Edzard Ernst

The discussion about the value of homeopathy has recently become highly acute in Germany. Once again, it seems that German homeopaths fight for survival with all means imaginable. This can perhaps be better understood in the light of what has happened during the Third Reich. In 1995, I published a paper about this intriguing bit of homeopathic history (British Homoeopathic Journal October 1995, Vol. 84, p. 229). As it has miraculously disappeared from Medline, I take the liberty of re-publishing it here in full and without further comment:

In the early part of the 20th century, there was a strong lay movement of ‘natural health’ in Germany. It is estimated that, when the Nazis took over in 1933, the number of lay practitioners equalled that of physicians. The Nazis jumped on this bandwagon and created the Neue Deutsche Heilkunde (new German medicine)–forced integration of health care to a single body under strict political control [1].

A systematic attempt was orchestrated to scrutinize homoeopathy. The motivation was probably threefold: it fitted the Neue Deutsche Heilkunde concept, it was put forward as a ‘pure German’ line of medicine, and homoeopathy was also seen as potentially a cheap way of keeping the nation healthy, freeing resources for preparatory war efforts. The results have never been published and may be lost for ever. However, an eye- witness report was written after the war by Dr Donner, a homoeopathic physician of high standing. His report, probably not entirely objective, makes fascinating reading [2].

Dr Donner joined the Stuttgart Homoeopathic Hospital in the mid 1930s. He became involved in the German Ministry of Health’s initiatives to scrutinize homoeopathy. Following a detailed study of the literature he expressed profound doubts as to the validity of homoeopathic provings. Experiments to replicate such provings in 1939 showed the importance of the placebo phenomenon and subject/evaluator blinding. His and his colleagues’ results gave no evidence of validity.

A concept by which homoeopathy was to be scrutinized emerged. It foresaw the tests to be supervised by conventional physicians with sufficient knowledge of homoeopathy. About 60 university institutions were to participate. Each team included homoeopaths, toxicologists, pharmacologists and internists. The tests protocols were to be adapted to the special needs of homoeopathy—e.g, freedom of homoeopathic prescription. Donner argues that never before did homoeopathy have such ideal conditions for evaluation. He reports on about 300 planning meetings with staff from the ministry.

Experts were perfectly aware of problems such as the placebo effect and spontaneous remissions and therefore planned large, placebo-controlled trials. These were to be performed on patients with tuberculosis, pernicious anaemia, gonorrhoea and other diseases where homeopaths had claimed to treat successfully.

On the occasion of the 1937 Homoeopathic World Congress in Berlin, Nazi officials decided to start the trials on homoeopathy on a large scale. ‘Hundreds of millions’ of Reichsmark were available. Donner describes several provings and clinical trials in some detail. Without exception, their results yielded no indication for the validity of homoeopathy.

Although there had been previous agreement to the contrary amongst all participants, it was agreed that these negative findings should not be published at this stage, but a new experimental beginning should be sought. Further experiments were planned which could not be concluded due to the outbreak of war.

In 1947, the subject was again discussed by those who were initially involved. The original documents seem to have survived the war. They had not yet been published and are not likely to have been lost or destroyed.

Dr Donner finishes his report by urging the reader to draw the right conclusions. The ‘fiasco’, he maintains, must be blamed not on the individuals involved in these experiments but on the situation inside German homoeopathy. Future evaluations of homoeopathy should be performed to a high scientific standard and without illusions.

Dr Donner’s report is presently being published for the first time [2]. As it is in German, the above summary might be helpful for an international readership.

References

1 Ernst E. Naturheilkunde im Dritten Reich. Dtsch. Arzteblatt 1994 (accepted for publication).

2 Donner. Report to be published in issues 1 5 of Perfusion. Pia Verlag, Nuernberg.

Guest post by Richard Rawlins

It is 18 years since Health Secretary Alan Milburn launched a scheme for family doctors to prescribe exercise, aerobics, swimming, and yoga for those who are overweight and at risk of strokes, heart disease or suffering from osteoporosis, diabetes or stress. Splendid! But have any benefits resulted? We do not know.

