English version will appear soon
English version will appear soon
The Central Association of Homeopathic Physicians (DZVhÄ) has recently published an article on its website under the heading “Encouraging Evidence on Homeopathy” (in German) and also sent out several press releases.
The largest (but by no means the only) review of homeopathic studies currently available is the 2015 “NHMRC” review, published by the Australian Health Authority in a summary information paper, which concluded that no homeopathically treated condition has been shown to be effective (beyond placebo and contextual effects). Of course, this did not suit homeopath’s ideas and they tried for years to obtain a former version of the review, which was claimed to have originally spoken for homeopathy, but was then “suppressed”. Under “Release the first Report” homoeopaths from all over the world kept on raging until the Australian health authorities agreed to publish the “first version” from 2012. The homeopathic fraction is now trying to capitalize on this release and derive “encouraging evidence” from it.
This is astonishing, because the own homeopathic research of the highest evidence class (among others four systematic reviews by R.T. Mathie on behalf of the Homeopathic Research Institute) corresponds exactly with the findings of the NHMRC review of 2015: There is no reliable evidence that homeopathy is specifically effective in any clinical picture.
From the preliminary draft of a major review, one suddenly wants to derive results that not even one’s own homeopathic research was able to achieve with years of effort?
A review of the “prehistory”
In a press release dated 12.04.2017, the DZVhÄ reported on a complaint against the review of the Australian Health Authority NHMRC of 2015, which found no reliable evidence for homeopathy for any indication. The DVZhÄ coined the term “deception of the public” by allegedly serious failures of the NHMRC.
They announced that the English Homeopathy Research Institute (HRI) had “filed a complaint with an official Commonwealth office and published the first results of its research”. This “official Commonwealth office” was the Ombudsman of Her Majesty in Australia, who – to this day – was obviously somewhat astounded being expected to make a decision on a scientific question. This is probably the reason why such a decision – now after several years – does not exist. The existence of the complaint was confirmed after a long back and forth, but neither the HRI was the complainant nor was the text of the complaint ever disclosed. By the way, just as little as the “results of the research” by the HRI, nothing ever published did go beyond the enumeration of several points of a rather general nature (there was always talk of a “200-page paper”, which at any rate nobody outside the HRI got to see).
One, if not the central point, of the excitement was the allegation that there had been a first version of the NHMRC review, which, since it had allegedly been positive for homeopathy, had then been “suppressed” and replaced by the version published in 2015. Even petitions in Australia and England called for their disclosure. At the end of August then somewhat unexpected happened – the disclosure of the draft by the Australian health authority.
Now nobody could imagine, apart from the homoeopaths, who in the meantime had gotten stuck into this matter, that a state medical research centre had “suppressed” a draft of a major review, which – contrary to all previous investigations – would have come to a positive result for homoeopathy. And this is exactly what the NHMRC explained on the occasion of the publication of the draft: they wanted to “take the wind out of the sails” of the circulating rumours by the best of all possibilities, namely transparency. One may assume that this was done on the recommendation of Her Majesty’s Ombudsman in Australia, who has been sitting there with the complaint for several years now and obviously can’t do anything with it.
We will let representatives of the NHMRC have their say on the classification of the publication. First of all, the Executive Director Research Translation Branch , Alan Singh. Among other things, he writes:
“I would like to inform you that I am releasing an unfinished draft report, in an annotated form, of an overview of systematic reviews of homeopathy that was started in 2012 but never completed (frequently referred to as the 2012 draft report). There have been a number of enquiries about the 2012 draft report and requests for its release. I am aware of ongoing community interest in the content of this draft report, and that a substantial body of misinformation has grown up about it.
To address this misinformation, an annotated version of the 2012 draft report will be made available on the NHMRC website. The annotations provide context as to why the report was not developed further for use in NHMRC’s Homeopathy Review that produced the NHMRC Statement on Homeopathy and the NHMRC Information Paper: Evidence of the effectiveness of homeopathy for treating health conditions (2015). The 2012 draft report is simply an initial summary of the authors’ findings of systematic reviews on homeopathy: it was never completed and has not undergone the usual NHMRC quality assurance steps (for publication). (…)
NHMRC strongly encourages interested members of the community to refer to the 2015 NHMRC Information Paper: Evidence of the effectiveness of homeopathy for treating health conditions. This states that ‘based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.”
So the draft was the first – deficient – collection of material done by an external contractor – and no longer. The numerous comments of the NHMRC in the now published draft explain these deficiencies in detail. Ultimately, the accumulation of these shortcomings has been the deciding factor in abandoning and restarting the project. As you can see, it is basically an exaggeration to speak of a draft report at all.
This is simply the background to the “secret first draft/report”.
Science does not mean cherrypicking
What makes the DZVhÄ think to draw conclusions on homeopathic evidence from such a disordered and unevaluated conglomerate? Very simple – or even not. Just take the draft and use the proven method of “cherrypicking” to find passages from the preliminary assessments by the first contractor that seem to fit best. In addition, ignore the NHMRC’s numerous marginal comments, which explain why these classifications were not useful. The following illustration from a “homeopathic” tweet, which claimed to have “convicted” the NHMRC and discovered “evidence”, shows this visually in all clarity. One refers to the original statements in the first material collection and completely ignores (or sees in it a “suppression of the facts”) what the NHMRC noted in detail thereon. Color lottery: Black is valid, blue not, red is the color for cherrypicking?
