Homeopathy/PreviousVersion

Overview

Many natural scientists and medical doctors have doubts about homeopathic healing methods, and point out that implausible claims need extraordinary proof. Homeopaths respond that the overall evidence for homeopathy, including clinical research, animal research, basic sciences research, historical usage of homeopathic medicines in the successful treatment of people in various infectious disease epidemics, and widespread and international usage of homeopathic medicines today, indeed provide the required extraordinary evidence for the benefits of this system.

Homeopathy has a rich history; many famous people over the past 200 years have been users and advocates of it , and it is an important element in the history of medicine generally. The growth of homeopathy in the 19th century had a significant influence in determining how 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.

Homeopaths are proud of their history, and are convinced of the efficacy of their remedies based mainly on their clinical experience, bolstered by the outcomes of most of their clinical trials. 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, one of the countries where homeopathy has relatively strong public support, a survey cited by the British Homeopathic Association found that 15% of the public "trust" homeopathy.

Many scientists and medical professionals also are interested in homeopathy. They are interested in why so many people believe in homeopathy, when they consider that it has no plausibility. They are interested too in why some studies appear to have positive outcomes—do these reflect real efficacy, or can they be accounted for by flaws in study design or in statistical analysis, or "publication bias"—the tendency for small studies with chance 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.

Historical origins

The early Greek physician Hippocrates of Cos (c. 450 BCE - 380 BCE) , who is considered to be the "father of medicine", is also claimed by homeopaths as a pioneer in their own tradition—notably because Hippocrates taught that "Natural forces within us are the true healers of disease," but also because he thought that some diseases could be cured by the same things that caused them—arguably an early expression of the principle of similars. In the 15th century the alchemist, physician, and astrologer Paracelsus proposed the healing power of "signatures", by which he meant that the appearance of a substance in nature (its color and its shape) represented the types of diseases that it could cure. It was not until the late 18th century, however, that this theory was coupled with an experimental method to determine in detail what symptoms a substance causes and thereby what a particular medicine might cure. This experimental method was developed by the German physician Samuel Hahnemann with his method of "provings"—studies of the effects, in humans, of high dosages.

In 1783, disillusioned with the medicine of his time and the many toxic effects of its treatments, Hahnemann, who knew nine languages, 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.

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.

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.

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 he “potentized” them between each stage of dilution by vigorous shaking (succussion). Homeopathy thus became inextricably linked with this process of ultradilution—repeated dilution of substances by 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.. 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 would stimulate this life force.

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. In 1844, the first U.S. national medical association - the American Institute of Homoeopathy - was established. 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, and the Universities of Ohio State, Iowa, Minnesota and 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. 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.

In the early 20th century, the "Flexner Report," sponsored by the Carnegie Foundation with support from the American Medical Association, triggered major changes in American medical education. As a result, most homeopathic schools 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.

Homeopathic "provings"

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 and Repertory, or nowadays in expert system software. Homeopathic provings 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, and the investigators found that the central idea of this new remedy is the “search for support”. 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).

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.

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.

Homeopathic manufacture of remedies

In the U.S.A., the Homœopathic Pharmacopœia of the United States is a legally recognized handbook that describes how to manufacture homeopathic drugs. This reference is 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 than conventional drugs and medical devices. A summary describes the principles:

FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications 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 which indicates that the drug is homeopathic.

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. 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, 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, 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 — and controversial — 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. When insoluble solids such as oyster shell 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 the Decimal potencies ("D" or "X" potencies). 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 the last dose, have material doses of the original substances in the medicine. The higher potencies (30, 200, 1,000 and higher) are more commonly prescribed by professional homeopaths, and typically homeopaths 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 dilution factor at each stage is 1:100 ("C" potencies), 1:50,000 ("LM" potencies) or 1:10 ("D" or "X" 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 (see the section "Attempts to provide a scientific foundation for homeopathy" below), and it is extremely unlikely that even one molecule of the original substance would be present in a $30C$ dilution. Thus, homeopathic remedies of a high "potency"' contain just water, but according to homeopaths, the structure of the water has been altered (see memory of water).

"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" 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 assertion that a disease/problem can be cured by remedies that (in macroscopic, milligram doses) produce the same symptoms as those of the disease. This assertion, known as "the law of similars", is a guiding principle in homeopathy. Homeopaths consider that two conventional concepts, vaccination, and hormesis, can be considered as analagous to homeopathy's law of similars and the use of small doses.

Scientists and medical doctors today do not think that the principle of similars is generally true or useful, and they explain the efficacy of vaccination without referrring to it. Physicians of the 19th century however did consider that the principle could be valuable. For example, Emil Adolph von Behring (1854-1917), who won the first Nobel Prize in medicine in 1901 for discoveries that led to vaccines against tetanus and diphtheria, and who some consider to be the father of immunology, asserted that vaccination is, in part, derived from the homeopathic principle of similars.

In spite of all scientific speculations and experiments regarding smallpox vaccination, Jenner’s discovery remained an erratic blocking medicine, till the biochemically thinking Pasteur, devoid of all medical classroom knowledge, traced the origin of this therapeutic block to a principle which cannot better be characterized than by Hahnemann’s word: homeopathic.

Although homeopathic remedies and vaccinations both use low doses of active ingedients, there are important differences. First, the doses used in homeopathic remedies are always very much lower than used in vaccines. Second, vaccines produce a measurable immune response (e.g., immunoglobulin production). Homeopathic remedies do not routinely produce a measurable immune response. Thus conventional treatments involve application of measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic preparations above the $24X$ ($12C$) potencies do not contain enough molecules to activate any known metabolic or signalling pathway.

Mithridatization (which is not a term used in contemporary science or medicine) may be a better metaphor than vaccination for homeopathic treatment. Mithridatization is the chronic administration of subtoxic doses of a toxin, in an attempt to develop resistance (or "tolerance") to large doses of the toxin. It is said that Mithridates VI Eupator, King of Pontus (132-63 BC), used this technique to protect himself from his enemies.

There are many different mechanisms by which tolerance can develop - and exposure to repeated small doses does not always result in tolerance. A herpetologist who receives many small doses of snake venom may indeed become tolerant to them. A beekeeper, however, may become hypersensitive to the venom and, after receiving a sting, go into anaphylaxis. This type of response to small, not necessarily precisely measured, doses is not predictable on an individual basis. "Allergic desensitization" is a technique used in conventional medicine to treat individuals who have a specific allergy to something that they cannot easily avoid. This involves exposing the patient repeatedly to tightly controlled doses, increasing the doses gradually over time. This treatment can be dangerous (exposure of sensitive individuals to an allergen can produce anaphylaxis), and it has very inconsistent efficacy, so is normally only attempted when the allergy poses serious restrictions on the patient's normal life.

Both mithridatization and homeopathy might be considered as instances of hormesis, which describes the phenomenon that some chemicals at high concentrations have opposite biological effects to those at low concentrations.