Beliebtheit von Homöopathie und Freibier – finde den Unterschied!

Vier volle Biergläser ohne Unterschied als Sinnbild des Freibier-Verglaichs
Ununterscheidbar…

Ein wesentlicher “Link” zwischen den Vertretern der Homöopathie und der Politik ist das Beschwören einer vorgeblichen „Beliebtheit“ der Zuckerkugeltherapie. Oft genug hat das INH vorgebracht, dass dies ja schließlich kein Argument in einem medizinisch-wissenschaftlichen Diskurs sei. Dafür braucht man gar nicht das im Titel angezogene „Freibier“-Beispiel zu nehmen – bei dem liegt die Beliebtheit auf der Hand. Bei Homöopathie keineswegs.

Es ist doch klar, dass sanfte, nebenwirkungsfreie, sichere und dazu auch noch wirksame Therapien von jedermann gewünscht werden. Es leuchtet aber ebenso ein, dass all diese Attribute dann völlig nutzlos sind, wenn die dahinterliegende Therapie schlicht und einfach unwirksam ist. Das „Beliebtheitsargument“ rückt allein die erste Aussage in den Vordergrund und unterschlägt die zweite.  Eine „Argumentation“, die geschickt auf die „Zielgruppe Politik“ ausgerichtet wurde.  In aktuellen Debatten und politischen Statements zur Homöopathie ist „Beliebtheit“ eine stets mehr oder weiniger deutlich zu vernehmende Grundmelodie.

So weit, so sinnbefreit. Aber nehmen wir doch die „Beliebtheit“ mal beim Wort. Ist sie wirklich so groß, wie es die VertreterInnen der Homöopathie glauben machen wollen? Aus unserer mehrjährigen Aufklärungsarbeit heraus haben wir inzwischen nicht unbedingt den Eindruck, dass das so ist. Die Reaktionen auf öffentliche Vorkommnisse in diesem Jahr (gewisse Abmahnungsdesaster und gewisse satirische TV-Beiträge) lassen die Zweifel am reinen Tatsachengehalt des Beliebtheitsarguments weiter wachsen.

Nicht nur einmal haben wir darauf hingewiesen, dass die Umfrageergebnisse, die die Homöopathiefraktion seit langem ins Feld führt, eine Ableitung von „Beliebtheit“ nicht zulassen. So, wie sie dastehen, können sie allenfalls große Unwissenheit bei der Bevölkerung und korrespondierend dazu große Erfolge bei der Vermarktung und Bewerbung der Homöopathie belegen. Unbestritten haben schon viele Menschen von Homöopathie gehört (Allensbach 2014:  94 %). Wenig verwundert auch, dass etliche davon Homöopathika bereits verwendet (60 % der Gesamtbefragten) und beinahe 9 von 10 Anwendern „gute Erfahrungen“ mit Homöopathie gemacht haben (46 % “hat geholfen”, 39 % “hat nicht immer geholfen”). Wir haben schon oft erklärt, was es damit auf sich hat.

Weniger bekannt ist, dass es von Allensbach auch eine Befragung dazu gab, ob diejenigen, denen die Homöopathie bekannt war, mindestens ein Wirkprinzip benennen könnten. Was eigentlich die Kernfrage ist, denn wie kann etwas als „beliebt“ attributiert werden, über das man gar nichts weiß, zudem auch noch im Kontext von Gesundheit? Und da sah es dann so aus:

Balkengrafik; dargetellt wird das Umfrageergebnis, dass nur 17 Prozent derer, die von Homöopathie gehört haben, eines der Grundprinzipien der Methode benennen können.

Siebzehn Prozent – von 94 Prozent. Angesichts dessen die „Beliebtheit“ der Homöopathie zum entscheidungsrelevanten Faktor für die Politik hochzujazzen, ist schon – na, sagen wir mal, sehr gewagt.


Interessanter noch wäre eine Befragung, die Aufschluss darüber gäbe, ob die Leute nach einer Aufklärung über die wirklichen Grundprinzipien der Homöopathie immer noch an ihren Ansichten festhalten würden. Und genau das haben die amerikanischen Skeptiker vom Center for Inquiry (CFI) im September 2019 getan.

Das CFI führt bekanntlich Rechtsstreite wegen Betruges gegen die größte amerikanische Apothekenkette CVS und die Kaufhauskette Walmart. Dabei geht es – um genau zu sein – um die Tatsache, dass CVS und Walmart in ihren großen Selbstbedienungs-Drugstores die homöopathischen Mittel ohne besondere Hinweise mitten zwischen den regulären Pharmazeutika stehen, nur nach Indikationen geordnet. Das CFI hat sowohl CVS wie auch Walmart mehrere Male aufgefordert, dies zu ändern, ohne dass hierauf jemand reagiert hat. Und nun stützen sich die Betrugsklagen gegen beide auf diesen Umstand.

War da nicht was mit Kennzeichnung, 2017 von der Verbraucherschutzbehörde FTC (Federal Trade Commission) gefordert? Ja, in der Tat, aber nicht alle Hersteller halten sich daran (anders als Anordnungen der Food and Drug Administration -FDA- haben die Regeln der FTC keine Gesetzeskraft) und ohne Zweifel sieht man die Kennzeichnung auch nicht unbedingt, wenn die Packung da so friedlich im Regal herumsteht. Wie dem auch sei – die Prozesse bewegen sich derzeit im nach amerikanischen Recht üblichen Vorfeld von Anträgen, Gegenanträgen, auch von Feststellungen des rechtlichen Schutzinteresses. Und um den letzteren Punkt, das Verbraucherschutzinteresse und damit das Klagerecht, zu belegen, hat das CFI eine Befragung von Käufern homöopathischer Husten-, Erkältungs- und Grippemittel („cough, cold and flu“) bei CSV und Walmart „vor Ort“ in Auftrag gegeben. Mit mehr als interessanten, wenn auch nicht unerwarteten Ergebnissen.

Das CFI konstatiert insgesamt, dass sich ein großer Prozentsatz der Befragten nach der Aufklärung über Homöopathie von CVS und Walmart „getäuscht und hintergangen“ fühlt und ihr Vertrauen in diese Händler  „missbraucht“ sehen. Dieses Gesamtfazit ist natürlich der Prozesstaktik geschuldet. Wie aber sieht es konkret aus?

Infografik aus dem Origianlbeitrag des Center for Inquiry zur Umfrage bei CSV und Walmart
Klick für größere Darstellung

Fast die Hälfte (46 %) der Befragten gab an, dass sie sich nach der Indikations-Kennzeichnung der Gänge und Regale richten, sich also darauf verlassen, was ihnen die Händler vorgeben. 3 Prozent fragen einen Angestellten (der dort allerdings kein Apotheker ist).

