements in symptoms, recurrence, healthcare utilisation, and quality of life by 2–3 months, with early outcomes favouring placebo. The certainty of evidence for all outcomes was low. No serious adverse events were reported.
The authors concluded that the evidence from individual trials suggests that both individualised and non-individualised homeopathy may benefit clinical improvement, reduce infection recurrence, reduce antibiotic use, and enhance quality of life in tonsillitis, with no safety concerns reported. However, substantial heterogeneity across studies and methodological limitations restrict the ability to draw definitive conclusions about homeopathy’s effectiveness in patients with tonsillitis. Further well-designed, adequately-powered trials with standardised outcomes and consistent methodological approaches are needed to strengthen the evidence base and enable more robust conclusions.
My critical evaluation of this paper is impeded by the fact that two of its authors were once members of my own team. On the one hand, this might assure me that their review is of a high standard, on the other hand it hinders me to voice harsh criticism. Fortunately, they include their own valid criticism of their project:
One study was a pilot study and therefore not appropriately powered [36] and one was published by a single researcher not following a formal publication protocol or underwent a formal peer-review process [34]. One study used an add-on design [31] which is a recognised methodology in clinical research, not unique to homeopathy, and their limitations regarding attribution of effect are well understood and acknowledged. We do acknowledge the possibility of publication bias and the limitations of a small evidence base. We also note there are issues arising from numerous outcomes, subscales, and repeated time-point analyses, which substantially increases the likelihood of false-positive findings.
Further variability was introduced by unclear definitions of some secondary outcomes and by differences in definitions across studies. Two of the five studies reported on their funding body. One did not receive funding [37] and Palm et al., 2017 [31] was sponsored by Deutsche Homoopathie-Union, DHU-Arzneimittel GmbH & Co. Germany.
They also are open about the funding of their work:
Existing funds held by Homeopathy Research Institute (HRI) – donated by Manchester Homeopathic Clinic Charitable Trust – were donated to University of Bristol to conduct the systematic review. The funders had no involvement in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
So, what should we make of their effort? Let me just state this:
If I had to advise them on how to improve their review substantially, I would have suggested they re-phrase their conclusion. I am sure that something like this would have been much more adequate:
Most of the included trials were positive yet, because of substantial heterogeneity and methodological limitations of the primary studies, the evidence collectively fails to show that individualised or non-individualised homeopathy are effective treatments for tonsillitis.
