Homeopathy/PreviousVersion: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Raymond Arritt
(→‎Preparation of homeopathic remedies: use simpler language and add a concrete example)
imported>John Stephenson
({{PreviousVersion}})
 
(975 intermediate revisions by 21 users not shown)
Line 1: Line 1:
{{subpages}}
{{PreviousVersion}}
{{TOC|right}}
<div class="usermessage plainlinks">The Editorial Council has made a unanimous decision on December 17, 2010, to blank this draft article and to place a minimum of a one-year moratorium on any further edits to this article. The discussion concerning this decision may be found at [http://locke.citizendium.org/cz_ec/DR-2010-006].  The Talk page remains, but its present contents will be moved to an archive.  The Approved Main Article also remains in place. This page is now protected by the Constabulary and no further edits can be made to it. After one year has passed, Citizens may ask the Editorial Council to reconsider their decision but there is no guarantee that they will do so.
<br>
The Secretary of the Editorial Council, [[User:Hayford Peirce|Hayford Peirce]] 04:09, 17 December 2010 (UTC)


'''Homeopathy''' or '''homoeopathy''' is a 200 year old system of alternative medicine based on the "principle of similars", which asserts that substances that ''cause'' a particular syndrome of symptoms can also help to ''cure'' diseases which display similar symptoms. <ref>For the selection of a homeopathic medicine, the term "symptom" refers to important external manifestations of a disease, without the medical distinction between [[symptom]] and [[sign (medical)|sign]]. As a medical term, [[syndrome]] may be closer to the combination of manifestations used in homeopathic remedy selection, although the procedure for diagnosis is the same.</ref> Its principles are based on the theory that the symptoms of a disease reflect efforts of the human body to resist damage from infection, environmental toxins, or various stresses. Homeopaths historically called this inherent survival response to be the body's ''vital force'' - akin to what [[physiology|physiologists]] would call the body's "defense systems" (or ''qi''<ref>''Qi'' is the correct spelling in pinyin, which is the Romanization scheme approved by the Chinese government and used by (probably) most western scholars today. "Ch'i" (note the apostrophe!) is the correct spelling in the Wade-Giles system, which was widely used before pinyin, survives in many older texts, and is still used by some western scholars today. </ref> in [[traditional Chinese medicine]]). Homeopathy is a fundamentally different model of health whose principles are not used or accepted by most scientists or physicians.
==== Moratorium extended ====
The moratorium has been extended by another year. [http://ec.citizendium.org/wiki/EC:D-2012-002 EC:D-2012-002]. --[[User:Peter Schmitt|Peter Schmitt]] 01:20, 20 January 2012 (UTC)
</div>


Homeopathic treatment involves ''remedies'', which are extremely small doses of substances repeatedly diluted and vigorously shaken ("succussed") in [[Water|water]] or [[Ethanol|ethanol]], and ultimately dispensed in pills or liquid form. These substances are chosen for their ability (in large doses) to provoke the same symptoms that the remedy is intended to heal (and thereby for their presumed ability to stimulate natural healing). Such substances must be administered in extremely small doses; it is a homeopathic principle that the process of repeated dilution with succussion makes the remedy more potent as long as the the toxicology of the remedy is similar to the syndrome of symptoms the sick person is experiencing. Serial dilution, with vigorous shaking in-between each dilution, often continues to the point where none of the original substance remains in the remedy; homeopaths assert that the process of dilution and succussion fundamentally changes the nature of the medicinal solution and enable it to have profound healing effects. The principle of similars and the pharmacological method of dilution and succussion are used uniquely by homeopaths and are rejected by modern scientists. Most scientists and physicians believe that these remedies have no benefits beyond placebo effects.
<hr><br>
 
The term '''homeopathy''' derives from the Greek ''hómoios'' (similar) and ''páthos'' (suffering). Some principles of homeopathy have been used in various forms in medical systems for thousands of years in diverse cultures<ref>{{citation
| first = Linn | last = Boyd
| title = The Simile in Medicine
| publisher = Boericke and Tafel| year = 1936}}</ref>, but they were first methodically set out by a German physician, [[Samuel Hahnemann]] (1755–1843), who observed that a medicine sometimes evoked symptoms similar to those of the illness for which it was prescribed. Related maxims such as the "Law of similars" are common in general anthropology,<ref name=Fraser>{{citation | url = http://www.gutenberg.org/dirs/etext03/bough11h.zip |first =James George | last = Frazer | contribution = Chapter III: Sympathetic Magic; 1. The Principles of Magic | title = The Golden Bough: A study of magic and religion | publisher = Project Gutenberg}}</ref> traditional healing <ref name=>{{citation |title =Early Anthropology in the Sixteenth and Seventeenth Centuries | first= Margaret Trabue | last =Hodgen | publisher = University of Pennsylvania Press | year= 1964 | url = http://books.google.com/books?id=Wa12Spdp_WYC&pg=PA392&lpg=PA392&dq=%22like+cures+like%22+anthropology&source=bl&ots=ffDShkiaCD&sig=wNySoaO7B5gqz89DgEGQU7eCCrg&hl=en&sa=X&oi=book_result&resnum=3&ct=result}}, p. 392</ref> and the literature of homeopathy.<ref name=Scofield>{{citation | | title = Homeopathy “Similia Similibus Curentur” |first= Edward L.W. | last = Scofield | journal = Innominate Society | date = June 20, 2001 | url = http://www.innominatesociety.com/Articles/Homepathy%20Similia%20Similibus%20Curentur.htm}}</ref>
When homeopathy was developed in the 19th century by Hahnemann and his followers, conventional medicine offered no safe and effective drugs; by contrast, homeopathic treatments were at least not actively toxic.
 
Physicians are concerned that some patients seek homeopathic treatment as a first resort, even for conditions where there are effective conventional treatments. For example, [[asthma]] and other respiratory disorders with a seemingly mild initial presentation can be a life-threatening condition, and acute attacks, if not treated promptly and effectively, can lead to sudden death. According to conventional opinion, prescribing homeopathic remedies in these cases may delay the delivery of conventional treatment with potentially serious consequences. Medical organisations advise that there is no evidence that homeopathic remedies are effective in these circumstances, and recommend that they should only be used in conjunction with conventional treatment<ref>e.g. [http://www.asthma.co.za/articles/ref10.htm Asthma Medicines and how they work] National Asthma Education Programme; [http://www.asthma.org.uk/all_about_asthma/medicines_treatments/index.html How can I treat my asthma?] Asthma U.K.</ref>. A number of homeopaths consider [[vaccination|vaccines]] to be actively dangerous and recommend they not be used, which public health specialists say presents a danger to the community.<ref>[http://www.abc.net.au/news/stories/2009/03/19/2520754.htm Health service warns against homeopathic whooping cough remedy]</ref> Some homeopaths advise against the use of drugs to prevent malaria, to which advice even the director of the Royal Homeopathic Hospital objects (see Section "Safety" below).
 
Although most physicians and scientists doubt its therapeutic value beyond a [[placebo effect]], homeopathy is practised by some medical doctors, as well as by other health professionals in most countries. In Europe, homeopathic remedies are one of the most popular of the alternative and complementary treatments, with between 11% and 27% of general practitioners in each country prescribing homeopathic remedies at least occasionally.<ref>Fisher P, Ward A (1994) Complementary Medicine in Europe ''British Medical Journal'' 309: 107-10</ref>  In India, homeopathy has the status of a 'national system' of medicine, and approximately 100 million Indians use homeopathic remedies as their sole method of medical treatment.<ref>Prasad R (2007) Homoeopathy Booming in India ''Lancet'' 370:1679-80</ref>
 
==Overview==
 
Homeopathy has a long history, and its growth in the 19th century had a major influence in determining the way that conventional medicine organised and developed, and in how it came to formulate its present vision of evidence-based medicine, in contrast to practice based on individual clinical experience.  However, the theory underlying homeopathy is considered to violate accepted principles of the physical and biological sciences, and in key respects the treatment advice offered by homeopaths is in disagreement with conventional medicine.
 
It is an accepted maxim in science that "extraordinary claims need extraordinary proof".  With regard to homeopathy, the "extraordinary claim" is that extremely dilute preparations – often chemically and physically indistinguishable from water – can have a healing effect. For their part, homeopaths state that the overall evidence for homeopathy, including clinical research, animal research, basic sciences research, historical usage of homeopathic medicines in the treatment of people in various infectious disease epidemics, and widespread and international usage of homeopathic remedies today, indeed provide the required extraordinary evidence for its benefits.<ref name=Bell>{{citation
| author = Bell I
| year =2005
| title = All evidence is equal, but some evidence is more equal than others: can logic prevail over emotion in the homeopathy debate?
| journal = J Alt Comp Med
| url = http://www.jspshomeocollege.in/Research/Article-3%20JACM.pdf 
| volume = 11 | pages = 763–9}}</ref>
 
Homeopathic remedies are used by many people throughout the world. Like many other complementary and alternative therapies, homeopathy generally scores highly in "patient satisfaction" surveys, and it has a reservoir of public support. In the U.K. for instance, a survey cited by the British Homeopathic Association found that 15% of the public put trust in homeopathy.
 
Many scientists and medical professionals also are interested in homeopathy. They are interested in ''why'' so many people use homeopathy, since they believe it has no scientific plausibilty. They are interested too in why many studies have positive outcomes&mdash;do these reflect real efficacy, or can they be accounted for by flaws in study design or in statistical analysis, or "[[publication bias]]"&mdash;the tendency for positive outcomes to be published while studies with negative or inconclusive outcomes are not. They also are interested in whether positive results against expectation sometimes reflect manipulation of data or perhaps even fraud. 
 
