Homeopathy

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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 system of alternative medicine that treats "like with like", using remedies that it is claimed would, in healthy individuals, produce similar symptoms to those it would treat in an ill patient. Practitioners believe that the potency of a remedy can be increased by systematically diluting the dosage, along with succussion or shaking, to a point where it is unlikely that even a molecule of the original ingredient is present.

Although homeopathy is reported to be "growing in popularity" , and as "increasingly being endorsed by doctors" , it is controversial because it does not satisfy the scientific standards of evidence-based medicine. For example, "the process of the randomised controlled trial...[is] the expression of the scientific method in clinical medicine." [1]

The term "homeopathy" was coined by the Saxony physician Christian Friedrich Samuel Hahnemann (1755–1843) and first published in 1796.

Basic principles

The law of similars

The "natural law" expressed by Hahnemann, the one from which homoeopathy derives its name, is similia similibus curentur - let like cure like. This means that the appropriate substance to treat a disease is that 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 corresponding remedy for a given disease picture.

Provings and pathogeneses

The crucial task was to find out the symptoms associated with various substances, remedial pathogeneses (also spelled pathogenesies; the singular forms being pathogenesis and pathogenesy, resp.). 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 homoeopathic Materia Medica.

This technique is based upon a naive idea that most changes experienced by provers after intaking a remedy are produced by the remedy. However, 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 Conrad 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 just this picture of mass-hysteria. Homoeopaths do not deny the fact. To quote a proving master (Jeremy Sherr): "For instance in the proving of Diamond quite a few provers experienced tearing or straining of tendons and ligaments in the ankle and wrist joints. However, in addition to the provers experiencing these symptoms a large number of 'extras' - supervisors, placebo provers, other class members and close relatives - experienced similar injuries..." His explanation of the induced symptoms is of no less interest than the fact itself: "all the individuals participating become a whole and unified organism... their vital forces merge".

But even with stricter procedures, psychogeny is inevitable, in particular, due to the introductory instruction of provers, which procedure strongly suggests a possibility of adverse reactions. To quote Jeremy Sherr again: "...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.

But the main difficulty resides in the character of symptoms reported. In fact, proving protocols look as unordered heaps of disparate sensations and disturbances, many of them accidental, unrelated to the action of the substance. 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. The first to lapse into this trap was Hahnemann himself (Hughes, Manual of Pharmacodynamics, 1893, p.28 ff.). It is a matter of subjective judgement which symptoms are included into pathogeneses. 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. Hahnemann's observation looks still less credible in view of his statement made in the same critical remark to Cullen's Materia medica where he described the results of his experiment. He wrote that "substances which produce some kind of fever (very strong coffee, pepper, arnica, ignatia-bean, arsenic <emphasis added>) counteract these types of intermittent fever." Neither arnica, nor ignatia produce anything resembling fever. Apparently, Hahnemann was rather confused in the subject. A plausible explanation of Hahnemann's observation was first proposed by Theodor von Bacody, an advocate of homoeopathy. He suggested that during his sojourn in Transylvania Hahnemann had contracted malaria germs that remained inactive in his spleen. The surmise found factual confirmation in Hahnemann's own words. Namely, he was delivered from a relapse of quartan fever with 6 drams of Cinchona extract (Tischner R.: Geschichte der Homöopathie, T.II, p.163). So, the symptom was indeed aroused by Cinchona, but it did not pertain to the physiological action of Cinchona, to its pathogenesis.

Another inconsistency is brought to light when homoeopathic excipients are regarded as substances. In remedies preparation, medicinal substances (drugs) are most often mixed with physiologically indifferent substances called excipients. In homoeopathy, the notion of excipient changes its meaning as compared with the conventional definition. From the homoepathic point of view, excipients are substances as all others. Consequently, they have been proved as particular remedies in their own right. Saccharum lactis was proven by Swan in the potencies from 30^th upward; he regarded cold pains as its keynote. Saccharum officinale was also proven, and is used in practice. Alcohol (Ethanolum, Ethylicum) was proven as well. This circumstance creates yet another difficulty for homoeopathic theory. The reason is that homoeopathic pharmacopoeia allows conversion of triturations into dilutions, and vice versa. The former procedure is used quite frequently. Thus, when dilution is prepared from a trituration and is subsequently attenuated further, the lactose of the trituration becomes potentized as any other substance. Thence, there should be a number of sensitive persons who should reproduce its pathogenesis. There should have been mass observations of this sort; but there is no rumor of them. Possible explanations are: that homoeopathic practitioners are unobservant; that the pathogeneses of the excipients have no factual basis; that the action of highly potentized substances has nothing to do with the substances that gave them their denomination. Whichever the case, it hardly corroborates the belief in sound empirical foundation of homoeopathy.

