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Homeopathic remedy Rhus toxicodendron, derived from poison ivy.

Homeopathy (also homœopathy or homoeopathy; from the Greek, όμοιος, hómoios, "similar" + πάθος, páthos, "suffering" or "disease") is a controversial form of alternative medicine that aims to treat "like with like". Homeopaths see the underlying causes of sickness as imbalances in a hypothetical vital force and believe that treatment of diseases with extremely diluted substances, which in larger quantities cause symptoms of the disease, can harmonize and re-balance the vital force in the body and so restore health.[1] The process of producing remedies in homeopathy is known as "potentization" and involves serial dilutions of the drug, combined with vigorous shaking (called "succussion") and is accomplished in a series of stages; the number of stages varies according to the type of treatment. Homeopaths contend that remedies will retain some imprint (or memory) of the diluted substance despite the fact that at higher dilutions, no molecules of the original substance are likely to remain.[2]

Homeopathy traces its origins to the late 18th century when it was founded by German physician Samuel Hahnemann. The term "homeopathy" was coined by Hahnemann and first appeared in print in 1807.[3] During the 19th century homeopathy had a substantial impact upon medicine and in 1830 the first homeopathic schools opened and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States.[4] Hahnemann developed homeopathy after noticing the effects of Cinchona bark on himself. Cinchona bark contains quinine and is often used as a treatment for malaria, however Hahnemann noticed that if ingested by healthy individuals, cinchona bark would produce some symptoms of malaria. From this experience Hahnemann deduced that an effective drug must produce the symptoms in healthy individuals that are similar to the symptoms of the sick patient which they are supposed to be treating. This idea would later become known as the "law of similars" otherwise known as "like cures like".[1] Based on later experiments, Hahnemann reasoned that using natural doses of substances would generally not help patients because if they produced effects similar to those of the disease, they would only make symptoms worse. Thus he proposed the dilution of substances in water or alcohol in order to eliminate such bad effects of a drug while hoping to retain its therapeutic value. Homeopathy contends that the vital force in the body has the ability to react or adapt to disturbances, which in homeopathy is referred to as the "law of susceptibility". This law states that various causes can attract hypothetical disease-causing entities called "miasms", which upon invading the body produce symptoms of disease. Hahnemann devised the miasm hypothesis as a deeper cause of sickness, to account for his observation that homeopathic remedies were sometimes failing to produce lasting cures of some long-standing chronic diseases. The main miasm in homeopathy is called the "psora" (Greek: itch), and is thought to be the cause of most diseases including epilepsy, cancer, deafness, and cataracts.[5]

Today there are estimated to be over 100,000 homeopathic physicians practicing homeopathy worldwide and an estimated 500 million people receiving homeopathic treatments.[6] Over 12,000 medical doctors and health care practitioners administer homeopathic treatments in the United Kingdom, France, Denmark and Germany. An estimated 32% of French patients, 28% of Danish patients and 16% of UK patients have used homeopathic treatments at least once. In the United States homeopathy is less popular with an estimated 1.7% of patients having reported use of homeopathic treatments.[7] While Homeopathy is considered to have helped pave the way for modern medical practices, the medical efficacy of it's treatments are frequently disputed by experimental studies. More recent and controlled clinical trials of homeopathy have shown mixed results and systematic reviews have found numerous flaws and possibilities of bias in experiments showing positive results.

While the methods of homeopathy including it's focus on patients and emphasis on clinical trials was ahead of it's time when it was conceived, it has received a significant amount of criticism on scientific and medical grounds and is considered by many scientists to be ineffective.[8][9] The hypothesis that extreme dilution makes any pharmaceutical more powerful is inconsistent with the principles of chemistry and physics as well as the observed dose-response relationships of conventional drugs. The scientific community asserts there is no convincing scientific evidence supporting the contention that water retains any memory of a substance. Researchers conclude that any positive effects that arise after homeopathic treatment are simply a placebo effect.[10] Homeopaths are also often accused of giving 'false hope' to patients who might be better advised to seek effective conventional treatments and studies have shown homeopaths frequently advise patients to not seek standard medical procedures including drugs which can prevent diseases such as malaria.[11][12] Most meta-analysis done on homeopathy have concluded that its effects are unlikely to be beyond that of placebo, and those studies that have shown positive results for Homeopathic treatments were flawed in design.[13][14][15]

