Decision on Homeopathy in France – and Germany? – An Interim Conclusion

An empty bottle symbolizing the French decision against reimbursement of homeopathy with a little wooden shield with the words This week, French Health Minister Agnès Buzyn announced the French government’s decision to remove homeopathy completely from the statutory health insurance scheme by 2021. For a transitional year, the reimbursement rate for homeopathic medicines is to be halved from 30 to 15 per cent. According to Mme Buzyn, she also wants to use this “transitional year” for more information about homeopathy and thus achieve greater acceptance for the decision, until it has a full effect in 2021.

This final decision was preceded within the last 15 months by the most comprehensive evaluation of homeopathy ever carried out in France. In the end, the Haute Autorité Santé made a clear statement: homeopathy lacks a specific efficacy that goes beyond mere contextual effects and thus does not justify a position as a reimbursable medicine in public health care.

The decision of the French government is explicitly based on the undeniable scientific facts, which do not attribute more relevance to homeopathy than any other sham therapy and deliberately puts other aspects such as the “popularity argument”, the “marginal” costs in the health care system but also economic interests of manufacturers aside. Thus, the French government has also decided not to participate further in the maintenance of a public reputation of homeopathy.

The findings on which this Decision is based have been known and validated for a long time. Basically, it is more interesting that and why homeopathy, despite all this, has been able to establish and maintain its reputation and its special position. The development in France once again highlights the factors that played a role in this.

In Germany, as elsewhere, the rise of homeopathy to a veritable industry originated in the late 1970s with its “New Age” affinity, which propagated a misunderstood closeness to nature as well as an indefinite “neomysticism”. In this era, it was possible to label the method sustainably as a “natural, gentle and side-effect-free” alternative to medicine and thus bring it closer to naturopathy. This quickly and sustainably influenced public perception. With the EU Medicines Directive and national regulations such as the German “internal consensus” in the Medicines Act, all this was legitimised. This marked the beginning of a new era of “homeopathic research”, driven by the desire to gain not only formal but also scientific legitimacy.

This “drawing a bill to the future” could not be redeemed. At the end of the 1970s, some defenders of the “special therapeutic directions” may have been personally convinced that proof of the effectiveness and mode of action of homeopathy could already be found. After 42 years of internal consensus and the search for scientific legitimation, this has demonstrably failed. Credit’s run out.

There is no scientifically sound evidence for a plausible mechanism of action of homeopathy, so it is not surprising that all meta-analyses and reviews of efficacy carried out in the last 30 years have revealed no reliable evidence for any indication. That is the actual state of affairs today. And this is the basis of the overdue questioning of homeopathy as part of medicine and as part of medical legislation, the legitimation of which has become untenable.

That is why it is high time – as France has just demonstrated – to draw conclusions from the special position of homeopathy in medicine and pharmaceutical law, which has been shown to be wrong and unjustified. The credit of the method is used up. What could make this more clear than the comprehensive evaluation of the scientific knowledge situation, which was carried out again with great seriousness in France – with “devastating” results, as the French media repeatedly expressed?

In the current discussion about an end to the official legitimization of homeopathy, its representatives either refer back to the untenable positions of the 1970s (“pluralism in medicine”), gloss over, distort or even deny the clear scientific state of knowledge (“there are hundreds of studies….”, “the homeopathic basic research…”) or present completely irrelevant aspects that have nothing to do with the core problem (“restriction of the freedom of therapy”, “paternalism of the responsible patient”, the “peanuts argument” and more).  All this is irrelevant for the objective of homeopathic criticism to help the principles of evidence-based patient-oriented medicine achieve a breakthrough in the public health system. France takes a first step with the withdrawal of reimbursability, Spain and England are already going further by taking homeopathic remedies the official quality as medicine. It is time to draw the consequences in Germany, too, from the fact that the granting of special rights for the “special therapeutic directions” in the Medicines Act, which appear at least partly explainable (if not correct) from the situation at the time of the consultation of this Act, has long since proved to be a wrong way and a dead end.

Homeopathy in Germany is currently still a major obstacle to the consistent implementation of evidence-based medicine in the public health system. It is the anchor of pseudomedicine within drug law. Thus it is a kind of legitimation for a multitude of other, often extremely dangerous pseudomedical methods. It cannot be ruled out at all that the call for the same special rights that are currently granted to homeopathy could also come from other directions. In view of the existing privileged status of homeopathy, there is little that can be argued against.

The legitimacy of the demand to end the special position of homeopathy in medicine and public health stems from all this. This demand is not marginal, forced by any “fanatical opponents”, nor – as recently suggested – a campaign of “economically interested circles”. This demand is a call for integrity and honesty in medicine and for a step towards a reliable and sustainable public health system.

Following the decision in France, Germany is the only country within the EU retaining the reimbursement in statutory health insurance based on a special position for homeopathy in pharmaceutical law.

What’s the matter?


 

Medical homeopathy and patient safety – touchstone homeopathy congress

The German Central Association of Homeopathic Physicians (DZVhÄ) presents its members to the public as guarantors of good medical care. Among other things, this is necessary to counter the criticism that the use of homeopathy may delay the timely medical treatment of serious illnesses. Also from the policy the position of the DZVhÄ is stressed for the patient security in the context of homopathic treatments. For example by Annette Widmann-Mauz, then State Secretary in the German Ministry of Health, at the International Homeopathy Congress 2017 in Leipzig (LMHI), hosted by the DZVhÄ.

Already the lectures on the LMHI were proof for the fact that the DZVhÄ its role does not only not become fair, but a danger for patients can be. In addition to homeopathic treatment options for cancer, HIV and acute abdomen, the homeopathic treatment of autism was also presented.

At this year’s national congress of the DZVhÄ in Stralsund, it became clear once again that patients cannot expect members of this association to redeem their claim to patient safety.  A child and youth psychiatrist held a lecture and a seminar there, the announcement of which already made clear that the lecturer does not care about scientific evidence or does not know about it.

In the announcement of the lecture “ADHD, Autism & Co. – What is this? – Diagnoses from the point of view of child psychiatry and homeopathy” was to be read among other things:

What the child psychiatrist calls autism may be described by the homeopathic physician as “vaccine damage syndrome (…)”.

The seminar “From the practice of the child psychiatrist” will deal with various homeopathic therapy approaches. Among other things, the “CEASE Therapy and Inspiring Homeopathy (T. Smits)” is called here.

A causal connection between autism and vaccinations was already suspected in the 1980s, but at the latest at the beginning of the 2000s it was clear that this causal connection did not exist. Since then, further evidence has been added to prove again and again that there is no causal link between vaccination and autism.

Nevertheless, at the congress of the medical organization dedicated to homeopathy in 2019, a link between vaccinations and autism is still being claimed. WHO has identified vaccine fatigue as one of the top 10 health threats. How do long disproved statements, which already caused a large part of this problem in the past and are likely to aggravate it, fit into an organization that, according to its own repeated statements, is committed to patient safety and evidence-based medicine and thus justifies the leadership of medical homeopathy?

This lecture and the seminar concept must have wandered through many hands before they became part of the official program. Apparently, none of the people involved in the program noticed that these statements were nonsense. What about the scientific training of the members of an association that is responsible for something like this?

It is no such different thing with the so-called CEASE therapy than with the autism legend. Behind CEASE lies much more than an ineffective homeopathic treatment of people with autism spectrum disorder (ASD).

The Dutch doctor Tinus Smits had identified the use of nasal spray during pregnancy, the warming up of milk in the microwave, anaesthesia during childbirth and other things, as well as vaccinations as the alleged cause of autism. Here, too, the disproved connection between vaccinations and autism is repeated.

Smits also claimed to be able to use his method to diagnose the specific individual trigger of ASD and then perform homeopathic “detoxification”. In addition, he pretends to be able to “heal” ASD completely with his method. Apart from awakening unrealistic expectations among the affected persons, the accusations against the mothers, who are suggested to be (co-)responsible for the illness of their child through “misconduct” (e.g. nose drops during pregnancy), should not be neglected either. CEASE therapy is another deplorable example of how principles of medical ethics are violated with methods that are not evidence-based and lack plausibility.

Here, too, no one of the DZVhÄ congress responsibles seems to have looked at Smit’s central assertions. Even classical homeopaths may be critical of some of them, as they deviate greatly from Hahnemann’s teachings. Once again it is confirmed that quality control by the DZVhÄ does not take place and that neither homeopathic nor evidence-based criteria are checked internally.

The DZVhÄ has not yet been able to provide an adequate and intersubjectively verifiable answer to the question of the specific effectiveness of homeopathy. From the point of view of politicians and the public, thus the worst case would be a well-paid treatment with placebos. Unfortunately, it is shown again and again that in the DZVhÄ, apart from the views on homeopathy, there are other scientifically disproved views which become a danger for patients.

The health insurance companies that conclude direct contracts with the DZVhÄ are also responsible here. They expose their patients to the danger of receiving treatment that not only contradicts the current medical status, but can also cause harm. From our point of view, the DZVhÄ is not a partner for responsible treatment of patients. After LMHI 2017, this year’s congress was further proof of this.


Read more:

Autism lie:

New Meta-analysis Confirms: No Association between Vaccines and Autism – at Autism Speaks

Lie stories – disproved! – Susanna doesn’t need globules (in German)

CEASE therapy:

Article about Titus Smits and CEASE by the Dutch skeptics “Verenigung tegen de kwakzalverij” (in Dutch language)

Seven things you might want to know about ‘CEASE’ therapy (as practised by homeopaths and naturopaths) – article by Prof. Edzard Ernst


Picture credits: Website German Medical Congress for Homeopathy 2019 (Screenshot)

Author: Dr. med. Jan Oude-Aost

Hello! We’re from INH and want to talk about homeopathy with you!

Picture with the INH speakers, from left: Dr. Christian Luebbers, Dr. Natalie Grams, Dr.Ing. Norbert AustIn an interview with Pharma Relations, Mathias Hevert, Managing Director of Hevert Arzneimittel, accused the “skeptics” of taking a “clearly biased stance towards homeopathy”, of neither wanting to inform nor being willing to discuss.

We do not know who the “skeptics” are supposed to be here. We regret, however, that Mr. Hevert obviously did not inform himself in any way about the aims and contents of the INH – for example on this page – and instead makes such statements.

Mr. Hevert has today received the INH letter published below with reference to these statements:


 

Mr. Mathias Hevert
Management Hevert Arzneimittel
by e-mail info@hevert.de
July 2, 2019

July 2, 2019.

Your interview on Pharma-Relations

Dear Mr. Hevert,

With this letter we refer to your interview, which was published on 01.07.2019 on Pharma-Relations (Link). In particular, we’d like to address the accusation having a “clearly biased attitude towards homeopathy” and the claim that we wouldn’t be open to discussion. You, on the other hand, would welcome a scientifically based and fact-oriented discussion at any time.

We would like to convince you that our attitude is not based on an unreflected bias, but is rather the result of a long and intense occupation of the doctrine of homeopathy. We have looked at homeopathy from different angles and come to the same conclusion in different ways: from our point of view homeopathy does not work beyond placebo. Homeopathic preparations are in higher as well as in lower potency unsuitable to bring about specific effects, especially not those which are supposed to unfold according to the homeopahtic doctrine. There is no scientifically valid evidence for an effect beyond placebo.

On the other hand, we as skeptics are of course open to your arguments as to why our point of view should be wrong. With the exception of Prof. Frass, formerly of Med-Uni Vienna, our previous offers for a discussion with representatives of homeopathy have not yet been taken up. We are therefore pleased that you welcome a scientifically sound and fact-based discussion at any time, and would like to enter into a corresponding dialogue with you. After all, we consider the same facts, but come to different conclusions, which at least in principle could be dispelled in a discussion.

One could imagine different procedures, from a moderated discussion in a smaller circle to a public panel discussion. Perhaps a moderator of a TV talk show could also be inspired by this topic. Of course, we assume that as a business economist you will be supported by experts from inside or outside your company or association.

As minimum result it could result from this discussion that you would learn more and better know about the motives and arguments of the skeptics, the GWUP and the INH and wouldn’t have to make further wrong statements about the relevant persons from ignorance.

We look forward to your answer with interest.

Dr. – Ing. Norbert Aust – Dr. med. Christian Luebbers


We are curious.

The INH on its own account – Notes to the public discourse

The INH is pleased to note that the critical debate on homeopathy is gaining in breadth. But now, criticism of homeopathy is increasingly expressed in a form that we cannot approve of, because it exceeds the limits of legitimate intensification, irony or satire.

The INH therefore sees reason to refer to principles for the discourse on homeopathy which are part of its self-understanding:

  • Our criticism is directed at the doctrine of homeopathy and the institutions that represent it, but not at the patients and users applying homeopathy. Obviously, it is apparently unavoidable that there are people who perceive the fact-based dispute with homeopathy as a personal attack. However, this is by no means our intention.
  • Our criticism also goes to the public health institutions, which are supposed to protect patients from quackery and ineffective therapies, but obviously fail in the case of homeopathy.
  • We strictly reject any form of attack on persons. In particular, derogatory and insulting statements are not a means of pertinent discussion for us.
  • We treat all discussion partners with due respect and keep a polite tone, even if the other side is lacking in this.
  • We consider homeopathy to be a false doctrine that currently occupies an unjustified special position in public health. But we accept that it is possible to take a different position, without that in any way would devalue the person who advocates this.
  • We reject statements which place homeopathy and its users close to crimes or offenders, which in any other way merely express an aggressive attitude or which, without any factual connections, are merely intended to provocatively heat up the mood.

Does homeopathy work? – A guest contribution by Abhijit Chanda (berationable.com)

Introduction

Again and again we hear of India as the “promised land” of homeopathy. Again and again the critics are reproached of India as a shining example when it comes to constructing a “proof” of its validity through the widespread spread of homeopathy.

All the more we are pleased to be able to present here today a guest contribution of an Indian author who grew up with homeopathy there and has nevertheless found a critical and negative attitude. The following article first appeared on his blog (berationable,com, and also The Rationable Podcast).

We can only speculate here about the reasons for the widespread spread of homeopathy in India. Therefore we find the message of our guest author highly interesting that the reputation of homeopathy in India is largely based on the fact that it comes from Germany – one cannot imagine there that something wrong or nonsense (“bogus”) would come from Germany. On the one hand this is astonishing and on the other hand it unmasks the reference of the local homeopaths to the popularity in India as a circular conclusion.

We consider this contribution to be an extremely important document from a part of the world where critical-rational thinking is only slowly beginning to spread. We have great respect for our guest author, who has found such a critical attitude in his completely different socio-cultural environment that it hits the heart of the matter.

We are very happy about the possibility of the publication and would like to thank our guest author!


Does homeopathy work?
A guest contribution by Abhijit Chanda (berationable.com)

Homoeopathy, especially in India, is a treatment method in which a lot of people believe. In fact, India is one of the biggest markets for homoeopathic medicine, if not the largest. Plus, it’s getting support from the government through the AYUSH initiative. My parents gave me homoeopathic treatments as a child, and they swear by it. In fact, most people do. There are college degrees for it, doctors prescribe it, and infants and animals are said to benefit from it too! But does homoeopathy really work? As I found out, it kind of does, but not in the way you think.

Disclaimer: This is going to be a long article, so bear with me. If you can’t here’s a TL;DR version. But I recommend you go through this to get the nuances, and my side of the story.

TL;DR

  1. Homoeopathy is an ancient practice created in the 1700s as a counter treatment to bloodletting and other rather horrific medical practices

  2. Homoeopathy is a process of diluting a small amount substance in more water than the whole earth can contain to treat your ailment

  3. There has been no evidence to show that it works any better than a placebo, even after hundreds of clinical trials have been conducted.

MY STORY

For most of my life, I have taken it for granted that homoeopathy worked. I didn’t know how or why, I just knew that my parents and most other people swore by it, so there had to be something to it. I was treated with homoeopathy several times. In one case, it actually made things worse. The homoeopathic doctor responded with, “Things sometimes have to get worse before they get better.” I have to admit, as much as I wasn’t impressed with that answer, I liked the taste of the medicines. Always sugary and sweet or even with that little bit of alcohol. What more does a kid need in his life than to eat something sugary sweet for medicine!

It was only when I started becoming more of a science enthusiast, did I realise that the rest of the scientific world didn’t think that homoeopathy worked. Richard Dawkins and James Randi were the first people I encountered who had publicly ridiculed homoeopathy. I couldn’t believe what I was seeing! How could this form of treatment be so ineffective and yet have millions of followers?

The picture shows a pharmacist in Homoeopathic pharmacy Varanasi Benares India
Pharmacist in Homoeopathic pharmacy Varanasi Benares India

HOW HOMOEOPATHY WAS BORN

It took me a while to get to the root of the question – does homoeopathy work at all? I think the most comprehensive and interestingly told account was on a podcast called Skeptoid by Brian Dunning. It’s an excellent collection of everything you need to know about Homeopathy in just around 15 minutes. You should certainly check it out.

So here’s what I found out about how homoeopathy came into existence.

Back in the 1700s, the prevalent medical treatments of the time involved balancing the four humours: blood, phlegm, black bile and yellow bile. The prevailing theory was that sickness was caused by an imbalance of these “humours”, which wasn’t at all funny because the way to balance them was primarily through bloodletting, leeching, or purging. If you’re wondering if these words mean what you think, they do. They were all about somehow getting rid of some of the fluids to blame for the disease, whether it was the blood by opening a vein and letting it flow out of the victim or more slowly by using a leach. Enemas, vomiting and sweating were other ways of getting rid of these diseases. Of course, these did work some of the time if the patient had a condition that called for such treatment. However, many ended up dying due to malnutrition, dehydration or loss of blood. Or all of the above.

Out of these archaic so-called medical practices, a German physician called Samuel Hahnemann found a treatment that didn’t at all affect his patients adversely. He called it Homoeopathy. The theory was published in 1807 and was governed by a couple of laws:

  1. Law of similars: which basically states that like cures like. He claimed that if you use a toxin that causes certain effects on a person, that same toxin can be used to alleviate those symptoms, but only if it was diluted very thoroughly

  2. The Law of Infinitesimals: The more dilute the solution was, the more profound would be its ability to balance the humours.

So, as you can see, this does sound somewhat similar to how vaccines work – where a weaker version of a virus is injected into a person to teach the immune system to fight the disease. And vaccines work brilliantly!

HOW HOMOEOPATHIC REMEDIES ARE MADE

Portrait of Samuel Hahnemann, inventor of homeopathiy
Samuel Hahnemann

However, homoeopathy is different in a fundamental way. The solutions are so dilute, there’s almost no chance that even a molecule of the original toxin remains in the final product. How? To show you how this works, I’ll quote Brian Dunning from Skeptoid.com, who explains it particularly well:

Dilutions of homoeopathic products that are sold today usually range from 6X to 30X. This is homoeopathy’s system for measuring the dilution, and it doesn’t mean 1 part in 6 or 1 part in 30. X represents the roman numeral 10. A 6X dilution means one part in 106 or one in one million. A 30X dilution means one part in 1030 or one followed by 30 zeros. A few products are even marketed using the C scale, Roman numeral 100. 30C is 10030. That’s a staggering number; it’s 1 followed by 60 zeros, about the number of atoms in our galaxy. In 1807, they knew more about mathematics and chemistry than they did about medicine, and it was known that there is a maximum dilution possible in chemistry. Some decades later it was learned that this proportion is related to Avogadro’s constant, about 6 × 1023. Beyond this limit, where many of Hahnemann’s dilutions lay, they are in fact no longer dilutions but are chemically considered to be pure water. So Hahnemann designed a workaround. Hahnemann thought that if a solution was agitated enough, the water would retain a spiritual imprint of the original substance, and could then be diluted without limit. The water is often added to sugar pills for remedies designed to be taken in a pill form. So when you buy homoeopathic pills sold today, you’re actually buying sugar, water, or alcohol that’s “channelling” (for lack of a better term) some described substance. The substance itself no longer remains, except for a few millionth-part molecules in the lowest dilutions.

Let’s look again at Avogadro’s number. 6 × 1023 atoms are called a mole, a term any chemistry student is familiar with. How big is that number? Well, if you had 500 sheets of paper, you’d have a stack about two and a half inches high, like a ream that you’d buy at the stationery store. If you had 6 × 1023 sheets of paper, your stack would reach all the way from the Earth to the Sun. And not only that: it would reach that distance four hundred million times. Think about that for a moment. One sheet of paper, in a stack that’s 400,000,000 times the distance from the Earth to the Sun. That’s a typical homoeopathic dilution. Sounds pretty potent, doesn’t it?

Brian Dunning from Homeopathy: Pure Water or Pure Nonsense

Quackwatch has another way of putting it. Here’s an excerpt from their article, Homeopathy: The Ultimate Fake by Stephen Barrett MD:

Robert L Park, Ph.D., a prominent physicist who is executive director of The American Physical Society, has noted that since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.

That’s really hard to wrap your head around, isn’t it? To put it in simpler terms, the amount of dilution any substance goes through in homoeopathy makes it almost impossible to find even a single molecule of the original material in the final product. Simpler still, none of the original substance will find its way into your regime of treatments.

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HOW DO THE TREATMENTS WORK THEN?

According to Hahnemann, the process of diluting and shaking the concoction (potentization) imprints the essence of the substance onto the water molecules, which then interacts with the body’s “vital force”.

It does seem a bit spiritual, doesn’t it? So is homoeopathy a spiritual medicine? It certainly seems so, even though I don’t think many people would believe that. However, there is another explanation that I’ve heard.

WATER HAS MEMORY

Apparently, water can “remember”, or retain the spiritual imprint of the substance that has been in it, and that is what helps treat you.

A French scientist by the name of Jacques Benveniste published a study in the science journal Nature in 1988. This caused quite a ruckus in the scientific community as it didn’t seem plausible. But as the study methodology seemed sound, the journal had published it. But it did come with a note from the editor, John Maddox, asking people to “suspend judgement” until the study was replicated.

In brief, the study took human antibodies, put them a test tube, shook it thoroughly and then diluted it to a point where not even a molecule of the first sample would be present. The team reported that when human basophils were exposed to this water, they reacted as if there was an allergic reaction.

When the time came, John Maddox along with magician and paranormal researcher, James ‘The Amazing’ Randi, and Walter W Stewart, a chemist, set up the study. They noticed that Benveniste‘s team knew where the vials with the first solutions were. Therefore, they decided to make the study double-blinded – meaning none of the researchers, or the team from Nature, would possibly know which test tube or vial was which, and went to elaborate lengths to ensure there was no cheating.

Long story short, the study came out negative, showing no effects at all. Benveniste‘s study had been debunked.

THE EVIDENCE

There have been literally hundreds of studies done to test homoeopathy. Every single meta-analysis and systematic review of the research published has come back with results claiming homoeopathy works no better than a placebo. There were quite a few studies that showed homoeopathy is better than placebo, but after analysing them, it was found that either their sample sizes were tiny or their methods were questionable.

There are way too many studies and reviews to go into each of them or even describe them in brief. However, the entry in Wikipedia has an excellent overview of the evidence along with all the links to the studies, if you want to dig deeper.

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SO WHY DO SO MANY PEOPLE SWEAR BY HOMOEOPATHY?

This is probably the most critical question here. After my faith in homoeopathy had been shaken, I shared what I had found, hoping my friends would see that they had been fooled just like I had been. I wasn’t ready for their responses. They defended homoeopathy quite aggressively. It felt like I had offended them by saying their beloved alternative medicine didn’t have any evidence behind it.

However, I want nothing more than to share what I’ve found and ask you to consider the evidence. So, if I’ve angered and offended you in some way, and you think homoeopathy does indeed work, let’s have a civil discussion about where you think I’ve gone wrong.

Still, let’s try and figure out why it seems to work so well:

  • Natural healing: More often than not, our immune systems and other healing processes in our bodies heal many disorders naturally. If one takes homoeopathy and the body heals itself in the meanwhile, of course, the former gets all the praise. One way you can observe this is when a homoeopathic doctor or follower says something like, “It’s only effective if you take it for over a long period”. For many conditions, this gives the body enough time to heal by itself, but homoeopathy gets the credit. Unfortunately, this doesn’t happen for chronic or serious diseases.

  • The placebo effect: This is a very profound and still slightly mysterious phenomenon. The placebo effect is when a sick person feels better when they have been given a fake treatment. A few examples of this are sugar pills, saline drips or injections, or even sham surgeries. It has been found that these treatments really do help patients feel better. The more severe the intervention, the more profound the effect. However, it’s essential to remember that the effects are temporary. If a patient has a chronic condition or a severe disease that isn’t going away, the sickness will return eventually. And not everyone feels the effect of the placebo. That’s why medicines are tested in Randomized Controlled Trials (RCT) – Randomized meaning there is a random selection of people participating in the test; Controlled meaning people are assigned to get either the placebo or the real medicine in such a way that neither the testers nor the people in the trial know which one they are getting. Then, the scientists unveil the results and see which people got the placebo and which didn’t. If the group who got the real medicine show marked improvement, the medicine being tested is a success. If not, it’s deemed only as effective as the placebo and rejected. (Of course, these trials have to be done multiple times by independent groups on different populations over a long period before the medicine is allowed to come to the market). The high-quality studies that tested homoeopathy in RCTs found they were no better than placebo, which means they don’t really have any significant effect at all.

  • Regression towards the mean: We sometimes suffer from conditions that may not have a cause. They come, and they go. For example, headaches, allergies, rashes or itches etc. These are usually the natural process and reactions of the body, and they tend to go away. If you have a sudden, acute response, it could get aggressive and then subside and disappear. If you have a chronic condition that lasts for a long time, there will be times when it gets better and then becomes worse. Regression towards the mean is what this natural variation is called. If you have a homoeopathic remedy and your symptoms subside, it could either be the placebo effect or merely a regression towards the mean.

  • Confirmation bias: When I was biased about the Ketogenic Diet, it seemed that, everywhere I looked, I found evidence that confirmed my beliefs that keto worked. When one is convinced about an idea, the mind selectively finds reasons to reinforce it. Similarly, it’s likely that firm believers in homoeopathy would count all the times the treatments made them feel better but subconsciously forget the times it didn’t.

  • Misdiagnosis: It’s also possible that a misdiagnosed condition could make it seem more severe than it is. And then, when you got better, you gave homoeopathy the credit.

  • Standard medicine: Many people take conventional medicine along with homoeopathy if they believe in it. Doctors are reluctant to stop them from taking it because, if it makes their patients feel better, even if it’s due to the placebo effect, it’s worth it because it could help them stick to their prescriptions. Of course, when they get cured, chances are they’ll give homoeopathy credit rather than the medication.

  • Stopping an unpleasant treatment: Sometimes treatments for specific diseases can have unpleasant side-effects. If someone ends that treatment and uses homoeopathy instead, the side-effects will wear off. And, as homoeopathy has no known side-effects, it will get the credit in making them feel better.

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HOMOEOPATHIC HEALING OF INFANTS AND PETS

Some have said that homoeopathy treated an infant or a pet. After all, since they don’t know what homoeopathy is, how can they possibly be susceptible to the placebo effect?

They do seem to have a point. But since we have established that homoeopathy doesn’t work, there must be something else at play here. The placebo effect and confirmation bias work here too, just as they do in adult humans. When a child or a pet is given homoeopathic remedies, the way they are treated by the parent or the master could also affect how they feel. Especially when they are cuddled or cared for more, they would feel better. Animals and children can also recover naturally from mild infections and transient conditions like rashes given enough time.

Another critical factor is the parents’/owners’ confirmation bias. If they are sure the remedy is helping, chances are they’ll see an improvement in their child’s or pet’s condition even if there isn’t one. Plus, the other factors I mentioned earlier also play parts here, and none of those is dependent on the child or pet’s awareness of the medicine.

HOLISTIC TREATMENT VS SYMPTOMATIC TREATMENT

Homoeopathy is said to be a holistic form of treatment, where the patients, body, mind and spirit are taken into account. Even their daily routine, diet, work life and other factors are considered when consulting a homoeopath.

On the other hand, proponents of homoeopathy and other alternative medicines say that modern medicine treats only the symptoms and not the root cause of the disease.

I feel many people take this idea for granted without really thinking about it. Modern medicine is a systematic process where a patient is asked questions about their conditions and how long they have persisted. Based on this, the patient may need to get some tests done to confirm or deny the doctor’s suspicions. These tests can reveal the root cause, and the treatment will be prescribed accordingly. For example, if you go to a doctor with a fever, he or she will ask you about it, and based on your other symptoms like maybe a cough or a cold, or an upset stomach, get in the ballpark of what kind of an infection you have. If it’s a bacterial infection, they’ll give you an antibiotic to kill the germs. If it’s a viral without any known treatment like the flu, they will probably treat it symptomatically to make sure the fever stays down. If you have something more extreme, like cancer, they might recommend surgery to get the cancerous cells out of you or to kill it with chemotherapy or radiation. That’s going down to the root cause.

On the other hand, the homoeopath will have an in-depth consultation, but the treatments they give have been formulated based only on the symptoms. They will find a toxin that causes similar symptoms and then dilute it down to nothingness before they give it to you. From whatever I’ve read, there seems to be little or no regard for specific germs, cancers, viruses or any other root causes for diseases taken into consideration. In fact, the germ theory of disease hadn’t even been formulated back when homoeopathy was first thought up by Hahnemann. How can they possibly claim to get to the root cause of any disease?

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MODERN MEDICINE HAS SIDE-EFFECTS

Yes, they do. There’s no denying it. All medicines have side effects. If you look at the little leaflet inside the box or even look it up online, any drug you search for will have a list of side effects – some short, some long. And they will be divided by how common they are, as well as advice to see your physician if you experience any of these.

You see, every medicine goes through a long process of RCTs to uncover their effects and side effects in Petri dishes in the lab, to animal studies and human studies, which are conducted on a large population. This is to figure out what the effects and side effects are. A medicine that goes on the shelf is usually one that has the lowest side effects versus the most potent effects. Even if you look at chemotherapy, a treatment we all know to be harrowing for the patient, the sickness, hair falling out, loss of appetite and so on, are all preferable to dying. People go through chemotherapy to kill cancer in the most effective ways possible while still giving the patient a fighting chance to survive.

On the other hand, paracetamol, or Crocin as you might know it, are pretty safe, or so we think. We pop them without a thought if we have a headache or a fever. But they do have side effects. Here’s what I found on Drugs.com:

Rare (Side effects)

  • Bloody or black, tarry stools
  • bloody or cloudy urine
  • fever with or without chills (not present before treatment and not caused by the condition being treated)
  • pain in the lower back and/or side (severe and/or sharp)
  • pinpoint red spots on the skin
  • skin rash, hives, or itching
  • sore throat (not present before treatment and not caused by the condition being treated)
  • sores, ulcers, or white spots on the lips or in the mouth
  • sudden decrease in the amount of urine
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellow eyes or skin

As you can see, these are pretty rare and most people won’t be affected by any of it. But it’s important to know about these, just in case you’re the one in a million who does. Dr Shantanu Abhyankar, a renowned, practising Obstetrician and Gynaecologist based in Wai, Maharashtra, talked about this in his TEDxPICT talk:

“In fact, modern medicine has devised methods to document, study and, as far as possible, mitigate these side effects. We are open, we are frank. Which is not the case with many other “pathies”. And come to think of it, side effects need to be compared with what you are going to use that particular product for. Oral contraceptive pills have side effects, but then you have to compare the side effects of oral contraceptive pills with the side effects of not using oral contraceptive pills. If you use oral contraceptive pills, you get contraceptive action and a few side effects. But if you don’t use them, then maybe you’re faced with an unwanted pregnancy. You have to undergo the trouble of eliminating that unwanted pregnancy or add in the socio-economic burden of continuing an unplanned pregnancy. Finally, not all side-effects are bad. Take the same example of oral contraceptive pills. Women who take oral contraceptive pills are protected against endometrial cancer, ovarian cancer and so many other disorders. Women who take oral contraceptive pills have less menstrual blood flow, which is a boon to already anaemic Indian women. So, it’s not that all side effects are bad. In fact, when somebody claims that a “pathy” [referring to forms of medicine like allopathy, naturopathy or homoeopathy] doesn’t have any side effects, it probably means that there is no effect at all. Or it probably means that there is no drug at all.”

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BIG PHARMA

The Big Pharma conspiracy theories are at another level. According to some, modern medicine is just a profit-centred industry bent on keeping you sick. Alternative therapies like homoeopathy are nobler and want the best for you, and not for their pockets.

