Homeopaths Without Borders practice exploitation not humanitarianism
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5448 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5448
All rapid responses
Unfortunately, Christine Jahnig appears not to have fully understood the points to which she is replying. I crave your indulgence in clarifying these
The "findings of the Swiss HTA" are not "findings of a Swiss HTA". This claim is specifically refuted by Dr. Gurtner of the Swiss Federal Office of Public Health (http://www.smw.ch/content/smw-2012-13723/). The process of review of complementary and alternative medicine (PEK) resulted in the withdrawal of funding for homeopathy: this would not have happened if the report were as Ms. Jahnig characterises it.
It is not unreliable because it was written by homeopaths, it is unreliable because it reverses the hierarchy of evidence in order to reach a predefined conclusion, and because the authors have a material and undeclared conflict of interest (http://www.smw.ch/content/smw-2012-13594/), and of course because it is not the document homeopathists claim it to be (http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/).
To say that Bornhöft et. al analysed all of the homeopathy literature is to miss the point: Linde et. al (http://www.ncbi.nlm.nih.gov/pubmed/10391656) eloquently describe the relationship between poor study methodology and positive outcome in homeopathy trials. Bornhöft et. al. fail to make this connection. Many of the studies they consider to be good, lack blinding, controls or some other fundamental component of sound science, and they themselves make clear that their self-appointed task is to find a way of justifying homeopathy despite the lack of plausible mechanism, rather than to critically evaluate whether it is efficacious. The authors posit "cognition based medicine" as an alternative to evidence-based medicine, in order to allow subjective (including placebo) effects to be counted as evidence of efficacy. This is, to put it mildly, controversial.
In fact, evidence-based medicine already gives homeopathy an easier ride than it should. Ioannidis (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124) describes why an inert treatment will always end up with a body of evidence showing a weak positive effect. It is telling that the US National Center for Complementary and Alternative Medicine (NCCAM) is no longer funding trials of homeopathy (http://scienceblogs.com/insolence/2012/11/19/the-success-of-nccam-grants...) and concludes that there is "little evidence to support homeopathy as an effective treatment for any specific condition" (http://nccam.nih.gov/health/homeopathy).
NCCAM has spent at least a billion dollars evaluating alternative treatments, including homeopathy, and has yet to validate a single one.
Ms. Jahnig seems to think that criticism stems from a "bias against homeopathy" This is an easy mistake to make, but a mistake nonetheless. Criticisms of homeopathy stem not from a bias against it, but from the application of normal standards of scientific rigour. This is "biased against homeopathy" in the same way that evolutionary biology is biased against young-Earth creationism. Beliefs that are claimed to be scientific, but fail the basic tests of scientific inquiry, are apt to be rejected by a large majority of the scientifically literate.
There is only one standard. That is why the All Trials initiative (http://www.alltrials.net/) exists. Simon Singh and Ben Goldacre, both of whom have written well known debunkings of homeopathy, are among the driving forces behind that initiative.
A homeopathy study will typically start by stating that homeopathy is popular, has been around for 200 years, and is based on the idea that like cures like and dilution increases potency. A scientific review will begin by noting that despite its popularity and age, there is no evidence that like cures like or that dilution increases potency. Bornhöft et. al. started from the premise that homeopathy works and set about assembling a hierarchy of evidence to support that belief, scientific reviews such as Linde and Shang et al. (http://www.ncbi.nlm.nih.gov/pubmed/16125589) explore what the data actually says and find that the evidence for homeopathy is weak, consistent with the null hypothesis.
If you remove the starting assumption that homeopathy is valid and ask not "how can I show this to be true?" but "is this true?" you get an answer the homeopaths don't like. This is their problem, not that of science.
It does not matter how often homeopaths claim that this is a Swiss HTA report and convincingly demonstrates that homeopathy is safe and effective, the responsible official specifically states that it isn't, and doesn't.
One final point: Homeopathists do not get to decide who may and may not comment on their beliefs, as Ms Jahnig appears to wish. Poisoning of the well aside, Gurtner's criticisms of the Bornhöft report are, if anything, more damning than Shaw's. The Chief Medical Officer and the Chief Scientific Advisor are also on record as rejecting the claims of homeopathy in robust terms.