Perhaps, the fanciful nature of pathogeneses is best illustrated with different homoeopathic preparations of the same chemical substance. Such is the case of Causticum Hahnemanni. It was obtained by Hahnemann of caustic potash, and introduced in 1805 under the name of Acris tinctura. In the 2^nd volume of the 2^nd edition of the Materia medica pura we find the pathogenesis of this preparation, now named Ätzstofftinktur - Tinctura acris sine kali; in the Chronic Diseases it is called simply Ätzstoff or Causticum By some twist of reasoning, Hahnemann considered it to be the caustic principle of the alkali, but later chemical analyses unanimously found it to be a weak solution of caustic potash of varying strength. Thence, the remedy should have the same pathogenesis as Ammonium causticum: they represent the same substance. Not at all. The latter has a rather scarce symptomatic picture (respiratory symptoms, mostly), whereas of the former Clarke, for instance, says: Causticum is one of the great polychrest medicines… it is both antipsoric and antisycotic and antisyphilitic… the leading feature of the Causticum is paralysis…, and so on. Such is the reliability of pathogeneses.

Another illustration is the fact that homoeopaths manage to produce provings 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 provings at all. Among nearly 3000 remedies used today, approximately only 300 have comprehensive materia medica information. Some further 1500-or-so are based on fragmentary knowledge. The rest are used without empirical knowledge of their homeopathic properties at all.

Choice of a remedy

Another silent assumption in the homeopathic theory is an old belief which the late 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, with requirements to simility 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 constitutional treatment. This principle states that the simillimum should correspond to all characteristic features manifested by an individual, 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, and 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 in principle.

Yet another problem is that 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. To cope with this obstacle, an assistant tool for finding the simillimum was invented, namely, 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 observing in the proving the very symptom resulting from the combination.

As a result, the simility principle remains ill-defined, or rather undefined. It was 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 that forms the foundation of the homeopathic system, and through the application of which homeopaths arrive at their diagnosis. As Kent put it in his "Aphorisms and Precepts", "The Law of Similars is a Divine Law. So soon as you have accepted the Law of Similars, so soon have you accepted Providence, which is law and order."

As so far the law of similars 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 (ibidem, 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 (and is practiced) with mother tinctures. The origin of the attenuation procedure is rooted in the phenomenon of homoeopathic aggravation.

Homeopathic aggravation

Expectedly, patient's symptoms may become worse in response to homeopathic treatment. This is termed homeopathic aggravation. 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, which process is known as trituration. There are 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. Apparently, it was suggested to him by his musings on the nature of friction. His argumentation proceeded along the following line: since cold steel contains a hidden store of caloric which can only be released by friction, thence friction should release any hidden power of substances, including the so-called curative power - understood substantially! - in case of medicinal substances. As he wrote in 1825: "The effect of friction is so great, that not only the physical properties, such as caloric, odour, etc., are thereby called into life and developed by it, but also the dynamic medicinal powers of natural substances are thereby developed to an incredible degree".

The conception of succussions as the source of medicinal strength of potentized remedies was fully implemented in practice. Thus, if previously the number of succussions used at each step of dynamisation was 10, by the year 1833 Hahnemann cut them to 2, out of fear of too strong aggravations. He warned homoeopaths against unintentional raise of potency through casual shaking: "There are, however, homoeopathists who carry about with them on their visits to patients homoeopathic medicines in the fluid state, and who yet assert that they do not become more highly potentized in the course of time, but they thereby show their want of ability to observe correctly." By this reason, he recommended carrying remedies in the form of dry pellets - he considered that in this form the remedy cannot be further potentized. Accordingly, it is believed by many modern practitioners that the succussion just before administration activates the remedy, and makes it more powerful.

