JREF Swift Blog

The Swiss Endorse Homeopathy

Political bodies are notoriously unreliable as authorities on scientific controversies. Sometimes they get it right - sometimes they get it horribly wrong. The outcome depends heavily on the people involved (what is their ideology and agenda) and political forces that are putting their meaty thumbs on the scale. But also on which experts are relied upon for information, analysis, and advice.

Politicians are generally not scientists. As with journalists, even the science savvy among them still lack sufficient expertise to formulate a definitive opinion (although that often does not stop them from trying), so they need to consult experts. This can be tricky when experts disagree, in which case (unless a thorough sampling is done) expert advice can be a crapshoot.

Recently the Swiss government decided to approve homeopathy as part of their health service. In 2005 they had previously stopped paying for many so-called alternative medicines, but reversed the decision with regard to homeopathy based upon a review of the subject and, it seems, through popular demand.

Now, of course, homeopathy apologists and proponents are crowing about the decision, including Dana Ullman who blogs regularly for the Huffington Post. He starts off with this absurd argument from authority:

"The Swiss government has a long and widely-respected history of neutrality, and therefore, reports from this government on controversial subjects need to be taken more seriously than other reports from countries that are more strongly influenced by present economic and political constituencies."

He doesn't state how Switzerland's history of neutrality would in any way make their review of any particular scientific topic more reliable. It seems he just likes this recent decision by the Swiss, and is desperate to grab at any straw of legitimacy for his favorite pseudoscience. He then goes on to characterize the report as, "the most comprehensive evaluation of homeopathic medicine ever written by a government." (italics in original). Again, I'm not sure how he came to that conclusion.

Recently the British government also reviewed the topic of homeopathy. From what I can tell of both reports, the UK review was more comprehensive and more thoroughly assessed the range of scientific opinions on the topic. Their report, Evidence Check 2: Homeopathy is a devastating analysis of homeopathy, which they call "witchcraft." After a thorough review of the evidence they concluded that there is no possible way homeopathy can work, as that would require major rewriting of our understanding of physics, chemistry, and biology. Further, the clinical evidence shows that homeopathy is indistinguishable from placebo. Strangely, there is no reference to the UK report in Ullman's recent article.

After telling us how wonderfully scientifically objective the Swiss are, Ullman goes on to completely distort the scientific record on homeopathy, something for which he is infamous. He would have us believe that the basic scientific evidence proves that homeopathy can affect biology, and the clinical evidence shows that it works splendidly. This, of course, is a fiction based upon a willful misreading of the literature, or perhaps just a profound naivete as to the limitations of clinical research.

Ullman also does not make clear in his article (although you can see this from reading the references and footnotes) that this report was based upon published studies through 2003, and so is a bit out of date. Further it was largely based on a report prepared for the Swiss government - Effectiveness, Safety and Cost-Effectiveness of Homeopathy in General Practice – Summarized Health Technology Assessment, by Bornhöft G et. al.

The article is essentially a systematic review, and it is clear from the language used by the authors that they are anything but objective. They berate critics of homeopathy for being closed-minded to the clinical evidence based upon misguided plausibility arguments. They also specifically take a different approach to reviewing the evidence, specifically to include weaker forms of evidence - which they acknowledge changes the outcome of reviews from negative to positive.

What they fail to do is put into proper perspective the pattern of evidence in the literature. What we see with homeopathy is what we would expect from testing a treatment that is literally a placebo (a sugar pill with no active ingredient). There is a range of outcomes with the most rigorous studies strongly tending to be negative. You can only get positive results with less rigorous method, where researcher bias can have an effect.

In short - this was a rigged review by homeopathy proponents, and is at odd with other more objective reviews. It is also out of date.

A 2010 systematic review by Edzard Ernst of Cochrane systematic reviews of homeopathy concluded:

"The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo."

So - a thorough review of the best clinical evidence shows that there is no single indication for which homeopathy has been shown to work better than placebo.

The fact is - doing research is hard, and clinical medical research especially so. The published research is a complex body of information, and it takes a great deal of knowledge and care to interpret it properly. There is researcher bias, publication bias, the need for replication, ways to exploit researcher "degrees of freedom" - choices that researchers make in terms of outcomes and methods that can profoundly affect results.

Over time medical researchers have found ways to become more rigorous in order to minimize bias and error. Homeopathy apologists want to reduce rigor and loosen criteria to rely on more squishy evidence - because that is the only kind of evidence that can appear to support homeopathy.

They also desperately want to dismiss concerns about plausibility - because homeopathy fails right there. Homeopathic remedies are literally nothing, they are placebos. It is not closed-minded to take that into consideration in evaluating the overall evidence. Homeopathy is an extraordinary claim, and it has not met the burden of proof to establish that it's real. In fact the clinical evidence independently shows that homeopathy does not work.

The Swiss government has made a grave error in their recent decision. It seems as if their primary error was relying heavily on a biased review, and not balancing that with other opinions. The UK review was a more thorough and legitimate process, and they came to the exact right conclusion - homeopathy is witchcraft.

Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s new Science-Based Medicine project.



Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.