There is no conspiracy, homeopathy is simply wrong, like pretty much every other medical belief of its time. We no longer use purging or blistering or bloodletting to balance the humours, so there is no longer a valid place for doing nothing as an alternative to these practices.
Competing interests: No competing interests
After reading the comments made here by Alan Henness, Guy Chapman and Shyan Goh, I believe it is appropriate and, in fact, necessary to expand and clarify the facts about the three studies they mention.
Shyan Goh notes two studies along with links to discussions of them provided by a site well known for its bias against homeopathy.
The first study on the use of homeopathic potassium dichromate in critically ill patients was published in the peer-reviewed journal Chest in 2005. It can be seen at:
www.ncbi.nlm.nih.gov/pubmed/15764779
In addition to the study there is clinical proof of its efficacy. Dr. Martin Forest, certified in pulmonary and internal medicine and Director of the Intensive Care Unit at Shore Health Systems, a major U.S. hospital and part of the University of Maryland Medical Systems, added it to their formulary because it allows patients to be taken off ventilators sooner than would otherwise be possible and results in shorter hospital stays and reduced costs. The medical system serves 100,000 mid-shore residents, has over 200 consulting and attending staff members and offers a wide array of medical services.
The second study on adjunctive homeopathic treatment in severe sepsis can be seen at:
www.ncbi.nlm.nih.gov/pubmed/15892486
It shows that on day 180 75.8% of the homeopathy group had survived as compared to 50.0% of the placebo group. No adverse effects were observed.
It is somewhat ironic that Mr. Henness and Mr. Chapman would imply the findings of the Swiss HTA weren't valid by claiming it was "written by homeopaths" while, at the same time, offering up criticisms of the study made by people well known for their own personal bias against homeopathy -- one being Edzard Ernst. It's hard to know why David Shaw would be commenting on homeopathic research. He is a bioethicist not trained in medical research and not trained in homeopathic research. His resume includes working as a moral philosophies tutor, an English instructor and a lecturer in ethics at the Dental School, U. of Glasgow. His papers include "Cryogenics: Seeking life after death" and "We should not let families stop organ donation from their dead relatives". Mr. Henness even offers his own comments as a reference. I'm curious about his credentials as a medical or homeopathic researcher.
Gudrun Bornhoft, M.D., and Peter Matthiessen, M.D., were the editors of the Swiss HTA. The study itself was conducted by appropriately qualified professionals without a vested interest. The investigating team was composed of 13 members. Ten are trained in conventional medicine. Of them six are also trained in homeopathy. The other three are trained in physics, electrical engineering and sociology. 8 of the thirteen held academic positions. Six were involved in CAM research.
The full text of the study along with the names and qualifications of the authors of each chapter can be seen at:
link.springer.com/book/10.1007/978-3-642-20638-2/page/1
The study analyzed all of the homeopathic literature over the past 40 years not just literature on respiratory infections and allergies. It included all the major evidence for homeopathy from major pre-clinical research (studies on human cell lines, plants and animals and basic research into chemical changes) and trials on people, systematic reviews, meta-analyses and epidemiological research.
The results of the HTA are "Many high quality investigations of pre-clinical basic research proved homeopathic high potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Allergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional interventions. 8 out of 16 placebo-controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly classical homeopathy has few side effects and the use of high potencies is free of toxic effects. Taking external and internal validity into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate applications be regarded as safe."
www.ncbi.nlm.nih.gov/pubmed/16883077
The PEK report was a sub-study. It found that:
1. Patients are more satisfied with the care in practices offering CAM
2. Total annual costs are markedly lower than the average for con med
3. The actual increase in costs resulting from covering the 5 CAM modalities studied proved to be markedly lower than expected
4. Markedly fewer CAM patients reported side effects except in phytotherapy
www.hpathy.com/editorials/busting-the-lancet-the-pek-study-2/
Competing interests: No competing interests
Elisabeth von Wedel's response is a reasonably standard example of the standard homeopathist view.
