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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.

Homeopathy is considered controversial because its hypotheses and claims have not been verified to, or are at odds with, the standards of modern medicine and the scientific method.

Basic principles

The law of similars

The "natural law" expressed by Hahnemann, the one from which homeopathy derives its name, is similia similibus curentur - let like cure like. This means that the appropriate substance to treat a disease is one which induces similar symptoms in a healthy person. Thus, the logical structure of the homeopathic doctrine is tripartite: one should know the symptoms of diseases, one should know the symptoms induced by appropriate substances, and there should be a set of rules to find the correspondending remedy for a given disease picture.

Provings and pathogenesies

The crucial task was to find out the symptoms associated with various substances, remedial pathogeneses. They are to be determined through provings on healthy persons (provers), who ingest the substance (most often diluted), and then carefully note all changes they experience on any perceptible level (physical, emotional, cognitive). Such pathogeneses constitute the homeopathic Materia Medica.

This technique is based upon a naive idea that most changes experienced by provers after intake of a remedy are produced by that remedy. It became known rather soon that the very fact of taking part in a proving can exert considerable psychogenic effect. The symptoms of provings can be elicited by pure vehicle given by way of a drug. For instance, when Wesselhoeft had to conduct a re-proving of Carbo vegetabilis, he began by furnishing his fellow-workers with a number of blank powders of sugar of milk. No inconsiderable array of symptoms were reported to him as the result of the ingestion of these placebos, before a single particle of the drug has been absorbed. Strictly speaking, it was an instance of the nocebo effect, particularly easy to elicit in hysterical persons. The so-called seminar provings widely practiced today present the picture of mass-hysteria. But even with stricter procedures, psychogeny is inevitable due to the introductory instruction of provers, which procedure strongly suggests a possibility of adverse reactions, such as "...If in doubt phone your supervisor. Be on the safe side and do not take further doses." Still further the psychogenic pressure, however unobtrusive, is promoted by discussing the symptoms with the prover, which is a widely spread practice nowadays.

In fact, proving protocols look as unordered heaps of disparate sensations and disturbances, many of them accidental, unrelated to the action of the substance. But to make things still more confused, the principle of provings only on healthy provers was soon neglected. In 1796, Hahnemann wrote: "The reaction of the diseased organism ... to an untested or imperfectly tested remedy, gives such intricate results, that their appreciation is impossible for most acute physician. Either nothing happens, or there occur aggravations, changes, amelioration, recovery, death - without the possibility of the greatest practical genius being able to divine what part of the diseased organism, and what the remedy (in a dose, perchance, too great, moderate, or too small) played in effecting the result." However, a great part of the symptoms included into pathogeneses were obtained on sick persons, with disease symptoms often taken for pathogenetic ones. And Hahnemann was the first to lapse into this trap (Hughes, Manual of Pharmacodynamics, 1893, p.28 ff.). It became a matter of subjective judgement which symptoms are included into pathogeneses. Still, relevant or not, the chosen symptoms find their way into the homeopathic Materia Medica.

The very remedy that sparked in Hahnemann his unsolicited enlightenment, Cinchona bark is an example of the unreliability of pathogeneses. Whenever taken by healthy provers after Hahnemann, it never produced the symptom of fever. A plausible explanation of the fact was first proposed by Theodor von Bacody, an advocate of homeopathy. Apparently, Hahnemann had contracted malaria germs that remained inactive in his spleen. Then, the symptom was indeed aroused by Cinchona, but does not pertain to the physiological action of Cinchona, to its pathogenesis .

At first, Hahnemann proved substances known as poisons or as remedies in his time. Hahnemann's finding from provings were first recorded in his Materia Medica Pura. Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies. Modern drugs and chemicals are being added continually. As a result, homeopathy uses a variety of animal, plant, mineral, and chemical substances. But on a par with them, there are pathogeneses of non-existent and even magic substances, as Galvanismus or Electricitas introduced in XIX century, up to Positronium, Berlin Wall, Sai Baba's magic dust (Vibhuti), or thunderstorm (Tempesta) introduced recently.

