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File:Samuel Hahnemann.png
Samuel Hahnemann, the father of homeopathy

Homeopathy (also spelled homœopathy or homoeopathy) from the Greek words όμοιος, hómoios (similar) and πάθος, páthos (suffering), is a controversial system of alternative medicine. The model of homeopathy was developed by the Saxon physician Samuel Hahnemann (1755–1843) and first published in 1796.

Homeopathy calls for treating "like with like", a doctrine referred to as the "Law of Similars". The practitioner considers the totality of symptoms of a given case, then chooses as a remedy a substance that has been reported in a homeopathic proving to produce a similar set of symptoms in healthy subjects. The remedial substance is usually given in extremely low concentrations. Dilutions are performed according to a procedure known as potentization.

Basic principles

Theory of disease

The conventional theory of disease in Hahnemann's time 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, the use of laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours causing trouble, such as giving feverish (and so hot and wet) patients substances associated with cold and dry.

Beginning with his early work, Hahnemann rejected the prevailing physical model, in favour of a view of disease as more dynamic or spirit-like. He came to consider the spiritual factors as the root cause of all disease, in what he termed the "highest disease." Some later homeopaths, in particular James Tyler Kent, have tended to put even more emphasis on spiritual factors.

Vitalism had been a part of mainstream science through the 18th century. Whereas modern medicine sees bacteria and viruses as the causes of many diseases, some modern homeopaths regard them as effects, not causes, of disease. Others have to some extent adapted to the views of modern medicine by referring to disturbances in, and stimulation of, the immune system, rather than the vital force.

Scientific medicine has discarded vitalism and its associated beliefs in favour of the germ theory of disease, as part of a physiological model based on the work of scientists like Louis Pasteur, Alexander Fleming, and Joseph Lister. Moreover, following Avogadro's discovery it has firmly rejected the possibility of highly diluted homeopathic preparations having any medicinal action, but it was rather just the Placebo Effect.

The "Law of Similars"

Homeopathy rests on a principle known as the "Law of Similars". Hahnemann first expressed it as the exhortation similia similibus curentur or "let likes cure likes." The idea did not originate with Hahnemann, but he was the first to use it as the basis of a system of medicine. The "Law of Similars" is generally considered by homeopaths as a law of nature. Following this principle, the appropriate homeopathic substance for treating a disease is one which induces similar symptoms in a healthy person.

The relation of similarity is primarily determined through provings, in which relatively healthy volunteers who are given a substance in homeopathic form record changes in their physical, mental, emotional, and spiritual symptoms. This information is subsequently compiled and presented remedy-by-remedy in a Materia Medica. Subsequent versions of the Materia Medica additionally incorporate symptoms observed to have been cured by the remedy. A homeopathic repertory is an index of the Materia Medica, namely a listing of symptoms, followed by remedies reputed to cure them. With the growth of information on remedies such an index has become an indispensable tool for narrowing down the range of possibilities of appropriate remedy for a given case, although it is still properly treated as an adjunct to the Materia Medica.

At first, Hahnemann proved substances known to him as poisons or as remedies. Hahnemann's findings from provings were first recorded in his Materia Medica Pura. Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies, and modern drugs and chemicals are being added continually to contemporary versions. As a result, homeopathy uses a wide variety of animal, plant, mineral, and chemical substances of natural or synthetic origin. Examples include Natrum muriaticum (sodium chloride or table salt),lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other homeopaths during and after Hahnemann's time, notably Hering and Lux, developed remedies called nosodes, which are homeopathic dilutions of the agent or the product of the disease in question. Rabies nosode, for example, is made by potentizing the saliva of a rabid dog. Some homeopaths also use a number of more esoteric substances, known as imponderables because the prepartions do not originate from a material substance but from electromagnetic or electrical energy presumed to have been captured by direct exposure (X-ray, Sol (sunlight), Positronium, and Electricitas (electricity)) or through the use of a telescope (Polaris). Recent ventures by individual homeopaths into the realm of esoteric substances include Tempesta (thunderstorm), and Berlin wall.

Today, about 3000 remedies are used in homeopathy, of which approximately 300 are used based on comprehensive Materia Medica information, a further 1500-or-so on relatively fragmentary knowledge, and the rest are used experimentally in difficult clinical situations based on the law of similars, either without empirical knowledge of their homeopathic properties or through purely empirical knowledge independent of the law of similars. Examples include: the use of an isopathic (disease causing) agent as a first prescription in a 'stuck' case, when the beginning of disease can be traced to a specific event such as vaccination; the use of a biologically or chemically related substance when a remedy fails to act yet seems well-indicated; and more recently, the use of substances based on their place in the natural classification of their respective kingdoms (the periodic table or relevant biological taxonomy). This last approach is considered very promising by progressives in the homeopathic community, because it allows for grouping remedies and classifying the ever-burgeoning Materia Medica, but is rejected by many purists because it involves speculation about remedy action in the absence of proper provings.

