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===Evidence-based medicine===
===Evidence-based medicine===
There is wide consensus that [[evidence based medicine]] is the best standard for assessing efficacy and safety of health-care practices, and much of modern medicine is subject to efforts to comply with evidence-based standards.  
There is wide consensus that [[evidence based medicine]] is the best standard for assessing efficacy and safety of health-care practices, and much of modern medicine is subject to efforts to comply with evidence-based standards.  
<ref>[http://bmj.bmjjournals.com/cgi/content/full/321/7258/442 "Declaration of Helsinki should be strengthened" ''BMJ'' 2000;321:442-445]</ref> Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled [[double-blind]] clinical trials, to test whether the drug has an effect that is better than either a placebo or a different treatment, and the results of such trials are independently replicated. Some trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placeboHowever, many are open to technical criticism or involve samples too small to allow firm conclusions to be drawn..<ref>[http://www.annals.org/cgi/reprint/138/5/393.pdf Jonas WB ''et al''(2003) A critical overview of homeopathy" ''Ann Intern Med'' 138:393-399] {{cite journal | author=Jonas WB ''et al''| title=A systematic review of the quality of homeopathic clinical trials | journal=BMC Complement Altern Med | year=2001 | pages=12 | volume=1 | id=PMID 11801202}}</ref> Systematic reviews by the [[Cochrane Collaboration]] thus found insufficient evidence that homeopathy is beneficial for asthma, dementia, or induction of labor <ref> ''The Cochrane Collaboration'' [http://www.cochrane.org]</ref>. 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 not found clear evidence to support the efficacy of homeopathic treatments, but in many cases the available evidence has been too flawed to exclude a possible beneficial effects either.
<ref>[http://bmj.bmjjournals.com/cgi/content/full/321/7258/442 "Declaration of Helsinki should be strengthened" ''BMJ'' 2000;321:442-445]</ref> Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled [[double-blind]] clinical trials, to test whether the drug has an effect that is better than either a placebo or a different treatment, and the results of such trials are independently replicated. Some trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placeboHowever, many are open to technical criticism or involve samples too small to allow firm conclusions to be drawn..<ref>[http://www.annals.org/cgi/reprint/138/5/393.pdf Jonas WB ''et al''(2003) A critical overview of homeopathy" ''Ann Intern Med'' 138:393-399] {{cite journal | author=Jonas WB ''et al''| title=A systematic review of the quality of homeopathic clinical trials | journal=BMC Complement Altern Med | year=2001 | pages=12 | volume=1 | id=PMID 11801202}}</ref> Systematic reviews by the [[Cochrane Collaboration]] thus found insufficient evidence that homeopathy is beneficial for asthma, dementia, or induction of labor <ref> ''The Cochrane Collaboration'' [http://www.cochrane.org](ref/>. 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 not found clear evidence to support the efficacy of homeopathic treatments, but in many cases the available evidence has been too flawed to exclude a possible beneficial effects either.