Nachdem den Befragten die wesentlichen Fakten über die pseudowissenschaftlichen Grundlagen der Homöopathie mitgeteilt wurden,

  • zeigten 41 Prozent der Befragten erhebliche Betroffenheit („described their feelings in deeply negative terms“),
  • fast ein Viertel der Befragten (23 Prozent) benutzten Wörter wie “schlecht”, “schrecklich”, “entsetzt” und “verärgert”,
  • 15 Prozent äußerten, sie sich würden sich “abgezockt”, “betrogen” oder “getäuscht” fühlen, seien “aufgebracht” oder würden eine Rückerstattung verlangen,
  • drei Prozent kamen dahin, sich selbst als “dumm” oder “töricht” wahrzunehmen.

Die Information über den realen Hintergrund der Homöopathie ließ den Vertrauensfaktor gegenüber CSV / Walmart um 17 Prozentpunkte zurückgehen. (79 auf 62 %). Bei 13 Prozent verkehrte sich die Wahrnehmung dahin, dass sie den Handelsketten nur noch “ein wenig” oder “gar nicht mehr” vertrauen (29 auf 16 %).

63 Prozent der Befragten sprachen sich für die Kennzeichnung von homöopathischen Arzneimitteln aus, wie von der FTC empfohlen. 78 Prozent der Befragten gaben nach der Information zu Protokoll, dass sie jetzt eine eher negative Meinung zu homöopathischen Produkten hätten. Immerhin 10 Prozent gaben an, schon einmal unbewusst ein homöopathisches Produkt erworben zu haben, obwohl ein pharmazeutisches gewollt war.

Ein kleiner Schlussgag:

Vor der näheren Information wusste nur ein Prozent aller Befragten, dass es sich bei “Anas barbariae” , dem „Wirkstoff“ der Boiron-Cashcow Oscillococcinum (meistverkauftes Homöopathikum in den USA), um den alkoholischen Auszug aus Herz und Leber einer Ente handelt (Moskauer Ente, Moschusente, Cairina moschata). 22 Prozent dachten, dass Anas barbariae die Bezeichnung für einen pharmazeutischen Stoff sei, 13 Prozent hielten es für ein Vitamin. Nachdem die wahre Natur des Inhaltsstoffs erklärt wurde, sahen fast die Hälfte der Befragten (46 Prozent) das Produkt „weniger positiv“.

Fazit:

Wir zweifeln nicht an ähnlichen Ergebnissen bei einer solchen Befragung in Deutschland – vielleicht nicht mit identischen Werten, denn in Deutschland ist die Homöopathie nun mal mit „sozialer Reputation“ stark verankert. Aber die Tendenz wird unbezweifelbar genauso sein, wie es auch unsere tägliche Aufklärungsarbeit immer wieder zeigt: Wer bislang un- oder desinformiert war und gegenüber sachlicher Information über die Grundannahmen der Homöopathie unvoreingenommen ist, wird seine Schlussfolgerungen ziehen.

Und eigentlich – ja, eigentlich müssten hier bei uns die Apotheken die Aufgabe übernehmen, die in den USA die Befrager übernommen haben (immerhin gibt es hier die Apotheken statt Selbstbedienung): Konsequente faktengerechte Aufklärung über Homöopathie, sofern sie über die Theke der Offizin gehen soll. So manche tut es – sehr viele aber wohl eher nicht.

Jedenfalls ist eines klar. Die Politik sollte endlich realisieren, dass eine  vermeintliche „Beliebtheit“ der Homöopathie nicht einmal in die Nähe dessen kommt, was man gemeinhin ein Sachargument nennt. Und dass man auch in der Politik, wenn man dem Raum gibt, Verantwortung trägt: Nämlich dafür, dass unhaltbare bis potenziell gefährliche Fehlannahmen breiter Kreise über eine spezifisch unwirksame Methode fortbestehen, die ungerechtfertigterweise als Teil von Medizin angesehen wird.


Bericht des CFI über die Befragung mit Link zur Originalstudie

Allensbach-Studie 2014

Anmerkungen zur Allensbach-Studie und anderen Erhebungen bei fowid


Bildnachweise: Bild von tookapic auf Pixabay / Allensbach – Dr. C. Lübbers / Center for Inquiry

Offener Brief an die bayerischen Landtagsabgeordneten: Homöopathie ist keine Antibiotika-Alternative!

Das Bild zeigt die Vorderansicht des Maximilianeums in München auf der Isarhöhe, dem Sitz des Bayerischen Landtags
Maximilianeum München, Sitz des Bayerischen Landtages

Am 24. Oktober berichtete das kritische Portal “MedWatch”, dass dem Bayerischen Landtag ein Antrag der Fraktionen von CSU und Freien Wählern vorliegt, in dem die Beforschung von alternativmedizinischen Methoden, “namentlich der Homöopathie”, zur Verringerung / Vermeidung des Einsatzes von Antibiotika gefordert wird. Der Gesundheitsausschuss des Landtages hat nach unseren Informationen bereits mehrheitlich dem Landtag empfohlen, entsprechend zu beschließen.

Salopp gesagt, hört hier aber nun wirklich der Spaß auf. Uns ist wohl bekannt, dass immer wieder Homöopathie als Antibiotikaalternative propagiert und auch angewandt wird. Vor allem in der Nutztierhaltung ist dies erschreckend weit verbreitet (und wird von der EU-Tierarzneimittelrichtlinie auch noch befördert). Es gab vor etwa einem Jahr sogar den Versuch, über eine Crowdfunding-Plattform Geld für entsprechende “homöopathische Forschung” einzubringen, was glücklicherweise im Ansatz steckenblieb. Nun, inzwischen sind wir weiter: Von der Nutztierhaltung zur Humanmedizin, vom Crowdfunding vergleichsweise bescheidenen Ausmaßes zum Anzapfen öffentlicher, durch Steuereinnahmen refinanzierter Mittel.

Selbstverständlich kann dies nicht unwidersprochen bleiben. In der Erwartung, dass fachliche Argumente in dieser Sache noch eine Chance haben, hat das INH den nachfolgenden Offenen Brief an alle (per Mail erreichbaren) bayerischen Landtagsabgeordneten geschickt:


 

An die Mitglieder
des Bayerischen Landtages

 

04.11.2019

Antrag “Todesfälle durch multiresistente Keime vermeiden IV – Studie zu einem reduzierten Antibiotika-Einsatz”

Sehr geehrte Damen und Herren,

in obigem Antrag schlagen Abgeordnete der CSU und der Freien Wähler vor, dass in einer Studie untersucht werden soll, ob durch Einsatz von Alternativmedizin, namentlich der Homöopathie, der Einsatz von Antibiotika reduziert werden kann.

Hiermit möchten wir Sie davon überzeugen, dass der Antrag abgelehnt werden sollte, da diese Untersuchung angesichts bereits vorliegender Erkenntnisse sinnlos ist und eine Verschwendung von Steuermitteln darstellt.