The "Law of Similars" is the guiding principle in homeopathy, but calling it a "law" is misleading. It is, rather, an axiom or postulate which forms the foundation of the homeopathic system and through the application of which homeopaths arrive at their diagnosis. As it cannot be disproved scientifically (since a failure to cure homeopathically can always be attributed to incorrect selection of a remedy), the "Law of Similars" derives its justification from its contribution to the clinical results that homeopaths claim. The application of this principle, however, is not straightforward: there exist multiple methodologies for determining the most-similar remedy (the simillimum), and homeopaths will often disagree on the diagnosis. This is due in part to the complexity of the idea of 'totality of symptoms' to which the law refers, as homeopaths will not use all the symptoms of a patient, but will decide which are the most characteristic; this evaluation of the gathered clinical data is the aspect of diagnosis requiring the most knowledge and experience. Finally, the remedy picture as found in entries of the Materia Medica is always more comprehensive than the symptomatology that a single individual can ever exhibit. These confounding factors mean that a homeopathic diagnosis remains presumptive until it is verified through testing the effect of the remedy on the patient.

See also: List of common homeopathic remedies

The "Theory of Infinitesimals"

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and side effects diminished) by dilution in a particular procedure known as dynamization or potentization. Liquids are successively diluted (with water or, in the case of water-insoluble material, alcohol) and shaken by ten hard strikes against an elastic body, a process called succussion. Insoluble solids are diluted by grinding them with lactose, a process known as trituration. Homeopathic practitioners claim to observe that the vigorous agitation following each dilution transfers some of the "essential property" of the substance to the water. The dilution factor at each stage is traditionally 1:10 (D or X potencies) or 1:100 (C potencies). Hahnemann advocated the use of 30C dilutions for most purposes, i.e. dilution by a factor of 100 = 10.

However, since Avogadro's number is only 6.022 × 10 particles/mole the chance that even one molecule of the original would be present in a 15C solution is small and the chance of one molecule of the original being present in a 30C solution is infinitesimal.

Some later homeopaths, in particular Kent, advocated the use of much higher potencies, whose manufacture could no longer be practically achieved by the traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which in some way integrate dilution and succussion into a continuous process (Korsakoff). Higher dilutions are generally considered stronger and 'deep-acting'. This is in contrast to pharmacology and biochemistry, which hold that the effects of a substance are always due to its physical or biochemical activity in the patient's body, and therefore that generally the more of an active ingredient is present in a drug, the more effect (whether positive, negative, or both) it will have.

The choice of potency will depend on a number of subjective factors. These include how deep-seated the disease appears to be; whether the disease is primarily physical or more mental/emotional; the patient's sensitivity based on the practitioner's intuitive assessment or previous reactions to remedies; and the desired dosing regimen based on patient-compliance considerations (e.g., low potency repeated often vs. high potency repeated seldom). There are many theories and traditions of potency use. For example, as a general rule French and German homeopaths use lower potencies than their American counterparts. What most homeopaths agree on is that the choice of potency is secondary to the choice of remedy: a well chosen remedy will act in a variety of potencies, but an approximately matched remedy might act only in certain potencies.

Chronic disease

Although homeopathy is often used for the treatment of acute illness, there are several distinctive theoretical principles that apply mainly to the homeopathic treatment of chronic disease:

Suppression

A prominent role in the homeopathic theory of disease belongs to the notion of suppression. Its initial meaning consisted of the belief that there are diseases whose external manifestations prevent development of inner symptoms of the same disease. In his Chronic Diseases Hahnemann argued that mistreatment of diseases of the skin leads to disease 'deeper' in the organism, listing numerous cases in support. Present-day homeopaths invoke this notion in their claim that symptoms are not in themselves the disease, but rather represent an underlying disturbance of the organism's vitality. As they seek to address this underlying disease, homeopaths do not automatically regard the disappearance of a symptom (whether spontaneous or in response to some treatment) as a favorable event: under some cases this could instead indicate a weakening of the organism's ability to express the symptom, and because the underlying disturbance is still present, sooner or later it is expressed as a symptom elsewhere in the organism. They further claim that the tendency of past skin manifestations to reappear transiently following successful homeopathic prescribing is considered evidence in support of the this notion. It is maintained that although suppression is sometimes necessary for the patient's welfare or may even be life saving, it is regarded unfavorably in the context of long-term prognosis. In the modern context the issue arises mainly with respect to the use of corticosteroid treatment for skin disease, allergies, and asthma, and the use of chemotherapy, as homeopathic treatment is claimed to be significantly less effective under immune-system suppression.

Critics assert that the notion of suppression is deeply flawed, being based on erroneous intepretation of some clinical facts Hahnemann adduced in support of the theory. This is illustrated by Hahnemann's reasoning about the development of symptoms of syphilisTemplate:Fn: Physicians of his time regularly tried but failed to stop the progression of the disease by destroying the chancre that manifests early on. Hahnemann saw a non-existent causal relation between these events, arguing that the removal of the chancre was the cause of the disease's progression, writing that syphilis

"...can only proceed from the uncured indwelling veneral disease, whose external substitute and suppresser (the chancre, which, as long as it exists undisturbed, prevents the outbreak of the syphilis) has been destroyed locally by the physician, and can consequently no longer hinder its outbreak."

But since the clinical course of untreated syphilis involves the spontaneous disappearance of the primary chancre only to be followed by more extensive skin and systemic manifestations some time later, Hahnemann was wrong both in his observations (that the chancre remained indefinitely when untreated) and theory (that localized treatment of the chancre was the cause of later symptoms).

Direction of cure

Hahnemann's protégé Constantine Hering systematized Hahnemann's observations concerning the relation between symptoms by noting that homeopathic treatment often brought back previously suppressed symptoms of the patient (known as "return of old symptoms"), with cure tending to proceed:

  • from more vital to less vital organs;
  • from the interior to the surface; and (when applicable)
  • from the head and torso to the extremities.