However, there are massive, multi-national, profit-led homoeopathic companies as well, and they get their merchandise stocked in major pharmacies worldwide. In India, the market for homoeopathy, according to one source, is Rs. 2,758 crores and predicted to grow 30% each year! Sure, it’s nowhere close to mainstream pharmaceuticals, but that seems to be changing. They don’t sound like the underdog to me, especially when they are being promoted by the government so aggressively through the AYUSH initiative.

ALLOPATHY

You may have noticed how I’m avoided using the word “Allopathy” in this article. The term is used to describe mainstream medicine now. Dr Shantanu Abhyankar described the origins of the word first coined by Samuel Hahnemann:

“He coined [allopathy] as a derogatory word to describe the practices that were prevalent then. And the practices were very bad. Allopathy means the hodgepodge mixtures being administered to cure whatever conditions came your way [sic]. Usually, bloodletting was very common and was offered for every disorder. But then, over the years, keeping in step with the science, allopathy has completely changed, and what allopathy was described for the practices then prevalent is totally misfit today [sic]. Today’s allopathy is no allopathy at all.”

Modern medicine has come so far from its archaic practices. This is because, in the pursuit of finding the secrets of human health, medicine has used science to ascertain what works and what doesn’t. In this process, our life-expectancy has soared and infant deaths have been minimised. Many diseases have even been considered eradicated! Now, AIDS is no longer a death sentence, and neither is cancer. This is all because of scientific progress and the evolution of evidence-based medicine.

CONCLUSION

Here I am, a decade later, seeing homoeopathy from a completely different perspective than what I used to. It’s probably one of the most profound discoveries in my life and has been one of the factors that have led me to question everything, including, most importantly, myself.

Now, homoeopathy has become one of the most studied fields in the world, with an impenetrable mountain of evidence that has piled up against its claims. These studies have been done by many independent teams and analysed and reviewed by some of the most reliable scientific organisations in the world. There’s just no denying it. There is no evidence for it working…ever. Why? Because it’s just water. And if it’s brought into contact with sugar, it somehow transfers its memories to it. The more I think about it, the more implausible it sounds.

And it’s not just me. Many governmental bodies like UK’s National Health Service (NHS), The American Medical Association, the FASEB and National Health and Medical Research Council of Australia, have stated that there is no evidence to support the use of homoeopathic treatments. Even representatives of the WHO have said that homoeopathic remedies should not be used to treat tuberculosis or diarrhoea.

So, what do you think? Is it worth your time and money to buy water and sugar pills that have shown no evidence of working, or would you instead go to a regular doctor and get real medication that has a good chance of treating you? I, for one, will be going to the latter.

CRITICAL TOOLS

  • Reliable sources: The most critical tools I used to get to the bottom of this topic was to find as many reliable sources that I could find who spoke about homoeopathy. They are all linked to relevant sections in the article. What makes them reliable? They consistently interpret real scientific evidence to support their statements and reviews.

  • Independent sources: I also look for sources that are not associated with one another so there is little to no chance of this information being propaganda.

  • Conflicting Sources: I’ve also tried to find sources that at pro-homoeopathic so that I can see if their evidence is any more compelling than the other side. This adds a level of falsifiability to the claims and simultaneously challenges my beliefs.

Tell me what you think in the comments.

Until next time, I wish you good health and rationable thoughts.


FURTHER READING

Picture credits:

Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Samuel Christian Friedrich Hahnemann. Line engraving by L. Beyer after J. Schoppe, senior, 1831. By: J. Schoppeafter: L. BeyerPublished: – Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Open letter of the INH to the German Federal Minister of Health on the “internal consensus” of the German medical law

Yesterday, on 13.06.2019, German TV satirist Jan Böhmermann so satirically as accurately analysed homeopathy in his programme “Neo Magazin Royale” and thus articulated in his special way the – in our opinion –  widespreaded displeasure about the role of the sham method homeopathy in public health care.

We regard the time as appropriate to turn now with our core concern to the Federal Minister for health. Today he received the following open letter from the INH:


 

Information Network Homeopathy
We explain – you have the choice

 

14 June 2019

Mr
Federal Minister for Health
Jens Spahn
by e-mail

Dear Federal Minister Spahn,

As Information Network Homeopathy, we have been contributing to the public education about the background of homeopathy since 2016 and have also focused on the so-called “internal consensus” of the German Medicines Act.

Yesterday evening, we were able to experience on German television how homeopathy became the subject of prominent satire. For more than 20 minutes Jan Böhmermann burned down a fireworks on homeopathy in his “Neo Magazin Royale”, which – like all good satire – presented nothing but the facts. We regard this as a clear sign that the public reputation of homeopathy, not least supported for decades by the internal consensus, is eroding massively. More and more people see the fact that homeopathy is spent on an effective medical method as an unreasonable anachronism, as science-medical as well as intellectual impertinences.

The construction of the so-called internal consensus in Paragraph 38 of the AMG represents nothing less than the partial reversal of the meaning of the AMG into its complete opposite: Instead of applying intersubjective scientific standards to everything that “pharmaceuticals” want to be, it creates an incomprehensible protective space for remedies of “special therapeutic directions” – a “black hole” in pharmaceutical law – by expressly dispensing with evidence of efficacy.

The lack of intersubjectivity in it is obvious: no one can comprehend the healing promises of homeopathy (or anthroposophy) according to objective standards. After more than 200 years, it remains with claims that could never be verified in any way according to intersubjective criteria. This is the undeniable state of the art of science, which the legal situation nonsensically contradicts – and this contradictions serve the interested circles as a false justification for their untenable positions.

It is time that the legislator no longer provides an apparent legitimation for this and revises the internal consensus of the AMG. In the right understanding, there is only one medicine: the one that works. The one that can scientifically answer the question “Where is the proof?”. In addition, there is no need and no place for somewhat “alternative”, “complementary” or “integrative” in medicine. The dividing line between medicine and non-medicine is the proven effectiveness according to scientific standards. Homeopathy has remained beyond this boundary for over 200 years and cannot invoke more than a legal fiction.

We have no doubt about your personal attitude to the problem and are convinced that our concern is in good hands with you, given the energy you have shown in your office so far. In view of the circumstances described and current developments, give up the political restraint that has so far left the internal consensus untouched! Take the initiative to put an end to the unspeakable anachronism of the internal consensus and to subject to the same rules all remedies that strive access to the market as a pharmaceutical. A factually untenable legal fiction should no longer be the basis for errors and misinformation about homeopathy and should no longer serve to discredit the state of science and those who publicly represent it. Particular interests casted in legal structures should be a thing of the past, especially if they contradict the facts.

We are at your disposal at any time with our expertise in any form you like.

Respectfully

For the Homeopathy Information Network

Dr. med. Natalie Grams (Head / Spokeswoman)
Dr. med. Christian W. Lübbers (Spokesman)
Dr. Ing. Norbert Aust (Spokesman)


 

France: Negative opinion on homeopathy submitted by the Supreme Health Authority

On several occasions we have reported on the progress of the critical debate on the role of homeopathy in the French health system. In almost breathtaking speed, a protest article of the group #NoFakeMed in Le Figaro has developed into a debate, which in the meantime has yielded statements of the supreme French Medical Association as well as the Academies of the Sciences of Medicine and Pharmacy (in a joint statement), all of which clearly position themselves against the role of homeopathy in the health care system and which have not been lacking in clarity about the unscientificness, ineffectiveness and possibly dangerousness of homeopathy.

The official statements had been requested by the French Minister of Health, Agnés Buzyn, who at the beginning of the debate had expressed herself somewhat nonchalantly ignorant about homeopathy (“if it helps to avoid toxic medicines…”). But then she had promised to follow the final statements of the chambers and academies and above all the recommendation of the highest French health authority, the HAS (Haute autorité de santé) in her final decision. Of course, Mrs. Buzyn played for time, involving all the authorities that could be found in France. But that didn’t quite work out. After little more than a year after the article in Le Figaro, the final opinion of the HAS is now available –  LeMonde reports..

And it’s devastating for homeopathy. Although the HAS speaks of a “disputed” effect of homeopathy, which is not comprehensible according to the statements of the two academies – but that may already be a politically shaded formula. However, the recommendation to Mrs Buzyn is clear: No more refunds for homeopathy in public health.

And the key sentence is unmistakable:

“No studies have demonstrated the superiority of the homeopathic approach in terms of efficacy (…) over conventional treatments or placebo.”

Mrs Buzyn’s decision will be made in June. Before that, the three major homeopathy producers in France, Boiron, Weleda and the lesser-known Lehning, still have the opportunity to bring counter-arguments. Lo and behold – the nagging has already begun. Boiron “beckons” with the loss of 1,000 jobs and the “marginal” costs – in the French cash register system recently 130 million euros annually – would not be of any significance in view of the fact that there are proper placebo effects for it after all… so at least franceinfo. We remind ourselves that nowhere was the cost factor decisive where homeopathy was given its farewell. Besides, we know The body itself can heal in many cases, the natural course of the disease usually also brings healing, placebo may have only a small part in all this, does not heal diseases – and is everywhere, where there is care and attention, completely free to have.

We do not believe that Boiron will be on the verge of ruin only because of the abolition of reimbursement by the social security system.

Be that as it may – it’s going to be exciting and the matter is just before the finish line in France. Let’s simply note that the 200-year-old business model of homeopathy is now falling victim to science and honesty, as it looks. After all, the facts are as indisputable as the existence of the phases of the moon.

Picture credits: Screenshot franceinfo, 15.5.2019

Belgium: Consumer protectors take position – “Homeopathy is ineffective, even dangerous”.

The Brussels Times reports under this title on 15 May 2019 and quotes Simon November, spokesman for the consumer protection organisation “Test Achats”:

“The requirements of effectiveness, safety and quality to bring a product to market and be allowed to use the name of medication are sadly not the same for all products,” commented Simon November, spokesperson for Test-Achats. “Homeopathic products are required to be accompanied by a minimum of documentation, and the working of the product barely has to be proven. And that, while classic medications have to go through an entire process of trials and study panels. We simply cannot accept that difference.”

The Brussels Times continues: “The organisation (Test Achats) describes homoeopathy as ‘quack medicine’, which would be bad enough if it only robbed the patient of money.  But there are conditions where the patient really has no time to lose on products whose effectiveness has not been demonstrated. People who are suffering from very real heart and vascular conditions should immediately seek treatment by a doctor, and with truly effective medication.”

Tell me about it. We also think that the criticism may have to focus even more on the danger potential of homeopathy. They are real dangers – but they rarely become visible and are therefore “out of mind”. The consequences and delays caused by homeopathic “therapies” are not recorded anywhere and ultimately virtually all end up in the case statistics – and deaths – of scientific medicine. There are very few reports about it. And in the famous case reports of the homoeopaths, with which they want to prove “evidence”, such cases are of course not to be found – only those are presented there that have recovered thanks to their self-healing powers and the natural course of the disease.

What is the general situation in Belgium, by the way?

The Federaal Kenniscentrum voor de Gezondheidszorg, the official health information service, has already stated in 2011 in a paper “State of affairs on Homeopathy in Belgium (Stand van zaken van de homeopathie in België):

“From a purely clinical point of view, there is no valid empirical evidence for the efficacy of homeopathy beyond the placebo effect.”

The Belgian skeptics “skepp” reported in detail on their website about this statement under the title “Homeopathy: geen bewijs dat het werkt en toch veel gebruikt” (“Homeopathy: No proof of an effect and still much used”).

It is up to the health insurance funds in Belgium (similar to the “statutory benefits” in Germany) whether they reimburse homeopathy or not. As you would expect, practically everyone does, with a view to the competition, which you just don’t want to give a marketing advantage to. However, there was a collapse of this front in Belgium last year: one of the major insurers announced that it would no longer cover homeopathy reimbursements.

For some time now, the therapeutic use of homeopathy in Belgium has only been reserved for “qualified” people. In 1999, homeopathy, acupuncture, chiropractic and osteopathy were considerably regulated by the so-called “Colla Law”. One may argue, however, whether it is the right way to persuade the therapists of these directions to found professional associations and to believe that this would suffice an already dubious quality aspect. But the actual aim was to prevent the practice of these forms of therapy by non-physician therapists. In fact, in 2014, a royal decree was added and the end of the non-medical practice of these therapies was sealed. The decree regulated

1. homeopathic therapists must be licensed doctors, dentists or midwives.

2. they must have a degree in homeopathy from an (official) university or college.

3. doctors, dentists and midwives may only use homeopathy for evidence-based indications.

Well, yeah. Let’s disregard the last point, which should actually mean the end of homeopathy, if you take it as it stands. Of course nobody does. (This does not mean, of course, that the indications must be evidence-based, but rather the therapies for the indications. But it is exactly written so in the original text.) Well-intentioned, but actually more than half-hearted, sometimes even nothing more than a appreciation of the sugar ball method – if such a regulation came into force in Germany, the Central Association of Homeopathic Physicians would probably celebrate longer…

No, a prerogative for physicians in homeopathy is not a solution at all. Such regulations arise from the illusion that there exists a “qualified” homeopathic therapy. The lever does not have to be applied to the group of persons exercising the method, but to the method itself, as is currently the case in Spain and France. And that is why we would like to thank the Belgian consumer protectors, who have taken just this approach with their recently published statement. Let us hope that in Belgium, too, there will be realised that homeopathy – no matter who is practising it – has no place in the qualified health care of the population.

And German health policy? Instead of attentively reflecting on developments in Europe – and worldwide – and questioning one’s own position, policy continues to hide behind the popularity-“argument”. However, we do not want to accuse health policymakers of not knowing that “popularity” is not a criterion for the validity of medical means and methods. But we criticize them for pretending to be. Belgium may be half-hearted as far as the official attitude to homeopathy is concerned, but Germany is at best chicken-hearted, if at all.


Picture credits: Screenshot Brussels Times 15.05.2019

Open letter to the Prime Minister of Mecklenburg-Western Pomeriana on her patronage of the Homeopathic Medical Congress 2019

The picture shows the Chancelly of state and the Castle (residence of county parliament), Schwerin, Mecklenburg-Western Pomeraina
Chancelly of state and Castle (residence of county parliament), Schwerin, Mecklenburg-Western Pomeraina

This year’s Homeopathic Medical Congress of the Central Association of Homeopathic Physicians will take place in Stralsund from 29 May to 1 June 2019. As usual with such meetings, the DZVhÄ assured itself also this time again of the support in the policy, by offering  the patronage over the meeting to the Prime Minister of the country Mecklenburg-Western Pomerania. Of course there is also a well-meaning greeting connected with it.
In (bad) tradition, the Prime Minister followed this wish. The greeting was published on the website of the medical congress.

The INH feels compelled to send the following open letter to Prime Minister Mrs. Schwesig:


To the

Minister President of the State of Mecklenburg-Western Pomerania
Mrs. Manuela Schwesig
– State Chancellery –
Schloßstr. 2-4
19053 Schwerin

Dear Prime Minister,

From various sources we could see that you have taken over the patronage of the Homeopathic Medical Congress of the German Central Association of Homeopathic Physicians taking place in May 2019 in Stralsund. We are also familiar with your greeting to the Congress.

We have a critial view on both the assumption of patronage and the greeting to the congress. Allow us to explain the reasons for this below. We consider it important to make representatives of politics familiar with our concern, an enlightened approach to the subject of homeopathy, and to explain our motives.

Since 2016, we, the Information Network Homeopathy, its members and supporters, have been explaining that homeopathy is a sham therapy that has neither ever been able to provide valid proof of its effectiveness nor to eliminate the incompatibility of its basic assumptions with scientifically proven principles. There is a consensus on this among almost the entire world’s scientific community. To illustrate this, we refer as one voice among many to the 2017 judgement on homeopathy by EASAC, the Advisory Council of the Association of European Academies of Science:

Scientific mechanisms of action—where we conclude that the claims for
homeopathy are implausible and inconsistent with established scientific concepts.
Clinical efficacy—we acknowledge that a placebo effect may appear in individual patients but we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect. ”

As a consequence, in more and more countries homeopathy no longer finds a place within scientifically based medicine and public health systems. In this connection, reference is made to the end of the prescribability of homeopathic remedies in England, which is now followed by the inclusion of homeopathic remedies in the blacklist of the British Ministry of Health, so that they can no longer be registered as medicines.

In particular, we draw attention to current developments in France and Spain. In both countries, the professional associations and scientific academies of both medicine and pharmacy have clearly distanced themselves from homeopathy and demanded that it no longer be given a place in the public health system. In Spain, the current government has already taken concrete measures to remove homeopathy from therapeutic practice. In France the political decision on this is currently pending, the recommendations of the chambers and the academies of science leave nothing to be desired in terms of clarity: homeopathy is medically worthless to potentially harmful.

In the USA, the Food and Drug Administration, in consultation with the FTC, is in the process of creating an increasingly stringent regulatory framework for homeopathic medicines. Consumer protection organisations are currently suing distributors of homeopathic medicines for fraud. In Australia, the possibility of covering homeopathy through private supplementary insurance was even abolished by law in 2017. In Austria, the compulsory elective subject homeopathy at the MedUni Vienna was recently cancelled without replacement, the “Homeopathic Emergency Outpatient Clinic” was closed and the accumulated research work in these areas was rejected by the Scientific Council of the MedUni as “unscientific”.

Many other political and scientific organizations in other countries have also positioned themselves against homeopathy as part of medicine and health care.

The extraordinarily effective homeopathic lobby in Germany has apparently succeeded in keeping such developments at bay. The danger of isolation of German health policy in the circle of EU partner countries in particular can no longer be dismissed here.

The efforts of the relevant lobby to present homeopathy as a proven form of therapy essentially equivalent to scientific medicine are manifold and extensive. This alone does not change the facts, the broad scientific consensus that considers homeopathy only as a relic of medical history and not as a justified part of modern health care.

Here now the circle closes for the occasion of this writing. The Central Association of Homeopathic Physicians is one of the pillars of homeopathic advocacy in Germany. He is very interested in public reputation. Of course, in view of the massively dwindling importance of the pre-scientific homeopathic method in Europe and worldwide, it is of great importance to obtain the patronage of high-ranking political representatives for the homeopathic congresses, for example.

However, this only strengthens the public reputation of homeopathy, which is scientifically and, in our opinion, unacceptable from the point of view of health policy, and leads to a consolidation of the already all too widespread assumption among the population that homeopathy is a recognised form of therapy, which should at any rate be regarded as equivalent to scientific medicine.

That is why the core concern of the homeopathy information network is that homeopathy should no longer be given public credibility or a place in the public health system – especially with regard to the good treatment of children to which you referred. We do not consider the current situation to be scientifically or ethically justifiable. A “therapy” that does not have more to show than the contextual effects (especially placebo) that occur with any kind of attention – even non-medical – cannot be justified as a medical therapy. It should also not be allowed to hide the fact that homeopathy is incorrectly offered and advertised by its representatives as specifically effective drug therapy.

Medicine today defines itself as that which can prove specific effects beyond the “background noise” of the always present placebo effect. Contrary to the perpetuated claims of the homeopathic interest groups and their self-referring events such as the “Homeopathic Medical Congress”, homeopathy cannot do this – and is therefore not a factor for the goal of a generally more human approach to patients in medicine, which we consider to be very desirable.

We would be pleased if we had opened a perhaps not so familiar view on the topic of homeopathy for you. The fact is that the general perception of homeopathy is currently characterised by decades of unchallenged influence by interested circles. Homeopathic criticism is as old as the method itself. However, it was not until 2016 that the Homeopathy Information Network was established as the first independent association of interests, whose members pursue the common goal of educating the general public about homeopathy on the basis of scientific facts.

It is clear to us that as a high state representative you must do justice to a broad pluralistic spectrum of social groups. We, the undersigned, would, however, ask you to refrain in the future from giving additional nourishment to the false and inappropriate public image of homeopathy through – undoubtedly well-meaning – commitment.

Scientifically founded as well as generally understandable sources of information for the classification of homeopathy as a disproved method from pre-scientific times are extensively available. We would also like to draw your attention to the information provided on the website of the Homeopathy Information Network. If you wish, representatives of the information network would also be happy to meet you in person.

Yours sincerely

For the Homeopathy Information Network

Dr. Natalie Grams.
Dr. Norbert Aust
Dr. Christian W. Lübbers


Picture credits: Private / own picture

France: Academies of science position themselves against homeopathy

More than a year ago, the discussion about homeopathy in health care in France began, triggered by the merger of 124 doctors (the #NoFakeMed initiative), who made a clear statement to the public. The waves went up quickly, the public debate flared up, #NoFakeMed members were even sued before the Medical Association – and probably also before the ordinary courts – for the insubordination to stand up against unscientific and specifically ineffective homeopathy. The French health policy, in the person of Health Minister Buzyn, was initially rather cautious (“does no harm, may be useful even if it avoids ‘poisonous’ medicines”), but then came under pressure when the central French Medical Association took a stand against homeopathy. Ms. Buzyn played for time by requesting an expertise from the French Medical Science Academy. We reported here and here.

This expertise has been available since yesterday (25 March 2019). And more: There was a joint communiqué from the medical and pharmaceutical academies. Le Figaro reports.

In a joint declaration (addressed to the government), the boards (of the academies) called for an end to the reimbursement of homeopathy (within the framework of public health) and an end to their teaching at the Faculties of Medicine and Pharmacy.

“End the reimbursement of homeopathy by statutory social security. Note that it is a placebo and inform patients accordingly; indicate on the packaging that there is no scientific evidence of efficacy; no longer accredit a university degree (in homeopathy) in a medical faculty or certificates and diplomas in pharmacy or veterinary education. More than a year after the publication of the Forum (#NoFakeMed) in Le Figaro Santé by 124 doctors, which relaunched a debate as old as the therapy itself, the Medical Academy voted 58 votes in favour (16 against, 8 abstentions) this Tuesday afternoon for a communiqué signed jointly with the Pharmaceutical Academy to reaffirm its positions on homeopathy.

What the Medical Academy had already made clear in 1984, 1987 and 2004 and then via its participation in the Scientific Advisory Board of the Academies of European Sciences 2017 (EASAC), was repeated in the press release adopted on Tuesday: “The state of scientific data does not permit verification of one of the principles of homeopathy (similarity and high dilutions)” (meaning that these principles have unscientific bases), and “meta-analyses could not prove the effectiveness of homeopathic preparations”.

According to Le Figaro, the working group of the Medical Academy takes care not to refer to homeopathy as “medicine” at any point in its text. Yes, she does not even want to accept the term “alternative medicine” (quite rightly, as we find). The working group acknowledges that, according to surveys, the French “believe” in homeopathy and apply it, doctors prescribe it, hospitals integrate it into their range of services. “Social data”, which the two academies “cannot ignore” – but “which can be explained by a lack of knowledge and/or underestimation of the placebo effect with the expectation of an effect – the only possible, but also sufficient explanation for the effects of homeopathy according to the state of the art”. Homoeopathy is therefore at most “initial” for the placebo effect and a conditioning of the patient (after apparent previous successes), but the patient has a right to receive clear and verifiable information.

“We are pleased that both academies are clearly positioned. It is time for government and administrative authorities to take note of this,” says Dr Jérémy Descoux, cardiologist and president of the Fakemed collective, which emerged from the #NoFakeMed forum, which was launched last March. Descoux himself would have liked an even more concise discourse that would have placed the ethical implications of homeopathic prescriptions more at the centre of attention. “To prescribe and deliver homeopathy is to ultimately accept the premises of homeopathy; and when we offer homeopathy to a patient, we are at least ambiguous in our medical ethos towards him,” he says.

Some members of the Academy declared that they had voted against the communiqué – but not out of disagreement on the matter, but out of concern for a text that is still “ambiguous, given our duty to inform the authorities clearly and decisively”.

Well, do we still have to comment on this with regard to German health policy, including the fact that neither the organised medical profession nor other large organisations of the health care system have positioned themselves in a similar way? We are grateful for a multitude of individual voices from these circles who share our criticism of homeopathy, but “officially” we still state a vacuum. The homeopathy lobby uses this vacuum to gain political credit with its unproven claims about the effectiveness of the method and its meaningless appeals to the “popularity” in the general public. The latest activity is even a petition for the – purely insurance and legal – abolition of homeopathy tariffs at some insurance companies, which still affects 562 people throughout Germany. With this grotesque (you can’t call it any other way) about 77,000 signers have already been reached. It is doubtful that the majority of them can see through the background of this propagandistic effort. Will the addressees do it? We very much hope so. And we hope for more – for the return of reason and honesty in matters of homeopathy and health care.

Our appreciation and thanks go to the French skeptics, the small NoFakeMed community, who gave the impetus to the development in their country and helped the facts to victory despite violent hostilities. Let us now hope for the insight of German health policy before Germany makes a fool of itself as a country of homeopathy with eternal status!

… and they know what they are doing (and they do it anyway) – Pseudoscience with Academics

A guest contribution by Dr. phil. Susanne Dietz

There are existing, unfortunately, the Jakeszs, Hubers, Broers, Burkarts, Dahlkes, etc. of this world, who spread esoterically and spiritually veiled beliefs (in addition to the occasionally available professional competence in their field) and earn money with them.

Since I myself have been active in the academic sector and know that there is a very special commitment to knowledge, for a long time it has been an absurdity for me to experience how some intellectually crashed “scientists” or physicians consciously inflict damage on their field and mislead other people – against better knowledge and thus assumingly with lack of conscience.

The attitude of integer scientists to such revelation oaths of scientific ethos still consists too frequently in declining and saying: “I have better things to do than to deal with something like this. It’s clearly obvious that xy is off track.”

Sorry, but no, it is not obvious, not clearly recognizable for many. The average citizen recognizes only that here someone “of the discipline” confirms his world of faith and cites this again and again as testimonial for the conservation of his view of a “spiritual/esoteric world”. But he does not recognize (or is not willing to recognize) that this is only a fact-negative interpretation of reality. A reality which – in light of a research which hat advanced far in the 21st century – has little or nothing to do with esotericism, but with rules and laws which we often do not suit and are partly difficult to understand because they run contrary to our everyday thought structures and processes.

Such an indifferent attitude on the part of scientists of integrity makes it possible for laypersons to engage in pseudo-scientific cherry-picking for more or less base motives, and thus to give themselves a scientific touch that is de facto none. And to improve oneself pecuniarily with it – not exactly seldom.

Our world, our existence, our finiteness is not easy to understand and also not easy to accept. It is understandable to me that many therefore gather a view of the world that gives them pseudo security and well-being. But I cannot agree with that.
Because it doesn’t change anything that faith and knowledge are two pairs of boots and at the end of the day that what we know is preferable to what we believe – simply because it is KNOWLEDGE. And the nature of secure knowledge – such as the ineffectiveness of homeopathy beyond placebo – is its non-negotiability.

If, then, the scientific community does not publicly clearly reject and clarifies postulates from doctors like R. Jakesz, or J. Huber (by the way: these are doctors and by no means scientists) or D. Broers (whose imaginative academic career is more than questionable) and other esoterically inclined “colleagues” or hypotheses from pre-scientific times like those of Samuel Hahnemann, they commit in my eyes a sin of omission that damages the status and reputation of science.

I would wish therefore more and more people and committees from the scientific / academic field to take a clearer stand against such currents, just as the Münsteraner Kreis (German transdisciplinary scientific network against pseudomedicine in medical and non-medical practice) does against homeopathy.

We have the opportunity to obtain specific information: There are Cochrane, Higgs (Swiss scientific portal), Information Network Homeopathy, GWUP (German skeptics association), MaiLab (very popular scientific video blog), MedWatch (investigative project of misleading medical advertisement and information), and bloggers like Dr. Natalie Grams, Dr. Florian Aigner, Dr. Norbert Aust and many, many more. So there would be offers for every social and intellectual group to protect themselves against esotericism and pseudomedicine, their false assertions and manipulations – and thus to protect their own purses and health.

However, getting this information is a commitment to themselves – and is not always lived, not even by academics. What does that tell us? That the personal feeling of well-being counts more for some people than the awareness of the limits of the possible that indeed goes hand in hand with knowledge implying some inconveniences and imponderables that have to be endured in the real world. Even some students prefer to believe and repress, although they know better. And that’s where the fun ends.

Because academics know one thing:

Conspiracy theories of all kinds are lived errors of thought, which are clearly recognizable as such and can be named – and must also be named, so that the manifold damages, which can emanate from esoteric influences of all kinds, are contained. The responsibility lies with the scientific community of the 21st century, simply because it has the ability to do – and knows better.

Ergo: If academics, some doctors and some scientists make use of esotericism, this has a clear proximity to wilful intent and has to do with self-interest and manipulation of others. Consequently, I cannot resist assuming that it is fraud. The sentence: “They don’t know what they’re doing” doesn’t work.

At this point it is no longer a matter of desire – I EXPECT from academics to differentiate, clear conclusions (i.e. not to base them on simplistic cause-effect thinking) and to position themselves clearly against esotericism. No academic can tell me that he doesn’t know better – or at least could know better – if he did what he learned: research cleanly.

And why did I write this? I did my doctorate and the title is not just an academic achievement to me. Above all, I associate it with a clear academic ethos: I feel committed to interdisciplinary, clean, development-oriented acquisition of knowledge, preservation of knowledge in line with reality, and a faithful transfer of knowledge.

Dr. phil. Susanne Dietz


The above article first appeared in the blog “Draufgeschaut” by Dr. Susanne Dietz and is published here with the kind permission of the author.
Original article at http://dietz-trainings.com/#4#blog#30


Picture credits: Pixabay CC0

Open Letter by the GWUP Science Board and the INH to Melanie Huml, Secretary of State for Health, Bavaria

On 13 December 2018, the CSU parliamentary group in the Bavarian state parliament published a press release entitled “Naturopathy should be more firmly anchored at Bavarian universities”. This corresponded both with a similar parliamentary motion from the middle of the year and without doubt with the decision of the state government of Baden-Württemberg to establish a chair for “Naturopathy and Integrative Medicine” in Tübingen.

The press release makes it clear that it was much more about homeopathy than about naturopathy – the well-known misinterpretation of both terms was the basis for the whole meeting. Two representatives of homeopathy – the chairwoman of the Hahnemann Society and a clinical pratician from an institution of the LMU Munich who was co-financed by the Foundation for Nature and Medicine (formerly Carstens Foundation) – had spoken to the parliamentary group and apparently found an open ear for their lobbying for homeopathy (“so popular with people”). The Bavarian Minister of State for Health, Mrs. Melanie Huml, was also present.

This procedure caused the science advice of the GWUP and the INH to send the Minister of State and the parliamentary groups in the Bavarian federal state parliament the following open letter:

Mrs. Minister of State
Melanie Huml
Bavarian State Ministry of Health and Care
Haidenauplatz 1
81667 Munich, Germany


E-mail: poststelle@stmgp.bayern.de

(For information to the health policy spokespersons of all fractions and as an open letter on www.netzwerk-homoeopathie.info)

Homoeopathy in Health Care and Universities – CSU Group Press Release 13.12.2018

Dear Mrs. Minister of State,

From the above-mentioned press release of the CSU parliamentary group in the Bavarian state parliament we can see that there – in your presence – representatives of the pseudomethode “homoeopathy” have made representations in order to take representatives of Bavarian state politics for a promotion of their method with the aim of a stronger anchoring in health and higher education policy.

We, the science advice of the society for the scientific investigation of Parawissenschaften (GWUP), hold the goal direction conceived there into the eye both health and universitypolitically for missed.

The Hom?opathie is after world-wide scientific consensus a sham therapy, which could furnish neither ever a valid proof of efficacy, nor the incompatibility of its basic assumptions with scientifically in the best way occupied bases clear out. It is therefore our concern that homeopathy should no longer be given public credibility or a place in the public health system and that it should only be given a place in the medical-historical part of the curricula at universities.

A “therapy” that does not have more to show than the contextual effects (especially placebo) that occur with any kind of attention – even non-medical – cannot be justified as a medical therapy. It should also not be allowed to hide the fact that homeopathy is incorrectly offered and advertised by its representatives as specifically effective drug therapy.

To illustrate this internationally widely recognised position, we refer to the 2017 decision on homeopathy by EASAC, the advisory board of the Association of European Academies of Science:

“(We conclude from our research) that the claims on homeopathy are implausible and contrary to established scientific principles.
We acknowledge that a placebo effect may occur in individual patients, but we agree with earlier detailed studies and conclude that there are no known diseases for which there is robust and replicable evidence that homeopathy is effective beyond this placebo effect.

The international study situation is clear. In the meantime, ten systematic reviews, including those of homeopathy representatives, have shown that there is no evidence for any single indication of homeopathy. How could it be any different for a method that partly violates natural laws?

