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Homeopathy (also spelled homœopathy or homoeopathy) from the Greek όμοιος, hómoios (similar) and πάθος, páthos (suffering), is a therapy that strives to treat "like with like" (the etymological origin of the word homeopathy: 'similar suffering'). The term "homeopathy" was coined by the Saxon physician Christian Friedrich Samuel Hahnemann (1755–1843) and first appeared in print in 1807, although he had previously outlined his axiom of medical similars in a series of articles and monographs from 1796 onwards. Homeopathy is particularly popular in Europe and India although less so in the USA, where such therapies have been more tightly regulated. Stricter European regulations have also been implemented recently by the EDQM.

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Samuel Hahnemann, the father of homeopathy

Homeopathy rests on the premise of treating sick persons with very diluted agents that, in undiluted doses, produce similar symptoms in a healthy individual. Its proponents assert that the therapeutic potency of a remedy can be increased by serial dilution of the drug, combined with succussion or vigorous shaking. In common with conventional medicine, homeopathy regards diseases as morbid derangements of the organism. However, it differs in preferring to view each case of sickness as a strictly individual phenomenon. It is the man that is sick and to be restored to health, not his body, not the tissues. Homeopathy views a sick person as having a dynamic disturbance in a hypothetical "vital force," and so reject the standard medical diagnoses of named diseases.

The theory of homeopathy is inconsistent with accepted laws of chemistry and physics, as it states that extreme dilution makes drugs more powerful by enhancing their "spirit-like medicinal powers." Although some trials show a difference between homeopathic treatments and placebos, most trials have methodological problems, and better-quality trials tend to give negative results.

The principle of medical similars

Homeopathy is based on the 'Principle of Similars', first expressed by Hahnemann in the exhortation similia similibus curentur or 'let likes cure likes'. This is the exact opposite of 'contraries' upon which the Galenic medicine of his day was based, and in which Hahnemann had been trained. The 'law of similars' is an ancient medical maxim , but its modern form is based on Hahnemann's conclusion that a constellation of symptoms induced by a given homeopathic remedy in a group of healthy individuals will cure a similar set of symptoms in the sick. Symptom patterns associated with various remedies are determined by 'provings', in which healthy volunteers are given remedies, and the resulting symptoms are compiled by observers into a 'Drug Picture'.

Speaking of his first proving, Hahnemann said: "with this first trial broke upon me the dawn that has since brightened into the most brilliant day of the medical art; that it is only in virtue of their power to make the healthy human being ill that medicines can cure morbid states, and indeed, only such morbid states are composed of symptoms which the drug to be selected for them can itself produce in similarity on the healthy."

Homeopathic practitioners rely on two types of reference in prescribing. The Homeopathic Materia Medicae comprise indexes of Drug Pictures organized by remedy and describe the symptom patterns associated with individual remedies. The Homeopathic repertory is an index of sickness symptoms, listing all remedies associated with specific symptoms. The first Homeopathic repertory was George Jahr's, published in 1835.

At first, Hahnemann tested substances commonly used as medicines in his time, such as antimony and rhubarb, and poisons, like arsenic, mercury and Belladonna. Perhaps in this he was mindful of Paracelsus: "poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy." This subtle connection between poison and medicine, or 'what can kill can cure' was also observed by Shakespeare: "In the infant rind of this small flower, poison hath residence and medicine power:..."

Hahnemann recorded his first provings of 27 drugs in the Fragmenta de viribus in 1805 and later in his Materia Medica Pura, which contained 65 drugs. He was most heavily engaged in proving in the 1790s and early 1800s, but he never abandoned these experiments. Another phase of proving commenced with his Miasm theory and The Chronic Diseases , published in 1828, and containing 48 freshly 'proven' drugs.

Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies, and new substances are continually added to contemporary versions. Homeopathy uses many animal, plant, mineral, and synthetic substances. Examples include Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other homeopathic remedies, ('isopathic' remedies') involve dilution of the agent or product of the disease. Rabies nosode, for example, is made by diluting the saliva of a rabid dog. Some modern homeopaths use of more esoteric substances, known as "imponderables" because they do not originate from a material but from electromagnetic energy presumed to have been somehow "captured" by alcohol or lactose (X-ray, Sol (sunlight), Positronium, and Electricitas (electricity) or through the use of a telescope (Polaris). Recent ventures by homeopaths into even more esoteric substances include Tempesta (thunderstorm), and Berlin wall.