Thus, as an example, a patient originally treated with medicinal ointments for a body-wide rash, later became asthmatic, and was now being treated homeopathically for suicidal depression, would tend first to recover emotionally while experiencing transient asthma symptoms and the reappearance of his skin rash, which would leave the core of his body first and his extremities last. Although this set of observations later became known as "Hering's Law of Direction of Cure", it is not a strict law but a clinical pattern whose presence indicates a high likelihood that deep cure has taken place and that recurrence is unlikely.

Homeopathic aggravation

The phenomenon of existing symptoms worsening in response to homeopathic treatment is termed homeopathic aggravation. The idea of aggravation can be considered a consequence of the law of similars, whereby a remedy acts by accentuating the disease symptoms, thus prompting the organism's healing response. Some homeopaths regard a quick aggravation as an indication of strong vitality and tend to be encouraged by its presence, while others strive to avoid aggravations in favor of the patient's comfort throughout treatment.

Constitutional treatment

Although Hahnemann himself did not have an explicit theory of physical constitution or psychological disposition, he did observe that general symptoms pertaining to the whole organism (e.g., reactions to weather, perspiration and sleep patterns) plus the patient's disposition were of special importance both diagnostically and for case management. Later homeopaths, notably James Tyler Kent, increasingly used overall disposition as a basis for determining the remedy and assessing the patient's vitality in response to treatment. Such treatment, which was applied in cases of chronic illness, became known as constitutional prescribing. Recent developments in the understanding of remedies and the homeopathic process, such as George Vithoulkas' essence prescribing and Rajan Sankaran's concept of central delusion, are continuations of this trend.

Because in the present social context classical homeopaths are usually seen for chronic complaints, these principles feature prominently in current homeopathic education and practice. In accordance with this view of disease, classical homeopathic treatment of chronic disease requires a long interview, often longer than an hour, to determine the totality of the patient's symptoms: a thorough history is taken, including childhood and physically or psychologically traumatic or memorable events; important or recurrent dreams are elicited; and a unified understanding of the person's unique perception of the world is sought.

Miasms

Although nowadays homeopathy is especially known for its treatment of chronic diseases, Hahnemann recognized already early on that homeopathy, like conventional medicine, had more difficulty with these than with acute illness. In response, in his later years he developed the concept of miasms, an idea that is still as complex as it ever was, and which remains contentious. After some years of homeopathic experience Hahnemann began noticing that many of his chronic patients tended to relapse even after prolonged homeopathic treatment: though they responded to remedies, over time their symptoms would tend to shift around without a fundamental improvement in their state. This led to his hypothesizing that health was not only determined by the person's present vitality, but also related to historical factors in the person's own life, as well as that of immediate ancestors; what he called miasm (from the Greek for taint). These factors had to be addressed before the patient could experience satisfactory improvement of the symptoms, while in cases where the miasmatic load was heavy only partial improvement was to be expected.

Hahnemann described three types of miasm in his Chronic Diseases (vol. 1):

  • Psora (possibly from Greek for itch): This was associated with cutaneous manifestations such as scabies, as well as diseases that tended to present as constantly irritating or distracting yet completely reversible (e.g. eczema, mild asthma, recurring infections). Hahnemann considered this the primordial miasm, arguing that improper treatment of such manifestations throughout history was what led to chronic disease and the other miasms.
  • Sycosis (from the Greek for fig-wart): This was associated with genital infections such as fig-wart (today recognized as HPV) and gonorrhea. These infections and diseases such as cutaneous warts, benign tumors, and psychological neuroses had the shared quality of being relatively fixed yet non life-threatening. Psychologically such states were associated with the need to accept the problem as an irremediable defect.
  • Syphilis (from the disease name) was associated with syphilis and other manifestations such as bone ulcers, organic heart disease, and dementia that had the shared tendency of producing irreversible tissue destruction.

Later in the nineteenth century the following miasms, which are considered intermediate in severity between sycosis and syphilis, were further delineated:

  • Tuberculosis: Associated with the infection as well as with life-threatening yet reversible asthma or pneumonia and (psychologically) with constant dissatisfaction and desire for change;
  • Cancer: Associated with malignant states as well as Obsessive-Compulsive Disorder and psychological traits of perfectionism, and excessive responsibility or ambition.

More recently, the highly influential Rajan Sankaran has further developed the understanding of the psychological qualities of miasms, and has made miasms an integral aspect of his diagnostic approach. He further expanded the list of miasms by largely supplanting Psora in favor of several, more specific miasms previously subsumed under it:

  • Acute: Diseases (whether acute of chronic) that present with a pattern of recover (with no ill effects) or succumb;
  • Typhus (after the clinical pattern of the infection): Enormous, short-term struggle followed by recovery;
  • Ringworm (after the clinical pattern of the infection): Cyclical recovery followed by likely recurrence;
  • Malaria (after the clinical pattern of the infection): Low-grade, fixed illness (similar to a sycotic manifestation) punctuated by acute exacerbations.

He further added a miasm between cancer and syphilis:

  • Leprosy (after the clinical pattern of the infection): Destructive, irreversible, yet not necessarily life-threatening manifestations such as leprosy and other disfigurements and AIDS that lead to both physical and social disability.