Most homeopathic remedies lack solid provings. Among nearly 3000 remedies known today, approximately only 300 are used based upon comprehensive materia medica information. A further 1500-or-so are based on relatively fragmentary knowledge, and the rest are used without empirical knowledge of their homeopathic properties.

The choice of a remedy

There is another silent assumption in the homeopathic theory; it is an old belief which James I put as follows: "...I doubt not, but for every disease there is in nature a severall symple". However, "there are many diseases which it would be absolutely impossible to reproduce in the human organism by artificial means (Hempel C.J., Organon of Specific Homeopathy, p.114 ff.) - so there can be no homeopathic remedies for them.

To explain away the preponderable cases where the simility principle did not work, the latter was re-defined, so that the requirements to simility were becoming still wider (thus enabling explanations to the sense that "the real simillimum" was not found). There are two principal variants of this extension of the meaning of simillimum. The first one is illustrated by the definition included in the "Eighteen Theses". The latters were accepted in 1836 by the Central Association of Homoeopathic Physicians of Magdeburg as an explanation of the fundamental principle of homoeopathy, in contrast to more dogmatic views of Hahnemann himself, and remained the foundation of most homoeopathic doctors in Germany. On the issue in question, the fourth thesis says: "The choice of the homoeopathic curative remedy is regulated by the totality of symptoms in the most comprehensive meaning of this term. It not only includes the complaints of the patient, and the result of the medical examinatiom, but all the pathological findings, from the termination of health, to the present condition in their sequel, duration and transitions."

The other way to extend the meaning of simillimum is represented by the constitutional treatment. This principle requires that the simillimum should correspond to all characteristic features manifested by the organism, both pathological and constitutional. This stand can be traced back to Hahnemann. As he wrote in §5 of the Organon: "...the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration."

Thus, the claim of clinical evidence is extended still further - in a way recognised by a preponderable majority of homoeopaths. To wit, characteristic features (pathological or constitutional) of persons treated by remedies with apparent success may be included into remedial pathogenesies. Constitutional prescriptions are at least in part based upon prominent non-pathological features of the individual. These features cannot be based on provings.

The concept of constitutional prescribing was given a particular twist of meaning by Kent who was of the opinion that it is the sick individual as a whole to be cured rather than the totality of the characteristic symptoms or the pathological condition of the diseased organs of the patient. Therefore, he gave highest or first rank to the general characteristic symptoms of the patient as a whole. Kent's understanding was based on his religious conceptions. According to his Swedenborgian view, all disease process starts at the level of will and understanding. Since the mind is posited to be the deepest level in the hierarchy of the physical body, treating the symptoms expressed through the will and understanding will heal that level, and permit it in turn to heal the other levels. To treat 'constitutionally' was to treat that level.

This hierarchization of symptoms opens the door for yet another source of subjectivity in choosing the remedy. Obviously, if the ranking of symptoms is re-evaluated, the remedy chosen may be quite different.

In addition, the remedy picture (its array of symptoms) as found in entries of the Materia Medica is always more comprehensive than the symptomatology that a single individual can ever exhibit. An assistant tool for finding the simillimum is represented by repertories. A homeopathic repertory is supposed to be an index of the materia medica. However, it is not so. In the overwhelming majority of cases, provings do not provide sufficient number of complete symptoms as prescribed by the homoeopathic theory. The way out was invented by Bönninghausen who first conceived the idea of completing the array of symptoms shuffling them so that modalities of a symptom might be associated with other symptoms. Perhaps, it was not especially embarrassing for Bönnighausen who was a professional lawyer. Thence, repertories are filled with constructed symptoms, without necessarily having in the proving the very symptom resulting from the combination.

As a result, the simility principle remains ill-defined, or rather undefined. It is never stated clearly which symptoms shown by an individual should be matched by the simillimum, and which should not. In fact, most practitioners oscillate between mutually exclusive definitions in particular cases. The notorious difficulty and unreliability of homoeopathic prescription are manifestation of the dizziness of the concept.

There is no clear-cut, precise rule for choosing homeopathic remedies in particular cases. Thence, the law of similars cannot be called a "law". It is, rather, an act of faith which forms the foundation of the homeopathic system and through the application of which homeopaths arrive at their diagnosis. As so far it was neither proved nor disproved scientifically, its claimed justification is derived from anecdotal clinical cases of spectacular effectiveness.

