As I was contemplating over the weekend what to write about, it struck me. Today is the last day of World Homeopathy Awareness Week, and somehow no one at SBM has written about it. It’s also rather convenient in that I’m currently out of town imbibing real science at the annual meeting of the American Association for Cancer Research (AACR) in Chicago, meaning that I haven’t had a lot of time to write up one of my typical epic posts. Fortunately, however, because I write elsewhere, I always have material that I can revise and repurpose for SBM in situations like this when I don’t have enough time to compose one of my 5,000 word magnum opuses. Acknowledging Homeopathy Awareness Week before it’s over seemed like a good idea.

I like to refer to homeopathy as The One Quackery To Rule Them All, so much so that I ought to copyright it. There are, of course, very good reasons for that, and, although I sometimes refer to reiki or “energy medicine” or “energy healing” as contenders for the title of The One Quackery To Rule Them All, because the idea that humans can channel “healing energy,” be it the patient’s own or from a “universal source,” is arguably equally ridiculous to the notion that diluting a substance to nonexistence produces stronger remedies, thanks to the “memory of water.” Still, for the sheer ridiculousness of its precepts, I still give the nod to homeopathy, albeit just barely, because of the contortions and distortions of science and logic engaged in by homeopaths to justify their quackery. Also, homeopaths have Dana Ullman.

The sheer ridiculousness of homeopathy is one reason why I view Homeopathy Awareness Week as being even more ridiculous. After all, if homeopathy is The One Quackery To Rule Them All, then Homeopathy Awareness Week, which concludes today, must be the biggest waste of a perfectly good week as I can think of. The reason Homeopathy Awareness Week starts on April 10 is because Samuel Hahnemann, the founder of homeopathy, was born on April 10, 1755. The official website of World Homeopathy Week describes it this way:

In celebration of all those who have healed with Homeopathy, homeopaths and supporters share education and accessibility of homeopathy around the world, beginning on Dr. Samuel Hahnemann’s Birthday every year.

During World Homeopathy Awareness Week (WHAW) free public events such as lectures, media interviews, volunteer first-aid at sports events, free & reduced clinics, written materials, pieces on Twitter and Facebook, publication articles and much more are shared in over 40 countries.

Through more awareness and access to homeopathy resulting in profoundly improved health, the paradigm in the understanding of healing and healthcare can truly shift.

Join us! April 10th – April 16th every year. This year April 2018 we are celebrating our 14th World Homeopathic Awareness Week.

Each year, World Homeopathy Week has a theme. Some of them are quite disturbing:

2006: Homeopathy for Children
2007: Homeopathy for Women’s Health
2008: Homeopathy in Sport’s Medicine
2009: Homeopathy and Allergies
2010: Homeopathy for Mental Well-Being
2011: Homeopathy and the Musculoskeletal System
2012: Homeopathy for Infertility
2013: Homeopathy for Trauma & Disasters
2014: Homeopathy for Men’s Health
2015: Homoeopathy for Infectious Diseases
2016: Homeopathy as Preventative Medicine.
2017: Homeopathy For Elderly

And this year:

The theme for 2018 is ‘Homeopathy for Pregnancy and Childbirth’. Some of you might not be aware of homeopathy, or its benefits. But throughout this special week you’ll learn loads more! Homeopathy can offer effective help to those personally affected by crises. In such times the right homeopathic remedies can help treat individual and long term experiences.

Homeopathy for pregnant women and childbirth? The thought is horrifying. However, consistent with the theme of this year’s “celebration,” you just know that I had to do some Googling for webpages related to this year’s theme, and Google I did. Sadly, there were a lot of articles to choose from, a disturbingly large number.

A homeopathic case report

Here’s the “case report” that I found for homeopathy in induction of normal labor and preventing caesarean section. The report comes to us courtesy of Sapna Gupta and Dr Parul G Wadhwani, BHMS MD of the Nehru Homoeopathic Medical College and Hospital.

The case is presented thusly:

A 25 year old primigravida, consulted on 29 January 2017 for delayed engagement. In her last visit to Obstetrician on 28/1/17, the doctor told her that there is already a delay in descent of child into the uterus and cervix was thick and not effaced, which should have taken place by this time of gestation in a primigravida and if the same does not happen within 3-4 days, Caesarean section shall be required.

