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. Homeopaths believe that the 'potency' of a remedy can be increased by serial dilution, when combined with vigorous shaking. The word 'homeopathy' was coined by the German physician Christian Friedrich Samuel Hahnemann (1755-1843). Hahnemann, born in Meissen, studied medicine in Leipzig and Vienna, and became eminent as a linguist, as a practical physician and as a notably enlightened public health reformer before creating his new health system. He believed his new system to be humane and effective , but it was received by the establishment with derision and contempt. Homeopathy has survived however, and today has more than 100,000 practitioners worldwide, and 500 million users.

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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 Law of Similars

For the early Greek physician Hippocrates of Cos, who lived at about 400 BCE [8], the four 'humours' (blood, black bile, yellow bile and phlegm) were key to understanding disease. This idea persisted through the influence of Galen (131-201 AD) until at least 1858, and Rudolf Virchow's theories of cellular pathology. Diseases, or so it was thought, were the result of some 'imbalance' of the humours, and conventional medicine still focused on restoring that balance, either by attempting to remove an excess of a humour, or by suppressing the symptoms. "Bloodletting, fever remedies, tepid baths, lowering drinks, weakening diet, blood cleansing and everlasting aperients and clysters (enemas) form the circle in which the ordinary German physician turns round unceasingly", wrote Hahnemann while translating into German the Treatise on Materia Medica (1789) by the Edinburgh physician William Cullen.

From 1783 onwards, disillusioned with the medicine of his day and the many toxic effects of its cures, Hahnemann began to use smaller and smaller doses of drugs, trying to minimise their toxic effects while retaining their efficacy. He had concluded that diseases are not caused by "...any disease matter, but that they are solely spirit-like derangements of the spirit-like power that animates the human body", and was searching for some way to harness this power for healing. Cullen had written that Cinchona bark (which contains quinine) was effective because it was bitter, and Hahnemann pondered about this; he felt that this explanation was implausible because other substances that were as bitter had no therapeutic value. Accordingly, he took Cinchona bark himself, and saw that its effects were similar to the symptoms of the diseases that it was prescribed for. . For Hahnemann, this was a breakthrough, and it led him to formulate the 'Principle of Similars' on which homeopathy is based, expressed by him as similia similibus curentur or 'let likes cure likes'.

Provings

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.

James Tyler Kent (1849-1921) [9] was almost as important as Hahnemann to the development of homeopathy; his Lectures on Homoeopathic Materia Medica (1905) listed 217 remedies. Kent emphasized the metaphysical and clinical aspects of Hahnemann's teachings; the core doctrines of miasm and vital force, and the importance of spiritual factors as the 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" ). Modern medicine recognizes that bacteria and viruses as the causes of many diseases, but for Kent "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 Vital Force". In the UK, his ideas became homeopathic orthodoxy by the end of the First World War, and some homeopaths still regard microbes as effects, not causes, of disease.

Today, homeopaths use about 3000 different remedies from animal, plant, mineral, and synthetic substances, including 'Natrum muriaticum' (sodium chloride or table salt)[10], 'Oscillococcinum' (a 200C product made from duck heart and liver that is prescribed for colds and flu-like symptoms) 'Roadrunner' (Geococcyx californianus) [11] and 'Arnica' [12]. Other 'isopathic' remedies involve diluting the agent or product of the disease; for example, Rabies nosode is made from the saliva of a rabid dog. Some homeopaths use more esoteric substances, known as 'imponderables' because they originate from electromagnetic energy 'captured' by alcohol or lactose ('X-ray', 'Sol' (sunlight), 'Positronium', and http://homeoint.org/clarke/e/elect.htm 'Electricitas'](electricity), or with a telescope ('Polaris'). Recent ventures into more esoteric remedies 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 the wrong choice of 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 are through medical dowsing or other psychic powers, but these are not accepted by most homeopaths.

Preparation of similars

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 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). The number of molecules in a given weight of a substance can be calculated by Avogadro's number; the chance that there is even one molecule of the original substance in a 15C solution is small, and it is very unlikely that one molecule would be present in a 30C dilution. Thus, homeopathic remedies of a high 'potency' contain just water, but water that, according to homeopaths, retains some essential property of one of the substances that it has contacted in the past.