<!-- Commented out by Paul Wormer (Paragraph is not about homeopathy)
This interest has a broader relevance than homeopathy. A huge number of research papers are published every year in the scientific literature - [[PubMed]] covers more than 6,000 journals in biology and medicine, and excludes many journals that do not meet its quality criteria. Many of these papers report results that turn out to be wrong for different reasons. Usually, errors are exposed when attempts to replicate the data fail; often contradictory results are reported, but often papers are quietly "forgotten" - never cited because their flaws become evident. Sometimes in conventional science overt fraud is revealed, but often it is impossible to confirm that fraud is present. But in conventional science generally, what counts is replicability - it doesn't matter whether unreliable results are the result of fraud or error, individual reputations depend on publishing important data that can be replicated consistently. Accordingly, scientists are professionally concerned with understanding the sources of error - including all sources of error, in study design, methodology, analysis and interpretation; and for some of them, homeopathy seems like a source of examples where they feel that the conclusions "must" be wrong, so finding the sources of error can teach useful lessons.
-->
<!-- Commented out as irrelevant by Daniel Mietchen
Of course, it is possible that scientists and physicians have it wrong; perhaps homeopathy is indeed effective, and, if so, there is something important to be studied. Scientists enjoy a considerable degree of trust, and their assertions are often accorded considerable "authority". Some may exploit this authority, but the ethos of science generally is one of disciplined skepticism - including skepticism about ''all'' that we think we know. Scientific theories are ''never'' proven, but always provisional, subject to revision and occasional abandonment as knowledge grows. So scientists generally reject arguments from authority as being of any value - only arguments from reason, embracing current knowledge and understanding count, and these are arguments that each scientist must make for himself or herself, and make afresh as fresh knowledge comes.
 
Scientists in almost any area expect that, what today is the consensus understanding will, in some tomorrow, by a mere curiosity in the history of science. They expect that many of their present "answers" will turn out to be not quite right and some will be quite wrong. However, they generally think it very unlikely that homeopathy will ultimately prove to have any validity.
-->
 
===Historical origins ===
{{main|History of Homeopathy}}
Hahnemann coined the term homeopathy and defined the fundamental paradigm. Earlier healers, such as
the early Greek physician [[Hippocrates of Cos]] (c. 450 BCE - 380 BCE) <ref name=Hippo1>{{citation | url = http://www.iep.utm.edu/h/hippocra.htm | title = Internet Encyclopedia of Philosophy | contribution = Hippocrates (c. 450 BCE to 380 BCE) | first = Michael | last = Boylan | year = 2006}}</ref>, who is considered to be the "father of medicine", is also claimed by homeopaths as a pioneer in their own tradition.
 
Hippocrates taught that "Natural forces within us are the true healers of disease," but also because he recorded what some physicians of that day did to initiate healing:  he noted that some physicians cured people by using the same medicinal substances that caused the symptoms that the sick people were experiencing-—arguably an early expression of the "principle of similars." It was not until the early 19th century, Hahnemann created an experimental method, called "drug provings," whereby a substance is given to healthy human substances in continual dosage until symptoms are elicited.  Initially, Hahnemann and other homeopaths gave their experimental subjects crude doses of medicinal substances, but over time, homeopaths found that they could also elicit symptoms in healthy subject when given potentized doses of medicines in repeated doses.   
 
In 1783, disillusioned with the medicine of his time and the many toxic effects of its treatments, Hahnemann gave up his medical practice and devoted himself to translating medical books, including many of the leading textbooks of the day. Among them was the ''Treatise on [[Materia Medica]]'' (1789) by [[William Cullen]], the leading physician of the 18th century. Cullen had written that cinchona bark (which contains [[quinine]]) was effective in treating [[malaria]] because of its bitter and astringent properties. Hahnemann questioned this theory because he knew that other substances were as bitter and astringent, but had no therapeutic value in this deadly disease. <ref>{{citation
| author = Morrell P
| url = http://homeoint.org/morrell/articles/index.htm
| title = Articles on Homeopathy}}</ref>
<ref name=Timeline>{{citation
| title = Homeopathy Timeline
| journal = Whole Health Now: Homeopathy Information for the Professional
| url = http://www.wholehealthnow.com/homeopathy_pro/homeopathy_1825_1849.html}}</ref>
 
Being an avid experimenter, Hahnemann took cinchona bark himself and saw that the symptoms that it caused were similar to the symptoms of the diseases for which it was prescribed. He then experimented with other substances and found that the symptoms that they caused were also similar to the symptoms of the diseases for which they were prescribed. These experiments led him to formulate the "principle of similars" - ''similia similibus curentur'' or "let likes cure likes". He used his experiments and the principle of similars to develop a new system of health care, as an alternative to the often toxic and ineffective drugs and treatments offered by conventional physicians of the time.
===Initial publication===
Hahnemann named his system of health care "homeopathy" (meaning "similar to disease"). He coined the term "allopathy" ("different than disease") to refer to the conventional medicine of the day, because its drugs were sometimes "similar," sometimes "opposite," but usually just "different" to the symptoms of the sick person.<ref>Hahnemann S (1796) translated into English as [http://www.minutus.org/library/article_read.asp?id=6 "Essay on a New Principle"]. Hahnemann's[http://www.homeopathyhome.com/reference/organon/organon.html
''Organon der Heilkunst''] in English translation</ref>
 
For the first two decades of Hahnemann's practice of homeopathy, he used "crude" doses of various medicinal substances ("crude", in homeopathic use, means doses that still contain some of the original ingredient). He strove to find the lowest doses at which his remedies would still be effective, as he thought this the best way to avoid any adverse side-effects. To his surprise, it seemed that reducing the dose did not reduce the effectiveness of his treatments. Instead, he concluded that his remedies worked better the more he diluted them as long as the medicines were properly “potentized,” that is, they were serially diluted (either 1:10, 1:100, or 1:50,000) with vigorous shaking (succussion) in-between dilutions. Homeopathy thus became inextricably linked with this process of [[ultradilution]]—-repeated dilution of substances with succussion. Hahnemann did not offer a clear explanation as to how or why these potentized medicines might have therapeutic benefits; he distrusted all theoretical explanations and argued that all that mattered was whether a treatment was therapeutically effective.<ref>Dean ME (2001) [http://shpltd.co.uk/dean-homeopathy.pdf Homeopathy and the progres–s of science] ''Hist Sci''xxxix</ref>. He believed that diseases were caused by "spirit-like derangements of the spirit-like power that animates the human body" and that effective healing called for medicines that was also "spirit-like" and would stimulate this life force.
===United States===
Homeopathy was introduced into the U.S.A. in 1825 by [[Hans Burch Gram]], a [[Boston]]-born doctor who had studied homeopathy in [[Europe]]. In 1830 the first homeopathic schools opened. The first homeopathic medical college in the U.S.A. opened in 1835, in [[Allentown, Pennsylvania]], and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the U.S.A. Apart from his ventures into homeopathy, Hahnemann had been a prominent and respected public health reformer, and in the 1830s the Medical Society of the Country of New York had granted him honorary membership. However, a few years later the society rescinded this when they realized the "ideological and financial threat" that homeopathic medicine posed.<ref>Kaufman M (1988) "Homeopathy in America: The Rise and Fall and Persistence of a Medical Heresy", in N. Gevitz, ''Other Healers: Unorthodox Medicine in America.'' Baltimore: Johns Hopkins</ref> In 1844, the first U.S. national medical association - the [[American Institute of Homoeopathy]] - was established.<ref>[http://www.homeopathyusa.org/ American Institute of Homeopathy]
:Winston, J (2006) "[http://www.wholehealthnow.com/homeopathy_pro/homeopathy_1825_1849.html Homeopathy Timeline]". The Faces of Homoeopathy. Whole Health Now.</ref>
 
By the end of the 19th century, 8% of American medical practitioners were homeopaths, and there were 20 homeopathic medical colleges (including [[Boston University]], [[New York Medical College]], [[Ohio State  University]],[[University of Iowa]], [[University of Minnesota]] and [[University of Michigan]]) and more than 100 homeopathic hospitals in the U.S.A. One reason for the growing popularity of homeopathy was its relative success in treating people suffering from the infectious disease epidemics that raged at the time. <ref>Coulter HL (1973) ''Divided Legacy'' (vol. II, pp 544-6; III, pp 267-70, 298-305). Berkeley: North Atlantic</ref> [[Cholera]], [[scarlet fever]], [[typhoid fever]], and [[yellow fever]] were rampant and killed many people, but death rates in homeopathic hospitals were often very much lower than in the conventional hospitals, whose cures – purging, blood-letting and mercury treatments, were often worse than the diseases, and did nothing to combat them. Death rates in conventional hospitals were typically two- to eight-fold higher than in homeopathic hospitals for patients with these infectious diseases. <ref>Bradford TL (1900) ''The logic of figures: The comparative results of homeopathic and other treatments.'' Philadelphia: Boericke and Tafel</ref>
===Changes in medical education===
After the turn of the century both the number of homeopathic colleges and the number of students declined rapidly.  In 1900 there were 21 homeopathic schools in the U.S.; by 1909, there were 14. In the following year the "[[Flexner Report]]," sponsored by the [[Carnegie Foundation]] with support from the [[American Medical Association]], triggered major changes in American medical education. This further weakened homeopathy's status and by 1925 the number of homeopathic schools declined to only two. Most  were closed down, while others became conventional medical schools (including Boston University, New York Medical College, and Ohio State University). In the 1960s, the popularity of homeopathy began to revive again in the U.S.A, and a 1999 survey reported that over 6 million Americans had used homeopathy in the previous 12 months.
 
According to the American Homeopathic Pharmaceutical Association, the 1995 retail sales of homeopathic remedies in the U.S.A. were estimated at $201 million and growing at a 20% per year; the number of homeopathic practitioners in the U.S.A. increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.
 
===Homeopathic "provings"===
{{main|Homeopathic proving}}
Homeopathic practitioners determine the specific therapeutic indications for their remedies from experiments in toxicology called ''provings,'' in which volunteers are given repeated doses of substances (usually in single-blind or double-blind trials), until symptoms of overdose are observed. The effects of each medicinal substance are recorded in textbooks, called ''Materia Medica''<ref name=Boericke-Materia>{{citation
| title = Homeopathic Materia Medica
| first = William E. | last = Boericke
| url =http://www.homeoint.org/books/boericmm/index.htm
}}</ref>
and ''Repertory'',<ref name=Boericke-Repertory>{{citation
| title = Repertory
| first = Oscar E. | last = Boericke
| url = http://www.homeoint.org/books4/boerirep/index.htm
}}</ref>
or nowadays in expert system software. [[Homeopathic proving]]s provide an experimental basis to determine what a substance causes in overdose and thereby what it is thought to cure. The symptom complexes that these substances cause are subsequently used to compare with a patient's physical and psychological symptoms in order to select, as the appropriate most similar ''remedy'', the substance whose effects are closest to the patient's symptoms—called the "simillimum".
 
