Of course, homeopaths are promoting homeopathy for COVID-19

There’s no doubt that the COVID-19 pandemic has represented a golden opportunity for antivaxxers and, of course, quacks of all varieties. It makes a sort of unfortunate sense, if you think about it. For one thing, when the pandemic first started, COVID-19 was this mysterious respiratory virus that could cause severe acute respiratory syndrome (SARS) with respiratory failure and death, and we didn’t know a lot about the biology of SARS-CoV-2, the coronavirus that causes it, except in comparison to other coronaviruses that had caused serious disease, such as the original SARS and SARS-Middle Eastern respiratory syndrome (SARS-MERS) and was much more dangerous and lethal to the elderly and people with significant comorbidities (i.e., diabetes) than it was to younger people. Early on, the virus seemed more lethal overall because testing was insufficiently widespread to detect everyone infected with it, meaning that only symptomatic (and sometimes only very symptomatic) patients were tested. However, as the pandemic dragged on it became apparent that, although COVID-19 is considerably more lethal than influenza, even the H1N1 strain, a large fraction of COVID-19 cases are asymptomatic or mildly symptomatic, particularly among people under 50. It also became apparent that these younger patients could spread the virus even while asymptomatic, thus fueling the easy spread of the pandemic. So it shouldn’t be too surprising that homeopaths started touting homeopathy, as an effective preventative or treatment for COVID-19 being touted by the Hahnemann society and a Swiss doctor named Jens Wurster.

As coronavirus continues to spread and doctors across the world scramble for an effective treatment, here in Germany we have some wonderful (some would say unbelievable news): The cure has been found.

The key, according to Germany’s Hahnemann Society, is homeopathic medicine. “It has been shown that even the first seven days of the illness can be effectively treated,” the organization’s website announces triumphantly.

And the Hahnemann Society is not alone in vaunting the healing powers of homeopathy for COVID-19. Prominent Swiss doctor Jens Wurster claims to have used homeopathy to achieve “impressive treatment outcomes” for 70 patients, “both those with mild symptoms and severe cases.”

The Locarno-based doctor has split opinion in German medicine. Before moving into COVID-19 treatment, he persuaded cancer patients to switch to homeopathic globules, earning himself a reputation among many as “an absolute charlatan,” as oncology professor Jutta Hübner from Jena University Hospital succinctly puts it.

But Michaela Geiger, a doctor of integrated medicine and chair of the German Central Association of Homeopathic Physicians (GCAHP), sees things differently. “Just as mainstream medicine is still debating the best treatment, so is homeopathy,” she says. Geiger sees Wurster’s reports of healing through homeopathy “as a contribution to this ongoing exchange of experiences.”

I will say one thing about this article. As you will see, it is annoyingly full of false balance, stating the opinions of homeopaths and believers in homeopathy on the one hand, and of science-based doctors and critics on the other, without describing how ridiculous homeopathy is. For example, look at the last two paragraphs of that quoted passage, where Dr. Hübner’s correct characterization of using homeopathy to treat cancer is correctly characterized as being the work of “an absolute charlatan,” but no explanation of why homeopathy is quackery and why homeopaths are “absolute charlatans” is given. All one really has to do is to explain correctly the two laws of homeopathy and what homeopathic “provings” are to make it quite clear to the average person without a lot of knowledge about homeopathy why homeopathy is a serious contender for the title of “The One Quackery To Rule Them All.”

Worse, the writer pivots to an opinion from a doctor using “integrative medicine” and a “homeopathic physician” that homeopathy is just like any other mainstream treatment that is as yet unproven for COVID-19, ignoring that, from a basic science standpoint, homeopathy is utter mystical pseudoscience and quackery. That’s why, before I get into why homeopaths and quacks (but I repeat myself) like Wurster think that their magic water might have activity against COVID-19 (other than the fact that quacks like Wurster think their magic water works against pretty much any illness), I feel obligated to review what homeopathy is even though I’ve discussed why homeopathy is quackery on this blog more times than I can remember in the last 16 years. (Basically, I haven’t discussed homeopathy in a while, largely thanks to other issues of science, pseudoscience, and ideology brought up by the pandemic.)