Today, about 3000 remedies are used in homeopathy; about 300 are based on comprehensive Materia Medica information, about 1500 on relatively fragmentary knowledge and the rest either without knowledge of their homeopathic properties or through speculative knowledge independent of the law of similars. This approach harks back to the ancient 'doctrine of signatures,' which Hahnemann rejected as uncertain guesswork: "The ancients imagined that the yellow colour of the juice of...(Chelidonium, Yellow Poppy) was an indication (signature) of its utility in bilious diseases. The moderns from this extended its employment to hepatic diseases...the importance of human health does not admit of any such uncertain directions for the employment of medicines. It would be criminal frivolity to rest contented with such guesswork at the bedside of the sick. Only that which the drugs themselves unequivocally reveal of their peculiar powers in their effects on the healthy human body – that is to say, only their pure symptoms – can teach us loudly and clearly when they can be advantageously used with certainty; and this is when they are administered in morbid states very similar to those they are able to produce on the healthy body."

Examples of this impulse to expand the materia medica include: the use of an isopathic (disease associated) agent as a first prescription in a 'stuck' case, when the beginning of disease coincides with a specific event such as vaccination; the use of a chemically-related substance when a remedy that was well-indicated fails. A good example of this is found in the Bowel Nosodes which were introduced by the British homeopaths, Edward Bach (1886-1936), John Paterson (1890-1954) and Charles Edwin Wheeler (1868-1946) in the 1920s. Their use is based on the variable bowel bacterial flora thought to be associated with persons of different homeopathic constitutional types. The Bowel Nosodes are rarely used outside British homeopathy.

More recently, homeopathy has embraced the use of substances based on the periodic table or biological taxonomy. This approach may well create neat systems for grouping remedies and classifying the ever-burgeoning Materia Medica, but its usefulness is questioned by some purists on the basis that inherently it involves speculation about remedy action without provings.

There are many methods for determining the most-similar remedy (the simillimum), and homeopaths sometimes disagree about the required remedy. This is partly due to the complexity of the 'totality of symptoms' concept; homeopaths do not use all symptoms, but decide which are the most characteristic; this subjective evaluation rests on knowledge and experience. Finally, the Drug Picture in the Materia Medica is always more comprehensive than the symptoms exhibited by any individual.

Other ways of selecting remedies are through medical dowsing or other psychic powers. However, these methods are not accepted by most homeopathic practitioners.

The law of similars is not a scientific law; it is not built on a hypothesis that can be falsified; a failure to cure homeopathically can always be attributed to incorrect selection of a remedy: I have often heard physicians tell me that it was due to suggestion that my medicines acted so well; but my answer to this is, that I suggest just as strongly with my wrong remedy as with the right one, and my patients improve only when they have received the similar or correct remedy.

See also: List of common homeopathic remedies

Preparation of similars

Succussion and dilution

Vijzel

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and the side-effects diminished) by dilution, in a procedure known as dynamization or potentization. Liquids are progressively diluted (with water or alcohol) and shaken by ten hard strikes against an elastic body (succussion). For this, Hahnemann had a saddlemaker construct a special wooden striking board covered in leather on one side and stuffed with horsehair. ref>It can be viewed at the Hahnemann Museum in Stuttgart.<Website of The Institute for the History of Medicine</ref> Insoluble solids, such as Quartz and Oyster shell, are diluted by grinding them with lactose (trituration). The original serial dilutions by Hahnemann were performed using a 1 part in 100 or centesimal scale, or 1 part in 50,000 or Quintamillesimal (LM or Q potencies). Higher 'potencies' are considered to be stronger 'deep-acting' remedies.

The dilution factor at each stage is traditionally 1:10 ('D' or 'X' potencies) or 1:100 ('C' potencies). Hahnemann advocated 30C dilutions for most purposes, i.e. dilution by a factor of 100³⁰ = 10⁶⁰. As Avogadro's number is only 6.02 × 10²³ particles/mole, the chance of any molecule of the original substance being present in a 15C solution is small, and it is extremely unlikely that one molecule of the original solution would be present in a 30C dilution. For a perspective on these numbers, there are in the order of 10³² molecules of water in an Olympic size swimming pool; to expect to get one molecule of a 15C solution, one would need to take 1% of the volume of such a pool, or roughly 25 metric tons of water. Thus, homeopathic remedies of a high "potency" contain, with overwhelming probability, only water. Practitioners of homeopathy believe that this water retains some 'essential property' of one of the substances that it has contacted in the past.

Alternative methods

High potency remedies were first produced in the 1830s. Though Hahnemann wished to see 30c as standard potency in homeopathy, most of his contemporaries preferred tinctures and 3x, while others, like the powerfully-built horse-trainer, Caspar Julius Jenichen (1787-1849), General Korsakoff (1788-1853) and Dr N Schreter (1803-1864), were busy raising potency to heights beyond his wildest dreams.

Jenichen sat or stood stripped naked to the waist, holding the bottle in his fist in an oblique direction from left to right, and shook it in a vertical direction. The fluid, at every stroke, emitted a sound like the ringing of silver coins. He paused after every 25th potency, and the muscles of his naked arm vibrated...he was latterly able to give 8400 strokes in an hour.