Wir teilen die Ansicht, dass das Thema der Antibiotikaresistenzen dringender Aufmerksamkeit und wohl auch einer Bereitschaft der öffentlichen Hand bedarf, sich – auch finanziell – zu engagieren. Der Ansatz des oben bezeichneten Antrages scheint uns dafür aber wenig geeignet zu sein. Wir halten es für erforderlich, Ihnen nachstehend die Gründe für diese Einschätzung zu erläutern.

Zur Begründung:

Das Bemühen, den Einsatz von Antibiotika zu reduzieren, ist ein sinnvolles und notwendiges Vorhaben, um die weitere Ausbreitung multiresistenter Keime zu verhindern und damit die Gesundheit der Bürger zu schützen. Die Weltgesundheitsorganisation WHO und ihre Teilorganisationen betreiben dazu bereits seit geraumer Zeit Aufklärungskampagnen, so findet z.B. vom 18. bis 24.11.2019 die weltweite „World Antibiotic Awareness Week“ statt [1]. Wissenschaftliche Empfehlungen zur Reduzierung von Antibiotikagaben werden umfangreich kommuniziert. Aber: Der Einsatz von alternativmedizinischen Therapien, insbesondere der Homöopathie, ist dagegen in keinem Fall zielführend.

Wenn eine Therapieentscheidung ansteht, können nur zwei Fälle auftreten:

(1) Es liegt eine bakterielle Infektion vor und der Einsatz von Antibiotika ist angezeigt: Dann wäre die Anwendung von pseudomedizinischen Verfahren, die nicht über einen Placebo-Effekt hinaus wirksam sein können, unterlassene Hilfeleistung zum Schaden des Patienten.

(2) Es liegt keine bakterielle Infektion vor, dann sind keine Antibiotika angezeigt. Die einzig richtige Konsequenz ist, keine Antibiotika zu verordnen, auch nicht als Präventivmaßnahme. Gleiches gilt für harmlose, selbstlimitierende Infektionen, in denen der Einsatz der Homöopathie ebenfalls keinen reellen Vorteil ergibt.

Zum Hintergrund:

Die Ursache von bakteriellen Infektionskrankheiten sind Bakterien, die durch das körpereigene Abwehrsystem bekämpft werden. Kritisch wird dies, wenn diese Abwehr nicht ausreicht, die Erreger einzudämmen oder zu vernichten. In diesem Fall ist eine Antibiotika-Behandlung notwendig, um die Bakterien abzutöten.

Da der Antrag sehr stark auf die Homöopathie abzielt und keine anderen Therapieoptionen erwähnt, konzentrieren wir uns auf diese Therapieform.

Grundsätzlich ist zu bedenken, dass Infektionskrankheiten vor der Entdeckung der modernen Antibiotika die Todesursache Nummer eins waren. Sie waren Ursache für die damals geringe Lebenserwartung, insbesondere durch die hohe Kindersterblichkeit. Penicillin wurde erst 1928 entdeckt, aber erst nach dem 2. Weltkrieg fanden Antibiotika eine weitere Verbreitung in der Alltagsmedizin, und erst danach hat die Sterblichkeit infolge von Infektionen deutlich abgenommen. Ganz offensichtlich war die seit Anfang des 19. Jahrhunderts weit verbreitete Homöopathie nicht in der Lage, zu einer Lösung dieses Problems beizutragen. Es drängt sich die Frage auf, was sich an der homöopathischen Lehre weiterentwickelt hätte, dass sie heute bessere Voraussetzungen bieten soll, schließlich sind die Lehren des Gründers Samuel Hahnemann damals wie heute die in der Homöopathie anerkannten Therapiegrundsätze.

Zur Homöopathie:

Die Homöopathie ist ein Therapiekonzept aus dem ausgehenden 18. Jahrhundert, an dem die Fortschritte der medizinischen Erkenntnis weitgehend spurlos vorbeigegangen sind. “Verstimmung der Lebenskraft” und “Miasmen” sind Grundlagen ihrer Krankheitslehre, die trotz der ab der zweiten Hälfte des 19. Jahrhunderts erzielten fundamentalen Fortschritte des medizinischen Wissens unverändert beibehalten wurden und in der Wissenschaft schon lange als obsolet gelten. Keime – Viren, Bakterien, auch Parasiten – sind dem homöopathischen Konzept wesensfremd und sind es auch nach Erschließung der infektiologischen Grundlagen stets geblieben.

Im homöopathischen Therapiekonzept genügt eine durch Verdünnen und Schütteln erzeugte geistartige Arzneikraft des passenden Mittels zur Behandlung jeder Krankheit, indem die verstimmte Lebenskraft wieder ins Gleichgewicht gebracht wird. Dies gelingt umso besser, je mehr der eigentliche Wirkstoff durch das Potenzieren aus dem Präparat heraus verdünnt und je öfter am Ende reines Wasser mit reinem Wasser weiter verdünnt wurde. Einzig Miasmen, sogenannte Urübel, die auch von den Vorfahren ererbt sein können, stehen nach der homöopathischen Lehre bei chronischen Erkrankungen einer erfolgreichen Therapie entgegen. Hormone, Vitamine, Enzyme etc. spielen keine Rolle. Selbst einfache Diagnoseverfahren wie Messung der Körpertemperatur, des Pulsschlages oder des Blutdruckes haben keinen Niederschlag in den einschlägigen Repertorien gefunden, nach denen in der klassischen  Homöopathie die passenden Mittel identifiziert werden.

Im Gegensatz zu den Angaben im Antrag ist es trotz vieler klinischer Studien bislang noch nie gelungen, eine Wirksamkeit der Homöopathie bei auch nur einem einzigen Krankheitsbild überzeugend nachzuweisen, schon gar nicht bei Infektionskrankheiten. Dies haben bislang alle systematischen Reviews ergeben, die die vorliegenden Einzelstudien zusammenfassend ausgewertet haben. Es mag einzelne Studien geben, in denen scheinbar ein positiver Effekt aufgetreten ist, aber eine Bewertung der Qualität der jeweiligen Studie ergibt regelmäßig, dass deren Studiendesign unzulänglich war oder den beteiligten Forschern Fehler unterlaufen sind. Alle elf Reviews, darunter auch vier, die im Rahmen eines Projektes des englischen Homeopathy Research Institute durchgeführt wurden, kamen zu dem Schluss, dass die vorliegenden Ergebnisse nicht darauf schließen lassen, dass die Homöopathie über einen Placeboeffekt hinaus wirksam sein könnte[2]. Viele Internationale Wissenschaftsvereinigungen (z.B. die Europäischen Akademien der Wissenschaften[3]) und nationale Körperschaften haben entsprechende Empfehlungen ausgesprochen oder Konsequenzen gezogen, zuletzt in Frankreich, wo ab 2021 keine Homöopathika mehr von den Krankenkassen erstattet werden. Dort wurde zuvor die gesamte Studienlage auf mehreren Ebenen nochmals evaluiert – mit negativem Ergebnis.