Such justification is not much convincing in view of such examples as effectiveness of paper remedies. The latters are used by some homeopaths so that the name of a remedy is written upon a piece of paper, and this piece of paper is then used like the remedy itself (a kind of sympathetic magic); the link above recites the many positive results obtained after wearing for two weeks a paper inscribed "LOSE EXCESS WEIGHT 2 LBS. A WEEK 30C".

Just as well, homeopaths' faith into apparent clinical results is compromised by cases confirming the efficacy of distant homeopathy. The latter, also a kind of sympathetic magic, uses things that once were in touch with the patient to transmit the action of a remedy over distances of thousands of miles (for instance, the remedy is applied to patients' uprooted hair whereas the patient himself is in another city). In a book on distant homeopathy (Sahni B.: Transmission of Homeo Drug-Energy from a Distance, 1993, New Delhi, B.Jain Publishers), the miraculous cures, some of them of cancer, are recited on about hundred pages (ibid., pp. 107-200).

The theory of infinitesimals

In the eye of a layman, the most characteristic and controversial tenet of homeopathy is that the potency of a remedy can be enhanced (and side effects diminished) by attenuation through a particular procedure known as dynamization or potentization. In fact, it is not so. Homoeopathy can be practiced with mother tinctures. The origin of the attenuation procedure is rooted in the phenomenon of homoeopathic aggravation.

Homeopathic aggravation

Expectedly, existing symptoms may become worse in response to homeopathic treatment. This is termed homeopathic aggravation, and is to be considered a consequence of the law of similars. Hahnemann met with severe aggravations as early as in 1797 (Eine plötzlich geheilte Kolikodynie; in "Archiv für die homöopathische Heilkunst" 1829, 199-203; included in The Lesser Writings, p.303-307.). To avoid them, he began lessening the dose of homoeopathic remedies through particular techniques known as attenuations.

By some reason, from the very start (by 1801) Hahnemann jumped from conventional doses to attenuations higher than 1:1,000,000. One could expect that, after some steps of attenuation, there should be a limit below which no medicinal influence of substances could be traced. And at any rate, one could expect that sufficiently diluted remedies would cause no further aggravations. But, since Hahnemann ascribed any change in the condition of the patient under treatment to the action of the intaken homoeopathic remedy, each time he met an adverse reaction he ascribed it to an exceeding dose. Thence, however mild acting, or however ineffective a remedy could be, there always should have been some cases of aggravation ascribed to remedial action.

The techniques of attenuation

Attenuations are stepwise procedures, the concentration of the remedy being lessened at each step according to some ratio called the scale of attenuation (or potentization). For the centesimal scale (1:100), liquids are successively diluted (with water or occasionally alcohol) and shaken by 10 hard strikes against an elastic body, a process called succussion. Insoluble solids are diluted by grinding them with lactose, a process known as trituration. There is also the decimal scale (1:10) and the fifty-millesimal or LM-scale (1:50,000).

Sometimes, homeopaths use much more intriguing techniques of preparing potentized remedies. In 1832, Korsakov described the method known now as dry grafting. A single dry globule of a potentized remedy is put in a bottle half-filled with sugar globules. The bottle is shaken for five minutes, and this way all the globuli should acquire the property to exert the influence of the initial remedy upon organism, "as if by contagion", as he put it. Hahnemann approved of the idea, saying that it "is a sort of infection, bearing a strong resemblance to the infection of healthy persons by a contagion brought near or in contact with them".

Hahnemann's explanation for increased strength of higher potencies was of mechanical nature. Further developed, it gave rise to such techniques as Jenichen's succussive potencies. Until he introduced the LM-scale, Hahnemann advocated the use of 30C dilutions for most purposes, i.e. dilution by a factor of 100 = 10. Since Avogadro's number is 6.022 × 10 particles/mole, the chance that even one molecule of the original would be present in a 30C solution is vanishingly small.

