Data from Edzard Ernst - Curated by EPG Health - Last updated 07 April 2017
Homeopathy has been with me since my childhood. As a young boy growing up in Germany, I once fell acutely ill with a colic of some kind. The pain was excruciating. Our family physician, a nationally famous homeopath, was called and treated it successfully by injecting a mainstream drug. Another time, I had caught a mild form of infectious hepatitis. He monitored my liver function and gave me homeopathic remedies. My liver subsequently normalised, and we all concluded that homeopathy had cured my condition. I am sure this sounds utterly bizarre or even irresponsible to most modern physicians but, to me, it seemed entirely normal at the time. For me, like for many Germans, homeopathy was simply an established part of medicine.
The relatively peaceful co-existence of homeopathy and conventional medicine in Germany is bewildering to people who have not grown up with this duality. How can doctors claim they are grounded in science and, at the same time, tolerate or even practice a type of medicine that is as remote from science as astrology is from astronomy? I am not sure that I know the answer to this question even now, and back then I had not yet started wondering.
How can doctors claim they are grounded in science and, at the same time, tolerate or even practice a type of medicine that is as remote from science as astrology is from astronomy?
At medical school, homeopathy had rarely been mentioned but I had, of course, heard from our professor of pharmacology that this type of medicine was complete and utter nonsense. Pharmacologists tend to become particularly enraged when anyone mentions the ‘H-word’ because homeopathy contradicts almost every single principle they teach.
After graduating from medical school, it was time to find a job. This task turned out to be more difficult than anticipated: all good positions were taken, and – believe it or not – in desperation I accepted a post in Germany’s only homeopathic hospital. Before starting, I quickly read up about homeopathy. What I learnt was more than bewildering.
In a nutshell, homeopathy is based on two main assumptions that were described by Samuel Hahnemann about 200 years ago. The first is often called the “like cures like” principle (similia similibus curantur). Hahnemann asserted that, if a substance causes a certain symptom in a healthy person, it could be useful in treating these particular symptoms when they occur in a patient. This might sound elaborate or complicated but, in fact, it turns out to be surprisingly simple: because my eyes start watering when I am chopping onions, for example, onion is a homeopathic remedy for treating hay fever - which is, of course, characterized by watering eyes.
A typical homeopathic remedy is so much watered down that it no longer contains a single molecule of the original substance
The second principle is often referred to as the “memory of water.” To use the above example of the onion as a remedy for hay fever, homeopaths do not use the pure onion extract. Instead they dilute and shake, and dilute and shake the extract many times over. They call this process “potentisation” to indicate their conviction that it renders the remedy not less but more potent. Dilutions are often in steps 1:100, which is characterized by the letter C (centum). A typical homeopathic remedy is so much watered down that it no longer contains a single molecule of the original substance. A ‘C30’ potency of onion, for instance, contains 1 part onion extract in 1,000,000,000,000,000,000,000,000,000,000,000,000, 000,000,000,000,000,000,000,000 parts of water or other diluent. Another way to express this extraordinary phenomenon is perhaps even more dramatic: for a “C30” pill to contain just one single molecule of the substance printed on the label, the pill would have to have a diameter similar to the distance between the earth and the sun. Once we have fathomed this simple premise, we can immediately see why scientists find homeopathy so hard to swallow.
Homeopaths acknowledge the fact that the repeated dilutions may indeed result in not one molecule of the original active ingredient remaining, but crucially, they also claim that the repeated shaking - a process they call “sucussion” - transfers some sort of indefinable energy from the onion to the water - hence, the phrase “memory of water.”
...on the one hand, homeopathic remedies could not possibly work; on the other hand, they clearly did help some patients to get better.
When I began working as a physician in the homeopathic hospital, I knew, of course, that homeopathy lacked scientific plausibility. There is no reason to assume that evoking similar symptoms will cure a disease and there is even less basis to the notion that diluting a substance will render it more powerful. But I was prepared to concede pragmatically that it if helps, it helps. After all, I had benefitted from these strange remedies myself on numerous occasions. Perhaps my appointment would enable me to get to the bottom of this paradox: on the one hand, homeopathic remedies could not possibly work; on the other hand, they clearly did help some patients to get better. This was an intriguing contradiction and, from that perspective alone, the offer of working as a homeopath was a chance I didn’t want to pass up.
