Homeopathy/PreviousVersion

Homeopathy is a system of Complementary and Alternative Medicine that strives to treat "like with like" ; its remedies involve treating an illness with an infinitesimally small dose of a substance that, at bigger doses, can cause symptoms like those of the illness itself. Homeopaths believe that the "potency" of a remedy is increased by serial dilution, when combined with vigorous shaking. The word "homeopathy" was coined by the Saxon physician Christian Friedrich Samuel Hahnemann and first appeared in print in 1807.

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Samuel Hahnemann(1755-1843), the "father" of homeopathy

Homeopathy (also spelled homœopathy or homoeopathy, from the Greek όμοιος, hómoios (similar) and πάθος, páthos (suffering)) regards diseases as "morbid derangements of the organism", that involve some disturbance in a "vital force." Homeopaths reject the standard medical diagnoses of named diseases; each case of sickness is a strictly individual phenomenon — "It is the man that is sick and to be restored to health, not his body, not the tissues". The theory of homeopathy is inconsistent with accepted laws of chemistry and physics.

The Principle of Similars

In Hahnemann's day, conventional medicine focused on restoring "balance" in the four humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, laxatives, enemas and emetics) or by suppressing symptoms (such as by cooling patients who were feverish). By contrast, Hahnemann believed that diseases are not caused "...any disease matter, but that they are solely spirit-like derangements of the spirit-like power that animates the human body." In the 18th century, such vitalism was part of mainstream science, but in the twentieth century, it was replaced by the germ theory of disease. Modern medicine sees bacteria and viruses as the causes of many diseases, but some modern homeopaths still regard them as effects, not causes, of disease.

Homeopathy is based on the 'Principle of Similars', expressed by Hahnemann as similia similibus curentur or 'let likes cure likes'. The idea came to him while he was translating into German the Materia Medica (1789) of William Cullen, the so-called "Scottish Hippocrates". On reading that Cinchona bark (which contains quinine) was effective because it was bitter, he felt that this was implausible; other substances that were as bitter had no therapeutic value. To understand the effects of Cinchona bark, he took it himself, and observed that its effects on him were similar to the symptoms of the diseases that it was prescribed for. This notion was not novel; others before Hahnemann, including Anton von Störck (1731-1803), had advocated "treatment by cautious use of poisons." Hahnemann had studied briefly in Vienna, where Störck eventually became head of the University.

Homepathic remedies are found by 'provings', in which volunteers are given substances, the effects of which are recorded as a 'Drug Picture'. Of his first proving, Hahnemann said: "with this first trial broke upon me the dawn that has since brightened into the most brilliant day of the medical art; that it is only in virtue of their power to make the healthy human being ill that medicines can cure morbid states, and indeed, only such morbid states are composed of symptoms which the drug to be selected for them can itself produce in similarity on the healthy." At first, Hahnemann tested substances that were then used as medicines, such as antimony and rhubarb, and poisons, like arsenic, mercury and Belladonna. He recorded his first provings of 27 drugs in the Fragmenta de viribus in 1805 and later in his Materia Medica Pura, which contained 65 drugs. Nearly as important as Hahnemann to the development of homeopathy was James Tyler Kent (1849-1921), whose Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies. Kent's influence in the USA was limited, but in the UK, his ideas became homeopathic orthodoxy by the end of the First World War. Kent sought to re-emphasize the metaphysical and clinical aspects of Hahnemann's teachings's; he insisted on the core doctrines of miasm and vital force, and emphasized the importance of spiritual factors as the root cause of disease.

"...for it goes to the very primitive wrong of the human race, the very first sickness of the human race that is the spiritual sickness... which in turn laid the foundation for other diseases."

For prescribing, homeopaths use the Materia Medicae, which are indexes of Drug Pictures, and the Homeopathic repertory, an index of symptoms listing the remedies associated with them. Today, homeopathy uses about 3000 remedies; about 300 are based on Materia Medica information, 1500 on fragmentary knowledge, and the rest either without knowledge of their homeopathic properties or speculatively. Homeopathy uses many animal, plant, mineral, and synthetic substances, including Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other 'isopathic' remedies' involve dilution of the agent or product of the disease. Rabies nosode, for example, is made by diluting the saliva of a rabid dog. Some modern homeopaths use more esoteric substances, known as "imponderables" because they do not originate from a material but from electromagnetic energy "captured" by alcohol or lactose (X-ray, Sol (sunlight), Positronium, and (electricity)Electricitas, or with a telescope (Polaris). Recent ventures by homeopaths into even more esoteric substances include Tempesta (thunderstorm), and Berlin wall.