Homeopathy is what I like to refer to as “The One Quackery To Rule Them All,” although other equally magically ridiculous (or even arguably more magically ridiculous) alternative medicine treatments like reiki, distance healing, and the like do give homepathy a run for its money for the title. Be that as it may, having been born, raised, and trained in medicine in the US, I always have to note that homeopathy isn’t as big a deal here as it is in the UK and Europe, particularly in Germany and France. When I first learned what homeopathy really is, I was gobsmacked when I also learned that it is way more accepted there in ways that it isn’t in the US, where seldom will you find an actual physician prescribing homeopathy, although, of course, there are a number of over-the-counter homeopathic remedies that one can buy at major pharmacy chains like CVS, Walgreens, and the like. In the US, however, most people are blissfully unaware of the magical principles of homeopathy, such as the law of similars (i.e., “like cures like,” the principle that states that, in order to relieve a symptom, you should use an herb, medicine, or other compound that causes the symptom) and the law of infinitesimals (which claims that diluting a remedy makes it stronger). And don’t even get me started on homeopathic “provings,” in which healthy people take the substances used in homeopathic remedies and then report their findings.

Although the law of similars is without a basis in science, biology, or physiology, and homeopathic provings result in some truly hilariously ridiculous nonsense, it is the law of infinitesimals that best illustrates the utter absurdity of homeopathy. Here’s the idea. This law states that, to make a remedy stronger, you dilute the remedy. And, wow, do homeopaths ever do that! A typical homeopathic remedy is 30C, with “C” signifying a 100-fold dilution. So a 30 C homeopathic dilution is equal to thirty 100-fold dilutions or (10^-2)³⁰, or a 10⁶⁰-fold dilution. Those of you with a chemistry background will notice right away that this is an incredibly large number compared to Avogadro’s number, which is 6.022 x 10²³ and is the number of molecules in a mole of a chemical. So, even if one starts with a mole of a substance (whose weight equals its molecular weight in grams), the resulting 30C dilution will dilute it over 10³⁶-fold beyond the number of starting molecules. In other words, it’s incredibly unlikely that there will be a single molecule of starting substance left, other than potentially any that might “carry over” between serial dilutions sticking to the glassware. As Richard Dawkins put it, the numbers just don’t add up:

For even more, let’s look at this talk by the late, great James Randi, even though he skewers more than just homeopathy:

Also, 30C is by no means the most “potent” homeopathic dilution there is. Far from it! Some remedies go up to hundreds of C or even “M,” which signifies a thousand. Basically, any homeopathic dilution above around 12C is almost certainly just water (barring “carryover contamination” from the serial dilutions), and dilutions “weaker” than that are generally still so incredibly dilute that it is unlikely that the compound included, even if it has pharmacologic activity, is unlikely to have an effect, although, sadly, that is not always the case, such as with belladonna in homeopathic teething rings.

So let’s look at Wurster’s claim. First, although the infection fatality rate (IFR) for all comers infected with COVID-19 is not clearly known yet and can vary by location, healthcare system, age distribution of the population, and whether the disease is so prevalent as to overwhelm healthcare facilities, it is likely to be under 1%, a lot under 1% for the young, and many times 1% for the elderly and those with certain serious co-morbid conditions. Also, even this far into the pandemic, only a minority of the population in most countries have been infected. Thus, to determine if a treatment prevents illness from COVID-19 requires a lot of patients, which is why tens of thousands of patients are being enrolled in the phase 3 clinical trials of various COVID-19 vaccine candidates. Similarly, even for those who are infected and show symptoms, most will be asymptomatic or mildly symptomatic, while only a minority will develop severe disease requiring hospitalization. An even smaller percentage will require ICU care, and a smaller percentage than that will die. To determine if a remedy will prevent progression to severe disease if given early in the course of COVID-19 thus requires a lot of patients, albeit not as many as a preventative requires, to determine if it’s effective and safe. This extreme clinical variability in severity and outcomes in COVID-19 cases is also why properly designed and performed randomized controlled clinical trials are required. Unsurprisingly, what the Hahnemann Society offers is nothing more than case reports: (mostly Google Translate plus my tweaking of the English that results):

A case report describes in the style of a narrative the medical history of an individual patient with the medical problem, the findings with diagnoses, the therapeutic interventions, and follow-up consultations. The results are presented (including the undesirable ones), and the authors discuss the course and draw conclusions that provide new information. In these case reports, the cooperation of the patients is intended in order to make the report more precise, more complete, more transparent and more concise from a multiple perspective.

In contrast to randomized controlled studies, case reports depict the therapeutic reality. They are particularly suitable for isolating the first signs of effectiveness in new diseases. For this reason, this format is initially used scientifically for research into the new disease Covid-19 , caused by the SARS-CoV-2.

The Hahnemann Society’s latest research project collects data from case reports on Covid-19. The project is called:

“Data collection on case reports Covid-19 Hahnemann Association.”

In this clinical research project, we are cooperating nationally and internationally with research groups to further improve the evidence for the treatment of Covid-19 with homeopathy.