Her last menstrual period was on 2/5/16 and as per ultrasound report dated 8/1/17, her expected date of delivery was 26.1.17 +_2 weeks. Her antenatal period had been uneventful except that she suffered from dry cough during her pregnancy.

Apart from above findings, she also complained of pain in vagina since last 4 days which aggravated in the evening and was worse turning in bed and first motion. It was better by continued motion and warm fomentation. She used to go for long evening walks which relieved her pain. Also, there was pain in left leg.

OK, so we have a young woman expecting her first child. Her estimated due date was 1/26/27, but she presented three days after her expected date, with her fetus not having descended into the true pelvis. This process is known as “lightening” or, in lay terms, “dropping,” and it’s a sign of impending labor, as the fetal head drops into the pelvis and becomes engaged within the pubic bones. The authors note that in first time mothers, dropping usually occurs between three to four weeks before deliver, but it can happen earlier. In women who have already had children, it might not happen until right before labor begins. In their view, this woman was in danger of requiring a Caesarian section.

You can see where this is going, of course. The homeopaths treated the patient with homeopathy:

29/1/17 (1 PM): Pulsatilla 200/ three doses/ 30 minutes interval.

30/1/17: On waking in the morning, patient felt a sense of relief on her chest, a symptom suggestive of engagement, and also felt as if the uterus has come down. BY 1 PM, labor pains started and at 5: 30 pm , she was admitted to hospital. Obstetrician confirmed that the cervix was dilated and effaced. At 10:30 PM, she delivered a healthy baby boy by normal labor.

So what, exactly, is pulsatilla? Basically, it is the diluted extract of pulsatilla nigrans, described by the British Homeopathic Association as “one of our oldest and most useful homeopathic medicines” and that it was “proved by Samuel Hahnemann in 1805 and was extensively used by him to treat many hun­dreds of patients.” Recall the Two laws of homeopathy, first the idea that, to treat a symptom you must use something that causes that symptom in asymptomatic patients (a principal with no basis in science or even clinical observation) and, second, that serial diluting a compound, with vigorous shaking (succussation) at each dilution step to “potentize” it makes a homeopathic remedy stronger. Never mind that diluting anything beyond 12C (twelve 100-fold dilution steps) is unlikely to leave any molecules of residual starting material, at least in an ideal world. In the real world, there might be a tiny amount of starting compound that carries through dilution steps by sticking to the glass vials used to dilute the homeopathic remedy, but even then that’s doubtful given the number of dilution steps.

In any case, pulsatilla is more commonly known as the whole meadow anemone, also known as the pasqueflower or windflower, a member of the Ranunculaceae or buttercup family. The BHA describes it as “soft and beautiful with pendulous bell­shaped flowers, purple petals and a gold heart.” The BHA further describes pulsatilla as “predominantly a female remedy,” and, no, the complete description is not sexist at all (not):

It is classically thought to suit blonde, blue­eyed females of a mild, shy and tearful disposition. Yet there is often much more to these fair types, for they are usually quite paradoxical in virtu­ally all areas of their life.

The image they project often belies what they feel inside. Although they tend to be good­natured yet they can hide their indignation about some slight they may have received. They tend to bottle things up and hold onto emotions. On the other hand they can certainly be weepy. Indeed, they will tend to weep when they describe their symptoms and their upsets, but they will also be moved to tears when listening to music, watch­ing a romantic film or even seeing distressing news on the television. They can be hopeless romantics and will prob­ably be moved to weep when shown kindness or given a present. The emotions they hold onto can also be very nega­tive ones. They can hold grudges and classically they feel peeved. They can become quite jealous, quite sorrowful, depressed and very anxious.

