Homeopathy health insurance benefit: “Assumption of costs is a kind of accolade”

The scientist Mukerji has been working on homeopathy for years. In the interview, he welcomes the plans to abolish reimbursement for homeopathy. So far, this has given pseudoscience the appearance of seriousness.

tagesschau.de: What do you have against homeopathy, Mr. Mukerji?

Nikil Mukerji: Homeopathy has long been a topic in the Society for the Scientific Investigation of Parasciences (GWUP). There we classify it as pseudoscience. It presents itself as science. In fact, it contradicts the known laws of nature and an effect via context effects – especially placebo effects – has never been reliably proven.

tagesschau.de: And yet many people in Germany turn to homeopathic remedies when they are sick.

Mukerji: In my opinion, the previous assumption of costs by the statutory health insurance companies played a major role here. This was a kind of downfall for homeopathic remedies and gave the homeopathy industry a semblance of respectability for a long time. In international comparison, we have made ourselves a laughing stock as a country. Because no other country still indulges in such irrationality.

tagesschau.de: Proponents of homeopathy point to studies that show an effect that goes beyond the placebo effect. Some meta-studies also state that an effect cannot at least not be ruled out.

Mukerji: Strictly speaking, one can only rule out logical and mathematical impossibilities. For example, I cannot rule out the possibility that they will suddenly disappear when I close my eyes. However, I don’t believe it.

tagesschau.de: But how do you explain positive study results for homeopathy?

Mukerji: On the one hand, the quality of studies is crucial. If it is too low, you should ignore the respective study. In addition, high-quality studies can also suggest an effect without it being real. Because every study has a probability of error, which is measured by the so-called p-value. This can be a maximum of 0.05. To put it simply, this means that the measured effect of a homeopathic remedy can only be explained by chance to a maximum of five percent. The problem: If you do enough studies with an ineffective substance, then it is practically guaranteed that a supposed effect will be noticed at some point.

tagesschau.de: What role does the so-called publication bias play in science?

Mukerji: Studies with surprising or sensational results are more likely to be published than studies that find nothing. This effect distorts the study situation – even with homeopathy. Considering all of this, the available studies taken together do not show that homeopathy works beyond context and placebo effects. Anyone who only considers work that supports their own convictions is cherry-picking. Belief in homeopathy generally seems to be based on this and similar errors in thinking.

tagesschau.de: It is often said that more research needs to be done into the effectiveness of homeopathy. What do you think of it?

Mukerji: Nothing at all. From a scientific point of view, homeopathy cannot work. And we already have an enormous body of empirical evidence showing exactly that.

tagesschau.de: Some critics of homeopathy are generally against conducting further studies on its effectiveness. How come?

Mukerji: The probability that a methodologically high-quality study will erroneously find an effect (alpha error) is about as high as the probability of rolling a 1 and a 2 with two dice. So this kind of thing happens all the time.

The more studies are conducted, the more likely it is that at least individual studies will produce positive results by chance. When viewed in isolation, these look like valid evidence. Citing them selectively may create the false impression that homeopathy has a scientific basis. Such research is not only wasteful, it can also be dangerous – especially if patients prefer homeopathics to effective medications.

Some therefore consider homeopathy research as an unethical waste of resources. Yet we live in a free country. Of course, everyone is allowed to use private funds for homeopathy research. Of course I wouldn’t want to shake that.

tagesschau.de: With homeopathic remedies, an active ingredient is potentiated, which means it is very often diluted. Can a remedy still be effective as a result?

Mukerji: Whether you find this plausible or not depends on your worldview. According to homeopathic teachings, this is eminently plausible. Samuel Hahnemann, the founder of homeopathy, believed that homeopathy works by – and I quote – “taking hold of our life force… in a spirit-like (dynamic) way”. 200 years ago you could still put forward such a thesis without embarrassing yourself – although there was already criticism of Hahnemann at that time.

Enlightened, critically thinking people with a scientifically grounded understanding of the world can actually only smile about it. Homeopathy contradicts established knowledge: the principle that like can be cured by like is medically untenable. And the typical homeopathic medicine does not contain any active ingredient because it has been diluted away. By the way, skeptics like me regularly demonstrate this in the form of self-experiments in which we take globules by the bottle. Nothing has ever happened yet. As well as? Nothing in it, nothing on it!

tagesschau.de: The separate approval procedures for homeopathic remedies are also criticized.

Mukerji: In fact, this point is the bottom of the barrel. Pharmaceutical medications are based on real research that must meet high standards. This does not apply to homeopathic remedies because the Medicines Act provides for an exception: it is sufficient if, according to the principle of the so-called “internal consensus”, it is determined that the evidence based on homeopathic knowledge is sufficient. The homeopathy scene declares – arbitrarily from a scientific point of view – what works.

Some homeopathic remedies are only registered. No information about the alleged effectiveness is required here. In my experience, most people don’t know this, and many people think it’s a joke when you explain it to them.

tagesschau.de: According to plans by Health Minister Karl Lauterbach, statutory health insurance companies will no longer cover the costs of homeopathic remedies and treatments in the future. However, according to Lauterbach, the savings should only be between 20 and 50 million euros. Why do you still think it makes sense?

Mukerji: To some extent it’s also about the principle, as Lauterbach says. Personally, I think so too. An irrational method should not be financed by the state. This means that homeopathy is given the cloak of rationality. Shamanism or other pseudo-medical procedures are not covered by statutory health insurance companies.

In addition, the exact savings potential for the health insurance companies is difficult to quantify. The anamnesis discussions with homeopaths in particular are likely to be expensive. My colleagues Udo Endruscheit and Norbert Aust from the Homeopathy Information Network (INH) assume that the real savings potential could be higher.

tagesschau.de: For some, Lauterbach’s initiative does not go far enough, as it leaves open the possibility for statutory health insurance companies to take out additional insurance for homeopathy. Why is this criticized?

Mukerji: There is the view that supplementary insurance prolongs the central problem that originally arose from the coverage of costs by statutory health insurance companies: it continues to give the impression that homeopathy is a recognized medical treatment method. And this means that people continue to have their money taken out of their pockets because they wrongly view homeopathy as effective. But I would relax there. The most important thing is to abolish the assumption of costs by the solidarity system.

The interview was conducted by Pascal Siggelkow, tagesschau.de.