Drawn to its logical conclusion, the idea that succussion as such is sufficient to upgrade the potency of a remedy means that the potency of a liquid remedy can be counted merely by the number of succussions it was subjected to, without addition of new menstruum. This way the process of potentization was as if short-circuited, creating what is named succussion potencies. So with Jenichen's potencies - the first high potencies chronologically. Apparently, Jenichen counted some varying number (10, 12, or 30) of vigorous shakes as one potency. (His potencies also differed from the Hahnemannian ones in some other technical features).

Until he introduced the LM-scale, Hahnemann advocated the use of 30C dilutions for most purposes, i.e. dilution by a factor of 100^-30 = 10^-60. Since Avogadro's number is 6.022 × 10^-23 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, which is 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^th 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 30^th 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, namely the fluxion process that 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.

Theory of disease

Despite initial expectation, in most cases homoeopathic treatment does not bring on a quick and smooth cure. Homoeopaths had to invent some theoretical principles to explain away incessant exacerbations and deteriorations. A distinctive homoeopathic theory of disease has emerged this way.

Suppression

A prominent role in this theory 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 interpretation 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. He fancied that syphilis "...can only proceed from the uncured indwelling venereal 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".

Present-day homoeopaths 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 homoeopath 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) from within outward, 3) 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.

A good refuting 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 this Greek word was "stain", "stigma". 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 symptoms in its place of intrusion, usually skin. When 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" (Chronic Diseases, p.15).

Similar speculations continue up to the present time, the list of miasms being steadily expanded. 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

Debut

By 1790 Samuel Hahnemann, the would-be founder of homoeopathy, made his living mainly by translations. This very year he was commissioned with translation of a then authoritative treatise on materia medica written by William Cullen, a famous physician from Edinburgh. Cullen introduced a new physiological theory closely akin to vitalism. Its pivotal notion was that of nervous force; the latter played the role of the vital force in vitalistic theories. The theory became a frame for a new system of medicine, and in his book Cullen classified remedies accordingly as increasing or decreasing the tone. In particular, there was considered, on twenty pages in the second volume, the medicinal effects of Peruvian, or china bark. In Cullen's view, the remedy exerted its action on fever through its tonic effect on the stomach due to its bitter taste and astringent properties. This assertion struck Hahnemann as completely unfounded: "By combining the strongest bitters and the strongest astringents we can obtain a compound which, in small doses, possesses much more of both these properties than the bark, and yet in all Eternity no fever specific can be made from such a compound." Exasperated, he decided to make an experiment with the remedy upon himself. "I took, for several days, as an experiment, four drams of good china twice daily... To sum up: all those symptoms which to me are typical of intermittent fever... - all made their appearance. This paroxysm lasted from two to three hours every time, and recurred when I repeated the dose and not otherwise." With this observation, Hahnemann fell upon the idea that "Peruvian bark, which is used as a remedy for intermittent fever, acts because it can produce symptoms similar to those of intermittent fever in healthy people."

It is a commonplace statement in homoeopathic literature that Hahnemann broke with contemporary medical practice moved by higher considerations, being disappointed by its inefficacy. The legend was invented by Hahnemann himself. He used to tell an edifying story in a lofty style, which now sounds somewhat comical: "After I have discovered the weakness and errors of my teachers and books, I sank into a state of sorrowful indignation, which had nearly altogether disgusted me with the study of medicine. I was on the point of concluding that the whole art was vain and incapable of improvement. I gave myself up to solitary reflection, and resolved not to terminate my train of thought until I had arrived at a definite conclusion on the subject." But reality was that his main motive was pecuniary: he was not able to earn for his living. Thus, he wrote in a letter of 29.08.1790: "I cannot reckon much on income from practice. This I know from fourteen years' experience". And in another letter of the same date: "I have entirely given up my practice for the past year, because it cost me more than it brought in..." There is striking difference between these quotations from his private letters as opposed to his stilted public professions; they clearly show that his claim was disingenuous.

Hahnemann's initial publication on the subject of homoeopathy met rather favourable reception. It is noteworthy, because it was not a rule for new ideas, which always had to overcome conservative opposition. A natural comparison is with Edward Jenner's discovery of vaccination, published at about the same time (in 1798). After some period of embittered struggle and resistance, vaccination was universally adopted. In a converse manner, after a short period of benevolent attitude, homoeopathy was repudiated.