Such high potencies could not be made by traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which integrate dilution and succussion into a continuous process (Korsakoff). . Such machines are still sold today and some manufacturers claim it is undefined "vibrations" that produce the healing effect and, when the correct vibration is selected, only water need be added to produce a remedy. Today, radionics potentising devices are used by many homeopaths to prepare remedies, . These are based on the work of the British engineer, Malcom Rae (1913-1979) and devices he developed in the 1960s.

Another technique used by some homeopaths involves using "a paper remedy. Write the remedy and potency on a piece of paper and place the paper on the left hand side of the body with the writing towards the body." One homeopath, "finds out what they need, writes the remedy down on a piece of paper, they put it in their pocket and it works." In essence, this comprises an emerging alternative homeopathic tradition, "`paper remedies' i.e., a name of a remedy just written on a piece of paper."

The practitioner's choice of what potency is appropriate derives in part from a judgement as to whether the disease is acute and superficial or 'deeper' and more chronic in nature; whether it is primarily physical or mental/emotional; the patient's sensitivity and previous reactions to remedies; and the practitioner's preferred posology (dosing regimen), e.g. low potency repeated often, vs. high potency repeated seldom. French and German homeopaths generally prefer to use lower potencies than their American & British counterparts. Most homeopaths assert that the choice of potency is secondary to the choice of remedy: i.e. that a well-chosen remedy will act in a variety of potencies, but an approximately matched remedy might act only in certain potencies, or not at all.

Miasms

By 1816, Hahnemann was concerned at the failure of his homeopathic remedies to produce lasting cures for chronic diseases. He found that "...the non-venereal chronic diseases, after being time and again removed homoeopathically … always returned in a more or less varied form and with new symptoms." To explain this, Hahnemann introduced the miasmatic theory, that three fundamental "miasms" are the underlying root causes of all the chronic diseases of mankind: Syphilis, Sycosis (suppressed gonorrhoea), and Psora. This miasm theory was first published in 1828. Though Hahnemann first suspected miasms in 1816, he took 12 years before he published his views. It is possible that the study of Freemasonry under the guidance of his Patron, the Grand Duke Ferdinand of Anhalt-Coethen influenced his thinking. He adopted a reclusive lifestyle while residing in Koethen and his new inclination towards metaphysical pursuits may explain his sudden adoption of Olfaction (inhaling the remedy), which he continued to use until his death in Paris in 1843. Olfaction might derive from Arabian medicine and the art of Perfumery.

The miasm of Psora, he concluded, underpinned most of the chronic diseases known to medicine. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". The sense of this is indicated by Hahnemann's Note 2 to §11 of the Organon: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..."

According to Hahnemann, miasmatic infection causes local symptoms, usually in the skin. If these are suppressed by external medication, the hidden sickness cause goes deeper, and manifests itself later as organ pathologies. In §80 of the Organon he asserted Psora to be the cause of such diseases as epilepsy, cyphosis, cancer, jaundice, deafness, and cataract.

Even in his own time, many followers of Hahnemann, including Hering, made almost no reference to Hahnemann’s concept of chronic diseases. Today, some homeopathic practitioners find Hahnemann’s theory difficult to reconcile with current knowledge of immunology, genetics, microbiology and pathology, as it seems to ignore the importance of genetic, congenital, metabolic, nutritional, and degenerative factors in sickness; the theory also fails to differentiate the multitude of different infectious diseases. However, most insist that the key elements of his theory are valid. For instance, most of them believe that the fundamental cause of disease is internal and constitutional, and that it is contrary to good health to suppress symptoms, especially skin eruptions and discharges. They also accept Hahnemann's concept of latent Psora, the early signs of an organism’s imbalance, which indicate that treatment is needed to prevent the development of more advanced disease.

However, the miasm theory is not the 'be all and end all' of homeopathy. Hahnemann strongly advocated good hygiene, fresh air, regular exercise, good nutrition as precursors of good health (see his 1792 essay: The Friend of Health); he was also a pioneer in 1792-3 of humane treatment of the insane (1796, Description of Klockenbring During his Insanity) a year before William Tuke and Philippe Pinel, and he published tracts in which he described the cause of cholera as "excessively minute, invisible, living creatures" Asiatic Cholera, 1831. Hahnemann's acceptance of this emerging idea of infectious disease before its final proof by Robert Koch and Louis Pasteur indicates some of his medical views incorporated ideas that were at the cutting-edge of contemporary science. These 17th-century epidemiological theories built on the ideas of Girolamo Fracastoro in the 16th century and the discovery of microbes by Anton van Leeuwenhoek one hundred years previously.

History

In Hahnemann's day, the conventional theory of disease was based on the four humours. Mainstream medicine focused on restoring the balance in the humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours causing trouble, such as by lowering the body temperature of patients who were feverish. By contrast, Hahnemann promoted an immaterial, vitalistic view of disease: "...homeopathy...can easily convince...that the diseases of man are not caused by any substance, any acridity...any disease matter, but that they are solely spirit-like (dynamic) derangements of the spirit-like power (the vital principle) that animates the human body."