The law of similars is not a scientific law, and a failure to cure can always be attributed to incorrect selection of a remedy; in Kent's words, "I have often heard physicians tell me that it was due to suggestion that my medicines acted so well; but my answer to this is, that I suggest just as strongly with my wrong remedy as with the right one, and my patients improve only when they have received the similar or correct remedy". There are many ways to find the most-similar remedy (the simillimum), and homeopaths sometimes disagree. This is partly due to the complexity of the 'totality of symptoms' concept; homeopaths decide, from their knowledge and experience, which symptoms are the most characteristic: the Drug Picture in the Materia Medica is always more comprehensive than the symptoms of any individual. Other ways of selecting remedies are through medical dowsing or other psychic powers, but these are not accepted by most homeopaths.

Preparation of similars

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The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and the side-effects diminished) by dilution, in a procedure known as dynamization or potentization. Liquids are progressively diluted (with water or alcohol) and shaken by ten hard strikes against an elastic body (succussion). For this, Hahnemann had a saddlemaker construct a special wooden striking board covered in leather on one side and stuffed with horsehair. Insoluble solids, such as Quartz and Oyster shell, are diluted by grinding them with lactose (trituration). The original serial dilutions by Hahnemann used a 1 part in 100 or centesimal scale, or 1 part in 50,000 or Quintamillesimal (LM or Q potencies). The dilution factor at each stage is traditionally 1:10 ('D' or 'X' potencies) or 1:100 ('C' potencies). Hahnemann advocated 30C dilutions for most purposes (i.e. dilution by a factor of 100³⁰ = 10⁶⁰). As Avogadro's number is only 6.02 × 10²³ particles/mole, the chance of any molecule of the original substance being present in a 15C solution is small, and it is extremely unlikely that one molecule of the original solution would be present in a 30C dilution. There are about 10³² molecules of water in an Olympic size swimming pool, so to expect to get one molecule of a 15C solution, one would need roughly 25 metric tons of water. Thus, homeopathic remedies of a high "potency" contain, with overwhelming probability, only water, but water that, according to homeopaths, retains some 'essential property' of one of the substances that it has contacted in the past.

Alternative methods

High potency remedies were first produced in the 1830s. Although Hahnemann wished to see 30c as standard potency in homeopathy, most of his contemporaries preferred tinctures and 3x, while others, like the powerfully-built horse-trainer, Caspar Julius Jenichen (1787-1849), General Korsakoff (1788-1853) and Dr N Schreter (1803-1864), were busy raising potency to extremes:

Jenichen sat or stood stripped naked to the waist, holding the bottle in his fist in an oblique direction from left to right, and shook it in a vertical direction. The fluid, at every stroke, emitted a sound like the ringing of silver coins. He paused after every 25th potency, and the muscles of his naked arm vibrated...he was latterly able to give 8400 strokes in an hour.

Such high potencies could not be made by traditional methods, but required succussion without dilution, higher dilution factors (LM potencies are diluted by a factor of 50,000), or "Korsakoff machines" that continuously combine dilution and succussion. Such machines are still sold today; some manufacturers claim that undefined "vibrations" produce the healing effect and, that when the correct vibration is selected, only water need be added to produce a remedy. Today, radionics devices are used by many homeopaths to prepare remedies, based on the work of the British engineer, Malcolm Rae (1913-1979) and devices he developed in the 1960s. Another technique involves a "paper remedy" - "finds out what they need, writes the remedy down on a piece of paper, they put it in their pocket and it works."

Miasms

By 1816, Hahnemann was concerned at the failure of homeopathic remedies to produce lasting cures for chronic diseases: "...the non-venereal chronic diseases, after being time and again removed homoeopathically … always returned in a more or less varied form and with new symptoms." He introduced the theory that three fundamental "miasms" underlie of all the chronic diseases of mankind: Syphilis, Sycosis (suppressed gonorrhoea), and Psora. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". The sense of this is indicated by Hahnemann's Note 2 to §11 of the Organon: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..."

According to Hahnemann, miasmatic infection causes local symptoms, usually in the skin. If these are suppressed by medication, the sickness goes deeper, and emerges later as organ pathologies. In the Organon he asserted that Psora was the cause of such diseases as epilepsy, cyphosis, cancer, jaundice, deafness, and cataract. However, even in his own time, many of his followers, including Hering, made almost no reference to Hahnemann’s concept of chronic diseases. Today, some homeopathic practitioners find Hahnemann’s theory difficult to reconcile with current scientific knowledge, as it seems to ignore the importance of genetic, metabolic, nutritional, and degenerative factors in sickness, and fails to differentiate between the many different infectious diseases. Nevertheless, most homeopaths believe that the core of his theory is valid: that the fundamental causes of disease are internal and constitutional and that it is contrary to good health to suppress symptoms, and they accept the concept of "latent Psora", the early signs of an organism’s imbalance which indicate that treatment is needed.The Canadian Academy of Homeopathy

The miasm theory is not the 'be all and end all' of homeopathy. Hahnemann advocated good hygiene, fresh air, regular exercise, good nutrition as precursors of good health (see his 1792 essay: The Friend of Health); he was also a pioneer in 1792-3 of humane treatment of the insane (1796, Description of Klockenbring During his Insanity) a year before William Tuke and Philippe Pinel, and he published tracts in which he described the cause of cholera as "excessively minute, invisible, living creatures", indicating his acceptance of ideas of infectious disease.