Even false arguments such as those repeatedly put forward in favour of homeopathy cannot change this. Neither is a “popularity” of homeopathy in the population a justification for unscientific and specifically ineffective methods in health care and university curricula, nor can the method be attributed to naturopathy. The latter is a downright “urban legend” that has been propagated by interested parties for decades.

This is probably the most deeply rooted error about homeopathy in the public. Homoeopathy is a conceivably “artificial” thought construct, which is based among other things on the esoteric ideas of the effect of “spiritual forces”. It thus contradicts the basic idea of naturopathy, which assumes a real effect of natural entities (light, air, sun, herbal extracts…).

We therefore feel compelled to raise our voices against any influence that could strengthen the position of homeopathy in public and political perception due to such misinformation, as the establishment of a chair would undoubtedly be. Rather, we are of the opinion that both a sustainable health system and the future higher education of physicians are dependent on the principles of evidence-based medicine and not to promote unscientific methods. Anything else would be a step backwards, a waste of resources and the opposite of a health policy that sees itself as modern.

Medicine is pragmatic and open to new findings, like any good science. This leads to – and has always led to – that methods, regardless of their origin or age, are included in the canon of medicine if they can prove a specific effectiveness according to scientific criteria. If they cannot do this, they are not entitled to the predicate “medicine” even with the attributes “alternative”, “complementary” or “integrative”. Furthermore, it should be warned against equating “naturopathy” with these terms.

In this context, the experience at the Medical University of Vienna, which had introduced homeopathy as a subject in order to teach a critical approach to the method, seems important to us. This has not proved successful, but has even turned into the opposite. The appearance of representatives of homeopathy as lecturers (and allegedly “experts”) led to the fact that in teaching the concrete application of the method instead of the scientific-critical view came to the fore. From our point of view a critical examination of the teachings of “alternative medicine” would be quite sufficient if one shows in the basic subjects to what extent such doctrines of salvation contradict the critical-rational scientific view inherent in the higher education system.

We point out that the MedUni Vienna recently drew the consequences from this and cancelled the homoeopathy lectures. University Rector Markus Meier distanced himself in this context from unscientific procedures and charlatanry. This is just one example – there is an increasingly critical approach to homeopathy internationally on a broad front, also and above all in EU partner countries.

From this point of view, in our opinion, the idea should also be seen that a chair is explicitly required for “integrative” or “complementary” medicine, as articulated in the motion for a resolution to the Bavarian Parliament of 10.07.2018 (Bill to Bavarian parliament 17/23310).

We would like to sensitize you as the minister of the Free State of Bavaria responsible for health policy to this topic. The intensified – in particular political – activities of the homoeopathic lobby, which obviously go back to the increasing, justified criticism of the homeopathic method, causes us concern. In our view, it would be fatal to hold on to, or even further strengthen, the pseudo-method of homeopathy, both in terms of good general health care and in terms of strengthening the population’s competence in health issues, which undoubtedly need to a great extent.

Thank you for your attention.

Yours sincerely,
the Science Council of the Society for the Scientific Investigation of Parasciences and the Information Network Homeopathy

Dr.-Ing. Norbert Aust
Prof. Dr. Michael Bach
Lydia Benecke
Prof. Dr. Dr. Ulrich Berger
Prof. Dr. Peter Brugger
Udo Endruscheit
Prof. Dr. Edzard Ernst
Thomas Fraps
Prof. Dr. Dittmar Graf
Dr. Natalie Grams.
Prof. Dr. Wolfgang Hell
Prof. Dr. Dieter B. Herrmann
Prof. Dr. Johannes Köbberling
Prof. Dr. Martin Lambeck
Dr. Nikil Mukerji
Dr. Rainer Rosenzweig
Prof. Dr. Dr. Gerhard Vollmer
Prof. Dr. Barbro Walker
Dr. Christian Weymayr
Dr. habil. Rainer Wolf

Spain – Homeopathy criticism now also government official

We had reported that on 22 June this year, the Madrid Medical Association, de facto the supreme medical association of Spain, issued a very clear declaration against the use of homeopathy in medical practice and referred to the medical obligations in the Code of Ethics of the Spanish Medical Profession.

Now this position is also government official: The Spanish health minister María Luisa Carcedo is quoted by the portal La Vanguardia: ” I will fight the pseudoscience, and homeopathy belongs to it.

The image shows Mrs Maris Luisa Carcedo, Spanish health minister, in her office room
Maria Luisa Carcedo, Spanish health minister

The decisive part of the interview with Minister Carcedo at La Vanguardia translated:

“Q: What about the healers, charlatans and miracle sellers?

A: We will take it up. We’ve had the prosecution take up the use of chlorine bleach as a cure for autism, and we will continue to do so with other things. As soon as we identify a situation that could pose a threat to public health, we will report it. It is our duty as health authorities to take action against those who want to do business at the expense of naivety or by exploiting the faith of part of the population.

Q: Do you include homeopathy in the pseudosciences?

A: Homeopathy is an “alternative therapy” that is not scientifically proven.

Q: More than 600 health professionals have appealed to you to respect their right (within the framework of freedom of therapy) to use homeopathy.

A: Health facilities have a duty to use products with proven efficacy, i.e. medicines that have undergone rigorous clinical trials and criteria. When homeopathic medicinal products provide scientific evidence, they are considered as such. This is not the case at present.

Q: Will you remove homeopathy from pharmacies, propose an increase in VAT … ? What are you going to do?

A: We are working with the Ministry of Science on a strategy to combat pseudosciences. Once this strategy is in place, we will present measures on individual methods/means, but it is clear that it is urgent to raise public awareness and show which products are useful and which are not, and to explain the damage that the decision for an alternative therapy can do.

Most remarkable. Even more noteworthy is a message from the French news channel Franceinfo (in France the discussion about homeopathy in health care is also intensively underway) on its homepage:

“The Spanish Ministry of Health has asked manufacturers (of homeopathic remedies) to subject their products to the same efficacy tests as other medicines.

The debate on homeopathy is cross-border. This is confirmed by Spain’s recent decision. The Spanish Ministry of Health now requires homeopathic manufacturers to subject their products to the same authorisation procedure as conventional medicines so that they can be indicated. If manufacturers refuse, they must indicate on the packaging that the therapeutic effect of the treatment has not been demonstrated. This is an opportunity for homeopathy to have its efficacy recognised. (sic!)”

So, words are very quickly followed by deeds.

In Germany, too, an indication may only be advertised in the case of a marketing authorisation, not a simple registration. However, the Spanish regulation still goes further: The “authorisation procedure” of Commission D at the German BfArM does not necessarily require a science-based authorisation procedure as with “normal” pharmaceutical medicinal products, but also makes an “authorisation” possible in an “internal consensus”. In addition, the positive labelling obligation as a therapeutically unproven means would clearly go beyond the German regulations. The Spanish rules are roughly equivalent to the stricter regulations of the FTC (the consumer protection authority) in the USA since 2017. Approvals based on scientifically valid proof of efficacy are unlikely. One considers: The demand for scientifically proven proofs of efficacy would – transferred to Germany – be tantamount to a lifting of the internal consensus and would make the reimbursability by statutory health insurance funds de facto invalid via the social code!

All we have left is our usual “Ceterum censeo”:

Where is the reaction of the German health system, politics, the medical profession and the other players in self-administration in the health system? To say it once again emphatically: The (scientific) debate about homeopathy is over! And it should be added: The health-political probably also soon – with exception of Germany?!?


Picture credits: La Vanguardia

Infinite Stories – once again to the Australian NHMRC’s 2015 review on homeopathy

The homoeopaths have long since discovered the title of Michael Ende’s well-known work “Die unendliche Geschichte” (“The Infinite Story”) as a quiet motto for themselves, as their constantly repeated “arguments” in favour of homeopathy prove. In a special context, they once again prove impressively that they are not about more than a constant warming up of the familiar on the hearth of rumours and half-truths.

In an article on “Nature and Medicine” Jens Behnke tries to keep the “serious accusations” against the review of the Australian health authority NHMRC, which have been floating freely in the homeopathic universe for more than two years, at operating temperature.

Let us remember that the Australian Health Authority’s review, conducted in rare cases with transparency and explicit involvement of the homeopathic side, is considered to be the most comprehensive study of the effectiveness of homeopathy ever. What was extremely badly received in some circles: Some time after the review was published in 2015, the information circulated that three homeopathic organisations from Australia had lodged a complaint against the NHMRC with Her Majesty’s Ombudsman (the “grievance box” for citizens’ concerns), complaining of “serious shortcomings” in the review. Significantly, the first news of this in Europe appeared in April 2016 (about eight months after the complaint had been lodged) in an institution that – quoting Prof. Ernst – had “often been at war with the truth”. The German Central Association of Homeopathic Physicians immediately circulated this report (original link expired, wording here) and, in particular, coined the word of “deception of the public” which has been recurring ever since.

The British Homeopathy Research Institute picked up this story in Europe, made itself, so to speak, the advocate of the matter and, according to its own statements, also prepared a “paper of evidence”. Since then, the ominous “deficiencies” of the review have been haunting the homoeopathic scene time and again and serve as arguments “against” the criticism of homoeopathy – now, once again, on “Nature and Medicine”.

Which is remarkable:

  • The text of the complaint was never made public,
  • the three complainants in Australia refuse to provide any information upon request (and have since erased any reference to the input from their websites),
  • the Ombudsman does not appear to be moving (a decision normally takes a maximum of three months, the filing date is August 2016 – which is only worth Mr Behnke a succinct final sentence on an alleged “ongoing procedure”) and
  • what has become known about the alleged “shortcomings” of the review has long since been invalidated.

Furthermore it was and is not recognizable in the least, what the known “complaints” are supposed to change in the result of the review – which in the end is no different than all other homeopathy reviews since 1991. Especially not different than the meanwhile three reviews of Robert H. Mathie, his sign employee of the British HRI. Just like the NHMRC, Mathie comes to the conclusion that there is no reliable evidence for homeopathic treatments.

We reported several times, contentwise here and here, to the history here, in detail in the Homöopedia. Compared to the status of these contributions, nothing has simply changed in the matter. Nevertheless, Mr. Behnke considers it necessary to remind the homeopathic fan community once again of the alleged “scandal” about the NHMRC review, which is slowly reminding us of a tabloid report.

In all this, the question is allowed: What is all this about? What is the point of reheating this rumour conglomerate, which has been kept warm on the stove of rumours for far too long? The intention to keep a “never ending story” alive here at the expense of critical voices is obvious. Recently, the – unexplained – fate of the complaint to the Australian Ombudsman has even been joined by a “petition” for “disclosure” of an alleged “first version” of the NHMRC review.

Incidentally, where does the homeopathic faction get its “findings” from on a “first version” of the review – a point apparently perceived as central – and what are the conclusions drawn from it? With the best will in the world, we do not know. In view of the “criticism” on this point, can we perhaps hope in the future for a section under “Nature and Medicine” in which all draft stages of Mr. Behnke’s articles will be published without interruption?

We find this – amazing. Because in the end all this shows a complete lack of interest in a real dissolution of the node protected by the homeopaths. Since when has a complaint to Her Majesty’s citizens’ grief box or a petition based on completely unproven rumours been a form of scientific debate?


Credits: Pixabay Creative Commons Lizenz CC0

Homeopathic study: The legend of the five times eight rats

Scientific Reports, quite a medical journal of good reputation, published on 10.09.2018 a paper entitled “Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS- mediated neuropathic pain [1] in rats“. The paper concludes that homeopathic high potencies based on Rhus toxicondendron (poison ivy, a traditional homeopathic remedy for pain symptoms) are at least as effective as Gabapentin in reducing pain and its molecular correlates (i.e. changes in the cellular signalling pathway), both in cell experiments (in vitro) and in animal experiments with rats.

Once again, parts of the homeopathic scene (associated with the exaggeration that the article appeared directly in “Nature“) announced the ultimate breakthrough in the effort to prove homeopathy “scientifically”. The Italian daily La Repubblica drew more attention to the matter with an article that was entranced by the statement:

The studies published in Scientific Reports confirm the effectiveness of homeopathic ultra-thin dilutions: Homeopathic medicine works and has statistically significant biological effects in alleviating neuropathic pain in rats. The effect of the dynamised dilutions was similar to that of Gabapentin […]”.

Note the lack of subjunctive, also the uncritical use of the term “statistically significant”, which as a statistical probability value does not allow conclusions to be drawn about the actual effect size, but which is suggested by the formulation. No reproach against a daily newspaper, but a suggestion for the public that is welcome in homeopathy and never corrected.

Proof of the efficacy of homeopathic high potencies – a bold statement, which must be considered in view of the contradiction to the homeopathic study situation according to the postulate “extraordinary claims require extraordinary proof”.

First of all, it is a completely unscientific conclusion that the paper “confirms the effectiveness of homeopathic ultra-thin dilutions”. A single study has no evidential value, but at most an indicative value, especially if it produces a highly unlikely result. Such a result must be replicated independently – preferably several times – before the described effect can be assumed with sufficient probability to be actually present and further scientific discussion can be initiated. All this is missing here.

A first glance shows that the in vivo tests on rats involved a total of 40 animals, which were divided into five test groups (n=8). This is astonishing with regard to the small number of test subjects. Should the “groundbreaking” result of the study be seriously based on the data of a verum group of eight animals? It can’t be inferred from the study that case number planning was carried out, highly required for intervention studies and representing a factor for the validity of the later results. Above all, if differences – as here – are to be determined in five differently parameterized groups (not only verum versus placebo or standard means), the careful determination of a sufficient and meaningful number of test objects is anything but trivial.

The publication also shows relatively easily identifiable uncleanliness / abnormalities, which the portal RESIS – Research Integrity Solutions – explains in a contribution by Enrico Bucci from Temple University in Philadelphia.

This starts with the fact that graphical representations of the in vitro results are partly incorrectly labeled, partly the same graphics were published for different parameters. Even more important is the fact that different effect/time diagrams (one for a cold test, one for a heat test in animal experiments) in all (!) displayed data points (“every experimental point”) correspond 1 : 1 (which is not immediately visible due to the differently selected axis sizes), so that RESIS draws the conclusion that something elementary cannot be correct here – random chance excluded. The raw data are not published – of course not. RESIS states: If there are really two different experiments, the shown coincidence of the data is simply impossible.

RESIS points out that these are not the only statistical-numerological inconsistencies and rightly believes that this is enough to discredit the validity of the study. Other portals and forums have also already taken a critical look at the work, e.g. PubPeer, where the panelists go into even more critical detail.

A particularly strange circumstance, in which journals usually tend to react very sensitively, is added. One of the authors of the Indian research group names a mail address that was demonstrably used in another work by an author of another name. This is not only completely unusual, but also doesn’t correspond in any way to good practice and integrity in publishing.

The pharmacology professor Silvio Garattini, who has discovered further methodological shortcomings on the sanita24 portal, concludes: “Homeopathy remains a method without scientific proof, and there is no change of that because of the alleged efficacy claimed by the studies published in Scientific Reports”.

We agree – and ask ourselves together with RESIS, how such a work can survive a peer review for a journal, also in view of the responsibility a journal has towards the scientific community and the public. This does not mean, however, that there can be no mistakes in scientific publishing, not at all. However, one can rely on the self-control of the scientific community, as in this case.

After all, the publication of Scientific Reports now carries an editor’s note that refers to the objections against the work and announces “appropriate editorial measures” “as soon as this matter has been clarified”. The quick-shot statement of the authors of the study that this may be all, but does not change the result seems to no longer satisfy the editors of Scientific Reports.


Supplement, 11.10.2018, 15:00 o’clock:

In the meantime, “Nature”, the “mother journal” of Scientific Reports, also reports on the matter. They are striving for neutrality, but with a rather critical undertone.


Supplement, 11.06.2019:

As Retraction Watch reports, the study has just been retracted by Scientific Reports. Scientific Reports published a comprehensive retraction note today (11.06.2019). It says:

Following publication, the journal received criticisms regarding the rationale of this study and the plausibility of its central conclusions. Expert advice was obtained, and the following issues were determined to undermine confidence in the reliability of the study.

The in vitro model does not support the main conclusion of the paper that Rhus Tox reduces pain. The qualitative and quantitative composition of the Rhus Tox extract is unknown. Figures 1G and 1H are duplicates; and figures 1I and 1J are duplicates. The majority of experimental points reported in figure 3 panel A are duplicated in figure 3 panel B. The collection, description, analysis and presentation of the behavioural data in Figure 3 is inadequate and cannot be relied upon.

As a result the editors are retracting the Article. The authors do not agree with the retraction.

In other words, everything that was already the main object of criticism eight months ago bears out. Nature resp. Scientific Reports must not be criticized for the period of time that has elapsed until the retraction, here is carefully examined and external neutral expert knowledge is used. All the more important is a complete retract. It is noteworthy that the main author of the study does not agree at all with the withdrawal and repeats his indications that it is a matter of “typos” and perhaps a little laxity in the publication. This can probably be seen as a mixture between massive confirmation bias and defensive strategy. More interesting, the question remains how such a work could “slip” through the peer review of a highly respected scientific publication.

Our conclusion:

Another case from the colourful wreath of the famous “many studies” that “undoubtedly prove the effectiveness of homeopathy”, as it is heard every day. The special thing about this case compared to many others is its deep fall: After all, it was loudly exclaimed as the ultimate proof of the “efficacy of homeopathic ultra-dilutions” and thus settled even a few floors above the well-known “results” of Jacques Benveniste and Luc Montagnier – these two had “only” postulated that they had found “differences” between pure solvent and homeopathic high potencies, not more. Here in the case of the “rat study” it was even up to “efficacy of homeopathy”…

Failed, once more. The lack of evidence of homeopathy is a fact; it has not been able to prove such evidence either for individual indications or as a method. With studies such as this, she at least continues to contribute to its discrediting. We rest our case.


 

1] ROS: Reactive Oxygene Species, known as “free radicals”. A mediating role of ROS in intra- and intercellular signalling processes is considered to be assured


Picture credits: Screenshot Scientific Reports online

France: In the fast lane in the case of homeopathy

The discussion about alternative medical methods in the health system, especially homeopathy, has quickly and apparently sustaining gained momentum in France.

We reported on the request of the National Council of the Medical Chamber of 22 March this year that the National Academy of Medical Sciences and the Ministry of Health should decide on the scientific relevance of “alternative and complementary methods, namely homeopathy”. This was flanked by the #FakeMed medical initiative, which strongly opposed pseudomedicine and all forms of its direct and indirect acceptance and promotion in health care.

The public discussion – also in the media – was intensively taken up afterwards. Health Minister Buzyn, who had expressed herself somewhat indifferently in public after the National Council of the Medical Chamber’s call, came under fire. But even the dissenting votes were not long in coming: The homeopathy lobby in France began to target the physicians’ association #FakeMed as the supposedly weakest link in the chain of critics and to try to shift the matter to both a professional and a legal level. The press, including leading newspapers such as Libération, Le Monde and Le Figaro, reported in part extensively.

Le Monde stated on 25 May 2018 that on 18 May the Academy of Medical Sciences, referring to its earlier opinion of 2004, described homeopathy as “a method developed two centuries ago on the basis of a priori concepts without any scientific basis”. This is not a direct verdict, but at least a very strong position setting, especially as an answer to the initiative of the Supreme Medical Chamber. Le Monde leaves no doubt that this verdict is tantamount to classifying homeopathy as “unscientific”. It might only be a side note that the Association of French Homeopathic Physicians, on the other hand, refers the EPI3 study financed by Boiron, on which we have already made comments here (a detailed discussion on EPI3 worth reading by Dr. Norbert Aust here).  Le Monde refers to this without digression as a “bad study” and quotes the pharmacology professor François Chast: “We are in the world of faith”.

Now Le Figaro reports that the National Council of the Medical Association has for the first time positioned itself – with a new version of a part of the medical code of honour of the chambers, which – as Le Figaro finds – “does not completely close the door for homeopathy”, probably because of the concessions in complementary measures (which we consider problematic). But pseudomedical means and methods are distinguished from scientific medicine here with unprecedented clarity. The text leaves no doubt that the Chamber does not place it at the discretion of doctors to use unproven methods instead of scientifically proven therapies. This Decision is given below in translated form:

Updating of the generally binding ethical framework by the National Council of the French Medical Chambers:


The medial use of the terms “alternative and complementary medicine”, in particular with regard to homeopathy, maintains an ambiguity which leads to confusion and interpretation disputes.

“Without questioning the freedom of critical or divergent opinions of each individual in the public sphere, the National Council of the Medical Association demands that the Medical Association should be able to take a more pro-active approach to the issue:

  • that the term ‘medicine’ as a prerequisite for any therapeutic procedure first includes a medical process of clinical diagnosis, which may be supplemented by additional examinations with the involvement of competent third parties;
  • that every physician must practice medicine according to scientifically gained knowledge and data both in the making of the diagnosis and in the therapy proposal;
  • that, since the data derived from science are essentially based on continuous development, controversy over a particular method of treatment, whether medical or not, must lead to an up-to-date, impartial and rigorous assessment of the medical service provided by the medical and scientific community.

The National Council therefore affirms that the medical care of a patient must meet the requirements of quality, safety and urgency of care.

A medically recommended treatment can in no case be an alternative to the knowledge gained from science and the state of the art, but it may include an adjuvant or complementary, medical or other prescription, which the doctor will decide to the best of his knowledge and belief in the individual situation after giving the patient fair, clear and appropriate information.

However, the National Council recalls that the Code of Medical Ethics prohibits the presentation of unattended treatment or therapy as safe and therapeutic effective.

This is the ethical framework that applies to the entire medical profession.

Text adopted by the plenary session of the National Council of the Medical Association on 14 June 2018 (original here)”


Despite the reviving resistance of the lobby, it will probably soon become densely for homeopathy in the French health care system. The polite and unmistakable positions of the highest medical association and the highest scientific authority give a “broad hint” in the direction of the Ministry of Health to draw the political consequences from this joint positioning of practical and research medicine.

We take note that the French medical profession represented by its supreme body has taken the initiative to distance itself from pseudomedical methods, in particular homeopathy. And the highest medical scientific authority in the country follows. And that, since in our country the Medical Association did not even consider it necessary to even debate or even vote on the previously intensively discussed abolition of the “additional medical designation of homeopathy”.

Once again we ask: What’s about us in Germany?


Picture credits: Pixabay Creative Commons License

France: Doctors’ collective #FakeMed – a crystal-clear statement on pseudomedicine

A clear message from the French medical profession

On Thursday 12 April 2018, French Health Minister Agnès Buzyn made a brief statement on French television on the question of the reimbursement of homeopathy costs by public health care.

She is ” in favour of maintaining the reimbursement of homeopathy, a medicine that probably has a placebo effect but does no harm. There is an ongoing evaluation of what we call complementary medicine. (…) If they (the methods of “complementary medicine”) continue to be useful (?) without being harmful, they will continue to be reimbursed by social security. (…) The French are attached to homeopathy, it probably (!) has a placebo effect. If she can prevent the use of toxic drugs (she obviously means pharmaceutical drugs…), I think that’s a gain for the general public, it doesn’t hurt”.

A remarkable statement for an oncologist, we note.

But what – at least in Germany – had not become quite so clear anywhere, that is the reason for this statement by Mrs. Buzyn – and we consider that far more significant than the statement itself.

She reacted to an intervention by the National Council of the Medical Chamber on 22 March this year, in which the latter called on the scientific (National Academy of Medical Sciences) and political institutions (Ministry of Health) to decide on the scientific relevance of “alternative and complementary methods, namely homeopathy” – with explicit reference to the statement of the EASAC of September 2017.

In this context, there is the activity of a group of doctors called “#FakeMed”, which entered public with a press release of 28 March 2018, which leaves nothing to be desired in terms of clarity on the subject of pseudomedicine, especially homeopathy, and makes a number of very concrete demands on the Medical Association. We note with great interest and agreement that forces are forming in our neighbouring country which no longer want to accept the continuing and expanding legitimacy of sham therapies, especially homeopathy, unchallenged.

Because of the importance of the declaration from France, we give a translation here in a slightly abbreviated form:

Press Release 28 March 2018:
Fierce debate on alternative practices
The collective #FakeMed proposes:

The Hippocratic Oath is one of the oldest known ethical obligations. He demands a doctor who cares for his patients just as honestly as he does in the best possible way.

These two obligations require a doctor to constantly improve his (medical) knowledge and to inform his patients about what he can reasonably offer and which treatments are unnecessary or contraindicated.

It is not a great art – and usually rewarding – to demonstrate one’s knowledge. But it is much more difficult to recognize and accept one’s limits. One can therefore easily be tempted to offer medical care without a scientific basis. This temptation has always been there. It was and is nourished by charlatans of all kinds who use the moral credit of their qualification and reputation to promote illusory therapies with illusory efficacy.

The commitment to honesty is enshrined in the ethical codes of the medical professions and in the French Health Code. These rules prohibit charlatanry and deception, they require the prescription and execution of treatments for which efficacy has been established. They prohibit the use of obscure products or products whose ingredients are not clearly declared. The National Council of the Medical Association is responsible for ensuring that its members do not promote practices for which there is no scientific proof of benefit or which may even be dangerous. The Council must ensure that doctors do not become commercial agents of unscrupulous industries. It must sanction those who have lost sight of the ethical requirements of their profession. Nevertheless, even in 2018, the Medical Association continues to tolerate practices that contradict its own code of ethics; public institutions promote such practices or even contribute to their funding.

We are now forced to respond clearly and forcefully to the spread of these esoteric practices and the growing public distrust of evidence-based medicine.

Homeopathy, like other so-called “alternative medicine”, is by no means scientific. Their methods are based on beliefs that promise a “wonderful, gentle and safe recovery”. In September 2017, the Scientific Council of the Academies of European Sciences (EASAC) published a report confirming the lack of effectiveness of homeopathy. In most developed countries, doctors are prohibited from prescribing homeopathic medicines.

The so-called “alternative” therapies are ineffective beyond the placebo effect and can even prove to be dangerous. They can be dangerous, because they treat irrelevant symptoms, over-medicate the population (conditioning for ingestion, treatment of pure disorders and mild illnesses not requiring treatment) and create the illusion that any situation can be solved with one of their “treatments”. They can be dangerous because they are based on a fundamental distrust of conventional medicine, as the unjustified polemic about vaccines shows. Finally, they can be dangerous because their application delays necessary diagnoses and treatments, which sometimes leads to dramatic consequences, especially in the treatment of serious diseases such as cancer.

These practices are also costly for the public purse. Training for such practices takes place in publicly funded structures. “Alternative” consultation hours are opened in hospitals at the expense of other medical services. Some of these treatments are reimbursed by the (loss-making) French health insurance. In France, 30 % of homeopathic medicinal products can be reimbursed (up to 90 % in the Alsace-Moselle region) and enjoy an exceptional status exempting them from proof of efficacy. This will finance a wealthy industry whose representatives have no hesitation in massively insulting those who criticise it (“There is a Ku Klux Klan against homeopathy,” said Christian Boiron, president of the world’s leading company in the industry, in the July 15, 2016 newspaper “Le Progrès”) or simply putting aside the undeniable scientific evidence requirements.

We want to distance ourselves comprehensively from these practices, which are neither scientific nor ethical, but irrational and dangerous.

We call on the French Medical Association and the French authorities to do everything in their power to implement these demands:

Doctors or health professionals are no longer allowed to further promote these “alternative medical” practices with their professional qualifications.
Homeopathy, mesotherapy or acupuncture diplomas are no longer recognised as medical degrees or qualifications.
It must be ensured that medical faculties or institutes providing health training may no longer issue diplomas for medical practice concerning methods without scientific proof of effectiveness.
No more reimbursement for health care, medications or treatments from disciplines that refuse a rigorous scientific assessment.
Promote initiatives aimed at providing information on the nature of alternative therapies, their harmful effects and their real efficacy.
All health professionals must abide by the ethical consequences associated with their profession, which necessarily result from the ineffectiveness and irrationality of pseudomedical methods, by refusing to carry out useless or ineffective treatments. Instead, they must offer treatments according to the recommendations of scientific societies and the latest scientific findings, demonstrate sincerity and honesty to their patients and offer empathetic listening instead of “alternative methods”.

End of quote.

We are very pleased that well-founded and decisive criticism of pseudomedicine, first and foremost of its “driving force” homeopathy, is now growing together into an international activity. For Germany, this means, as we have already stated on several occasions, increased pressure to act if we do not want to fall into a health policy offside internationally and, above all, within the EU.

German health policy, German Medical Association, medical profession: We’re waiting!


Read more on “Respectful Insolence”: https://respectfulinsolence.com/2018/04/13/fake-medicine-science-based-medicine-versus-homeopathy-france/


Picture credits: Screenshot fakemedecine.org

Open letter of the INH to the Siemens health insurance company (SBK)

In the context of the discussion on the reimbursement of homeopathy by statutory health insurance funds, the CEO of SBK drew attention to himself on Twitter with the “argument” that the small amount spent on homeopathy in his company was ultimately irrelevant “from an insurance point of view”. After this position had been contradicted on Twitter, SBK published a “Background Information: Homeopathy at the SBK” on its website and explicitly referred to this as part of the debate.

The Information Network Homeopathy feels compelled to comment on this publication with an open letter to SBK, which is given below:

 

To the
Siemens Company Health Insurance Fund (SBK)

By e-mail (info@sbk.org)

09.01.2018

Open letter of the information network Homöopathie on the publication of the SBK “Background information: Homeopathy at the Siemens company health insurance fund”

Ladies and Gentlemen,

your institution is one of the many health insurance companies that reimburse the costs of homeopathic treatment, which has been under discussion for some time. On Twitter, your CEO drew additional attention by putting forward the “peanuts” argument, i.e. the opinion that the low expenditure on homeopathy was not a significant part of the total expenditure anyway. This has already been contradicted on Twitter to the extent that this is not the only, not even a priority aspect in the demand that homeopathy no longer be reimbursed by health insurance funds.

Thereafter, you have clarified your point of view on homeopathic reimbursement (https://www.sbk.org/themen-standpunkte/hintergrundinformation-homoeopathie/ ), for which we would like to thank you first of all, because this enables a discourse. In the following we therefore deal with what you state in your clarification and orient ourselves on the headings of the various points as used in your publication:

1. To what extent does the Siemens Company Health Insurance Fund (SBK) cover treatment by homeopaths?

At this point, you inform us that you offer a separate optional tariff for homeopathic services (“pharmaceutical tariff”), which is actuarially self-supporting (i.e. the area of statutory services “for all” is not affected).

However, this information is incomplete.

According to the information on the SBK website, this only applies to the drug part, i.e. the globules; the medical treatment part of homeopathy is covered by a selective contract with the management company of the Central Association of Homeopathic Physicians as part of the statutory benefits, as is the case also with other health insurance funds, and thus also affects all insured persons who have no “interest” in homeopathy.

Even in the case that homeopathy would be a complete part of an optional tariff offer: The health insurance funds, especially the statutory ones, are important players in the health care system. We can certainly see that the legislator – unlike in the vast majority of industrialised countries – has not (yet) consistently implemented the orientation of public health towards evidence-based medicines and methods. Unfortunately, indeed. However, it cannot then be the task of the health insurance funds to undermine the confidence of their policyholders in rational medicine by offering a “vendor’s tray” of unscientific and ineffective methods, not even within the framework of a “voluntary tariff”, and thereby make a not insignificant contribution to the irrationality and hostility towards science that unfortunately prevails anyway. Apart from the fact that such offers, understood correctly, should actually be an ethical problem for health insurance companies.

One should bear in mind that the offer of unscientific methods with the authority of a statutory health insurance directly threatens the necessary further development of the health system in terms of performance, effectiveness and sustainability. Homeopathy is the “entry point” for the acceptance of further pseudomedical methods and often correlates with things like vaccination “skepticism” (perhaps less in the medical profession, but basically very well). Thus homeopathy is the dividing line beyond which there is a danger of further attention by patients to more dangerous pseudomedical methods. The responsibility of the statutory health insurance funds here is considerable. They should send a clear signal against such tendencies.

2. To what extent has the effectiveness of homeopathy been proven and what is SBK’s opinion of studies which consider homeopathic treatment to be free of effects?