Still the homoeopathic theory did not bother much about considerations of physical presence of matter, as well illustrated by the olfaction technique (used uptoday). It is a method of dispensing potentized homoeopathic remedies, introduced by Hahnemann. As he wrote to Bönninghausen in a letter of 28.04.1833: "the homoeopathic physician ... could dispense his own remedies by simply applying the small bottle every fortnight to both nostrils of his chronic patient who comes to visit him, or at the bedside of the acute patient, without even allowing him to swallow the smallest amount of material medicine. His conception of its mechanism of action can be seen from his wordings in the §288 of the 5 Edition of the Organon where he says that "it is especially in the form of vapour, by olfaction and inhalation of the medicinal aura <emphasis added> that is always emanating from a globule impregnated with a medicinal fluid in a high development of power,... that the homoeopathic remedies act most surely and most powerfully."

However, the use of infinitesimals should not be equalled with homeopathy. Critical view of ultra-molecular potencies was common among homeopaths in XIX century. In 1879, the American Institute of Homoeopathy even undertook the research known as the Milwaukee Test. Provers were given 10 vials, one containg a homeopathic remedy in 30C, and 9 containing placebo. At the end, only one person selected the remedy, while the other 8 selected the placebo. The AIH's conclusion was that the 30th potency is nothing other than placebo.

The use of high potencies prevailed mostly because of the influence the Swedenborgian lineage of homeopaths exerted upon American homeopathy. They advocated the use of ultra-high attenuations, such as 1M (1,000C), 10M (10,000C), and even CM (100,000C). Their manufacture could not be achieved by the traditional methods, and American homeopaths started inventing machines to automate the process of potentization. A new principle of potentization was introduced by Fincke, the fluxion process which consisted in constant flow of water through a vessel which originally contained some initial attenuation.

No abstract figures, be they CM or MM, will impress greater than a vivid presentment of the process itself. Fincke's potencies were made as follows. Tap water streamed through a tube into a dram vial containing an initial potency (3C, 30C, or some other) which had to be raised. The liquid in the vial was displaced by the running water and ultimately went down the drain. The potency was considered to be raised by one degree whenever one dram of water ran through the latter. To obtain one dram of CM, more than 400 litres of water should flow through the thimble-sized vial; to obtain one dram of MM - more than 4,000 litres.

The proponents of high and ultra-high potencies generally consider them as stronger and 'deep-acting'. But there are many theories and traditions of potency use. What most homeopaths agree on is that the choice of potency is secondary to the choice of remedy.

Theory of disease

Homoeopaths' approach to treating diseases, and their evaluation of the results are guided by some distinctive theoretical principles.

Suppression

A prominent role in the homeopathic theory of disease belongs to the notion of suppression. Its initial meaning consisted in the belief that there are diseases whose external (in particular, skin) manifestations prevent development of inner symptoms of the same disease. This notion originated from erroneous intepretation of some clinical facts, which is well illustrated by Hahnemann's reasoning about the development of symptoms of syphilisTemplate:Fn. As known today (but not in Hahnemann's time), the untreated first stage of syphilis, the chancre, disappears spontaneously after a certain period, and just as regularly, the secondary stage manifests itself in due time. Some physicians tried stopping the disease by destroying the chancre, obviously in vain, without any influence upon further course of the disease. But Hahnemann beheld a non-existent causal relation between those events. Thus he wrote 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".

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).

Yet present-day homeopaths still invoke this notion to state their belief that symptoms are not in themselves the disease, but rather represent an underlying disturbance of the organism's vitality, and it is this underlying disturbance that the homeopath needs to address. It is asserted that superficial manifestations of disease may disappear only to be replaced later on with more deep affections (e.g., respiratory complaints, organic heart disease, and mental illness). In such cases their original disappearance is considered to be suppressive, and their transient reappearance following homeopathic prescription is considered evidence in support of this notion.

Direction of cure

The notion of suppression underlies the so-called Hering's Laws of Direction of Cure, first set forth by Constantine Hering in 1845. In his formulation:

1) The improvement takes place from above downward, 2) and from within outward, 3) and the disease passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last.

As an invented example, a patient who was originally treated with medicinal ointments for a body-wide rash, who 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.

A good real example is that of syphilis. According to Herings' law, skin symptoms should be last to disappear, whereas in fact they are first to go away. At any case, homeopathic writers themselves note that cases when clinical manifestations change in compliance with Hering's laws are exceptionally rare.