They can also hold firmly to their views, in that they can be deeply reli­gious, or dogmatic about things that they hold dear. Their views can be held so rigidly that any slight personal mis­demeanour, especially if of a sexual nature, can be regarded as a great sin and they hold onto guilt. And figura­tively speaking they can beat themselves up with this guilt, just as they can with any of the other negative emotions. Pulsatilla types are full of fears. They can fear the dark, illness, death, ghosts, doctors, dentists and appointments. Sympathy always helps them. A cuddle or a hug may make them weep, but it will usually help. It is that touch, that comfort that is important.

So what do homeopaths think that pulsatilla is good for? The BHA describes it as being useful for grief and bereavement, painful periods, premenstrual syndrome, vaginal discharge, menopause, venous problems, and wandering pains. The BHA also gamely notes that it’s “not just women,” but that pulsatilla “often works well when men have a problem with their testicles,” such as mumps orchitis (which you’re going to see a lot of if homeopaths, who are generally antivaccine, had their way.) Oddly enough, failure of the fetal head to engage or delayed labor is not listed as a use for pulsatilla. It is, however, listed elsewhere as a treatment for delayed labor. For instance, this article by a woman named Piper Martin who offers a training course she calls—shudder—the Homeopathic Midwife, Pulsatilla 200C – when and why to use this remedy, tells you when to use this homeopathic remedy to “augment” labor. Remember that a 200C dilution is two hundred 100-fold dilutions or a 10-400 dilution. As I like to mention whenever discussing homeopathy, there are only estimated to be around 1080 atoms in the known universe. So Pulsatilla 200C is basically water, and that’s what our intrepid homeopath is using in the case review I started with.

Circling back to that case review, I’m not an obstetrician (obviously), but it didn’t take me long to find evidence that the authors were also acting a bit precipitously. For instance, contrary to the view that in nulliparous women (women with no children) the fetal head is engaged 1-2 weeks before labor, one study suggested that in 75% of nulliparous women the head was not engaged until labor and that there was no statistical difference between the unengaged-head group and the engaged-head group was determined for incidence of vaginal delivery, cesarean section for cephalopelvic disproportion, midforceps delivery, mean and low Apgar scores, and birth weight. It’s also been noted that, even in some primigravida mothers, the head doesn’t engage until labor starts, and that this is within the range of normal.

So basically, a young primigravida woman presented to them three days after her estimated due date (for which an error range of ±two weeks was cited), her baby’s head not having engaged. They gave her three doses of pulsatilla, and she went into labor a day later. Who can argue with that? I can. It’s almost certainly coincidence, given that, even if pulsatilla had any effect at all inducing labor, what they gave her was diluted to nonexistence. Also, there is actually a Cochrane Review on homeopathy for the induction for labor. Its results are negative, although, just like nearly all Cochrane reviews, it describes the data as there being “insufficient evidence to recommend the use of homoeopathy as a method of induction” and that “rigorous evaluations of individualised homeopathic therapies for induction of labour are needed.” No, they are not. That’s because, even if the herbal and plant-based remedies used as the starting solution for dilution had medicinal value for the condition being treated, homeopathic dilutions like pulsatilla 200C cannot work because there is no active drug in them.

None of this, of course, stops homeopaths from providing laundry lists of homeopathic remedies to assist with labor and delivery, be it the ubiquitous Arnica montana for “soft tissue damage (perineum or abdomen) following birth or caesarian section” (though it seems to be good for everything!) or Cocculus for “tremendous tiredness because of breastfeeding and the nights of broken sleep.” One site notes that “200C often works well during and after labor.” Again, 200C is the most watery of homeopathic remedies. Well, not quite. There do exist dilutions beyond 200C, as incredible as that sounds.

Science-based medicine versus homeopathy in France

While on Twitter, I saw something about “fake médicine”:

Yes, this story is from France. It reminded me of another story I discussed from France a while ago, in which Nobel Laureate turned antivaccine and pro-homeopathy crank Luc Montagnier made an appearance in which he tried to argue that vaccines could cause sudden infant death syndrome. This time around, it’s more about homeopathy. Unfortunately, like the story about Montagnier, there is very little in the way of English language reporting on this story. That always makes me leery of taking on a story, because I fear that I’ll miss something important and get the story wrong. On the other hand, I have a great antipathy towards quacks who try to silence critics with legal thuggery, as my posting history makes plain. Also, even after 30 years I can still read and speak French well enough to get the gist of most articles I read without using Google Translate. So I decided to dive in and see if I could figure out what’s going on.

