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 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

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 corresponding remedy for a given disease picture.

Provings and pathogenesies

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). 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. 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 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, 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 is 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. He suggested that Hahnemann had contracted malaria germs which 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 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 fragmentary knowledge, and the rest are used without empirical knowledge of their homeopathic properties at all.

The choice of a remedy

Another silent assumption in the homeopathic theory 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, 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 the 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.

The concept of constitutional prescribing was given a particular twist of meaning by Kent, the second most influential homoeopath after Hahnemann. Kent, a devout Swedenborgianist, 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 anchored in his religious conceptions. According to his Swedenborgian view, any 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. 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 which 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 (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 (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, 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. 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, 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 homoeopathic 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".

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.

An invented example: a patient originally treated with medicinal ointments for a body-wide rash, later became asthmatic, and 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 this Greek word 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".

Later speculations produced more miasms, such as tuberculosis and cancer. Their definitions are no better than Hahnemann's. So, tuberculosis is said to be 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.

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

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