The household explanation consists in reference to well-established laws of physics and chemistry. However, this explanation may be valid only for later times, but not for that of Hahnemann's first publication. At the time when he was gradually introducing attenuations, concepts of modern molecular physics were either in cradle, or yet unborn. Dalton's law of aliquot proportions was proclaimed in 1801. Dalton's investigations lay foundation for modern atomic theory - and just by that reason, i.e. out of distrust to the atomic theory - they were accepted cautiously and gradually. Even in the scientifically advanced England, Davy used the term proportionate numbers instead of atomic weight, and Wollaston used the term equivalents for the same purpose. In France, Gay-Lussac did not venture to derive from his own investigations a law establishing that equal volumes of simple gases contain equal number of atoms. Such was the state of affairs in leading scientific powers - in England and France, whereas Germany was still slowly freeing itself from the predominance of the phlogiston theory. Atomic theory was in possession of the top vanguard of scientists, but not of the bulk of educated strata; it could not be the cause of the violent opposition encountered by Hahnemann. The medical profession certainly was not in the vanguard of science. Rather, repudiation of Hahnemann's ideas was caused by everyday practical experience of physicians who did not see the results claimed by Hahnemann.

Hahnemann's attitude to his brainchild contributed much toward such a dénouement. He proclaimed the simility principle as a universally applicable and infallible law of nature. He experienced a profound personality shift after hitting upon the principle of simility, and his assessment of the latter was very far from scientific objectivity. He completely discarded negative practical experiences of other professionals with his method. Judging by the fact that he never conceded any fact as an evidence against the validity of this principle, on subjective level it was a fixed idea, at best. His assessment of himself changed drastically as well. He came to consider himself as God's elect: "When I burdened myself with the task of finding help for suffering humanity ... I was only carrying out that plan for which The Great Spirit gave me power and insight."

Hahnemann had all personal traits of a religious leader. And indeed, the atmosphere within the circle of his first followers was that of a newly founded religious sect. He did not tolerate differing views, was despotic in doctrinal matters, and extremely vindictive towards all dissidents. Some of his letters are really revealing in this aspect. He not only did not wish to consider any observations contrary to his opinions, he simply tried to suppress them. Thus, he wrote to Stapf, the editor of the Archiv für die homöopatische Heilkunst, asking him to prevent any publications of clinical cases which could confirm the views contrary to his own: "I pray of you to eliminate from your Archiv all superficial observations of pretended successful treatment." Homoeopathy survived; but it survived as a medical sect.

In quest of allies

Homoeopathy proved to be capable of holding out. However, in European countries it never succeeded in gaining respectability with a majority, or even a considerable part of public opinion, to say nothing of the scientific circles. Consequently, homoeopaths had to use other means than conviction to promote their credo.

Royal protection

From Hahnemann on, homoeopaths especially sought to enroll princely or at least aristocratic patients who might patronize and support the teaching. A reading-book example is given by the history of homoeopathy in Britain, introduced there by Frederick Quin.

Born in 1799, he was possibly the illegitimate son of the Duchess of Devonshire. After graduating in 1820, he became the Duchess' family physician. After her decease in 1824, he became physician to Prince Leopold of Saxe-Coburg, later King Leopold I of Belgium. With his social attributes, Quin was ideally placed to establish homoeopathy within the highest levels of English society. He counted the Dukes of Edinburgh and Beaufort among his patients, and became physician to the household of the Duchess of Cambridge.

The royal family became adherents of homeopathy as well. From Edward VII through his son George V, his sons Edward VIII and George VI right up to today's royals, they all clung to it. Prince Charles' recent advocacy of homoeopathy is the latest example. George VI paid the most: he pursued homoeopathic treatment until he died of lung cancer in 1952.

Apparently, the main reason why homoeopathy appeals to aristocracy is because the doctrine is so simplistic. Be it as it may, the high society support was used enormously by homoeopaths to their advantage. In particular, through his influential connections such as Lord Ebury, Quin was able to obtain an amendment to the 1858 Medical Act, withholding a recommendation about the type of medicine approved in Britain. The bill was specifically designed to outlaw quackery; as a result of Quin's offstage manoeuvres, homoeopathy avoided censuring by Parliament as a deviant mode of medical practice.