An example of a proving is that of Bambusa arundinacea ([[bamboo]]). In this proving, the 20 subjects did not know whether they were taking the bamboo or a [[placebo]], and the investigator knew only the substance name, but not, at that time, its properties. The 6C and 30C potencies were used. The symptoms elicited by the treatments are detailed in a 237-page book, which details the hundreds of symptoms that bamboo was found to cause (and therefore, accord to homeopathic principles, potentized doses of this medicine will stimulate to heal people whose symptoms are similar to this syndrome of symptoms).<ref>’’Bamboo - Homeopathic Proving of Bambusa Arundinacea, Repertory and Cases’’ By Bernd Schuster Germany, paperback, 237 pages ISBN: 3980595811. Reviewed here [http://www.minimum.com/reviews/bamboo-proving.htm Bamboo: A Homeopathic Proving Reviewed by Julian Winston], and discussed here [http://www.homoeopathie-online.com/materia_medica_homoeopathica/bambus.htmhttp://www.minimum.com/b.asp?a=bamboo-schuster ''A Reading of Bamboo’'], a seminar given by Nick Churchill, March 2000 to the Czech Homeopathic Society
</ref>
In the first two phases of the proving, all of the subjects were given the remedy in various potencies. In the third phase, seven of them were given placebo. The study started in October 1994 and lasted until February 1995, during which time they recorded every symptom they experienced in a diary and noted whether it was a persistent, new, old, altered or unusual symptom. The recorded symptoms take up 84 pages in the book. The symptoms are then converted into repertory rubrics in the next 46 pages. The last 76 pages consist of the author's commentary about the proving symptoms, and 14 cases in which bamboo was the prescribed remedy.
 
Homeopaths prescribe this remedy (in potentized doses) when a sick person has a syndrome of symptoms that resemble the syndrome of symptoms that it causes in drug proving. The recorded symptoms need to be interpreted by an experienced homeopath to understand the conditions for which the remedy might be considered as possibly useful. In the case of bamboo, some homeopaths have determined that one of the themes of people who will benefit from this medicine is a "search for support." The proving cites that this remedy is also useful in treating post-natal depression accompanied by irritability and impatience, for example, when a mother makes statements like "I can't handle my child and I have no desire to get out of bed." In cases requiring physical support, it is indicated when there is a need for support in the back associated with pain, sciatica, stiffness and changes to the spine. Finally it is indicated with symptoms such as swelling of the breasts before menses accompanying depression.<ref>[http://www.wellbeing.com.au/natural_health_articles?cid=7163&pid=16483 Bamboo, a new remedy for postnatal depression] by Linlee Jordan ''Wellbeing'' Issue, 91 Page, 27</ref>
 
In September 2006 the U.K.’s licensing body, the ''Medicine and Healthcare Products Regulatory Agency'', altered their regulations to permit homeopathic remedies to be advertised using homeopathic provings to support their claims (justifying phrasing such as “For the relief of...”). This change elicited protests from scientists, who called it a departure from the principle that such claims should be justified by evidence of efficacy.<ref>[http://www.senseaboutscience.org.uk/index.php/site/project/86 New regulations on licensing of homeopathy] The Medicines for Human Use (National Rules for Homeopathic Products) Regulations 2006, ''Sense about Science''</ref>
 
===Homeopathic manufacture of remedies===
In the U.S.A., the ''Homœopathic Pharmacopœia of the United States''<ref name=HPUS>{{citation
| title = The Homœopathic Pharmacopœia of the United States (HPUS)
| author = Homeopathic Pharmacopoeia Convention of the United States
| url = http://www.hpus.com/whatishpus.php
}}</ref> is a legally recognized handbook that describes how to manufacture homeopathic drugs. This reference text is recognized and approved by the [[Food and Drug Administration]] (FDA), the governmental agency that regulates drugs. Medicines listed in the HPUS defines them as homeopathic drugs which grants them a different standard of drug regulation due to their long-term history of safety<ref name=21CFR>{{citation
| journal = U.S. Code of Federal Regulations (CFR)
|title = Part 210 - Current good manufacturing practice in manufacturing, processing, packing, or holding of drugs; General Part 211 - Current good manufacturing practice for finished pharmaceuticals
| url = http://www.fda.gov/cder/dmpq/cgmpregs.htm
| author = Center for Drug Evaluation and Research, U.S. [[Food and Drug Administration]]
| contribution = § 211.137 Expiration dating.
}}</ref>
than conventional drugs and medical devices. A summary from the FDA describes the principles:
<blockquote>FDA regulates homeopathic drugs in several significantly different ways from other drugs. Manufacturers of homeopathic drugs are deferred from submitting [[new drug application]]s to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and indicates that the drug is homeopathic. The imprint on conventional products, unless specifically exempt, must identify the active ingredient and dosage strength as well as the manufacturer.<ref name=FDA-HP>{{citation
| title = Homeopathy: Real Medicine or Empty Promises?
| first = Isadora Stehlin
| publisher = [[Food and Drug Administration]]
| url = http://www.fda.gov/fdac/features/096_home.html
}}</ref>
</blockquote>
In 1938, the federal [[Food, Drug, and Cosmetic Act]], sponsored by New York Senator [[Royal Copeland]], a homeopathic physician (and former homeopathic medical school dean), gave the FDA the power to regulate drugs and granted legal recognition to the "Homeopathic Pharmacopeia of the United States" as a compendium of drugs. In contrast, non-homeopathic drugs for which a [[New Drug Application]] is required must be accompanied by approved evidence of safety and efficacy; simple listing in a reference is not sufficient.<ref name=FDA-HP /> Today, homeopaths use about 3,000 different remedies, from animal, plant, mineral, or synthetic sources.
 
By convention, the first letter of the Latin-derived name of such preparations is capitalized. When the source is well-defined, the traditional name rather than [[chemical name|chemical]], [[International Nonproprietary Name]] or biological nomenclature, is preferred, such as ''Natrum muriaticum'' rather than ''sodium chloride''.
Ultimately, any substance can become a homeopathic medicine if "drug provings" (tests to determine the symptoms produced by toxic doses) are first conducted to determine what it causes in overdose and therefore what it can cure in potentized doses. Remedies used in homeopathy are commonly made from plants, trees, fungi, and algae,<ref>[http://www.nhm.ac.uk/research-curation/research/projects/homeopathy/index.html Plants and fungi used in homeopathy] Natural History Museum</ref> as well as from a wide variety of mineral and animal sources. Even some unusual substances, called imponderables, can and are made into homeopathic medicines, including electricity, X-ray, and magnetic north and south poles.
 
Homeopathic remedies are available in several different forms (single medicine, homeopathic formula or complex medicines, and a limited number of external applications). Remedies for internal consumption come either in pill form or as liquid. Most do not require a doctor's prescription, but some may need one if the dosage is in a non-potentized or low potency dose and if the substance is potentially toxic (in Europe, a medicine must be diluted at least 1:10 three times to be deemed homeopathic). In the U.S.A., if a homeopathic remedy is claimed to treat a serious disease such as cancer, it can be sold only by prescription. Only products sold for “self-limiting conditions”—colds, coughs, fever, headaches, and other minor health problems that are expected to go away on their own—can be sold without a prescription (over-the-counter).
 
===Preparation of homeopathic remedies ===
The most characteristic &mdash; and controversial &mdash; principle of homeopathy is that the efficacy of a remedy can be enhanced and its side-effects reduced by a process known as "dynamization" or "potentization". In this process, liquids are diluted (with water or ethanol) and shaken by ten hard strikes against an elastic body ("succussion"), to get the next, succeeding higher potency. For this, Hahnemann had a saddlemaker construct a wooden "striking board", covered in leather on one side and stuffed with horsehair.<ref>Hahnemann's "striking board" is displayed by the [http://www.igm-bosch.de/english/f10.htm Hahnemann Museum] at the Institute for the History of Medicine (IGM), Stuttgart</ref> When insoluble solids such as oyster shell<ref>[http://www.homeoint.org/morrell/articles/pm_calc.htm Calcarea Carbonica - The Collector of Days and Fossils] by Peter Morrell</ref> are used for remedies, they are diluted by grinding them with [[lactose]] ("[[trituration]]"). The original serial dilutions by Hahnemann used a 1 part in 100 (centesimal; "C" potencies), or 1 part in 50,000 (quintamillesimal; "LM" or "L" potencies). Dr. Constantine Hering of Philadelphia later introduced dilutions of 1 part in 10 (Decimal; "D" or "X" potencies. In all cases, progressively higher "potencies" of a homeopathic remedy contain progressively ''less'' of the original ingredient.
 
A large number of homeopathic medicines sold in health food stores and pharmacies are "low potencies," that is, doses that are 3X, 3C, 6X, 6C, 12X, and 12C, all of which except for 12C contain some of the original substance in the medicine. The higher potencies (30C, 200C, 1,000C and higher), which contain none of the original substance are more commonly prescribed by professional homeopaths, who typically have found these doses to be powerful enough to only need a single dose to have a long-term effect (from several weeks to several months or longer). Research studies that determine the efficacy of homeopathic medicines are discussed elsewhere in this article.
 
The number of [[molecule]]s in a given weight of a substance can be calculated by [[Avogadro's number]] (see the section "Proposed scientific foundations for homeopathy" below), and it is extremely unlikely that even one molecule of the original substance would be present in a dilution of 12C or greater. Thus, homeopathic remedies of higher "potency"' contain just water, but according to homeopaths, the structure of the water has been altered (see [[memory of water]]).<ref>In the case of a 30C potency, in order to give a reasonable likelihood that at least one patient received one molecule of the original substance it would be necessary to administer ten trillion doses per second to each of the six billion inhabitants of Earth continuously for a million years.</ref>
 
"[[Classical homeopathy]]" or "Hahnemannian homeopathy" refers to the original principles of this medical system in which a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing rather than only the diagnosis of a disease. "[[Commercial homeopathy|Commercial]]" or "user-friendly" homeopathy refers to the use of a mixture of remedies in a single formula containing individual ingredients that are generally chosen by the manufacturer for treating specific ailments. Such homeopathic remedies are used by consumers all over the world for self-treatment of common self-limiting ailments and injuries.
 
