A follower of SBM e-mailed me to say that they had a recent experience with a plastic surgeon who prescribed homeopathic Arnica to promote wound healing following surgery. They were surprised not only by this one example, but on further investigation that this is actually common practice.

We are always alert to the infiltration of rank pseudoscience into the medical profession, and if true, this would be a prime example. I did some exploration myself, and found that this is unfortunately true. A simple Google search for “plastic surgery, Arnica” provided numerous examples of plastic surgery practices recommending Arnica, like this one:

You can find Arnica in a number of over-the-counter products, including creams, tablets and gels. At the Morgenstern Center, we offer two forms of Arnica available for purchase at our office:

Arnica 12C Pellets: start taking 2 days prior to surgery and continue for approximately 2 weeks post operatively. Take as directed (5 pellets 3 times/day).
Arnica Cream: start post operatively and apply to the area of bruising as directed by our surgeons. This is not a substitute for your antibiotic ointment which is to be applied to your surgical incisions. The cream is not to be placed on open incisions at any time.
We are committed to helping you look and feel your absolute best. Using advanced techniques and technologies, and recommending post-operative aftercare measures are just a couple of the ways Dr. Morgenstern brings you state-of-the-art care and great results.

For a quick review of what homeopathy is – it is perhaps the best example of 100% pure pseudoscientific nonsense in medicine. It is largely based on two principles, that substances which can cause symptoms can actually treat those same symptoms in tiny doses, and that the “essence” of these potions is realized by extreme dilutions and “succussions” (vigorous shaking). The ingredients themselves are often fanciful, sometimes nonexistent, and have more in common with witchcraft than medicine. This doesn’t really matter, however, because starting ingredients are typically diluted out of existence anyway.

The “12C” preparation referred to above, for example, mean a dilution of 1:100 (that is the C) 12 times. So that is a 1:1,000,000,000,000,000,000,000,000 dilution (1 x 10^24). If you recall Avagadro’s number is the number of molecules or other units in one mole (for reference, one mole of water weighs 18 grams) of a substance, and is 6.022140857 × 10^23. So if you start with one mole of Arnica, you will end up with less than one molecule on average after a 12C dilution. (This is why the Merseyside skeptics called their anti-homeopathy campaign the 10:23 campaign.) So Dr. Morgenstern is recommending sugar pills (iconic placebos) and calls this “state-of-the-art.”

I could not find any data to show what percentage of plastic surgeons prescribe magic potions to their patients, but it is clearly common given the number of easily found examples.

The extreme implausibility of a homeopathic dilution of Arnica is enough to conclude that it does not work. But that has not stopped some from trying to answer the question with clinical research. This is almost certainly a waste of resources as messy clinical research is unlikely to be sufficient to overturn the laws of physics. It would take the most rigorous research and clear results to even get close – which, of course, we do not have. Typically what we find when researching clinical questions based on highly implausible (breaking the laws of physics level) treatments is lots of low quality research, and maybe some higher quality studies. There is always a clear relationship in that the more rigorous the study the smaller the effect, and the best studies tend to be negative. This is a pattern consistent with no effect, which is also consistent with the laws of physics.

This pattern of no real effect is what we find with all of homeopathy, and homeopathic Arnica for wound healing is no exception. The earliest systematic review I could find was from 1998 (lead author was Edzard Ernst, which is no surprise as he is known for high quality reviews of alternative practices), which found:

Eight trials fulfilled all inclusion criteria. Most related to conditions associated with tissue trauma. Most of these studies were burdened with severe methodological flaws. On balance, they do not suggest that homeopathic arnica is more efficacious than placebo.

What about in the last 20 years? There has not been much. The only study that would have met the inclusion criteria for the above review was this one from 2003, which found:

There were no group differences on the primary outcome measures of pain (P=0.79) and bruising (P=0.45) at day four. Swelling and use of analgesic medication also did not differ between arnica and placebo groups. Adverse events were reported by 2 patients in the arnica 6C group, 3 in the placebo group and 4 in the arnica 30C group. The results of this trial do not suggest that homeopathic arnica has an advantage over placebo in reducing postoperative pain, bruising and swelling in patients undergoing elective hand surgery.

Other than this there are a few preliminary or basic science studies published in homeopathy or alternative medicine journals. So yet again, there is some preliminary and essentially useless studies, and a few reasonable quality clinical trials which are essentially negative. Not only is this level of evidence (regardless of plausibility, but all the more damning given the extreme implausibility) not sufficient to form a basis for practice, it is sufficient to condemn the practice as ineffective.

Why, then, is the practice apparently common among plastic surgeons? That is an interesting question requiring further exploration, and I would be happy to hear from some of my colleagues in plastic surgery, but here are some possibilities. First, it seems that the practice is most common in (and perhaps limited to) cosmetic surgery. Cosmetic surgery is elective surgery purely for cosmetic purposes. Reconstructive surgery is cosmetic and functional surgery following some injury, disease, or to correct a developmental anomaly. These are different subspecialties within plastic surgery.

Cosmetic surgery has incorporated many “spa” practices to enhance their services and the experience of their clients. The “spa” services culture, which has existed for hundreds of years, is based largely on pseudoscience or hand-waving claims. The spa is where you can now find salt rooms, reflexology, have your chakras aligned, and partake in steam baths of dubious efficacy.

So my hypothesis is that the spa culture has infected the profession of cosmetic surgery, and the frequent use of homeopathic Arnica for wound healing has come along for the ride. But regardless of why it is used, homeopathic Arnica is demonstrable nonsense and clearly useless, and has no legitimate place in any medical practice. And if you are a science-based cosmetic surgeon offended by this post – direct your ire at your pseudoscience-using colleagues.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.