History

Modern homeopathy was created by German Physician Samuel Hahnemann during the late 18th and early 19th century. The system of similars emphasized in homeopathy was first described by doctors of the vitalist school of medicine and one of the most prominent proponents of vitalism was the Renaissance physician Paracelsus. Paracelsus subscribed to many of the same principles as the modern founder of homeopathy, Samuel Hahnemann. Vienna physician Anton Freiherr von Störck and Scottish physician John Brown also held similar medical beliefs to Samuel Hahnemann prior to the conception of homeopathy

18th century medicine

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the perceived brutality of medicine of the 19th century.

In Hahnemann's day, mainstream medicine was a degenerate form of Galenism, with a theory of disease based upon the ancient Greek idea of four humours. Medicine of the time professed to restore the balance of the humours, mostly by employing such measures as bloodletting and purging, use of laxatives, enemas and substances that induced vomiting, as well as suppressing symptoms using complex mixtures of plant and mineral drugs in strong doses. Such measures often made symptoms worse or proved fatal. By contrast, Hahnemann rebelled against these methods, and the use of mixed drugs in strong doses, favoring the use of single drugs in milder doses. He later came to promote an immaterial, vitalistic view of how living organisms function and thought that diseases have spiritual, as well as physical causes.[16][17] During the 18th century vitalism was part of mainstream science. However, in the twentieth century, medicine discarded vitalism in favor of the germ theory of disease, following the work of Robert Koch, Louis Pasteur, Alexander Fleming, Joseph Lister and many others.

Modern theory of homeopathy

File:Samuel Hahnemann.png
Samuel Hahnemann, considered to be the father of homeopathy

Samuel Hahnemann conceived of homeopathy while translating a Materia Medica, a treatise by Scottish physician and chemist William Cullen, into German. On reading about Cinchona bark, from which quinine is extracted and is used to treat malaria, he noticed that Cullen described the mechanism of the substance as having "stomach strengthening properties". Hahnemann was skeptical of this explanation and decided to understand the effects of Cinchona bark by taking it himself. Upon ingesting Cinchona bark, he noticed that he experienced fever, shivering and arthralgia (joint pain). These symptoms are similar to some of those of malaria, which the substance was supposed to be treating. From this experience he deduced that all effective drugs must produce the symptoms in healthy individuals that are similar to the diseases which they are supposed to be treating. This later became known as the "Law of similars" and the most important concept of homeopathy.[1] This experiment was by no means unique, as others before him had tried the same approach including Anton Freiherr von Störck who in the 1760's advocated treatment by cautious use of poisons."[18] The term "homeopathy" was coined by Hahnemann and first appeared in print in 1807,[3] although he began outlining his theories of 'medical similars' in a series of articles and monographs in 1796.[19]

Hahnemann began to conduct extensive experiments to determine which symptoms were produced by various substances. This process would later become known as "proving". The tests were time consuming and required subjects to clearly record all of their symptoms as well as the time of their appearance and the results suggested to Hahnemann which drugs would be useful for treatments. The first collection of provings of 27 drugs was published in 1805 and a second collection of 65 remedies appeared in the Materia Medica Pura of 1810. Having surmised that large doses of the substances would be unsuitable, Hahnemann advocated extreme dilutions of the substances by ten or one hundred fold. He gathered and published a complete overview of his new medical system in his 1810 book: The organon of the healing art, who's 6th edition published in 1921 is still used by homeopaths today.[1]

