A non‐scientific treatment for patients with psoriasis – advocated in a scientific journal

Editor When patients who believe in homeopathy are asked by their homeopathic physicians whether homeopathy makes them feel better, which answer would you expect? In a recent issue of the Journal of the European Academy of Dermatology and Venereology (JEADV), Witt et al. present such results and conclude that ‘under classical homeopathic treatment, patients with psoriasis improved in symptoms and quality of life’. Those who are acquainted with homeopathic thinking will not be surprised to read that the patients’ additional ailments as documented at baseline, such as migraine, hypertension or allergic rhinitis, were likewise ‘considerably relieved’. If this improvement represented more than a placebo effect, we would have to accept that our presently prevailing conception of the physical world is wrong. Moreover, dermatologists would no longer be needed to treat chronic skin disorders like psoriasis. At the beginning of the study, virtually all patients expected that ‘homeopathy will help’ (62.2%), or ‘will maybe help’ (35.4%). Hence, the results of this study represent a convincing example of self-fulfilling prophecy. Needless to say that there were no controls; according to non-scientific thinking, homeopathy is just another form of scientific medicine wherein controls are notoriously difficult to recruit and, in principle, unimportant. All of the study physicians had ‘passed certified training in classical homeopathy’ and they used ‘high potencies’ of 83 different remedies. From a scientific point of view, all of these remedies contain the same mixture of water and ethanol and have no ‘memory of water’, which is why they cannot be distinguished by any chemical, physical or biological test. Their labels are the only distinguishing criterion. If the labels are removed, even a board-certified classical homeopath will be unable to distinguish them. We do not dispute, however, that impressive Latin names like Natrium muriaticum, Lycopodium, Pulsatilla, or Lachesis may exert a powerful placebo effect on both physicians and patients who believe in such labels. From a non-scientific view, such homeopathic preparations are ‘individualized’ remedies that exert different effects in different patients and represent a ‘medicine for the whole person’. In the light of science, however, such high dilutions can surely only be seen as a delusion. Readers adhering to regular medicine might be calmed by the following statement in the paper: ‘Our study does not support conclusions as to the effectiveness of the homeopathic remedies because no methodology for this purpose (control group, randomization, blinding) was built into its design and patients could use additional conventional therapies.’ The next sentence, conversely, will be appreciated by those who believe in non-scientific methods: ‘The aim of the investigation – to provide systematic and detailed information about status and effects of homeopathic medical care in routine medical practice – was fully met.’ In other words, everything is perfectly true, including the opposite of what we first said! The authors’ intention is quite clear. They are publishing the claims of their uncontrolled study in various forms and in different academic journals. In this way they bestow a scientific appearance on a genuinely non-scientific method like homeopathy. This strategy appears to be quite successful. But what was the intention of the JEADV when accepting a manuscript that propagates non-scientific medicine? Did the editors want to foster ‘pluralism of medical theories’? Or does this article simply reflect editorial laxness? It seems that to be of higher or lower scientific standards, is no longer the question. The article of Witt et al. is not compatible with any scientific standard at all.