Support by religious groups

Beside royal patrons, homoeopaths tended to rely upon other lay persons and organizations invested with political power or at least with social influence to further the spread of their faith. As a rule, allies were found among social powers of anti-scientific stand. The best known example is the connection of homoeopathy in the USA with Swedenborgianism.

All prominent American homoeopaths in XIX century, from Hering to Kent, were members of the New Jerusalem Church; and the members of the New Jerusalem Church were supporters and followers of homoeopathy almost to a man. With Kent, the Swedenborgian theosophy found its way into the homoeopathic doctrine, which fact is acknowledged by homoeopathic writers (see e.g. Winston J.: The Faces of Homoeopathy, Tawa, 1999; p.166-167). In particular, the priority given to mental symptoms in choosing the remedy is dictated by theosophic fantasies. By the same token, Kent's Swedenborgian speculations dictate the potencies used in particular cases. Kent felt that potentization reduced a homeopathic remedy to its simple substance, and this way the remedy itself entered into the Swedenborgian fourth state of matter. It is maintained that high potency approaches the spirit, while low potency approaches matter. Then, going higher in potency means going deeper into causes. The high potencies are regarded as solely capable of reaching into the higher world and thus solely capable of destroying the true causes of disease. The low potencies are regarded as superficial and trifling, as too close to matter and not close enough to the nature of the vital force to be of much use.

A less known story is the connection of Russian homoeopathy with the Russian Orthodox Church (Kotok A.: Homeopathy and the Russian Orthodox Clergy; in: Medizin, Gesellschaft und Geschichte, 16, 1997, pp.171-193). Yet another example is the role of the Missionary School of medicine, founded in England in 1903, and connected with the Faculty of Homoeopathy in London, in the spread of homoeopathy during the early part of the 1900's.

Under the Nazi patronage

But only once in two centuries, their hour of triumph appeared to dawn upon homoeopaths. It happened in Germany in 1933, when Nazis came to power.

Nazis' position in respect of what was then called the school medicine was rather hostile. The same year they took power, they proclaimed a policy of support for all brands of alternative medicine (a review of their practical steps in this directions can be found in Jütte R.: Geschichte der Alternativen Medizin, München, 1996, pp.42-55). Homoeopaths enthusiastically hailed the new ideology. Hans Wapler, the editor of the Allgemeine Homöopathische Zeitung, wrote about "decisive importance which political utilization of Similia similibus by Hitler gained in Germany" (Allgemeine Homöopathische Zeitung 181 (1933), p.317-319). After being kind of cinderella in the Weimar Republic, homoeopathy (as all other brands of alternative medicine) suddenly became patronized and protected. Homoeopathic and naturopathic hospitals were functioning in Berlin, Bremen, Dresden, Gera, Hamburg, Köln, München, Nürnberg, Recklinghausen, Stuutgart, and Wuppertal. Not only could homoeopaths treat patients as they wanted, feeling behind them the benevolent attitude of the State. It was imposed upon regular doctors to use the methods of alternative medicine. As the Reichsärzteführer (State's Chief Physician) put it, "each physician will be obliged to use, along with the medical procedures of the school medicine, the procedures which utilize natural forces and drugs" (Hippokrates 7, 1936, p.371). In fact, it was the biggest clinical trial of homoeopathy throughout its history; the miracle cures that fill up the pages of homoeopathic textbooks, could now be produced en masse. Yet nothing came of it; homoeopaths showed no spectacular results. Then their patrons lost the war, and the things resumed their normal course.

Credibility

Hahnemann's claim was that the doctrine is vindicated by obvious and unquestionable efficacy of homoeopathic treatment. All later experience showed that this is not the case. Among homoeopathic posits, there is one incompatible with well established laws of physics - the concept of dynamisation. (The concept of the vital force was not so damaging because, in fact, it is easily removable from the doctrine.) Therefore, the need for physical underpinning, either experimental or theoretical, came to be felt by Hahnemann's contemporaries already.

Laboratory research

The memory of water

At the first stage of attempted homoeopathic research, a number of physico-chemical parameters were measured without a preconceived hypothesis concerning the nature of the phenomenon, on the off-chance, just in hope that something would be found out. Nothing was found. Later attempts proceed from some hypotheses on the nature of the changed substratum. The prevalent idea is that the vehicle somehow acquires a new, permanent and stable, structure. Usually, the studied vehicle is water, and the idea is referred to as the memory of water.