Hahnemann's explanation for the increased strength of higher potencies was that the friction involved in succussion could release the hidden power of substances, including their curative power. As he wrote in 1825: "The effect of friction is so great, that not only the physical properties, such as caloric, odour, etc., are thereby called into life and developed by it, but also the dynamic medicinal powers of natural substances are thereby developed to an incredible degree".

Alternative methods

Hahnemann wanted to see 30C as the standard potency in homeopathy, but most of his contemporaries preferred tinctures and 3X, while others, including Caspar Julius Jenichen (1787-1849) and the Russian General Count Iseman von Korsakoff (1788-1853) [13] 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' [14] that continuously combine dilution and succussion. Such machines[15][16] are still sold today; some claim that '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 'geomagnetic potentiser' invented by Malcolm Rae (1913-1979) [17], an electronic engineer and dowser. 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."

In 1832, Korsakov described the method of 'dry grafting'. A single dry globule of a potentized remedy is put in a bottle half-filled with sugar globules. The bottle is shaken for five minutes, and this way all the globuli should be able to exert the influence of the initial remedy, "as if by contagion". Hahnemann approved of the idea, saying that it "is a sort of infection, bearing a strong resemblance to the infection of healthy persons by a contagion brought near or in contact with them".

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". In Hahnemann's words: "...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 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.

Hahnemann was also a powerful advocate of good hygiene, fresh air, regular exercise, and good nutrition as essential for good health (see his 1792 essay: The Friend of Health). He was also a pioneer 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 describing the cause of cholera as "excessively minute, invisible, living creatures", indicating his acceptance of some of the conventional ideas about infectious disease.

The Spread of Homeopathy

I do not expect that homeopathy will ever be established as a legitimate form of treatment, but I do expect that it will continue to be popular. (James Randi, magician and skeptic [18])

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 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 has been recognized as a 'special form of therapy' since 1978, meaning that its remedies do not have to have been proved to be efficacious, but since 2004, most are not 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 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 [19] ; 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.

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

Homeopathy was brought to the USA by Dr Hans Burch Gram (1787-1840) in 1825 and became popular there partly because of the excesses of conventional medicine and partly by the influence of Constantine Hering (1800-1880). Hering immigrated to America in 1833 and became known as the 'father of American homeopathy' [20]. Hering's contributions to the theory of homeopathy include his "laws" of cure. [21]. He proposed that healing proceeds (and symptoms disappear):

From above downwards.

From within outwards.

From a more important organ to a less important one.

In the reverse order of their coming.

By 1900, hardly any city in the USA with a population of more than 50,000 was without a homeopathic hospital, but 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 almost disappeared. Nevertheless, in 1995 sales of homeopathic remedies were estimated at US$201 million, and the number of homeopaths increased from less than 200 in the 1970s to about 3,000 in 1996.

The skeptical view of homeopathy

As I understand it, the claim is that the less you use Homeopathy, the better it works. Sounds plausible to me. (David Deutsch, physicist [22])

From the very beginnings of homeopathy, its claims were treated with skepticism by the medical and scientific establishments. Sir John Forbes (1787-1861), physician to Queen Victoria, declared in 1861 that most cases of disease which recover under homeopathy "recover by means of the curative powers of Nature alone." He concluded that homeopathy is "one of the greatest delusions...of the healing art" and the only good it brings is by lessening "the monstrous polypharmacy which has always been the disgrace of our art - by at once diminishing the frequency of administration of drugs and lessening their dose." [23] 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."

Homeopathy was developed at a time when many of the most important concepts of modern chemistry and biology, such as molecules and germs, were understood poorly if at all. While proponents may consider the mechanism of homeopathy to be an interesting side issue, skeptics consider the lack of any plausible mechanism to be a serious problem, raising the bar on the quality of evidence required before accepting the existence of the phenomenon under the motto "Extraordinary claims require extraordinary proof".

In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree. Although the hypothesis of atoms can be traced back to the ancient Greeks, their size was not calculated until 1865 (by Loschmidt). There are 6.02×1023 particles in a mole (Avogadro's number), so homeopathic dilutions greater than about 24X or 12C are virtually certain to contain not even a single molecule of the initial substance. This is recognized by advocates of homeopathy, who assert that the essential healing power of their preparations 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'. This concept is closely related to the belief in a 'vital force', which was common in Hahnemann's day, but was discarded by the scientific community as more and more life processes came to be describable in purely materialistic terms, and as the medical model of disease came to be focused on the failure of particular organs and processes in the body. .

