O Homeo, Homeo, wherefore art thou Homeo?
Deny thy fantasy and refuse thy name.
Or if thou wilt not, be but sworn my love
And I’ll no longer be a Realist.
‘Tis but thy fantasy that is my enemy:
Thou art thyself, though not a Hanneman.
What’s Hanneman? It is nor hand nor foot
Nor arm nor face nor any other part
Belonging to reality. O be some other name.
What’s in a name? That which we call a dilution
By any other name would smell not at all;
So Homeo would, were he not Homeo call’d,
Retain that dear delusion which he owes
Without that title. Homeo, doff thy fantasy,
And for that name, which is no part of thee,
Join reality.

Regular readers know I like to refer to our “Distinguished” Competition (we so need standard irony punctuation) using the rubric SCAM: Supplements, Complementary, and Alternative Medicine. It’s perhaps too cute by half (and not my invention) but I have never been happy with the nouns used to describe SCAMs. What is the opposite of science-based medicine? Fantasy-based? Fiction-based? BS- based? The nonsensical ravings of a lunatic mind-based? How would you even pronounce NRLM? See? We got issues here. But NRLM is perhaps the most fitting.

Of all the NRLM-based cults, homeopathy may be the most unhinged from reality. Well, there is Tong ren. Perhaps it is a fool’s errand to try to rank NRLMs that are based on less reality than Superman, Green Lantern, and Triplicate Girl. Although the last are/is the patron saints/saint of all bureaucracies in the multiverse.

COVID has been a boon to all NRLM-based therapies, allowing them to churn out what Harriet Hall has dubbed Tooth Fairy Science:

…refers to doing research on a phenomenon before establishing that the phenomenon exists. Tooth Fairy science is part of a larger domain that might be called Fairy Tale science: research that aims to confirm a far-fetched story believed by millions of scientifically innocent minds. Fairy Tale science uses research data to explain things that haven’t been proven to have actually happened. Fairy Tale scientists mistakenly think that if they have collected data that is consistent with their hypothesis, then they have collected data that confirms their hypothesis.

These studies get published in the Journal of Tooth Fairy Science or some equivalent and listed on the Pubmeds, sometimes resulting in remarkably credulous responses by legitimate medical organizations.

Pubmed has 80 hits for COVID and Homeopathy, compared to 28 for naturopathy, 51 for chiropractic, and a whopping 213 for acupuncture. The last not a surprise since COVID 45 started in China and there are far too many papers to review in one blog entry without an ondansetron prescription.

It is worth a high-level view of this peculiar medical literature to see what the homeopaths are up to. Many of these articles are from India, where homeopathy is popular and India may have surpassed the US in COVID 45 deaths. Association is not causation. But. Remembering that homeopathy is literally nothing, I am not so certain that applying homeopathy to COVID in India warrants the warning from one abstract, not in large friendly letters, that suggested, “there is no need to be panic”.

There are three broad uses of homeopathy for COVID 45. Actually, zero. Humor me here. But amongst homeopathic weaponry are for such diverse elements as prevention, vaccination, treatment, and long COVID.

One way to approach homeopathy is using Bayes Theorem, which makes my head hurt. As I have mentioned before, I took, and dropped, statistics 4 times in college. Once a year for 4 years. So I am not the best for explaining Bayes, but in medical practice, the basic application is that the less likely the disease, the more likely a positive test result is a false positive. Similarly, the less plausible the intervention, the more likely positive results are spurious.

Since the prior plausibility that homeopathic therapies will do anything is exactly zero, we understand that any positive homeopathic study is a false positive. Why waste time on the studies? Because it can be fun to point at homeopathy and laugh. And no matter how implausible an NRLM study, someone in reality-based medicine, as we will see, will be snookered into touting it. Same as it ever was.

Let’s look at some of the 80 hits (and I seriously considered a Rickroll for the last link) and see what the homeopaths are up to and, perhaps, have a chuckle along the away. So no drinking milk.

COVID-19 Pneumonia: A Potential Role of Homeopathy. Well, no potential role if you are a fan of reality, but the author feels that homeopathic remedies

may potentially improve the pneumonia in COVID-19 non-responder patients, especially in the early stages of the disease.

and suggests, as do many NRLM papers, that someone waste time and money to do a real clinical trial to demonstrate efficacy. I will note that most patients with COVID do fine and that in the early stages of disease, you do not know if they are going to be a non-responder. So how would one judge when to give said nostrum? The author suggests three nostrums, Arsenicum album, Stannum, and Ribes nigrum because he has found them helpful. When would one use Arsenicum? When

“Air passages constricted. Asthma worse at night. Burning in chest. Suffocative catarrh. Cough worse after midnight; worse if lying on the back. Expectoration. Wheezing respiration.”