“It is true that there are no scientific studies which clearly prove the efficacy of homeopathic medicinal products, but this does not mean that they couldn’t be effective.” This sentence in your publication opens the door to any arbitrariness and has nothing to do with a scientific-rational view on the problem. As the INH has just stated in its article “Scientists claim that homeopathy is impossible“, the “reverse conclusion” quoted by you is an absolute empty statement – simply because the ineffectiveness (impossibility) of something can in principle not be proved. Homoeopathy, however, has the scientifically conceivably highest improbability against itself that it could ever succeed in proving its effectiveness, let alone in explaining a mechanism of action that is compatible with the state of scientific knowledge. It is highly implausible, contradicts everyday experiences and is also incompatible with natural laws. Any explanatory model of homeopathy would require a massive revision of the valid and proven scientific view of the world. One cannot therefore – especially not as a health insurance company that should position itself credibly and seriously towards its policyholders – retreat to the Hamlet argument of “There is between heaven and earth…”.

In response, it should be sufficient to quote once again the summary of EASAC, the Advisory Board of the European Academies of Science:

“[We conclude]  that the claims for homeopathy are implausible and inconsistent with established scientific concepts.
We acknowledge that a placebo effect may appear in individual
patients but we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect.”

We conclude from our research that the claims about homeopathy are implausible and contrary to established scientific principles.
We recognize that individual patients may have a placebo effect, but we agree with previous detailed studies and conclude that there is no known disease for which there is robust and replicable evidence that homeopathy is effective beyond this placebo effect.”

This is the valid statement of the scientific world on homeopathy. The position you have formulated is thus untenable according to generally valid rational standards.

3. Why is it not a problem for the SBK to pay for an unprovable form of treatment (= homeopathy), while this is not possible with glasses, for example?

In fact, the statutory health insurance funds are not allowed under German social insurance law to replace homeopathy reimbursements with benefits for spectacles and higher grants for dental prostheses. This is well known to the Homeopathy Information Network and has been explained in detail in an article on its website. Nevertheless, we understand that this is often mentioned as a wish by policyholders who reject homeopathy.

Here, too, we encounter a fundamental misunderstanding in your argumentation when you refer to the possibility granted by law to include homeopathy in the catalogue of statuory benefits. As also mentioned in the article from the INH website quoted above, no health insurance company is forced to do so. You yourself write that reimbursement of the special therapeutic directions is “not excluded” – but that brings your consideration to an end. However, the Federal Social Court has already decided several times that the same criteria of “necessity, economic efficiency and expediency” must be applied to the means of special therapeutic directions (homeopathy, anthroposophy, phytotherapy) as to all other drugs. A relevant social-legal commentary states in agreement: “An advantage of drugs of the special therapy directions with the consequence that quality and effectiveness of the achievements do not correspond to the generally recognized conditions of the medical realizations … contradicts … the legal defaults”.

Already in point 2 it was stated that homeopathy, according to worldwide scientific judgement, contradicts established scientific principles and that there is no reliable and reproducible evidence of specific efficacy for any disease. Such a method can never meet the social security reimbursement requirements of “necessity, cost-effectiveness and expediency” – in our opinion, any health insurance fund that reimburses homeopathy by way of statutory benefits is moving on very thin ice under the current legal situation. In this context, we see interest in the fact that you describe homeopathy as an “unprovable form of treatment” in your statement.

One more word on the objection that even in the field of “normal” medicine, ineffective drugs and methods are paid for: A health insurance company shouldn’t do that either. However, the legal situation here is different: every statutory health insurance fund is for “normal” pharmaceutical drugs and therapeutic methods bound by the approval decisions of the Federal Joint Committee for Drugs and Medicines: What the Federal Joint Committee allows in this area is by law standard benefit of the statutory health insurance funds. It is inconclusive and unreasonable to play this fact off against the reimbursement of homeopathy, for which or against which each statuary insurance fund can decide for itself.

4. What are the annual costs of homeopathic treatments for the contributor?

Here we come to the initial argument, which has led users on Twitter to criticize the statement made by your CEO in this regard. It should suffice to point out that the exclusion of homeopathy from the British public health system was associated with the explicit statement of the NHS (National Health Service) that it was not – not even secondary – a matter of cost savings, but rather of “lack of clinical efficacy” and the resulting “low cost-effectiveness”, i.e. the non-existent cost-benefit ratio. Because: Nothing is always too expensive. From the statements of the other government agencies that removed homeopathy from their health systems in 2017 (Australia and Russia), we also couldn’t find that costs played a role, let alone a decisive one. The same shall apply to the statement of the Scientific Advisory Board of the European Academies of Sciences (EASAC) quoted above. Once more, it is about honesty and probity towards patients, credibility and the best possible care within the healthcare system. The statutory health insurance funds should play a pioneering role in this and not focus on the “wishes” of the insured, but on objectifiable standards. Nihil nocere – above all, do not harm, this old Hippocratic principle also applies here. And damage is – as explained – produced in many ways when statutory health insurers handle homeopathy with their authority as a proven effective method.

5. Why does the SBK not rather reduce the additional contribution (above regular taxes) for policyholders instead of further paying for homeopathic treatments?

The comments made under point 4 make it unnecessary to comment on this matter. Of course, we do not wish to endorse the ‘peanuts’ argument that EUR 1.1 million would not ultimately be important. Every euro of contributions from insured people must be used with due care in the interests of honesty towards the members. For example, the money would be very well spent on voluntary therapies for very rare diseases or similar cases. But this doesn’t affect our core concern.

Concluding remark

In principle, we oppose a strategy of health insurance companies to drive on a “competition” that has gone out of control with a “magic shop” full of things that are ineffective, but are “desired” by a certain clientele. The original idea of health policy, to initiate competition within the statuary insurance system via rationalisation effects and the level of contributions, has – as the merger of many health insurance funds makes clear – certainly had its results. However, we consider it fundamentally wrong to extend this to “competition for benefits” as a means of “catching customers”. We also consider it completely out of the question that ineffective and potentially dangerous methods such as homeopathy should be used for this purpose.

Yours sincerely

Information Network Homeopathy

Dr. Natalie Grams.
Dr. Norbert Aust
Dr. Christian Lübbers
Udo Endruscheit


 

Criticism on criticism on Homeopathy #1: “There is no evidence”

“There is no scientific evidence that homeopathy works.”

It is evident that homeopathy associations are dealing with critical arguments more intensively than before, e.g. with the work of the Information Network on Homeopathy (INH), a Germany-based team of doctors, pharmacists and other scientists with a skeptic’s approach on homeopathy. The Homeopathy Research Institute (HRI) on the other hand is a London-based organization that promotes more homeopathy research and tries to present homeopathy as scientifically proven.

On the HRI website, you can find a menu item “FAQ Homeopathy”, where they try to argue some of the key statements made by homeopathy critics. The articles are presented in English, German and a few other languages. These articles seem to be meant as templates to refute critics like us, and they were used for a small brochure by DHU (Deutsche Homöopathie Union), which will very likely be distributed at the various lectures and training sessions DHU promotes. DHU by their own account is the leading manufacturer of homeopathic preparations in Germany, offering and sponsoring trainings for doctors, pharmacists, midwives etc., not to forget their support for a lot of health-related websites targeted at a lay audience.

In a short series of articles, we want to examine how and why we homeopathy critics come to our conclusions, and what to think of the counter-arguments of homeopathy promoters. Our articles will be published in three text versions in German, which will be posted simultaneously on my blog, on the website of the INH, and at Susannchen; and if these pieces are received favorably, we will translate the most detailed version to English, too (this is what you see here).

Background: Why do we need scientific evidence of efficacy?

It certainly is of advantage if the doctor you consult for your complaints uses a therapy that they know is suitable for having a beneficial effect on your complaints. The therapist’s personal experience is certainly not enough to establish the efficacy of a therapy – not to mention the question of what happens to the patients on whom the experience is gathered by trial and error.

After all, it is not so easy to identify if a therapy is successful. One of the reasons is the pronounced tendency to self-healing, without which we would have gone extinct as a species long ago. This means that people (or animals or plants) become healthy and may recover even from life-threatening conditions without the help of medical interventions. Even in severe infectious diseases, there are people who survive them. If a doctor administers a therapy and the patient recovers afterwards, it is not certain that it was the therapy that caused the improvement. In pre-scientific times, for example, a lot of things were considered effective cures that today seem outright bizarre, like using the dust of church bells, crushed sketches of saints, or the fat and bones of executed criminals. Assuming that not all doctors from the Middle Ages up to the middle of the 19th century were charlatans, these people were convinced that they could actually heal with their cures, simply because they saw that patients became healthy afterwards, sometimes maybe even despite their interventions. The gathering of experience by the therapist may lead to misconceptions about the power of his cures.

It is obvious that medicine will improve – and has done so in the recent past – by identifying and discarding ineffective therapies. Doctors of today have a wide range of effective methods at their disposal, with data on the conditions they may be useful for, and the probabilities of success, or they can find out risks and benefits. Waiving evidence of efficacy would mean a step backwards into the pre-scientific era, when it was more or less a matter of good luck whether the doctor prescribed an actually helpful medicine.

Background: What is scientific evidence?

Evidence of efficacy requires a drug to show an effect in patients which is established by scientific experiments. Such trials are performed on a larger number of patients so that the results are not distorted by individual patients’ characteristics. The participants are randomly divided into two groups, one of which takes the drug to be tested (“verum group”), the other a placebo without any active substance (“control group”). It is important that the patients themselves are “blinded” and do not know whether or not they received the actual medication. The same holds for the doctors or caregivers, so that all the patients receive the same care. Scientifically sound evidence of efficacy will be based on such studies. This is the gold standard of evidence, the placebo-controlled, randomized, double-blinded clinical trial (PCT). This study design is suitable for the individualized therapy approach of homeopathy as well. There are a number of such studies (also systematic reviews of them): all subjects go through the initial consultation and a drug is prescribed. In the pharmacy either the prescribed drug or a placebo is randomly supplied to the patient.

If the remedy under test is effective, the outcomes between the two groups will differ, but it is necessary to determine whether the difference observed really is likely to be caused by the drug. Even in a control group that actually remains untreated, improvements occur which are evidently not caused by the drug. This may be due to the self-healing powers of the immune system, natural self-limiting disease propagation, or the often-cited placebo effect, in which the patient’s expectations and trust in the cure cause an improvement in the patient’s condition, or at least they strongly promote the improvement.

Since both the placebo and verum group usually show improvements in symptoms, the result must be evaluated with statistical methods to check if different outcomes between the groups may have been caused by chance alone, due to allocation of the patients to their groups. So the result of a clinical study is not a clear yes-or-no. Only if the probability that the difference between the groups has been caused by chance is below a scientifically agreed threshold of 5%, it is concluded that the drug may have caused the difference, and hence may be having an effect.

However, even ineffective drugs may produce improbable results occasionally, that look like a telltale sign of a less than 5% probability, but still are a product of mere chance alone. Therefore a single positive study cannot be a scientific “proof”, but it must be replicated independently – at least by a different team of researchers with a different set of patients. Almost certainly there will be fluctuations during replications, some may even yield quite different results. To arrive at a final conclusion from a set of trials, a systematic review is required, in which all published studies on a particular cure for a given clinical condition are examined and an overall result is determined. It is important that all available studies are taken into consideration, not only the positive ones. Such a review would then be considered reliable evidence if the data basis is adequate – but still would not be considered an eternal “proof” in the sense that it’s impossible for this conclusion to be wrong. Individual studies can only provide a more or less strong indication of potential efficacy.

To note: Even if a systematic review would yield positive findings for homeopathy, this could establish the effectiveness of homeopathy for the specific condition under investigation only. No study or review can prove the efficacy of homeopathy in general.

Background: Why are case studies and individual reports not proof of an effect?

Due to the self-healing powers already referred to, which certainly exist at different levels in different individuals, there are always people who can improve even in serious conditions without any cure – people that can survive the most serious infectious diseases or even cancer, for example. There may be only a few of them, but they do exist. “Mortality of 80% when untreated” indicates that 20% of untreated people survive. As a result, there will always be patients who can report that they have (supposedly) been cured because of this or that therapy, or because of whatever they did – like prayer, or promising to be good in the future, or erecting a church, or whatever –, even if it did not contribute anything real to progress their recovery. On the other hand, there always will be people who do not respond to an otherwise effective treatment and who may die from a disease despite a usually successful cure.

Consider the results of a recent study on alternative medical treatment of cancer. The results seven years after diagnosis and after alternative or conventional treatment looked like this (data transformed to meaningful numbers and entities) [1]:

Patients after seven years Alternative Therapy Conventional Therapy
Survived 144 208
Deceased 136 72

From the 144 patients who survived for seven years under the alternative therapy, certainly a whole lot of case studies can be derived, all of which indicate the success of alternative medicine. You may even refer to the 72 patients that died under conventional cancer therapy to stress the point of alleged superior performance of the alternative therapy.

Even if positive cases under conventional therapy may find their way into case studies as well: what for sure will remain unnoticed is the fact that considerably more of the conventionally treated patients survived than under alternative treatment. And for sure there will be very few case studies of the deaths under alternative treatment, if any at all. At least the author of this piece is not aware of any such case studies from alternative medicine that had a negative outcome. But this does not mean, they do not exist – only that the therapist is unwilling to share his failure.

The fact that considerably more patients under alternative medicine died than in the conventional group is completely lost in case studies. After all, those who have died in excess are lying in their graves and do not boast their failure in talk shows, books, or interviews.

After all, it is hardly to be expected that therapists will publish their failures in case studies and disseminate them as widely as their positive results advertising them with the same rigor: A very important point to assess the effectiveness of a therapy is therefore missing. That would be like counting only the goals that your team scored – forgetting they received a lot more from their opponents.

In a nutshell: Case studies of successful treatments, even in large numbers, only show that there are a number of people who recover under the alternative treatment – and nothing else. There is no denying that these cases exist, but this is no indication if there might be many more patients who did not fare so well. But the real patients and their therapists would need some information on the chances of recovery – which includes the ratio of failed treatments.

Facts: What evidence is available?

HRI states that by the end of 2014 there have been 189 randomized controlled clinical studies, 104 of which compared homeopathy with placebo. Of these, 43 allegedly showed positive results for homeopathy, 5 were negative, and 56 were “unclear” – which brings them to the conclusion, that there are more positive than negative studies which is considered to indicate some efficacy of homeopathy.

What’s strange: Apparently, the authors of this HRI article consider the fact that the efficacy of a homeopathic remedy is “unclear”, that is it cannot be reliably distinguished from a placebo, i. e. it works in the same way as a piece of sugar, is not a negative result. That’s quite amazing. One wonders whether patients who spend their money on an ineffective, sugar-like remedy and perhaps hope for an improvement of their condition would see it the same way?

In any case, by no means the majority of studies have yielded positive results.

The ratio of more than 40% of successful studies looks impressive at first, but is misleading still.

First of all, because of the probability of the false-positive results of 5%, it is to be expected that there will be some positive studies, which are nevertheless random results.

Then there is the so-called publication bias, also known as file-drawer effect: the fact that positive results are readily and willingly published, whereas negative ones tend to remain in the file-drawer forever, never to be spoken or heard of again.

In addition, there are shortcomings in the published studies, such as inadequate blinding of the test subjects, or inappropriate methods of evaluation, which can lead to the results being skewed in a positive direction, and a lot more issues that render a study of poor quality. All of this increases the proportion of positive studies in the database.

As already explained, evidence for efficacy of homeopathy for any indication can only be derived if studies have been independently repeated and the results of all of them pooled in a systematic review. It goes without saying that this review should cover the entire available evidence, not just the positive results.

Such reviews do exist indeed. Starting with a work by Kleijnen et al. from 1991 [2] to the recent work by Mathie et al. in 2019 [3], there are twelve major reviews, which examine homeopathy across indications, and all more or less yield the same result: On first glance the evidence in total may indicate that there could be small effects above placebo, but the quality of the available studies is so poor that no reliable conclusions can be drawn. Neither for homeopathy in general nor for any indication is there reliable evidence that homeopathy outperforms placebo. The largest review published so far, the one by the Australian Ministry of Health in 2015, comes to this conclusion [4], as does Mathie whose affiliation is the Homeopathy Research Institute.

Conclusion
There is in fact no scientific evidence that homeopathy works.

 

What homeopaths tell us about it

The HRI muses that 43% of positive studies are the same ratio of success as in conventional medicine. So what? What is such a comparison supposed to show? If I want to compare my literary skills with those of Charles Dickens, it is certainly not helpful to ascertain that my ratio of torn and discarded pages may be the same as his. It would be important to compare what remains – in terms of quality of course, not quantity. Or does this article sound anything like David Copperfield?

Such an approach based on the motto “Who won?” is absurd. In addition, homeopathic studies are confirmation research, i. e. the search for a positive result. In the lore of homeopathy there is no need for clinical trials, and in Europe homeopathic preparations are exempt from providing data on evidence in the recognition process to become a medicine to be sold in pharmacies only. This may well lead to an increased confirmation bias. Compared to real research you should expect the positive evidence might be expected to be exaggerated due to lack of scientific skepticism. Taking into account the strong claim of homeopaths that their treatment is on the same level as conventional medicine – if not better –, you should expect a much more convincing database of positive evidence than there is available today.  You should expect the homeopaths to take great pains to explain how the negative results came about; their ratio of successful trials looks very poor for such a powerful treatment.

Another aspect is raised, namely the lack of public funding for research into homeopathy. Please note the following: DHU belongs to the Dr. Willmar Schwabe group, like the largest manufacturer of homeopathic medicines in Austria, Peintner. According to their website, Schwabe sells products for 900 million euros per year and spends a meager 32 million euros on research. Typical research spending for the pharmaceutical industry is about 14%, for Schwabe this would be around 125 million euros. There seems a lot of potential room for further research funding. [5, 6].

Quintessence:

We critics of homeopathy maintain our position: there is no scientific evidence for an effect of homeopathy that exceeds placebo – and this is not due to the lack of money that could be invested in research.

 


Dr.-Ing. Norbert Aust,
Informationsnetzwerk Homöopathie (INH)
drnorbertaust@t-online .de

Thanks to Udo Endruscheit and Sven Rudloff for their support in preparing this english version. 


Sources / References:

  1. Johnson SB, Park HS, Gross CP, Yu JB: ”Use on Alternative Medicine for Cancer and its Impact on Survival”; JNCI J Natl Cancer Inst (2018) 110(1): djx145, doi: 10.1093/jnci/djx145 [https://academic.oup.com/jnci/article/doi/10.1093/jnci/djx145/4064136]
  2. Kleijnen J, Knipschild P, ter Riet G: “Clinical trials of homeopathy“, BMJ 1991; 302:316-23, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1668980/pdf/bmj00112-0022.pdf]
  3. Mathie RT et al.: Systematic Review and Meta-Analysis of Randomised, Other-than-Placebo Controlled, Trials of Non-Individualised Homeopathic Treatment.
  4. National Health and Medical Research Council. 2015. “NHMRC Statement on Homeopathy“, Canberra: NHMRC 2015  [https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02_nhmrc_statement_homeopathy.pdf]
  5. NN: „Statistics 2015 – Die Arzneimittelindustrie in Deutschland“, vfa-Brochure, S. 10, [https://www.vfa.de/embed/statistics-2015.pdf]
  6. Website Fa. Wilmar Schwabe, Facts and Figures per December 31, 2016 [https://www.schwabepharma.com/about-us/facts-figures/]

Update, May 2019: Supplemented by the latest study situation (Mathie 2019)


Picture credits: Fotolia_130625327_XS

Criticism on criticism on Homeopathy #2: “Missing positive trials”

 

The second part of our series about the “homeopathic criticism on criticism on homeopathy” covers why critics conclude that there is no reliable evidence for the efficacy of homeopathy beyond placebo.

„There is not a single good quality trial showing homeopathy works“

This is how the UK-based Homeopathic Research Institute (HRI) cites their critics on their website “Homeopathy FAQs” [1]. The above statement is absolutely correct, though somewhat trivial: One single study never can “show” that “homeopathy” works. At best, if a trial is of good quality, it may give an indication that homeopathy might be more effective than placebo in the one medical condition that was tested in the trial, but not more. For reasons why this is the case, please refer to our previous article “Criticism on criticism on Homeopathy Pt.1: There is no evidence” [2].

“There is no reliable evidence that homeopathy is more effective than placebo in any clinical condition“

This is the correct, no longer trivial statement of the critics on homeopathy, for it can be falsified by presenting reliable evidence for efficacy in the case of a single clinical condition only. Though HRI does not explicitly refer to the proper wording, it is clear they want to argue against the notion of non-existing positive results. To identify examples of clinical conditions where homeopathy is shown as effective beyond placebo is a proper way in the attempt to contradict us critics, for the existence of just one such condition would prove the statement wrong.

Background: What is reliable evidence?

State-of-the-art evidence would include clinical trials designed as placebo-controlled double-blinded randomized clinical trials (RCT), which we explained comprehensively in part 1 of this series [2].

However, one single study alone cannot be reliable evidence. Evidence requires at least that a study has been replicated independently, i. e. repeated with other patients by another independent research team, which came to similar results. Since it is usually not easy to evaluate and pool different studies, a systematic review is required to build a solid conclusion, in which all available studies are considered, not just the most favorable ones.

To properly appreciate a study it is essential to consider its quality, which indicates how reliable it resembles reality. This is done by checking whether some essential criteria are met. Current procedure is to check for the “risk of bias” as set forth by the Cochrane Collaboration [3]. Eventually, a study is rated to be of “low”, “unclear” or “high” risk of bias from what could be expected in the real world. Naturally, a low risk would indicate a good quality study, a high risk of bias a poor one.

To determine this risk of bias, researchers refer to a list of criteria mainly to assess if the procedures for blinding and randomization were sufficient, and if the results of all the patients are reported completely. Authors must disclose these items in their report, otherwise the study is considered to be of unclear risk of bias, which indicates neither good nor bad quality.

It should be evident that reliable evidence can consist of low risk of bias studies only, where chances are good that the result is for real. If, for example, blinding of patients was insufficient, then patients in the placebo group, who now know they did not receive a possibly active treatment, might not attribute any positive development to the treatment and might not report it. On the other hand, patients who know of having received the (possibly) active drug, might be on a lookout for any positive development and might overrate its impact. Especially in studies on homeopathy, many of the data are assessed by asking for a patient’s subjective ratings of their experience, which renders it very important that the patient is “unbiased” in filling out the questionnaire or in answering the interviewers.

Not only insufficient blinding is likely to distort the outcome of a clinical study in favor of homeopathy. As evidence indicates, on average any shortcoming in quality does the same and yields more positive results [3, Chapter 8.5]

In a nutshell:

Reliable evidence consists of a number of independently replicated RCTs, a systematic review checking the quality of all the relevant studies in the field, and compiling a conclusion which resembles the best guess at what is to be expected in the real world.

HRI does quite acknowledge that more research is needed to replicate the available “promising” studies and that this has not yet been done sufficiently. But what does that mean for the question of existing evidence? Well, an independent replication may or may not yield similar results as before, which gives way to a somewhat unclear position: Homeopaths are certainly wrong assuming that future replications will surely corroborate the original findings, while critics cannot prove that successful replications are impossible. Consequently, the statement “there is no reliable evidence” is an absolutely correct scientific statement, not excluding that this could change in the future. This is in fact the strongest possible reservation against the evidence base in homeopathy, in accordance with todays sciences self-perception – which should not be misunderstood as assertion about that this might not happen in the future.

What good evidence is available?

However, the HRI points out positive studies on homeopathy for some clinical conditions, in order to refute the above statement of the critics. Here is a short overview:

(1) Individualized homeopathic treatment of childhood diarrhea

There is a review by Jacobs et al. where three studies with herself as lead author are considered [4]. All studies were performed under the same protocol. So, this is certainly not a summary of independent replications. Any shortcomings in study design or protocol or even handling might go unnoticed.

In the review of Jacobs, three studies are considered:

Jacobs (1993) with a small number of children in Nicaragua [5],
Jacobs (1994) with a larger number of children also in Nicaragua [6],
Jacobs (2000) with children in Nepal [7].

In the CORE-Hom database of the Carstens-Foundation [8] only one more study for the same clinical condition is listed (Cadena (1991)), but the record indicates that no statistical evaluation was included in that particular study. The three studies above thus completely reflects the available evidence for the homeopathic treatment of childhood diarrhea.

An assessment of the quality of these studies can be found in the systematic review on individualized homeopathy by Mathie et al. [9]: Only the paper from 1994 was rated “unclear risk of bias”, while the other two were rated as “high risk of bias”, that is, of poor quality.

Conclusion: Due to the poor quality of the available studies, there is no reliable evidence for a homeopathic treatment of childhood diarrhea. Note: There is a fourth paper on childhood diarrhea by the same author using non-individualized homeopathy, which could not show any advantage of homeopathy either.

(2) Individualized homeopathic treatment of otitis media in children

The HRI cites two works here:

Jacobs (2001) [10]
In the review of Mathie (2014), this study is rated as of medium quality only [9]. In this preliminary study the results were not statistically significant, some minor advantages of homeopathy beyond placebo occurred but are likely to be attributed to random effects. In order to prove this effect, the authors wrote that a considerably larger study would be required (243 evaluated subjects, not only 72, as in this paper).

Sinha (2012) [11]
According to the authors of this study, this was only a pilot study that was carried out without any blinding – which prevents it from being reliable. This study was not yet subject to quality assessment in any systematic review. But even on first glance the study looks very doubtful: The authors compared homeopathy to standard treatment, which, in this setting in India, consisted in 95 % of the cases of the use of antibiotics, which most authors consider useless as the condition is mostly caused by viral infection. Also, they looked at a condition which according to German guidelines remits in 78% of the cases within two to seven days. This corresponds very poorly with the study’s timeline of observations at 3, 7, 14, and 21 days after diagnosis, whereby the first three days remained without intervention – which renders the only statistically significant result occurring at day three meaningless.

A review performed by the Australian Ministry of Health lists another study, Harrison (1999), which was judged to be of poor quality only [21].

The CORE-Hom database lists another PCT [8]. In this work by Mössinger (1985) the data of 38 children were analyzed. According to the database, no significant advantage beyond placebo was achieved.

Conclusion: There is not a single high-quality study here that would have produced a reliable positive result.

(3) Use of the homeopathic remedy Galphimia glauca against hay fever

Here the HRI refers to a work by Wiesenauer (1996), which represents a systematic review of essentially his own work on this subject [13]. He comes to a positive conclusion, not shared by other authors:

Linde (1997) investigates four works by Wiesenauer [14], which pooled together show a positive effect (odds ratio 2.03 in favor of homeopathy), although Linde concludes that he has found no indication for which there is sufficient evidence that homeopathy is effective beyond placebo. Obviously, this statement is not based on the figures alone but allows for the questionable quality of the studies.

Mathie in his systematic review of non-individualized homeopathy found insufficient quality in three of Wiesenauer’s studies (1 medium, 2 poor) and has included two other works in his meta-analysis of hay fever (”allergic rhinitis“) [15]. He also concludes that there is a lack of reliable evidence for the efficacy of homeopathy for any clinical condition.

The review by the Australian Ministry of Health comes to the same conclusion.

Conclusion: In contrast to the author of the one review cited by HRI, all other reviews agree that there is no reliable evidence. Since the lead author of the studies himself is probably more prone to be biased in favor of his results, the negative assessment from the other three reviews appears more solid.

(4) Use of pollen C30 as an isopathic remedy against hay fever

HRI cites a study by Reilly (1986) [16], which is indeed considered by most reviewers to be of high quality – except for Mathie (2017). He considers this paper of poor quality due to unclear reporting of the blinding and incomplete reporting of results [15].

Even if we admitted that this study was rated as good quality by most reviewers and yielded a positive result, there is still no replication of this promising work for homeopathy – for more than 30 years now. Why this is the case is open to speculation: it is impossible to judge whether an attempt to replicate the positive result has failed or not.

(5) Use of the homeopathic remedy Oscillococcinum for the treatment of influenza

The HRI indicates a study in which Oscillococcinum is supposed to be effective against influenza. This work by Mathie (2012) is a Cochrane review, i. e. a systematic review carried out according to strict rules [17] and, if the statement of the HRI would apply, should actually be counted as reliable evidence.

First of all, it was not influenza that was treated, but influenza-like infections, i. e. common colds. Then Mathie, who works for the Homeopathy Research Institute himself and for sure is not an opponent of homeopathy, comes to the conclusion:

“There is not enough evidence to draw solid conclusions about Oscillococcinum for the prevention or treatment of influenza or flu-related infections. Our results do not exclude the possibility that Oscillococcinum may have a useful clinical effect, because of the low quality of the studies in question, the evidence is not convincing.“

Well, a reliable proof of thoroughly positive effects looks different.

(6) Use of the homeopathic complex remedy Vertigoheel against vertigo

The paper by Schneider et al. is a review of four papers that examined the remedy Vertigoheel for the treatment of vertigo in comparison to other therapies [18]. Only two of the papers (Weiser 1998 [19] and Issing 2004 [20]) were randomized controlled studies. Unfortunately, these works are not included in Mathie’s reviews. In the review of the NHMRC, the work of Issing is rated at medium to high risk of bias, while the work of Weiser is rated at medium risk [21].

In all four papers, it was found that the results obtained with Vertigoheel did not differ from the conventional therapies – although this is only meaningful if these conventional treatments are effective beyond placebo themselves and have been applied properly.

If Vertigoheel actually was effective, however, this is a point more against the teaching of homeopathy than in favor. The prescription was not based on an individual assessment of similarity between symptoms and the drug’s “remedy-picture”, which should be established in a detailed first session. Instead it was based on the not very specific diagnosis of ”dizziness“, which can have a large variety of different causes. Secondly, Vertigoheel is a complex remedy of four different homeopathic remedies, which, according to homeopathic teachings, at least makes it very difficult to achieve healing. It should be noted that Heel’s complex remedies are not considered to be homoeopathic drugs, but should act in accordance with homotoxicology, a doctrine of salvation based on the alleged detoxification of the body and not on influencing the alleged vital force as in homeopathy [22].

Conclusion: Once again there is no reliable evidence of homeopathy as an effective treatment for this condition. Based on the quality of the relevant studies, the results should not be considered as valid. But if homeopaths insist on their validity, then the studies rather indicate that the foundations of homeopathy are wrong.

In summary

At best, there is only a single good study that showed some benefit of homeopathy – Reilly – amongst all the examples given by the HRI. It is unclear how many clinical conditions were considered in PCTs of homeopathy, as many different figures are given: The UK-based Faculty of Homeopathy says 61 conditions, 85 conditions were considered in the review by the Australian Ministry of Health, and the German CORE-Hom database lists more than 50 indications under the letter “A” alone. With the standard risk of an Type I error (false positive result) of 5%, it is to be expected that there are a few studies that are of good quality and in favor of homeopathy. In this respect, Reilly’s study seems more the exception proving the rule (which is further mitigated by the fact that this work has not been reproduced for decades – or has been reproduced with a negative result, but this never came to be published – we don’t know that).

Clinical relevance

It is well known that homeopathy raises strong claims of its efficacy:

“A carefully selected homeopathic medicine can relieve quickly, safely, gently and without side-effects the symptoms of severe, acute and chronic complaints, such as migraine, neurodermitis, bronchial asthma, colitis, rheumatism and many other diseases. This also applies to acute conditions of a bacterial or viral origin.” [23]

This is what the president of the German Central Association of Homeopathic Doctors, essentially the highest German homeopath, writes on her practice homepage. Thus the patient who decides in favor of homeopathic therapy can expect that their state of health will improve substantially more and/or faster than if they hadn’t done anything at all. Therefore, studies of homeopathy should not only result in a statistically significant benefit beyond placebo; this would only mean that the effect is just strong enough to be recognized in sophisticated statistical analysis and might be of no practical benefit. But it should also be clinically relevant, i. e. show a noticeable and substantial improvement for the patient.

The clinical relevance in a study results from two aspects: On one hand, if the study authors have chosen a characteristic as main outcome measure that meets the expectations of the patient well enough for them to judge the treatment as a success or not. On the other hand, however, the difference must also be substantial, so the benefit should be of a magnitude the patient can really experience. Irrespective of the quality of the studies cited by the HRI – i. e. their credibility – here is a short look into what their results indicate regarding clinical relevance:

Childhood diarrhea:

Jacobs chooses the number of unformed stoolson the third day of treatment. At this point in time, this figure has decreased significantly in both study groups, from an average of 7.7 events per day to 3.1 in the control group and to 2.1 under homeopathic treatment. This advantage of only one event per day disappeared completely on day 4:2.0 events in the homeopathic group, 2.1 under placebo, i. e. hardly distinguishable. By the way: the third day is the only day with a significant result. The difference of one event on day three alone certainly is some relief for the family – but is it a substantial improvement over placebo?