===''Similia similibus curentur'' : the law of similars===
 
''Similia similibus curentur,'' or "let likes cure likes", is the homeopathic principle that a disease or syndrome can be cured by potentized doses of remedies that produce similar symptoms when experimentally given in toxic doses to healthy people. This assertion, known as "the law of similars", is a guiding principle in homeopathy. Homeopaths have proposed that two conventional concepts, [[vaccination]] and [[hormesis]], can be considered as analogous to homeopathy's law of similars and the use of small doses.  In contrast, scientists and medical doctors do not think that the law of similars is valid or useful. Vaccines are now known to work by mechanisms unrelated to the law of similars.
 
[[Hormesis]] refers to the phenomenon whereby some chemicals at high concentrations have opposite biological effects to those at low concentrations<ref>Calabrese EJ, Blain R (2005) The Occurrence of Hormetic Dose Responses in the Toxicological Literature, the Hormesis Database: An Overview, ''Toxicology and Applied Pharmacology'' 202:289–301.</ref>, and homeopaths have argued that this mechanism is an example of the principle of similars in justifying the use of low doses to have intended effects that are opposite to those seen at high doses. Thus hormesis has been hypothesized as an explanation for some homeopathic effects, although hormesis provides no explanation of effects of extreme dilutions: hormetic effects still are constrained by the Avogadro limit.<ref>Calabrese EJ, Baldwin LA (1998) Hormesis as a biological hypothesis
''Environmental Health Perspectives Supplements'' [http://www.ehponline.org/members/1998/Suppl-1/357-362calabrese/full.html 106, S1]</ref>
 
Although homeopaths suggest that immunization is an example of "likes curing likes", there are differences.  The doses used in homeopathic remedies are always ''very'' much lower than used in vaccines. Vaccines produce a predictable and measurable immune response (e.g., [[immunoglobulin]] production), while homeopathic remedies don't have predictable objective markers to monitor. Thus conventional treatments involve application of measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic preparations above the <math>24X</math> (<math>12C</math>) potencies do not contain any molecules of the original substance from which they were prepared, and therefore cannot activate any known metabolic or signalling pathway.
 
== Professional homeopaths: who are they? ==
There are no universal standards for homeopathic education, so licensing and regulation varies from country to country and in the U.S.A. from state to state. Some countries have exclusively homeopathic medical schools ([[India]], [[Pakistan]], [[Mexico]] etc.), some have naturopathic medicine colleges in which students are taught homeopathy as part of their curriculum (Germany has its ''heilpraktika'' [health practices]; the U.S.A., Canada, and Australia have naturopathic medicine schools that include homeopathy), and some countries certify "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant "certification" as homeopaths. In the U.S.A., there is also a separate certification process available only to MDs and DOs (there are similar choices of certification available in the U.K. for medical doctors, who have done at least MBBS). Also in the U.S.A., naturopathic physicians have their own homeopathic certifying agency.
 
In Europe complementary medicine is practiced by many conventional physicians. Over a third of France's 54500 general practitioners use complementary methods, although this number does not state how much of the complementry medicine is homeopathic versus acupuncture, manipulative therapies, etc.: 5% exclusively, 21% often, and 73% occasionally.<ref name="Fisher1994">{{citation
| author = Fisher P and Ward A
| year = 1994
| title = Medicine in Europe: complementary medicine in Europe
| journal = Brit Med J
| url = http://bmj.bmjjournals.com/cgi/content/full/309/6947/107
| volume = 309
| pages =107-11}}</ref>  Pediatric homeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status. Nearly half of the homeopathic treatments of children are by medical doctors or by ''Heilpraktiker'' (non-medical practitioners).<ref>Y. Du and  H. Knopf, ''Paediatric homoeopathy in Germany: results of the German health interview and examination survey for children and adolescents (KiGGS)'', Pharmacoepidemiology and Drug Safety Vol. '''18''' , pp. 370&ndash;379 (2009) [http://dx.doi.org/10.1002/pds.1720 online]</ref>.  In German obstetrics departments the use of complementary and alternative medicine (mainly acupuncture and homeopathy) is widespread.<ref>Münstedt K, Schroter C, Brüggmann D, Tinneberg HR, and von Georgi R, ''Use of complementary and alternative medicine in departments of obstetrics in Germany'', Forschende Komplementärmedizin  Vol. '''16''' pp 111-116 (2009)</ref> In The Netherlands almost all general practitioners occasionally refer patients to alternative practitioners, while half of them practice alternative medicine themselves (mostly homeopathy) <ref>Visser and Peters, quoted in P. Knipschild,  J. Kleijnen  and  G.  ter Riet, ''Belief  in  the  efficacy of  alternative  medicine among general practitioners in The Netherlands'', Social Science and Medicine  Vol.  '''31''',  pp.  625-626,  (1990)</ref>
 
In India, where there are more than 200,000 registered practitioners of homeopathy, homeopathy is formally recognised by the Government as one of the Indian "National Systems of Medicine", under the Department of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy)<ref>[http://indianmedicine.nic.in/html/homoeopathy/homoe.htm Indian Ministry of Health and Family Welfare]</ref>, while conventional, western medical education is controlled by the Medical Council of India<ref>[http://www.mciindia.org The Medical Council of India]</ref>. About 10% of the Indian population depends ''solely'' on homeopathy for their health care needs.<ref>Prasad R., ''Homoeopathy booming in India'', Lancet,  vol. '''370''' pp. 1679&ndash;1680 (2007) </ref> In India it is illegal to practice as a homeopath without a license and professional qualifications.
 
===A typical homeopathic visit===
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:30%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|When a homeopath is conducting an interview to characterise a patient's syndrome of symptoms, some "categories of change" are identified as important:
:(1) [[emotion]]
:(2) mentation
:(3) specific physical functioning
:(4) general physical changes
:(5) perception of self
:(6) relationships
:(7) [[spirituality]]
:(8) [[lifestyle]]
:(9) [[energy]]
:(10) [[dreaming|dream]] content and tone
:(11) well-being
:(12) perceptions by others
:(13) life relationships
:(14) a sense of freedom or feeling less "stuck"
:(15) [[sleep]]
:(16) coping
:(17) ability to adapt
:(18) [[creativity]]
:(19) recall of past experiences<ref name="pmid12676034">{{cite journal |author=Bell IR ''et al.'' |title=Homeopathic practitioner views of changes in patients undergoing constitutional treatment for chronic disease |journal=J Alt Complement Med |volume=9 |pages=39–50 |year=2003 |pmid=12676034 |doi=10.1089/10762800360520785 |url=}}</ref>
|}
 
Homeopathic remedies can be prescribed by professional homeopaths, [[naturopathy|naturopath]]s, [[acupuncture|acupuncturist]]s, [[chiropractic|chiropractor]]s, and physicians with additional homeopathic training and certification, and how these decide what to prescribe will differ accordingly. Classical homeopaths place emphasis on the patient's unique symptoms and their psychological state, and they gather this information from an interview, typically lasting from 15 minutes to two hours, with one or more follow-up consultations of 15 to 45 minutes. They place special emphasis on the way the patient experiences their disease—i.e. they give priority to the overall syndrome of symptoms and the unique and idiosyncratic symptoms which they consider different than the conventional medical approach of trying to identify the causes of the disease. The goal is to determine the factors that might predispose the patient to disease and find a treatment that will strengthen that particular patient's "overall constitution".
 
After the interview, the homeopath consults the [[#Homeopathic references for diagnosis and treatment|references]] described in the table on the right. Some homeopaths make quick prescriptions based on "keynotes"—the highlights of the best known characteristics of a remedy, but the real challenge of homeopathic practice is to find the remedy that best matches the patient's syndrome of physical and psychological symptoms—the "[[#Homeopathic_.22provings.22|similimum]]". A fundamental reason for conflict between conventional medicine and homeopathy is that homeopathy rejects the concept of treatments that target ''mechanisms'' of disease, and instead uses remedies that target ''syndromes of symptoms'' that they believe strengthen a person's overall constitution. Some homeopathic protocols might look like the following:
 
*A physician qualified in both homeopathy and conventional medicine, after diagnosing a chronic condition that does not indicate the need for medical urgency, will usually first prescribe a homeopathic remedy which is likely to have fewer side effects than conventional drugs.
*Homeopaths recognize that trauma might require conventional medical attention but may complement the conventional treatment with homeopathy.
*Homeopaths disagree with conventional medicine about the role of immunization and chemoprophylaxis for infectious diseases and prefer to prescribe homeopathic remedies that they believe will strengthen a person's immune and defense system.
*For some disease conditions, such as [[asthma]] and [[acute bronchitis]], homeopathic remedies are often prescribed not only to alleviate chronic symptoms, but also to treat acute attacks. Homeopathic remedies might also be used after an asthmatic episode with the intent to prevent recurrences.
*An adequately trained homeopath is expected to recognize symptoms that indicate an acute and potentially fatal condition. <!--The practitioner is expected to have emergency medical training and equipment appropriate to his or her level of training in the place of practice (e.g., dressings and basic airway management tools for an individual with training at the [[Emergency Medical Technician]] (EMT) of Basic or higher level, and preferably an [[defibrillator|automatic external defibrillator]] and [[advanced cardiac life support]] resources generally accepted as appropriate for an office. Potentially serious acute ailments may require medical supervision, but homeopaths sometimes prescribe remedies either for adjunctive use or as alternatives to conventional treatment. -->
 
The homeopathic treatment of acute injuries does not need the same depth or breadth of interview as treatment of chronic conditions. According to homeopaths, because the symptoms of a common cold or a headache or an allergy vary from person to person, each may need a different remedy. However, they believe that people who experience an injury generally have similar symptoms, so they think that some homeopathic remedies might be routinely useful in such cases.
 