Dass es trotz intensiver Bemühungen, oftmals unter Beteiligung von Homöopathen, nicht gelungen ist, einen belastbaren Nachweis für eine therapeutische Wirksamkeit der homöopathischen Mittel zu finden, lässt darauf schließen, dass es die behaupteten spezifischen Effekte der Mittel einfach nicht gibt.

Leider geben die Antragsteller nicht an, auf welche Studien sie sich beziehen. Identifizierbar ist alleine die Studie von Frass et al., die als einzige überhaupt die Wirksamkeit bei der Behandlung von Patienten mit einer schweren Sepsis untersucht[4], ein Krankheitsbild, das man in wenigen Tagen überwunden hat oder daran verstirbt. Es war allerdings nicht so, wie das im Antrag aufgeführte Zitat suggeriert, dass die zusätzliche Gabe von homöopathischen Präparaten den Behandlungserfolg auf der Intensivstation verbessert hätte. Einen signifikanten Unterschied gab es nämlich erst nach sechs Monaten, wo mehr Patienten der mit Placebo behandelten Kontrollgruppe verstorben waren als solche, die tatsächlich Homöopathika erhalten haben. Allerdings macht Frass keine Angaben, woran die Patienten lange, nachdem die Sepsis überwunden war, verstorben sind. Es könnte sich auch um Unfälle gehandelt haben, die zufällig in der Kontrollgruppe häufiger aufgetreten sind, wenn die Patienten dort nicht ohnehin aufgrund ihrer in der Studie dokumentierten schlechteren gesundheitlichen Situation eher verstorben sind. Die Arbeit von Frass ist daher auch aus Gründen, die dem medizinischen Laien einsichtig sind, ohne jede Aussagekraft hinsichtlich einer Wirkung von Homöopathika bei Infektionskrankheiten.

Die im Bereich HNO vorliegenden Studien sind ebenfalls nicht geeignet, eine therapeutische Wirksamkeit bei Infektionen zu belegen. Bei den meisten Studien dieser Art wurden selbstlimitierende Infektionen betrachtet (Infektionen der oberen Atemwege, Mittelohrentzündung, banale Erkältungen), die gewöhnlich von Viren herrühren, gegen die Antibiotika wirkungslos sind. Man schließt dann von der Vergleichbarkeit der Ergebnisse der Homöopathie zu den in diesen Fällen unwirksamen Antibiotika, dass die Wirkungsweise beider Therapien gleich wäre — was in diesen Fällen der beiderseitigen Wirkungslosigkeit ja auch stimmt — und überträgt dies argumentativ auf die Gesamtheit der Indikationen, in denen Antibiotika eingesetzt werden.  Aus dem gemeinsamen Fehlen eines Merkmals kann jedoch nicht auf eine Übereinstimmung bei anderen Merkmalen geschlossen werden: Ein Löwe kann genauso wenig fliegen wie ein Seehund — daraus aber zu schließen, sie könnten dann auch vergleichbar gut schwimmen, ist sicher falsch.

Es sei abschließend darauf hingewiesen, dass Forschung in der Homöopathie angesichts der mangelnden Plausibilität der Grundlagen und Inhalte generell wenig Aussicht auf einen wissenschaftlichen Erkenntnisgewinn bietet. Es handelt sich vielmehr um Bestätigungsforschung, bei der weniger die vorurteilsfreie Suche nach neuem Wissen im Vordergrund steht, sondern lediglich versucht wird, Belege für das krude Gedankengebäude zu finden, wobei unerwünschte negative Ergebnisse einfach ignoriert werden. Beispielsweise hat die Münchner Kopfschmerzstudie eindrücklich gezeigt, dass es auch bei besten Voraussetzungen nicht gelingt, Kopfschmerz mittels Homöopathie erfolgreich zu behandeln[5]. Hier hatte sogar die mit Placebo “behandelte” Vergleichsgruppe die besseren Ergebnisse erzielt. Wie ein Blick in die vielfältigen Angaben zur Wirksamkeit einzelner homöopathischer Präparate zeigt, ist diesem Ergebnis auch nach über zwanzig Jahren nicht Rechnung getragen worden: Nach wie vor gehören Kopfschmerzen in jeder erdenklichen Ausprägung zum Einsatzgebiet der allermeisten Homöopathika.

Zusammenfassung

Die Homöopathie bietet trotz der vergleichsweise umfangreichen Forschungsergebnisse keinerlei Anlass zu der Annahme, man könnte damit irgendeine Krankheit erfolgreich medikamentös behandeln, Infektionskrankheiten schon gar nicht. Für diese Rückschlüsse liegen genügend Forschungsergebnisse vor, nicht nur zur homöopathischen Therapie selbst, sondern auch zu den Grundlagen von Physiologie und Pharmakologie, die die Grundlagen der Homöopathie völlig absurd erscheinen lassen.

Ein Einsatz der Homöopathie in Fällen, in denen Antibiotika angezeigt sind, ist gefährlich, in allen anderen Fällen, auch als Zusatz zur Antibiotikabehandlung, sinnlos.

Es besteht somit keine Rechtfertigung dafür, Steuermittel für eine weitere Forschungsarbeit aufzuwenden, wenn nicht die bereits vorliegenden Ergebnisse ausgewertet worden sind und sich dabei eine Lücke gezeigt hat, wo Forschungsergebnisse fehlen und ein positives Resultat möglich sein könnte.

Aus unserer Sicht wäre es wesentlich effektiver, analog zur Initiative RESIST der Kassenärztlichen Vereinigung Bayern aus dem Jahr 2017 auf eine Reduktion der Verordnung von Antibiotika hinzuwirken (https://www.kbv.de/html/resist.php). Im Übrigen sei darauf hingewiesen, dass zum Thema Antibiotikaresistenzen, deren Vermeidung und Perspektiven für die Zukunft in einem von der WHO koordinierten Netzwerk weltweit geforscht wird – in Deutschland unter Federführung des Deutschen Zentrums für Infektionskrankheiten (dzfi).

Wir halten es für dringend angezeigt, die vorstehenden Hinweise und Erläuterungen im Beratungs- und Entscheidungsprozess zum Empfehlungsbeschluss des Gesundheitsausschusses zu berücksichtigen.