Ironically, Ms. von Wedel asserts that " homeopathy is clinically effective, cost-effective and safe as proved by the study of Bornhöft and Matthiessen" - David Shaw, author of the commentary to which she is replying, published a rather damning analysis of this paper, characterising it, justly, as a "case study in research misconduct" (http://www.smw.ch/content/smw-2012-13594/) - the only error I can see in this is that Shaw mistakenly characterised it as a Swiss HTA report, a forgivable error since it has been extensively promoted as such by homeopathists. Dr. Gurtner of the Swiss Federal Office of Public Health set the record straight on this (http://www.smw.ch/content/smw-2012-13723/), and pointed out that the overall conclusion of the Swiss review process was that there is no credible evidence that homeopathy is effective - hardly possible if Bornhöft et. al. had "proved" homeopathy to be effective.
It is this constant re-use of refuted claims that leads people to the conclusion that homeopaths are not only unable to provide good evidence, but fail, at a very fundamental level, even to understand the process of scientific analysis and debate.
Ms. von Wedel states "We are fully aware of the fact that further research has to be done in order to understand the efficacy of homeopathy"
This is, I am happy to say, false. No more research is needed. Science offers an explanation for all the observed effects, which is not only complete but is also consistent with other science. Placebo effects, expectation effects, natural course of disease, regression towards the mean, cognitive errors.
In short, the null hypothesis.
In the absence of any observation that refutes the null hypothesis, or that anything else should be expected, further investigation is not only unnecessary but unjustifiable (http://www.parliament.uk/business/committees/committees-archive/science-...).
Competing interests: No competing interests
Shyan Goh has dealt with two of Elisabeth von Wedel's research citations (her references 6 and 7) in support of homeopathy. I would like to deal with a third.
Von Wedel cites the 'Swiss HTA', as it is commonly - and erroneously [1] - referred to (her reference 8), as evidence that 'clearly demonstrate[s] the effectiveness of [homeopathy]'.
Indeed, the Swiss homeopathy report is glowing in its praise for homeopathy. Unfortunately, written mainly by homeopaths, it has been severely criticised [2] and even referred to as 'a case study of research misconduct'. [3]
A full analysis of the history and context of this report and criticism by the Swiss Programm Evaluation Komplementärmedizin (PEK) set up to examine the evidence for homeopathy can be read in the blog post written by myself and Sven Rudloff [4]. Suffice to say, the report should be regarded as neither independent nor authoritative.
The PEK concluded: [5]
"...it is very obvious that all or some of the authors have a positive attitude towards the treatments in question or are convinced about their efficacy. Unquestionably, strict proponents of the usual hierarchy of evidence will regard the presented evaluations as scientifically untenable and unreasonably positive... Even less skeptical academic doctors will regard many interpretations as very optimistic and not scientifically convincing."
And:
"The positive interpretation of the current evidence seems understandable, as long as one does not require especially high evidence standards, given the low plausibility of homeopathy in the light of established scientific knowledge. Very skeptical people will regard the reviewed evidence as not very convincing."
Additionally, the original report only looked at the evidence for homeopathy for upper respiratory tract infections and allergic reactions, so even if its conclusions were significant, they could not be extrapolated to the homeopathic treatment of any other condition.
A far higher standard of evidence for homeopathy would be required to convince even a slightly sceptical person.
1. Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
2. Edzard Ernst. 2012. “A Critique of the Swiss Report Homeopathy in Healthcare - Ernst - 2012 - Focus on Alternative and Complementary Therapies - Wiley Online Library.” Accessed June 2. http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01160.x/full.
3. “SMW - Swiss Medical Weekly - The Swiss Report on Homeopathy - a Case Study of Research Misconduct.” 2012. Accessed June 2. http://www.smw.ch/content/smw-2012-13594/.
4. Henness, Alan, and Rudloff, Sven. 2013. “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” Accessed January 29. http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/.
5. “Bundesamt Für Gesundheit - Programm Evaluation Komplementärmedizin (PEK).” 2013. Accessed October 12. http://www.bag.admin.ch/themen/krankenversicherung/00263/00264/04102/ind.... (Quoted translations by Sven Rudloff)
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.
David M Shaw has understood the main aims of the Homeopaths without Borders
(in German Homöopathen ohne Grenzen, HOG) mission: “it seeks to propagate homeopathy in countries where it has not previously had a foothold“ (1).