The Munich homeopathic hospital was housed in a modern building set in a pleasant park in the southern suburbs. With only around 100 beds, it was a small but nationally respected institution. The hospital itself seemed well-run; it was immaculately clean, there was an unusually tight discipline about everything, and the food was the best I ever ate in any hospital anywhere in the world.
In the entrance-hall, there was a big sign “Here we do not smoke!” which was not at all typical of hospitals at that time. In the 1970s, smoking was still allowed everywhere, even in some hospitals. So the non-smoking policy was way ahead of its time. The wording of the sign was, however, unusual and somewhat patronising, I thought. It did not simply say “No smoking” or “Please abstain from smoking” but delivered its message in an Olympian tone, almost as a value judgment.
Everyone working in this place was very kind but, at the same time, my colleagues were often pushy, given to minding other people’s business and quite unashamedly an evangelical mission whose goal was to convert everyone to the gospel of Samuel Hahnemann.
Despite the fact that we were dishing out remedies which, as my pharmacology professor had insisted, contained precisely nothing, patients usually did get better, some even dramatically so.
Being a “real doctor” was terrifically exciting. Initially, I was merely shadowing experienced colleagues, but after a few weeks, I was given more responsibility. What I saw was impressive. We were treating mostly chronic conditions, anything from asthma to rheumatoid arthritis and from migraine to obesity – lots of obesity. Despite the fact that we were dishing out remedies which, as my pharmacology professor had insisted, contained precisely nothing, patients usually did get better, some even dramatically so. I was bowled over! Soon I found myself treating my mother, siblings and friends for this or that minor illness. Even our dogs did not escape my enthusiasm for the newly discovered pilules containing sugar and…..sugar.
Yes, I was impressed, but occasionally I also had doubts: Was it really the remedy itself that was responsible for the recovery of our patients, or was it the careful, compassionate attention paid to the patients that brought about their improvement? Perhaps the patient would have improved even without any therapy at all? Crucially, was not every young doctor impressed when treating his first patients and watching them recover? Was I perhaps deluding myself about the powers of the ultra-diluted homeopathic remedies? These nagging doubts stimulated reflection and made me eager to explore further and learn more.
The medical director seemed to like me and took me under his wing. We frequently had long discussions about all sorts of issues. His reply to my question “What precisely causes the improvement of our patients?” amazed me with its disarming honesty. “It’s mostly due to the fact that we discontinue all the useless medications they had been taking previously.” I had never thought of that possibility at all.
I was struck by the amount of nonsensical prescriptions many patients had accumulated during the often long years of their medical history.
But it was true: we did scrap most of the unnecessary drugs. I was struck by the amount of nonsensical prescriptions many patients had accumulated during the often long years of their medical history. All these drugs did, of course, have the potential to cause side-effects. Throwing them overboard was therefore quite likely to improve our patients’ symptoms, provided these drugs were truly superfluous. All this was hardly amazing and even my pharmacology professor would surely have approved. What was remarkable, however, was that my boss did not claim that his homeopathic pellets were the prime reason for the improvement. Perhaps he did not himself believe in homeopathy? Such heretical thoughts!
The placebo effect, I suggested, might be another reason for homeopathy’s success, and my boss agreed. During my time in this hospital, I witnessed many instances of its amazing power. Once, during a ward-round, a patient experienced an acute asthma attack just as we were passing by her bedside. I had never seen anything like it; within minutes she seemed to suffocate in front of our very eyes. She was deteriorating fast into what I thought was a critical state. I was alarmed, if not panicked. My boss, however, remained strangely calm: “Don’t worry”, he told the patient, “we will give you an injection immediately. It will have an instant effect. Trust me; you will be fine in just a minute.” With that we all left the room; outside, the nurse was instructed to prepare a saline injection. This, we all knew, would have no effect at all; saline injections are pure placebos. I was told to go back to the patient and administer the injection intravenously. I was horrified: how could this help a patient on the brink of death? But when I argued my corner, my concerns were dismissed peremptorily.
Never forget the incredible power of placebo
So I did my best. On arrival at the patient’s bedside, I continued reassuring her that my injection was powerful and would be dramatically effective. And to my utter amazement, so it proved to be. Seconds after I had injected the saline, the patient began to breathe normally, her colour normalised, and she relaxed. “Never forget the incredible power of placebo,” my boss later told me.