In 2005, The [[Lancet]] published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials <ref>{{cite journal | author=Shang A,''et al''| title=Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy | journal=Lancet | year=2005 | pages=726-32 | volume=366 | issue=9487 | id=PMID 16125589}}</ref> based upon the Swiss government's "Program for Evaluating Complementary Medicine" (PEK). The outcome suggested that the clinical effects of homeopathy 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 effects, i.e. it tested the global hypothesis that the reported effects of homeopathy 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. For comparison, they subjected an equal set of conventional medicine trials to identical analysis. The prediction was supported by the study; conventional tests showed a real effect independent of sample size, the homeopathy studies did not. The study does not prove that homeopathy is never effective, or that all its findings are placebo effects, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet accompanied the meta-analysis with invited editorials, and published several critical responses.<ref>Fisher P (2006) Homeopathy and The Lancet ''eCAM'' 3:145-47 [http://ecam.oxfordjournals.org/cgi/content/full/3/1/145]; Jobst KA (2005) Homeopathy, Hahnemann, and The Lancet 250 Years On: A Case of the Emperor's New Clothes? ''J Alt Comp Med'' 11:751-54.[http://www.liebertonline.com/toc/acm/11/5]</ref>
In 2005, The [[Lancet]] published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials <ref>{{cite journal | author=Shang A,''et al''| title=Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy | journal=Lancet | year=2005 | pages=726-32 | volume=366 | issue=9487 | id=PMID 16125589}}</ref> based upon the Swiss government's "Program for Evaluating Complementary Medicine" (PEK). The outcome suggested that the clinical effects of homeopathy 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 effects, i.e. it tested the global hypothesis that the reported effects of homeopathy 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. For comparison, they subjected an equal set of conventional medicine trials to identical analysis. The prediction was supported by the study; conventional tests showed a real effect independent of sample size, the homeopathy studies did not. The study does not prove that homeopathy is never effective, or that all its findings are placebo effects, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet accompanied the meta-analysis with invited editorials, and published several critical responses.<ref>Fisher P (2006) Homeopathy and The Lancet ''eCAM'' 3:145-47; doi:10.1093/ecam/nek007 [http://ecam.oxfordjournals.org/cgi/content/full/3/1/145]; see also Jobst KA (2005) Homeopathy, Hahnemann, and The Lancet 250 Years On: A Case of the Emperor's New Clothes? ''J Alt Comp Med'' 11:751-54.[http://www.liebertonline.com/toc/acm/11/5]</ref>





Revision as of 01:06, 1 November 2005

Homeopathy (also spelled homœopathy or homoeopathy) is a therapy that strives to treat "like with like".[1], that is, to treat illnesses with infinitesimal doses of drugs that cause the same symptom as the illness. The word "homeopathy", coined by the Saxon physician Christian Friedrich Samuel Hahnemann (1755–1843), first appeared in print in 1807, although he had previously outlined his axiom of medical similars in a series of articles and monographs from 1796 onwards.[2]. The word is derived from the Greek όμοιος, hómoios (similar) and πάθος, páthos (suffering), 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 by the European Directorate for the Quality of Medicines.[3]

File:Samuel Hahnemann.png
Samuel Hahnemann, the father of homeopathy

Homeopathy rests on the premise of treating sick persons with very diluted agents that, in undiluted doses, produce similar symptoms in a healthy individual. Its proponents assert that the therapeutic potency of a remedy can be increased by serial dilution of the drug, combined with succussion or vigorous shaking. In common with conventional medicine, homeopathy regards diseases as "morbid derangements of the organism" but it differs in preferring to view each case of sickness as a strictly individual phenomenon.[4] It is the man that is sick and to be restored to health, not his body, not the tissues.[5] Homeopathy views a sick person as having a dynamic disturbance in a hypothetical "vital force," and so reject the standard medical diagnoses of named diseases. [6] The theory of homeopathy is inconsistent with accepted laws of chemistry and physics, as it states that extreme dilution makes drugs more powerful by enhancing their "spirit-like medicinal powers."[7] Some trials show a difference between homeopathic treatments and placebos, but most have methodological problems, and better-quality trials tend to give negative results.

The principle of medical similars

Homeopathy is based on the 'Principle of Similars', expressed by Hahnemann as similia similibus curentur or 'let likes cure likes'. This is the opposite of 'contraries' upon which the Galenic medicine of his day was based, and in which Hahnemann had been trained. The 'law of similars' is an ancient medical maxim [8], but its modern form is based on Hahnemann's conclusion that a constellation of symptoms induced by a given homeopathic remedy in a group of healthy individuals will cure similar symptoms in the sick. Symptom patterns associated with various remedies are determined by 'provings', in which volunteers are given remedies, and the resulting symptoms are compiled by observers into 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."[9]

For prescribing, homeopathic practitioners use The Homeopathic Materia Medicae, which are indexes of Drug Pictures organized by remedy and describe the symptom patterns associated with individual remedies, and on The Homeopathic repertory which is an index of symptoms, listing all remedies associated with specific symptoms. The first Homeopathic repertory was George Jahr's, published in 1835. [10] At first, Hahnemann tested substances then used as medicines, such as antimony and rhubarb, and poisons, like arsenic, mercury and Belladonna. Perhaps in this he was mindful of Paracelsus: "poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy."[11] This subtle connection between poison and medicine, or 'what can kill can cure' was also observed by Shakespeare: "In the infant rind of this small flower, poison hath residence and medicine power:..." [12] Hahnemann 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. He was most heavily engaged in proving in the 1790s and early 1800s, but he never abandoned these experiments. Another phase of proving commenced with his Miasm theory and The Chronic Diseases [13], published in 1828, and containing 48 freshly 'proven' drugs.

Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies, and new substances are continually added to contemporary versions. 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 Electricitas (electricity) or through the use of a telescope (Polaris). Recent ventures by homeopaths into even more esoteric substances include Tempesta (thunderstorm), and Berlin wall.

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. This approach harks back to the ancient 'doctrine of signatures,' which Hahnemann rejected as uncertain guesswork:

"The ancients imagined that the yellow colour of the juice of...(Chelidonium, Yellow Poppy) was an indication (signature) of its utility in bilious diseases. The moderns from this extended its employment to hepatic diseases...the importance of human health does not admit of any such uncertain directions for the employment of medicines. It would be criminal frivolity to rest contented with such guesswork at the bedside of the sick. Only that which the drugs themselves unequivocally reveal of their peculiar powers in their effects on the healthy human body – that is to say, only their pure symptoms – can teach us loudly and clearly when they can be advantageously used with certainty; and this is when they are administered in morbid states very similar to those they are able to produce on the healthy body." [14]

Examples of this impulse to expand the Materia Medica include the use of an isopathic (disease associated) agent as a first prescription in a 'stuck' case[15] when the beginning of disease coincides with a specific event such as vaccination; the use of a chemically-related substance when a remedy that was well-indicated fails. An example is the Bowel Nosodes[16], introduced by the British homeopaths Edward Bach (1886-1936), John Paterson (1890-1954) and Charles Edwin Wheeler (1868-1946) in the 1920s, based on the bowel bacterial flora thought to be associated with persons of different homeopathic constitutional types. Bowel Nosodes are rarely used outside British homeopathy. More recently, homeopathy has used substances based on the periodic table or biological taxonomy. This approach is questioned by some purists on the basis that it involves speculation about remedy action without provings.[17]

The law of similars is not a scientific law; it is not built on a hypothesis that can be falsified, and a failure to cure can always be attributed to incorrect selection of a remedy: "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". [18] 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 exhibited by any individual. Other ways of selecting remedies are through medical dowsing[19] or other psychic powers.[20] However, these are not accepted by most homeopathic practitioners.

See also: List of common homeopathic remedies

Preparation of similars

Succussion and dilution

Vijzel

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. [21] 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). Higher 'potencies' are considered to be stronger 'deep-acting' remedies. 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. For a perspective on these numbers, there are about 1032 molecules of water in an Olympic size swimming pool; 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. Practitioners of homeopathy believe that this water 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. Though 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), [22] General Korsakoff (1788-1853) and Dr N Schreter (1803-1864), were busy raising potency to heights beyond his wildest dreams.

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. [23]

Such high potencies could not be made by traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which integrate dilution and succussion into a continuous process (Korsakoff). [24]. Such machines are still sold today and some manufacturers claim it is undefined "vibrations" that produce the healing effect and, when the correct vibration is selected, only water need be added to produce a remedy. Today, radionics potentising devices are used by many homeopaths to prepare remedies, based on the work of the British engineer, Malcom Rae (1913-1979) and devices he developed in the 1960s.[25] Another technique involves "a paper remedy. Write the remedy and potency on a piece of paper and place the paper on the left hand side of the body with the writing towards the body." [26]

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." To explain this, Hahnemann introduced the miasmatic theory, that three fundamental "miasms" are the underlying causes of all the chronic diseases of mankind: Syphilis, Sycosis (suppressed gonorrhoea), and Psora. [27] The miasm of Psora, he concluded, underpinned most of the chronic diseases known to medicine. 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..."