It is a priori evident that the idea is flawed. The symptom spectra of homoeopathic remedies are believed to be stable, highly differentiated, strictly individual, with no tendency to blending. The natural structures of the vehicle, characterized by relative stability, cannot represent them because their number is finite and much lesser than the known number of remedies. Unnatural structures, imposed upon the solvent by admixture of solute molecules during the first step of dynamisation, would need some force(s) not only maintaining them, but also assuring their transmission to further quantities of the solvent in the process of potentization. Researches that claim to have found such structures invariably become mockery. A model example is the comparatively recent claim by Shui-Yin Lo of discovering the presence of ice crystals that form in very dilute ionic solutions. Homoeopathic community experienced the appropriate jitters. Lo tried to exploit his ice crystals commercially in laundry business, and was consequently prosecuted by the Oregon Department of Justice for fraud ([2]). The experts stated that using the laboratory techniques of transmission electron microscopy and ultraviolet spectroscopy ... we obtain<ed> similar results for water claimed to contain "IE" structures as for West Chester, Pennsylvania tap water ([3]). And the presumable photographic images of ice crystals were found to depict microorganisms.

The Benveniste affaire

If there is no means to demonstrate any distinctive physico-chemical feature of high dilutions versus pure solvent, there remains a possibility to demonstrate their physiological influence. The idea is simple enough to be first implemented rather long ago, in the researches of Persson at Leningrad. The latter involved stimulation and inhibition of enzyme activity by dilute substances, including dilutions well past the point where solute molecules theoretically disappear.

Essentially the same approach was worked out much later in laboratories of a homoeopathic pharmaceutical firm in Lyon. The most famed of the experiments concerned the action of anti-IgE antiserum. A working group in the INSERM 200 laboratory headed by Jaque Benveniste believed to have traced this specific action of the antiserum after the latter was attenuated according to the classical homoeopathic procedure up to rather high dilutions. The results of the experiments were submitted for publication to the prestigious magazine Nature, and after some delay caused by vacillations the paper came out.

The publication caused uproar. The Nature had to organize an investigation to verify the reliability of the results of those experiments. The magazine created a committee consisting of three persons who passed a week in Benveniste's laboratory. The findings were revelatory (Maddox J., Randi J., Stewart W.W.: "High-dilution" experiments a delusion. Nature 334 (1988), 6180, 287-290). First of all, "We were surprised to learn that the experiments do not always "work". There have been periods of several months at a time during which solutions at high dilution have not degranulated basophils. Indeed, the laboratory had just emerged from such a period." It means that the results were misrepresented in the original article, since there was no hint at such a circumstance. There was also quite a few of other technical blunders. But the decisive event was the experiment run by the committee itself in the laboratory. It was the only strictly double-blind experiment made in this affaire, and it proved to be a failure. The question was settled factually. Incidentally, later Benveniste made claims that he uncovered the language of molecules, which led to his complete scientific ostracism.

Contonian statistics

A remarkable fact: upon scrutiny, every investigation claiming to bear out physical existence of homoeopathic attenuations turned out to be unscrupulous. The latest among them came comparatively recently, also from Lyon. Its main author, Rolland Conte, moved later to Australia, to exploit his invention commercially.

The gist of the approach did not consist in a new method of physical measurement of the properties of dilutions, but in an alleged new method of inferring results - by means of calculations - from results already obtained through available methods of measurement. The technique of the approach was first outlined in a paper published in 1994, then in a book published two years later (Conte R.R., Berliocchi H., Lasne Y., Vernot G.: Théorie des hautes dilutions et aspects expérimentaux; Paris, 1996).

The very layout of the text reveals much about credibility of the approach. First, the authors introduce summarily a number of notions from more involute areas of mathematics and quantum physics. Significantly, the notions are heaped upon the prospective reader (presumably, mainly lay homoeopaths and homoeopathic pharmacists, who are hardly at home with such terms) without appropriate explanation or at least definition. The terms are such as "the problem of the undecidable", "the axiom of choice", "the second quantification", "Feynmann's sample", and the like. But when the authors progress to the operational part of the work, that is, to inference of specific conclusions concerning particular experimental results, these notions are nowhere used. They emerge again only in the concluding part, where the authors interpret the experimental findings allegedly validated by the proposed method of calculations, and serve as speculative explanations of the formers. They are not inherently connected with the operational core of the work, and only grandstand the presentation.