The Spread of Homeopathy

Homeopathy is popular in Europe and India, but less so in the USA, where non-orthodox therapies have been more tightly regulated. Stricter regulations have also been implemented recently in the EC. There are estimated to be more than 100,000 practitioners of homeopathy worldwide, and 500 million people receiving treatment. More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatments in the UK, France, and Germany. In Germany, homeopathy, anthroposophically extended medicine and herbalism were recognized as "special forms of therapy" in 1978, meaning that their remedies are freed from the usual requirement to prove efficacy, but, since January 1, 2004, most homeopathic remedies are no longer covered by public health insurance. In Switzerland, homeopathic remedies were covered by the basic health insurance system, if prescribed by a physician, until June 2005, when the Government, after a 5-year trial, withdrew insurance coverage for homoeopathy and four other complementary treatments, as that they did not meet efficacy and cost-effectiveness criteria.

In the UK, homeopathy was established by Dr Frederick Quin (1799-1878) at around 1827. (Two Italian homeopathic doctors (Drs Romani and Roberta) had been employed two years previously by the Earl of Shrewsbury, but had quickly returned to Naples as they could not tolerate the damp English climate.) Homeopathy became the preferred treatment of the upper classes: the Dukes of Edinburgh and Beaufort were among Quin's patients, and he became physician to the Duchess of Cambridge. At its peak in the 1870s, there were large hospitals in Liverpool, Birmingham, Glasgow, London and Bristol; the Bristol hospital was funded by the W.D. & H.O. Wills tobacco family, while the Hahnemann Hospital in Liverpool was built by members of the Tate family of sugar importers, who also funded the Tate Gallery in London. Today, homeopathic remedies are sold over the counter, and there are five homeopathic hospitals funded by the National Health Service and many regional clinics. Homeopathy is not practised by most of the medical profession, but is supported by the Prince of Wales and other members of the royal family. The Society of Homeopaths, founded in 1978, has 1300 members.

Homeopathy came to India with Dr Martin Honigberger (1795-1869) in Lahore, in 1829-30 India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals. The Indian "Association of Qualified Homoeopaths" is the largest of its kind, and 10% of the population are estimated to use homeopathy exclusively for their medical needs.

Homeopathy was established in the USA by Dr Hans Burch Gram (1787-1840)in 1825 and gained popularity, partly because of the excesses of conventional medicine, and partly due to Constantine Hering (1800-1880), who immigrated to America in 1833 and became known as the "father of American homeopathy. By 1900, hardly any city with a population of more than 50,000 was without a homeopathic hospital and many smaller communities could claim them. In the 1930s, the popularity of homeopathy waned, partly due to the Flexner Report of 1910, which led to the closure of virtually all medical schools teaching alternative medicine, and by the 1950s, homeopathy had been almost extinguished. Nevertheless, in 1995 sales of homeopathic remedies were estimated at US$201 million; and the number of homeopathic practitioners increased from less than 200 in the 1970s to about 3,000 in 1996; however, a recent study indicates that the percentage of people seeking homeopathic treatment in the USA fell from 3.4% in 1997 to 1.7% in 2002

Scientific testing of homeopathic remedies

In the USA, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration, but unlike conventional medicines, homeopathic remedies need not be approved by the FDA before sale, nor do they need to be proved either safe or effective, nor to be labeled with an expiry date, or undergo finished product testing. Unlike conventional medicines, homeopathic remedies do not have to identify their active ingredients as they have few or no active ingredients.

From the very beginnings of homeopathy, its claims were treated with considerable skepticism by members of the medical and scientific establishments. According to Sir John Forbes (1787-1861), physician to Queen Victoria, the extremely small doses were regularly derided as useless, ridiculous and "an outrage to human reason." Professor Sir James Young Simpson said, of the highly diluted drugs, that there is "no poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly."

As homeopathic remedies at potencies higher than about D23 (10^-23) contain no detectable ingredients apart from the diluent (water, alcohol or sugar), there is no known basis for these preparations having medicinal action. However, attempts to replicate these studies on leukocytes failed.</ref> A recent review concludeed that "...there are some hints from experimental research that homeopathic substances diluted and succussed beyond Avogadro’s number are biologically active but there are no consistent effects from independently reproducible models." Although some patients report benefits from homeopathic preparations[14], scientists usually attribute these to the Placebo Effect, the regression fallacy and/or the Forer effect.