It is possible that the study of Freemasonry under the guidance of his Patron, the Grand Duke Ferdinand of Anhalt-Coethen influenced him.[28] He became reclusive while in Koethen, and his new inclination towards metaphysical pursuits may explain his sudden adoption of Olfaction (inhaling the remedy), which he continued to use until his death in Paris in 1843.[29] Olfaction might derive from Arabian medicine and the art of Perfumery.[30]

According to Hahnemann, miasmatic infection causes local symptoms, usually in the skin. If these are suppressed by external medication, the hidden sickness cause goes deeper, and manifests later as organ pathologies. In the Organon he asserted Psora to be 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 [31] 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 the multitude of different infectious diseases. Nevertheless, most homeopaths hold that the key elements of his theory are valid: that the fundamental cause of disease is 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 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" Asiatic Cholera, 1831. Hahnemann's acceptance of this idea of infectious disease before its proof by Robert Koch and Louis Pasteur indicates that he incorporated ideas that were at the cutting-edge of contemporary science.

History

In Hahnemann's day, the conventional theory of disease was based on the four humours. Mainstream medicine focused on restoring the balance in the humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours, such as by lowering the body temperature of patients who were feverish. By contrast, Hahnemann promoted an immaterial, vitalistic view of disease: "...that the diseases of man are not caused by any substance, any acridity...any disease matter, but that they are solely spirit-like (dynamic) derangements of the spirit-like power (the vital principle) that animates the human body." [32] In the 18th century, vitalism was a part of mainstream science, but in the twentieth century, was discarded in favour of the germ theory of disease, following the work of Pasteur, Fleming, Lister and others. Modern medicine sees bacteria and viruses as the causes of many diseases, but Kent, and some modern homeopaths regard them as effects, not causes, of disease. Others have adapted to the views of modern medicine by referring to disturbances in the immune system, rather than the vital force.

The idea that 'like cures like' came to Hahnemann while 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, Hahnemann felt this implausible because other substances were as bitter but had no therapeutic value. To understand the effects of Cinchona bark, he took it himself, and saw that his reactions were similar to the symptoms of the disease it was used to treat. At least one writer has suggested that Hahnemann was hypersensitive to quinine, and may have had an allergic reaction[33] This experiment by Hahnemann was not unique; others before, including Anton von Störck (1731-1803), had advocated "treatment by cautious use of poisons."[34] Hahnemann had studied briefly in Vienna (1777) where Störck eventually became head of the University. The proving idea had also been recommended by the Swiss medical botanist, Albrecht von Haller, (1708-77), who Hahnemann admired, and whose Materia Medica he translated in 1806.

Nearly as important as Hahnemann to the development of homeopathy was James Tyler Kent (1849-1921). Kent's influence in the USA was limited, but in the UK, his ideas became homeopathic orthodoxy by the end of the First World War.[35] Kent's attempt to rescue an idealized pure homeopathy from what he saw as its degenerate mongrel forms was authoritarian, as he sought to re-emphasize the metaphysical and clinical aspects of Hahnemann's teachings, in particular, he insisted on the core doctrines of miasm and vital force; emphased case totality rather than rote prescribing for 'named diseases' emphased psychological symptoms (to supplement physical pathology) in prescribing; and regular use of very high potencies. Influenced by Swedenborgianism, Kent emphasized spiritual factors' as the root cause of disease.[36]

"...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."

Homeopathy around the world

There are estimated[37] to be more than 100,000 practitioners of homeopathy worldwide, with an estimated 500 million people receiving treatment.

Europe

More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatment in the UK, France, and Germany. Homeopathy was regulated by the European Union in 2001, by Directive 2001/83/EC. The numbers using homeopathy is increasing, with the British market increasing by about 20% per year, and even faster growth in Germany and Portugal.[38] In Germany, homeopathy, anthroposophically extended medicine and herbalism were recognized as "special forms of therapy" in 1978, meaning that their medications are freed from the usual requirement of proving efficacy. Since January 1, 2004, homeopathic medications, with some exceptions, are no longer covered by the country's public health insurance.