Miasms are determined through careful inquiry into the patient's personal and family medical history in search for previous infections (especially ones that from which recovery was incomplete) such as tuberculosis or diseases such as cancer. The presence of such manifestations can influence the choice of remedy beyond the presenting symptoms, and also provides a prognostic measure in a similar way as familial inheritance influences prognosis in conventional medicine.

The acceptance of miasms varies within the homeopathic community. Some homeopaths find the concept unhelpful or otherwise unacceptable; others will make occasional use of it; while other yet strive in every case to determine the miasmatic nature of the illness in order to facilitate prescribing (since remedy selection can be assisted by knowledge of the miasm). Of the latter two groups some regard miasms as objective features of the disease, while others view them merely as clinically useful categorizations.

History

According to homeopathic lore, Hahnemann began developing the homeopathic method after coming upon the idea that "like cures like" while translating a work on malaria. Upon reaching a passage stating that quinine was an effective treatment because it was bitter and astringent, Hahnemann felt this implausible because there were many other substances that were equally bitter yet lacked any therapeutic value. To better understand the effects of quinine, he decided to take it himself and observed that his reactions were similar to the symptoms of the disease it was used to treat.

For Hahnemann and his students the whole of the body and spirit was the focus of therapy, not just the localised disease. Hahnemann himself spent extended periods of time with his patients, asking them questions that dealt not only with their particular symptoms or illness, but also with the details of their daily lives. It is also suggested that the gentle approach of homeopathy was a reaction to the violent forms of heroic medicine common at the time, which included techniques such as bleeding as a matter of course.

Homeopathy was brought to America in 1825 and rapidly gained in popularity, partly due to the fact that the excesses of conventional medicine were especially extreme there, and partly due to the efforts of Constantine Hering. Homeopathy reached its peak of popularity in America in the decades 1865–1885 and thereafter declined due to a combination of the recognition by the establishment of the dangers of large doses of drugs and bleeding and dissent between different schools of homeopathy.

Nearly as important as Hahnemann himself to the development and popularization of homeopathy was the American physician James Tyler Kent (1849 – 1921). His most important contribution may be his repertory, which is still widely used today. Kent's approach to homeopathy was decidedly authoritarian, emphasizing the metaphysical and clinical aspects of Hahnemann's teachings, in particular

  • insistence on the doctrines of miasm and vitalism;
  • more emphasis on psychological symptoms (as opposed to physical pathology) in prescribing; and
  • regular use of very high potencies.

Kent's influence in America was somewhat limited, but his ideas were re-imported into the United Kingdom, where they became the homeopathic orthodoxy by the end of the First World War.Template:Fn

In the 1930s the popularity of homeopathy began to wane, especially in Europe and the United States, partly due to advances in biology and conventional medicine, to the Flexner Report (1910) which led (in North America) to the closure of virtually all medical schools teaching alternative medicine, and due to a decline in coherence in the homeopathic community. Homeopathy experienced a renaissance in the 1970s, largely thanks to the efforts of George Vithoulkas in Europe and North America, that continues to this day. In India homeopathy had remained relatively strong throughout the 20th century due to its isolation from the above factors, and at present Indian homeopaths are among the most influential world-wide. Finally, the rise in popularity of homeopathy must also be seen as part of the general rise in interest in alternative medicine over the past few decades.Template:Fn

The ease with which large databases can be manipulated has brought about profound changes in the way homeopathy is practised. Today many homeopaths use personal computers to sift through hundreds of thousands of pages of provings and case studies. Because the information about lesser-known remedies is more accessible, it is now more common for homeopaths to prescribe them, which in turn has lead to an increase in the number of new provings. Database technology has also encouraged researchers to reorganize and restructure existing information.

See also: List of important homeopaths

Homeopathy around the world

There are estimatedTemplate:Fn to be over 100,000 physicians practising homeopathy world wide, with an estimated 500 million people receiving treatment. Over twelve thousand medical doctors and licensed health care practitioners administer homeopathic treatment in the United Kingdom, France, and Germany. Since 2001 homeopathy is regulated in the European Union by Directive 2001/83/EC. The latest amendments to this directive make it compulsory for all member states to implement a special registration procedure for homeopathic remedies.

In the United Kingdom, as in most countries, homeopathic remedies may be sold over the counter. The UK has five homeopathic hospitals where treatment, funded by the National Health Service, is available and there are numerous regional clinics. Homeopathy is not practised by the majority of the medical profession but there is a core of public support, especially in Scotland and also from the English royal family.

Homeopathy has been used in India since the middle of the 19th century and is today a widely practised and officially recognized system of medicine there. India has the largest homeopathic infrastructure in the world in terms of manpower, institutions and drug manufacturing industry. There are 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitalsTemplate:Fn

In the United States, homeopathic remedies are, like all healthcare products, subject to regulation by the Food and Drug Administration. However, the FDA accords homeopathic remedies a treatment significantly different from that accorded to other drugs. Homeopathic products are not required to be approved by the FDA prior to sale, not required to be proven either safe or effective prior to being sold, not required to be labeled with an expiration date, and not required to undergo finished product testing to verify contents and strength. Homeopathic remedies have their own imprints that, unlike conventional drugs, do not have to identify their active ingredients on the grounds that they have few or no active ingredients. In the United States only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter, while homeopathic medicines that claim to treat a serious disease can be sold only by prescription. Neither the American Medical Association nor the American Academy of Pediatrics has an official policy for or against homeopathy, but unofficially, the AMA has denounced homeopathy as unscientific quackery, and will censure any physician who advocates homeopathy as a viable alternative to drug treatment or sugery. As an historical note, the AMA was originally founded in response to the American Foundation for Homeopathy, although it was not considered an official policy, nor stated anywhere in their charter. Reading the homeopathic journals of the time, however will highlight the intense political debate going on which prompted the formation of the AMA.