It didn’t take me long to come across at least one interesting Tweet:

This is Agnès Buzyn, ministre des Solidarités et de la Santé (Minister of Solidarity and Health), stating support for homeopathy, specifically, “If it continues to be beneficial, without being harmful, it will continue to be reimbursed.” This is a pretty damned irresponsible thing for any minister of health in any country to say. Twitter was not pleased:

But what is this all about? It didn’t take me long to find a website called fake médicin, which contains a statement by 124 French doctors condemning alternative medicine and homeopathy in particular and calling on the French government to stop funding homeopathy and other alternative medicines. There’s an English version there too, but the statement is still worth citing fairly extensively. The doctors behind this statement begins by invoking the Hippocratic Oath as one of the oldest known ethical commitment that “requires a physician to provide the best possible care to his patients, in the most honest way,” noting that these two obligations “require a physician to continually seek to improve his or her (medical) knowledge and to inform his patients about what he can reasonably offer, as well as what treatments are unnecessary or contra-indicated.” It also cites French law:

…they forbid charlatanism and deception, impose the prescription and distribution of treatments for which the efficacy was established. They also proscribe the use of obscure remedies or remedies which do not clearly list the substances that they contain.

You can see where this is going with respect to homeopathy. The statement goes on to point out that the French General Medical Council is responsible for ensuring that its members “do not use their credentials to promote practices for which science was unable to demonstrate their usefulness or practices which can even be dangerous” and “do not become sales representatives of unscrupulous industries.” Here’s where the hammer falls, when the statement points out that the General Medical Council still tolerates practices that “are at odds with its own code of ethics” and that “public bodies organise or even contribute to the financing of some of these practices.”

Before I get to the meat of the statement, I was wondering just who was behind the fake médicine website. The site’s authors describe themselves as:

We are a group of health professionals with a wide variety of specialties and methods of practice. Our common viewpoint is that medicine must adapt its practices to the facts and seek to disseminate these facts by popularizing via Youtube videos, blogs, or through social networks.

We are not an association, we are perfectly apolitical and we are not driven by a conflict of interest, except perhaps the promotion of critical thinking.

In the era of “fake news”, fashionable term but serious issue, we have long noticed the activism of pseudo-medicines on the internet, trying to discredit our discipline to better sell theirs. We have also seen the damage that such speech can produce in the health field, such as anti-vaccine movements, or other conspiracy movements.

Yes, support for science-based medicine is important, and this group has it. The authors note:

The so-called “alternative” therapies are ineffective beyond any placebo effect and can even prove to be dangerous.

  • They can be dangerous because they treat irrelevant symptoms and over-medicalise populations, giving the illusion that any situation can be solved with a “treatment”.
  • They can be dangerous because they fuel and rely on a fundamental distrust of conventional medicine as shown by the unjustified polemics surrounding vaccines.
  • Finally, They can be dangerous because their use delays the diagnoses and necessary treatments, sometimes leading to dramatic consequences, especially in the treatment of serious diseases such as cancers.

I couldn’t have said it better. It’s also noted that support for pseudomedicines (i.e., quackery) is also a waste of money that taxpayer euros should not be spent on. Indeed, in France, homeopathic products can be reimbursed at a rate of 30% (but up to 90% in the Alsace-Moselle region) and benefit from a preferential status that exempts their manufacturers (like Boiron, a French multibillion dollar company) from having to demonstrate their efficacy.

So here’s what fake médicine calls for:

We urge the French General Medical Council and the French public authorities to make every effort to:

  • No longer allow physicians or healthcare professionals to continue to promote these practices using their professional credentials.
  • No longer recognise in any way homeopathy, mesotherapy or acupuncture diplomas as medical university degrees or qualifications.
  • Ensure that Medical Schools or institutes which deliver health trainings, may no longer issue diplomas covering medical practices for which the efficacy was not scientifically demonstrated.
  • No longer reimburse health care, medicines or treatments from disciplines which refuse to subject themselves to a rigorous scientific assessment.
  • Encourage initiatives aimed at delivering information on the nature of alternative therapies, their deleterious effects, and their real efficacy.
  • Require all caregivers to abide to the deontology of their profession, by refusing to deliver useless or ineffective treatments, by offering care in accordance with the recommendations of learned societies and the most recent scientific evidence and by demonstrating pedagogy and honesty towards their patients and offering an empathic listening.