The real value of the approach can be assessed through examination of its operational part, that is, the technique of calculation. The logical frame of the latter looks as follows. The premise is incontestable: so far all attempts to prove the physical reality of high potencies crashed because the experimental findings are not reproducible, not only those made in different laboratories, but also those made in serial experimentation within the same laboratory. And now Conte claims to have found a way to extract a reproducible parameter from experimental findings using a mathematical technique he introduced to develop a model of economics. The idea consists in representation of serial measurements by definite integrals over the whole series of measurements. Namely, for a quantitative attribute, one calculates the definite integral L(v) , which the authors call Contonian lagrangian. The authors say that the form of the lagrangian should be nearly linear. More generally, the whole method is said to be applicable not to any kind of data, but only to a particular kind of data which represent what the authors call Contonian processes (characteristically, nowhere defined in the publication). However, the meaning of this notion becomes clear from its properties as described by the authors. Namely, the Contonian processes are just such sequences whose L(v) are nearly linear. What does it mean?

If the subintegral area as a function of its upper limit has "linear appearance", the rate of increase of the subintegral area should be nearly constant. Under what condition measurements can give constant rate of increase of the subintegral area? When the average value of experimental findings remains approximately the same. But what meaning can be assigned to steady average value of a parameter indicative of a particular characteristic of homoeopathic attenuations? First of all, it means that the parameter does not change notably with increasing attenuation. The authors specifically stressed this condition, producing particular kind of calculations to demonstrate the property of self-similitude for Hahnemannian attenuations, that is, identity of properties of intervals of the range of attenuations divided by considerable distances. In particular, the authors adduce as practically identical Contonian frequency values for the intervals between 6CH and 7CH, and 49CH and 50CH, respectively. So, if Contonian statistics can prove something in this particular case, it is that the experimental data used are worthless, because they do not even reflect any difference between material and immaterial potencies.

The bulk of the text consists of trivial mathematical transformations that serve as mere embellishments. A gem of pseudo-scientific finesse deserves particular mention. Namely, to impart deductive force to their system, the authors make it axiomatic. They introduce an axiom (Axiom 1, p.57) that asserts: "the process of dilution-dynamisation creates an effect directly measurable in physical and/or biological experiments". That is, the most controversial part of the problem is solved just by postulating the wished answer. Such a ploy presumes an extraordinary naiveté on the part of prospected readers. The follow-up is obvious: however inconsistent be the results of an experimentation with homoeopathic dilutions, it is asserted that they really measure something, just by virtue of this ludicrous axiom.

Pseudo-scientific underpinnings

For want of experimental confirmation, homoeopaths clutched at every new para-scientific doctrine with pretensions of discovering hidden dimensions of the universe. The first such doctrine was mesmerism, and Hahnemann was an enthusiast of mesmerism throughout his life. By the middle of XIX century, the notions that originated from mesmerism found further development that influenced theoretical constructs of homoeopathy. In particular, it was the conception of odic forces developed by Carl von Reichenbach. Among homoeopaths, its main enthusiast was Adolf von Gerhardt.

Still more damaging to the reputation of homoeopathy was the hasty support given by homoeopaths to the so-called "electronic reactions of Abrams" (ERA). Its scientific validity is demonstrated by the claim that the religion of a person can be determined through the method. In the September 1922 issue of his journal, Physico-Clinical Medicine, Abrams printed a chart showing abdominal areas of dullness for Catholic, Seventh Day Adventist, Theosophist, Jew, Protestant, and Methodist. The controversy about ERA prompted the well-known magazine Scientific American to bottom one's own inquiry. The final conclusion appeared in the September issue of 1924. It stated: "...the so-called electronic reactions do not exist. They are either faked by the unscrupulous practitioner, or, when the practitioner is sincere, they are baffling products of his subconsciuos mind".