During the 19th century homeopathy had a substantial impact upon medicine and in 1830 the first homeopathic schools opened and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States.[4] Homeopathic hospitals also appeared and practitioners of homeopathy often had better outcomes compared to those of their counterparts in mainstream medicine. This was likely due to the fact homeopathic treatments were rarely dangerous compared to those of the mainstream which often included blood letting or treatments with poisonous or noxious compounds. In homeopathy patients were less likely to be killed by the medical procedure which was supposed to be helping them.[1]

The last homeopathic school which taught exclusively homeopathy was closed down in the U.S. in 1920, though the Hahnemann School of Medicine, now part of Drexel University, continued to offer homeopathy electives until the 1940's.[1]

General philosophy

Homeopathy is a vitalist philosophy in that it regards diseases and sickness to be caused by disturbances in a hypothetical vital force or life force in humans and that these disturbances manifest themselves as unique symptoms. Homeopathy contends that the vital force has the ability to react and adapt to internal and external causes, which homeopaths refer to as the "law of susceptibility". The law of susceptibility states that a negative state of mind can attract hypothetical disease entities called "miasms" to invade the body and produce symptoms of diseases[1], However, Hahnemann rejected the notion of a disease as a separate thing or invading entity[20] and insisted that it was always part of the "living whole".[21]

Miasms and disease

The theory of miasms was conceived by Hahnemann because he was concerned about the failure of his homeopathic remedies to produce lasting cures for chronic diseases. He noted that "...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." Hahnemann explained this by associating various miasms with specific diseases that have historically plagued mankind. Hahnemann envisioned various miasms and each separate miasm being responsible for various types of diseases. One of the main miasms was called the "psora"(Greek for itch) and was described as being related to any itching diseases of the skin, and in homeopathy is thought to be the foundation of many disease conditions. Hahnemann viewed psora as primarily derived from suppressed scabies. On Psora, Hahnemann stated it is "the only real fundamental cause and producer of all the other numerous, I may say innumerable, forms of disease..."[22] Hahnemann asserted Psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts. Originally Hahnemann presented only three miasms, others have been added by homeopaths during the last 200 years since their inception, including tubercular miasms and cancer miasms.[23]

This idea of miasms was first introduced in 1828[24], though Hahnemann first suspected something similar to miasms as early as 1816. According to Hahnemann, miasmatic infection causes local symptoms, usually in the skin. If these are suppressed by external medication, the hidden cause goes deeper, and manifests itself later as organ pathologies.[23] Homeopathy contends that treating symptoms by directly opposing their actions, as is done in conventional medicine, is not effective in treating diseases because the miasms still remain, and that the only way to correct the ailments is to correct the disturbance of the vital force.[25]

Law of similars

Hahnemann experimented with Cinchona bark, which is used as a treatment of malaria, and observed that the side effects he experienced from the quinine in the Cinchona bark were similar to the symptoms of malaria. He reasoned that treatments for diseases must produce symptoms similar to of those disease being treated when taken by healthy individuals. From this Hahnemann conceived of the "law of similars", otherwise known as "like cures like". Hahnemann believed that by inducing artificial symptoms of a disease, the artificial symptoms would create another disturbance in the vital force thus pushing out the old disturbance and that the body would naturally recover from the artificially induced disturbance. The basic idea is that to cure a person suffering from an illness, one should administer a dilute dose of a substance that produces the same symptoms of the illness being treated in healthy individuals.[26]

Development of remedies

Dilution and succussion

Mortar and pestle used for grinding insoluble solids into homeopathic remedies including quartz and oyster shells.

In producing treatments for diseases,homeopaths use a process called "dynamization" or "potentization" where the remedy is diluted into alcohol or water and then vigorously shaken by ten hard strikes against an elastic body in a process called "succussion". Hahnemann thought that the use of remedies which present symptoms similar to those of disease in healthy individuals would only intensify the symptoms and exacerbate the condition, so he advocated the dilution of the remedies to the point the symptoms were no longer experienced. During the process of potentization, homeopaths believe that the vital energy of the diluted substance is activated and it's energy released by vigorous shaking of the substance. For this purpose, Hahnemann had a saddle maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.[27] Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose (trituration).