In 2015, Simon Stevens, CEO NHS England, emphasised the importance of NHS staff being cared for: “NHS staff have some of the most critical but demanding jobs in the country. When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order.” He identified “ten leading NHS employers to spearhead a comprehensive initiative to boost NHS staff health at work by committing to ‘six key actions’, including “by establishing and promoting a local physical activity ‘offer’ to staff, such as running, yoga classes, Zumba classes, or competitive sports teams…”

Mr Stevens pointed out that his proposals would cost £5m, but would “help solve the problem of the NHS bill for staff sickness” – then standing at £2.4bn a year.

Good idea. I like to keep fit, and yoga may well help – but is there any evidence it does? Has there been any evaluation of Mr Stevens’ initiative? Has it worked – by any criterion?

More recently, Mr Stevens has climbed aboard the ‘Social Prescribing’ band wagon and declared he would like to see patients provided with yoga, paid for by the NHS.

In January, Health Secretary Matt Hancock announced the need to support a “growing elderly population to stay healthy and independent for longer” with “more social prescribing, empowering people to take greater control and responsibility over their own health through prevention”. And at a ‘Yoga in Healthcare Conference’ in February, Mr Duncan Selbie, chief executive of Public Health England, spoke of extra money promised under the government’s NHS Long Term Plan to fund yoga classes.

Mr Selbie, told doctors and yoga practitioners at the conference: “The evidence is clear … yoga is an evidenced intervention and a strengthening activity that we know works.”

The problem is, Mr Selbie did not provide any evidence in support of his assertions. It is likely there is none. Do not take my word for it – that is the opinion of the US National Center for Complementary and Integrated Health – an institution founded and dedicated to establishing evidence of any benefit from complementary and alternative treatment modalities, and funded to the tune of $164 million p.a.

Promotion for the conference suggested that “The Yoga in Healthcare Alliance (YIHA), the College of Medicine and Integrated Health (CoMIH) and the University of Westminster is collaborating to bridge the worlds of yoga and healthcare with the first ever Yoga in Healthcare Conference.” The YIHA claims it is “working with the NHS to provide yoga to patients.” Its Yoga4Health programme is a 10-week yoga course commissioned by the West London Clinical Commissioning Group, for patients registered at a GP in West London.

In a statement, the YIHA said: “There is significant robust evidence for yoga as an effective ‘mind-body’ medicine that can both prevent and manage chronic health issues and it also delivers significant cost savings to healthcare providers…The College of Medicine will be offering a certificate of attendance to all delegates that can be used towards CPD points.”

On the face of it, that all seems rational and reasonable, but consider, the conference opened with a speech from Dr. Manjunath Nagendra, Chair of the Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. AYUSH is an “Indian governmental body purposed with developing, education and research in the field of alternative medicines.”

Now it is one thing to cover the background and history of a therapeutic modality at a conference on yoga, but quite another to give respectful house room to a promoter of anachronistic concepts based on vitalism and having no basis in reality. Good luck to those who believe in vitalism, but why is NHS England involved? Is NHS England content to promote alternative medicine? We should be told – perhaps we should all climb on that bandwagon.

Amongst an array of speakers, most with an interest in having alternative medicine paid for by the NHS, Dr Michael Dixon of the CoMIH, spoke on ‘Social Prescribing and Yoga’ and Drs. Patricia Gerbarg and Richard Brown on “The Therapeutic Power of Breath, a Key Public Health Intervention.”