Miasms

As early as in 1816, Hahnemann found "...a continually repeated fact that the non-venereal chronic diseases, after being time and again removed homoeopathically by the remedies fully proved up to the present time, always returned in a more or less varied form and with new symptoms, or reappeared annually with an increase of complaints." After more than 10 years of struggling with the problem, the senile Hahnemann (he was 72 when he communicated the fruits of his musings to two of his pupils) introduced a new theory currently known as the miasmatic theory. He proclaimed that there are only three fundamental diseases - fundamental miasms - behind all the multitude of the chronic diseases of the mankind: syphilis, sycosis (an outdated nosological unit confounding gonorrhoea and figwart disease), and psora. The latter - the miasm of psora - was said to be a single underlying miasm behind most part (assessed by him as seven eighths) of various diseases known to the medical science.

The basic notion of the new theory, that of miasma, was not invented by Hahnemann; it was an old medical concept adopted by him. The main meaning of the Greek word miasma was "stain", "stigma"; but in medicine the word came to be used in a specific sense of "pestiferous exhalations". Hahnemann's notion of miasm was of that kind as well. Thus, he wrote in 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, that is, infects it at a distance without anything material from the infective child going or capable of going to the one to be infected. A purely specific conceptual influence communicated to the near child small-pox or measles in the same way as the magnet communicated to the near needle the magnetic property...".

The new conception was a short-circuited generalization of Hahnemann's understanding of syphilis (see above in "Suppression"). So, in a footnote to §282 he spoke of "the three great miasms while they still effloresce on the skin, i.e., recently erupted itch, the untouched chancre (on the sexual organs, labia, mouth or lips, and so forth), and the figwarts". Their development looked schematically as follows. Miasmatic infection causes local symptomatics in its place of intrusion, usually skin. If this local pathology is removed ("suppressed") by external medication, the disease goes deeper, and manifests itself by manifold organ pathologies.

The fundamental miasm of psora was obtained by merely substituting itch for chancre in this speculative model. This imaginary inner disease - generalized itch - was promulgated to the range of all-pervading universal underlying pathology (in §80 of the Organon he asserted psora to be the only real fundamental cause and producer of such forms of disease among others as epilepsy, cyphosis, cancer, jaundice, deafness, and cataract). Its diagnosis presented no difficulty: "even the first little pustule of itch with its unbearable voluptuous itching, forcing a man irresistibly to scratch, and with the following burning pain, is in every case and every time the proof of a universal itch-disease which has been previously developed in the interior of the whole organism".

Further speculations in the nineteenth century produced the following miasms. Tuberculosis is associated with the infection as well as with asthma or pneumonia and (psychologically) with constant dissatisfaction and desire for change. Cancer is associated with malignant states as well as with obsessive-compulsive disorder and psychological traits of perfectionism, and excessive responsibility or ambition. Similar speculations continue up to the present time, the list of miasms being steadily expanded. For instance, one of such classifications considers the following miasms. Acute: diseases that present with a pattern of recover (with no ill effects) or succumb. Typhus (after the clinical pattern of the infection) characterized by enormous, short-term struggle followed by recovery. Ringworm (after the clinical pattern of the infection) characterized by cyclical recovery followed by likely recurrence. Malaria as a low-grade, fixed illness punctuated by acute exacerbations. Leprosy represented by destructive, irreversible, yet not necessarily life-threatening manifestations such as leprosy or AIDS.

Although the acceptance of miasms varied and varies within the homeopathic community, nowadays in some way or another the concept is used by a majority of homoeopaths.

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

Scientific skeptics 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 is 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.

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. However, the review was published in an obscure Brazilian journal and is not considered as being very high up the evidence pyramid.
  • 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:

  • 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.
  • 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."

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, the skeptics must still address the widespread claims of successful treatments. These skeptics begin by pointing out that anecdotal evidence of controversial phenomena does not constitute evidence that a cure has taken place. 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 considered by skeptics not to have any direct effect at all, naturally they do not claim that the remedies themselves have any harmful effects. The main potential harm from homeopathic treatment, therefore, 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

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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