In Switzerland, homeopathic medications were formerly covered by the basic health insurance system, if prescribed by a physician. This ended in 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. This change applied only to compulsory insurance; homeopathy and other complementary medicine is covered by additional insurance, if the treatment is provided by a medical doctor.

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 Dr Quin's patients, and he became physician to the Duchess of Cambridge.[39] Homeopathy continued to have an elite clientele, including members of the royal family until the mid-nineteenth century. At its peak in the 1870s, Britain had many homeopathic dispensaries and small hospitals and 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. [40] 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.[41] Medically qualified homeopaths in Britain are represented by the Faculty of Homeopathy: the Faculty, incorporated by an Act of Parliament in 1950, has over 1,400 members throughout the world.

India

Homeopathy came to India with Dr Martin Honigberger (1795-1869) in Lahore, in 1829-30 [42] India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals. The Association of Qualified Homoeopaths in India is the largest of its kind, and 10% of the population are estimated to use homeopathy exclusively for their medical needs [43]

The USA

Homeopathy was established in the USA by Dr Hans Burch Gram (1787-1840)in 1825 [44] and gained popularity, partly because the excesses of conventional medicine were extreme there, and partly due to Dr Constantine Hering (1800-1880), who immigrated to America in 1833 and became known as the "father of American homeopathy". [45] Homeopathy thrived, and 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.[46] In the 1930s, the popularity of homeopathy waned, partly due to advances in conventional medicine and partly due to the Flexner Report in 1910, which led to the closure of virtually all medical schools teaching alternative medicine in the USA. By the 1950s, homeopathy had been virtually extinguished in the US.

In the USA, sales of homeopathic medicines in 1995 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[47]; however, a recent study indicates that the percentage of people seeking homeopathic treatment in the USA declined from 3.4% in 1997 to 1.7% in 2002[48] Today, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration, but unlike conventional medicines, homeopathic products do not have to be approved by the FDA before sale, or proved to be either safe or effective, or be labeled with an expiration date, or undergo finished product testing to verify contents and strength. Unlike conventional drugs, homeopathic remedies do not have to identify their active ingredients on the grounds that they have few or no active ingredients. Only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter; homeopathic medicines that claim to treat a serious disease can be sold only by prescription.

Scientific testing of homeopathic treatment

Early critiques of high dilutions

Sir John Forbes (1787-1861), physician to Queen Victoria, said the extremely small doses were regularly derided as useless, ridiculous and "an outrage to human reason."[49] Although such homeopathic cures were accepted by regular physicians at the time, they were ascribed entirely to the body's innate healing powers. Professor Sir James Young Simpson said of the highly diluted drugs: "no poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly." [50]

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. Some tests have suggested that potentized solutions up to D120 can have statistically significant effects on organic processes, including the growth of grain, histamine release by leukocytes[51] and enzyme reactions. However, attempts to replicate these studies on leukocytes and enzymes have failed. A recent review summarized the situation as follows: "...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."[52] Although some patients report benefits from homeopathic preparations,[53] 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 standard for assessing efficacy and safety of health-care practices, and much of modern medicine is subject to efforts to comply with evidence-based standards. [54] Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind clinical trials, to test whether the drug has an effect that is better than either a placebo or a different treatment, and the results of such trials are independently replicated. Some trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placeboHowever, many are open to technical criticism or involve samples too small to allow firm conclusions to be drawn..[55] Systematic reviews by the Cochrane Collaboration thus found insufficient evidence that homeopathy is beneficial for asthma, dementia, or induction of labor Cite error: Closing </ref> missing for <ref> tag based upon the Swiss government's "Program for Evaluating Complementary Medicine" (PEK). The outcome suggested that the clinical effects of homeopathy 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 effects, i.e. it tested the global hypothesis that the reported effects of homeopathy 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. For comparison, they subjected an equal set of conventional medicine trials to identical analysis. The prediction was supported by the study; conventional tests showed a real effect independent of sample size, the homeopathy studies did not. The study does not prove that homeopathy is never effective, or that all its findings are placebo effects, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet accompanied the meta-analysis with invited editorials, and published several critical responses.[56]