For critics, a closely related question is that of logical consistency of the theory. The theory assumes that water is imprinted by the properties of molecules that it once came in contact with, even when the molecules are diluted away. If so, then where did the pure water used in this process come from? The water that homeopaths use was once in contact with other chemicals, including chemical wastes, radioactive metals, dinosaur urine, and various poisons. According to this skeptical interpretation of homeopathic theory, all water in the world should remember its contact with millions of chemical substances and not just the properties of the chemicals that the homeopath claims will be useful. The answer of the homeopaths, that dynamization involves succussion as well as dilution, is unconvincing, because it seems improbable that one can amplify order in a solution by shaking it, and because a lot of shaking goes on in the natural world as well.

Scientific testing of remedies

It is not a matter of theory or belief or opinion … Homoeopathy must rest upon facts ( James Tyler Kent)

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.

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. A recent review concluded that some experimental research has offered hints that homeopathic substances diluted and succussed beyond Avogadro’s number might be biologically active but overall, independently reproducible models have found no consistent effects. Many patients report benefits from homeopathic preparations[24], but scientists usually attribute these to the Placebo Effect, the regression fallacy and/or the Forer effect.

There is wide agreement that evidence based medicine is the best way to assess the efficacy and safety of health-care practices. Ideally, a drug should be tested in large, multi-centre, randomised, placebo-controlled, double-blind trials, to test whether it has an effect that is better than either a placebo or a different treatment. Some trials of homeopathy have indicated that some remedies might be more efficacious than placebos, but many are technically flawed, or involve samples too small to draw firm conclusions. Systematic reviews byThe 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 some evidence that it appears to shorten the duration of the disease. Overall, systematic reviews have found no clear evidence of the efficacy of homeopathic remedies..

In 2005, The Lancet published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials. The outcome suggested that the clinical effects of homeopathic remedies might all be placebo effects. The Lancet study is notable as a 'global' meta-analysis of homeopathy, not an analysis of particular remedies, i.e. it tested the hypothesis that all of the reported effects of homeopathic remedies are placebo effects. If so, then reports of positive effects reflect publication bias (the tendency to publish results when they show a positive effect but not when they are negative), and the magnitude of such effects should diminish with sample size and study quality. They analysed an equal number of conventional medicine trials similarly; these showed a real effect of treatment, in that the size of the reported effect was 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 an editorial entitled 'The end of homeopathy' which argued that doctors should recognise the absence of real curative powers in homeopathic medicine. The Lancet subsequently published a selection of critical correspondence.

Medical organizations' attitudes towards homeopathy

People use homeopathy because they believe it works. Although homeopathy, like other placebos, does not work in a clinical sense, it can induce physiological changes. It can also coincide with getting better anyway. (Sense About Science)

In the USA, the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, funds research into homeopathy. According to its statement on homeopathy, individual, controlled clinical trials of homeopathy had produced mixed results; in some, homeopathy appeared to be no more helpful than a placebo; but in others, some benefits were seen that the researchers believed were greater than expected from a placebo. Despite the lack of clear empirical support for homeopathy, the statement concluded that "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. "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"

According to the Indian Ministry of Health and Family Welfare, homeopathy is one of the National Systems of Medicine in India, and it plays an important role in health care for many 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."

Safety of homeopathic remedies

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 United States Food & Drug Administration's view of homeopathy is that there is no real concern about the safety of most homeopathic products, as they "have little or no pharmacologically active ingredients". There have been some reports of illness associated with the use of homeopathic products, but in cases that they reviewed, the FDA concluded that 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 that homeopaths 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." [25].

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."

A particular concern is that homeopaths discourage the use of vaccines. This attitude dating back to Hahnemann, who said "...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." 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.

External links

• Complementary Medicine - Therapies: Homeopathy[26] BBC's "Complementary Medicine" article on Homeopathy
• Homeopathy In Perspective — critical online book, covering the history and present state of homeopathy