I am always amazed are the specificity of homeopathic symptoms. What if the cough is worse at 11:59 p.m.? And if you are standing at a time zone line and jump across at the strike of midnight. Would that change the treatment?

That symptom complex is not like any COVID 45 I have taken care of. So often NLRM providers complain the real doctors only treat symptoms, not the underlying cause of dis-ease. But homeopathy is all about the symptoms, ignoring the underlying pathophysiology completely. COVID is too new for any homeopathic provings specific to that illness. So they can ignore COVID and just go after symptoms.

I suspect that it is the alleged immune effects that will be credited for the effects of most NLRM interventions and as a target for the those interventions. Support the immune system like it needs a sling.

Homeopathic Remedies in COVID-19: Prognostic Factor Research. It was open label, multi-centric, outpatient, observational study aka designed to be completely useless for any conclusions. Twenty-seven different homeopathic nostrums were given and, in a disease where most people get better, most people got better. They credited the homeopathy:

homeopathic medicines were associated with improvement in symptoms of COVID-19 cases.

and suggested further studies.
Such garbage.

Homeopathy combat against coronavirus disease (Covid-19) got retracted. Why?

… the lack of empirical data and the lack of testing of the proposed model as a severe limitation that invalidates the conclusions drawn in the article. The conclusion that epidemiological studies are needed to evaluate homeopathic treatment are not justified based on the model developed by the authors. The simplified approach provided by the authors is not appropriate to model the complex biological associations and not based on evidence-based health research principles.

Doesn’t that apply to every homeopathy paper ever published? And almost every NRLM studies? I think so.

I did not realize that there was homeopathic psychiatry. Insert your own joke here. Well, there is in India where it is proposed that to cope with COVID isolation a

… web-portal will capture all the patients’ symptoms. Then homeopathy E-Prescriptions would be generated by the psychiatrists. This transmission of E-Prescription would be done using the proposed secret session key using Advanced Encryption Standards. Ignatia, Natrum Sulphuricum, Aconite, Arsenicum Album, Belladonna, etc are the important homeopathy medicines as prescribed by the homeopathy psychiatrists in COVID-19. Mathematical calculations were done on this proposed technique with positive efficacy. Hence, homeopathy telemedicine is the pivotal way to cure psychiatric patients remotely in this Post-COVID-19 “New Normal” context.

If mathematical calculations show positive efficacy, who am I to argue? Why bother with e-prescriptions when the homeopathic effect can be sent over the phone? Let’s get digital here people.

Homeopathy is popular in India where millions have received homeopathy as a COVID preventative. I will not suggest there is any association between homeopathy and the tremendous numbers of infection and deaths from COVID in India. Nope. Not me.

AYUSH for COVID-19: Science or Superstition? AYUSH is an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy. I think with our Bayesean knowledge alone we can safely assign the answer the question in the title to the latter rather than the former option.

The big problem for reality-based thinkers is that every study uses several dozen interventions. Some ‘personalize’ for the individual, others ‘personalize for the epidemic:

Successful homeopathic prescriptions are based on careful individualization of symptoms, either for an individual patient or collectively in the case of epidemic outbreaks.

It is nice to be able to have it both ways. It is the odd thing about many NLRM based therapies when viewed from reality. It is the system that is the catholicon, not the specific intervention within the system. It is homeopathy that is effective, not the specific remedy.

They are also trying nosodes for COVID. We have vaccines that are safe and effective and instead they are testing the homeopathic, well, not equivalent. I always wonder how NLRM studies make it through ethics committees and I would love to read the informed consent. But then I have always been a fan of science fiction and comics.

And there is homeopathic immunotherapy for COVID: dilute the convalescent serum from COVID patients and inject it in the ill. Really. Convalescent serum was tried early in the COVID epidemic and was not effective. Diluting the serum is unlikely to improve its efficacy.

Of course, there are no quality studies to show benefits from homeopathy. And, despite the plea that (bold added)

For homeopathy, shunned during its 200 years of existence by conventional medicine, this outbreak is a key opportunity to show potentially the contribution it can make in treating COVID-19 patients. This should be done through performance of impeccably controlled, prospective, randomized clinical trials, with publication of their findings in well-ranked conventional medicine journals. If the homeopathy community fails to take advantage of this rare opportunity, it might wait another century for the next major pandemic.

I doubt they will have to wait another century for a pandemic to prove their catholicon is worthless. New word. I learned a new word. I will use it freely moving forward. Catholicon. Sweet. I don’t expect any homeopathy studies that will meet those criteria. And even homeopaths recognize they are doing a bad job with clinical studies.