Three potency scales are in regular use in homeopathy. Hahnemann pioneered and always favored the centesimal or "C scale", diluting a substance 1 part in a 100 of diluent. Some homeopaths developed a decimal scale (D or X) diluting the substance 1 part in 10 of diluent. Hahnemann never used this scale but it was very popular throughout the 19th century and still is in Europe. This potency scale appears to have been introduced in the 1830s by the American homeopath, Dr. Constantine Hering.[28] In the last ten years of his life Hahnemann also developed a quintamillesimal (Q) or LM scale diluting the drug 1 part in 50,000 parts of diluent.[29] Higher potencies in homeopathy, which are more diluted, are considered to be stronger deep-acting remedies. Hahnemann advocated 30C dilutions for most purposes, i.e. dilution by a factor of 10030, and a common homeopathic treatment for the flu is a 200c dilution of duck liver, called Oscillococcinum in homeopathy. As Avogadro's number is only 6.022 × 1023 particles per mole, the chance of any molecule of the original substance being present in a 15x solution is very small, and the chances of a single molecule of the original substance remaining in a 24x(12c) dilution would be roughly 1 in 2 billion. For a perspective on these numbers, there are in the order of 1032 molecules of water in an Olympic size swimming pool and if such a pool were filled with a homeopathic substance, to expect to get a single molecule from the original substance in a 15C solution, one would need to swallow 1% of the volume of such a pool, or roughly 25 metric tons of water.[30]

For more perspective, 1ml of a solution which has gone through a 30C dilution would have been diluted into a volume of water equal to that of a cube of 1,000,000,000,000,000,000 meters per side, or about 105 light years. Thus, homeopathic remedies of the standard dilutions contain, with overwhelming probability, only water. Practitioners of homeopathy believe that this water retains some 'essential property' of the original substance, due to the shaking after each dilution.[31] Hahnemann believed that the dynamization or shaking of the of the solution caused a "spirit like" healing force to be released from within the substance. He thought that even after every molecule of the previous substance has been removed from the water, the spiritual healing force still remained.[30]

It should be noted however that not all homeopaths advocated extremely high potencies. Many of the early homeopaths were originally doctors and generally tended to use lower potencies such as "3x" or "6x", rarely going beyond "12x". A good example of this approach is that of Dr. Richard Hughes, who dismissed the extremely high potencies as unnecessary. This was the dominant pattern in Europe throughout the 1820's to 1930's, but in America many practitioners developed and preferred the higher dilutions. This trend became especially exemplified by James Tyler Kent and dominated US homeopathy from the 1850s until its demise in the 1940s. The split between lower and higher dilutions also followed ideological lines with the former stressing pathology and a strong link to conventional medicine, while the latter emphasized vital force, miasms and a spiritual take on sickness.[32][33]

Provings

In order to determine which specific remedies could be used to treat which diseases, Hahnemann experimented on himself for several years as well as with patients. His experiments did not initially consist of giving remedies to the sick, because he thought that the most similar remedy, by virtue of its ability to induce symptoms similar to the disease itself, would make it impossible to determine which symptoms came from the remedy and which from the disease itself. Therefore, sick people were excluded from the provings. The method used for determining which remedies were suitable for specific diseases was called "proving". A homeopathic proving is the method by which the profile of a homeopathic remedy is determined. The word 'proving' derives from the German word 'Prüfung' meaning 'test'.

During the process of proving, Hahnemann used healthy volunteers who were given remedies, often in molecular doses, and the resulting symptoms were compiled by observers into a "Drug Picture". During the process the volunteers were observed for months at a time and were made to keep extensive journals detailing all of their symptoms at specific times during the day. During the tests volunteers were forbidden from consuming coffee, tea, spices, or wine. They were also not allowed to play chess, because Hahnemann considered it to be "too exciting", however they were allowed to drink beer and were encouraged to moderately exercise. After the experiments were over, Hahnemann made the volunteers offer their hands and take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms. [34]

The first recorded 'proven' drugs were published by Hahnemann in his 1796 Essay on a New Principle and later in his Materia Medica Pura which contained 27 and 65 proven drugs respectively. In his Lectures on Homoeopathic Materia Medica published in 1905, James Tyler Kent listed 217 remedies, and newer substances are continually added to contemporary versions.