Inevitably, another enjoying a trip on the bandwagon, is the Prince of Wales. In a written address to the conference he advised: “The ancient practice of yoga has proven beneficial effects on both body and mind…For thousands of years, millions of people have experienced yoga’s ability to improve their lives … The development of therapeutic, evidence-based yoga is, I believe, an excellent example of how yoga can contribute to health and healing. This not only benefits the individual, but also conserves precious and expensive health resources for others where and when they are most needed…I will watch the development of therapeutic yoga in the UK with great interest and very much look forward to hearing about the outcomes from your conference.” The Prince claimed yoga classes had “tremendous social benefits and builds discipline, self-reliance and self-care”, which, he said. contributed to improved general health.

The Prince supplied no evidence to support those assertions. No scientific evidence, no economic evidence such as cost-benefit analyses.

The Prince was “delighted” to discover that the conference was examining the health benefits of yoga and claimed it was “the first of its kind in the UK”. Hardly – there have been many conferences on yoga and health, but the semanticists will hide behind the phrase: “…of its kind” – that is, this was the first UK conference involving the ‘College of Medicine and Integrated Health’ together with representatives of NHS institutions. Semantic sophistry.

Originating in India, the principles and practices of yoga developed as one of the six branches of the Vedas – a Hindu spiritual and ascetic discipline, a part of which, including breath control, simple meditation, and the adoption of specific bodily postures, is now more widely practised for health and relaxation. The word yoga comes from the Sanskrit ‘yug’, meaning to yoke or unite. Not fingers touching toes or noses reaching knees, nor the union of mind and body, although, this is a sense commonly applied within the yoga community. The union that the word yoga is referring to is that of uniting individual consciousness and experience of reality with Divine consciousness – a spiritual state perceived when we quiet our five senses and reconnect with the Supreme Self within. That requires faith.

The concept of yoga is inevitably on the agenda of those who perceive a need to foster ‘integration’ and ‘harmony’ – but as oncological surgeon Dr Mark Crislip has pointed out: “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie it does not make the cow pie taste better, it makes the apple pie worse.”

Back to reality. Academics from Northumbria University have begun a £1.4m four-year study exploring the impact of yoga on older people with multiple long-term health conditions. In the UK, two-thirds of people aged 65+ have multimorbidity – defined as having two or more long-term health conditions such as diabetes and heart disease.

“Treatments for long-term health conditions account for 70 per cent of NHS expenditure, so researchers want to look at the effectiveness clinically and cost-wise of an adapted yoga programme for older adults with multimorbidity, to reduce reliance on medication.”

Excellent. But for now – the jury is out. Until we do have evidence of the anticipated benefit, we should all bear in mind the view of the Director of the US NICCIH. Commenting on “Yoga for Wellness” Dr Helene Langevin says:

“In a national survey, 94 percent of adults who practiced yoga reported that they did so for wellness-related reasons—such as general wellness and disease prevention or to improve energy – and a large proportion of them perceived benefits from its use. For example, 86 percent said yoga reduced stress, 67 percent said they felt better emotionally, 63 percent said yoga motivated them to exercise more regularly, and 43 percent said yoga motivated them to eat better.”

But what does the science say? Does yoga actually have benefits for wellness? The NCCIH tells us:

“Only a small amount of research has looked at this topic. Not all of the studies have been of high quality, and findings have not been completely consistent. Nevertheless, some preliminary research results suggest that practicing yoga may help people manage stress, improve balance, improve positive aspects of mental health, and adopt healthy eating and physical activity habits.”

“May help” does not mean “it does help”. And whilst TLC is always lovely, and virtually all interventions “may help relieve stress and improve positive aspects of mental health”, the jury is out as to whether yoga actually does have such benefits. And the NCCIH cites “preliminary research…”. “Preliminary” – after some thousands of years?

Shorn of esoteric metaphysical mishmash, yoga may well assist many patients come to terms with their ailments, but the association of NHS institutions with the CoMIH suggest an agenda to have a wider variety of un-evidenced alternative modalities smuggled into the NHS, contrary to policy that NHS healthcare should be based on evidence. Surely that is to be deprecated. NHS England should explain its endorsement for conferences such as this lest all those who are struggling to advance health care on a rational scientific base pack their bags and go home.