Vitalism was a part of mainstream science in the 18th century. In the twentieth century, medicine discarded vitalism in favour of the germ theory of disease, following the work of Louis Pasteur, Alexander Fleming, Joseph Lister and many others. Modern medicine sees bacteria and viruses as the causes of many diseases, but Kent, and some modern homeopaths regard them as effects, not causes, of disease. Others have adapted to the views of modern medicine by referring to disturbances in, and stimulation of, the immune system, rather than the vital force.

Homeopathy stemmed from the idea of medical similars, that 'like cures like', while Hahnemann was translating into German the Materia Medica (1789) of William Cullen, the so-called "Scottish Hippocrates". On reading that Cinchona bark (which contains quinine) was effective because it was bitter, Hahnemann felt this implausible because other substances were as bitter but had no therapeutic value. To understand the effects of Cinchona bark, he decided to take it himself, and saw that his reactions were similar to the symptoms of the disease it was used to treat. At least one writer has suggested that Hahnemann was hypersensitive to quinine, and that he may have had an allergic reaction.

This proving experiment by Hahnemann was by no means unique, as others before had tried the same approach, including Anton von Störck (1731-1803), who, in the 1760’s, advocated "treatment by cautious use of poisons." Hahnemann had studied briefly in Vienna (1777) where Störck eventually became head of the University. The proving idea had also been recommended by the Swiss medical botanist, Albrecht von Haller, (1708-77), who Hahnemann admired, and whose Materia Medica he translated in 1806.

For Hahnemann, the whole body and spirit was the focus of therapy, not just the localised disease. Hahnemann spent a lot of time with his patients, asking them not only about their symptoms or illness, but also about their daily lives. This gentle approach contrasted with the violent forms of heroic medicine common at the time, which included techniques such as bleeding as a matter of course.

Nearly as important as Hahnemann to the development of homeopathy was James Tyler Kent (1849-1921). Kent's influence in the USA was limited, but in the UK, his ideas became the homeopathic orthodoxy by the end of the First World War. His most important contribution may be his repertory, which is still used today. Kent's attempt to rescue an idealized pure homeopathy from what he saw as its degenerate mongrel forms was authoritarian, as he sought to re-emphasize the metaphysical and clinical aspects of Hahnemann's teachings, in particular:

• insistence on the core doctrines of miasm and vital force;
• emphasis on case totality rather than rote prescribing for 'named diseases'
• emphasis on psychological symptoms (to supplement physical pathology) in prescribing; and
• regular use of very high potencies.

Influenced by Swedenborgianism, Kent reputedly emphasized spiritual factors' as the root cause of disease.

"...for it goes to the very primitive wrong of the human race, the very first sickness of the human race that is the spiritual sickness... which in turn laid the foundation for other diseases."

Homeopathy around the world

There are estimated to be more than 100,000 practitioners of homeopathy worldwide, with an estimated 500 million people receiving treatment. More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatment in the UK, France, and Germany. Homeopathy was regulated by the European Union in 2001, by Directive 2001/83/EC.

In the UK, homeopathy was established by Dr Frederick Quin (1799-1878) around 1827. Two Italian homeopathic doctors (Drs Romani and Roberta) had been employed two years previously by the Earl of Shrewsbury, but soon returned to Naples as they could not tolerate the damp English climate. Homeopathy soon became the preferred medical treatment of the upper classes: the Dukes of Edinburgh and Beaufort were among Dr Quin's patients, and he became physician to the Duchess of Cambridge. The main supporters of the homeopathic hospital, until Quin's death in 1878, were members of the aristocracy. Homeopathy in Britain continued to have an elite clientele, including members of the royal family until the mid-nineteenth century. At its peak in the 1870s Britain had many homeopathic dispensaries and small hospitals as well as large hospitals in Liverpool, Birmingham, Glasgow, London and Bristol, mainly funded by the local gentry.: the Bristol hospital Image was funded and run by the W.D. & H.O. Wills tobacco family, while the Hahnemann Hospital in Liverpool Image was built by members of the Tate family of sugar importers, who also funded the Tate Gallery in London.

Today in Britain, homeopathic remedies are sold over the counter. Britain has five homeopathic hospitals funded by the National Health Service and many regional clinics. Homeopathy is not practised by most of the medical profession, but there is public support for it, including from the Prince of Wales and other members of the royal family. The largest organisation of homeopaths in Britain, the Society of Homeopaths, was founded in 1978 and now has 1300 members. The medically qualified homeopaths in Britain are represented by the Faculty of Homeopathy: the Faculty, which was incorporated by an Act of Parliament in 1950, has over 1,400 members throughout the world.