Homeopathic repertory

Homeopathic repertory by James Tyler Kent.

A compilation of reports of many homeopathic provings is known as a homeopathic materia medica. In practice the usefulness of such a compilation is limited because a practitioner does not need to look up the symptoms for a particular remedy, but rather to explore the remedies for a particular symptom. This need is filled by the homeopathic repertory, which is an index of symptoms, listing after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data from clinical experience in addition to provings. There is often lively debate among the compilers of a repertory and interested practitioners over the veracity of a particular inclusion. The first symptomatic index of the homeopathic materia medica was arranged by Hahnemann. Soon after, one of his students Clemens von Bönninghausen, created the Therapautic Pocket Book, another homeopathic repertory. The first such Homeopathic Repertory was Dr. George Jahr's Repertory, published in 1835 in German language and then again in 1838 in English and edited by Dr. Constantine Hering. This version was less focused on disease categories and would be the forerunner to Kent's later works. It consisted of three large volumes. Such Repertories increased in size and detail as time progressed.[35]

Treatments

Homeopathic remedy arsenicum album derived from arsenic.

Homeopathic treatments of patients generally begin with detailed examinations of the patients history including questions regarding one's physical, mental and emotional state, one's life circumstances and presenting physical/emotional illness. Homeopaths then translate a patients entire health status into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type.[5] The goal is to develop a comprehensive representation of the individual's overall health. This information can then be compared with similar established data in the drug provings found in the homeopathic materia medica. Assisted by further dialogs with the patient, the homeopath then aims to find the one drug most closely matching the 'symptom totality' of the patient. There are many methods for determining the most-similar remedy (the simillimum), and homeopaths sometimes disagree. This is partly due to the complexity of the "totality of symptoms" concept. That is, homeopaths do not use all symptoms, but decide which are the most characteristic. This subjective evaluation of case analysis relies on knowledge and experience of the homeopath doing the diagnosis.[5]

Remedies

Old Homeopathic belladona remedy.

"Remedy" is a technical term used in homeopathy to refer to a substance prepared with a particular procedure and intended for treating patients. Homeopathic practitioners rely on two types of reference when prescribing remedies. The Homeopathic Materia Medicae which is comprised of alphabetical indexes of Drug Pictures organized by remedy and describe the symptom patterns associated with individual remedies. They also rely on homeopathic repertories which consist of indexes of symptoms of diseases and listing all remedies associated with specific symptoms.[36]

Homeopathy uses many animal, plant, mineral, and synthetic substances in it's remedies. Examples include Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Homeopaths also use treatments made from diseased or pathological products called nosodes, from the Greek word nosos, meaning disease. Substances such as fecal, urinary, and respiratory discharges, as well as tissue and blood products, are used in the fabrication of nosodes.[37] Homeopathic remedy prepared from healthy specimens are called Sarcodes.

Old bottle of Hepar sulph made from Calcium sulfide.

Some modern homeopaths are exploring the use of more esoteric substances, known as "imponderables" because they do not originate from a material but from electromagnetic energy presumed to have been "captured" by alcohol or lactose. Examples include X-ray's, sunlight[38], or electricity.[39] Recent ventures by homeopaths into even more esoteric substances include "thunderstorms"(collected via rainwater)[40] or even samples of the Berlin wall.[41] Today there are about 3,000 different remedies commonly used in homeopathy.[42]

Isopathy

Isopathy is a therapy derived homoeopathy and was invented by Johann Joseph Wilhelm Lux in the 1830s.[43] Isopathy differs from homeopathy in general in that the remedies are made up either from things that cause the disease, or from products of the disease such as pus. Many so-called "homeopathic vaccines" are in fact a form of isopathy.[44]