So you reach into the trash of the NHMRC, pull out a crumpled note and think you can find in the original text “evidence” for misconduct, a “suppression” of valid results? To top it all off, you also ignore the accompanying remarks, which prove why the original statements were not usable? By the way, the systematic reviews compiled by the first contractor had all been known for a long time – nobody would have had to wait for the NHMRC to “suppress” them. Let’s remember: the draft (this time the right one) of the 2015 review was pre-published with the request to report publications not yet covered in it. This has indeed been done, the final review took into account a number of “post-notified” publications. More transparency? Nearly impossible.
One thing should be noted at this point. A systematic review is an overall view of many studies or – as here – of many previous reviews under methodical and statistically comparative evaluation of the work involved. The fact that studies / reviews with different results being included there is inherent in the system and precisely intended – it is a matter of the overall result. To select and uphold individual results with positive evidence, even if they are real, from the preparation of a review is an absurd reversal of the meaning of a review / a meta-analysis – namely the methodical determination of the “over-all evidence” just without “cherrypicking” – into its complete opposite. A review / a meta-analysis can only be viewed and criticized from the point of view of the final result. Even if one finds problematic evaluations of the studies / reviews included, the first question to be clarified is always whether they have any effect at all on the final result.
Solid evidence versus “encouraging evidence”
Here we come up to the term “encouraging evidence” again.To be seen in the screenshoat, the NHMRC rightly notes that the term “encouraging evidence” does not exist in the context of this study. Why not? Well, it does not exist at all as a term, it is simply not a scientific category, but a euphemism that the first contractor had inserted by “free fantasy”, so to speak. It is highly significant that precisely this passage, which convincingly proves the lack of qualification of the first contractors, is now also used as a positive term by the DDZVhÄ and widely quoted.
Prof. Anne Kelso, the general director of the NHMRC, becomes even clearer in her official statement on the publication of the draft (after all, this is the statement of the head of a high-ranking institution of the Australian government):
“As part of the process to develop the NHMRC Statement on Homeopathy, an initial contractor was engaged to review the scientific evidence on the effectiveness of homeopathy in treating a variety of clinical conditions with the aim of providing Australians with reliable information about its use. Thecontract was terminated in August 2012 with the mutual agreement of NHMRC and the contractor. The draft of the unfinished report, titled The Effectiveness of Homeopathy: an overview review of secondary evidence (i.e. the 2012 draft report), was not endorsed by the expert Homeopathy Working Committee.
A second reviewer was contracted and provided an overview of published systematic reviews and a review of submitted literature. The second contractor developed the NHMRC Information Paper: Evidence of the effectiveness of homeopathy for treating health conditions (published in March 2015 at the same time as the NHMRC Statement on Homeopathy).
The document I am releasing comprises the 2012 draft report in its entirety, with annotations that have been reviewed by the previous Chair of the Homeopathy Working Committee. These annotations have been made for context and to avoid misunderstanding of the draft report. ”
Truth or oppression?
Now one might still think that all this is just the next step in the suppression and manipulation of an alleged “truth”. One should only be aware that the threshold for the establishing of a veritable conspiracy theory would be finally crossed by that. What if the whole NHMRC review didn’t exist – what would that change? For the lack of evidence for homeopathy: nothing at all. There would be ten instead of eleven major systematic reviews to prove this.
But this is how one abuses the openness and transparency of the NHMRC: instead of disproving the conclusions of the 2015 review in a scientifically sound and reliable way (there has been sufficient time to do so), poking through the waste paper basket and searching for anything seeming useful für alleged evidence – for promoting a desired but not factual opinion.
It is significant that of all things the scientifically nonsensical term of an “encouraging evidence” is used for this as well. What this has to do with a scientific discussion about a medical question remains the secret of the DZVhÄ. Well, perhaps that’s the only way to keep in the debate a question being decided long ago at all – and to call for “more research” after more than 200 years without proof of efficacy. Isn’t that more in the direction of conspiracy theory, away from serious scientific discourse? We wish a good journey.
Previous publications of the INH on the NHMRC report:
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?
English version will appear soon.
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.
Homoeopathy is an ancient practice created in the 1700s as a counter treatment to bloodletting and other rather horrific medical practices
Homoeopathy is a process of diluting a small amount substance in more water than the whole earth can contain to treat your ailment
There has been no evidence to show that it works any better than a placebo, even after hundreds of clinical trials have been conducted.
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?
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:
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
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
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?
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.
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.
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.
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.
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?
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.”
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.
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.
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.
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.
Wellcome Library, London. Wellcome Images firstname.lastname@example.org 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/
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
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
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!
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 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
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
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
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
English version will appear soon …
English version will appear soon.
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:
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..:
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:
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
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
English version will appear soon.