Homeopathy's popularity in the United States is growing. The 1995 retail sales of homeopathic medicines in the United States were estimated at US$201 million and growing at a rate of 20 percent a year, according to the American Homeopathic Pharmaceutical Association. The number of homeopathic practitioners in the United States has increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.

In Germany, about 6,000 physicians specialize in homeopathy. In 1978 homeopathy, along with 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, albeit with some exceptions, are no longer covered by the country's public health insuranceTemplate:Fn. Most private health insurers continue to cover homeopathy.

In Austria homeopathy has been a recognized part of the medical system since 1983.

In Switzerland homeopathy is one of the five classes of complementary medicine. At one time, homeopathic medications were covered by the basic health insurance system, as long as they were prescribed by a physician. This practice ended in June 2005. The Swiss Government, after a 5-year trial, has withdrawn insurance coverage for homoeopathy and four other complementary treatments because they did not meet efficacy and cost-effectiveness criteria.

In Mexico the Instituto Politécnico Nacional (IPN) has had a school of Homeopathy since 1936. This school has both bachelor and master degrees.

Diversity

There is, and always has been, considerable diversity in the theory and practice of homeopathy, some of which are mentioned below:

Pragmatism versus mysticism

One notable distinction is between what can be called the 'pragmatic' and the 'mystical' approach - but it should be remembered that there are not two distinct groups, but a spectrum of attitudes and practices. An early advocate of pragmatism was Richard Hughes, while the most influential mystic was James Tyler Kent. The pragmatists tend to be open to "whatever works," whereas the mystics tend to rely on authority and tradition. There is still considerable diversity in both camps because the pragmatists usually define "working" based on personal experience and the mystics use various sources as authorities. The pragmatists tend to see homeopathy as complementary medicine and are more willing to co-exist with conventional doctors. The mystics, some of whom are also conventional doctors, see homeopathy as alternative medicine and have more confidence that homeopathy can be used effectively against all diseases. Pragmatists are more likely to be interested in proving homeopathy within the framework of mainstream science, and will talk about such concepts as the "memory of water" and stimulation of the immune system. The mystics see less need to justify their methods with conventional criteria; for them homeopathy acts on a vital force that is, so far, not accessible to science. The pragmatists are more likely to prescribe relatively low dilutions because the action of those seems more plausible, whereas mystics will often use high dilutions in single dose. Finally, pragmatists are more likely to use homeopathy in non-classical ways (see below).

Classical versus non-classical homeopathy

Hahnemann's formulation of homeopathy and subsequent advances are often referred to as classical homeopathy in contrast with variants of homeopathy that do not observe all of its original tenets: in particular, classical homeopaths use one remedy at a time and base their prescription also on incidental or constitutional symptoms. But in reality homeopathic remedies are frequently used both by professionals and by the lay public based on formulations marketed for specific medical conditions. Occasionally single remedies are so used, but more typically mixtures of several remedies known to be useful for certain conditions are used in a practice collectively known as complex homeopathy. Some formulations are simply based on a 'shot-gun' approach of prescribing the most commonly indicated single remedies in mixture form, while other formulations, such as those by Heel and Reckeweg, are proprietary mixtures marketed for specific diagnostic critera based on various diagostic systems described in accompanying manuals. Much of the public and some practitioners 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 yet consider it a misuse of the term as such practice merely represents the use of homeopathic preparations without regard to (classical) homeopathic principles. Numerically the use of non-classical approaches probably exceeds that of classical homeopathy, at least in places like France and Germany where over-the-counter preparations are popular and where many doctors use natural medicines in a conventional clinical setting.

The popularity of homeopathy

Over the past two decades the use of homeopathic remedies and visits to homeopathic practitioners have increased. Possible reasons for this trend are:

  • Reported clinical efficacy: Some homeopathic patients may have personally found previous treatment to be effective, or heard from friends, colleagues, and the press of many cases in which a sickness was healed after homeopathic treatment. Some reinforce their favorable judgement with selective reference to positive scientific reports. Though they are aware that science has found no adequate explanation for the mechanism of homeopathy, they may subscribe to an empirical view of the matter: whatever works in their experience is good enough for them. This attitude arguably characterizes most health consumers nowadays, whose main concern is for perceived efficacy rather than scientific sanction of their treatment choice. This attraction is possibly further amplified from the inability by conventional healthcare to treat long term diseases.
  • Disaffection with the establishment: Some reject the medical establishment, which is perceived to place too much emphasis on machines and chemicals and to treat the disease, not the person. Homeopathic practitioners often spend more time dealing with their patients than do conventional practitioners. Furthermore, homeopathic preparations have few if any side effects and are generally much cheaper than conventional medications.
  • Attraction to the homeopathic world-view: Some are attracted to homeopathy through its holistic world-view, their desire for their story to be heard out in detail, their belief that their individually diagnosed complaints belong together in one pattern (classical homeopaths will usually prescribe one remedy to cover assorted ailments), and so on.
  • Exhaustion of other options: Some come to homeopathic treatment following years of other conventional or alternative treatment. They therefore try homeopathy, figuring that they have nothing to lose, even though in some cases they actively disbelieve it.