Homeopathy arrived in India with Dr Honigberger (1795-1869) in Lahore, in 1829-30, and is officially recognized. "The first doctor who brought homeopathy to India was Dr. Martin Honigburger, who first came to the Punjab...in 1829." India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals. The Association of Qualified Homoeopaths in India (IHMA) is the largest of its kind.

Homeopathy was established in the USA by Dr Hans Burch Gram (1787-1840) in 1825 and rapidly gained popularity, partly because the excesses of conventional medicine were extreme there, and partly due to the efforts of Dr Constantine Hering (1800-1880), who immigrated to America in 1833 and became known as the "father of American homeopathy". Homeopathy in the US rose to prominence. "By 1826 homeopathy had taken root in France, Italy, England and the Scandinavian countries....the doctrine arrived in New York in 1825." "Homeopathy spread first in Germany, then France, and England. Its greatest popularity, however, was in America." "Nowhere did (homeopathy) flourish as luxuriantly as in the United States." "...by the early 1840s American homeopathic practitioners were gaining considerable influence and prestige." In 1880-1900 Hardly any city numbering over 50,000 souls was without a homeopathic hospital and many smaller communities could claim them."

Historical note

In the 1930s the popularity of homeopathy waned, especially in the USA and Europe, partly due to advances in conventional medicine and partly due to skepticism toward homeopathy, which led to the closure of virtually all medical schools teaching alternative medicine in the USA. Homeopathy in the West had a renaissance in the 1970s, largely because of George Vithoulkas.

Homeopathy declined due partly to recognition by the establishment of the dangers of large doses of drugs and bleeding, and via dissent between different schools of homeopathy. However, The Carnegie Foundation issued the Flexner Report in 1910 that supported allopathic (conventional) medical schools while condemning homeopathic schools. With newer medicines and $350 million being poured into allopathic medicine and hospitals by John D. Rockefeller, homeopathic schools began to close due to lack of support and money," so that, by the 1950s, homeopathy had been virtually extinguished in the US.

In the USA, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration. However, the FDA treats homeopathic remedies very differently than conventional medicines. Homeopathic products do not have to be approved by the FDA before sale, they do not have to be proved to be either safe or effective, they do not have to be labeled with an expiration date, and they do not have to undergo finished product testing to verify contents and strength. Unlike conventional drugs, homeopathic remedies do not have to identify their active ingredients on the grounds that they have few or no active ingredients. In the USA, only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter; homeopathic medicines that claim to treat a serious disease can be sold only by prescription.

In Germany, about 6,000 physicians specialize in homeopathy. In 1978 homeopathy, anthroposophically extended medicine and herbalism, were recognized as "special forms of therapy", meaning that their medications are freed from the usual requirement of proving efficacy. Since January 1, 2004 homeopathic medications, with some exceptions, are no longer covered by the country's public health insurance. Most private health insurers continue to cover homeopathy.

In Switzerland, homeopathic medications were formerly covered by the basic health insurance system, if prescribed by a physician. This ended in June 2005. The Swiss Government, after a 5-year trial, withdrew insurance coverage for homoeopathy and four other complementary treatments, claiming that they did not meet efficacy and cost-effectiveness criteria. This change applies only to compulsory insurance; homeopathy and other complementary medicine is covered by additional insurance, if the treatment is provided by a medical doctor.

Classical versus non-classical homeopathy

Hahnemann's formulation of homeopathy is often referred to as classical homeopathy. Classical homeopaths use one remedy at a time, and base their prescription also on incidental or constitutional symptoms. However, homeopathic remedies are often used both by professionals and by the public based on formulations marketed for specific medical conditions. Some formulations use a 'shotgun' approach of the most commonly indicated single remedies in mixture form, while others, such as those by Heel and Reckeweg, are proprietary mixtures marketed for specific diagnostic criteria based on various diagnostic systems. Many members of the public are not familiar with classical homeopathy, and equate these practices with homeopathy; others are familiar with the classical approach but regard these as legitimate variants; while others consider it a misuse of the term. Use of non-classical approaches is confined mainly to places where over-the-counter preparations are popular and where many doctors use natural medicines in a conventional clinical setting.

The popularity of homeopathy

A study exploring the use of complementary medicine found the following percentages of various countries' population to be using homeopathy for some of their health needs (data from 1985-92):

Country	Percentage of population using homeopathy
Belgium	56%
Denmark	28%
France	32%
Netherlands	31%
Sweden	15%
UK	16%
USA	3%

The numbers using homeopathy is increasing in Europe, with the British market increasing by about 20% per year, with even higher rates of growth in Germany and Portugal. In India, 10% of the population are estimated to use homeopathy exclusively for their medical needs. A recent study indicates that the percentage of people seeking homeopathic treatment in the USA declined from 3.4% in 1997 to 1.7% in 2002. In the USA, sales of homeopathic medicines in 1995 were estimated at US$201 million, and growing at 20% per year, according to the American Homeopathic Pharmaceutical Association, and the number of homeopathic practitioners increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.