And yes he is right! HOG is a non-profit organisation consisting of well-trained and experienced homeopathic practitioners, who offer some of their time and expertise to support people in need by the means of homeopathy.
Offering a thorough training in homeopathy to local medical staff, so that they are fully aware of its possibilities and its limitations, is our ultimate reason.
In his article Shaw considers this to be exploitation instead of humanitarianism based on the assumption that homeopathy is not effective. Thus he accuses members of HOG of unethical behaviour; homeopathy altogether is unethical following various articles of the author. (2,3,4)
In his reasoning he just ignores the fact that there is plenty of research being done that clearly demonstrate the effectiveness of this method (5,6,7,8, just to name a few).
Being the chair of HOG and Homeopaths World Wide (HWW) I want to take the chance and object to the accusation of Shaw.
First of all it needs to be declared that nobody is ever prevented from seeking biomedical healthcare! HOG offers homeopathic treatment always alongside the available possibilities. Considering the fact that homeopathy is clinically effective, cost-effective and safe as proved by the study of Bornhöft and Matthiessen (8), it would be rather unethical not to offer homeopathic treatment especially in situations where medical aid is not available. The work of our members in Kenya is a living example: the education of traditional birth attendants (TBAs) in the use of homeopathic remedies to prevent post partal bleeding did help a lot to reduce women’s postpartum mortality. Our educated TBAs live and work in remote areas of rural Kenya. TBAs and their patients have to overcome long distances by boat or donkey to the next hospital, frequently women died before reaching help. Being a practising homeopath, having experienced these situations in the field, I am wholeheartedly convinced about the ethics of our practise.
Whenever a new project is set up, which by the way happens only on request, the members of HOG do inquire about local healing traditions. One of our aims is to reinforce the knowledge about local plants and their healing effects, in order to respect cultural knowledge and traditions. It is easy to rest at the homely desktop and theorize and condemn harmful homeopathy instead of going out and have an open-minded look of what is happening in the field.
We are fully aware of the fact that further research has to be done in order to understand the efficacy of homeopathy. HOG is ready and interested in controversy discussions like these in order to support a further development of homeopathy. This was one of the reasons we invited sceptics of homeopathy to a public discussion in the frame of our symposium in Berlin in June this year. Sadly only two members of the scene have been courageous and curious enough to come and discuss.
References:
(1) BMJ 2013;347:f5448
(2) Shaw, D. (2010) 'Unethical aspects of homeopathic dentistry', British Dental Journal, 209(10), 493-496
(3) Shaw, D. (2011) 'Homeopathy and medical ethics', FACT: Focus on Alternative and Complementary Therapies, 16(1), 17-21.
(4) Shaw, D. M. (2010) 'Homeopathy is where the harm is: five unethical effects of funding unscientific 'remedies'', Journal of Medical Ethics, 36(3), 130-131
(5) Linde K et al. Critical review and meta-analysis of serial agitated dilutions in experimental toxicology. Hum Exp Toxicol, 1994: 13 (7): 481-92
(6) Frass M, Dielacher C, Linkesch M, Endler C, Muchitsch I, Schuster E, Kaye A.
Influence of potassium dichromate on tracheal secretions in critically ill
patients. Chest. 2005 Mar;127(3):936-41.
(7) Frass M, Linkesch M, Banyai S, Resch G, Dielacher C, Löbl T, Endler C,
Haidvogl M, Muchitsch I, Schuster E. Adjunctive homeopathic treatment in
patients with severe sepsis: a randomized, double-blind, placebo-controlled
trial in an intensive care unit. Homeopathy. 2005 Apr;94(2):75-80.
(8) Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ by Gudrun Bornhöft and Peter F. Matthiessen (Editors). 2011. ISBN 978-3-642-20637-5
Competing interests: No competing interests
Guy Chapman:
In other words you cannot provide any evidence whatsoever that homeopathy did not work in the two instances I related.
You've stated twice that you are not a doctor and not medically qualified so you are clearly not qualified to offer any opinion at all.
I rest my case. Thank you!
Steve Tonkin:
Ditto.
Competing interests: No competing interests
I had homeopathic treatment back in the late 1980s for IBS. It worked, whereas conventional medicine had not.