Homeopaths who practice "classical homeopathy" prescribe just one remedy at a time—a remedy that best fits the overall syndrome of the patient. The same remedy might thus be prescribed for patients suffering from very different diseases; conversely, patients suffering from what would be diagnosed conventionally as the same disease may be prescribed different remedies. For example, hay fever would be treated with any of several remedies, usually based on the specific symptoms, but sometimes on the etiology of the allergy. Some common remedies are: Allium cepa (''[[onion]]'', which causes tears to flow and a clear burning nasal discharge that irritates the nostrils), Euphrasia (''eyebright'', which causes a clear and bland nasal discharge along with tears that burn and irritate the skin under the eye), Ambrosia (''ragweed'') and Solidago (''goldenrod''); plants whose pollen is aggravating to some hay fever sufferers. These remedies are commonly given during the ''acute'' symptoms of hay fever. At other times, a professional homeopath will often treat these patients with a constitutional remedy based on the patient’s genetic history, health history, and present overall physical and psychological state, with the intent to strengthen the person’s general health, thereby reducing the frequency or intensity of the symptoms of hay fever.<ref>Dennis Chernin (2006) ''The Complete Homeopathic Resource for Common Illnesses.'' Berkeley: North Atlantic. Stephen Cummings and Dana Ullman (2004). ''Everybody's Guide to Homeopathic Medicines.'' New York: Jeremy Tarcher/Putnam.</ref>
 
==Prevalence of homeopathic use==
 
Support by (conventional) medical professionals and third party coverage for alternative and complementary medicine is different in different parts of the world. In the U.S.A.  one survey <ref>Levine SM ''et al.'' (2003) Complementary and Alternative Medical Practices: Training, Experience, and Attitudes of a Primary Care Medical School Faculty'' J Am Board Fam Pract ''16:318–26</ref> found that 39% of the faculty of a medical school for primary care physicians considered use of homeopathic remedies legitimate, although only 8% had personal experience with them. A survey of physicians representing a broad variety of specialties in a mid-sized southeastern US city found<ref>Jump J ''et al.'' (1998) Physicians’ attitudes toward complementary and alternative medicine'' Integrative Medicine'' 1:149–153</ref> that 17% of the respondents considered homeopathy legitimate medical practice, but only 1.4% of the respondents had actually prescribed such medicine.
 
In Europe the relative popularity of therapies also differs between countries. Regulation of practitioners varies widely: in most countries only registered health professionals may practice, but in the United Kingdom practice is virtually unregulated. Of 248,000 registered practitioners of medicine in the U.K., about 400 are members of the Faculty of Homeopathy. Because homeopathy is still not a fully regulated profession in the U.K., anyone can declare themselves to be a homeopath and practice without any qualification ("common law" that allows freedom of choice in medical care in England has a long history).<ref>Morrell P (2000) [http://homeoint.org/morrell/british/background.htm British Homeopathy during two centuries] </ref>  Germany and some Scandinavian countries have intermediate systems. In most member states of the European Union, including [[Belgium]], [[France]], [[Spain]], [[Italy]], and [[Greece]], the practice of medicine, except by statutorily recognized health professionals, is illegal, which has the consequence  that in those countries, all (or virtually all) professionals that prescribe homeopathic remedies are MDs.<ref name=Fisher1994 />
The [[Netherlands]] adopted  in 1999 a new law regulating professions in individual health care, which gives more freedom to practitioners of complementary and alternative medicine, including homeopathy.
 
Some homeopathic treatment is partly covered by some European public health services, including in France, The Netherlands, and Denmark. In France, 35% of the costs of homeopathic remedies prescribed by a medical doctor are reimbursed from health insurance. In the U.K., five homeopathic hospitals are funded by the [[National Health Service]] (NHS) and homeopathic remedies are sold over the counter, and there, homeopathy is one of the most popular alternative and complementary treatment modalities.
 
In 2007, the over-the-counter market in homeopathy was around £40million in the U.K. ([http://www.trusthomeopathy.org/media_centre/facts_about_homeopathy/popularity_and_market_place.html Popularity and the market place] British Homeopathic Association); the total over-the-counter market was £1.2 billion in 1994. Family doctors in the U.K. issued 796 million prescriptions in 2007, of which 49,300 were for homeopathic remedies, down from 83,000 in 2005 ([http://www.timesonline.co.uk/tol/news/uk/health/article4390216.ece Fall in homeopathy prescriptions hailed as sign of changed attitudes] ''The Times'' July 28th 2008). In January 2008, it was reported that the NHS was progressively withdrawing funding for homeopathic treatments because of doubts about their efficacy.<ref>[http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/homeopathy-in-crisis-as-nhs-trusts-drop-services-775699.html Homeopathy 'in crisis' as NHS trusts drop services] ''The Independent'' January 30, 2008)</ref>
 
In France and Denmark licenses are required to diagnose any illness or to dispense any product whose purpose is to treat illness.<ref name=WHO>
{{cite web
|url=http://whqlibdoc.who.int/hq/2001/WHO_EDM_TRM_2001.2.pdf
|title=Legal status of traditional medicine and complementary/alternative medicine: A worldwide review
|accessdate=2007-09-12
|year=2001
|format=PDF
|work=World Health Organization
|publisher=[[World Health Organization]]
}}</ref> In many countries, however, there are no specific legal regulations concerning homeopathy. In Austria, the public health service generally requires proof of effectiveness to reimburse medical treatments, but makes an exception for homeopathy.<ref name="WHO" />
 
Almost 70% of all over-the-counter homeopathic remedies are sold in Western Europe. France is the largest market for homeopathic remedies in the world, worth over 300 million euros in 2003 (in a total over-the-counter drug market of over 770 billion euros), followed by Germany (200 million euros). The global self-medication market is estimated at 48.2 billion dollars (13.4% of the world pharmaceuticals market), of which sales of homeopathic remedies account for 0.3%. <ref>[http://www.boiron.com/en/htm/01_homeo_aujourdhui/realite_eco_homeo.htm Economic reality of homeopathy] 2003 figures ''Homeopathy Today''</ref>
 
==The claims for homeopathy==
Homeopaths view illness as a systemic condition, a disturbance in the overall homeostasis of the total being. Accordingly, they consider that almost ''any'' sick person may benefit from proper homeopathic treatment. <ref>"homeopathy is designed to treat the whole person and can therefore be considered in almost any situation where a person's health is depleted." [http://www.trusthomeopathy.org/about_homeopathy/which_conditions_is_it_used_for/ British Homeopathic Association]</ref> As the American Institute of Homeopathy puts it in their "Standards of Practice": ''"The physician must remember that he is treating a patient who has some disorder; he is not prescribing for a disease entity."'' <ref>[http://homeopathyusa.org/home/standards-of-practice.html American Institute of Homeopathy Standards of Practice]</ref>.
 
Homeopathic practitioners claim that their remedies are useful for a wide range of ailments. These include minor ailments from cuts and bruises to coughs and colds. Patients also come to homeopaths with long-term problems that have not responded to conventional medicine, and homeopaths prescribe remedies to people with these conditions. Some of the common ailments for which patients seek homeopathic care are [[eczema]], [[chronic fatigue syndrome]], [[asthma]], [[migraine]], [[irritable bowel syndrome]], allergic disorders, [[arthritis]], [[fibromyalgia]], [[hypertension]], [[Crohn's disease]], [[premenstrual syndrome]], [[rhinitis]], [[anxiety]] and [[depression]]. They also treat patients with the most serious diseases, including [[multiple sclerosis]], [[chronic obstructive pulmonary disease]], [[cancer]].<ref>Ullman D, Oberbaum M, Bell I,, Singer SR. Homeopathy for Primary and Adjunctive Cancer Therapy. In:  Abrams D, Weil A. Integrated Oncology. Oxford: Oxford University Press, 2009.</ref> <ref>[http://www.cancerhelp.org.uk/help/default.asp?page=251 Cancer Research UK]</ref> and AIDS<ref>[http://www.amishhospital.com/aids.htm Amish Hospital and Research Center]</ref>
 
Homeopaths claim that there is objective evidence that some of their treatments are beneficial (see [[Tests of the efficacy of homeopathy]]), and they believe that the success of homeopathy for the last 200 years is itself an indication of its value.
 
===Conflict with conventional medicine===
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:50%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|'''[[James Tyler Kent]] and homeoprophylaxis'''
 
Some homeopaths also believe that their treatments can ''prevent'' disease, a notion known as "'[[homeoprophylaxis]]".
 
James Tyler Kent (1849-1916) was prominently associated with the spread of homeopathy in the U.S.A., and much modern practice of homeopathy is based on his repertory, published in 1897. Kent denied the conventional germ theory of infectious disease, declaring that
 
''"The microbe is not the cause of disease. We should not be carried away by these idle allopathic dreams and vain imaginations but should correct the Élan vital".''
 
Instead, he believed that illness had spiritual causes:
 
''"You cannot divorce medicine and theology. Man exists all the way down from his innermost spiritual, to his outermost natural." <ref>[http://www.homeoint.org/morrell/articles/pm_kent.htm Kent's influence on British Homeopathy]
by Peter Morrell</ref> ''
 
Kent promoted the idea that homeopathic remedies could not only cure diseases, but also prevent them:
 
''"The great prophylactic is the homeopathic remedy. After working in an epidemic for a few weeks, you will find perhaps that half a dozen remedies are daily indicated and one in these remedies in a larger number of cases than any other. This one remedy seems to be the best suited to the general nature of the sickness. Now you will find that for prophylaxis there is required a less degree of similitude than is necessary for curing. A remedy will not have to be so similar to prevent disease as to cure it, and these remedies in daily use will enable you to prevent a large number of people from becoming sick. We must look to homeopathy for our protection as well as for our cure".''
 