One of my colleagues had taken to combining homeopathy with something even more bizarre: dowsing. Whenever he was not sure which homeopathic remedy to prescribe, he would take out his pendulum and brood over that patient’s case notes until the swing of his instrument told him which the right treatment was. Even in the eccentric atmosphere of the homeopathic hospital, this was considered to be fringe medicine. We used to smile at this procedure and had our doubts about its validity. But nobody ever challenged him, or asked him to explain exactly how the swing of his pendulum could reliably resolve a thorny clinical or therapeutic dilemma. It was instances of this kind that, after a few months, began to kindle in me an increasingly urgent need to move on.
It had already occurred to me that some of my colleagues used homeopathy not least because they could not quite cope with the demands of conventional medicine. In a way, it is almost understandable that, if a physician was having trouble comprehending the multifactorial causes and mechanisms of disease and illness, or for one reason or another could not master the equally complex process of reaching a diagnosis or finding an effective therapy, it might be tempting instead to employ notions such as dowsing, homeopathy or acupuncture, whose theoretical basis, unsullied by the inconvenient absolutes of science, was immeasurably more easy to grasp. Some of my colleagues in the homeopathic hospital, I began to suspect, were not cut out to be “real” doctors.
When he finally pushed the horrifyingly thick, long biopsy needle through the patient’s skin in the direction of her liver, he turned white and then promptly fainted.
One day, we were to perform a liver biopsy on a patient. This was a very big event in the off-beat environment of the homeopathic hospital, way outside our routine. The task fell, of course, to the most experienced doctor, whom I volunteered to assist. Already during the preparations, he seemed exceedingly nervous. When he finally pushed the horrifyingly thick, long biopsy needle through the patient’s skin in the direction of her liver, he turned white and then promptly fainted. The patient was in considerable discomfort, and I was left attending to both of them. Eventually I attracted help and we managed to pull out the biopsy needle and obtain what looked like a decent tissue sample. The biopsied tissue was then sent off for analysis. Two days later, the report arrived on our desk. The first sentence was very disrespectful of our endeavours. “Thank you for sending us this “Schaschlik” (the German word for a mixed meat skewer one might order in a restaurant) for histological analysis.” It turned out that we had sampled bits of our patient’s diaphragm, lung and liver. Fortunately the patient was blissfully unaware of any of these problems; she had not experienced any suspicious symptoms and survived our incompetence quite splendidly.
I left the homeopathic hospital after about 6 months. Subsequently, I worked in several conventional hospitals in the areas ranging from general medicine to surgery and rehabilitation medicine. Eventually, I secured a post at the University of Munich in the Department of Rehabilitation Medicine where I was expected to engage in all three elements of university-based medicine: patient care, teaching and research. Somewhat to my surprise, the latter took me over completely after joining a London-based group of scientists conducting research into the flow properties of blood. I made a PhD in this subject, returned to clinical medicine, and after several years became a professor first in Hannover and then in Vienna.
Despite all this, homeopathy and the fundamental questions it had raised would remain close to my heart.
Despite all this, homeopathy and the fundamental questions it had raised would remain close to my heart. In 1993, I was appointed to the first chair in complementary medicine at the University of Exeter. Now it was my job to do the science and find the answers. Together with a team of about 20 multidisciplinary, multinational scientists, I conducted clinical trials and systematic reviews. During the two decades of this research, the results became indisputably clear: homeopathic remedies are elaborate placebos.
Uncontrolled studies of homeopathy almost invariably yield positive findings. Homeopaths celebrate such results as a proof of their method, ignore the fact that they might be due to bias, and ignore the fact that the most rigorous of the ~300 controlled clinical trials available to date tend to generate negative results. The explanation of the apparent contradiction between controlled and uncontrolled studies is, however, all too obvious: the perceived benefits of homeopathy are due to non-specific effects (e. g. placebo), once these are adequately controlled in clinical trials, the results show that highly dilute homeopathic remedies are indistinguishable from placebos.
As I began to describe this embarrassing but nevertheless true state of affairs more and more openly, I made plenty of enemies, not least the UK’s most influential homeopathy-fan Prince Charles. The consequences for my team were dire and dramatic (the full story is in my book ‘A SCIENTIST IN WONDERLAND’). Yet all attempts to silence me have so far failed. On the contrary, since about three years I am publishing a lively blog (edzardernst.com) where I can express my views unhindered, and I am working on a book entirely focussed on homeopathy.
The reaction of homeopaths to all this? “BUT HE KNOWS NOTHING ABOUT HOMEOPATHY!”