The scientific validity of homeopathy

The following are the main scientific issues that arise in the ongoing debate between skeptics and proponents of homeopathy:

Homeopathic claims contradict established scientific theories

Most scientists consider homeopathy to be lacking any plausible mechanism. They often view homeopathy as a pseudoscientific remnant from the age of alchemy, when important concepts such as molecules and germs were understood poorly or not at all. In the view of modern scientists, the basic interactions of molecules are sufficient to explain all known chemical and biological phenomena, even if many processes are too complex to be understood at this time. This consensus developed during and after the formulation of homeopathy, as a result of discoveries like the size of atoms by Loschmidt in 1865, the synthesis of urea by Friedrich Wöhler in 1828, and advances in understanding many more diseases.

The primary criticism of homeopathy by established science are the lack of evidence in form of patient studies conforming to a high scientific standard and the lack of a chemical mechanism to explain how ultra-dilute solutions can retain an imprint of a molecule that no longer exists in solution. Regardless of whether the dilution medium is water or alcohol, molecular physics does not allow for imprinting of anything in a liquid medium once those molecules have been diluted to near nonexistence and experiments trying to measure this effect have mostly failed.

Critics also reject homeopathic theory as being logically inconsistent. Why should only the properties of the one intended remedy be imprinted during dynamization, and not the properties of all of the impurities in the water, particularly since all of the substances in complex mother tinctures are presumably imprinted? Why should artificial shaking and swirling imprint the water, but not similar processes in nature? Why should the same information be imprinted by dynamization with alcohol or by trituration with sugar, although the properties of these substances are very different from those of water?

Theoretical and laboratory investigation of homeopathic preparations

The main difficulty in providing scientific support for the effect of homeopathic remedies lies in the lack of explanation for the purported effects of remedies. This is both a problem in itself and a hindrance to the acceptance of favourable clinical evidence (see below).

Nevertheless there is a small-scale research effort, primarily by physicists and chemists, to try to detect phenomena relating to, and provide potential mechanisms for, the purported effects of submolecular or "ultra-dilute" solutions. In addition there are occasional results that become identified by the homeopathic community or researchers as relevant to homeopathy. Though, there is some question as to whether these results are relevant to homeopathy.

The following are examples of observations of anomalous properties of diluted materials reported in peer-reviewed publications:

Anomalous physical properties of homeopathic water have been observed:

  • L. Rey "Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride" (Physica A, 2003; 323:67-74) observed physical properties that related to the original composition of the solution prior to dilution.
  • Vittorio Elia and Marcella Niccoli in "Thermodynamics of Extremely Diluted Aqueous Solutions," (Annals NY Acad Sci, 1999; 827:241-248) observed differences in thermal properties between double-distilled water undergoing homeopathic serial dilution-and-succussion with no starting solvent and ones with solvent initially present;
  • See also their "New Physico-Chemical Properties of Extremely Diluted Aqueous Solutions" J Thermal Analysis and Calorimetry, 2004; 75:815-836.

Immunological effects of ultradilute preparations on living cells have been observed:

The phenomenon of hormesis has been suggested to be a plausible mechanism for how low potency homeopathic preparations still containing molecules of the solute can work. It does not, however, address the question of the efficacy of the submolecular preparations.

Recent theoretical hypotheses concerning mechanism of action invoke clathrates, which are non-random aggregations of solutes in solution that seem to occur also in water-alcohol mixtures such as are frequently used in homeopathy:

This theory suggests physical and not chemical differences between pure water and homeopathic preparations. One predicted physical test which would tell difference is NMR. A recent study using NMR failed to distinguish between homeopathic solutions:

It is important to note that there is still no proposed mechanism for how such clathrates can invoke healing once inside the body.

Clinical trials

A meta-analysis is a tool for aggregating and evaluating research data from a series of individual clinical trials that address a single topic, within which can be found references to individual trials. To date, specific meta-analyses of peer-reviewed publications which suggest no significant difference between placebo and homeopathy include:

  • Walach (1997) Template:Fn found that the effects of homeopathy were not significantly different from those of a placebo.
  • Ernst (1999) Template:Fn was more ambiguous and did not find evidence of effects greater than placebo. However, he suggests that studies were not of good enough quality to point in either direction.
  • Rodrigues & Moritz (2003) Template:Fn concluded that "ample evidence exists to show that the homeopathic therapy is not scientifically justifiable", because of serious shortcomings in terms of publication bias and lack of methodologically sound trials validating homeopathy.
  • White et al. (2003) found that there was no evidence that adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo in improving the quality of life of children with mild to moderate asthma in addition to conventional treatment in primary care.
  • Shang et al. (2005) Template:Fn state in The Lancet, a leading medical journal, that no convincing evidence has been found that homeopathy performs any better than placebo, whereas under the same evaluative criteria conventional medicine performs better than placebo, and concluded that doctors should be able to inform patients of the "lack of benefit." The trial results were derived from a comparative review of 8 trials of homeopathy verus 6 of trials of conventional medicine selected from two groups of 110 matching trials, based on predetermined criteria of internal validity that sought to extract the best-quality trials in both groups.