The whole of facts related to the ERA undisputably demonstrates them to be a classic instance of charlatanism. Why should homoeopaths had been involved in the affaire? Because Abrams claimed to be capable of determining the "vibratory rate" of drugs, homoeopathic drugs included. He stated that not only homoeopathic potencies do have their "vibratory rates" (the evidence of their effectiveness), but also that higher potencies evince stronger effect than the lower ones. The long wished for confirmation of the reality of high potencies was there! It was enough to assure blind support of the International Hahnemannian Association (IHA) for Abrams and his followers, whatever negative evidence was produced against the ERA.

The IHA rushed to save the reputation of the ERA. It created its own committee under the heading of Stearns to re-investigate the affaire. The results of the endeavours of the committee submitted to the IHA in 1925 revealed their complete incompetence in such issues. Without disproving any of the numerous negative results of the tests done by the Scientific American, they still claimed that there is enough evidence "that Abrams's claims had at least some basis in fact", rejecting the Scientific American report as biased and "directed toward disproving".

With all that, it was impossible to put by the egregious inconsistencies in the internal arrangement of Abrams' devices. It is really enlightening to see how the matter was treated in a pamphlet written by Stearns much later, in 1942. He had to admit that "the investigation of the AMA, undertaken by the Scientific American, failed to obtain reliable and consistent evidence from the Abrams proponents." After that, the non-sequitur conclusion: "The wonder was that despite his crudities of technique Abrams was able to discover so much that was fundamental..."

Clinical testing

Some patients report benefits [4], which scientists might explain as placebo or the regression fallacy. The placebo effect can be large, so conventional drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind clinical trials, the object of which is to test whether the drug has an objectively-demonstrable effect that is significantly better than a placebo. Many clinical trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo[5]. However, many of the trials are open to technical criticism or involve samples that are too small to allow firm conclusions to be drawn.

In August 2005, The Lancet published a meta-analysis of trials of homeopathy, the largest and most rigorous analysis so far, involving 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials . The outcome of this suggested that the clinical effects of homeopathy are likely to be placebo effects.

Safety of homeopathic treatment

The FDA considers that there is no real concern over the safety of homeopathic products "because they have little or no pharmacologically active ingredients". There have been a few reports of illness associated with the use of homeopathic products, which may be because some homeopathic remedies are prepared by serial dilution of toxic substances, presenting a risk that by accident they might contain undiluted toxic substances. The medical literature contains several case reports of poisoning by heavy metals such as arsenic and mercury found in homeopathic remedies. However, in cases that they reviewed, the FDA discounted the homeopathic product involved as the cause of the adverse reactions. In one case, arsenic was implicated, although FDA analysis revealed that the concentration of arsenic was too low to cause concern. Perhaps the main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath.[6]

External links

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

Uncritical

• American Institute of Homeopathy
• Extensive Homeopathy Information and Discussion Forum
• North American Society of Homeopaths
• The Society of Homeopaths - UK Organisation Representing Professional Homeopaths
• Homeopathy Links from The Holistic Medicine Resource Center
• Complementary Medicine - Therapies: Homeopathy BBC's "Complementary Medicine" article on Homeopathy
• Referrals to Certified Classical Homeopaths
• Homeopathy Medicine Portal Products and Directory with extensive user forums on homeopathic remedies and debates.
• Alliance of Registered Homeopaths
• Homéopathe International — The English language version of Homéopathe International
• Homeopathy Timeline with historical and biographical information
• Adjuvant homeopathic treatment in Breastcancer, a pilot study [7] (in German)
• Oxford Homeopathy - Research articles by Oxford Homeopath, Steven Cartwright
• Christian Friedrich Samuel Hahnemann An historical overview

Hypocritical

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

Critical

• A skeptic's view of homeopathy
• Magical Thinking in Complementary and Alternative Medicine
• Homeopathy: The Ultimate Fake - Stephen Barrett, M.D.
• HomeoWatch (Homeopathy Watch) — A Skeptical Guide to Homeopathic History, Theories, and Current Practices, operated by Stephen Barrett, M.D. (founder of Quackwatch)
• H2G2 entry on homeopathy.
• The Skeptics Dictionary
• "The Scientific Evidence on Homeopathy" - American Council on Science and Health
• A close look at homeopathy
• Dilution or Delusion?
• National Council Against Health Fraud Position Paper on Homeopathy
• Are the clinical effects of homoeopathy placebo effects?.pdf. A 2005 study published in The Lancet.