Otitis media:

Jacobs‘ placebo-controlled study did not even yield a significant benefit, so there is no need to worry about clinical relevance.

Galphimia glauca in hay fever:

Two weeks after the start of treatment, 34 (of 41) patients in the homeopathy group were free of symptoms or experienced significant relief, in the control group it was 21 (of 45) patients. After four weeks, 30 (of only remaining 37) patients in the homeopathy group were free of symptoms or had a significant improvement. In the control group, it was 20 (of only 35) patients [24]. Further out, only relative figures from other works are available, which do not permit an assessment of relevance.

Whether this will show a substantial effect remains to be seen.

Pollen C30 against hay fever:

In Reilly’s work, the severity of hay fever symptoms was determined by the patients themselves ever day, given on a visual analogue scale ranging from 0 to 100 (0 = no symptoms at all, 100 = extremely bad). At the beginning, the mean value in both groups was about 45, but with a big variance. The same showed in the changes: In the homeopathy group, scores ranged from an improvement by 80 points to a deterioration by 50 points. Practically the same thing happened in the control group: The range was from an improvement by 80 points to a deterioration by 60 points. If the patients had compared their results, they would not have been able to identify individual patients whose results were so good or so bad as to clearly identify them to be of the homeopathy or control group. The higher mean improvement of 17.1 points in homeopathy compared to only 2.1 points in the control group is a difference that no patient can actually perceive.

Oscillococcinum for influenza:

This is the graph on Ferley's work which is discussed in this paragraphIn the two works by Ferley [25] and Papp [26] the success of the therapy is judged by the recovery rate on the second day after start of treatment. In fact, there is a statistically significant advantage of the homeopathy group – which is only present on this very day, neither the day before nor the day after. This is illustrated in the graphic, which also shows how „radical“ homeopathy has been.

The graph shows the results of Ferley’s work [25], which were converted to even numbers of participants in both groups. From day 1 to day 2, the homeopathy group has achieved a small advantage indeed, but the parallel curves show otherwise that the recovery rates are practically the same.

The average duration of the illness was reduced only by about 6 hours, which should be meaningless, especially at night, if they happen while the patient is asleep. This is certainly not the therapeutic success that patients would want to achieve.

Vertigoheel against dizziness:

No comparison with placebo possible, as the drug was not compared with placebo but with other therapies.

In summary:

Even if one ignores the lack of credibility of the studies and takes a look at the results alone, the assertion that homeopathy can quickly achieve a drastic improvement of the patient’s situation is by no means apparent in the studies quoted by the HRI. At best, there is one potential use, Galphimia glauca in hay fever, but this would still have to be verified on the basis of independent study replications.

Quintessence

The works presented by the HRI as ”good studies“do not satisfy this claim – by far. Studies have been judged to be of inadequate quality in existing reviews of homeopathy. At best, there could be just one indication where a good study shows a positive result. This promising work on isopathy in hay fever has not been replicated for thirty years now, however. In addition, for statistical reasons, it is to be expected that even good studies will occasionally yield positive results, due to the risk of a Type I error (probability for false-positive results).

The clinical effects, on the other hand, are relatively minor and in no way support the claim of homeopathy to be a thoroughly effective therapy, helping patients to a substantial degree.

The HRI’s arguments against ”There is not a single good quality trial showing homeopathy works“ is thus not supported by evidence.


Acknowledgement:

This article is published here with kind permission of the author, Dr. Norbert Aust. The author would like to thank Udo Endruscheit and Sven Rudloff for their help with this English version of his original blog-article: http://www.beweisaufnahme-homoeopathie.de/?p=3312


References

[1] NN.: „There isn’t a single good quality trial showing homeopathy works“, webpage of the Homeopathy Research Institute, checked 01.12.2017, Link

[2] Aust, N: Criticism on criticism on Homeopathy Pt. 1: There is no evidence, blog-article (Link) and INH website (Link)

[3] Higgins JPT, Green S.: Cochrane Handbook for Systematic Reviews of Interventions; The Cochrane Library, 2008. Link
(Chapter 8: Asessing Risk of Bias)

[4] Jacobs J, Jonas WB, Jiminez-Perez M et al.: “Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials“, Pediatr Infect Dis J (2000);22:228-234 Link

[5] Jacobs J, Jiminez LM, Gloyd S et al.:“Homoeopathic treatment of acute childhood diarrhea – a randomized clinical trial in Nicarague“,British Homeopathic Journal (1993);82:83-86

[6] Jacobs J, Jiminez LM, Gloyd SS et al.: “Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Trial in Nicaragua“, Pediatrics(1994);93(5):719-725 Link

[7] Jacobs J, Jiminez M, Mathouse S et al.: “Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal“, Journal of Alternative and Complementary Medicine(2000);6(2):131-139 Link

[8] NN: “CORE-Hom database, A database on Clinical Outcome Research in Homeopathy“, database of the Carstens-Foundation, free access requires registration , Link

[9] Mathie RT, Lloyd SM, Legg LA et al.: “Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis“, Systematic Reviews 2014;3:142, Link

[10] Jacobs J, Springer DA, Crothers D: “Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial“, Pediatr Infect Dis J (2001);20(2):177-83 Link 

[11] Sinha MN, Siddiqui VA, Nayak C et al.: “Randomized controlled pilot study to cpmpare Homeopathy and Conventional therapy in Acute Otitis Media“, Homeopathy (2012);101:5-12, Link

[12] NN: DEGAM-Leitlinie Nr. 7: Leitlinie „Ohrenschmerzen“, aktualisierte Fassung 2014, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, AWMF-Registernummer 053/009 Link (in German)

[13] Wiesenauer M, Lüdtke R:“A Meta-Analysis of the Homeopathic treatment of Pollinosis with Galphimia Glauca“, Forschende Komplementärmedizin (1996);3:230-234, Link

[14] Linde K, Clausius N, Ramirez G et al.: “Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials“, The Lancet (1997);350:834-843 Link

[15] Mathie RT, Ramparsad N, Legg LA et al.: “Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: Systematic review and meta-analysis“, Systematic Reviews 2017;6:663 Link

[16] Reilly TR, Taylor MA, McSharry C et al.: “Is homeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as model“, The Lancet (1986) 328:8512:811-816 Link

[17] Mathie RT, Frye J, Fisher P:“Homeopathic Oscillococcinum (R) for preventing an treating influenza and influenzy-like illness (Review)“, Cochrane Database of Systematic Reviews 2012 Issue 12 Art.No.: CD001957 Link

[18] Schneider B, Klein P, Weiser M: “Treatment of Vertigo with a Homeopathic Complex Remedy Compared with Usual treatments“, Arnzneim.-Forsch./Drug Res.(2005);55(1):23-29 Link

[19] Weiser M, Strösser W, Klein P: “Homeopathic vs. Conventional Treatment of Vertigo: A Randomized Double-blind Controlled Clinical Study“, Arch Otolaryngol Head Neck Surg. (1998);124(8):879-995 Link

[20] Issing W, Klein P, Weiser M: “The Homeopathic Preparation Vertigoheel(R) Versus Gingko biloba in the Treatment of Vertigo in an Elderly Population: A Double-Blinded, Randomized, Controlled Trial“, J. Altern. Complement. Med. (2005);11(1):155-160 Link

[21] National Health and Medical Research Council. 2015. “NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions “, Canberra: NHMRC;2015 Link

[22] NN: Homotoxikologie, article in Homöopedia.eu (in German) Link

[23] Entry „Homöopathie“ on the website of C. Bajic  Link  – checked 25.11.2017 (in German)

[24] Wiesenauer M, Häussler S, Gaus W: “Pollinosis-Therapie mit Galphimia Glauca”, Fortschr. Med (1983);101(17): 811-814 Link

[25] Ferley JP, Tmirou D, D’Adhemar D et al.: “Evaluation of a Homeopathic Preparation in the Treatment of Influenza-Like Syndromes“, Br. J. clin Pharmac. (1989);27:329-335  Link

[26] Papp R, Schuback G, Beck E, et al.: “Oscillococcinum(R) in patients with influenzy-like syndromes: A placebo-controlled double-blind evaluation“, British Homeopathic Journal (1998);87(2):69-76 Link


Picture credits: Fotolia_130625327_XS

Criticism on criticism on homeopathy #3 – “Homeopathy is impossible”

“Scientists claim that homeopathy is not possible”

… states the Homeopathy Research Institute as allegedly supposed dictum of critics on homeopathy.

The third part of our series about homeopathic criticism on criticism of homeopathy deals with the Homeopathy Research Institute’s statement: “Scientists claim homeopathy is impossible”.

Whether scientists would use this wording to express their views on homeopathy seems to be rather doubtful, the Homeopathy Research Institute (HRI) does not offer any reference of such a statement in their article anyway (https://www.hri-research.org/resources/homeopathy-faqs/scientists-say-homeopathy-is-impossible/). However, this is not very likely, because a serious scientist would utter such a statement only if there was clear evidence for anything. But this is impossible in our case, since the non-existence of something cannot be proven. What scientists actually say about homeopathy is:

  • Scientific mechanisms of action—where we conclude that the claims for homeopathy are implausible and inconsistent with established scientific concepts.
  • Clinical efficacy—we acknowledge that a placebo effect may appear in individual patients but we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect. There are related concerns for patient-informed consent and for safety, the latter associated with poor quality control in preparing homeopathic remedies. [1]

So there is no statement of homeopathy being “impossible” as such, but only that it contradicts everything we know from science, technology and everyday life about how nature works. Of course, this can be all wrong, since our knowledge is an approximation of reality only. Therefore, a scientist will always refer to the current state of knowledge –  which does not necessarily mean that they consider it likely that this will really be proven false.

Background: Why is homeopathy implausible?

The world exists and develops quite obviously in a multitude of processes and phenomena. The fundamental laws that control these processes and which are being researched by science must therefore be compatible and must not contradict each other. A natural law cannot be valid in one case and invalid in another under the same conditions. If such problems arise, this is an indication that our understanding of the matter is not yet complete, e.g. some important conditions might not have been identified yet.

Any inconsistency in our knowledge indicates an error in our understanding. Usually this triggers research to find the root cause and to result in a better understanding of nature’s laws. Consequently, to be plausible in science, any doctrine would have to be consistent, showing no internal contradictions and not being in conflict with other branches of science.

Homeopathy does not meet these requirements, because it is full of internal contradictions and there is no reasonably plausible explanation for any effectiveness of the remedies in use, which would not be in conflict with well-established knowledge.

To cover all the issues in detail would exceed the limits of an article as this one, so a few examples will have to suffice.

  • Internal contradictions

According to the homeopathic “law of similarity”, a remedy is able to cure the symptoms in an ill person that it can invoke in a healthy one. This is one of the pillars of homeopathy; it is even where the name is derived from (“homeopathy” = “similar to suffering”). Obviously, this must also apply in the reversal, so that a remedy can trigger the symptoms in a healthy person that it can cure in an ill one. Homeopathic drug “provings”, and with this the homeopathic database for prescribing proper remedies to patients, is dependent on the fact that healthy subjects take a remedy and record the symptoms that occur afterwards.

First off, if this was true, homeopathic remedies would be extremely dangerous –  after all, according to homeopaths, you can cure and therefore cause all kinds of acute and chronic illnesses with homeopathic remedies, which is in contrast to the claimed gentleness and safety of their use. Homeopathy follows the logic that every intake of their remedies will cause an “effect”, a healing one when it was “perfectly appropriate” and a harmful one when this is not the case. Either a homeopathic remedy can cause undesirable effects (“side effects”) , or the drug trials do not work, and therefore the bases of homeopathic prescriptions, the so-called Materia Medica, are rubbish.

Either way, any specific therapy of patients would be impossible. Either because the doctrine is wrong, and the remedies are ineffective, or because the properties of the remedies are unknown and the effects a practitioner may evoke are unpredictable.

Homeopaths even agree that not being able to identify the right remedy at first go is quite possible, meaning that homeopathic remedies are wrongly prescribed quite frequently. This would turn homeopathy into a very risky therapy: since the wrong remedy would identify the patient as “healthy” concerning the drug-specific symptoms and start to create them.  Or does the remedy somehow know, even if it was wrongly prescribed, that the person is ill, though concerning another drug, and then it suppresses its urge to cause its own individual proving symptoms?

Over-the-counter sale of homeopathic medicines without a prescription would have to be banned, because a layperson would be far less able to identify the proper remedy for themselves. And by the way: Either a detailed anamnesis is required for the proper choice of drugs – then the OTC-sale of the remedies is a kind of fraud –, or the remedies can be ordered according to perfunctory diagnosis, then the extensive first anamnesis is humbug.

  • Outer contradictions

An explanation, i.e. an effective model of homeopathy, should be able to describe, for example, how the efficacy of a source material is enhanced by dilution and shaking. And how this is transferred to the patient when the source material is diluted out of the solution, and how the remedies differentiate whether the patient is ill or not.

Even for this basic process there is no explanation that would not fundamentally contradict our current understanding of physics, chemistry and physiology in one form or another. Of course, this explanation should also include why under similar conditions in similar processes these effects do not occur outside of homeopathy.

In technology and day-to-day life, there are many procedures where the “efficacy” of a substance is controlled by maintaining certain concentrations of the active substance in question. Drinking water is treated by removing the accompanying impurities of the natural surface water to such an extent that the maximum concentrations of pollutants are within the limits prescribed in the regulations for potable water. It’s similar for the treatment of water for medical purposes, the production of decaffeinated coffee, alcohol-free beer, skimmed milk, etc. None of these substances have as yet been found to be affected by shaking – for example, by vigorously slamming the coffee cup on the table. The effect of dilution could never be completely or partially removed – better: inverted – by succussion. Shaking or stirring is often used to mix substances and homogenize the concentrations. If homeopathic assumptions were correct, the very first bump on the table would increase the strength of the coffee.  After all, potentizing is said to be very powerful: 10 beats of shaking are sufficient to transfer the effectiveness to 99 times the volume of the solvent – and to even enhance the effect.

It is also inexplicable why this immense increase of power only happens when the solution is diluted in advance, and not when the liquid is shaken without being diluted before. An explanation has to account for this, too. Otherwise, at least liquid homeopathic drugs should not be sold, because random shaking movements during transport to the pharmacy, or later in the shopping bag or a pocket, would result in random increases of efficacy, which in turn would have to lead to an unpredictable result with the patient (Hahnemann, the inventor of homeopathy, was sure of this – it is reported that this was initial for the idea of using globules; therapists who could not see such an “transport effect” were taunted by him).

Furthermore, the model would have to provide an explanation for the fact that the amplification only affects the substance used as a mother tincture – and only the desired properties that is, not a toxic effect for instance – not the inevitable impurities of alcohol or water used as a solvent.

  • Conclusion

It may not be exactly correct to postulate the “impossibility” of such a model, because this cannot be proven. One can, however, consider how much of current science needs to be rewritten in order to explain the alleged mode of operation of homeopathy as well as the non-occurrence of these effects outside the homeopathic environment.

Revolutionary insights are usually honored with a Nobel Prize. In order to illustrate the extent of the contradiction between homeopathy and the natural sciences, the German physicist Martin Lambeck once pointed out how many Nobel Prizes would have to be awarded if the assumptions of homeopathy were actually scientifically proven [2]. His count reached well over 90. The introduction of the theory of relativity or quantum physics were mere trifles in comparison.

What scientists really say

Homeopaths like to quote scientists as witnesses for the claimed efficiency of their drugs and remedies, but quite frequently do so in a crude and misleading way, as found in HRI’s reference of Luc Montagnier.

Montagnier is a virologist who in 2008 was awarded the Nobel Prize for his work on the AIDS virus. In 2010, he gave an interview to the journal Science in which he answered questions about one of his – by the way highly controversial – papers [3]. In this article, he claimed to have found that some bacteria emit electromagnetic waves – and that these can be detected in the solution even when the bacteria are filtered off and the solution is further diluted [4]. The HRI quotes a passage from the interview, but only three short sentences out of context in which Montagnier sounds as if he would actually confirm homeopathy. However, here is the complete quote with HRI’s partial quote highlighted:

Q: Do you think there’s something to homeopathy as well?
L.M.: I can’t say that homeopathy is right in everything. What I can say now is that the high dilutions are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules. We find that with DNA, we cannot work at the extremely high dilutions used in homeopathy; we cannot go further than a 10-18 dilution, or we lose the signal. But even at 10-18, you can calculate that there is not a single molecule of DNA left. And yet we detect a signal. 

(original wording)

A wonderful example of cherry-picking: Montagnier actually said the phrase the HRI quotes, yes, but in the same breath he also contradicted some basic assumptions of homeopathy. If the HRI had the intention to inform its readers about the real background of Montagnier‘s work, then they should have mentioned:

  • It’s the DNA that causes the effect. The efficacy of inorganic substances or simple organic compounds would therefore remain unexplained.
  • Not even all organisms seem to produce the effect, but only certain bacteria.
  • The dilutions were only active in a comparatively narrow range, depending on the species of bacteria, between D8 and D12, i.e. not in the absurdly high dilutions as is customary in homeopathy (C200 and even higher).
  • The effects last only for a comparatively short period of less than 48 hours, and in no case for such a long period of time in which homeopathic remedies may even reach their customer.
  • The effect becomes weaker with increasing dilution and disappears completely above D18, whereas in homeopathy considerably higher potencies with correspondingly stronger dilutions are in use and are regarded as particularly effective.

There’s nothing there to support homeopathy.

Change in science

Again and again, according to the HRI, science is subject to constant change, which is supposed to suggest that the present knowledge is probably false:

“What the scientific establishment considers impossible at one point in time is a proven fact at a later stage “.

This statement is complete nonsense and is based on a completely wrong understanding of science.

In fact, science is constantly evolving and gaining better and more comprehensive insights in the processes of nature. Of course, “mistakes” also occur, meaning that hypotheses are made and considered to be confirmed, but later prove to be inaccurate. Finding errors and shortcomings, gradually and laboriously pushing out the limits of knowledge, improving the inadequate, replacing the wrong with (probably) more correct things, this is the core of scientific work. Usually, scientists who have disproved particularly sound hypotheses are awarded a Nobel Prize. These included, for example, Barry Marshall and Robin Warren, who were awarded the Nobel Prize in Medicine in 2005 for demonstrating that gastric ulcers can be attributed to bacterial infections, which was previously considered impossible because bacteria were not believed to survive gastric acid (this was, by the way, considered impossible, but not completely incompatible with natural laws).

This example, which is also cited by the HRI, does not prove that our knowledge is wrong, but rather that true science can detect and correct errors and thus obtain ever better knowledge of the actual facts. There are conclusions and hypotheses that may prove to be inaccurate later on, and these may be considered valid for quite a long time before, but with the scientific methodology it is possible to exclude inaccurate views.

If you want to describe the situation in one sentence, you can use a quote from the Swiss internist Wilhelm Löffler (Link):

“Almost all the errors of medicine that live on in popular belief were once scientifically accepted theories.”

There are also laws of nature that cannot be modified or replaced by anything else. These laws of nature are the absolute limit to speculation on “everything is possible” and “science cannot yet understand…”. It is by no means the case that everything that is considered impossible today will almost inevitably represent proven wisdom tomorrow, like the HRI tries to suggest. Perpetua mobilia are impossible and will remain so, also like a speed beyond the speed of light. And: where there is nothing, there is nothing that works.

Summary

Even though our knowledge of the ways of the world is still far from complete, it is very unlikely that one day a medical efficacy of homeopathic preparations will be explained, especially with the effects claimed in the various homeopathic repertories. The contradiction between homeopathic teaching and established knowledge of science, technology and everyday life is far too big. In the end, it would not only be necessary to find an explanation of the efficacy, but also to show why these effects do not occur in similar processes outside homeopathy. This means that for large parts of physics, biology and chemistry, completely new and contradiction-free explanatory models must be presented (the physicist and science theorist Thomas S. Kuhn expressly demanded the replacement of old paradigms only “including central concepts”).

This is so highly improbable that it can be considered impossible with highest probability, comparable to the probability of finding an atom/molecule of the mother tincture in a bottle of C200 potency. 1:10380 is not equal to zero – however, it is small enough for all practical purposes to be taken as zero.


Sources / References:

[1] European Academies Science Advisory Council: “Homeopathic products and practices: assessing the evidence and ensuring consistency in regulating medical claims in the EU“, EASAC:September 2017, Link

[2] Lambeck M.: Irrt die Physik? Über alternative Medizin und Esoterik, 3. erweiterte Auflage, Verlag C.H.Beck 2015, ISBN 3406670962

[3] Newsmaker Interview ‚French Nobelist Escapes ‚intellectual Terror‘ to Persue Radical Ideas in China‘, Science 330 (2010) p. 1732

[4] Montagnier L, Aissa J, Ferris S, Montagner JL, Lavalle C: Electromagnetic Signals are Produced by Aqueous Nanostructures Derived from Bacterial DNA Sequences‘, Intersiscip Sci Comput Life Sci (2009) 1: 81-90


Picture credits: Fotolia_130625327_XS

Criticism on criticism on homeopathy – #4: “They’re just sugar pills!”

“There’s nothing in it – They’re just sugar pills!”

… is the next thesis from homeopathic criticism to which the Homeopathy Research Institute dedicates the fourth part of its thirteen-part series in order to refute it. The HRI refers to the alleged evidence from “basic research on homeopathy” that globules are “more” than “sugar balls”.

To anticipate the conclusion – the globules are and remain sugar globules on closer inspection. While it is more correct to say that the globules contain “nothing effective” (and “more sugar in sugar” does not work from a certain point), it is explained below that the term “sugar balls” nevertheless hits the nail on the head.

“Laboratory experiments have shown that homeopathic remedies are not just sugar beads.”… this is what the HRI tells us. But what are they instead – and above all, what does this have to do with any proof of the validity of homeopathy? What is the statement when the HRI tells us: “The test results show that homeopathic remedies cannot be pure water or pure sugar. “Because that’s obviously the case, homeopathic remedies can be effective.” That’s a logical circular reasoning, but no proof.

This can be noted first: The attempt to prove physical-chemical changes in high potencies in any way has nothing to do with a proof of the correctness of Hahnemann’s homeopathy – independent of possible results – mainly because there is no idea how this could be causally related to a medicinal effect of homeopathy in the human body. Such a thing is rather a seemingly rational attempt to save the homeopathic building, since the concept of a “mental vital force” can no longer be conveyed in a scientific context – and rightly so.

In addition, the works quoted do not stand up to critical scrutiny neither in the interpretation nor of the results or in terms of design and implementation. They are either very controversial (antibodies to white blood cells, apparently this is the well-known work of Benveniste [1] – keyword water memory [2]) or only of very small effect strength and even contradict the homoeopathic doctrine (Endler); more about the latter can be found in the detailed article on the topic on Dr. Norbert Aust’s blog “Taking of Evidence in Homeopathy”[3] [4].

The fact that these two works are presented by the HRI as the top results in basic homeopathic research speaks for itself.

The following excursus shows how far away homeopathic basic research and the defence of HRI are from homeopathy in another respect:

One should also be aware that Hahnemann’s closed concept of homeopathy is not compatible with the search for or the proof of a “material”, i.e. with physical-chemical methods detectable effects in high potency drugs. Hahnemann constituted the “spiritual life force” (vis vitalis) as the supporting pillar of his homeopathy and the “spiritual medicinal power” in the remedy as the counterpart.

“Our vital force, as a spirit-like dynamis, cannot be attacked and affected by injurious influences on the healthy organism caused by the external inimical forces that disturb the harmonious play of life, otherwise than in a spirit-like (dynamic) way, and in like manner, all such morbid derangements (diseases) cannot be removed from it by the physician in any other way than by the spirit-like (dynamic1, virtual) alterative powers of the serviceable medicines acting upon our spirit-like vital force, which perceives them through the medium of the sentient faculty of the nerves everywhere present in the organism, so that it is only by their dynamic action on the vital force that remedies are able to re-establish and do actually re-establish health and vital harmony, after the changes in the health of the patient cognizable by our senses (the totality of the symptoms) have revealed the disease to the carefully observing and investigating physician as fully as was requisite in order to enable him to cure it.” (§ 16 Organon, 6th edition, trans. Boericke)

He vehemently condemned the “atomists” and “materialists”, who already at his time insisted that a mechanism of action could only be assumed if it was based on material interactions. He believed that he had found the “proof” for his concept of a non-material medicinal power in the use of magnetism as a homeopathic remedy (he deals with this in detail in the 6th edition of his “Organon”). This is not at all consistent with the research conducted by the HRI on the material verifiable and measurable effects of high potencies:

“How can they finally rhyme with their atomistic, material concepts of the effects of medicines that a well-prepared magnetic steel rod, […], can produce such a tremendous change of mood in our condition that we suffer severe pathological complaints from it, or, to such an extent that a magnetic rod can heal quickly and permanently the most violent evils to which it is appropriate as a medicine, conceals them in the above way, approaches them to the body, even approaches them only for a short time? Atomist! atomist! you for wisely in your limitation seeming atomist! say, what weighable magnetic heal penetrated there into the body to make those, often tremendous changes in his condition? Isn’t a centillion part of a grain (a fracture that has 600 digits to denominator) still infinitely heavy for the very imponderable part, for the kind of spirit that flowed from the magnetic rod into this living body? …” (Hahnemann, Reine Arzneimittellehre, 2nd edition, II. part, p. 212).

More than diluting?

The nevertheless very “materialistic” view of “basic research” is often presented as “progressiveness” or “further development”. The fact that these are unsuitable attempts at rationalisation is, however, clearly shown elsewhere: Hahnemann’s dogma that the shaking transfers “information” (the “spiritual medicinal power”) to the solvent and thus represents more than an increasing dilution of the original substance (up to the point where only solvent is shaken with solvent) is held unswervingly by the homeopaths. Quote HRI:

“The physical and chemical changes caused by shaking, and how they enable water to absorb the information of the substances diluted in it, are the big questions that researchers are trying to answer.”

It is probably more the case that no answer can be found here, because false and nonsensical questions are assumed. It would be correct to ask whether such phenomena exist, only then does it make sense to ask how this happens. However, this question already contains the premise, the unproven assumption, that there are actually effects in high potency dilutions (“possibility of water to absorb information about substances diluted therein”), which “only” require research.

This is the inadmissible argumentation with the “false premise”, which one “smuggles” into a discussion as given, in order to be able to lead a sham debate based on it. The premise at issue here, that water is capable of absorbing information by homeopathic potentiation, is unproven, there is no evidence for this, not even plausibility. Thus an argument based on this is invalid from the outset. However, there are the physical-chemical principles that have proven themselves in everyday life and technology, which tell us that a dilution is and remains a dilution and does not mutate into an ominous “transfer of information” because a homeopathic mother substance is involved. A specific effect that could transfer “information”, “vibrations”, “frequencies” or “energies” to the water is not known. [5]

In this respect, one must regard the HRI’s reference to the efforts of the “researchers” as a rhetorical-argumentative trick, with which an unproven and implausible premise is imposed on the debate. In practice – what are we talking about at all? In addition to these fundamental considerations, one should bear in mind what actually are the real orders of magnitude to which the attempt of homeopathic basic research to prove specific effects leads. Even if you are familiar with the system of homeopathic potentiation, you might be surprised if you consider the practical question of which product quantities can be produced with which potentiation.

During potentiation, the concentration of the drug decreases rapidly. As already mentioned, even low potencies show concentrations of active substances which are not sufficient for physiological reactions. Even a low potency of D6 contains more unavoidable impurities of the carrier substance (even at the highest purity level available) than the original substance. 100 kg 6X globules (purity 99.6 %) contain 400 g of random impurities and 0.001 g (!) mother tincture active ingredient.

The picture shows a 20-ton-lorry as desribed in the textLet us continue with a simple rule of three. One gram of mother tincture can be used to make 100 tons of Globuli 6X. You need five articulated lorries, each with a lifting capacity of 20 tons, to transport this quantity.

The picture shows a Panamax bulk carrier which can be loaded with 1,260 tons, as described in the article.12X produces so many globules from one gram of mother tincture that 1,250 bulk carriers of the PANAMAX class (each with a capacity of 80,000 tons) can just load them – all together with an active substance content corresponding to one third of a piece of sugar cube.

And here we have by no means arrived at what homeopaths in the true sense call “high potencies”, which generally means potentizations from 30C onwards.

Summary

Indeed, globules D6 and higher are pure sugars, in the sense that the impurities always present in the material are much higher than the content of what is supposed to be present as a homoeopathically specific substance. This already applies to potencies far below the range which is described by homeopathy as high potency. No basic research on homeopathy has so far produced a result which disproves this point of view. Even if one were to regard the results presented as correct, they do not constitute a basis for proving the effectiveness or a mechanism of action of homeopathy – there is no even plausible idea of causality.more than 20 years of intensive research in several institutions, with the express aim of “proving” homeopathy (“confirmatory research”), – without anything having been found so far which could somehow be regarded as the cause of the allegedly radical effectiveness of homeopathy? This should not be presented in a positive way.

[1] https://de.wikipedia.org/wiki/Jacques_Benveniste

[2] Refutation in: Memory in water revisited, Nature (1994), Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8255290?dopt=Abstract

3] http://www.beweisaufnahme-homoeopathie.de/?p=2093

[4] http://www.beweisaufnahme-homoeopathie.de/?p=2131

[5] For detailed information on shaking / potentiation in the Homöopedia (in German): http://www.homöopedia.eu/index.php/Artikel:Schütteln

A detailed article on the HRI thesis discussed here has been published on the blog “Beweisaufnahme in Sachen Homöopathie” (“Taking of Evidence in Homeopathy”) by Dr. Norbert Aust.

Previously published by INH in the series “Criticism on criticism on homeopathy”:

Part I – Scientific evidence
Part II – “Positive studies missing”
Part III – “Scientists say homeopathy is not possible”


Picture credits: Fotolia_130625327_XS /
Wikimedia Commons: (C) CostaPPPR / (C) Konrad Kaufmann / (C) Daizotec, Hanoi, Vietnam

Study uncovers: With alternative medicine many cancer patients die earlier than necessary!

If the doctor tells you that he has diagnosed cancer, then this is an incisive event for everyone. What to do now? Conventional treatment, i.e. chemotherapy, radiation, surgery or hormone therapy, depending on the severity and stage of the disease? Or alternative medicine, be it homeopathy, acupuncture, dietary change (dietetics), other approaches such as methods of traditional Chinese medicine, electro-carcinoma therapy, pseudo-natural therapies such as amygdalin therapy, gemstone therapy or coffee enemas – or perhaps completely offside methods such as using pendulums, mental healing, Reiki? Or is cancer a consequence of unresolved conflicts?
All this and much more has been and is used by cancer patients.

Anyone who undergoes conventional therapy with cancer is highly likely to live longer than if he or she were treated with alternative medicine. This conclusion can be drawn from a paper that researchers at Yale University in New Haven (Connecticut, USA) have now published [1].

Skyler B. Johnson and his colleagues searched the U.S. Cancer Registry for patients with breast, prostate, lung or colon cancer, the most common types of cancer, and – instead of conventional treatment – underwent “other unproven cancer therapies performed by non-medical personnel”, preferring some form of alternative medicine. 281 patients were found and, for comparison, twice the number of patients who had undergone conventional therapy with the same diagnosis and other conditions (age, sex, income, etc.) were sought. Patients whose tumors had already metastasized, in whom the cancer had reached the final stage or in whom the data were unclear were not considered.

The results are sobering for the followers of alternative medicine, as the following graph, calculated from the data of the study, shows. Here the number of deaths in both treatment groups is listed, the data for conventionally treated patients were also converted to 280 initial participants. Blue dots should represent 10 living patients, red dots 10 deceased:

It is obvious that at any time the number of deaths under alternative therapy is about twice as high as in conventionally treated people. After seven years, about half of the patients had died under the alternative therapy, while only a quarter had died under the conventional therapy. Depending on the type of cancer, the difference was even more pronounced: In breast cancer, the risk of death was five times higher with alternative medical therapy and four times higher with colorectal cancer than with conventional treatment.

A small but significant side consideration:

Let’s put ourselves in the time frame after seven years. Of the 280 patients originally treated as alternatives, 138 are still alive – although 67 more in the case of conventionally treated patients, namely 205. We can expect that the 138 alternative patients will probably swear by the fact that alternative medicine has helped them, that they are happy to have renounced the “evil” orthodox medicine, are convinced that this is the only way they can defeat their cancer without the assassination attempts “Big Pharma”. This can be exploited in a media-effective way and posted on the practice pages of the respective therapists as a victory message.

