Homeopathy

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 particular case, then chooses as a remedy a substance that has been reported in a homeopathic proving to produce similar symptoms in healthy subjects. The remedial substance is usually given in extremely low concentrations. Dilutions are performed by a procedure known as potentization.

With few exceptions, homeopathy is not accepted by medical doctors or scientists in the relevant fields.

Basic principles

Theory of disease

Hahnemann did not accept the conventional theory of disease of his day, which was based on the four humours. Mainstream medicine focused on restoring the balance in the humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours causing trouble, such as giving feverish (and so hot and wet) patients substances associated with cold and dry.

Hahnemann rejected this in favour of a view of disease as more "spirit-like". He came to consider the spiritual factors as the root cause of all disease. Some later homeopaths, in particular James Tyler Kent, put even more emphasis on "spiritual factors".

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

In the twentieth century, medicine discarded vitalism in favour of the germ theory of disease, based on the work of Louis Pasteur, Alexander Fleming, Joseph Lister and many others. It also rejected the possibility of highly diluted preparations having any medicinal action, but attributes claimed effects to the Placebo Effect.

The "Law of Similars"

Homeopathy is founded on the "Law of Similars". This is not a "scientific" law in the sense that it is not built on a hypothesis that can be falsified scientifically; a failure to cure homeopathically can always be attributed to incorrect selection of a remedy.

The "Law of Similars" derives its justification from the clinical results that homeopaths claim. However, there are many methods for determining the most-similar remedy (the simillimum), and homeopaths also often disagree about the diagnosis. This is due in part to the complexity of the idea of 'totality of symptoms'; homeopaths do not use all symptoms, but decide which are the most characteristic; this evaluation is the aspect of diagnosis requiring the most knowledge and experience. Finally, the remedy picture in the Materia Medica is always more comprehensive than the symptomatology that one individual ever exhibits. These factors mean that a homeopathic diagnosis remains presumptive until it is verified by testing the effect of the remedy on the patient.

Hahnemann first expressed the exhortation similia similibus curentur or "let likes cure likes." The relation of similarity is determined by provings, in which healthy volunteers given a substance in homeopathic form record changes in their physical, mental, and spiritual symptoms. This information is compiled in a Materia Medica. Subsequent versions of the Materia Medica incorporate symptoms observed to have been cured by the remedy. A homeopathic repertory is an index of the Materia Medica (a list of symptoms0, followed by claimed remedies.

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

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

See also: List of common homeopathic remedies

The "Theory of Infinitesimals"

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and the side-effects diminished) by dilution, in a procedure known as dynamization or potentization. Liquids are successively diluted (with water, or alcohol for water-insoluble materials) and shaken by ten hard strikes against an elastic body (succussion). Insoluble solids are diluted by grinding them with lactose (trituration). Higher dilutions are considered to be stronger 'deep-acting' remedies.

The dilution factor at each stage is traditionally 1:10 ("D" or "X" potencies) or 1:100 ("C" potencies). Hahnemann advocated 30C dilutions for most purposes, i.e. dilution by a factor of 100³⁰ = 10⁶⁰. As Avogadro's number is only 6.022 × 10²³ particles/mole, the chance of even one molecule of the original substance being present in a 15C solution is small, and it is extremely unlikely that one molecule would be present in a 30C solution. Thus homeopathic remedies that have a high "potency" essentially contain just water, but this water is believed by practitioners of homeopathy to retain some "essential property" of the substance once present.

A key criticism is that any water will, at some time in its history, have been in contact with many different substances. Thus, any drink may be considered to be an extreme dilution of almost any agent you care to mention. Thus, critics argue that almost everyone is almost always receiving homeopathic treatment for almost every condition. Proponents of homeopathy respond that the methodical dilution of a particular substance, beginning with a 10% solution and working downward, is different; exactly why this is different is not clear.