Evidence-based medicine

There is wide consensus that evidence based medicine is the best way to assess the efficacy and safety of health-care practices. Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind trials, to test whether the drug has an effect that is better than either a placebo or a different treatment. Some trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo. However, many are technically flawed or involve samples too small to allow firm conclusions to be drawn. Systematic reviews by the [15] The Cochrane Collaboration] found insufficient evidence that homeopathy is beneficial for asthma, dementia, or induction of labor They also found no evidence that homeopathic treatment prevents influenza, but reported that it appears to shorten the duration of the disease. Overall, systematic reviews have found no clear evidence of the efficacy of homeopathic remedies, but often the evidence has been too flawed to exclude possible beneficial effects either..

In 2005, The Lancet published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials based upon the Swiss government's "Program for Evaluating Complementary Medicine". The outcome suggested that the clinical effects of homeopathic remedies are likely to be placebo effects. The Lancet paper is notable for its design, as a "global" meta analysis of homeopathy, not an analysis of particular remedies, i.e. it tested the global hypothesis that the reported effects of homeopathic remedies are placebo effects. If so, then reported positive effects are due to placebo effects, publication bias, observer effects etc., and hence the magnitude of such effects should diminish with sample size and study quality. They analysed an equal number of conventional medicine trials in the same way; these showed a real effect independent of sample size, but the trials of homeopathy remedies did not. The study does not prove that homeopathy is never effective, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet article was accompanied by invited editorials, and some critical correspondence.

Medical organizations' attitudes towards homeopathy

The National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, funds research into homeopathy. According to its statement on homeopathy, "The results of individual, controlled clinical trials of homeopathy have been contradictory. In some trials, homeopathy appeared to be no more helpful than a placebo; in other studies, some benefits were seen that the researchers believed were greater than one would expect from a placebo." Nevertheless, "Some people feel that if homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine are not necessary."

According to The UK National Health Service there have been about 200 randomised controlled trials evaluating homeopathy, but they have not produced clear clinical evidence that homeopathy works. "Many studies suggest that any effectiveness that homeopathy may have is due to the placebo effect, where the act of receiving treatment is more effective than the treatment itself."

In 1997, the American Medical Association(AMA) adopted the following policy statement after a report on several alternative therapies including homeopathy: "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. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies"

The Indian Ministry of Health and Family Welfare states that:"Homeopathy has been recognised as one of the National Systems of Medicine and plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels."

Homeopathy and vaccination (See also Isopathy)

Homeopathy is superficially like vaccination, in that vaccines contain a small dose of the "disease" against which they offer protection (a vaccine is usually made from a bacterium or virus that is either dead or weakened so that it cannot produce symptoms, while still providing enough information to the immune system to generate antibody production). However, to most homeopaths, vaccination is not consistent with the principles of homeopathy; even if it is a crude application of the law of similars, they believe that vaccination has serious short and long-term (health) consequences, and might arouse latent inherited and constitutional weaknesses. In Hahnemann's words "...to use a human morbific matter (a Psorin taken from the itch in man) as a remedy for the same itch or for evils arisen therefrom, stay away from it! Nothing can result from this but trouble and aggravation of the disease."

Safety of homeopathic treatment

The United States Food & Drug Administration's view of homeopathy is that there is no real concern over the safety of most homeopathic products "because they have little or no pharmacologically active ingredients". There have been few reports of illness associated with the use of homeopathic products, but in cases that they reviewed, the FDA concluded the homeopathic product was not the cause of the adverse reactions. The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. For example, a 2006 survey by the UK charitable trust "Sense About Science," revealed homeopathic practices which were advising travelers against taking conventional anti-malarial drugs, instead providing them with a homeopathic dilution of quinine. Even the director of the The Royal London Homeopathic Hospital condemned this:

"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." .

Several scientists said the homeopaths' advice was reprehensible and likely to endanger lives. Professor Pasvol, a tropical medicine expert at Imperial College, London was reported as saying "Medical practitioners would be sued, taken to court and found guilty for far less. What this investigation has unearthed is appalling."

External links

• BBC's Horizon on homeopathy
• Complementary Medicine - Therapies: Homeopathy[16] BBC's "Complementary Medicine" article on Homeopathy
• Homeopathy In Perspective — critical online book, covering the history and present state of homeopathy
• Columbia-Presbyterian Hospital's presentation of homeopathic medicine [17]
• Homeopathy Timeline[18]
• An Overview By Steven Novella
• Magical Thinking in Complementary and Alternative Medicine[19]
• A Skeptical Guide to Homeopathic History, Theories, and Current Practices

[20]

• H2G2 entry on homeopathy