Mit freundlichen Grüßen

Für das Informationsnetzwerk Homöopathie

Dr. med. Natalie Grams, Heidelberg
Dr.-Ing. Norbert Aust, Schopfheim
Dr- med. Christian Lübbers, Weilheim


Mitunterzeichner:

Prof. Dr. rer. nat. Michael Bach, Gundelfingen
DDr. Ulrich Berger, Wien/Österreich
Dr. rer. nat. Jochen Blom, Gießen
Dr. Andreas Breß, Tübingen
Prof. Dr. phil. Peter Brugger, Zürich/Schweiz
Udo Endruscheit, Essen
Prof. emeritus Edzard Ernst, Exeter/UK
Prof. Dr. Dittmar Graf, Gießen
B.-Eng. Dirk Graefe, München
Dr. med. Peter Grimm, Regen
Dr. med. Dr. h.c. Rudolf Happle, Freiburg
Dr. med. Oliver Harney, Bietigheim-Bissingen
Prof. Dr. Wolfgang Hell
Prof. Dr. Dieter B. Herrmann, Berlin
Udo Hilwerling, Paderborn
Elke Hergenröther, Hollfeld
Prof. Dr. med. Jutta Hübner, Jena
Dr. Holm Gero Hümmler, Bad Homburg
Dr. Michael Jachan, St. Pölten/Österreich
Dr. rer. nat. Franz Kass, Willich
Monika Kreusel, Köln
apl. Prof. Dr. med. Dr. med. habil. Dipl. Psych Christoph J. G. Lang, Heroldsbach
Dr. Philippe Leick, Gerlingen
Dr. phil. Martin Mahner, Roßdorf
MUDr. Viliam Masaryk, Gera
Dr. Theodor Much, Wien/Österreich
Dr. Nikil Mukerji, München
Dr. med. Dipl. Psych. Claudia Nowack, Münster
Dipl. Phys. Ute Parsch, München
Dipl. Phys. Hans Pfeufer, Berlin
Kai Rabus, Apotheker, Berlin
Dr.-phil. Jan-Ole Reichardt, Münster
Rainer Rößler, Holste
Dr. Rainer Rosenzweig, Nürnberg
Holger von Rybinski, München
Prof. Dr. Norbert Schmacke, Bremen
Michael Scholz, Kronach
Dipl.-Pharm. Viola Stuppe, München
Dr. med. Tilman Schwilk, Schramberg
Dr. med. Wolfgang Vahle, Paderborn
Prof. Dr. Dr. Gerhard Vollmer, Freiburg
Dr. Rolf Wagels, Barsinghausen
Dr. Barbro Walker, Berlin
Dr. habil. Rainer Wolf, Würzburg
Dipl. Kfm. Christoph Zeitschel, Laatzen


[1]    Weitere Informationen: (Link)

[2]    NN: Systematische Reviews zur Homöopathie – Übersicht. Homöopedia des Informationsnetzwerks Homöopathie (Link)

[3]    EASAC: Homeopathic products and practices (Link)

[4]    M. Frass et al: Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit. In Homeopathy. 2005 Apr;94(2):75-80 (Link)

[5]    Walach H, Haeusler W, Lowes T et al.: ”Classical homeopathic treatment of chronic headaches”, Cephalagia(1997);17:119-126 (Link)


Mehr zu Antibiotika und Homöopathie:

Einwand: Globuli sind eh viel besser als Antibiotika!

Totes Kind in Italien: DZVhÄ sieht „ärztlichen Kunstfehler“

Artikel “Antibiotika” bei der Homöopedia


Bild von Franz Dürschmied auf Pixabay

Medical homeopathy and patient safety – touchstone homeopathy congress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Read more:

Autism lie:

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

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

CEASE therapy:

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

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


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

Author: Dr. med. Jan Oude-Aost

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

Introduction

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

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

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

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

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


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

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

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

TL;DR

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

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

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

MY STORY

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

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

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

HOW HOMOEOPATHY WAS BORN

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

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

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

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

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

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

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

HOW HOMOEOPATHIC REMEDIES ARE MADE

Portrait of Samuel Hahnemann, inventor of homeopathiy
Samuel Hahnemann

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

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

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

Brian Dunning from Homeopathy: Pure Water or Pure Nonsense

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

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

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

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HOW DO THE TREATMENTS WORK THEN?

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

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

WATER HAS MEMORY

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

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

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

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

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

THE EVIDENCE

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

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

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SO WHY DO SO MANY PEOPLE SWEAR BY HOMOEOPATHY?

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

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

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

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

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

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

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

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

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

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

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HOMOEOPATHIC HEALING OF INFANTS AND PETS

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

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

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

HOLISTIC TREATMENT VS SYMPTOMATIC TREATMENT

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

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

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

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

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MODERN MEDICINE HAS SIDE-EFFECTS

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

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

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

Rare (Side effects)

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

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

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

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BIG PHARMA

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

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

ALLOPATHY

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

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

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

CONCLUSION

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

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

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

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

CRITICAL TOOLS

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

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

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

Tell me what you think in the comments.

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


FURTHER READING

Picture credits:

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

… and they know what they are doing (and they do it anyway)

Pseudoscience with Academics

A guest contribution by Dr. phil. Susanne Dietz

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

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

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

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

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

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

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

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

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

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

Because academics know one thing:

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

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

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

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

Dr. phil. Susanne Dietz


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


Picture credits: Pixabay Creative Commons CC0

Homeopathic study: The legend of the five times eight rats

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Supplement, 11.10.2018, 15:00 o’clock:

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


Supplement, 11.06.2019:

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

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

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

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

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

Our conclusion:

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

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


 

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


Picture credits: Screenshot Scientific Reports online

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

A clear message from the French medical profession

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

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

A remarkable statement for an oncologist, we note.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

End of quote.

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

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


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


Picture credits: Screenshot fakemedecine.org

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

“There is no scientific evidence that homeopathy works.”

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

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

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

Background: Why do we need scientific evidence of efficacy?

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

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

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

Background: What is scientific evidence?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Facts: What evidence is available?

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

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

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

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

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

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

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

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

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

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

 

What homeopaths tell us about it

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

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

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

Quintessence:

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

 


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

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


Sources / References:

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

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


Picture credits: Fotolia_130625327_XS

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

 

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

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

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

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

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

Background: What is reliable evidence?

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

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

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

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

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

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

In a nutshell:

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

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

What good evidence is available?

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

(1) Individualized homeopathic treatment of childhood diarrhea

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

In the review of Jacobs, three studies are considered:

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

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

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

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

(2) Individualized homeopathic treatment of otitis media in children

The HRI cites two works here:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In summary

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

Clinical relevance

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

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

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

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

Childhood diarrhea:

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

Otitis media:

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

Galphimia glauca in hay fever:

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

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

Pollen C30 against hay fever:

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

Oscillococcinum for influenza:

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

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

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

Vertigoheel against dizziness:

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

In summary:

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

Quintessence

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

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

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


Acknowledgement:

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


References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Picture credits: Fotolia_130625327_XS

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

“Scientists claim that homeopathy is not possible”

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

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

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

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

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

Background: Why is homeopathy implausible?

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

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

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

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

  • Internal contradictions

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

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

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

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

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

  • Outer contradictions

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

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

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

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

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

  • Conclusion

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

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

What scientists really say

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

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

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

(original wording)

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

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

There’s nothing there to support homeopathy.