Later homeopaths advocated very high potencies, which could not be made by traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which integrate dilution and succussion into a continuous process (Korsakoff). The practitioner's choice of what potency is appropriate is subjective; it involves his or her opinion of how "deep-seated" the disease is; whether it is primarily physical or more mental/emotional; the patient's sensitivity based on the practitioner's intuitive assessment or previous reactions to remedies; and the desired dosing regimen (e.g. low potency repeated often, vs high potency repeated seldom). Generally, French and German homeopaths use lower potencies than their American counterparts. Most homeopaths believe that the choice of potency is secondary to the choice of remedy: i.e. that a well-chosen remedy will act in a variety of potencies, but an approximately matched remedy might act only in certain potencies.

History

Hahnemann developed homeopathy after coming upon the idea that "like cures like" while translating a work on malaria. On reading that quinine was effective because it was bitter, Hahnemann felt this implausible because other substances were as bitter but had no therapeutic value. To understand the effects of quinine, he decided to take it himself, and saw that his reactions were similar to the symptoms of the disease it was used to treat.

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

Homeopathy came to the USA in 1825 and rapidly gained popularity, partly because the excesses of conventional medicine were extreme there, and partly due to the efforts of Constantine Hering. Homeopathy reached a peak of popularity in 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 to the development of homeopathy was James Tyler Kent (1849 – 1921). Kent's influence in the USA was limited, but in the UK, his ideas became the homeopathic orthodoxy by the end of the First World War. His most important contribution may be his repertory, which is still used today. Kent's approach was authoritarian, emphasizing the metaphysical and clinical aspects of Hahnemann's teachings, in particular

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

Today, the ease with which large databases can be manipulated has profoundly changed the way homeopathy is practised. Today, many homeopaths use computers to sift through thousands of provings and case studies. Because information about lesser-known remedies is more accessible, it is now more common for homeopaths to prescribe them, which has led to an increase in the number of new provings.

See also: List of important homeopaths

Homeopathy around the world

There are estimated to be more than 100,000 practitioners of homeopathy worldwide, with an estimated 500 million people receiving treatment. More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatment in the UK, France, and Germany. Since 2001, homeopathy is regulated in the European Union by Directive 2001/83/EC; the latest amendments make it compulsory for member states to implement a registration procedure for homeopathic remedies.

In the UK, 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 many regional clinics. Homeopathy is not practised by most of the medical profession, but there is a core of public support, including from the English royal family.

In India, homeopathy has been practised since the middle of the 19th century, and is officially recognized. India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals. Also in India, Ayurveda, another form of medicine that could be likened to homeopathy, was used before 5000 B.C.

In the USA, homeopathic remedies are, like all healthcare products, regulated by the Food and Drug Administration. However, the FDA treats homeopathic remedies very differently to conventional medicines. Homeopathic products do not have to be approved by the FDA before sale, they do not have to be proved to be either safe or effective, they do not have to be labeled with an expiration date, and they do not have to undergo finished product testing to verify contents and strength. Unlike conventional drugs, homeopathic remedies do not have to identify their active ingredients on the grounds that they have few or no active ingredients. In the USA, only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter; homeopathic medicines that claim to treat a serious disease can be sold only by prescription. Neither the American Medical Association (AMA) 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 surgery. 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.

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

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

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

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

Classical versus non-classical homeopathy

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

The popularity of homeopathy

In the 1930s the popularity of homeopathy waned, especially in Europe and the USA, partly due to advances in conventional medicine, to the Flexner Report (1910) which led (in the USA) to the closure of virtually all medical schools teaching alternative medicine. Homeopathy had a renaissance in the 1970s, largely because of George Vithoulkas in Europe and the USA, that continues to this day. In the USA, in 1995, retail sales of homeopathic medicines were estimated at US$201 million, and growing at 20% per year, according to the American Homeopathic Pharmaceutical Association, and the number of homeopathic practitioners increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.

The rise in popularity of homeopathy is part of a general rise in interest in alternative medicine over the past few decades.

Possible reasons for the increasing use of homeopathic remedies are:

• Reported clinical efficacy: Some homeopathic patients may have found treatment to be effective, or heard from friends, colleagues, and the press of 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 no adequate explanation for homeopathy, they may take an empirical view: whatever works in their experience is good enough. 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 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).

• Exhaustion of other options: Some come to homeopathy after years of other conventional or alternative treatment. They try homeopathy, figuring that they have nothing to lose, even if they actively disbelieve it.