Each and every one of these demands is something that I can get behind totally. Some of them are even applicable to the US.

So far, as of my writing this, there are 1,929 signatories:

of which 822 are in medicine, 111 are in care, 99 are in pharmacy, 75 are in physiotherapy, 229 are in education or research, 253 are in engineering or computer science, 7 are in dental, 5 are in midwifery, and 329 in many other fields who feel concerned.

The complete list of signatories is here.

It also didn’t take me long to find out that there’s a hashtag created by these same French physicians, #fakemed. The activity on this hashtag has not gone unnoticed:

More importantly:

And:

And:

And:

Just click on the Tweets and hit the “translate” button if you don’t know enough French to figure out what is being said.

And:

It turns out that the statement caused a major kerfuffle in France, as alluded to in the first Tweet I cited above. I looked for an English language story about the dustup, but basically failed to find a good one. I did, however, find a story in the French version of Slate, Fake médecines, vraies questions de société, or Fake medicines, real issues for society. Here’s what’s been happening.

On March 18, the fake médicine text was published in a column in Figaro. Addressed to the National Council of the College of Physician, the initiative and statement were spearheaded by doctors who are active on YouTube and other social media, François, author of the Youtube channel Primum non nocere and Jérémy Descoux, of Asclepios. The reaction was swift and nasty (translation a combination of Google Translate and myself changing the wording when I can to make it less clunky English):

The next day, reactions were quick. On March 19, Jérémy Descoux was invited on the set of LCI to defend the terms used in his statement. Its opponents unanimously condemned the approach: The benefits of popular medicines would be misunderstood; the practices of these by medical doctors would protect against the risks of abuse; and we should not risk undermining the flourishing French homeopathy industry. On March 20, it was the turn of science journalist Mathieu Vidard, host of the radio show La tête au carré, to express in an editorial his disagreement with the terms of the platform: according to him, this one would continue the chimeric ideal of a purely rational medicine.

Those of you who pay attention to these things will recognize the sorts of logical fallacies, bad arguments, and misinformation used by Vidard. First, Vidard accused the doctors of “arrogance”:

Riding the theme of fake news, our doctors disguised as white geese drape themselves in the arrogance of their scientific respectability to knock – I quote – these false therapies with illusory efficacy.

Then there was the predictable appeal to popularity:

If this statement was not frankly insulting to practitioners as well as to the 40% of French people who use alternative medicine, we would have fun arguments of these fathers of morality.

I like to respond to this by saying that the fact that one third of Americans believe in ghosts doesn’t mean that ghosts are real. The same is true of homeopathy. That 40% of the French public has used homeopathy doesn’t mean homeopathy works.

There was an invocation of the “magic” of placebos (with a dash of tu quoque):

…no serious study has proven so far any effectiveness of [homeopathy]. The scientific content of alternative medicines is empty. Nothing but the placebo effect. So what?

Can all the allopaths boast of being able to treat each disease rationally? No, of course not.

So is not it possible to admit that there is sometimes a part of magic to cure?

At least he admits there’s no science behind homeopathy and alternative medicine.

Next up, the appeal to “holism” and the “human touch”:

In the conclusion of their statement, the 124 demand that all caregivers respect ethics and that they offer to their patients a benevolent ear. How dare we! It is precisely because of dehumanized conventional medicine that patients who are tired of being considered as mere limbs turn to practitioners who can spend time with them and listen to them.

As I like to say, if the problem in modern medicine is insufficient empathy and not enough time to give the patients a “benevolent ear,” the solution is not to farm that function out to quacks. It is to train doctors to do better and change the financial incentives in the system to value face-to-face time with patient far more than our current reimbursement system does. Hilariously, right after this passage, Vidard claims that attacking the “humanistic function” of homeopaths and doctors using alternative medicine, the 124 risk driving patients into the arms of real quacks. Yes, I’ve lost track of how many fallacy-filled articles like Vidard’s I’ve deconstructed over the years, just in English.