Change in science

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

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

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

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

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

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

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

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

Summary

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

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


Sources / References:

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

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

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

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


In the series “Criticism on our criticism on homeopathy” we also published:

Part I:  “There is no evidence

Part II: “Missing positive trials

Part IV: “They’re just Sugar Pills!

Learn more about the fundamentals of cognitive ability in the natural sciences: “What does ‘proved’ mean?


Picture credits: Fotolia_130625327_XS

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

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

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

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

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

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

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

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

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

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

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

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

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

More than diluting?

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

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

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

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

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

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

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

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

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

Summary

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

A small but significant side consideration:

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

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

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

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

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

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

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

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


Author: Dr. Norbert Aust

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


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


Picture credits: Fotolia_99355604_XS

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

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

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

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

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

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

Wir meinen:

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

Unterzeichner:

Für das INH

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

Für den Wissenschaftsrat der GWUP

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


Weitere aktuelle Stellungnahmen:

Blogbeitrag bei Edzard Ernst (auf Englisch) hier

Kritischer Kommentar von Wissenschaftsjournalist Werner Bartens in der Südeutschen Zeitung hier

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


Bildnachweis: Fotolia_90994398_XS

What are Bach Flower Remedies anyway?

About the inventor

Edward Bach was a doctor from Birmingham, England, who studied medicine at the University College Hospital in London and graduated from Cambridge. Before he began his studies, however, he worked in the family brass foundry. Bach saw the source of diseases mainly in psychological causes or in the intestines.

The photo shows a number of Bach Flower Remedies in their typical Stock Bottles of brown glass.
Bach Flower Remedies in the typical “Stock Bottles”

After leaving some real clinical positions behind, he worked from 1918 at the London Homeopathic Hospital, which he left again in 1920 in favour of a private practice. One of his main areas in the Homeopathic Hospital was the extraction of so-called “nosodes”, which are homeopathic remedies obtained from pathological endogenous substances such as blood or pus.

In 1930, however, he closed his practice again in order to devote himself to observing nature and herbal medicine in Wales. Here his principle that illnesses are only the expression of a conflict between soul and mind became firmly established. On 27 November 1936 Bach, just 50 years old, died of heart failure.

About the system

The system Bach came up with is relatively simple. He took a mental misfeeling, such as “mental stress and tension” and assigned him a plant essence. This plant essence in turn should harmonize the vibrations of the patient with the cosmic energy field through its vibrations and thus heal the disease. Bach put together a total of 37 flower essences as well as an essence from rock spring water and a combination of five essences, which is probably the best known product under the term “Rescue remedy”.

The selection of plants for the negative mental states was purely intuitive, with Bach assuming that a divine inspiration guided him in his selection. However, the main criterion for selection was that the plants correspond with the concept of archetypes in the sense of Carl Gustav Jung. The flower essences still bear English names today, as a kind of homage to their inventor.

About the production

At the beginning of the production of its essences Bach used only the dew that was on the flowers of each plant at sunrise. The morning sun, which shone through dew and blossom, was to enrich the water with the vibrations of the plant. Thus, as in homeopathy, the assumed healing power is based on the non-existent water memory. As his flower essences became more and more successful, Bach was no longer able to meet the demand with dew drops alone and devised two other ways of preparing the essences.

The first of these is the so-called “sun method”, in which the freshly picked flowers are placed in about half a litre of water and stand in the blazing sun for three to four hours. In Bach’s imagination the vibrations of the plants are transferred to the water as healing energy. This part of the production is strongly ritualized by Bach’s regulations. So the plants have to be collected before nine o’clock in the morning on a sunny and cloudless day. The places where the plants have to be picked are also specified.

After these three to four hours the treated water is diluted 1:1 with 40% alcohol (formerly brandy or cognac). This is for conservation purposes. This mixture is now the mother tincture, which must be diluted again in the ratio 1:240 with alcohol in order to produce the “effective” essences. The end user must dilute the essence again in water in order to take it.

The second method is the so-called “cooking method”, in which the plants do not stand in the sun but emit their vibrations during a 30-minute cooking process. The further treatment is then the same. This method is usually only used for very woody plants or for autumn and winter bloomers.

About the application

Bach flowers are not only available as drops, but also as ointments, sweets, chewing gums, globules, teas, sprays, etc. There are also Bach flowers for animals. The classic dosage form, however, is that of the “stockbottles” with a content of 10 ml.

The “right” essence can be found by going to a Bach flower consultant or a non-medical practitioner, swinging out the essences yourself, using a guidebook or selecting the plants purely intuitively on the basis of their appearance.

About the effectiveness

Bach died in 1936 and his doctrine was forgotten. It was not until the great esoteric wave of the 1970s that it became known again. Since then, several clinical studies have been carried out, but none of them have shown any effect.

Today, flower mixtures are also offered which are outside the canon of Edward Bach. Special attention was given, for example, to an essence that should be used in the case of child abuse. After strong protests, this essence was taken off the market. With homeopathy they have only the magic thinking in common – but they are often confused or equated with it and are considered “particularly natural or vegetable”. Especially esoteric would be more appropriate.

We find it particularly problematic that Bach’s remedies are mainly used for psychological complaints (e.g. anxiety, loneliness, panic attacks, examination anxiety, trauma, depression, weariness, thoughts of death) and can thus delay or even prevent necessary psychological or psychiatric therapies. Moreover, their widespread and uncritical use conveys that for such serious diagnoses it is sufficient to take “a few little blossoms” and everything is fine again.



More about this on our Homöopedia (in German): http://www.homöopedia.eu/index.php/Artikel:Edward_Bach


Picture credits: Pixabay License CC0

Objection: Globules are much better than antibiotics anyway!

Illustrative picture - bubbles in charging green tones symbolizing globules as well as germsAntibiotics versus globules – really?

“I’d rather take globules than antibiotics.”

“Doctors prescribe way too much antibiotics randomly.”

“If I take too much of it, I’ll be resistant in later diseases.”

These sentences can be heard very often in this or similar form. But all three sentences are wrong. Let’s look at them one by one:

1.  I’d rather take globules than antibiotics.

Taking globules rather than antibiotics is an understandable wish. But it’s a false comparison. If it were up to me: For example, I’d rather win the lottery than take antibiotics.

Antibiotics are highly effective drugs that are able to kill certain pathogens (bacteria) or prevent their multiplication. Although “anti bios” has the meaning “directed against life”, antibiotics are not effective against all life: parasites and viruses cannot be treated with antibiotics. Nor do we have to fear that humans and animals will be killed by antibiotics. Also not all antibiotics are effective against all bacteria. Bacteria can be “sensitive” or “resistant” (insensitive) to antibiotics.

There are many antibiotic groups whose representatives are not chemically related to each other. They have no common “roots”, but a common goal: the reduction of the number of pathogenic germs in the host organism; the “reduction of the germ load”. For each antibiotic it is possible to indicate which bacteria are sensitive or resistant to this antibiotic. And for each bacterium one can indicate which antibiotics it is sensitive or resistant to. With regard to pathogenic germs, every antibiotic has a “spectrum of action”.