However, none of the 67 who died too early compared to conventional therapy will be able to tell their story. For example, what it feels like to go to a real doctor shortly before the end and then come to the conclusion that the prospects for a few more years of life would not have been bad at all if you had only come earlier. Since these 67 nameless patients, whose premature deaths can only be recorded statistically, or their surviving dependants do not present themselves in a closed talk show, they can be dismissed as regrettable individual cases. After all, deaths also occur with conventional therapies. The premature death of these people remains largely unknown to the outside world.

The trust in alternative medicine has caused too early a death for 67 out of 280 people here! The course of the disease was not necessarily negatively affected – but because patients were led to believe that there was an effective alternative medicine, they did not perceive the obviously more effective conventional treatment. This is about the question “Who is harmed by alternative medicine?”

Even more: Looking into the future and counting the trends further into the future, there will continue to be relatively more deaths in the “alternative medicine” treated group, due to the late effects of an untimely or completely omitted effective therapy. In purely mathematical terms, this would mean that in the 13th year after the start of therapy, all “alternative” treated patients would have died, while a good half – around 140 – of conventionally treated patients would still be alive.

In this context, one inevitably remembers Steve Jobs, the legendary Apple boss, who still had time to recognize his mistake of trusting in alternative medical treatment – but not enough time to correct it. His biographer reports how important it was for Jobs to communicate this to the general public. Jobs explained his mistake with the sentence: “I think if you just don’t want to admit something, don’t acknowledge that it exists, then you can fall into “magical thinking”. Not a lack of intelligence, but a lack of rationality.

Although the researchers were unable to separate the individual alternative medical therapies on the basis of the statistical data collected, it can be assumed that the difference is not significant. They were all procedures that were similar in that they had no evidence of efficacy.

When transferring the results to the totality of all cancer patients, it may be necessary to make certain limitations, since some important influencing variables were not recorded. However, the group data tend to point in a different direction, with patients of alternative therapies being younger, more affluent, better educated and less burdened with additional diseases, but also in a later stage of cancer. So it may not always be the case that almost a quarter of patients in alternative medicine die prematurely within seven years, but the trend is unlikely to be reversed.

A decision for alternative medicine in an existing cancer diagnosis could therefore turn out to be a big mistake.


Author: Dr. Norbert Aust

Many thanks to Udo Endruscheit and Natalie Grams for their good contributions.


[1] Johnson SB, Park HS, Gross CP, Yu JB: Use on Alternative Medicine for Cancer and its Impact on Survival; JNCI J Natl Cancer Inst (2018) 110(1): djx145, doi: 10,1093/jnci/djx145


Picture credits: Fotolia_99355604_XS

Naturalness reconsidered – Why babies don’t need globules

Happy without globules! – A guest contribution by Miriam Weissberg, Midwife

Dear becoming and become parents!
I am a midwife with heart and soul, deeply convinced that homeopathy has no use whatsoever that would make it worthwhile to spend money on it, even though it is recommended by many colleagues. That’s why I’m turning to you today.

Many of you may have had the idea of using a homeopathic for the first time during pregnancy or after your baby has just hatched, because you expected it to gently improve an unpleasant condition without having to accept the possible risks and side effects of a “normal” medication.

Homeopathy – many people associate it with naturalness, the healing power of the plant kingdom. In fact, however, globules and co. (Bach flowers, Schüssler salts, homeopathic mixed preparations) are no closer to nature than analogue cheese and plastic flowers. Since they contain – depending on the degree of dilution or potentiation – only very few to no active substance molecules, their efficacy can never be greater than the placebo effect, as numerous scientific studies have clearly shown in the meantime.

Placebo is Latin and means “I will please”. The placebo effect thus means a subjective healing or mitigation of a pathological condition in the patient produced by a sham drug free of active substances, presumably triggered by stimulation of physiological self-healing processes or changes in self-perception.
So if homeopathic remedies are proven to have no specific medical benefit, what are they good for?

One could argue that placebos have their justification in paediatrics, where non-treatable disorders such as unspecific abdominal pain, restlessness and minor injuries (e.g. due to falls while learning to walk) are the order of the day. Why not give globules to the child in such situations when they support the self-healing powers via the placebo effect?
At this point I would like to hook in with my conviction that globules and co. are the wrong way to deal with illness and mood disorders, even if their administration can achieve an – often only apparent – improvement in condition.

For me, to reconsider naturalness means to ask myself what the child could need in the respective situation, what activates its self-healing powers without the use of sham drugs, and to give it THIS:

If it has fallen and injured itself, it needs loving comfort, a plaster and possibly a cool pack. If it is very over-excited and restless, a round of cuddling and reading aloud on the sofa might help. If it has unspecific abdominal pain, carrying it around, a hot-water bottle, or hold it face-down in your lap may be useful.

Whoever gives globules to his child in these and similar situations will ultimately only give him the impression that any physical complaints require medical intervention – in my opinion a very questionable message.
For me, however, reconsidering naturalness also means observing the child’s well-being and developing a feeling for when a visit to the paediatrician is necessary:

A child who has fallen could, for example, have a concussion in addition to the injury to the knee. Nonspecific abdominal pain could conceal inflammation of the middle ear or bladder. Restlessness or apathy could mark the beginning of a serious infection.
Those who first give their child globules in such situations and wait for the effects to unfold, could unfortunately also let unnecessary time pass, which prolongs the suffering of the child or complicates its medical treatment.

Those who love their children understandably want to protect them from discomfort and suffering or end such conditions as quickly as possible. Unfortunately, there is not a quick remedy for every condition in the form of a bead or a tablet – this realization often hits young parents hard for the first time when they experience helplessly how their baby bends in front of abdominal pain and nothing really helps against it.

From my point of view as a midwife I would like to encourage you in this context either to accept that this crisis cannot be ended immediately, but that it becomes easier through care and attention for the child. Or seek medical advice, even if you are afraid of being ridiculed for your supposed overconfidence. In my experience, paediatricians always understand insecure parents and are happy to advise them.

In this spirit I wish you and your children all the best and a wonderful time.


Picture: Provided for the INH (private)

This post first appeared on the Facebook page of “Susannchen braucht keine Globuli”.

Homeopathy as “refugee aid” – a medical and ethical problem!

Under the flag “Homeopathy for refugees in Germany” the “Homeopaths Without Borders” together with the initiative “Homeopathy in Action” advertise a nationwide network of homeopathy offers for the “treatment of refugees”. Again and again, related “offers” appear in refugee aid associations which – obviously in complete ignorance of the relevant connections – misinterpret and gladly accept such things as meaningful offers of help.

So one can read for example in an announcement of such an association:

… “Unfortunately, tablets are far too often desired and used to alleviate the symptoms. There are far too few therapy places for psychotherapeutic treatments. In the second part of the evening, we would like to present two free therapy offers from the field of natural medicine.
Dr. med. … and Mrs. …, alternative practitioner, will present the project “Homeopathy for refugees in Germany”.
Every Friday doctors and non-medical practitioners offer homeopathic treatments in the rooms of … as a holistic treatment method for physical and mental problems, if necessary also with the support of interpreters.
… The treatment leads to a reduction of stress and stress symptoms and has a balancing, relaxing effect, so that many people can cope better with stress and thoughts of trauma afterwards.

The activities of the “homoeopaths without borders” (a name trying to benefit from the good name of the “doctors without borders”) were not so long ago criticized in West Africa. There they were consistently rejected with their request to treat Ebola with homeopathy. Apparently, offers under the flag of humanitarian aid is part of the business model of the Homeopaths without Borders. The Süddeutsche Zeitung also reported on corresponding activities in the Munich area.

Quite apart from the therapeutic worthlessness of these “measures”, the question arises whether there is a particular ethical problem besides the medical one.

The fact is: People in need of help from a foreign culture, who as a rule cannot be regarded as “responsible and informed patients” in the sense of our health system, are literally recruited for homeopathic “methods”. People who have to deal with severe traumas – which is explicitly the “goal” of the actions of homeopaths without borders. There is no question about it: providing all these people with psychologically and psychotherapeutically professional care is an almost unsolvable task. But the offer of a sham therapy can’t be a solution! With traumatized people, often children?

Certainly one or the other superficial “success” will occur, precisely because of the psychologically occupied overall situation. But an improper treatment of mental disorders does not solve the problem. Neither is there a careful differential diagnosis (“trauma” is not a diagnosis), nor is anything lastingly done for the patient, nor does one gain knowledge about possible external or self-endangerment due to a psychological disorder. In the age group mainly affected here, one may have to reckon with borderline disorders, whose treatment with sham drugs is hair-raising. We do not like to remember the treatment of the assassin of Ansbach (German small city, where it came to a crime with causing death) with a completely inadequate “therapy” – here by a non-medical practitioner, with a devastating result.

In our opinion, the unspecific “treatment” of severe mental illnesses with homeopathic placebos instead of guideline-oriented drugs goes beyond any tolerable framework. Especially in cases of severe depression, the absence of a specific effective treatment can even be fatal in the worst case because of possible suicide risk. It is not unusual for a traumatised or severely depressed person to be able to undergo therapy at all only with the help of preliminary medication treatment individually adjusted by a specialist.

Even the aspect of the placebo effect must be viewed critically in this context. The language barrier and the origin from a different culture, also and especially in connection with psychological problems, make it seem largely unpredictable whether and how a placebo effect will occur. Since the patients, in this case, might even perceive the “treatment” as overly invasive or authoritarian, even a nocebo effect is conceivable.

Is it really so impossible to provide low-threshold help offers (skills) for those affected instead of idly watching how not only ineffective, but dangerous illusory therapies are offered here? And shouldn’t it be possible – as it happens also for German-speaking patients particularly in emergency situations or in “waiting position” – to publish information brochures in the appropriate languages and age-appropriately, which can help concerning first of all to understand one’s experience and to see that also other humans experience similar after comparable experiences?

Our opinion:

Here the consequence of the social reputation and political “ennobling” of homeopathy becomes visible in a devastating way. Under the guise of helpfulness and support for refugee initiatives, the “Homeopaths without Borders” spread their propaganda for ineffective treatment methods. In this particular case extremely irresponsible. The credulous refugee aid associations, which serve here as vehicles for the transport of the “message homeopathy”, cannot estimate the consequences of these “offers of help” at all and rely on the “good reputation” of homeopathy and the willingness to help shown. There is probably no legal means to prevent this. As always, this is rooted by the fact that homeopathy is anchored in the public health system.
Which indeed sets us apart from the states of West Africa.
Shouldn’t this finally be revised in view of such excesses?


Authors: Monika Kreusel, Udo Endruscheit


Picture: Fotolia_106344027_XS1

Conversation in medicine

The good conversation between patient and doctor is an essential part of the anamnesis, diagnostics and above all the therapy. Mutual trust between patient and doctor is of decisive importance.

 Often one hears of a general patients’ unsatisfaction regarding the therapy conversation. It is almost always complained that these conversations are too short, because the doctor has too little time. This general unsatisfactoriness with the medical conversations is mentioned as an important – perhaps even the most important – reason why patients visit a non-medical practitioner or homeopath because he is said to be better trained for the conversation than the doctor and takes more time for the conversation (which is unfortunately a false assumption: non-medical practitioners have no training in conversation and above all no experience with patients if they have passed their exam). Many patients acknowledge that the remuneration of physicians does not normally allow long therapy sessions, but they also know that the remuneration of the physician’s consultations is not the responsibility of the patients. It is obviously the law of the market that you pick up the minutes for conversation where you get them, even if you have to pay for the time yourself.

Doctors who are confronted with criticism of the “inadequate” conversation situation in practices and clinics often find this criticism justified. At the same time, the poor remuneration is cited as the reason for this unsatisfactory situation. Patients and doctors can jointly blame third parties for the precarious situation: politicians and health insurance companies.

Patients, physicians and pseudomedical practitioners largely agree in public that there are deficits in medicine in the area of therapy conversations, which can even excuse and justify a change from medicine to pseudomedicine.

However, this argumentation usually remains general and nebulous. Concrete deficits are not mentioned.

However, a large discrepancy is noticeable: On the one hand the culture of conversation in the medical business is criticized and considered “bad”, on the other hand the patients are very satisfied with their own doctors. – Of course, we cannot and will not deny that there are also doctors who do not comply with medical standards and who rightly offer cause for criticism. However, this is not about the individual doctor with human and professional weaknesses, but about the “medicine” par excellence. It is “medicine” that uncovers and names errors in diagnosis and treatment. The “medicine” is to name the violations of their standards without regard to the person of the doctor as what they are: malpractice.

A study on patient satisfaction is presented in an older, but still valid article in the German Medical Journal (Deutsches Ärzteblatt) from 2005. There it says (quote):

“The key to dissatisfaction is the lack of a culture of speech. The weak point in the German healthcare system was indentified in the communication between doctors and patients, because 61 percent stated that they were not always informed by their doctors about treatment alternatives and asked about their opinions. (1)

The generally high level of patient satisfaction cannot be reconciled with this study result. In a press release of the service “Jameda” it says (quote):

“3-year trend: overall satisfaction in the practices remains at a high level. Overall satisfaction, which also includes the category “relationship of trust”, was stable with Germany’s doctors. As in the previous years 2013 and 2014, overall satisfaction in 2015 will remain at a good level of 1.87.” (2)

Perhaps this discrepancy can be better explained by going into a little more detail and becoming more concrete.

In the case of mental illness, patients are treated by psychiatrists or psychotherapists. These specialists have excellent training in medical conversation skills. Homeopaths and non-medical practitioners are far from having such a qualification in conducting conversations as the doctors in this specialist group have.

But how does it look in the field of somatic medicine? Are their specialists well trained for interviews?

The big question is, which topics should specialists discuss with their patients? What questions should they answer their patients? What do patients want to know? A few exemplary situations will be presented.

From internal medicine:
What does a patient who has just been diagnosed with diabetes mellitus want to know?

He wants to know why he got sick. How’s his life changing? Does he have to give up cake for life? What are bread units? What is insulin? What is the difference between the different types of insulin? Do I have to check my blood sugar daily? How can I protect my blood vessels?

An internist – in this case an endocrinologist – can provide excellent answers to these questions because he is trained to answer them. However, training in psychotherapeutic conversation is not required to answer these questions. Diabetologists even offer complete training courses to answer these questions in particular.

Other examples from internal medicine: hypertension (high blood pressure), asthma, COPD. All patients with these diseases have questions about their lifestyle, about the risks of possible non-treatment, about the risks of therapy. Internists and general practitioners can provide excellent answers to these questions – they know these diseases in all their facets.

Neurologists answer questions on multiple sclerosis, epilepsy, migraine, Parkinson’s disease …

Surgeons answer questions about the risks of any operation in informed consent discussions …

Anaesthetists answer questions about the risks of anaesthesia in the premedication consultation …

The list is not complete. She doesn’t have to be either: All specialists are excellently trained to answer all questions on the diseases of their specialty competently and comprehensively – and family doctors no less. And the cooperation between general practitioner and specialist must not be forgotten or underestimated. And in principle, § 8 of the German professional code of conduct stipulates that doctors must inform their patients about all alternatives before diagnostic and therapeutic interventions.

Do the attending physicians also take enough time to answer the patient’s questions?

It may be that not all questions are answered immediately during the first conversation. But that is not necessary either – yes, it does not even make sense. The length of the discussions must also depend on the nature of the disease and the receptiveness of the patients. Many questions come later. But all patients with such incisive diagnoses come to the practices for checks over and over again. At the second, third or each later consultation, there is also the possibility for the patient and the doctor to discuss open questions. Every time you pick up a repeat prescription, it can be used for a conversation – and it doesn’t even have to be long. Even short conversations can be long enough. The duration of a single conversation is not as decisive as the overall medical care. And with an overall grade of “better than good”, one can assume that the overall medical care is obviously better in each concrete case than its reputation in the undifferentiated general.

As one can see from the text, the accusation related to the lack of information about “treatment alternatives”. Among other things, patients also complain that doctors speak in a scientific language they cannot understand. However, in one study 29% of the patients could not remember it after an informative talk. (3)

The question remains why so many patients (61% in 2005 – see above) did not feel sufficiently enlightened.

I think we should differentiate here too. Every surgeon will inform his patients not only about the operation, but also about the treatment alternative “no operation”. In the case of tumour patients, a whole treatment team consisting of surgeons, internists (chemotherapists) and radiation therapists is discussing the best treatment alternative – one could say ” struggling for it”. Orthopaedists will certainly promote physiotherapy or simply “more sport in everyday life” as an alternative to surgical therapy. Cardiologists also recommend a “cardio sports group” as a supplement to drug therapy – in the best case, sport can replace drugs.

In a study, the authors Bahrs and Dingelstedt came to the conclusion that around 80% of those questioned judged the duration of the conversation with the doctor to be “exactly right”. It was necessary to distinguish between “experienced time” and “calendar time”. The greatest need for discussion exists in medically undetermined or non-clarifiable situations. (4)

How can it be explained that about 80% of patients are satisfied with the duration of the conversation, but 61% do not feel sufficiently informed about treatment alternatives?

If patients do not feel sufficiently enlightened about treatment alternatives, then in many cases they mean “treatment alternatives” from the field of pseudomedicine – in any case, medical treatment alternatives belong to the standard program of every medical consultation.

However, “treatment alternatives” from the field of pseudomedicine are not equivalent to medical treatment including all medical treatment alternatives. The main difference is that “treatment alternatives” from the field of pseudomedicine are ineffective. The desire for as many effective treatment alternatives as possible is quite understandable and comprehensible. But a desire for efficacy does not generate efficacy. No “therapist” can force succeed of his method. Effective treatment methods can only be detected – they cannot be invented. We can be happy and thankful that we found some at all. For it is by no means self-evident that there are any treatment methods at all for sick living beings in our world – the only one we have.

In a specific treatment situation, the patient must learn a lot from the doctor. This does not include detailed information on ineffective treatment procedures: Time can and must be used more sensibly. In view of the large number of ineffective pseudomedical procedures, it is not possible anyway to provide sufficient information about all of them. In this respect, homeopathy is the most important, but by no means the only pseudomedical “alternative”, which is no alternative at all due to its proven ineffectiveness. If one has to spend the same length of time for information about homeopathy, Bach flowers, Schüssler salts, bioresonance, Reiki, spiritual healing, New Germanic Medicine – the list is far from complete and it gets longer practically every day – as for an effective medical treatment method, then no patient is helped with it. The opposite is the case: valuable time for real advice is sacrificed to procedures that should be excluded from the outset because of proven ineffectiveness. In the case of serious illnesses, it must be made clear to patients that wishful thinking does not help. – One may and can talk about a good feeling during the treatment and about the “wellness factor” – there is talk about it! – but as a doctor one must leave no doubt that the effective treatment is in the foreground and “wellness” has a secondary priority. The desire for a “nice way to health” is an understandable wish that is certainly fulfilled wherever such a possibility exists. But even if there’s no nice way to health: The important thing is that there is a way to health at all. – Unfortunately, it happens often enough that there is no way to health at all. In such cases a “nice way” is very important, even if it does not lead to health. But even in such cases, modern palliative medicine certainly offers better methods than all pseudomedical procedures.

Patients’ dissatisfaction with the alleged lack of information about “treatment alternatives” is apparently a problem between “reality” and “perception of reality”. Doctors are aware of this problem. And they know that the pretence of supposed “treatment alternatives” must catch the eye sooner or later than what it is: an empty promise. And doctors also know that empty promises are ethically problematic. Sacrificing time for ethically problematic empty promises when time is scarce does not defuse the ethical problem at all.

The information about the ineffectiveness of – often desired – “treatment alternatives” only belongs to a small part into the medical practice or into the clinics. Basic information should be an essential part of general health education. It belongs in schools and universities. And because there are undeniable deficits there, there is us: the Information Network Homeopathy (INH).

We, the INH, feel obliged to provide correct information about pseudomedicine – mainly in the form of homeopathy.

Medical information about treatment procedures and effective treatment alternatives within medicine is provided by doctors – despite scarce remuneration. Every doctor knows that patients must bring a willingness to cooperate – compliance – because otherwise every therapy is doomed to failure. Correct information is not only in the interest of the patient – it is also in the very interest of the treating physicians.

With a patient satisfaction of “better than good”, one can and must confidently assume that the criticism of the quality and quantity of medical consultations is based more on a deception of perception than on a real deficit.

Author: Dr. med. Wolfgang Vahle


Credits: Fotolia_54048950_XS.jpg


(1) Source: Dtsch Ärztebl 2005; 102(49): A-3389 / B-2865 / C-2683)
(Link: http://www.aerzteblatt.de/archiv/49427)

(2) Source: Note 18.05.2015 by Elke Ruppert)
(Link: https://www.jameda.de/presse/pressemeldungen/?meldung=128)

(3) Source: Gesundheitsmonitor 2014 – Was hindert und was fördert die Teilnahme an Krebsfrüherkennungsuntersuchungen? – (Health Monitor 2014 – What prevents and what promotes the participation in cancer screening programs?)
(Link: http://gesundheitsmonitor.de/uploads/tx_itaoarticles/2014-02-Beitrag.pdf

(4) Source: Gesundheitsmonitor 2009 – Otmar Bahrs und André Dingelstedt: „Auf der Suche nach der verlorenen Zeit: Zur angemessenen Dauer des hausärztlichen Gesprächs aus Sicht der Versicherten“ (“In search of lost time – About the appropriate duration of consultations in general practice from the patients’ point of view”)
(Link: http://gesundheitsmonitor.de/studien/detail/?tx_itaoarticles_pi1%5Barticle%5D=179&tx_itaoarticles_pi1%5Baction%5D=show&tx_itaoarticles_pi1%5Bcontroller%5D=Article&cHash=765eb0849f364edad0039f499bd2dc73)

Dead child in Italy: Homeopathic doctors association sees “individual medical malpractice”

Malpractice or systemic risk?

In Italy, a child died recently because his parents and the doctor who treated him only relied on homeopathy. The German Central Association of Homeopathic Physicians sees here a “medical malpractice”, thus the “famous” regrettable individual case, but no responsibility of homeopathy as such.

What is a “malpractice” in the medical profession? The correct legal term is “medical error”. It means that a medical treatment is not carried out according to the existing, generally (i.e. according to scientific principles) recognized standards. That homoeopathy does not belong to these generally accepted medical standards is a fact that is testified by the worldwide scientific community. The reason why the Central Association refers to evidence-based medical guidelines in this context is confusing anyway. To whom or what does the homeopathic medical profession feel obliged? The guidelines – or a claim of homeopathy, as the chairwoman claims it on her own homepage? (1) Neither is possible at the same time.

It seems somewhat presumptuous that the Zentralverein speaks here of a “malpractice” – this is why, according to the standards explained above, any treatment carried out by a doctor on a homeopathic basis would be a “malpractice” because it deviates from the generally accepted standards. At least as long as he carries out an homeopathic treatment exclusively, as in the present case.

It should only be mentioned in passing that these considerations have no relevance for non-physician homeopathic practitioners anyway, who, however, in many cases also have no problem wanting to use homeopathy to cure illnesses in which the self-healing powers fail.

In principle, homoeopaths, including the Central Association and above all the chairwoman herself (e.g. on her homepage (1)), are fuelling the hope that homoeopathy can help precisely in such and many other cases. This does not fit in with the relativizing withdrawal in the Central Association’s statement on this case.

In the decision for a homeopathic treatment instead of scientific medicine, the damage potential is already inherent in the core. The potential risk of such incidents exists in principle and from the outset when deciding on homeopathic treatment. In other words, incidents such as the one in question are not unexpected in the sense of a “production fault” or a similar incident in everyday life. They are inherent in the method, systemic, they are manifestations of an unnecessarily high risk level from the outset, since homeopathy cannot offer any specific medicinal effect. When a (no longer) self-limiting disease coincides with the erroneous assumption that it can be combated or even cured with homeopathy, this risk potential is inevitably realized, of course not very frequently, even to the point of death (which, however, has definitely occurred).

It is not for nothing that the main criticism of homeopathy is that it can prevent or delay effective medical treatments. This warning has been given often enough. Even complementary (accompanying) treatment with pseudomedical means or methods impairs the treatment success of well-founded therapies, e.g. due to a lack of compliance (2). For this reason alone it is mistaken to speak of a “malpractice”, a human error in individual cases.

Here the Central Association fails to recognize the reality in which patients rely on an actual and medically equivalent medicinal effect of homeopathic remedies – not least because (not only) repeatedly propagating such an effect itself.

It is not unusual for homeopathy supporters to completely turn away from medicine, to regard it as “poison”, “chemistry” and “harmful” and to reject antibiotic therapy in particular. This effect alone, without reference to a specific treatment case, gives rise to a systemic risk for supporters of the method, which is why the question is once again raised: Is it responsible for the political actors in the health care system to continue exposing consumers or patients to this potential danger by de facto equating homeopathy with evidence-based medicine? And to let people believe and trust that homeopathy is – even legally legitimized – a specifically effective medication therapy?

The explanation as “malpractice” – in the sense of the infamous “regrettable individual case” – we therefore do not want left unchallenged. Rather, we believe that in this case the systemic risk potentially present in any ineffective “alternative” therapy has manifested itself in a particularly tragic way.

We see here rather the “tip of the iceberg” than a “single malpractice”. There’s certainly a dark figure that we all don’t know. And: This boy died in a “normal” clinic. How often will a homeopathic pretreatment with its consequences not become known when it leads to a case of scientific medicine and is recorded with all possible consequences up to death in its statistics?

The special thing about this case is that it has received publicity. The next “individual case” is already waiting. Hopefully it won’t be another death. Seeing the error here not systemically in homeopathy clearly points in the wrong direction.


Supplement, 09 June 2019

The parents of the deceased boy have now given a suspended sentence of three months on probation for culpable manslaughter, according to the Independent.

As always, it is very difficult to decide on individual guilt in such a case. The parents deserve great respect for the fact that they spontaneously decided to release an organ transplant. It is also reported that the parents were not at all against scientific medicine in principle, but were worried because their boy had already received “a lot” of antibiotics in the past. Now these are fundamentally legitimate and understandable concerns of medical laypersons. The basic error, however, was to rely on homeopathy in this initial situation instead of consulting a competent doctor. And this apparently once again due to the conditioning through earlier “healing successes”. Things we’re all too familiar with.

The matter is not made any easier by the fact that, according to the information that has become known so far (source: Corriere della sera), the “therapist” is said to be a man who was temporarily excluded from the Medical Association and during this time was engaged in a wide variety of activities. When the Pesaro Medical Association enquired about the start of his homeopathic activity, he was said to have replied that he had no interest in an answer. What weighs heavily is that he had probably actively advised the parents not to take the boy to a clinic – with horror stories about what he would be administered there. The trial against him is scheduled for September 24.

Once again we see one of the key points of our criticism confirmed: Despite all the lack of understanding for how one can entrust oneself to such a “therapist”: It is not justifiable to leave homeopathy in its positive public reputation or even to confirm that it is a proven, demonstrably effective method that is ultimately equivalent to scientific medicine. In Germany, this misperception is also massively promoted by the legal privilege of internal consensus and the reimbursement practice of health insurance funds. The fact that every “non-treatment” such as homeopathy has inherent risks, which cannot be compared with a risk-benefit evaluation of a scientifically based treatment, must force a rethink.

This is precisely what fundamentally promotes such individual mistakes as in this case. And we believe that this is no longer justifiable – more than that, it never has been. Politicians and health insurance companies are urgently called upon to do their bit here.

 


(1) Quote: “I have been working classically homeopathically in my own practice since 1997. This method not only allows acute diseases such as flu, cough, gastrointestinal infections, middle ear infections, etc… to be healed quickly and gently, but is also a way to treat severe chronic diseases such as asthma, rheumatism, neurodermatitis, hypertension, etc…. With the help of the homeopathic anamnesis, the symptoms of the disease are worked out and then the appropriate homeopathic medication is administered. It leads to a retuning therapy with benefit for the organism.” (Called on 1 June 2017)

(2) Skyler B. Johnson, MD; Henry S. Park, MD, MPH; Cary P. Gross, MD; et al; Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers; JAMA Oncol. Published online July 19, 2018. doi:10.1001/jamaoncol.2018.2487


More on antibiotics and homeopathy here.

More about this case at “Die Ausrufer” LMHI – Antibiotika und tote Kinder and at DAZonline (in German).


Authors: Dr. Natalie Grams, Dr. Norbert Aust, Udo Endruscheit

Picture credits: Fotolia 145924672_5

INH’s statement on NHMRC

“Täuschung der Öffentlichkeit”?

Verschiedene Homöopathie-Verbände und -Vereine üben Kritik an der 2015 erschienenen umfangreichen Übersichtsarbeit des medizinischen Forschungsbeirats des australischen Gesundheitsministeriums zur Wirksamkeit der Homöopathie. Man spricht gar von einer “Täuschung der Öffentlichkeit“. Diese Arbeit kam zu einem für die Homöopathie unvorteilhaften Ergebnis: Man fand kein einziges Krankheitsbild, für das die Wirksamkeit einer homöopathischen Therapie zweifelsfrei erwiesen ist.

Angesichts der Ungenauigkeiten (“inaccuracies”) sehe man sich genötigt, beim Ombudsmann der australischen Regierung Beschwerde einzulegen, stellt das Homeopathy Research Institute fest. Bemerkenswert ist, dass die vorgebrachte Kritik sehr an der Oberfläche bleibt und nicht aufgezeigt wird, wie sich die Kritikpunkte auf das Ergebnis des Reviews ausgewirkt haben sollen.

Auf den Punkt gebracht

Die vom HRI vorgebrachten Kritikpunkte sind auf einfache Weise zu widerlegen, indem man die Berichte zum Review liest. Daraus ergibt sich zweifelsfrei:

  • Die Untersuchung fußt in Summe auf der Analyse von 225 Einzelstudien, die nicht nur in Englisch, sondern auch in vielen anderen Sprachen veröffentlicht wurden. Die kleinste Teilnehmerzahl einer Studie betrug vier Probanden.
  • Die Bewertung der Studie erfolgte nach einem Verfahren, das auch von der Welt-Gesundheitsorganisation empfohlen wird.
  • Beim Vorsitzenden der Arbeitsgruppe lag kein Interessenkonflikt vor. Die Person, die einen Interessenkonflikt erklärte, war eins von sieben Mitgliedern der Arbeitsgruppe. An der Arbeitsgruppe war auch eine Apothekerin beteiligt, die einen universitären Forschungsbereich zur Komplementärmedizin leitet, also eine gewisse Affinität zur Alternativmedizin aufweist.
  • Die Beteiligung eines Homöopathen war nach den Regeln des Beirats nicht erforderlich.
  • Selbst wenn es Vorversionen zu diesem Review gab, ist dies für die Methodik und das Ergebnis des vorliegenden Reviews belanglos.
  • In diesem Review wurden die gleichen Ergebnisse erzielt wie in vielen anderen zuvor, darunter auch den beiden Arbeiten von R. T. Mathie von 2014 und 2017, der als persönlichen Hintergrund eine Zugehörigkeit zum HRI angibt. Damit ist auch nicht erkennbar, wo in der Veröffentlichung ein Skandal liegen sollte, wie ihn Frau Bajic, Vorsitzende des Deutschen Zentralvereins homöopathischer Ärzte, ausgemacht haben will.

Die Kritik der Homöopathen ist anscheinend weniger auf eine wissenschaftliche Auseinandersetzung gerichtet, sondern zielt wohl eher darauf ab, dass dem in diesen Dingen unkundigen potenziellen Patienten vorgegaukelt wird, das Ergebnis des Reviews sei durch fragwürdige Einflussnahme dunkler Mächte zustande gekommen. Man nennt dies üblicherweise eine “Skandalisierung”.

Einzelheiten

Da die Diskussion um das Review wahrscheinlich noch einige Zeit andauern wird, sollen hier in einer größeren Zusammenstellung die Grundlagen aufgeführt werden, auf denen die obige Stellungnahme beruht.

Hintergrund

Im Jahr 2015 hat der für die medizinische Forschung zuständige Beirat NHMRC (“National Health and Medical Research Council)” des australischen Gesundheitsministeriums eine umfassende Übersichtsarbeit (“Review”) zur Wirksamkeit der Homöopathie veröffentlicht [1]. Darin kommt man zu dem Endergebnis, dass es kein Krankheitsbild gäbe, für das zuverlässige Nachweise vorlägen, dass die Homöopathie eine über Placebo, also über ein Präparat ohne jeden Wirkstoff, hinausgehende Wirkung entfalte. Man hat sich darum bemüht, die gesamte vorliegende Evidenz klinischer Studien zu sichten, entsprechend umfangreich ist der Bericht ausgefallen: Auf knapp 1000 Seiten ist bis ins Detail dokumentiert, wie man zu der Schlussfolgerung kam.