Scientific testing of homeopathic treatment

Early critiques of high dilutions

Sir John Forbes (1787-1861), physician to Queen Victoria (1841-61) said the extremely small doses were regularly derided as useless, ridiculous and "an outrage to human reason." Although such homeopathic cures were accepted as valid by regular physicians at the time, they were ascribed entirely to the body's innate healing powers. And Professor Sir James Young Simpson said of the highly diluted drugs: "no poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly."

Mechanism of action of homeopathic preparations

As homeopathic remedies at potencies higher than about D23 (10^-23) contain no detectable ingredients apart from the diluent (water, alcohol or sugar), there is no known basis for these preparations having medicinal action. Some tests have suggested that potentized solutions up to D120 can have statistically significant effects on organic processes, including the growth of grain, histamine release by leukocytes, and enzyme reactions. However, attempts to replicate these studies on leukocytes and enzymes have failed. A recent review summarized the situation as follows: "...there are some hints from experimental research that homeopathic substances diluted and succussed beyond Avogadro’s number are biologically active but there are no consistent effects from independently reproducible models."

Although some patients report benefits from homeopathic preparations, scientists usually attribute these effects to the Placebo Effect, the regression fallacy and/or the Forer effect. Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind clinical trials, to test whether the drug has an effect that is better than either a placebo or a different treatment. Many clinical trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo. However, many of the trials are open to technical criticism or involve samples that are too small to allow firm conclusions to be drawn.

European Journal of Cancer 2006 study

In January 2006 the European Journal of Cancer published a meta-analysis of six trials of homeopathic treatments for recovery from cancer therapy, including radio- and chemo-therapy. Three of the trials were randomised double-blind placebo-controlled clinical trials. The authors, from the Department of Complementary Medicine at the Universities of Exeter and Plymouth, found insufficient evidence to support the use of homeopathic remedies in cancer treatment.

Lancet 2005 study

In August 2005, The Lancet published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The outcome of this meta-analysis suggested that the clinical effects of homeopathy are likely to be placebo effects. The Lancet paper is notable not least for its design, as a "global" meta analysis of homeopathy, not an analysis of particular effects, i.e. it tested the global hypothesis that the reported effects of homeopathy are placebo effects. If so, then reported positive effects are due to placebo effects, publication bias, observer effects etc., and hence the magnitude of reported effects should diminish with sample size and study quality. For comparison, they subjected an equal set of conventional medicine trials for identical analysis. The prediction was supported by the study -whereas conventional tests showed a real effect independent of sample size, the homeopathy studies did not. The study does not prove that homeopathy is never effective or that all its findings are placebo effects, but does show that the totality of tests analysed show outcomes consistent with the interpretation that all of the reported effects are placebo effects. The Lancet accompanied the meta-analysis with invited editorials, and was criticized by a number of homeopathic researchers and statisticians on methodological grounds.

British Medical Journal 1991 study

In 1991, three professors of medicine from the Netherlands performed a meta-analysis of 107 controlled trials, of which 81 showed that homeopathic medicines were effective, 24 showed they were ineffective, and 2 were inconclusive. They concluded, "The amount of positive results came as a surprise to us." The proportion of positive results may be biased by the so-called 'drawer effect,' where studies with positive results are more easily and more readily published than studies with negative results (which tend to end up in the desk drawer). They found evidence for successful treatment of respiratory and other infections, diseases of the digestive system, hay fever, rheumatological disease, mental or psychological problems and other ailments. In addition, they found evidence that homeopathic treatment helped patients recover after abdominal surgery and to address pain or trauma. Most studies were flawed in some way, but the researchers found 22 high-caliber studies, 15 of which showed evidence that homeopathic medicines were effective. The meta-analysis concluded, "the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials."

Basophil stimulation

Madeleine Ennis and her team looked at the effects of ultra-dilute solutions of histamine on human white blood cells involved in inflammation. These cells, called basophils, release histamine when they are stimulated. However, exposure to histamine stops these cells releasing any more, an example of negative feedback regulation. Three of the four participating groups observed this inhibitory effect with homeopathic solutions of histamine, solutions so dilute that they probably didn't contain a single histamine molecule. These low-dilution effects were seen in six of the 24 independent sets of experiments. However, other investigators failed to find any effect from these ultra-dilute solutions and suggested that methodological problems accounted for the positive results.

