The evidence that homeopathy is ineffective for any and all medical problems and is nothing more than a placebo has grown steadily for over a century. Many reviews of the scientific research have been done, and despite hundreds of studies, no reliable evidence exists to support the core principles of homeopathy or the actual real-world benefits claimed by its practitioners. I reviewed this evidence in detail in support of a resolution before the American Veterinary Medical Association (AVMA) to declare homeopathy ineffective and discourage its use in veterinary patients. I also exhaustively examined the evidence provided in support of homeopathy and discussed why it is unreliable and unconvincing. The AVMA’s scientific advisory body, the Council on Research, agreed that “that there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.” Unfortunately, politics won out over truth, and the AVMA refused to acknowledge the obvious—that homeopathy is useless and veterinarians promoting it are deceiving animal owners.
Several scientific bodies around the world have reviewed the same evidence and come to the same conclusion. The United Kingdom House of Commons Science and Technology Committee conducted hearings and a thorough evidence review and came to stark and clear conclusions:
In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.
There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.
For patient choice to be real choice, patients must be adequately informed to understand the implications of treatments. For homeopathy this would certainly require an explanation that homeopathy is a placebo. When this is not done, patient choice is meaningless. When it is done, the effectiveness of the placebo—that is, homeopathy—may be diminished.
We recommend that the MHRA remove all references to homeopathic provings from its guidance other than to make it clear that they are not evidence of efficacy.
We consider that the way to deal with the sale of homeopathic products is to remove any medical claim and any implied endorsement of efficacy by the MHRA—other than where its evidential standards used to assess conventional medicines have been met—and for the labelling to make it explicit that there is no scientific evidence that homeopathic products work beyond the placebo effect.
It is unacceptable for the MHRA to license placebo products—in this case sugar pills—conferring upon them some of the status of medicines. Even if medical claims on labels are prohibited, the MHRA’s licensing itself lends direct credibility to a product. Licensing paves the way for retail in pharmacies and consequently the patient’s view of the credibility of homeopathy may be further enhanced. We conclude that it is time to break this chain and, as the licensing regimes operated by the MHRA fail the Evidence Check, the MHRA should withdraw its discrete licensing schemes for homeopathic products.
By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.
Despite significant political resistance, including from members of the royal family, this message has been heard, and homeopathy has been banned from government-provided healthcare in the UK.
The government of Australia conducted a similar, exhaustive review over several years, with plenty of opportunity for input from supporters of homeopathy. This review also agreed with those that went before, concluding:
Based on all the evidence considered, there were no health conditions for which there was reliable evidence that homeopathy was effective. No good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment.
NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective. Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.
Historically, the U.S. is less amenable to government regulation of health care than other developed countries. Homeopathy was grandfathered in to the FDA regulatory system by politicians in the 1930s, and since then there has been little political will to challenge the practice despite the powerful evidence against it. In 2016, however, both the Federal Trade Commission (FTC) and the FDA conducted reviews, with public comment, regarding their oversight of homeopathy. No report or action has yet resulted from the FDA review, and given the anti-science and anti-regulatory views of the current administration, it seems unlikely this will change any time soon. However, the FTC, which regulated advertising of healthcare products, did come out with a strong pro-science position on homeopathy last year:
For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy. Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading in violation of Sections 5 and 12 of the FTC Act.
Nevertheless, truthful, nonmisleading, effective disclosure of the basis for an efficacy claim may be possible. The approach outlined in this Policy Statement is therefore consistent with the First Amendment, and neither limits consumer access to OTC homeopathic products nor conflicts with the FDA’s regulatory scheme. It would allow a marketer to include an indication for use that is not supported by scientific evidence so long as the marketer…effectively communicates to consumers that (1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.
Essentially, what the FTC has said is that one can claim homeopathy works only if one admits that there is no scientific evidence for this claim and that it is based on pre-scientific folk beliefs with no validity.
The most recent addition to this chorus of official voices acknowledging the lack of benefit to homeopathy is the European Academies Science Advisory Council (EASAC), which recently issued a strong statement warning of the misleading nature of claims for homeopathy.
EASAC, the European Academies Science Advisory Council, is publishing the present Statement to reinforce and reiterate this extensive and well-founded critique and to encourage and support (i) policy makers in the EU in taking a more explicitly evidence-based approach to assessing the claims for homeopathy and (ii) all those interested in stimulating better public engagement with these contentious issues and in improving consumer’s rights to correct information.
…there is no robust, reproducible evidence that homeopathic products are effective for any known diseases, even if there is sometimes a placebo effect. Moreover, homeopathy can actually be harmful: by delaying or deterring a patient from seeking appropriate, evidence-based, medical attention and by undermining patient and public confidence in scientific evidence.
From analysis of the appropriately controlled, verifiable evidence base, any claimed efficacy of homeopathic products in clinical use can be explained by the placebo effect or attributed to poor study design, random variation, regression towards the mean, or publication bias…The scientific claims made for homeopathy are implausible and inconsistent with established concepts from chemistry and physics.
The promotion and use of homeopathic products risks significant harms as mentioned above. In addition, homeopathy raises issues of concern for patient informed consent if health practitioners recommend products which they know are biologically ineffective. There are also potential safety concerns for homeopathic preparations because of poorly monitored production methods.
There should be a consistent regulatory requirement for claims for the efficacy, safety and quality of all medicinal products to be based on verifiable and objective evidence, commensurate with the claims being made. The necessity for robust data applies to products for both human and veterinary medicine.
Public health system budgets are under increasing pressure. Evidence-based public health systems should not offer reimbursement for homeopathic products and services unless they are demonstrated to be efficacious and safe by rigorous testing.
The growing willingness of scientists, individually and through their organizations, and of regulatory bodies to confront pseudoscience and unscientific nonsense like homeopathy is an encouraging sing, and it is beginning to have an impact, as seen in the withdrawal of NHS support for homeopathic treatment. Ultimately, the more willing we in science are to challenge unscientific claims and methods and to take the time to explain the evidence to people, the more the public will be able to make sound, fully informed healthcare choices, which is what this blog is all about.