Das Homeopathy Research Institute, England, (HRI) hat offenbar nunmehr eine förmliche Beschwerde beim Ombudsmann der Regierung Australiens eingereicht [2], worüber der Deutsche Zentralverein homöopathischer Ärzte (DZVhÄ) auf seinen Seiten und in einer Pressemitteilung gleichen Inhalts berichtet [3], die von vielen Internetseiten aufgenommen wurde. Die Österreichische Gesellschaft für homöopathische Medizin (ÖGHM) hatte schon im Juni 2015 eine Kritik an dieser Studie veröffentlicht, in der diese Punkte ebenfalls aufgegriffen werden [4].

Stellungnahme des INH

Eine kritische Auseinandersetzung mit Forschungsarbeiten und deren Ergebnissen ist ein wesentlicher Bestandteil wissenschaftlichen Arbeitens und als solches prinzipiell zu begrüßen. Die Kritik des HRI und die darüber noch hinausgehenden Äußerungen des DZVhÄ und der ÖGHM sind jedoch kein Bestandteil einer akademischen Auseinandersetzung. Die Kritikpunkte sind entweder belanglos, indem sie unbedeutende Details hervorheben, oder grundlegend falsch, wie bereits ein einfaches Nachlesen in der Studie erkennen lässt.

Es spricht eher für als gegen die Studie des NHMRC, dass man seitens der Verfechter der Homöopathie zu solchen zweifelhaften Mitteln greifen muss, um zumindest bei den unkundigen Patienten den Schein zu wahren, es gäbe tatsächlich ernsthafte Gegenargumente. Solche werden üblicherweise in einer wissenschaftlichen Regeln entsprechenden Art und Weise in wissenschaftlichen Journalen veröffentlicht und damit ihrerseits zur Kritik der Wissenschaftsgemeinde gestellt.

Frühere Versionen des veröffentlichten Reviews

Der in 2015 veröffentlichte Bericht ist möglicherweise erst im zweiten Anlauf zustande gekommen. Selbst wenn es vorher eine andere Version gab, wie das HRI – allerdings ohne Belege oder nähere Angaben – behauptet: So what? Was ist an dem vorliegenden Review auszusetzen? Was an dem Review ist alleine dadurch falsch, dass es eine oder mehrere oder eine beliebige Zahl vorheriger Versionen gegeben hat, wenn es sich dabei nicht ohnehin nur um verschiedene Entwürfe gehandelt hat? Eine sachorientierte Kritik würde herausstellen, wo die Unzulänglichkeiten der vorliegenden Studie liegen, welche Schwächen sie enthält. Aber davon ist hier keine Rede.

Dieser Vorwurf stellt alleine einen Appell an den Leser dar, irgendwelche dunkle Machenschaften, vielleicht sogar eine Verschwörung zu unterstellen, insbesondere, wenn man dann – ebenfalls ohne Beleg – in den Raum stellt, die erste Version sei ohne Zweifel wegen eines für die Homöopathie positiven Ergebnisses zurückgewiesen worden. Was angesichts der klar gegen die Homöopathie sprechenden Evidenzlage aus Reviews und Metaanalysen kaum glaubhaft erscheint.

Datenbasis

Das Review beruht auf 176 Studien, die im ersten Durchgang detailliert begutachtet und für das Review ausgewertet wurden [5, S. 5]. Diese Datenbasis wurde ergänzt, indem die australischen Homöopathieverbände und die interessierte Öffentlichkeit weitere Arbeiten vorlegen konnten, die ebenfalls berücksichtigt wurden [5, S. 6]. Dies erweiterte die Datenbasis um weitere 49 Studien [6: S. 10; 7: S. 11 und 12 ], so dass in Summe 225 Einzelstudien im Review ausgewertet wurden.

Nirgends wird in dem Report eine Zahl von 1.800 Studien genannt, auf denen das Review basiere. Dennoch kritisiert das HRI, dass das NHMRC behauptet hätte, es wären 1.800 Studien ausgewertet worden, was in der Tat nicht korrekt wäre. Man muss schon ziemlich lange suchen, bis man diese ominöse Zahl 1.800 findet: Alleine in der Pressemitteilung vom 11. März 2015 [8] wird mitgeteilt, man habe über 1.800 Arbeiten gesichtet, wovon 225 die Einschlusskriterien erfüllt hätten. Was vollkommen zutreffend ist: Die gesamte initiale Literaturrecherche sowie die Einreichungen im Rahmen der öffentlichen Anhörung umfassten tatsächlich insgesamt 1.863 Artikel, Aufsätze, Fallberichte und Studien (einschließlich Mehrfachnennungen), wie sich aus den Angaben in den entsprechenden Teilberichten errechnen lässt [9: S. 22; 6: S. 10; 7: S. 11]. Dass auf diese “Rohmasse” Auswahlkritieren angewandt werden müssen (wofür es internationale Standards gibt, die hier beachtet wurden) liegt auf der Hand.

Einschlusskriterien für Einzelstudien und Bewertung

Alle Einzelstudien wurden einer detaillierten Betrachtung unterzogen, entweder anhand der Angaben in systematischen Übersichtsarbeiten, in denen sie bereits untersucht worden waren, oder im Falle der eingereichten Studien auch in Einzelbewertung [5: S. 14f].

Die Aussagekraft der Einzelstudien wurde im GRADE-Verfahren bewertet, bei dem mindere Qualität und zu kleine Teilnehmerzahl zu einem Urteil ‘nicht belastbar’ führten [5: S. 36]. Als Mindestwert für die Einstufung einer Studie als zuverlässig wurde beim Kriterium der Teilnehmerzahl ein Wert von 150 festgelegt. In der Tat wird dieser Zahlenwert nicht begründet – allerdings ist er wesentlich kleiner als üblich, also den üblicherweise kleinen Studien in der Homöopathie stark entgegenkommend und keineswegs nachteilig. Im GRADE-Handbuch sind 400 Teilnehmer als Richtwert angegeben, ab dem wegen der Teilnehmerzahl eine Studie einen Bewertungsmalus bekommt [10, Kap. 5.2.4.2]. Dass nur wenige Homöopathie-Studien die Qualitäts- und Größenkriterien erfüllten, ist ein generelles Problem, das auch schon in anderen Reviews bemängelt wurde.

Es sei angemerkt, dass das GRADE-Verfahren zur Bewertung der vorliegenden Evidenz von vielen Organisationen angewandt und empfohlen wird, darunter die Welt-Gesundheitsorganisation (WHO) [11].

Die Kritik des HRI, des DZVhÄ und auch anderer Organisationen wie der ÖGHM, Studien unter 150 Teilnehmern wären von der Betrachtung ausgeschlossen gewesen, ist damit völlig haltlos.

Ebenso unsinnig ist die Behauptung, die Studien, die nicht auf Englisch publiziert wurden, seien generell ausgeschlossen worden. In der Aufstellung der eingeflossenen Studien [12] findet man Arbeiten, die auf Französisch, Deutsch, Italienisch, Spanisch, Portugiesisch und Norwegisch veröffentlicht wurden. Lediglich bei den im Zuge der Anhörung eingereichten Arbeiten wurden in Summe 10 Studien wegen der Sprache ausgeschlossen [6: S. 10; 7: S. 11 und 12 ]. Angesichts der insgesamt 225 im Review betrachteten Studien fällt dies wohl eher nicht ins Gewicht.

Die Aussage von DZVhÄ und ÖGHM suggeriert dem Leser mithin etwas völlig Falsches, nämlich dass eine große Anzahl von Studien ausgeschlossen worden wäre, letztendlich nur 5 (!?) Studien in die Betrachtung eingeflossen seien.

Man könnte seitens der Homöopathen durchaus diskutieren, ob das angewandte Verfahren angemessen war oder das Ergebnis dadurch verfälscht wurde, alleine, das passiert nicht. Dass eine große Anzahl von Studien wegen zu kleiner Teilnehmerzahl oder Veröffentlichung in einer nicht-englischen Sprache vollkommen unberücksichtigt blieb, ist falsch, wie man sich mit einfachen Mitteln, nämlich durch Lesen des Reviews, vergewissern kann. Man fragt sich, für wie einfältig die Homöopathen ihre Kunden und besonders ihre Kritiker halten, ein solches derartig einfach zu entkräftendes Argument einzuführen.

Interessenkonflikt

Der Vorsitzende des Ausschusses, der die Arbeit begleitet hat (HWC – Homeopathy Working Committee), war Prof. Glasziou von der Bond-Universität in Queensland [5, S. 31]. Ursprünglich sollte Prof. Brooks von der Universität Melbourne die Leitung übernehmen, aber aufgrund eines Interessenkonflikts erfolgte eine Umbesetzung und Brooks arbeitete als einfaches Mitglied im HWC mit. Der Interessenkonflikt bestand darin, dass er Mitglied in einer Vereinigung “Friends of Science in Medicine” war, einer Vereinigung, die die wissenschaftliche Ausrichtung der Medizin fördern will und daher Positionen gegen die Alternativmedizin vertritt [13].

Und jetzt muss man sich einmal vergegenwärtigen: Eine Vereinigung wie das HRI wird praktisch ausschließlich von Therapeuten und Einrichtungen finanziert [14], die mit der Homöopathie ihr Geld verdienen. Man fördert Forschungsvorhaben und Studien zur Homöopathie, veröffentlicht selbst entsprechende Arbeiten, beispielsweise die letzten Reviews zur Homöopathie von Mathie et al. 2014 und 2017. Ausgerechnet dieses HRI kritisiert an einem 1.000-Seiten-Review, zu dem sicher mehrere Dutzend Menschen beigetragen haben, dass ein einziger Mitarbeiter des das Projekt steuernden Ausschusses einen möglichen Interessenkonflikt offengelegt hat – der darin bestehen soll, dass er einer Vereinigung für Wissenschaftlichkeit in der Medizin angehört? Wie lächerlich ist das denn?

Substanzielle Kritik hingegen würde aufzeigen, wie eine solche Voreingenommenheit, die hier übrigens noch nicht einmal auf wirtschaftlichen Interessen beruht, das Ergebnis hätte beeinflussen können. Beispielsweise wo das Design anfällig dafür war, etwa indem Entscheidungsspielräume gegeben wären, die zu einer Verfälschung in Richtung auf negative Ergebnisse hätten ausgenutzt werden können. Aber nichts dergleichen wird genannt. Auch hier zielt das Argument wohl auf den Leser, der wieder dunkle Machenschaften vermuten kann. Stichwort Skandalisierung.

Zusammensetzung der Arbeitsgruppe

Die Arbeitsgruppe zur Leitung der Untersuchung, das HWC, umfasste sieben Personen einschließlich des Vorsitzenden [5 S. 31 f]. Neben ausgewiesenen Wissenschaftlern der konventionellen evidenzbasierten Medizin (Allgemeinmedizin, Rheumatologie, Neurologie) fanden sich darin ein Vertreter der australischen Vereinigung der Krebskranken, eine Apothekerin, ein weiterer Forscher und ein Regierungsvertreter. Die Apothekerin ist Leiterin für Lehre und Forschung zur Komplementärmedizin an der Griffith University in Gold Coast, Queensland, und ist Mitglied der Gesellschaft für Forschung zu medizinischen Pflanzen und Naturprodukten.

Die Untersuchungen bestanden in einer Suche nach einschlägigen Literaturstellen zur Wirksamkeit der Homöopathie sowie in der Auswertung der gefundenen Daten zur Qualität der Studien, der Teilnehmerzahl sowie Krankheitsbild und Ergebnis. Letzteres wurde durch externe Dienstleister, die Firmen OPTUM und ARCH, vorgenommen.

Da es sich bei diesem Review also nicht um eine Leitlinie oder Therapieempfehlung handelt, ist ein Spezialist für Homöopathie entbehrlich [18, S. 4]. Die niedergelegten Daten zutreffend zu extrahieren erfordert kein spezielles Fachwissen, über das nur Homöopathen verfügen.

Die Regeln des NHMRC sehen natürlich vor, dass bei der Erstellung von Behandlungsleitlinien Vertreter der anzuwendenden Therapieform in der Arbeitsgruppe vertreten sein müssen, was sich ohne weiteres von selbst versteht. Aber beim bloßen Datensammeln und Auswerten ist dies nicht erforderlich.

Die entsprechende Kritik des HRI ist also nicht gerechtfertigt, zumal auch hier nicht dargelegt wird, wie denn jemand mit homöopathischen Fachkenntnissen zu anderen Ergebnissen hätte kommen können.

Schlussfolgerung

Die Kritik des HRI am Review der australischen Gesundheitsbehörde ist recht oberflächlich und berührt den Inhalt der Studie nur am Rande. Beim Leser soll ganz offensichtlich der Eindruck hervorgerufen werden, diese Arbeit sei aufgrund dunkler, gegen die Homöopathie gerichteter Machenschaften zustande gekommen. Eine substantielle Kritik unterbleibt vollkommen, es wird kein einziger sachlicher Aspekt der Studie diskutiert, der einen Einfluss auf das Ergebnis hätte haben können. Das HRI übt zwar Kritik an der Mindestanzahl von 150 Teilnehmern für eine belastbare Studie – was vom DZVhÄ auch noch falsch zitiert wird – bleibt aber ein Argument schuldig, warum diese im Vergleich zum originären GRADE-Verfahren recht entgegenkommende Festlegung ungerechtfertigt sein soll.

Es bleibt abzuwarten, wie die Entscheidung des angerufenen Ombudsmannes der australischen Regierung ausfallen wird. Seine Aufgabe ist aber weniger die Auseinandersetzung mit wissenschaftlichen Ergebnissen, sondern der Schutz australischer Bürger und Vereinigungen vor ungerechtfertigter Benachteiligung durch Regierungsbehörden. Wenn man dort die wissenschaftlichen Grundlagen betrachtet, dann dürfte das HRI wenig Aussicht haben, mit seiner Beschwerde etwas zu erreichen.

Randbemerkung

Das Review des australischen Gesundheitsministeriums kommt mit anderer Methodik und größerer Datenbasis praktisch zum gleichen Ergebnis wie die beiden Reviews, die Mathie in den Jahren 2014 und 2017 veröffentlicht hat [15, 16]. Auch dort fand man keine zuverlässigen Studien, die den Qualitätsanforderungen für einen “low risk of bias” vollumfänglich entsprochen hätten und gleichzeitig eine Wirksamkeit des Homöopathikums über Placebo hinaus zeigten. Dabei hatte man noch nicht einmal die Anzahl der Teilnehmer als ein Bewertungskriterium herangezogen:

“Individuell verschriebene Homöopathika zeigen möglicherweise einen kleinen spezifischen Behandlungseffekt.[…] Die generell geringe und unklare Qualität der Nachweise verlangt es aber, diese Ergebnisse vorsichtig zu interpretieren.” [15]

“Die Qualität der vorliegenden Nachweise ist gering. […] Zuverlässige Nachweise aus krankheitsspezifischen Meta-Analysen liegen nicht vor, weshalb diesbezügliche Schlussfolgerungen nicht möglich sind.” [16]

Schon Linde kommt in seinem Review von 1998 zu dem Schluss [17]:

“Wir fanden [in den betrachteten] Studien jedoch nur unzureichende Nachweise, dass Homöopathie für irgendein Krankheitsbild eine klare Wirksamkeit aufweist.”

Liebe Frau Bajic, lieber DZVhÄ: Worin liegt jetzt der Skandal, den Sie darin sehen, dass die Australier diese sicher nicht auf Voreingenommenheit gegen die Homöopathie beruhenden Ergebnisse vollumfänglich bestätigen und ihren Bericht veröffentlichen? Und was ist die korrekte Studienlage, auf die Sie hinweisen? Entschuldigen Sie, Ihr Forschungsreader zur Homöopathie, den Sie zitieren, hält einer eingehenderen Betrachtung ebenso wenig stand wie die vorgebrachte Kritik an der NHMRC-Studie, aber das ist hier nicht das Thema.

Für das INH: Dr. Norbert Aust


Quellen und Literatur

Bild: Fotolia_129323079_XS

Alle Links und Webseiten abgerufen am 12. Mai 2017

[1] NHMRC Statement on Homeopathy and NHMRC Information Paper – Evidence on the effectiveness of homeopathy for treating conditions, Webseite mit Download aller Teile des Berichts, Link: https://www.nhmrc.gov.au/guidelines-publications/cam02

[2] NN: The Australian Report, Webseite des Homeopathy Research Institute, Link: https://www.hri-research.org/resources/homeopathy-the-debate/the-australian-report-on-homeopathy/

[3] NN: Australische Homöopathie-Studie: “Eine Täuschung der Öffentlichkeit”, Webseite des Deutschen Zentralvereins homöopathischer Ärzte, Link: http://www.homoeopathie-online.info/australische-homoeopathie-studie-eine-taeuschung-der-oeffentlichkeit/

[4] Dellmour F: Australische “Studie”: Falsches Spiel mit dem Evidenzbegriff, Webseite der Österreichischen Gesellschaft für homöopathische Medizin, http://www.homoeopathie.at/wp-content/uploads/2015/06/Dellmour_Australische_Studie_2015_Vollversion.pdf

[5] NN: NHMRC Information Paper – Evidence on the effectiveness of homeopathy for treating health conditions, March 2015, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02a_information_paper.pdf

[6] NN: Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence, Review of Submitted Lietrature, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02g_reviewofsubmittedliterature140408.pdf

[7] NN: Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence – Review of Literature from Public Submissions, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02j_review_literature_public_submissions.pdf

[8] NN: NHMRC releases statement and advice on homeopathy, Pressemeldung vom 11. März 2015, Link: https://www.nhmrc.gov.au/media/releases/2015/nhmrc-releases-statement-and-advice-homeopathy

[9] NN: Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence, Overview Report, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02i_homeopathyoverviewreport140408.pdf

[10] Schünemann H, Brozek J, Guyatt G, Oxman A: GRADE Handbook, Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach, Updated October 2013, Link: http://gdt.guidelinedevelopment.org/app/handbook/handbook.html#h.qoxhi6qajv5t

[11] NN: The Grading of recommendations Assessment, Development and Evaluation (GRADE) Approach, Eintrag in der englischen Wikipedia, Link: https://en.wikipedia.org/wiki/The_Grading_of_Recommendations_Assessment,_Development_and_Evaluation_(GRADE)_approach

[12] NN: List of systematic reviews and primary studies already considered by NHMRC, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02f_listofconsideredevidence140407.pdf

[13] NN: History, Webseite der Vereinigung “Freinds of Science in Medicine”, Link: http://www.scienceinmedicine.org.au/index.php?option=com_content&view=article&id=114&Itemid=158

[14] NN: Our Supporters, Webseite des Homeopathy Research Institute, Link: https://www.hri-research.org/support-hri/collaborations/

[15] Mathie RT, Lloyd SM. Legg LA, Clausen J et al.: Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis, Systematic Reviews (2014) 3:142, DOI 10.1186/2046-4053-3-142

[16] Mathie RT, Ramparsad N, Legg LA, Clausen J et al: Randomised, double blind, placebo controlled trials of non- individualised homeopathic treatment: systematic Review and meta-analysis, Systematic Reviews (2007) 6:63, DOI 10.1186/s13643-017-0445-3

[17] Linde K, Clausius N, Ranirez G, Melchart D et al.: Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo controlled trials, The Lancet (1997); 350: 834-843

[18] NN: Summary of key issues: Draft information paper on homeopathy – expert review comments, Link: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02e_expert_review_comments.pdf


Zum Weiterlesen:

http://edzardernst.com/2017/04/ombudsman-investigates-flawed-homeopathic-study/

https://keineahnungvongarnix.com/2017/04/20/skandal-verschwoerung-gegen-homoeopathie-oder-doch-nicht/

http://scienceblogs.de/gesundheits-check/2017/04/17/auferstehung-von-den-toten-auch-homoeopathen-feiern-ostern/

On the developments in the USA and the demands of the FTC

Typical brown glass bottle with the well-known homeopathic remedy A bad day for homeopathy: On November 15, 2016, the U.S. Federal Trade Commission (FTC) issued its statement that in future, over-the-counter homeopathic remedies will have to be labelled as the product’s efficacy is not proven – unless, of course, the manufacturer can provide such evidence. As expected, the German homeopathy associations reacted immediately by pointing out that this demand could not be transferred to Germany. This wouldn’t also be necessary, as the German Medicines Act already would have stricter requirements than those resulting from the requirements of the FTC in the USA.

Requirements of the FTC

The FTC considers it necessary that manufacturers of products should only be allowed to claim that their products are suitable for the treatment of certain health conditions if they have an appropriate basis for doing so. This applies to over-the-counter (OTC) medicines, dietary supplements or food, including homeopathic preparations for self-medication of complaints that would also disappear on their own (“self-limiting”, e.g. a cold – only such can be sold freely in the USA). It was further concluded that health claims for homeopathic products are generally not based on modern scientific methods. For giving health, safety or efficacy claims, manufacturers need proper and reliable evidence, which in the case of medicinal products require well-done human clinical trials. However, these requirements are not met by the vast majority of OTC homoeopathic medicinal products, which is why corresponding claims of efficacy are misleading.

This misleading of customers can be remedied by the fact that manufacturers state the following in their marketing materials:
1. “There is no scientific evidence that the product works.”
2. “The products claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.”)

It is expressly pointed out that it is not permissible to compensate the reference to the lack of evidence by other claims or references. Since the indication of a field of application and the simultaneous reference to the lack of evidence could also be confusing, the manufacturers would have to check by means of surveys whether the information was understood by the customers.

Comments of the German Homeopathy Associations

The Verband der klassischen Homöopathen Deutschlands (Association of Classic Homeopaths – VKHD) and the Deutsche Zentralverein homöopathischer Ärzte (Central Association of Homeopathic Practicioners – DZVhÄ) are in agreement that the situation in the USA cannot be transferred to Germany. In Germany, homeopathic medicinal products are subject to pharmacy duty and, as registered medicinal products, are not sold under indication. As a result, they claim that there are already now stricter requirements than those resulting from an implementation of the FTC requirements in the USA.

We will not go into the usual misinformation that can be found on the homoeopath websites, such as that there is sufficient evidence or that homoeopathy is subject to examination. Simply for space reasons.

Comment of the INH

In principle, VKHD and DZVhÄ are certainly right: The situation in the USA is not directly comparable with the situation in Germany in detail – but is the matter settled? Certainly not.

The aim of the FTC is to ensure fair competition, which in the case of pharmaceuticals in particular means that customers are not misled as to the nature of what they are purchasing.

It is true that in Germany not the same methods are used as in the USA – but aren’t consumers also deceived about the nature of homeopathic remedies? Shouldn’t measures also be taken in Germany to prevent this deception? These may be different from those in the USA – but the claim that there are no explanatory models or evidence for a mode of action is certainly also necessary in Germany. Currently such is nowhere to be found.

Unlike in the USA, no indication is given for registered homeopathics in Germany. But does not the mere statement that the product sold is a medicinal product in the first place and, unlike in the USA, may only be sold in a pharmacy, lead much more astray than a manufacturer’s statement on a product in a supermarket could ever do?

Even if they do not specify any indications, the manufacturers in Germany have nevertheless found sufficient ways to overturn the ban on advertising with indications for registered homeopathic remedies. Simply stating that the product is a pharmacy-only product will raise the question in the patient as to what it can be used for or against. And the manufacturers will certainly be happy to help finding an answer. Doctors, pharmacists, non-medical practitioners, midwives are trained there:

Screenshot: Expert circles of the DHU on their website
Image 1: Expert circles of the DHU on their website

Extract from the range of specialist midwifery services with additional information on homeopathy for children
Image 2: Extract from the range of specialist midwifery services

Pharmacies then logically advertise in their displays with the information on homeopathics, which the manufacturers are not allowed to name directly. One sponsors relevant lectures by pharmacists, doctors, alternative practitioners on the application of homeopathy in the spring, in the flu season, in old age, on journeys etc..:

Screenshot: Events offered and promoted by the DHU for individuals
Image 3: Events offered and promoted by the DHU for individuals

The number of guidebooks on self-medication is immense, divided into all possible fields of application for humans, animals and plants. On the Internet, relevant websites are promoted by means of advertisements:

Screenshot: Sponsored guide page
Image 4: Sponsored guide page

Summary

Wee see, it is no need at all that an indication appears on the package insert. This “knowledge” is widespread and freely available – and this is increased by the manufacturers to the best of their ability. All this is presented to the customer as true and justified by the statement ‘Homeopathic medicine – pharmacy compulsory’ – even though it’s sugar only.

The requirements in Germany are not stricter than in the USA; on the contrary, the misleading of the consumer in Germany is much stronger than it was ever the case in the USA considering the overall system. There it was a pure manufacturer’s statement for which a homeopathic remedy can be used, and at least skeptical consumers will have been just as suspicious of such statements in the advertising country USA as they were of the praises of other products, which are supposed to make slim, eternally young, beautiful and of course healthy.

However, the situation in Germany is that pharmaceutical law encourages quackery in homeopathy by promoting what makes a remedy appear to be an effective medicine – pharmacy duty – but at the same time refrains from demanding what makes a remedy a remedy at all, namely demonstrable efficacy. The fact that universities, medical chambers and health insurance companies additionally strengthen this impression by dealing with homeopathy has a much greater potential for deception than manufacturers statements in the USA ever had.

In Germany, in view of this, even more far-reaching demands must be made in order to eliminate the deception of the consumer:

  • Marking of packages with the clear name of the product
  • Specification of the quantity of ingredients in an absolute unit of mass
  • Disclaimer that the efficacy of the product has not been demonstrated and that an efficacy would be contrary to scientific knowledge
  • Identical warning notices in the self help literature, “Quickfinders” and in relevant Internet pages as well as at lecture events
  • Elimination of the waiver of a proof of efficacy for homeopathies in pharmaceutical law
  • Abolition of the pharmacy obligation for homeopathic remedies for which there is no proof of efficacy according to recognised scientific standards
  • Elimination of the ‘additional designation homeopathy’ and further training offers for doctors
  • Elimination of the reimbursement for homeopathic therapies within the statutory health insurance
  • Elimination of homeopathy courses in the licensing regulations and in the curricula of the universities

Only when these points have been implemented will we have a situation like that which is now to be achieved in the USA through the FTC demands.


Author: Dr. Norbert Aust


Supplement, 07.07.2019

The implementation of the FTC’s demands is sluggish in the USA, to put it mildly. In contrast to decisions of the Food and Drug Administration (FDA), the publications of the FTC are not directly legally binding. As expected, this leads to a high degree of ignorance among most manufacturers.

However, the FDA confirms that it is preparing a basic regulation with legal force for homeopathics and related products that will probably include the demands of the FTC. We will report in due course.


Picture credits: Screenshots, Photo: Wikipedia Commons Bhavesh Chauhan

Offener Brief des INH und des Wissenschaftsrats der GWUP zur “Ringvorlesung Homöopathie” der LMU München

In einer aktuellen Veröffentlichung bewirbt die Ludwig-Maximilians-Universität München eine Veranstaltungsreihe (Ringvorlesung) im Wintersemester 2016/17 zum Thema “Homöopathie: Von der Theorie zur Praxis – Mit Praxisbeispielen und Patientenvorstellungen”. Dabei handelt es sich, wie ein Blick in die Ankündigung zeigt, um eine Reihe von Vorträgen, die den “homöopathischen Ansatz” bei unterschiedlichsten Krankheitsbildern vorstellen will.

Wir halten es für verfehlt, durch eine solche Veranstaltung der homöopathischen Methode zu akademischem Ansehen zu verhelfen, nachdem dies eigentlich längst als obsolet angesehen werden müsste:

  • 1939: Die von August Bier, einem seinerzeit führenden Homöopathen, durchgesetzte Einrichtung einer homöopathischen Fakultät an der Universität Berlin wird rückgängig gemacht – ausdrücklich wegen “Ergebnislosigkeit”.
  • 1958: Die gleiche Universität wehrt sich mit deutlichen Worten gegen den Versuch, diesen Lehrstuhl wieder aufleben zu lassen.
  • 1992: Die medizinische Fakultät der Universität Marburg weist in einer deutlichen Erklärung jede Relevanz der Homöopathie für den Wissenschaftsbetrieb zurück und verwahrt sich gegen ministerielle Bemühungen, Homöopathie in die Lehre einzubeziehen.

Vor diesem Hintergrund ist es mehr als befremdlich, dass die LMU den Lobbyisten vom Deutschen Zentralverein homöopathischer Ärzte eine Plattform bietet, zumal diese mit Lehre und Forschung, den Grundaufgaben jeder Universität, offenbar wenig bis nichts zu tun hat. Leider. Denn wir sind durchaus der Ansicht, dass richtig verstandene Lehre auch in Bezug auf die Homöopathie an einer Universität Platz finden könnte, ja sogar müsste.
Lehren! Das würde für die Homöopathie bedeuten, sie im medizinhistorischen Kontext zu vermitteln, ihre Widersprüchlichkeiten und Unverträglichkeiten mit naturgesetzlichen Gegebenheiten zu erörtern und den fehlenden Wirkungsnachweis und die sogenannte Grundlagenforschung zur Homöopathie vorzustellen und zu diskutieren. Das wäre im Hinblick darauf zu begrüßen, dass angehende Mediziner dann auch auf diesem Gebiet mit solidem Wissen und nicht mit einem Bündel von nicht hinterfragten Vorurteilen ins Berufsleben starten.

Davon ist in der Ankündigung der LMU allerdings nichts zu finden. Stattdessen besteht die Ringvorlesung aus einer Abfolge von Veranstaltungen, in denen die “homöopathischen Ansätze” bei unterschiedlichsten Krankheitsbildern präsentiert werden. Dabei reicht die Palette von einfachen selbstlimitierenden Erkrankungen wie Sinusitis bis hin zu schwersten Erkrankungen, sogar bis in den palliativmedizinischen Bereich. Die angekündigte Eingangsvorlesung “Geschichte und Philosophie der Medizin: Samuel Hahnemanns Begründung einer rationalen Heilkunde” wird wohl auch kaum zu einer methodenkritischen Einführung in die nachfolgenden Vorlesungen gedacht sein. So sind die angekündigten “Praxisbeispiele und Patientenvorstellungen” kein positives Merkmal, sondern bieten nur wieder die Möglichkeit, Homöopathie als “Erfahrungsmedizin” darzustellen.

Wir meinen:

  • Diese unkritische Behandlung der Homöopathie hat an einer wissenschaftlichen Fakultät nichts zu suchen.
  • Es ist mit dem Auftrag zu Forschung und Lehre unvereinbar, einer von der überwältigenden Mehrheit der weltweiten Forschungsgemeinde als spezifisch arzneilich unwirksam eingestuften Methode eine oberflächlich-werbende Darstellung zu geben.
  • Es wäre allenfalls geboten, die Homöopathie gut wissenschaftlich im Sinne einer Erörterung und Falsifikation ihrer Annahmen zu behandeln.
  • Das aktuelle Vorgehen entspricht nicht der Verantwortung der Hochschule gegenüber Studierenden und Patienten.

Unterzeichner:

Für das INH

Dr. Norbert Aust
Udo Endruscheit (Verfasser)
Prof. em. Dr. Edzard Ernst
Dr. Natalie Grams
Amardeo Sarma
Prof. Dr. Norbert Schmacke

Für den Wissenschaftsrat der GWUP

Prof. Dr. Michael Bach
Prof. Dr. Dr. Ulrich Berger
Lydia Benecke
Prof. Dr. Peter Brugger
Prof. em. Dr. Edzard Ernst
Prof. Dr. Dittmar Graf
Dr. Natalie Grams
Prof. Dr. Wolfgang Hell
Prof. Dr. Dieter B. Herrmann
Prof. Dr. Johannes Köbberling
Prof. Dr. Walter Krämer
Prof. Dr. Martin Lambeck
Dr. Rainer Rosenzweig
Prof. Dr. Dr. Gerhard Vollmer
Dr. Barbro Walker
Dr. Christian Weymayr
Dr. habil. Rainer Wolf


Weitere aktuelle Stellungnahmen:

Blogbeitrag bei Edzard Ernst (auf Englisch) hier

Kritischer Kommentar von Wissenschaftsjournalist Werner Bartens in der Südeutschen Zeitung hier

Interessanter älterer Beitrag zur Homöopathie an der LMU auch im Laborjournal hier


Bildnachweis: Fotolia_90994398_XS

The Placebo Business

Samuel Hahnemann was born on 10 April 1755

 Placebo and nocebo effects are not only found in medicine. These effects accompany us in daily life always and everywhere and are not bad in themselves. The ambience of a restaurant makes the schnitzel taste better and if “coffee” and not “café” is on the drinks menu, the taste will be judged more critically. The tricky thing about placebo/nocebo effects is that they are not subjective “imaginations” or apparent effects, but objectively measurable or observable changes. The effect is real. The particular malice of these effects in medicine lies in the fact that they occur in medicine and pseudomedicine both effectively positive and negative.