Yet I understand the scientific process required to evaluate treatments. If I want to claim that homeopathy works I would have to provide the evidence. I can't simply say to a critic 'well prove it didn't'. That's not how science works.
I can't explain how I got better with homeopathy. Perhaps it works or maybe I just got better anyway and the homeopathic treatment simply worked by placebo.
Christine E. Jahnig needs to learn a little about science, how to test a hypothesis and the basic scientific method of enquiry before making demands of scientists.
Competing interests: No competing interests
Christine Jahnig: I am not the one that bears the burden of proof for your claim.
I rest my case.
Competing interests: No competing interests
Christine Jahnig has fallen for one of the most common fallacies in alternative medicine: that science must disprove the anecdotal claims of alternative medicine.
I crave the indulgence of those familiar with the scientific method and its attendant burden of proof.
I do not have to prove that homeopathy did not cure Ms. Jahnig, all I have to do is show that the null hypothesis may explain it. It is by now well established that the null hypothesis offers a substantially more plausible explanation for every claim made by homeopaths; in the absence of credible evidence to contradict this, Ms. Jahnig's claim necessarily fails to persuade.
And this goes to the heart of the dispute. In Ms. Jahnig's opinion, homeopathy cured her. The consensus view of the scientific community, based on the available evidence, is that this is not the case (to a degree of probability indistinguishable from certainty).
By way of support, Ms. Jahnig asserts that "high blood pressure and high intraocular pressure are not conditions that reverse by themselves without medical treatment". Like Ms Jahnig, I am not medically qualified, but I do know that high blood pressure most certainly can resolve spontaneously without medication, especially in the presence of the kinds of lifestyle changes routinely recommended by homeopaths - most of which are entirely mainstream; from my reading around the subject it seems to me not at all implausible that such changes might also affect intraocular pressure - but, like Ms. Jahnig, I am straying down the route of speculation. There is no objective evidence that homeopathic remedies caused the affects Ms. Jahnig notes, and if there were, it would be a matter of pressing scientific interest. Hence my original comment.
Ms. Jahnig is correct that "homeopathy does not work" is a statement of belief or opinion; however, "there is no reason to suppose homeopathy should work, no way it can work, and no proof it does work" is a statement of fact drawn from the available evidence, as I showed previously in this discussion.
Even if homeopathy being wrong were only as certain as anthropogenic global climate change - and it is a good deal more certain than that - the onus would very clearly be on Ms. Jahnig to prove her case, as it amounts to an extraordinary claim and as Sagan said, extraordinary claims require extraordinary evidence.
Competing interests: No competing interests
Re: Homeopaths Without Borders practice exploitation not humanitarianism
Jahnig said:
"It is somewhat ironic that Mr. Henness and Mr. Chapman would imply the findings of the Swiss HTA weren't valid by claiming it was "written by homeopaths""
The Swiss homeopathy wasn't poor because it was written by homeopaths; it was poor because it was flawed, [1,2] as I have already pointed out. [3] However, it should be noted that Shaw commented on the authors' undeclared COIs.
But can we finally put to bed the idea that this was an HTA? It was not and this has been stated by the Swiss Government in the reference I have already provided. [4]
To make it clear, the author of that letter was Felix Gurtner, Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland. He clearly stated that the homeopathy report was simply one of several literature reviews and:
"the final PEK report does not classify the literature reviews as HTA reports"
If Jahnig believes Dr Gurtner is mistaken, I would suggest she presents her argument.
We did not know this at the time Sven Rudloff and I wrote our blog post, [5] so we have, unfortunately, propagated this error.
Jahnig continues:
"while, at the same time, offering up criticisms of the study made by people well known for their own personal bias against homeopathy -- one being Edzard Ernst."
That will not do here. If you believe Prof Ernst was biased in some way, please bring specific allegations to our attention, giving details from the paper I cited, so they can be critically examined.
"It's hard to know why David Shaw would be commenting on homeopathic research."
I assume that would be because Dr Shaw is an expert in bioethics and this is clearly a bioethics issue.