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. Avvording to its statement om homeopathy,[57] 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 statement on homeopathy, about 200 randomised controlled trials evaluating homeopathy have been conducted, but "it has proven difficult to produce 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 following statement[58] was adopted as policy of the American Medical Association (AMA) 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:[59] "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)

To some, homeopathy, particularly the use of nosodes, resembles vaccination, in that vaccines contain a small dose of the "disease" against which they are to protect. Hahnemann interpreted the introduction of vaccination as such: "But 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." By contrast, modern scientists see the two practices as fundamentally different. A vaccine is usually made from a bacterium or virus that cannot produce symptoms, while still providing enough information to the immune system to afford protection. Thus, by preparing the immune system to meet a future attack by the pathogen, vaccination hopes to prevent disease, in contrast to homeopathy's hope, which is to cure it. 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.

Safety of homeopathic treatment

The United States Food & Drug Administration (ref>FDA's view of homeopathy</ref> considers 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.[60] 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." [61].

Several scientists said the homeopaths' advice was reprehensible and likely to endanger lives. Professor Geoffrey Pasvol, a tropical medicine expert at Imperial College in 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." [62].

Notes

  1. Samuel Hahnemann biography
  2. Hahnemann S (1796) translated into English on Essay on a New Principle, 1796
  3. European Directorate for the Quality of Medicines EDQM website
  4. Morrell P Homeopathy Views the Uniqueness of Each Patient
  5. Lectures on homoeopathic philosophy. Kent JT Lecture 1. § 1. "The Sick"
  6. http://www.lyghtforce.com/HomeopathyOnline/Issue3/sequence.html Rudolf Verspoor Taking Homeopathy into the Shadows: A Sequential Causal Approach to Treating Chronic Disease Homeopathy Online
  7. Christian Friedrich Samuel Hahnemann's "Organon Of Medicine" translated by Dudgeon, Fifth Edition § 269
  8. whonamedit.com
  9. Hahnemann, Materia Medica Pura, Cinchona at Hpathy.com
  10. Website of Whole Health Now
  11. Source for Paracelsus quote at en.thinkexist.com
  12. Romeo and Juliet: act 2, scene 3. Oxford Shakespeare complete works. Oxford: Oxford University Press, 1974: 774
  13. Chronic Diseases - Samuel Hahnemann
  14. Hahnemann, Materia Medica Pura, section 19, Chelidonium majus at Hpathy.com
  15. Manish Bhatia Tautopathy - An Introduction
  16. Bowel Nosodes
  17. Homoeopathic Online Education
  18. Kent JT (1926) New Remedies, Lesser Writings and Aphorisms & Precepts quoted in Treuherz F (1984) Origins of Kent's homeopathy J Amer Inst Homeo 77:130-49
  19. "Diagnostic dowsing machines" www.homeoinfo.com
  20. "Medical dowsing" www.homeoinfo.com
  21. It can be viewed at the Hahnemann Museum in Stuttgart <Website of The Institute for the History of Medicine
  22. Biography of Mr Caspar Julius Jenichen (1787-1849) http://homeoint.org
  23. Biography of Mr Caspar Julius Jenichen (1787-1849) http://homeoint.org
  24. Such a Korsakoff potentising machine can be seen (here) and (here). Some old potentising devices can be seen (here)
  25. Website of Sussex College of Technology - CopenLabs
  26. Editorial at the web pages of the New Zealand Homoeopathic Society "finds out what they need, writes the remedy down on a piece of paper, they put it in their pocket and it works." Website of The Toronto Chapter of the Canadian Society of Dowsers
  27. The Chronic Diseases, their Nature and Homoeopathic Treatment, Dresden and Leipsic, Arnold. Vols. 1, 2, 3, 1828; vol. 4, 1830