Reviews suggesting an effect above placebo include:

  • Kleijnen et al (1991) concluded that "At the moment 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."
  • Linde et al (1997), who concluded "the results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo". However in his latter 1999 study this conclusion was largely withdrawn Template:Fn and questions have been raised about the original studyTemplate:Fn.
  • Linde & Melchart (1998) Template:Fn found that there was evidence to support homeopathy but this evidence was not very strong.
  • Cucherat et al (2000) Template:Fn found some evidence in support of homeopathy, but (like Linde & Melchart) found that higher quality studies were more likely to disprove homeopathy.

Persistent lack of concrete evidence of efficacy

Despite the available research, homeopathy has not been proven conclusively to work either in the clinic or in the lab, and the available research remains inconsistent and of variable quality. Another complicating factor is the claim by both sides of the debate for the existence of a publication bias: critics of homeopathy propose the likely existence of many negative trials of homeopathy that are not submitted for publication, whereas homeopaths claim that it is difficult to publish in the maintream scientific press because they present scientifically implausible conclusions.

Skeptic James Randi has offered an award of one million US dollars to anyone who can prove the existence of anything supernatural or paranormal; Randi stipulates that homeopathy qualifies as such. The million dollars are also available to anyone who can, by any means of their choosing, tell the difference between plain water and any homeopathic remedy of their choosing. A recent attempt to win the prize was aired on the BBC science program Horizon.Template:Fn The Randi challenge is not specific to homeopathy, and is not a specific scientific research protocol. Template:Fn

Having concluded that the controlled studies of homeopathy are too weak to be convincing, homeopathists say the skeptics must still address the widespread claims of successful treatments. Scientist would argue that if such cases were connected to the use of homeopathy and not caused by chance, placebo effect or other (simulatenously used) treatments, the effects should also be visible in controlled experiments. In particular, they argue that without control cases, it is impossible to distinguish between efficacy of a treatment and spontaneous remission. Without double blinding it is impossible to rule out observer bias and the placebo effect. Without reproduction in a separate study, it is difficult to rule out chance, fraud, or poorly understood systematic effects.

The possibility of testing homeopathy scientifically

It is often said that homeopathy does not lend itself to being tested through statistical means because of the individualized nature of homeopathic treatment and the role of the doctor-patient relationship. But while it may be difficult to objectively study some aspects of homeopathic treatment, the efficacy of homeopathic preparations in high dilution is easily studied using standard methods of placebo control: if the placebo and treatment groups cannot be distinguished at a statistically significant level on the basis of the clinical evaluation, patient report, or objective measures, then the hypothesis of efficacy can be rejected. Indeed, homeopathic remedies are popularly used over-the-counter in an analogous manner to conventional medicines (rather than following classical-homeopathic principles), so likewise should be amenable to testing.

Because homeopathy lacks the research infrastructure of modern medicine, but is largely clinically based, few homeopaths are properly trained in the methods of scientific research. Following a recent period of much interest in clinical support for homeopathy (possibly due to the rise of the evidence-based medicine movement, beginning in the early 1990s), many in the homeopathic community have concluded that, until a plausible mechanism-of-action is found, further clinical evidence will carry little weight, and the limited resources of the community should therefore be invested elsewhere, such as in improving educational standards. Moreover, proponents of alternative medicine often criticize the medical establishment and government agencies for failing to invest the necessary resources for testing their hypotheses thoroughly—demanding robust proof of efficacy according to the latest standards, while devoting only scant resources to the enterprise—although those that see little promise in alternative approaches often argue that such expenditure is unwarranted. Ultimately the issue becomes political, because health-care systems are subject to public scrutiny and preference. This concerns many in the scientific establishment, who regard this as a threat to the autonomy of science from political forces.

Some researchers of homeopathy downplay the importance of the placebo effect by pointing to reports of successful treatment of infants and animals. Even in such cases, in the absence of double-blinding, practitioner bias or patient expectation may still continue to play a role.

Yet another perspective favors the use of observational studies in place of placebo-controlled studies to compare the clinical efficacy of homeopathy to that of other methods of known efficacy. Although observational studies do not use placebo control, they have advantages such as lower cost and better modelling of clinical practice, which makes them an often-used alternative to controlled studies.

Finally, scientific studies do not in themselves represent objective data, but have to be scrutinized and interpreted by competent scientists. While skeptics tend to reject borderline results from scientific studies, because they have a prior belief that there can be no effect (due to the lack of a plausible mechanism), proponents of homeopathy tend to accept these results due to their predisposition toward homeopathy.

The status quo

Upwards of 130 clinical trials have been carried out investigating homeopathy or related uses of ultradilutions, mainly isopathy, and approximately 70% of these trials are in favour of some kind of efficacy above placeboTemplate:Fn. However, several meta-analyses have yielded inconclusive or unfavourable results, with two in particular observing that the higher quality trials were more likely to reject claims of efficacy over the placebo effect.

Linde et al (2001) Template:Fn summarize as such:

In conclusion, the available systematic reviews on homeopathy provide little guidance for patients and doctors. They rather reflect the ongoing fundamental controversy on this therapy and strengthen the perception that, on one side, positive evidence from clinical trials will not convince skeptics, and that on the other side negative results from trials not representing actual practice will not have any impact on homeopaths.