Our expertise in homeopathy led at the beginning of March 2020, after analyzing the study situation on Covid-19 and its clinical picture and course, to the development of the ” Emergency Setting Homeopathy | Covid-19 | Hahnemann Association “. This laid the foundation for the world’s first positive study on the drug treatment of Covid-19, because it came to a cooperation with the Turkish doctors and pharmacists association BÜTAD . The specialist colleagues from Turkey implemented the work proposals at breathtaking speed and evaluated the results ( Bütad press release ). These in turn are now the basis for further systematic research.

Notice that last sentence. The Hahnemann Society is not testing to see whether homeopathy is effective against COVID-19. Rather, it is looking for evidence that homeopathy is effective against COVID-19. There’s a big difference between the two. The first situation assumes the possibility that the treatment being tested might be ineffective and/or unsafe. The second does not and assumes that it does work, with the believer looking to produce evidence to support a pre-existing conclusion.

So what is this Turkish “study”? It’s nothing more than an “online case study.” I kid you not! Basically, homeopaths and doctors using homeopathy registered on an online platform to fill out a questionnaire about COVID-19 patients whom they treated with homeopathy. Guess what? Unsurprisingly, the doctors who participated in the survey—I refuse to dignify it by calling it an actual “study”—reported tha over 80% of their patients clinically diagnosed with COVID-19 (nope, no actual test for COVID-19 to nail down the diagnosis was required, and only 34% of patients actually underwent a COVID-19 nasal swab test, with only half of those being positive) improved, based on a sample of 30 patients, and that the homeopaths did not lose a single patient! Such is the “quality” of the research carried out by the Hahnemann Society.

This passage in the original report about homeopathy in Worldcrunch that I cited is particularly telling:

In the early days of the virus, homeopaths in Germany held back. And at first, the GCHAP distanced itself from members who jumped on the opportunity to claim their globules had antiviral properties.

Since then, however, there has clearly been a change of heart. The Association is now calling for its members to document their homeopathic treatment of corona patients: “Against the current background of rising COVID-19 infections, with this project we can find out how homeopathy can contribute to treating COVID-19.”

Such is often the course when it comes to quacks and a new disease. There are “responsible” quacks, who urge caution, but it isn’t long before belief in their form of quackery deludes even the “responsible” quacks and they decide that they have to try their magic nostrums on the disease. That’s why it’s really irritating to see the false balance in this article continue. Yes, the overall tone is skeptical of homeopathy, for example:

It wasn’t long before scorn began pouring in from abroad. “German homeopaths launch a placebo offensive against corona,” commented the Austrian newspaper Der Standard. “Scientists are tirelessly working to develop vaccines and treatments, and we hear again and again the sobering news that it will be a long wait before we have a vaccine. Meanwhile, German homeopaths are making reckless promises.”

In Austria, homeopathy is generally regarded with suspicion, if not outright scorn. The Medical University of Vienna distanced itself from “charlatanism” and removed homeopathy from the syllabus.

In other countries too, the tide has turned against homeopaths. The French Ministry of Health has ruled out any health benefits from homeopathy, while the Spanish government classes it as “pseudoscience” that must be combated. And the European Academy of Sciences makes it clear that homeopathic treatments are no more effective than placebos. In the United States, homeopathic remedies on sale must display a clear label saying that they have no proven health benefits.

However, the skepticism is peppered with passages like this appeal to popularity:

And yet, the fact remains that amid the confusion and fear of the pandemic, more and more people are turning to homeopathy. According to a survey by the Forsa Institute for Social Research and Statistical Analysis, two thirds of Germans would support the use of homeopathic remedies in treating COVID-19. That is not representative of the rest of Europe, or the world.

And more false balance:

The practice of homeopathy is contentious, and its critics often voice their opposition with something akin to hatred. The same goes for backers of the practice. In his blog, German homeopathy lobbyist and PR advisor Christian J. Becker boasts about journalists who have been “hit by complaints to the German Press Council.”

The bottom line is that quacks gonna quack and grifters gonna grift, and homeopaths are grifting quacks. If there’s one recurrent theme I’ve noticed about COVID-19 and pseudoscience, it’s that the pandemic represents an irresistable opportunity for pseudoscience promoters, conspiracy theorists, antivaxxers, quacks, and grifters. That’s why it’s utterly unsurprising that homeopaths have jumped on the COVID-19 grift train, with homeopathy believers even doing their best to promote their quackery in the peer-reviewed medical literature, with homeopaths pushing homeopathy for COVID-19 all over the world.