The scientific validity of homeopathy

Scientists consider homeopathy to be lacking a plausible mechanism to explain its alleged workings, and that homeopathy is a pseudoscientific remnant from the age of alchemy. Others reject homeopathy due to its "religious" nature, i.e. the lack of scientific principles or reasonable proof of efficacy.

The primary criticisms of homeopathy include the lack of evidence in form of studies conforming to a high scientific standard; the lack of a mechanism to explain how ultra-dilute solutions can retain an imprint of a molecule that no longer exists in solution; and the high level of subjectivity involved in both giving and receiving treatment.

Further criticism is based on theoretical understanding of physical/chemical/biological properties of matter and its interaction in the biological sphere. Regardless of whether the dilution medium is water or alcohol, the existing theory of molecular physics does not provide a mechanism for clinically efficacious imprinting of anything much in a liquid medium once those molecules have been diluted to near non-existence.

Experiments trying to measure this effect have failed, and none have ever been reliably reproduced, thus eluding one of the foundational requirements of science, consistent and reliable reproducibility of results in double-blind trials by largely impartial clinicians, practicing on largely impartial patients.

Critics also reject homeopathy as logically incoherent. They ask: 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 as 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?

Several meta-analyses have yielded inconclusive or unfavourable results, with two observing that the higher quality trials were more likely to reject claims of efficacy over the placebo effect.

Linde et al (2001) summarize as such:

In conclusion, the available systematic reviews on homeopathy provide little guidance for patients and doctors. They reflect the fundamental controversy on this therapy, and strengthen the perception that isolated examples of positive evidence from clinical trials will not convince skeptics, and 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 herbal components (akin to herbology). While herbs are used, homeopathy also uses 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.

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.

As the term homeopathy is well known and has good marketing value, the public can be confused by people who have adopted the term for other forms of therapy. For example, some companies 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 of Hahnemann can be called homeopathic. Many producers of homeopathic remedies also produce other types of alternative remedies, under the same brand name, which can create confusion for the general public.

Homeopathy and vaccination

To some, homeopathy, particularly the use of nosodes, resembles 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. However, 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

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.[2]

Sources

• Magical Thinking in Complementary and Alternative Medicine from the Skeptical Enquirer
• Homeopathy: The Test - programme summary from BBC
• 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)
• 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)
• Walach H "Unspezifische Therapie-Effekte. Das Beispiel Homöopathie" [PhD Thesis]. Freiburg, Germany: Psychologische Institut, Albert-Ludwigs-Universität Freiburg, (1997)
• Ernst E. "Classical homeopathy versus conventional treaments: a systematic review" Perfusion, (1999); 12: 13-15
• Moritz RV, Rodrigues A. "A critical review of the possible benefits associated with homeopathic medicine", Rev. Hosp. Clin. 58(6)
• 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
• Kleijenen J, Knipschild P, ter Riet G. "Clincal trials of homeopathy." BMJ (1991); 302: 316-323
• Bandolier Homeopathy - dilute information and little knowledge [3]
• 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.[4]
• James Randi Educational Foundation. "The JREF Million Dollar Paranormal Challenge 'FAQ'". [5] Retrieved 13 September, 2005.
• footnote to pp.12-13, Hahnemann's Chronic Diseases, ed. P. Dudley, B. Jain Publishers, 1998 reprint
• Response to Lancet article "Homeopathy, Research & The Lancet"
• [6]
• Answer to Lancet by George Vithoulkas "Answer to Lancet"

External links

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

Neutral

• 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
• Water Structure and Behaviour— balanced and up-to-date references to current scientific understanding of water, with specific entries on "memory effects" and homeopathy

Supportive

• 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
• Introduction and Information on Homeopathy
• Homeo Cure Center - Forum discussing health issues, homeopathic remedies, and veterinary homeopathy.
• Complementary Medicine - Therapies: Homeopathy BBC's "Complementary Medicine" article on Homeopathy
• Referrals to Certified Classical Homeopaths
• Alliance of Registered Homeopaths
• Homéopathe International — The English language version of Homéopathe International
• Homeopathy Timeline with a wealth of historical and biographical information
• Adjuvant homeopathic treatment in Breastcancer, a pilot study [7] (in German)

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