No one will ever need to write about homeopathy again. Edzard Ernst has said it all in his new book Homeopathy: The Undiluted Facts.
Far too many trees have died in the service of praising or debunking homeopathy in the two centuries since Hahnemann invented it. The forests can celebrate, because this is the definitive book about homeopathy. It is neither “for” nor “against” homeopathy; it is explanatory. It is dispassionate and as unbiased as it could possibly be. It says good things about homeopathy, shows how arguments for and against it have been flawed, and contains nothing that the most ardent homeopaths should be able to complain about (but complain they surely will, because the facts Ernst reports are not what they want the world to hear).
Homeopaths have complained that their critics are not qualified to comment. Ernst says that in order to provide responsible and reliable information, it would be helpful, perhaps even necessary, to have the following types of expertise:
- A sound knowledge of evidence-based medicine
- The ability to tell good from poor science
- Experience as a patient who has been treated by a homeopath
- Research experience in homeopathy
- Published scientific papers on the subject
- Application of homeopathy in clinical practice
- Skills of systematic analysis and critical thinking
Ernst has demonstrated that he fulfills each of these criteria. He has been a patient, a practitioner, and a researcher. As the world’s first Professor of Complementary Medicine, he has relentlessly and rigorously evaluated the evidence for all kinds of alternative medicine. Arguably, there is no one in the world better qualified to write this book.
He explains that he is not writing for those who are fully convinced that homeopathy is an effective and safe treatment for all ailments, nor is he writing for those who are persuaded that everything about homeopathy is rubbish. His aim is to provide a service to consumers by reporting the scientific facts in an accessible way.
The book’s format
There are two parts to the book. In ten chapters, he covers the definition and main principles of homeopathy; myths; current popularity, acceptance, and regulation; the history of homeopathy; different types of homeopathy and homeopaths; the patients; homeopathy as a criticism of conventional medicine; scientific evidence (what constitutes credible scientific evidence and what the evidence says both for and against homeopathy); and spurious arguments for and against homeopathy. The second part, longer than the first, is a Lexicon of Homeopathy that fleshes out the details, explains the terminology and concepts, and provides information about the players.
The book’s content
Homeopathy has been repeatedly discussed on this blog and elsewhere. Rather than repeating what has already been said ad nauseam about homeopathy, I’ll just mention a few of the points in the new book that struck me as interesting or noteworthy.
Epiphanies. Ernst says he was struck by the fact that almost all of the prominent homeopaths were converted by some personal, highly emotional epiphany. They say they started out as skeptics, and they claim to have a scientific mind; but their faith cannot be shaken by rational arguments.
Ullman. There is an entry in the Lexicon on Dana Ullman, a notorious supporter of homeopathy who has appeared repeatedly in the SBM comments. It quotes a judge who rejected Ullman’s expert testimony as “not credible” because of Ullman’s bias against conventional medicine, which Ullman views as witchcraft.
Vitalism. Ernst stresses that homeopathic theory is reliant on the outdated concept of vitalism. Although they have looked for a reality-based explanation, homeopaths basically believe some kind of spirit-like essence pervades the remedies and is responsible for their action.
Homeopathy is attractive. He explains what attracts consumers to homeopathy: it is risk-free; it offers compassion, empathy, and hour-long consultations; it doesn’t cause side effects like pharmaceuticals do. He cites a study showing that homeopathy’s patients are more likely than conventional medicine’s patients to be critical of mainstream medicine, to believe their general health could be improved, and to have higher psychiatric morbidity.
It fulfills a need. Ernst acknowledges that homeopathy fills a need. Patients want to establish a caring therapeutic relationship with a trusted provider, and they often fail to find that in conventional medicine. That doesn’t mean homeopathy is better than conventional medicine, or even that homeopathy is a viable alternative; it means conventional medicine can do better, and it might even learn a thing or two from homeopathy about establishing a good patient-provider relationship.
Guidance for patients. He provides guidance for patients consulting a homeopath or self-medicating with homeopathic remedies, including not using it as a replacement for proven conventional care and keeping their health care provider informed.
Cost-effectiveness. It has been claimed that homeopathy is less expensive, but cost-effectiveness research has not identified a single condition for which homeopathy would appear to be more cost-effective than the appropriate conventional treatment.
Ebola. There is an entry for Ebola in the Lexicon. There are few conditions that homeopaths do not claim to treat successfully. In 2014 a team of homeopaths went to Africa to treat patients with Ebola.
Real life effectiveness. Since scientific studies tend not to support their beliefs, homeopaths have introduced the concept of “real life effectiveness” to describe the effectiveness of the treatment itself plus all other phenomena that might be involved (placebo response, natural course of illness, regression to the mean, etc.). Ernst simply says “this is not an accepted concept in conventional medical research.” Of course it isn’t, and it shouldn’t be, for the obvious reasons.
Informed consent. Informed consent is an ethical imperative. For homeopathy, informed consent should provide this relevant information:
- Homeopathy is not biologically plausible
- Its effectiveness is unproven
- Not all homeopathic remedies are entirely free of risks
- Better treatments for the condition in question might be available
Variants of homeopathy. Ernst explains that there is not just one homeopathy but many. The most popular ones are auto-isopathy, classical homeopathy, clinical homeopathy, complex homeopathy, homotoxicology, and isopathy. There are also derivatives of homeopathy, including anthroposophical medicine, Bach flower remedies, and Schuessler salts.
Faulty criticism on both sides
Homeopaths have not been able to address criticism rationally. They think their critics fall into only two groups: those who are ignorant and repeat propaganda they’ve heard, and those who know homeopathy works but have a vested interest in destroying it.
Both homeopaths and their critics have used faulty arguments. He lists 20 spurious arguments by proponents, including the arguments that homeopathy has never been proven wrong, that Nobel Prize winners have used it, that it can’t be studied with clinical trials, and that only expert homeopaths can understand homeopathy well enough to competently criticize it. He lists and demolishes these seven spurious arguments by opponents of homeopathy:
- In its 200-year history, homeopathy has done no good at all
- There are no plausible theories to explain homeopathy
- There is no credible evidence at all that supports homeopathy
- All homeopaths are charlatans who have nothing to offer to their patients
- Patients who use homeopathy must be stupid
- The assumptions of homeopathy are being treated like dogmas
- Homeopathy is a cult
Conclusion: The people who need to read this book won’t
My favorite book on homeopathy used to be Jay Shelton’s Homeopathy: How It Really Works. It is not as complete as Ernst’s book, but it tells the same story and it might still be the best introduction for the average reader, more accessible and written in a more entertaining style that is more likely to hold the reader’s interest. But for doctors, scientists, educated laymen, and for anyone seeking a more complete story, Ernst’s book is unbeatable. It should be the last word on homeopathy.
For that matter, Oliver Wendell Holmes’ “Homeopathy and Its Kindred Delusions” should have been the last word when it was published in 1842. For the reasons explained in Ernst’s book, homeopathy has endured and will continue to endure; and the people who most need to read this book won’t.
This article was originally published in the Science-Based Medicine Blog.