Helpfully, Beatrice Kammerer, the author of the Slate.fr article, lists the fallacies used by defenders of homeopathy and gives several examples. Here are the fallacies:

  1. “Medicine is not only rational.” My response: True, but that does not mean medicine should embrace the irrational and pseudoscientific.
  2. “Scientific medicine is cold and dehumanized.” See my response above.
  3. “The doctor’s role is not to tell me what to believe in.” My response: No one says that it is, but a doctor’s role is to recommend therapies and treatments with scientific evidence supporting their efficacy and safety. Homeopathy fails on that account.
  4. “If doctors are forbidden to prescribe homeopathy, people will rush to charlatans!” See my response above.
  5. “Just because science does not understand how unconventional medicines work does not mean that they are ineffective.” My response: This is putting the cart before the horse. Show compelling evidence of efficacy, then we’ll talk. Many of these medicines are claimed to work through impossible mechanisms and homeopathy is an excellent example of this. For homeopathy to work, several well-established laws of physics and chemistry would have to be not just wrong, but spectacularly wrong.
  6. “Homeopathy may not cure, but it is good for many people.” My answer: The only people homeopathy is good for are homeopaths, the stockholders of Boiron, and the owners of companies manufacturing homeopathic remedies.

Of course, homeopaths being homeopaths, the entirely predictable result of a serious threat to homeopathy has resulted in complaints to the College of Physicians about some of the doctors behind the fake médicine site:

Here’s a story in Le Monde telling the tale:

Tension hasn’t decreased among doctors after the publication of a statement signed by more than 120 health professionals, March 19 in Le Figaro, against homeopathy and other alternative medicines. Following this statement, the newspaper confirmed on Thursday, April 12, that trade unions of homeopathic doctors, mesotherapists or accupuncturists have filed a complaint with the council of the order of the profession against 10 of 124 signatories – five doctors who expressed themselves in the media after the publication of the statement, and five others who signed it.

The statement criticized in particular “practices neither scientific nor ethical, but very irrational and dangerous” and spoke of “fake medicine” (“false medicine”). The signatories asked the Council of the Order, “not to allow doctors or health professionals who continue to promote [these practices] to use their title”.

The unions criticized these remarks as “offensive, defamatory and even insulting” and “contrary to the ethical principles of confraternity, and professionalism”, reports Le Figaro. They demand a “public apology.”

When a complaint is lodged with the Medical Association, the first step is an attempt at conciliation. If the mediation fails, “we will then draw lots of doctors from the list of [the signatories] every fortnight for new complaints,” warns Dr. Meyer Sabbah, the source of the complaint.

This is, of course, typical thuggery that homeopaths engage in. It reminds me of the time that Andy Lewis, a.k.a. Le Canard Noir, who ten years ago endured similar threats after he wrote a brilliant article, “The Gentle Art of Homeopathic Killing,” which showed that such claims actually violate homeopaths’ own code of ethics, resulted in a legal threat from the Society of Homeopaths. I’ve also documented similar types of legal thuggery from quacks directed at other skeptics speaking out. Many have been victims, ranging from Paul Offit to Brian Deer to Ben Goldacre to Simon Singh to Rhys Morgan to Steve Novella, all of whom have had legal threats directed at them or been sued outright. The most recent example is a naturopath quack (but I repeat myself) who is suing ex-naturopath and current skeptic and scientist Britt Hermes. This is what homeopaths and other quacks do when criticized. Add to this the likelihood that the statement by the 124 French doctors threatened a huge French company (Boiron), business considerations and national pride probably amplified the usual thuggish reaction.

It is to the credit of the 124 French doctors who spoke out about The One Quackery To Rule Them All. Their statement needs to be publicized far and wide, not just during Homeopathy Awareness Week, but going forward. Homeopaths like to portray themselves as a persecuted minority, but in France (and elsewhere), homeopathy is big business.

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.