However, the placebo and nocebo effects are not based on specific individual causes. There is no causal “physical-chemical” relationship. It doesn’t matter with which acting or method one works. The placebo and nocebo effects are neither specifically causal, nor can they be realized at will by certain events or actions. The positive placebo and “vice versa” negative Nocebo effects result from the whole spectrum of expectations, desires and hopes of each individual against the background of his religious and ideological views, its education including its completely subjective life and illness experiences. All this is conditioning. Placebo and nocebo effects can literally be caused by anything, as long as it is “psychologically” significant for the individual, or – to put it casually – corresponds to gut feeling.

Whether we like it or not, we consciously and unconsciously attach highly personal “meanings” to the entire process, the various drugs, the therapeutic spectacle, the people involved, the environment, in short all things and events, whether we like it or not, and contribute to placebo or nocebo effects in this way. These assigned meanings are subjective and prejudices. One orients oneself to this and of course these can also become effective in the sense of placebo and nocebo and this sometimes happens very spectacularly. And this is exactly where “advertising” comes in. Professional advertising psychologists know exactly how and with which images they can reach and influence their target audience. And that happens daily throughout the media.

The placebo effect is one of the main pivotal points in discussions about pseudomedicine. The placebo effect also meets the effect of homeopathy as the best-known pseudomedicine. The lack of causality based on natural science is replaced by fashionable pseudo-scientific swirling and, depending on the clientele, also by angels and the like, if one includes the feel-good and life-support area as a peripheral area of medicine.

Now the placebo effect is being discovered as a hope for legitimazion of pseudomedicine and is being given a completely erroneous meaning. One does not dizzy any longer over this effect, but markets thereby purposefully pseudomedicine and also homeopathy. Placebo is like a drug, but is gentle and free of side effects. To put it simply, one only has to swallow a placebo tablet or apply homeopathy. A naive and unattainable wishful thinking. If an application is very widespread, often used and the field of application concerns mainly harmless, temporary and self-healing complaints, then there will be accordingly many and also sensational “successes”. But however impressive, they are placebo effects and the effects are correspondingly limited.

The discovery of the placebo effect

Franz Anton Mesmer propagated “animalic magnetism” towards the end of the 18th century. His treatments were spectacular, “mesmerism” was booming. Benjamin Franklin, however, was able to demonstrate in 1784 as a member of the royal commission of inquiry in Paris that these “treatment successes” occurred when and only when the subjects knew that they were actually “mesmerized”. If the “healing” spectacle was hidden with the magnets, i.e. performed as blinded or omitted, the sensational effects were over. Benjamin Franklin succeeded, so to speak, in the first documented proof of the placebo effect. Benjamin Franklin showed that the success of medical actions was based on two chains of causes. The effect can lie in the belief in the therapist or his therapeutic spectacle, his method and his remedy as well as in the method and the remedy itself, if a physically causally conditioned effect of the last exists at all.

Evidence versus eminence and pseudomedicine

Since then, a distinction has been made between “physical” and “psychological” causes of action. Until then, the question of a causal effect had not arisen. All you could see was that it worked, and that was enough. From now on, scientific medicine developed. Remedies or therapies were only considered “properly” effective when it could be shown that their effect was independent of the expectations and beliefs of patients and doctors. To work or heal through mere “imagination” was already suspect at that time.

This unmasking of the therapeutic spectacle or the “actor physician” as an effective component of the phenomenon then referred to as hysteria was, however, also a confirmation of the ineffectiveness or effect of “transcendental” healing powers in medicine.

It must be remembered that for thousands of years in healing, the imploring of heavenly goodwill has been an indispensable part of medicine. A remedy alone could not work properly if it was not used with appropriate therapeutic evocation. Healing has always been an extensive ritual that reached into the beyond. The doctor or his art of healing could not heal alone, they could only contribute a part to the healing. Franz Anton Mesmer did not claim to possess supernatural abilities, but his therapeutic spectacle was as effective or ineffective as a heavenly spectacle. The charisma of the healer only had to be just as impressive as the miraculous relic in a pilgrimage cathedral.

This insight changed the development of medicine in the long term. Since that time, a distinction has been made in medicine between evidence and eminence. For a long time, what eminences thought was right and applied that. Today, evidence-based medicine is the standard. It is based on scientifically proven findings. Experience has shown that a personal observation simply does not suffice as proof in order to be able to claim a causal effect or a causal connection.

Today it is no longer part of medicine or the medical art of healing to call upon supernatural heavenly powers. No doctor will forbid his patient to pray, but he will certainly not prescribe the praying of three “Our Fathers” or even propose an exorcism, which is still practiced by the Catholic Church. And just as a heavenly spectacle cannot replace a specifically effective medicine, neither can a therapeutic spectacle do. And spiritual powers in drugs, as Hahnemann still thought, do not exist.

But the medicine based only on “eminence”, whose effectiveness is based on the good reputation, did not disappear. On the contrary, it lives on to this day in alternative, complementary and so-called holistic medicine. Here one justifies oneself still exclusively with the subjective observations and statements of eminences, the treating physicians and healed ones. The anecdotes as eminence-based testimonials are legally safeguarded with the indication that the effectiveness is not scientifically proven. The healing anecdotes correspond to the votive tablets in pilgrimage churches. And an evidently proven effect is still not a prerequisite for legal admissibility.

For the sick hoping for healing this is of no importance. They trust in eminence, they succumb to reputation. For them, individually reported healings or the reputation of the participants are proving enough. The importance attached to doctors, media personalities and stories of spectacular healings weighs more heavily than scientifically based assessments. The therapeutic spectacle, the special care, the recommendation and last but not least the reputation to be without technology, without chemistry, biological, natural etc. count more and act as a placebo.

The doctor or guru convinced of his method sees the success with his patients and clients. These in turn strengthen their practitioners in their belief that they recognize causally effectiveness in their treatment. The technical term for this is “performative deception”. The self-deception of patients and doctors reinforces each other. And a good doctor will give his patients hope. He has no choice: in the patients’ eyes he must appear as guarantor of effective treatment. However, it is only a small step from giving hope to the patient to believing that his treatment will actually have an effect even on life-threatening diseases. The best-known example of such “medicine” is homeopathy. The performative deception is the basis and characteristic of homeopathy. The homeopathic way of working, its setting favours self-deception. The effective therapeutic spectacle begins with the anamnesis. Every little ailment is recorded and treated and, contrary to all assurances, homeopathy is also recommended for life-threatening diseases instead of proven effective medical treatment. In the end, the “homeopaths without borders” “heal” Ebola with sugar beads in Africa.

To date, there is no valid proof of efficacy.

Yes, and there is no evidence of the phenomenon of homeopathy itself. The legendary Nuremberg salt experiment of 1835 and the numerous metastudies to date are clearly negative. The quality of positive studies is usually doubtful and negative study results are negated by homeopaths or highly professionally reinterpreted with idiosyncratic statistics. It is rounded off with allegedly “scientific” explanations of the effects of homeopathy. These are nonsense from a scientific point of view. Nothing but a science fiction effect is explained here.
Such means and methods cannot be objectified. The placebo effect is also and especially founded in eminence-based medicine and is therefore the link between medicine and pseudomedicine. In medicine, successes and failures are investigated and explained. This leads to new insights. In the always dogmatic pseudomedicine there is nothing to clarify. It has therefore also contributed nothing to our current tried and tested state of knowledge. The contribution of “alternative” medicine to progress of knowledge is zero.

The magic wand “Eminence” of yore is still working

Franz Anton Mesmer continued to do good business at that time. His patients remained loyal to him. Nothing has changed in this scenario to date. Therapies and remedies have taken all possible and impossible forms over time. Magnets and high-voltage sparks have been replaced by information, bioresonances, quanta, and much more bywords misusing physical terms. The evidence for the effect is missing. The postulated mechanisms of action contradict all proven and tested scientific findings and many of these universal remedies are also occasionally harmful to acutely life-threatening. The spectrum ranges from ineffective energetic cures to, for example, “Germanic New Medicine”. The last pages of free newspapers and local papers are full of advertisements using these bywords. Einstein’s just good enough for gravitational wave therapy.

For a myriad of newer means and methods, effect is generated with illustrious personalities and impressive advertising, without being able to present any valid evidence of efficacy beyond placebo. Nearly the entire alternative, complementary and holistic medicine still relies exclusively on the unique inspiration of its founders and the positive reports of its practitioners and patients. Charismatic personalities appear regularly in appropriate broadcast formats such as documentaries, health contributions etc. and promise to be able to heal everything or to have been healed with always amazingly simple therapies or means. Criticism is not much in demand. It usually serves only as a fig leaf for the semblance of critical and objective reporting.
The homeopathy of the Mesmer contemporary Hahnemann survived until today. And anyone who wants to, can put the label “homeopathy” on his pseudomedical hustle and bustle. Meanwhile also animals, plants and whole oceans are homoeopathically treated. And also well-known homoeopaths have nothing against it. You heal – and rest the case.

Realism as an opportunity?

The chances are bad. Everything, no matter how absurd, can and will be certified as a medical device. This only means that binding rules are laid down according to which production and applying are carried out. The lawyers are not bothered whether medical products or methods, which come on the market, correspond to our proven and tested scientific state of knowledge as well as are demonstrably effective and reasonable. They may not be “harmful” and may only be sold or used by officially authorized persons. The difference of a non-medical practitioner against an African shaman lies mainly in the possession of a cash register and her membership in the Chamber of Commerce. Many licensed doctors are certified homeopaths. The basics of pseudomedicine homeopathy, however, are as nonsensical as the basics of energetics. But the doctors are members of the Medical Chamber and non-medical practicioners of the Chamber of Commerce – this difference is much more serious than the first-mentioned above.

All the facts speak against homeopathy. It is pseudomedicine, superstition and big business in the health sector. Homeopathy is a lucrative health lottery. There’s only little placebos to win. Many people and especially young mothers and midwives associate homeopathy with biological, gentle, natural and see it as a complement and also an alternative to medicine. Psychologists can explain this phenomenon and advertising experts can be paid for using it. The lucrative gut feeling doesn’t fall from the sky.

The enlightened society must once again decide what kind of treatment is permitted and what kind of protection is appropriate for patients in a civilised society. Evidence, eminence and even pseudo are not clearly distinguishable for laymen. Do we want effective drugs or therapies with verifiable effects or is it also right to offer requisites for a folk-medical superstition and pseudomedicine in ordinations and pharmacies?

Hahnemann died on 2 July 1843 in Paris.


The author Dr. Edmund Berndt is a retired pharmacist and author of the book “Der Pillendreh. Ein Apotheker packt aus” (Rotating Pills – A pharmacist uncovers), Edition Vabene, 2009

Photo: Susanne Aust

How homeopathy overrides common sense

What makes common sense?

 As a university teacher, I try to teach my students one thing above all else: common sense. By this I mean the willingness and ability to adhere to simple reasoning principles when thinking, e.g. the principle of not only considering the pro-arguments for a position, but also the contra-arguments. Each of my students accepts these principles of reason – mostly immediately and without contradiction. Everybody! For they are so plausible that our own reason forces us to accept them.

Students often ask me why I spend so much time explaining things that every child should understand. The reason for this is simple: common sense is child’s play – until it is no longer. When we think about questions to which we have no emotional connection, we are sober, serene, reasonable. Our common sense works. However, this has an end as soon as it comes to things that are close to our hearts. Every means is right for us here to support the position that is most sympathetic to us. We then search for evidence for our point of view and ignore everything that speaks against it. Psychologists speak of “confirmation bias” or “disconfirmation bias” in this context. A research team around the American psychologist Dan Kahan has even found out that trial participants literally let five be straight when it comes to their own political views. They accepted arguments for their position even when they obviously violated basic rules of calculation (Kahan et al. 2013).

Homeopathy is a good example of a bad example

Common sense cannot be overridden only by our political orientations. In my courses I often use the topic “homeopathy” to demonstrate how easily intelligent people get stuck in outrageous theses. I choose this topic for two reasons:

  • Everything indicates that homeopathy is completely untrue. Their scientific initial plausibility goes towards zero.
  • Methodologically flawless empirical studies generate roughly the data one would expect when comparing one placebo with another.

Common sense therefore requires us to reject homeopathy, but many people, some of them quite intelligent, still believe in homeopathy.

The constellation of 1. and 2. ensures that discussions about the pros and cons of homeopathy are regularly transformed into a logical horror cabinet. Intelligent homeopathy advocates put forward arguments that are obviously far-fetched. They conclude in a way that they themselves would reject in other contexts because they are so blatantly contrary to common sense. To illustrate this, I would just like to add an example from the journalist Jens Jessen – after all, head of the feature section emeritus of the renowned weekly DIE ZEIT. He writes: “From the fact that something cannot be explained or proven with present methods, it does not follow at all that it does not exist. Right, gentlemen of the medical profession? Even strict epistemology does not permit such a conclusion. The same scepticism that speaks against homeopathy can also be used in its favour.”

This argument is a sin against common sense – not a small one. To see this, one only has to replace the word “homeopathy” with the word “yeti”, as the philosopher Norbert Hörster once suggested in another context. The result is: “The same scepticism that speaks against the Yeti can also be used in his favor.”

Anyone who allows such an argument for homeopathy to go through should therefore also believe in all other things for which we have no evidence, e.g. in the yeti. I suspect, however, that Jens Jessen does not believe in the Yeti. Because his common sense would certainly turn back on this subject.

Emotion versus Mind

This is exactly the point: homeopathy has managed to bind many intelligent people emotionally to itself. And they’re sometimes willing to say pretty crazy things to defend them. I want someone to say again that homeopathy is incapable of anything. Even though its medicines have no pharmacological effects, homeopathy is extremely effective in another way: it manages to override common sense. You too?


Author: Nikil Mukerji studied philosophy and economics. Today he is Managing Director of the Executive Program Philosophy Politics Economics (PPW) at the Ludwig-Maximilians-University Munich. He also works as a freelance business and political consultant for the Institut für Argumentation in Munich.
In his new book he explains – vividly and true-to-life – the central rules of rational thinking:  “Die 10 Gebote des gesunden Menschenverstandes” (The 10 Commandments of Common Sense, Springer, 2016)

Read also on our website:  Why people like to believe in homeopathy.


Photo: Shutterstock 81762259 Anna Omelchenko

Miasms in homeopathy –

Psora + Sykose + ererbte Sykose + Tuberkulinie + Lepröses Miasma+Syphilis + Akutes Miasma + Typhus + Ringwurm + Spiegelmiasma + Skrophulose + Egolyse + Miasmensplitting + Egotropie + primäre Psora + Überfunktion+Pseudopsora+Haltepunkt + Krätze + Carcinogenie  –
Miasmatische Begrifflichkeiten von damals bis heute

Der Begriff Miasma kommt aus dem Griechischen und bedeutet “Befleckung” (oder “Verunreinigung”)

In der klassischen Medizin, lange bevor man über Viren und andere Mikrooganismen als Krankheitserreger Bescheid wusste, verstand man darunter Ausdünstungen und üble Gerüche, die als Ursache für Krankheiten angesehen wurden. Diese Lehre gilt heute als überholt, sie hat aber durchaus zu richtigen Schlussfolgerungen geführt. Das Trockenlegen von Sümpfen, um den Gestank der Faulgase zu unterbinden, hat auch den Mücken als Krankheitserreger die Brutgebiete entzogen. Das Absondern der übel riechenden Pestkranken hat auch das Risiko der weiteren Ausbreitung gemindert.

Bei Hahnemann, dem Begründer der Homöopathie, hatte jedoch der Begriff des Miasmas eine ganz andere Bedeutung. Er verstand hierunter die tieferen Ursachen für chronische Krankheiten, die er mit seinem normalen Verfahren der Homöopathie nicht heilen konnte. Als Ursache für das Versagen nahm Hahnemann an, dass es tiefer sitzende Überbleibsel älterer nicht ausgeheilter ‘Urübel’ gab, eben die Miasmen, die sich nicht durch die äußere Symptomatik erkennen ließen. Diese hielt er sogar für vererbbar.

“Obwohl (…) heutigen Homöopathen der derzeitige wissenschaftliche Stand der Medizin bekannt ist, sprechen (sie) heute noch von “Miasmen”, wenn (sie) bestimmte Phänomene meinen, die in der homöopathischen Praxis beobachtet werden. Homöopathen, die das Werkzeug “Miasmatik” in ihrem Werkzeugkasten haben, sehen, dass viele Beschwerden auf eine oder mehrere andere verborgene Ursachen zurückgeführt werden müssen.” (Quelle)

Was stimmt an dieser Aussage der Homöopathie?

Der Fehler begann als gute Idee bei Hahnemann

Beginnen wir bei Hahnemann. Seine letzte wichtige Veröffentlichung, “Die chronischen Krankheiten”, wirkt auf den ersten Blick wie das Spätwerk eines mittlerweile verbitterten Greises. Dieses Bild verflüchtigt sich aber, wenn man sich näher mit dem Text beschäftigt. Man kann darin ein Paradebeispiel dafür sehen, dass man trotz einigermaßen folgerichtiger Ideen und Überlegungen zu falschen Schlussfolgerungen gelangen kann. Für seine Zeit waren die Erkenntnisse Hahnemanns beachtlich und innovativ! Auch stand er mit seiner Sichtweise der chronischen Krankheiten der modernen Medizin und Naturwissenschaft wesentlich näher, als seine heutigen Nachfolger, welche die Lehre von den chronischen Krankheiten “weiterentwickelt” haben und immer noch nutzen (trotz besseren Wissens).
Hahnemann war bekannt, dass viele Krankheiten “durch etwas” übertragen werden, also z.B. durch den Kontakt oder die Nähe zu einem Erkrankten oder einer anderen Infektionsquelle, einem tollwütigen Hund zum Beispiel. Er konnte also durchaus feststellen, dass eine – mit seinen Mitteln – nicht mehr feststellbare winzige Menge eines unbekannten Giftes zu erheblichen Beeinträchtigungen und Krankheitserscheinungen führen kann. Warum sollen dann nicht winzigste Mengen eines Heilmittels ebenfalls umfassende Wirkung zeigen können? Die Genese einer Infektionskrankheit, die Vermehrung der Erreger im Körper des Betroffenen, blieben ihm ja mangels Mikroskop verborgen. Hahnemanns Forderung, seine Medikamente in möglichst kleinen Gaben zu verabreichen, ist daher nicht so abstrus, wie es uns heute zunächst erscheint.
Hahnemann hatte durchaus richtig beobachtet, dass es Beschwerden gab, die sich oberflächlich durch Symptome auf der Hautoberfläche äußerten, aber nicht durch ein Behandeln dieser Symptome heilbar waren. Das ist das Bild, das wir auch heute von einigen Infektionskrankheiten haben, wie z. B. Masern, Windpocken etc.
Hahnemann tat das, was ein Wissenschaftler zu seiner Zeit machen musste: Er beobachtete “die Natur” und leitete daraus seine Erkenntnisse ab. Er beobachtete also tatsächlich Phänomene – und erklärte sie im Rahmen seiner Möglichkeiten. So weit, so gut. Doch er machte einen Fehler.

Ende der Homöopathie bei chronischen Krankheiten fehlgedeutet

Zunächst ist zu bedenken, dass Hahnemann unter einer “chronischen Krankheit” sicher nicht das Gleiche verstand wie wir heute, sondern es sich einfach um Symptome handelte, die er mit seiner normalen Vorgehensweise nicht erfolgreich behandeln konnte. Chronische Krankheiten waren also alle diejenigen, die sich der Homöopathie widersetzten.
Er sah an diesem Punkt aber nicht etwa, dass seine Homöopathie wohl nicht wirklich heilen konnte, sondern entspann eine Theorie: wonach etwas die Wirkung verhindern würde!
Im Kernpunkt führt er die chronischen Erkrankungen des Menschen, und zwar alle, ohne Ausnahme, auf drei Urübel zurück: Die Syphilis (Geschlechtskrankheit), die Sykosis (“Feigwarze”, ebenfalls sexuell übertragbare Krankheit) und die Psora (“Krätze”).
Aus seinen Beobachtungen leitete Hahnemann das Vorgehen bei der Behandlung dahingehend ab, dass bei der “miasmatischen Behandlung” zunächst die Natur der inneren verborgenen Krankheit in Erfahrung gebracht werden müsse, also im Anamnesegespräch frühere Infektionen herausgearbeitet werden müssen. Die homöopathische Behandlung muss sich zunächst auf diese innere Krankheit beschränken. Das vorzeitige Beseitigen der äußeren Hautbeschwerden nähme der inneren Krankheit nur das Ventil, woraufhin sich diese noch viel grässlicherer Ausdrucksmittel bedienen würde. Wenn man unter Hahnemanns Miasma eine unbehandelte Infektionskrankheit versteht, dann klingt die obige Behandlungsvorschrift auch aus heutiger Sicht gar nicht so unsinnig. Hätte er anstelle seiner Kügelchen Antibiotika verwendet – die gab es aber erst ein paar Dutzend Jahre später – wäre die Vorgehensweise durchaus erfolgsversprechend.
Hahnemann hatte aber nun mal nur seine Homöopathie eingesetzt. Unwahrscheinlich, dass er damit tatsächlich eine Syphilis-Infektion erfolgreich behandelt haben könnte. Das hatte ihn aber nicht von seinen Vorstellungen abgebracht, denn er nahm gleichzeitig an, dass eine Krankheit um so schwieriger zu behandeln sei, je länger sie bereits andauerte. Und eine zwanzig oder dreißig Jahre alte Infektion zu beseitigen, muss daher fast unmöglich gewesen sein, insbesondere, wenn der Patient durch Fehlbehandlungen seitens der Allopathen “verpfuscht” worden war. Wenn also eine Heilung einer miasmatischen Erkrankung nicht gelang, dann lag das an der Hartnäckigkeit der Krankheit, nicht an den Mängeln der Therapie. So weit verfügte Hahnemann aus seiner Sicht über ein durchaus stimmiges Weltbild, das in manchen Aspekten erstaunlich gut mit dem heutigen Kenntnisstand über Infektionen übereinstimmt.
Hahnemann hatte also aus seinen Beobachtungen durchaus eine folgerichtige Induktion aufgebaut – und sich dennoch geirrt. Es ist einfach nicht zutreffend, dass alle Beschwerden, die sich nicht auf Anhieb mit der Homöopathie behandeln lassen, auf drei Haut- und Geschlechtskrankheiten zurückzuführen sind. Auch wenn man unterstellt, dass die Abgrenzung zu anderen Krankheitsbildern mit ähnlicher Symptomatik nicht unbedingt klar und deutlich war.

Wie hätte man diesen Irrtum feststellen können?

In der Wissenschaft ist die Induktion, also die Schlussfolgerung von Beobachtungen auf vermutete Gesetzmäßigkeiten, ein wichtiger Schritt. Aber wie man sieht, man kann da auch in die Irre gehen, wenn man die Zusammenhänge falsch einschätzt. Daher ist es wichtig – und heute üblich -, die abgeleiteten Gesetzmäßigkeiten in einem zweiten Schritt zu überprüfen und das Ergebnis später zu veröffentlichen und so der wissenschaftlichen Gemeinschaft zur Diskussion zu stellen.
Die Aussage, dass die chronischen Beschwerden von den drei betrachteten Krankheiten verursacht werden, kann auf zwei Weisen falsifiziert werden:

  • Treten chronische Beschwerden auch bei Menschen auf, die keine entsprechende Krankengeschichte aufweisen?
    Damit hätte man herausfinden können, dass es auch chronische Krankheiten gibt, die eine andere Ursache haben und hätte daraufhin die Ursachenforschung erweitern können.
  • Treten in allen Fällen, in denen eine der als Ursache angenommenen Infektionen nur äußerlich behandelt wurde, die chronischen Beschwerden auf?
    Dies hätte die Behandlungsstrategie verbessern können. Beispielsweise hätte sich gezeigt, dass die Krätze tatsächlich nur eine durch Milben verursachte, auf die Haut beschränkte, Erscheinung ist.

Lassen wir dabei einmal außer Acht, dass ein Studiendesign, das dieses untersuchen könnte und dabei gleichzeitig mit ethischen Gesichtspunkten vereinbar wäre, nur schwierig zu realisieren sein dürfte. Hier geht es lediglich darum, aufzuzeigen, wie die Wissenschaft sicherstellt, dass Fehlschlüsse, wie sie hier Hahnemann unterlaufen sind, ausgeschlossen werden. Wie man sieht, versucht man die gefundene Regel zu widerlegen, indem man untersucht, ob das Gegenteil zutreffend sein könnte. Widersprüche führen zu einer Überprüfung der Regel. Hier hätte sich ein weites Feld aufgetan, aber dieses Vorgehen war nicht üblich.

Die miasmatische Behandlung heute

Es scheint gerechtfertigt, die Miasmen Hahnemanns als eine Bezeichnung für das im Inneren des Körpers ablaufende Geschehen bei einer unbehandelten und fortbestehenden Infektion zu verstehen. Dann wäre diese Vokabel mit den zunehmenden Kenntnissen über virale und bakterielle Infektionskrankheiten in der Vergangenheit überflüssig geworden. Auch sind heute viele chronische Krankheiten zumindest so weit bekannt, dass sie ihre Ursache nicht in früheren Infektionen haben (Rheuma, Diabetes, COPD etc.). Dennoch lebt das Miasma und seine Behandlung in der homöopathischen Literatur fort und wird quasi, wie im Eingangszitat erwähnt, als Parallelwissen zum heutigen Kenntnisstand gehandelt.

Es gibt jedoch bis heute keine einheitliche Definition von Miasmen oder eine allgemein gültige/akzeptierte Einteilung. Miasmen gibt es nach Hahnemann, Gienow, Sankaran, Scholten, Masi-Elizalde, Sanchez-Ortega, Burnett, Allen, Sonnenschmidt, Laborde, Vijayakar, Banergea, Banerjee und vielen anderen mehr. Dabei werden zwischen 3 und 12 Miasmen unterschieden. Gewisse Miasmen selbst scheinen vollständig in das Reich der Esoterik abgedriftet zu sein. Bei den Homöopathen sind also vielerlei unterschiedliche Verfahren als “miasmatische Behandlung” bekannt. Zu stören scheint das nicht. Alle beobachten natürlich “Phänomene” und alle berichten von Heilerfolgen – aber nicht von eklatanten Widersprüchen.

Damals interessant – heute falsch und dogmatisch

Man kann Hahnemann zugestehen, in der Natur zumindest einiger chronischer Beschwerden gar nicht so falsch gelegen zu haben und nur durch die beschränkten Möglichkeiten seiner Zeit zwangsläufig in seinen Irrtümern gefangen geblieben zu sein. Also in seinem Erkenntnisprozess durchaus einen richtigen Weg eingeschlagen zu haben, dabei allerdings in einem frühen Stadium verblieben zu sein.
Für seine Nachfolger, insbesondere die modernen, die Miasmentheorie bearbeitenden Homöopathen wie Masi-Elizalde (1933-2003), Sankaran (* 1960) oder Gienow (*1960), gilt diese wohlwollende Betrachtung ausdrücklich nicht. Sie könnten besser wissen, dass 1. die Miasmentheorie widerlegt und durch besseres Wissen ersetzt ist und dass wir 2. alle möglichen Phänomene nach Art einer self-fulfilling-prophecy irgendwie erklärbar machen können. Nur, im Gegensatz zu Hahnemann, haben wir heute Möglichkeiten mit Hilfe der Wissenschaft, dabei Fehler und Fehlwahrnehmungen aufzuspüren und zu korrigieren. Diesem Vorgehen verweigern sich Homöopathen jedoch konsequent und bleiben lieber in ihrer Luftblase aus Ideen von vor 200 Jahren gefangen. Der Wissenschaft allerdings werfen sie vor, sie möge doch auch “endlich mal über ihren Tellerrand hinaus schauen”.


(Autoren: Dr. Norbert Aust, Dr. med. Natalie Grams)

Mehr zum Thema Miasmen und zur Sicht der homöopathischen Szene auf die Miasmenlehre auch hier.

Foto: Wikipedia Commons The Yorck Project/Directmedia Publishing GmbH (Gemälde: Pietro Longhi)

Freiburg Declaration on Homeopathy

Freiburg, location of the foundation meeting of the Information Network Homoeopathy

In accordance to the Marburg Declaration *), we wrote the Freiburg Declaration on Homeopathy at our INH foundation meeting. It presents our position focused and can be co-signed here.

We declare:

Homeopathy is neither naturopathy nor medicine

Despite the political support and the silence of those who should know better, homeopathy is and remains a procedure that clearly contradicts sound scientific foundations. The members and promoters of the “Information Network Homeopathy” see homeopathy as a persistent doctrine that is neither naturopathy nor medicine. Doctors, pharmacists, veterinarians, biologists, natural scientists and other committed critics of homeopathy have come together in the network, which unites the goal of bringing this often veiled fact more clearly into the consciousness of society.

No special status for homeopathy

In more than 200 years of its existence, homeopathy has not managed to prove its specific effectiveness according to objective criteria. Rather, it survives only because it has a special status in the German health system, which the experts of the network do not believe it deserves. While pharmaceutical drugs have to prove their effectiveness according to objective criteria, homeopathy is exempt from this. We oppose such a two-tier system in medicine.

Homeopathy has also failed to demonstrate a plausible mechanism of action. Instead, its representatives give the impression that there are still uncertainties needed to be clarified. We vehemently contradict this. Homeopathy is not an unconventional method that requires further scientific examination. Its foundation consists of long-disproved theses such as the “rule of similarity”, the “vital force” or the “potentiation by dilution”.

Self-deception of patient and therapist

We don’t deny any therapeutic effects that can be achieved within the framework of homeopathic treatment. However, these have nothing to do with the specifically administered homeopathic remedy. Rather, the presumed and supposedly experienced effectiveness of homeopathic preparations is based on the suggestion and autosuggestion of patients and therapists. The mechanisms of such (self-)deceptions are manifold, but well known and researched. Improvements in well-being caused by contextual effects cannot and must not be causally attributed to the homeopathic remedy. We assume that many homeopathic physicians and alternative practitioners are not aware of the existence and variety of such mechanisms and act with the best of intentions. However, this does not change the fact that the conclusions they draw are wrong and can, therefore, be harmful.

Medicine and Science

We are by no means claiming that the scientific method we advocate can currently recognize and explain everything. But it enables us to explain that homeopathy cannot explain itself. And it is the best way we have to distinguish effective treatments from ineffective ones. A belief in the promise of salvation that is firmly anchored in the population, which is further nourished by interested parties, politics, and journalism, can never be a guideline for action in medicine.

Our aim of this declaration

The goals of our criticism are neither the patient seeking healing nor the individual homeopathically working therapist, but the established doctrine and the institutions of the health care system, which could recognize the absurdity of homeopathy long ago, but nevertheless do not intervene. We call upon the actors of the scientifically based health care system to finally turn away from homeopathy and other pseudo-medical procedures and return to what should be taken for granted: Scientifically validated, fair and generally comprehensible rules for high-quality medicine, geared to the well-being of patients.

Freiburg, February 2016


Authors:

Dr.-Ing. Norbert Aust, Initiator Information Network Homeopathy
Dr. med. Natalie Grams, Head of Information Network Homeopathy
Amardeo Sarma, GWUP Chairman and Fellow of CSI (Committee for Skeptical Inquiry)

First signatories:

Prof. Dr. Edzard Ernst, University of Exeter, UK
Prof. Dr. Rudolf Happle, author of the Marburg Declaration on Homeopathy
Professor Dr. Wolfgang Hell, chairman of the science board of the GWUP
Prof. Norbert Schmacke, Institute for Public Health and Nursing Research, University of Bremen
Dr. rer. nat. Christian Weymayr, freelance medical journalist

Here is an online petition where you can co-sign if you agree with our statement: Sign now!

Status: 2.153 signatories (26.06.2019)


*) Given 1992 by the medical faculty of the University of Marburg, Germany, against the attempt to make homeopathy compulsory in medical curricula