Misconceptions about homeopathy

Composition of homeopathic remedies

A common misconception is that homeopathic remedies use only natural, and thus presumed by some to be safe, herbal components (akin to herbology). While herbs are used in homeopathy, there is also use of non-biological substances (such as salts) and components of animal origin, such as duck liver in the popular remedy oscillococcinum. Homeopathy also uses substances of human origin, called nosodes. Some people have the opposite misconception, that homeopathic remedies are only based on toxic substances like snake venom or mercury.

Another difference is that although both use herbs, in herbology measurable amounts of the herbs are in the remedy, while in homeopathy the active ingredient is diluted to the point where it is no longer measurable.

Since the term homeopathy is well known and has good marketing value, the public can be further confused by people who have adopted the term for other forms of therapy. For example, some companies have combined homeopathic with non-homeopathic substances such as herbs or vitamins, and some preparations marketed as homeopathic contain no homeopathic preparations at all. Classical homeopaths claim only remedies prepared and prescribed in accordance with the principles established by 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 some confusion for the general public.

Homeopathy and vaccination

To some, homeopathy, particularly the use of nosodes, resembles the mainstream practice of vaccination, in that vaccines contain a small, closely-related dose of the disease against which they are to protect. Hahnemann himself interpreted the introduction of vaccination by Edward Jenner in 1798 as a confirmation of the law of similars. To those familiar with the modern practices of homeopathy and immunology, the two practices are fundamentally different. A vaccine is usually a bacterium or virus whose capability to produce symptoms has deliberately been weakened, 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 cure it.

Safety of homeopathic treatment

As homeopathic dilutions are usually considered by skeptics not to have any direct effect at all (since they should contain only water), it is usually assumed that the remedies themselves do not have any harmful effects. Since some homeopathic remedies are prepared by serial dilution of toxic substances, there is a risk that they may contain undiluted toxic substances. The medical literature contains several case reports of poisoning by heavy metals such as arsenicTemplate:Fn and mercuryTemplate:FnTemplate:FnTemplate:Fn found in homeopathic remedies. However, the main potential harm from homeopathic treatment arises not from the remedies themselves, but from the withholding of arguably more efficacious treatment, or from misdiagnosis of dangerous conditions by the non-medically qualified homeopathist.

References

  • Template:Fnb Jonas WB, Kaptchuk TJ, Linde K. "A critical overview of homeopathy" Annals of Internal Medicine, (2003); 138: 393-399
  • Template:Fnb Klaus Linde and Dieter Melchart "Randomized Controlled Trials of Individualized Homeopathy: A State-of-the-Art Review", Journal of Alternative and Complementary Medicine 4 (1998): 371-88 (structured abstract)
  • Template:Fnb M. Cucherat et al. "Evidence of Clinical Efficacy of Homeopathy: A Meta-Analysis of Clinical Trials", European Journal of Clinical Pharmacology 56 (2000): 27-33 (structured abstract)
  • Template:Fnb Walach H "Unspezifische Therapie-Effekte. Das Beispiel Homöopathie" . Freiburg, Germany: Psychologische Institut, Albert-Ludwigs-Universität Freiburg, (1997)
  • Template:Fnb Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials" Lancet (1997); 350: 834-943
  • 16 Kleijenen J, Knipschild P, ter Riet G. "Clincal trials of homeopathy." BMJ (1991); 302: 316-323
  • Template:Fnb Bandolier Homeopathy - dilute information and little knowledge
  • Template:Fnb Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB. "Impact of study quality on outcome in placebo-controlled trials of homeopathy" J Clin Epidemiol. 1999 Jul;52(7):631-6.
  • Template:Fnb James Randi Educational Foundation. "The JREF Million Dollar Paranormal Challenge 'FAQ'". Retrieved 13 September, 2005.
  • Template:Fnb footnote to pp.12-13, Hahnemann's Chronic Diseases, ed. P. Dudley, B. Jain Publishers, 1998 reprint
  • Template:Fnb Chakraborti D, Mukherjee SC, Saha KC, Chowdhury UK, Rahman MM, Sengupta MK: Arsenic toxicity from homeopathic treatment. J Toxicol Clin Toxicol 2003;41(7):963-7.
  • Template:Fnb Montoya-Cabrera MA, Rubio-Rodriguez S, Velazquez-Gonzalez E, Avila Montoya S: Mercury poisoning caused by a homeopathic drug. Gac Med Mex 1991, 127(3):267-70. Article in Spanish.
  • Template:Fnb Audicana M, Bernedo N, Gonzalez I, Munoz D, Fernandez E, Gastaminza G: An unusual case of baboon syndrome due to mercury present in a homeopathic medicine. Contact Dermatitis 2001, 45(3):185.
  • Template:Fnb Wiesmuller GA, Weishoff-Houben M, Brolsch O, Dott W, Schulze-Robbecke R: Environmental agents as cause of health disorders in children presented at an outpatient unit of environmental medicine. Int J Hyg Environ Health 2002, 205(5):329-35

External links

References

Neutral

Supportive

Books on scientific research on homeopathy:

  • Paolo Bellavite & Andrea Signorini (2002). The Emerging Science of Homeopathy: Complexity, Biodynamics and Nanopharmacology.
  • Rolland R. Conte, Henri Berliocchi, Yves Lasne, Gabriel Vernot (1996). Theory of High Dilutions and Experimental Aspects.

Critical

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