In principle, the use of antibiotics only makes sense if the disease is caused by germs that also lie within the spectrum of action of an antibiotic. If one uses an antibiotic that is effective against pathogenic germs, the germ load in the host organism is reduced. The immune system of the host organism can bring about healing under these improved conditions. The strengthening of the immune system is only induced by the reduction of the germ load itself. A non-specific strengthening of the immune system by foreign substances has not been proven – neither for preparations such as “Echinacin” nor for globules. An undirected use of antibiotics – even of ineffective ones in the case of resistant germs or viruses – cannot lead to a reduction in the germ load and therefore cannot support the immune system.

Occasionally there are studies that show that antibiotics do not work better than homeopathic remedies. To prove this false assertion, antibiotics are then used in the comparison group for diseases that do not respond to antibiotics. So it is not surprising that antibiotics do poorly in these studies. However, this does not mean that globules are preferable to antibiotics, but only that the study design was poor.

However, every use of antibiotics has a second component: under the influence of antibiotics and the resulting increased “selection pressure”, sensitive bacteria can become resistant or more quickly resistant. This accelerated development of resistance also affects germs that are not – not yet! – are pathogenic and can only become dangerous through their antibiotic-induced resistance. The use of antibiotics in viral diseases is therefore not only nonsensical because it is ineffective, but also harmful because it promotes resistance. Medicine as science knows this and teaches it. For this reason, antibiotics are available only on prescription. If there are doctors in individual cases who do not adhere to the guidelines of medicine, then this is a failure of the doctor and not a failure of medicine. In the event of legal proceedings in this regard, medicine would act as a witness against the doctor.

2. Doctors prescribe way too much antibiotics randomly? Why one does think that?

Because doctors are informed about the advantages and disadvantages of antibiotics, they use these drugs only – according to their knowledge and conscience – specifically.

In the case of some infectious diseases, the bacterial cause can be quickly identified without great effort. Other infectious diseases require complex diagnostics. If there is a bacterial infection, antibiotics are justified – even if the path to diagnosis was short: even short routes can be targeted. If the application is incorrectly unintended, the risk of developing resistance to previously sensitive germs increases. The more resistant germs there are, the greater the general health risk to the population. Therefore, germs that are resistant to one antibiotic must be killed by another antibiotic as soon as possible: Dead bacteria cannot pass on their resistances to the next generation of bacteria.

Particularly in mixed infections with a group of different pathogenic germs, even a “broad-spectrum antibiotic” may not be effective for all germs. In this case, several different antibiotics have to be taken one after the other (simultaneous taking is usually problematic because the different chemical mechanisms of action of antibiotics hinder rather than promote each other). Also a change of antibiotics to avoid the formation of resistance is by no means unintended, even if the necessity is not apparent to all patients. And in case of doubt, pathogens and their resistance are determined in the laboratory.

The latest developments, however, give us hope that in the future it will be possible to determine germs quickly and easily in the doctor’s practice and thus drastically reduce “misprescriptions” of antibiotics.

3  If I take too much of it, then I will be resistant in later diseases.

The term resistance refers only to pathogenic germs, not to the host organism (the human body) from which these germs are to be eliminated. The host organisms are “naturally” resistant to antibiotics. This means that only a chemical substance to which host organisms are resistant can be tested for possible antibiotic efficacy. Substances such as “cyanide” or “mercury” may have good ability to kill pathogenic germs. The use of these substances as “antibiotics” is out of the question: humans and animals are not resistant to cyanide or mercury. For humans and animals are cyanide or mercury poisons. It goes without saying that the antibiotics used in medicine must not be toxic to humans or animals, so that humans and animals are resistant to the antibiotics used is not a disadvantage but, on the contrary, a prerequisite for the use of antibiotics. Let us assume – in a game of thought – that people could become resistant to mercury, for example: then we would not have any disadvantage, but only another therapeutic option for infectious diseases caused by mercury-sensitive germs.

Conclusion: I’d rather take globules than antibiotics?

Globules are “homeopathic remedies”. The doctrine of homeopathy knows no germs, so for homeopathy the use of antibiotics is simply absurd. And that is why, conversely, the administration of globules to infectious diseases is no less nonsensical from the point of view of scientific medicine, because homeopathy categorically ignores precisely the actual causes of infectious diseases and the only effective remedies against them.

Antibiotic treatment of infectious diseases – especially severe infectious diseases – is by no means a purely symptomatic therapy, but a causal therapy (“treatment of causes”) that can save lives. A renouncement of a necessary antibiotic therapy can result in serious health damages – by omission.

Harmless diseases, on the other hand, require neither antibiotics nor globules. Homeopathic remedies are ineffective and superfluous for all diseases.


Further information can be found in the article Antibiotics on Homöopedia (in German)

Further information about the immune system on our family site (in German)


Picture credits: Pixybay License CC0

The Placebo Business

Samuel Hahnemann was born on 10 April 1755

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

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

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

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

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

The discovery of the placebo effect

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

Evidence versus eminence and pseudomedicine

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

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

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

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

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

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

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

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

To date, there is no valid proof of efficacy

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

The magic wand “Eminence” of yore is still working

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

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

Realism as an opportunity?

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

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

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

Hahnemann died on 2 July 1843 in Paris.

 


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

Photo: Susanne Aust for the INH

Miasms in homeopathy –

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

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

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

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

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

Was stimmt an dieser Aussage der Homöopathie?

Der Fehler begann als gute Idee bei Hahnemann

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

Ende der Homöopathie bei chronischen Krankheiten fehlgedeutet

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

Wie hätte man diesen Irrtum feststellen können?

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

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

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

Die miasmatische Behandlung heute

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

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

Damals interessant – heute falsch und dogmatisch

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


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

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

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

Homeopathy is esotericism

This true without lying, certain and most true.
That which is below is like that which is above and that which is above is like that which is below to do the miracles of one only thing.

(Tabula Smaragdina – Emerald Tablet – of Hermes Trismegistos, translated by Sir Isaac Newton)

The picture shows as an allegory on the article theme esotericism the magical endowed Medea on a painting by John William Waterhouse
Medea – painting by John William Waterhouse

The term esotericism originates from the ancient Greek “ἐσωτερικός”, which means as much as “directed inwards”. Esotericism was once regarded as a secret doctrine, but today it can be found everywhere in the alternative faith scene and has long been accessible to the general public.

Nowadays, esotericism is understood to mean practically any discipline that is neither empirically nor rationally verifiable and therefore does not agree with scientific findings – and to a large extent contradicts them – and deals with mythical and spiritual topics. Esotericism and occultism (lat. “occultus” = hidden, mysterious, dark) are closely related. Occultism is usually defined as the more practical part of the same worldview. Meanwhile, there is an increasing mixture of esotericism with ancient wisdom teachings of various cultures and predominantly Far Eastern religions.