  28. Website of Homéopathe International
  29. Website of The Homeopathic Academy of Naturopathic Physicians
  30. Manouchehr Saadat Noury "First Iranians who introduced perfumery" Persian Journal May 9, 2005
  31. Website of The Canadian Academy of Homeopathy
  32. http://homeoint.org/books/hahorgan/orgapref.htm Organon, Preface, xxix
  33. William.E.Thomas "The basis of homeopathy" Personal website
  34. Halina Zofia Lichocka "Chemical Analysis as a Method of Discovery in Pharmacy in the Age of Enlightenment in Europe" Proc 5th Int Conf Hist Chem
  35. Campbell A, Kentian Homeopathy Chapter 8 of Homeopathy in Perspective[1]
  36. Peter Morrell "Kent's influence on British homeopathy." Personal website
  37. Homeopathy Seeks More Acknowledgement from Deutsche Welle
  38. Fisher P, Ward A (1994) Medicine in Europe: Complementary medicine in Europe BMJ 309:107-111
  39. Leary B et al (1998) It Wont Do Any Harm: Practice & People At The London Homeopathic Hospital, 1889-1923, in Juette, R, G Risse & J Woodward (1998) Eds. Culture, Knowledge And Healing: Historical Perspectives On Homeopathy In Europe And North America Sheffield Univ. Press, UK
  40. Website of Homéopathe International; Image; Image
  41. The Society of Homeopaths
  42. Kishore J (1973) About entry of homeopathy into India, Bull Ind Hist Med 3:76-78
  43. Indian Hopeopathic Medical Association. Manchanda RK, Kulashreshtha M, Cost Effectiveness and Efficacy of Homeopathy in Primary Health Care Units of Government of Delhi- A study; Indian Ministry of Health and Family Welfare homeopathy page
  44. Questions and Answers About Homeopathy NCCAM, National Institutes of Health; [http://www.homeopathyusa.org/ American Institute of Homeopathy; North American Society of Homeopaths]
  45. "Homeopathy spread first in Germany, then France, and England. Its greatest popularity, however, was in America." Flinn LB (1976) Homeopathic influences in the Delaware community A retrospective reassessment Del Med J 48:418-428; "...by the early 1840s American homeopathic practitioners were gaining considerable influence and prestige" in Warner JH (1977) The nature-trusting heresy Perspectives on American History 11:291-324
  46. Cameron CS (1959) Homeopathy in retrospect Trans Stud Coll Phys Philadelp 27:28-33
  47. Website of Homoeopathic Medical Publishers
  48. Tindle HA et al(2005) Trends in use of complementary and alternative medicine by US adults: 1997-2002 Altern Ther Health Med 2005 11:42-9
  49. Forbes J (1846) Homeopathy, Allopathy and Young Physic London
  50. Simpson JY (1853) Homoeopathy, Its Tenets and Tendencies, Theoretical, Theological and Therapeutical Edinburgh: Sutherland & Knox 11
  51. Davenas E et al Human basophil degranulation trigtgered by very dilute antiserum against IgE Nature 333:816-8
  52. Walach et al (2005) Research on Homeopathy: State of the Art J Alt Comp Medicine 11:813–29
  53. Website of The Society of Homeopaths
  54. "Declaration of Helsinki should be strengthened" BMJ 2000;321:442-445
  55. Jonas WB et al(2003) A critical overview of homeopathy" Ann Intern Med 138:393-399 Jonas WB et al (2001). "A systematic review of the quality of homeopathic clinical trials". BMC Complement Altern Med 1: 12. PMID 11801202.
  56. Fisher P (2006) Homeopathy and The Lancet eCAM 3:145-47; doi:10.1093/ecam/nek007 [2]; see also Jobst KA (2005) Homeopathy, Hahnemann, and The Lancet 250 Years On: A Case of the Emperor's New Clothes? J Alt Comp Med 11:751-54.[3]
  57. NIH statement on homeopathy
  58. alternative theories including homeopathy. American Medical Association.
  59. Indian Ministry of Health and Family Welfare homeopathy page; and see Homoeopathy India Foundation [4]
  60. Science and Technology - Sixth Report Science and Technology Committee Publications
  61. Homeopathic practices "risk lives" By Pallab Ghosh BBC News science correspondent
  62. Homeopaths 'endangering lives' by offering malaria remedies Alok Jha, science correspondent Friday July 14 2006 The Guardian

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