Evidence-based medicine

There is consensus in the medical community that evidence based medicine is the best standard for assessing efficacy and safety of health-care practices Therefore, systematic reviews with strict protocols are important for validating therapies, and much of modern medicine is subject to efforts to comply with evidence-based standards. Systematic reviews by the Cochrane Collaboration found insufficient evidence that homeopathy is beneficial for asthma dementia, and induction of labor. They also found no evidence that homeopathic treatment can prevent influenza, but reported that it appears to shorten the duration of the disease. Systematic reviews conducted by other researchers found insufficient evidence that homeopathy is beneficial for osteoarthritis, migraine prophylaxis, delayed-onset muscle soreness, or symptoms of menopause.

Medical organizations' attitudes towards homeopathy

• The National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, states that:
  • The results of individual, controlled clinical trials of homeopathy have been contradictory. In some trials, homeopathy appeared to be no more helpful than a placebo; in other studies, some benefits were seen that the researchers believed were greater than one would expect from a placebo.
  • A common theme in the reviews of homeopathy trials is that because of these problems and others, it is difficult or impossible to draw firm conclusions about whether homeopathy is effective for any single clinical condition.
  • There is a point of view that homeopathy does work, but that modern scientific methods have not yet explained why. The failure of science to provide full explanations for all treatments is not unique to homeopathy.
  • Some people feel that if homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine are not necessary.
  • The National Center for Complementary and Alternative Medicine continues to fund research into homeopathy.

• The UK National Health Service statement on homeopathy includes the following:
  • Around 200 randomised controlled trials evaluating homeopathy have been conducted, and there are also several reviews of these trials. Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works. Many studies suggest that any effectiveness that homeopathy may have is due to the placebo effect, where the act of receiving treatment is more effective than the treatment itself.
  • Medical doctors and scientists do not generally accept homeopathy because its claims have not been verified to the standards of modern medicine and scientific method. Scientists argue that homeopathy cannot work because the remedies used are so highly diluted that in many there can be none of the active substance remaining.
  • Supporters of homeopathy counter the scientific arguments with claims for a high success rates in babies, infants, and animals. Others argue that much of the research conducted into the effectiveness of homeopathy is not representative of routine homeopathic practice and that homeopathic treatment cannot be properly tested through standard clinical means. See anti-intellectualism.

• In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on several alternative therapies including homeopathy:
  • There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.

• The Indian Ministry of Health and Family Welfare states that:
  • Homoeopathy today is a rapidly growing system and is being practiced almost all over the world. In India it has become a household name due the safety of its pills and gentleness of its cure.
  • Homeopathy has been recognised as one of the National Systems of Medicine and plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels.

Regulatory decisions

In 2006 Australia's Therapeutic Goods Advertising Code Council (TGACC) found that a homeopathic Hangover Relief Oral Spray marketed by Brauer Natural Medicine P/L was "in breach of section 4(1)(b) of the Therapeutic Goods Advertising Code 2005 ( the Code ), which states that an advertisement must contain correct and balanced statements only and claims which the sponsor has already verified , and section 4(2)(c) which prohibits misleading advertisements." The TGACC is established under Australian law and the Therapeutic Goods Advertising Code is generally consistent with the World Health Organisation's "Ethical Criteria For Medicinal Drug Promotion 1988"

Misconceptions about homeopathy

It is a common misconception that homeopathic remedies use only natural herbal components (akin to herbology). Herbs are used, but homeopathy also uses non-biological substances (such as salts) and components of animal origin, such as duck liver in the remedy oscillococcinum. In herbology, measurable amounts of herbs are used, while in homeopathy the active ingredient is diluted until it is no longer detectable, or to the point that they do not contain any of the original active ingredient at all (when the dilution exceeds the Avogadro's number). Homeopathy also uses substances of human origin, called nosodes. Some people have the opposite misconception, that homeopathic remedies are based only on toxic substances like snake venom or mercury.

As the term homeopathy is well known and has good marketing value, the public can be confused by people who have adopted the term for other forms of therapy. For example, some companies combine homeopathic with non-homeopathic substances such as herbs or vitamins, and some preparations marketed as homeopathic contain no homeopathic preparations at all. Classical homeopaths argue that only remedies prepared and prescribed in accordance with the principles of Hahnemann can be called homeopathic. Many producers of homeopathic remedies also produce other types of alternative remedies under the same brand name, which can create confusion.

Homeopathy and vaccination

See also: Isopathy

To some, homeopathy, particularly the use of nosodes, resembles vaccination, in that vaccines contain a small dose of the "disease" against which they are to protect. Hahnemann interpreted the introduction of vaccination applied nowadays as such: But to use a human morbific matter (a Psorin taken from the itch in man) as a remedy for the same itch or for evils arisen therefrom, stay away from it! Nothing can result from this but trouble and aggravation of the disease. Roberts: giving the identical instead of the similar means the difference between isopathy and homoeopathy.