Many ideas of the archaic world view can be found in “alternative medicine”. Esoterics of all fractions represent ancient ideas, which contradict all today known scientific knowledge and allegedly go back to Hermes Trismegistos. Hermes Trismegistos was (possibly) a priest who lived in the third century BC. Some speak of a deity, a syncretic fusion (i.e. a mixture of religious ideas into a new world view) of the gods Hermes and Thot. Esotericists repeatedly quote the hermetic philosophy, i.e. the fifteen sentences Trismegistos supposedly wrote down on emerald tablets. Esotericists believe that in these sentences “all knowledge of mankind is summarized”, whereby the second and central sentence is: “What is below is equal to what is above”.

The core of the esoteric world view is the assignment of the ten eternally existing primordial principles. These embody for symbolic astrology the basic building blocks of all life in the universe – to the “ten planets” (the “heavenly representatives” sun, moon, Venus, Mercury, Mars, Jupiter, Saturn, Uranus, Neptune, Pluto) and the four, respectively five elements. Accordingly, in the understanding of symbolic astrology, the world is constructed from ten eternally existing, divine primeval principles (archetypes), which can be found in hierarchies in all layers of being – from the macrocosm to the microcosm, from top to bottom and from inside to outside.

The well-known Austrian homeopath Clemens Fischmeister argued the same way in his article “Wie denkt ein klassischer Homöopath? (How does a classic homeopath think? – published in “Facharzt” 2002). There he writes: “The healing takes place in hierarchies, from top to bottom … from the most important to the less important organ” (Hering´s rule), whereby he described (completely unchallenged) the skin as the “most unimportant organ of man”!

Another basis of homeopathy is the “principle of similarity” (Similia similibus curentur). This is associated with the imaginative idea that it is possible to eliminate symptoms of disease by diluting and potentiating primal substances – e.g. arsenic – which in healthy test subjects trigger symptoms similar to those shown by the patient. This “principle of similarity”, which does not play the slightest role in modern medicine, is based on the medieval “theory of signatures”, which is closely linked to the analogous thinking of all esotericists. It is the doctrine of the “signs in nature” that supposedly point to inner connections and similarities within the framework of the entire divine creation. These signatures are thus a work of God which man only has to recognize. Accordingly, there are analogies between form, colour, smell, location and astrological classifications. In the logic of the faithful, above all the similarities are of great importance. For example, the kidney-shaped bean with the kidney, the brain-shaped walnut with the brain, heart-shaped leaves of the melissa with the heart, the mistletoe as a semi-parasite with cancer, the lady’s mantle with female organs and lungwort with the lungs are said to be related. Bitter-tasting plants are said to have a relationship to the “element” fire, which is related to the sun, and thus stimulate metabolic processes.

This ancient, imaginative and completely unscientific doctrine, which in its concrete formulation goes back to Paracelsus and the Neapolitan doctor and alchemist Giambattista della Porta, also conveys the belief that the colour of medicinal products gives an indication of the diseases for which they are intended to be used. The colour red, for example, for heart diseases, blue for reducing restlessness. The doctrine of the “divine signatures” is also part of many esoteric treatment methods such as Ayurveda medicine, traditional Chinese medicine and, last but not least, homeopathy.

Like many astrologers and homoeopaths today, the vitalist Hahnemann believed in the “spiritual essence of the primordial substance” – which unfolds more and more strongly through the process of potentizing (diluting and shaking towards the center of the earth) and acts most strongly as high potency -, in the “cosmic primordial force” and in the “primordial idea that permeates all levels from top to bottom”. In the vertical world view of astrology, for example, the original principle of Mars (“the god of war and ruler over the wild aries”) is analogous to aggression and ferocity, to certain organs and body parts such as blood, head, teeth, nails, gall, striated muscles, the “element” fire, to the red colour of the blood and to certain Martian plants.

In homeopathy, therefore, the often prickly “Martian plants” of astrologers are associated with certain human organs (blood vessels, gallbladder, muscles and head), the colour red and the element fire. This is why homeopaths prescribe the original substances Aconitum, Allium cepa and Belladonna – all “Martian plants” – for severe, feverish, fiery inflammations, for gallstones as well as for bright red head, bleeding and blood congestion. Exactly such nonsensical recommendations for the treatment of severe febrile diseases with the Mars plant Belladonna can be found again and again in various magazines and online.

Other planets and their earthly plants and metals also play an important role in the thinking of homeopaths. In astrology, the planet Saturn is always associated with the colour lead grey, the metal lead, with lime deposits, reduction and stone ailments. In addition, astromedics see a connection between the primordial principle of Saturn and the skeleton, kidney, gall bladder and spleen. It is therefore not surprising that the “original substance” lycopodium (a “Saturn plant”) and the metallic lead of homeopaths are used in patients with reduced general condition, dirty grey skin colour and “hardening” caused by gout, arteriosclerosis, diseases of bile, kidney (nephrosclerosis) and skeleton. The planet Uranus is connected to varicose veins, nerves and the sexual urge in the vertical world view of astrology. Consequently, the most important “uranium plant” in astrology – hamamelis – is used by homeopaths to treat symptoms caused by varicose veins, venous bleeding, nerve inflammation and testicular diseases.

Other examples are also included: Following closely astrological (pseudomedical) ideas, homeopaths prescribe the Venus metal copper for cramps of all kinds and disorders of the nervous system; the sun metal gold for cardiovascular disorders, increased blood pressure and depression; the Jupiter metal tin for nervous exhaustion, neuralgia and liver pain; or the moon metal silver for restlessness and neurasthenia.

Remarkably also the common “holy” numbers of all esotericists: The 12 stands in some schools of homeopathy for the modalities (12 environmental influences), in other esoteric pseudosciences for zodiac signs and houses in astrology, the 12 disciples and 12 senses of Rudolf Steiner. In homeopathy the 10 often stands for organ and emotional hierarchies, otherwise for heavenly tribes, number of perfection and regional centers of anthroposophy, the 10 commandments and 10 planets (incl. moon and sun). The number 5 is the often recommended dosage unit for taking globules, it also stands for the pentagram, the 5 elements, 5 seasons and 5 organs of Chinese medicine. In homeopathy, the number 4 partly stands for the 4 constitutions (corresponding to the four-juice doctrine of Hippocrates) and the 4 basic qualities; in other esotericism it stands for the quadrants in the horoscope, the 4 Vedas of Ayurveda, the 4 members of Anthroposophy, the 4 Gospels and Archangels.

Anyone who thinks that homeopathy has nothing to do with esotericism (Kabbalah, numerology, astrology, Ayurveda or anthroposophy etc.) is mistaken.


(Author: Dr. Theodor Much is the author of Der große Bluff: Irrwege und Lügen in der Alternativmedizin – The Great Bluff: Wrong ways and lies in alternative medicine; Goldegg Verlag, 2013)

 

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