The notion of homeoprophylaxis has not received support from systematic trials and has no place in conventional medicine. Suggestions that homeopathic treatments are an effective alternative to vaccination are regarded as irresponsible by many public health professionals, and also by some professional homeopathic organizations; in the U.K., The Faculty for Homeopathy recognizes the importance of childhood vaccination and does not support the common use of homeopathic remedies in place of conventional travel vaccinations and for malaria prevention, warning travellers "that there is no evidence that these provide any degree of protection." <ref>[http://www.trusthomeopathy.org/export/sites/bha_site/hh_article_bank/first_aid_and_travel/summer_2005.5_first_aid_on_holiday.pdf The travelling homeopath] Travel advice from The Faculty of Homeopathy and the British Homeopathic Association</ref>
 
|}
 
 
The conventional view is that homeopathy, insofar as it has any effect at all, exploits the [[placebo effect]] - i.e. that the only benefits are those induced by the power of suggestion, by arousing hope, and by alleviating anxiety. Conventional medical opinion does not deny the efficacy of placebo treatments in many cases<blockquote>...we all recognise the strong placebo effect in, probably, all aspects of medical treatment, whether they are conventional or not [Professor Tom Mead]<ref>[http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12305.htm House of Lords Select Committee on Science and Technology Sixth Report. Complementary and Alternative Medicine]
Chapter 3: Patient satisfaction, the role of the therapist and the placebo response.</ref></blockquote>, and placebos have played a large part in conventional medicine since their first deliberate use by [[William Cullen]] in the 18th century. Cullen used regular drugs as placebos, but at much lower doses than were thought to be effective. He gave them "to comfort and please the patient" rather than with any hope of a specific effect. He used the word "placebo" in this sense in lectures given in 1772. <ref>Kerr CE ''et al.''(2007) [http://www.jameslindlibrary.org/trial_records/17th_18th_Century/cullen/cullen-commentary.html William Cullen and a missing mind-body link in the early history of placebos.]In: The James Lind Library (www.jameslindlibrary.org).</ref>. Many modern physicians, however, consider it unethical to deliberately mislead their patients<ref>[http://www.medpagetoday.com/MeetingCoverage/AMA/3555 AMA: Ethics Council's Stance on Placebo Therapy Stirs Unease] MedPage Today 16th June 2006</ref>; rather than prescribing placebos themselves, some therefore prefer to refer patients to regulated practitioners of alternative medicine.
 
Some homeopaths, especially with medical training, will use conventional techniques to treat asthmatic and other [[respiratory medicine]], but will use homeopathic methods for long-term care. One of the challenges here is that the standard of medical therapy for asthma is to prevent inflammation, which commonly involves inhaled [[corticosteroid]]s that are not absorbed beyond the respiratory system.
 
Homeopaths also assert that corticosteroids are immunosuppressant drugs that only provide temporary relief of asthma symptoms and may lead to more serious chronic disease and to increased chances of death. Medical opinion is that this assertion is uninformed scare-mongering. They advise that corticosteroids prevent inflammation that can have serious consequences and symptom relief is a result of this anti-inflammatory action. Inhaled corticosteroids that stay on the breathing passages and do not spread through the body are medically preferred to systemic corticosteroid therapy and thus reduce immune suppressing effects of these drugs.
 
Most homeopaths believe that the fundamental causes of disease are internal and constitutional and that infectious disease is not just the result of infection but also of susceptibility. This viewpoint leads them to seek to avoid conventional treatments that suppress symptoms. [[medicine|Physicians]] accept that some disease is indeed a disturbance in normal function, whether due to external, genetic, or internal reasons. However, they consider that most disease can be attributed to a combination of external causes (such as viruses, bacteria, toxins, dietary deficiency, physical injury) and physiological dysfunction (including genetic defects and mutations such as those which trigger cancers), some of which are more than the healthy body can resist. Homeopaths consider them to be co-factors to disease, not causes of them. Conventional physicians often use drugs to suppress the symptoms of a disease (to alleviate the pain, injury, and distress that they cause), but they maintain that their main goal of medical treatment is to eliminate the [[etiology|causes]] of the disease with the help of drugs.
 
Whereas homeopaths emphasize that they provide remedies tailored to the individual patient's symptoms, conventional medicine focuses on treatments shown to be effective when given in a standard form to large populations of patients with a given disease. However, large clinical trials also seek to identify subgroups of patients (by age, gender, ethnicity, lifestyle, comorbidities etc.) that are "responders" or "non responders" to a new treatment, to provide a rational basis for individualization of treatments. Physicians have access to a very large repertoire of prescription drugs for this purpose (11,706 in the U.S. [[Food and Drug Administration]] ''Approved Drug Products with Therapeutic Equivalence Evaluations 26th Edition Electronic Orange Book (EOB)4'' ) <ref name=Maayan>{{citation
| journal =Mt Sinai J Med
| date = 2007
| volume = 74
| pages = 27–32.
| doi = 10.1002/msj.20002.
| title =Network Analysis of FDA Approved Drugs and their Targets
| author = Ma’ayan A ''et al.''}}</ref>, a repertoire that is constantly changing as less effective drugs are replaced by better drugs.
 
=== Medical organizations' attitudes towards homeopathy ===
The [[American Medical Association]] (AMA) was founded in 1847, three years after the [[American Institute of Homeopathy]].<ref name=AMA-12>{{citation
| author =American Medical Association Council on Scientific Affairs
| id = Report 12
| url=http://www.ama-assn.org/ama/pub/category/13638.html
| date = June 1997
|title=alternative theories including homeopathy
}}</ref>
From the 1860s to the early 20th century, the AMA's ethical code forbade its members to consult with fellow MDs who practiced homeopathy. Although the AMA did not enforce many of its ethical guidelines, the "consultation clause" was one of the few that it did.<ref>Harris Coulter, ''Divided Legacy: The Conflict Between Homoeopathy and the American Medical Association.'' Berkeley: North Atlantic, 1975.
</ref> The current AMA policy statement says: "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious."<ref name=AMA-12 />
 
==Safety and efficacy of homeopathy==
In conventional medicine (see [[New Drug Application]]), the basic phases of evaluating a drug are determining if it causes dangerous effects in healthy volunteers, if it is [[bioavailability|adequately present in the body to achieve an effect]], and if it is more effective than established treatments, against a disease.<ref>Not all trials are [[placebo]] controlled, but only those where there is no accepted treatment; new drugs must be compared with the best available existing treatment. See [[informed consent]].</ref>
 
In conventional medicine, [[randomized controlled trial]]s rely on statistical analysis of large groups of patients all of whom are given the same treatment to determine whether that treatment is indeed effective. This conflicts with an approach that believes that treatments must be individually tailored to each patient. In reality, some homeopathic trials do use some standardization, but not always to an extent which would make the trials statistically robust.
 
Few people question the safety issues in choosing homeopathic medicines themselves, and the U.S. FDA determines what dose is basically safe for over-the-counter sales of homeopathic medicines. However, homeopaths discourage the general public from using the homeopathic high potency medicines (the 200th potency and higher potencies) unless the person is adequately trained in homeopathy. Homeopaths warn the public that repeated doses of high potency medicines can lead the person to experience a "drug proving," a situation in which the person experiences symptoms akin to an overdose of the substance (the symptoms are generally known to resolve themselves shortly after the person stops taking the medicine).
 
===Proposed mechanism of action for homeopathic medicines===
{{main|Memory of water}}
Homeopathy was developed at a time when many important concepts of modern [[chemistry]] and [[biology]], such as molecules and germs, were understood poorly if at all. In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree.
 
Twenty years after Hahnemann's death, [[Josef Loschmidt]] established that a given volume of matter consists of a finite, albeit large, number of molecules. This implies that when a finite volume of solution is repeatedly diluted, there comes a point when the solvent is pure and does not contain a single solute molecule.  For example, a teaspoon of seawater (roughly 5 ml) contains about 160 mg of [[table salt|sodium chloride]] (NaCl), or about 2×10<sup>21</sup> molecules of NaCl. A 12''C'' dilution of seawater will have about one molecule of NaCl ''per liter''.  Thus homeopathic remedies diluted to more than about 12''C'' are virtually certain to contain not even one molecule of the initial substance. This is recognized by advocates of homeopathy, who assert that the essential healing power is not to be found in the chemical action of molecules, but perhaps in the arrangement of the water molecules, giving rise to the expression "the [[memory of water]]".  The homeopathic literature<ref name="Homeopathy2007">The special issue of the journal "Homeopathy", vol. '''96''', issue 3, pp. 141&ndash;230 (2007), [Editor Martin Chaplin], is dedicated to the problem, see the URL [http://www.sciencedirect.com/science/journal/14754916 The Memory of Water]. Copies of the articles in this special issue along with discussion are available at [http://www.badscience.net/?p=490 Homeopathy Journal Club] ''Bad Science'', a blog by [[Ben Goldacre]].</ref> proposes widely differing explanations for the purported existence of this water memory and has not yet converged on a single explanatory paradigm.
 
For instance, homeopaths point out that water is not simply a collection of molecules of H<sub>2</sub>O, but contain [[isotopologue]]s, molecules with different isotopic compositions such as HDO, D<sub>2</sub>O and H<sub>2</sub><sup>18</sup>O.  [[Mass spectroscopy]] can indeed detect different isotopologues, but their relative concentration is the same before and after homeopathic treatment&mdash;the concentration ratios can only be changed by nuclear reactions&mdash;so that the presence of  isotopologues in water cannot explain its memory. Homeopaths also suggest that the appearance of the H<sub>2</sub>O molecule in two proton-spin forms (''ortho'' and ''para'') may provide a mechanism for the memory of water. These two spin forms appear in a ratio 3:1 and are very difficult to separate or to convert into each other. The 3:1 ratio is determined by fundamental principles of  physics, and there is no known mechanism by which a homeopathic treatment could change this ratio. Moreover, even if it is assumed that homeopathic tinctures would somehow give rise to  ''ortho'':''para'' ratios other than 3:1, there is no proposed explanation for how these (chemically undetectable) ratios could have different healing qualities. 
 
Another suggestion is that double-distilled and deionized water contains trace amounts of contaminating ions.  In particular, water, as a result of repeated vigorous shaking, might include dissolved atmospheric gases in the form of nanobubbles, molecular ions produced from water reacting with airborne contaminants, and [[silicate]]s&mdash;tiny glass "chips".<ref>Anick DJ Ives JA (2007) The silica hypothesis for homeopathy: physical chemistry'' Homeopathy'' [http://dx.doi.org/doi:10.1016/j.homp.2007.03.005 doi 96:189-95]</ref><ref>Demangeat JL ''et al.'' (2004) Low-Field NMR water proton longitudinal relaxation in ultrahighly diluted aqueous solutions of silica-lactose prepared in glass material for pharmaceutical use'' Applied magnetic resonance'' 26:465-71</ref> Nanobubbles and their implications for water structure have been studied using nuclear magnetic resonance, with the conclusion that the effects are temporary and "should not be extrapolated to the so-called memory of water, often alleged to explain the effectiveness of homeopathy."<ref>Demangeat J-L (2009) NMR water proton relaxation in unheated and heated ultrahigh aqueous dilutions of histamine: Evidence for an air-dependent supramolecular organization of water'', ''Journal of Molecular Liquids'' [http://dx.doi.org/doi:10.1016/j.molliq.2008.07.013 doi 144:32-9] </ref> 
 
Some homeopaths believe that there might be an effect of successive shaking on water structure leading to "clustering" of water molecules. This contradicts the dominant scientific view that motions in liquid water are on the picosecond (10<sup>&minus;12</sup> second) time scale and that such clusters could not live longer than a few picoseconds. 
 