"He is a bioethicist not trained in medical research and not trained in homeopathic research. His resume includes working as a moral philosophies tutor, an English instructor and a lecturer in ethics at the Dental School, U. of Glasgow. His papers include "Cryogenics: Seeking life after death" and "We should not let families stop organ donation from their dead relatives". Mr. Henness even offers his own comments as a reference. I'm curious about his credentials as a medical or homeopathic researcher."
Ad hominems and attempts to poison the well will not work here. If you have an issue with specific details where you believe Dr Shaw has erred, I'm sure readers will be interested to hear about them.
Similarly, my credentials are irrelevant; what matters is whether sound arguments are presented and whether they can be countered with evidence. I note that Jahnig has not done this. Our blog post is well referenced to source documents, allowing any reader to verify what we say - assuming they can understand formal Swiss-German. However, if Jahnig can point out any errors we made, we will be only too happy to correct them.
"Gudrun Bornhoft, M.D., and Peter Matthiessen, M.D., were the editors of the Swiss HTA. The study itself was conducted by appropriately qualified professionals without a vested interest. The investigating team was composed of 13 members. Ten are trained in conventional medicine. Of them six are also trained in homeopathy. The other three are trained in physics, electrical engineering and sociology. 8 of the thirteen held academic positions. Six were involved in CAM research."
Interesting, but irrelevant. Let's also be clear that the document Jahnig refers to, written in English, is not the literature review written for the Swiss PEK. The English version was added to by its editors and published "without any consent of the Swiss government or administration". [4]
"The study analyzed all of the homeopathic literature over the past 40 years not just literature on respiratory infections and allergies."
Out of the 218-page report, the authors devote just 23 pages to the examination of the literature on the clinical efficacy of homeopathy. Titled 'Overview of Systematic Reviews on the Clinical Efficacy of Homeopathy', its two authors, Gudrun Bornhöft and Klaus v. Ammon, searched the literature for systematic reviews and meta-analyses, but only those published after 2000. The authors do list several papers that looked at a variety of indications, but, of these nine, other than providing a short description of each, they only present their comments on one of them. The following chapter, Chapter 10, "Clinical Studies on the Effectiveness of Homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions)" spends 29 pages examining trials for just these two conditions.
It is interesting to note how many of the original studies’ conclusions the homeopathy report ‘re-interpreted’ to be more favourable towards homeopathy, and their attempted justification for doing so. This was noticed by the PEK who marked them back down again, giving rise to my previous quotes from them.
"The results of the HTA are "Many high quality investigations of pre-clinical basic research proved homeopathic high potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Allergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional interventions. 8 out of 16 placebo-controlled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly classical homeopathy has few side effects and the use of high potencies is free of toxic effects. Taking external and internal validity into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate applications be regarded as safe.""
As I have already pointed out, the Swiss homeopathy report has been widely criticised; it would be more fruitful and would help further the discussion if Jahnig could address those criticisms.
For those who might not be aware, the result of the Swiss homeopathy report was that the Swiss Government ended the temporary reimbursement of homeopathy in the state health insurance scheme.
1. Edzard Ernst. 2012. “A Critique of the Swiss Report Homeopathy in Healthcare - Ernst - 2012 - Focus on Alternative and Complementary Therapies - Wiley Online Library.” http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2012.01160.x/full.
2. “SMW - Swiss Medical Weekly - The Swiss Report on Homeopathy - a Case Study of Research Misconduct.” 2012. http://www.smw.ch/content/smw-2012-13594/.
3. “Re: Homeopaths Without Borders Practice Exploitation Not Humanitarianism | BMJ.” 2013. October 12. http://www.bmj.com/content/347/bmj.f5448/rr/666410.
4. Gurtner, F. 2012. “The Report ‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ Is Not a ‘Swiss Report’.” Swiss Medical Weekly (December 17). doi:10.4414/smw.2012.13723. http://www.smw.ch/content/smw-2012-13723/.
5. Henness, Alan, and Rudloff, Sven. 2013. “That ‘neutral’ Swiss Homeopathy Report | Zeno’s Blog.” http://www.zenosblog.com/2012/05/that-neutral-swiss-homeopathy-report/.
Competing interests: Director of the Nightingale Collaboration, which challenges misleading healthcare claims.