Confirmation bias leading to lowering of symptom threshold, keynote prescribing, and deficiency in checking of all symptoms in each case were identified as the most important sources of bias.

Remember when I mentioned someone would be bamboozled by a homeopathy study? I give you PulmonaryAdvisor.com, who

…offers healthcare professionals a comprehensive knowledge base of practical information and resources focused on pulmonary and critical care medicine to assist in making the right decisions for their patients.

Just no critical thinking applied to NRLM. Pulmonary Advisor asks the question, “Can Homeopathic Treatment Speed Recovery in Patients With COVID-19?” Yes! And demonstrates yet again that mainstream medicine can’t appropriately evaluate NLRM studies due to a lack of understanding of NLRM medicine.

It was a study out of India where patients were randomized to receive standard therapy plus placebo vs. standard therapy plus individualized homeopathy (bold added):

Forty homeopathic medicines were prescribed for the patients. Of these, Arsenicum album was prescribed to 9.93% patients (n = 15), Bryonia alba and Phosphorus were to 7.94% (n = 12) patients each; Rhus toxicodendron to 6.62% (n = 10); Natrum muriaticum (n = 9, 5.96%); Hepar sulphuricum & Pulsatilla nigricans (n = 7, 4.63% each); Lycopodium clavatum & Nux vomica (n = 6, 3.97% each); Belladonna, Carbo vegetabilis, Chininum arsenicum, Gelsemium (n = 5, 3.31% each). At first prescription 44.37% (n = 67) of patients received 30C potency, 47.68% (n = 72) received 200C potency and the remaining 7.94% (n = 12) received higher potency. Of all, 63% (n = 96) patients received one homeopathic medicine only, while 36.42% (n = 55) patients required two or more homeopathic medicines during the study period.

Remember at 30 C

this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.

So any reality-based human would realize that this study compared two placebos and found one placebo was better at improving mostly subjective symptoms. And it was a single-blind study, the treating naturopath knew who was getting what. As we have learned, and relearned, when NRLM practitioners are not blinded to treatment groups, the results are unreliable. Actually, the results are reliable in that there will be a false-positive salubrious effect credited to the NRLM.

Two major flaws in the study: the underlying treatment is unhinged from reality. The other was inadequate blinding.

Pulmonary Advisor recognizes neither if these flaws, gullibly quoting the paper:

A major limitation of the current study is the fact that because of the large number of COVID-19 patients at the hospital, follow-up laboratory tests could not always be performed because of a resource crunch. Further, restricted access to patients because of the high transmissibility of COVID-19 limits the number of homeopathic prescriptions, since various patient attributes and disease characteristics need to be known when selecting these medications.

Yet another medical reviewer falling off the turnip truck. No critical thinking whatsoever. Hey, Harriet. Can you write a book similar to There’s No Such Thing as the Tooth Fairy! for healthcare providers? Sorely needed.

The treatment of COVID with homeopathy did result in the funniest line in the medical literature, also the saddest. From Adjunctive homeopathic treatment of hospitalized COVID-19 patients (COVIHOM): A retrospective case series I give you

At the start of treatment, each patient received Influenzinum, either in CH200 potency or in case of very bad condition, in CH10,000 potency on day one.

Remember, at 13 C

If pure water were used as the diluent, no molecules of the original solution remain in the water.

At 30 C

this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.

200C?

the total mass of pills that would have to be consumed to encounter a single molecule of the original substance would be billions of times greater than the mass of the Earth.

The multiverse isn’t likely not big enough to find one molecule on 10,000C. As many have said, it should be homeopathic delusions, not dilutions.

Still, there are some reality-based assessments. In Role of Complementary and Alternative Medicine in Prevention and Treatment of COVID-19: An Overhyped Hope, they sum it up as well as I could.

However, no clinical evidence of these alternative medicines to treat COVID-19, lack of high-quality data, little or no data to support their claims, lack of statistically significant number of participants, long-term efficacy, proper follow-up,no comparative control groups and no adherence to strict quality norms while conducting clinical trials are some of the concerns expressed by experts.
Therefore, unless research is not conducted as per standard protocols, CAM will be seen with a lot of skepticism in medical science.

Except at Pulmonary Advisor.

That’s it, a brief tour of some the NLRM homeopathic studies.

After that I need a drink. Thank the gods bartenders do not subscribe to homeopathic principles.

Catholicon.


Department of Self Aggrandizement

See my talk at SkepticCamp 2022. Alt Med in the Age of COVID: What is the Evidence.

Author

  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.