People sometimes wonder if the water used to make homeopathic medicines already has other memory imprints from its history prior to use in medicine. However, the water used by homeopathic manufacturers undergoes double-distillation, a process that homeopaths contend eliminates or substantially reduces previous memory. This raises the question: how do homeopaths know that this reduction is sufficient? If the ''presence'' of homeopathic qualities is below detection threshold, then surely the ''absence'' of such qualities is also undetectable.
 
In brief, for homeopathy to receive serious scientific consideration, there needs to be plausible explanations for the following:
*how the process of manufacturing a homeopathic remedy could yield a biologically active substance or solution, when the resulting remedy often is chemically and physically indistinguishable from pure water
*why the principle of similars might apply in the case of homeopathic remedies
*how a biological mechanism could have evolved to recognize the specific nature of homeopathic remedies
 
There also needs to be
*clear and irrefutable evidence for the efficacy of homeopathic remedies, evidence that cannot be explained by placebo effects
 
These stringent demands are often summarised by the maxim "Extraordinary claims require extraordinary proof".<ref>Coined by [[Marcello Truzzi]] and popularized in slightly different form by [[Carl Sagan]].</ref>
 
Meanwhile, homeopaths,  working towards an elucidation of the effectiveness of their medicines, complain that they are up against a double standard in medicine and science.<ref name = Bell /> They point out that there is a long history of  conventional medical treatments that are applied with positive effects, although  their mechanism of action is not known.  Only relatively recently, for instance, has it been understood how [[aspirin]] works, but before that doctors used it regularly despite an inadequate understanding of its actual mechanism. In due time, the homeopathic community asserts, the scientific basis of their methods will be unveiled.
 
<!-- The following seems duplicative to me, therefore commented out [Paul Wormer]
Some [[Materials science|materials scientists]], physicists, and other scientists have investigated how homeopathic medicines might work <ref name="pmid14619985">{{cite journal |author=Khuda-Bukhsh AR |title=Towards understanding molecular mechanisms of action of homeopathic drugs: an overview |journal=Mol Cell Biochem |volume=253 |pages=339–45 |year=2003 |pmid=14619985 |doi= |url=http://www.science.smith.edu/departments/Biochem/Chm_357/Articles/homeopathy_molecular%20mechanisms.pdf}}</ref><ref name=Bellavite2>{{citation | url = http://ecam.oxfordjournals.org/cgi/content/full/3/1/13
|journal = Evidence-based Compl Alt Med
|year =2006 | volume = 3| pages = 13-24| doi=10.1093/ecam/nek018
|title = Lecture Series, Immunology and Homeopathy. 2. Cells of the Immune System and Inflammation
|author= Bellavite P ''et al.''
}}</ref>
<ref>Mastrangelo D (2006) Hormesis, epitaxy, the structure of liquid water, and the science of homeopathy. ''Med Sci Monit'' 13:SR1-8 PMID 17179919</ref> <ref>Eskinazi D (1999) Homeopathy re-revisited: Is homeopathy compatible with biomedical observations? ''Arch Intern Med'' [http://archinte.ama-assn.org/cgi/content/extract/159/17/1981 159:1981-7]</ref>
including some reports of the alteration of water by homeopathic preparations, but there are no generally accepted theories about how these occur or about how those altered properties could affect biological systems.
-->
 
===Clinical trials testing the efficacy of homeopathic remedies===
{{Main|Tests of the efficacy of homeopathy}}
 
The “balance of evidence” as to whether homeopathy has any effects other than placebo effects depends on who is balancing the evidence. Homeopaths strongly value the evidence of their own experience in treating patients, supported by the satisfaction reported by their patients in surveys as well as supported by its 200 year history of treatment of hundreds of millions of people; they believe that this is sufficient evidence of efficacy, but also state that most published clinical trials have shown some beneficial effects. A 1991 global meta-analysis of homeopathic clinical trials published in the BMJ (British Medical Journal) of 105 trials, 81 with positive outcomes, concluded that the placebo response could not explain the positive responses: “Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible.”<ref> Kleijnen J ''et al.'' (1991). Clinical trials of homeopathy ''BMJ'' 302:316–23</ref> and another meta-analysis published in the ''Lancet'' in 1997 drew similar conclusions. <ref>Linde K ''et al.'' (1997). Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials? ''Lancet'' 350: 834–43. PMID 9310601. The results "were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo." </ref> Several meta-analyses evaluating the homeopathic treatment of specific diseases have found positive results, including the treatment of childhood diarhea, <ref>Jacobs J ''et al.'' (2003) Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials. ''Ped Infect Disease J'' 22:229–34)</ref> some post-surgical conditions <ref>Barnes J ''et al.'' (1997). Homeopathy for postoperative ileus? A meta-analysis. ''J Clin Gastroenterol'' 25:628–33.</ref>, side effects of conventional cancer treatment,<ref> Kassab S, Cummings M, Berkovitz S, van Haselen R, Fisher P. Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004845. DOI: 10.1002/14651858.CD004845.pub2 </ref> and respiratory allergies <ref>Taylor MA ''et al.'' (2000). Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ 321:471–6)</ref>.
 
Other meta-analyses have suggested that the effect from a homeopathic remedy was no better than a placebo <ref name="pmid12492603">{{cite journal |author=Ernst E |title=A systematic review of systematic reviews of homeopathy |journal=Br J Clin Pharmacol |volume=54 | pages=577–82 |year=2002 |pmid=12492603 |doi= |url= http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2125.2002.01699.x/full?cookieSet=1|accessdate=2008-02-12}}</ref> The [[Cochrane Collaboration]] is an organisation that publishes meta-analyses of trial results, and most of their analyses of homeopathic treatments indicate some treatment benefits. The most supportive of their analyses is of the possible benefits of [[Oscillococcinum]] for influenza and influenza-like syndromes. <ref name=Vickers2006>{{citation
| journal = Cochrane Database Syst Rev.
| date = 2006
| url = http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001957/frame.html
| title = Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes.
| author = Vickers AJ, Smith C.
| doi = DOI: 10.1002/14651858.CD001957.pub3 }}</ref>
 
Cochrane Reviews did a meta-analysis of seven [[randomized controlled trial]]s, three prevention trials (number of participants, <math>N = 2265</math>) and four treatment trials, <math>(N = 1194)</math>. This was a meta-analysis of seven [[randomized controlled trial]]s, three prevention trials (number of participants, <math>N = 2265</math>) and four treatment trials, <math>(N = 1194)</math>. Overall, the authors found no evidence of any benefits in preventing influenza, but there was evidence of a small effect on the duration of influenza symptoms. The outcome was deemed "promising", but  further trials were recommended, but not strong enough for the remedy to be recommended for first-line therapy.
 
Why do most trials report positive outcomes for homeopathy, but some show no effect, and how is it that the positive evidence does not persuade most scientists and leaders of academic medicine? In the U.S.A., The [[National Center for Complementary and Alternative Medicine]] (NCCAM) administers public-funded research into alternative medicine <ref name=NCCAM-HQ8>{{citation | url = http://nccam.nih.gov/health/homeopathy/#q8
| contribution = What has scientific research found out about whether homeopathy works?
| title = Questions and Answers About Homeopathy
| author = [[National Center for Complementary and Alternative Medicine]]}}</ref>, and some studies have reported positive outcomes, but NCCAM's acting deputy director, Jack Killen, said, in a ''Newsweek'' article, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." <ref name=Newsweek>{{citation
| url = http://www.newsweek.com/id/105581
| journal = Newsweek
| first = Jerry | last = Adler
| title = No Way to Treat the Dying
| date = February 4, 2008}}</ref>. In the U.K., the [[NHS]] recognizes that there have been about 200 randomised controlled trials evaluating homeopathy, some show efficacy of treatment and some don't. They conclude, "Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works".<ref name=NHSdirect>{{citation
| url = http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=197&sectionId=27#
| author = NHS Direct
| contribution = Homeopathy
| title = Health Encyclopedia}}</ref>
 
Homeopaths believe that such attitudes reflect bias against alternative medicine, and that because homeopathy does not lend itself to controlled trials, those with a negative outcome may be false negatives. Critics of homeopathy respond that the published trials of specific homeopathic remedies have been mostly small and flawed in design <blockquote>“Examples of problems they noted include weaknesses in design and/or reporting, choice of measuring techniques, small numbers of participants, and difficulties in replicating results. A common theme in the reviews of homeopathy trials is that because of these problems and others, it is difficult or impossible to draw firm conclusions about whether homeopathy is effective for any single clinical condition.”<ref> [http://nccam.nih.gov/health/homeopathy/#q8 Questions and Answers About Homeopathy] National Center for Complemenatary and Alternative Medicine (NCCAM)</ref></blockquote> Larger, high-quality trials have tended to show little or no statistically significant effects, as was concluded by the authors of the second Lancet study cited above when they re-analyzed these trials:  “There is increasing evidence that more rigorous trials tend to yield less optimistic results than trials with less precautions against bias.”  <ref>Linde K ''et al.'' (1999) Impact of study quality on outcome in placebo controlled trials of homeopathy. ''J Clin Epidemiol'' 52:631–6</ref> Homeopaths respond that the vast majority of the larger high-quality trials simply tested a single homeopathic medicine, without the requisite individualization of treatment common to homeopathic treatment.
 