According to the philosophy of homeopathy, the body could become susceptible to "morbific noxious agents". The challenge of the homeopath is to prevent disease in the first place with the first sign of symptoms, this could be imminent, long before an acute disease appears. Hahnemann classified succeeded vaccination of smallpox due to the interaction of two similar diseases (the law of similars). When an epidemic is near, one or a few remedies could be chosen to treat a population in order to prevent the epidemic. Hahnemann gave this the description of acute collective diseases. When the epidemic is there, according to Hahnemann, the homeopath observes a complete picture of the epidemic and can constitute from a small box of remedies the fitting remedy to each individual patient.

In contrast, modern scientists and doctors see the two practices as fundamentally different. A vaccine is usually a preparation made from a bacterium or virus that cannot produce symptoms, while still providing enough information to the immune system to afford protection. By preparing the immune system of a healthy organism to meet a future attack by the pathogen, vaccination hopes to prevent disease, in contrast to homeopathy's hope, which is to prevent or cure it with dilutions. Another important difference between homeopathic preparations and vaccine, is that vaccine contains measurable amounts of antigen, usually proteins or carbohydrates from the disease-causing organism, whereas homeopathic remedies have been diluted to such an extent they are unlikely to contain any detectable active ingredients. The predominant view of homeopaths is that vaccination is not consistent with the principles of homeopathy, even if it is a crude application of the law of similars, they also believe that vaccination holds serious short and long-term (health) consequences and that vaccination may potentially arouse latent inherited and constitutional weaknesses. However, their main objection is that vaccination is a mass-applied technique based on the germ theory of disease, a view homeopaths reject, instead preferring to individualize each case of sickness.

Safety of homeopathic treatment

The United States Food & Drug Administration considers that there is no real concern over the safety of most homeopathic products "because they have little or no pharmacologically active ingredients". There have been few reports of illness associated with the use of homeopathic products, but in cases that they reviewed, the FDA concluded the homeopathic product was not the cause of the adverse reactions. In one case, arsenic was implicated, although FDA analysis revealed that the concentration of arsenic was too low to cause concern.

The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. For example, a 2006 survey by the UK charitable trust "Sense About Science," revealed homeopathic practices which were advising travelers against taking conventional anti-malarial drugs, instead providing them with a homeopathic dilution of quinine. Even the director of the The Royal London Homeopathic Hospital condemned this:

"I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice." .

Several scientists said the homeopaths' advice was reprehensible and likely to endanger lives. Professor Geoffrey Pasvol, a tropical medicine expert at Imperial College in London was reported as saying "Medical practitioners would be sued, taken to court and found guilty for far less. What this investigation has unearthed is appalling." . Template:Wikiquote

Notes

• Online etext of Hahnemann's Organon der Heilkunst: German original (other format) and English translation

External links

Neutral

• A recent article on homeopathy testing from the Annals of Internal Medicine
• BBC's Horizon on homeopathy (transcripts, discussion, etc.)
• Complementary Medicine - Therapies: Homeopathy BBC's "Complementary Medicine" article on Homeopathy
• Homeopathy In Perspective — critical online book, covering the history and present state of homeopathy
• FDA's view of homeopathy
• Water Structure and Behaviour— balanced and up-to-date references to current scientific understanding of water, with specific entries on "memory effects" and homeopathy
• Columbia-Presbyterian Hospital's presentation of homeopathic medicine
• Can homeopathy withstand scientific testing? 30 November 2004 by F.J. van Sluijs A recent Dutch overview.

Advocacy

• A condensed history of homeopathy
• American Institute of Homeopathy
• Extensive Homeopathy Information and Discussion Forum
• North American Society of Homeopaths
• The Society of Homeopaths - UK Organisation Representing Professional Homeopaths
• Homeopathy Links from The Holistic Medicine Resource Center
• Homoeopathy India Foundation web site http://www.e-homoeopathy.com
• Homeopathy Medicine Portal Products and Directory with extensive user forums on homeopathic remedies and debates.
• Alliance of Registered Homeopaths
• Homéopathe International — The English language version of Homéopathe International
• Homeopathy Timeline with historical and biographical information
• Adjuvant homeopathic treatment in breast cancer, a pilot study [3] (in German)
• Webhomeopath - an on-line homeopathic repertory
• Christian Friedrich Samuel Hahnemann A historical overview

Critical

• An Overview By Steven Novella
• A skeptic's view of homeopathy
• Magical Thinking in Complementary and Alternative Medicine
• HomeoWatch (Homeopathy Watch) — A Skeptical Guide to Homeopathic History, Theories, and Current Practices, operated by Stephen Barrett, M.D. (founder of Quackwatch)
• H2G2 entry on homeopathy.
• The Skeptics Dictionary
• "The Scientific Evidence on Homeopathy" - American Council on Science and Health
• A close look at homeopathy
• Dilution or Delusion?
• National Council Against Health Fraud Position Paper on Homeopathy
• Malaria Risk of Homeopathic Advice
• The Danger Of Homoeopathic prescribing