But this does not explain why small trials should have more strongly positive outcomes than large trials. In fact this is a feature of trials of conventional medicine also – and it is believed that the explanation lies mainly in ‘’publication bias’’ – the tendency of trial outcomes to be published only if the outcome is clearly positive; many small trials with negative or inconclusive outcomes simply go unreported, because they are thought to be uninteresting.
 
In 1999, the government of [[Switzerland]], for a trial period of 5 years, allowed health costs for treatment with homeopathy and four other CAM modalities to be reimbursed under the country’s compulsory health insurance scheme, and set up a programme to evaluate the cost-effectiveness of these treatments (the Complementary Medicine Evaluation Programme (Programm Evaluation Komplementärmedizin, PEK). Under this programme, a team of scientists and practitioners, including a homeopath, conducted an innovative meta-analysis that became the single most cited study of homeopathy, arousing considerable media attention and a storm of protest from homeopaths. The study, which was also published in the ''Lancet'',<ref>Shang A ''et al.'' (2005) Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. ''Lancet'' 366:726–32</ref> adopted a novel approach; whereas traditional meta-analyses have tried to combine all studies of a given condition, this was a "global" meta-analysis of homeopathy testing the hypothesis that ''all'' reported effects of homeopathic remedies are placebo effects. If so, the authors reasoned, then the reports of positive effects reflect publication bias, and if this is the case then the magnitude of such effects should diminish with sample size and study quality, and for the largest and best studies there should be no effect.
 
They analyzed 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials. Overall, the conventional medicine trials showed some real effect of treatment, in that some effect was still present in the largest and best trials, but the trials of homeopathy remedies did not. The authors concluded that their analysis was consistent with homeopathy being no better than placebo treatment, and controversially suggested that no further research on homeopathy is necessary. The article was accompanied by an unsigned editorial entitled “The end of homeopathy”<ref> Editorial. The end of homeopathy ''Lancet'' 2005; 366:690 </ref>" and a signed editorial by [[Jan Vandenbroucke]], professor of clinical [[epidemiology]], at [[Leiden University]], the [[Netherlands]] <ref>Vandenbroucke JP (2005) Homoeopathy and ‘the growth of truth’ ''Lancet'' 366:691–2</ref> This does not mean that that people treated with homeopathy do feel better as a result - the clinical literature clearly shows this, but Vandenbroucke suggested that this could be because its practitioners treatments spend more time with people than doctors do.
 
The ''Lancet'' subsequently published a selection of critical correspondence, and received an angry open letter from the Swiss Association of Homoeopathic Physicians (SVHA). <ref> [http://www.homeopathy.org/research/editorials/Rutten.pdf Open letter] to the Editor of The Lancet from the Swiss Association of Homoeopathic Physicians (SVHA)</ref> which declared:
 
''“The meta-analysis may be statistically correct. But its validity and practical significance can be seen at a glance: not one single qualified homoeopath would ever treat one single patient in clinical practice as presented in any of the 110 analysed trials! The study cannot give the slightest evidence against homoeopathy because it does not measure real individual (classical) homoeopathy. It confounds real homoeopathic practice with distorted study forms violating even basic homeopathic rules.”''
In the Shang ''et al.'' review, 21 of the homeopathic trials were judged of “high quality”; these studies, overall, showed a benefit of homeopathic treatment. In the final phase of analysis, the researchers included only the largest of these studies; the 8 largest homeopathic trials showed that homeopathic treatment was comparable with a placebo, while 6 similarly large conventional medical trials were not compatible with a placebo effect. Of the 8 largest and best homeopathic trials, only one used an individualized approach to treatment, the other seven used a single medicine prescribed to homeopathic treated subjects. Such non-individualized treatment is common in the larger clinical trials (one of the trials even tested a rarely used homeopathic medicine, Thyroidinum, in the treatment of weight-loss, in a previously untested treatment protocol).
 
Subsequent critics of the Shang ''et al.'' analysis have questioned how definitive it actually is, noting that it involved subjective judgements of study quality. Several studies defined as "high quality" by Linde ''et al.'' (1997) were not defined by high quality by Shang ''et al.'' most of which showed a positive effect of homeopathic treatment.The Shang ''et al.'' analysis also excluded a relatively large study of chronic polyarthritis (N=176) by Wiesenauer because no matching trial could be found. The authors of an article in the ''Journal of Clinical Epidemiology'' <ref>{{citation
| author = Ludtke R, Rutten ALB
| year = 2008
| title = The conclusions of the effectiveness of homeopathy highly depend on the set of analyzed trials
| url = http://www.ncbi.nlm.nih.gov/pubmed/18834714
| journal = J Clin Epidemiol
| doi=  10.1016/j.jclinepi.2008.06.015}}</ref> and
<ref>{{citation
| author = Rutten ALB & Stolper CF | year = 2008
| title = The 2005 meta-analysis of homeopathy: the importance of post-publication data
| url = http://www.ncbi.nlm.nih.gov/pubmed/19371564?dopt=Abstract
| journal = Homeopathy
| doi= 10.1016/j.homp.2008.09.008}}</ref> say "This result can be interpreted differently. Following Shang's perspective it can be explained by small study bias (which includes publication bias). In contrast, one may hypothesize that Shang's result is falsely negative." The authors noted that four of the 21 best trials selected by Shang ''et al.'' dealt with preventing or treating muscle soreness—these consistently found no benefits to homeopathy, so if it is accepted that homeopathy is not useful in this condition, the remaining 17 trials show an overall significant effect, mainly determined by two trials on influenza-like diseases. Thus they argue that it is still possible that homeopathy might be effective for some conditions and not for others.
 
Proponents of homeopathy also note that some of the conventional medical studies analysed by Shang ''et al.'' may have shown a treatment effect but that some of these have since been withdrawn because of side effects found subsequently. Critics of homeopathy agree—they say that in conventional medicine, treatments are abandoned when trials show them to be ineffective or unsafe, or when a better drug is found; by contrast, no homeopathic treatment has ever been withdrawn after a trial showed it to be ineffective. The Shang ''et al.'' study did not evaluate "adverse effects" of treatment; three of the eight drugs tested in the larger trials, trials which suggested that were effective, have since been withdrawn because of concerns about their safety.
 
===Safety===
:''The highest ideal of cure is the speedy, gentle, and enduring restoration of health by the most trustworthy and least harmful way'' (Samuel Hahnemann)
 
The U.S. [[Food and Drug Administration]]'s (FDA) [http://www.fda.gov/fdac/features/096_home.html view of homeopathy] is that there is no real concern about the safety of most homeopathic products because they contain little or no active ingredients. The FDA has deemed that the vast majority of homeopathic medicines are [[over-the-counter drugs]] (OTC), that is, drugs that do not need a doctor's prescription and that are safe enough for home care. In the U.S.A., homeopathic remedies must have at least one indication for usage for a disease or condition that is self-limiting and that does not require medical diagnosis or medical monitoring. The [[European Union]] allows homeopathic medicinal products, "....provided they are prepared according to the European Pharmacopoeia or the pharmacopoeias currently used officially in the Member States" if they are at least 3X, that is, they may not contain either more than one part per 10&thinsp;000 of the mother tincture or more than 1/100th of the smallest dose of an active substance. No specific therapeutic indication may be given on the label of the product.<ref>[http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32001L0083:EN:HTML Directive of the European Parliament and of the Council] relating to medicinal products for human use.</ref> Some physicians, however, maintain that homeopathic treatment is ''relatively'' unsafe, because it might delay conventional medical treatment. Homeopaths respond to these concerns by stating that homeopathic medicines are actually safer and more effective than conventional medicines; they argue that it is conventional medicine that is the unsafe kind.
 
Probably every modern pharmacologist would agree with Hahnemann that the drugs prescribed by conventional physicians of the 19th century were at best ineffective and often dangerous. However, some homeopaths question whether even modern medical drugs are safe and effective, and recommend homeopathic remedies instead. For example, a 2006 survey by the U.K. charitable trust [[Sense About Science]] revealed that homeopaths were advising travelers against taking conventional anti-[[malaria]]l drugs, instead recommending they take a homeopathic remedy. Even the director of the The Royal London Homeopathic Hospital, Peter Fisher, condemned this practice, saying "I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice."<ref>{{citation
| url = http://news.bbc.co.uk/2/hi/programmes/newsnight/5178122.stm
| title = Malaria advice 'risks lives'
| first = Meirion | last = Jones 
| date = 13 July 2006
| journal = BBC}}</ref>
 
Another concern of conventional physicians is that some homeopaths discourage the use of [[vaccine]]s. These homeopaths assert that vaccination for common diseases such as [[measles]] and [[chicken-pox]] is unnecessary, and some believe that vaccines can even be damaging to health, because of the [[mercury]] and [[aluminum]] in them, because the bacterium or virus in the vaccine may neither be dead nor weak enough, or because some childhood infectious diseases may strengthen immune responsiveness. Such advice is considered irresponsible by nearly all public health professionals, who assess the benefits of vaccination as vastly outweighing the risks. For example, [[measles]] is not a major killer in the western world, where most children are vaccinated at about two years old, and vaccination initiatives in Africa have cut the incidence in half there.<ref>[http://news.bbc.co.uk/1/hi/health/6276139.stm Vaccine drive cuts measles deaths] ''BBC +'' 19th January 2007)</ref>
 
== References ==
{{reflist|2}}

Latest revision as of 08:28, 14 February 2021

This is an out-of-date version of the article that was created separately (possibly in error). It is retained here to preserve the edit history.
Do not edit this version: see 'Homeopathy' for the latest one.
The Editorial Council has made a unanimous decision on December 17, 2010, to blank this draft article and to place a minimum of a one-year moratorium on any further edits to this article. The discussion concerning this decision may be found at [1]. The Talk page remains, but its present contents will be moved to an archive. The Approved Main Article also remains in place. This page is now protected by the Constabulary and no further edits can be made to it. After one year has passed, Citizens may ask the Editorial Council to reconsider their decision but there is no guarantee that they will do so.


The Secretary of the Editorial Council, Hayford Peirce 04:09, 17 December 2010 (UTC)

Moratorium extended

The moratorium has been extended by another year. EC:D-2012-002. --Peter Schmitt 01:20, 20 January 2012 (UTC)


Retrieved from "https://citizendium.org/wiki/index.php?title=Homeopathy/PreviousVersion&oldid=16566"