Tautopathy

Tautopathy is a practice of alternative medicine that is similar to homeopathy in that it uses very diluted substances to treat illness. However, tautopathy does not rely on the law of similars, as homeopathy does. According to practitioners of Tautopathy, dilute solutions of lead and arsenic can cause the body to secrete excess amounts of these toxic metals.[45]

Veterinary homeopathy

Veterinary homeopathy is the term used to describe the treatment of animals with homeopathy. Hahnemann himself however did none of his work on animals and classical homeopathic principles would seem to conflict with the idea of homeopathic treatments for non humans as syphilis and gonorrhea aren't conditions that are recognized in animals.[5] In the USA veterinary homeopathy is used by veterinarian members of the Academy for Veterinary Homeopathy and/or the American Holistic Veterinary Medical Association.[46] In the UK, veterinary surgeons who use homeopathy belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons or BAHVS. Animals may only be treated by qualified veterinary surgeons in the UK and some other countries. Internationally, the body that supports and represents homeopathic veterinarians is the International Association for Veterinary Homeopathy or IAVH. There have been no rigorous scientific demonstrations of therapeutic effects of homeopathy in veterinary medicine and a German review of homeopathy in veterinary medicine has stated that the medical effectiveness of homeopathy in higher dilutions is not verified and that giving an animal a placebo can play an active role in influencing the owner to believe in the effectiveness of the treatment when none exists.[5]


Popularity of homeopathy

Woman looking at homeopathic remedies.

There are estimated to be more than 100,000 physicians practicing homeopathy worldwide, with an estimated 500 million people receiving treatment.[6] More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatment in the UK, France, and Germany. Homeopathy is particularly popular in Europe and India,[47][7] although less so in the USA,[48]. Surveys taken between 1985 and 1992 found that the percentage of the population that reported having used homeopathy at some time for various countries was:

Country Percentage of population using homeopathy[49]
Belgium 5.8% [50]
Denmark 28%
France 32%
Netherlands 31%
Sweden 15%
UK 16%
USA 3%

A more recent study indicates that the percentage of people seeking homeopathic treatment in the United States significantly declined from 3.4% in 1997 to 1.7% in 2002.[51]

Britain

Homeopathy was first established in Britain by Dr. Frederick Quin around 1827, although two Italian homeopathic doctors (Drs Romani and Roberta) had been employed two years previously by the Earl of Shrewsbury based at Alton Towers in North Staffordshire. Homeopathy in Britian quickly became the preferred medical treatment of the upper classes[52], as well as the aristocracy[53] and retained an elite clientele, including members of the royal family.[54] At its peak in the 1870s Britain had numerous homeopathic dispensaries and small hospitals as well as large busy hospitals in Liverpool, Birmingham[55], Glasgow, London and Bristol. The largest organisation of homeopaths in Britain, the Society of Homeopaths, was founded in 1978 and the Faculty of Homeopathy, which is based in London, has over 1,400 members and was incorporated by an Act of Parliament in 1950.[56] Charles, Prince of Wales is also an avid enthusiast of homeopathy and has inquired about the cost benefit of homeopathic therapies for the NHS.[57]

India

Homeopathy arrived in India with Dr John Martin Honigberger in Lahore, in 1829-1830[58][59]. India has the largest homeopathic infrastructure in the world, with 300,000 practicing homeopaths, 180 colleges teaching courses, and 7500 government clinics and 307 hospitals which dispense homeopathic remedies.[60]

United States

Homeopathy was first established in the USA by Dr Hans Burch Gram [61] in 1825 and rapidly gained popularity, partly because the inherent dangers of conventional medicine were extreme there and partly due to the efforts of Dr. Constantine Hering who in 1833 immigrated to America, and later became known as the "father of American homeopathy".[62] The height of it's influence was the end of the 19th century where hardly any city with over 50,000 people was without a homeopathic hospital. In 1890 there was 93 regular schools, 14 of them were fully homeopathic and 8 of them were eclectic and in 1900 there were 121 regular schools and 22 of them were homeopathic and 10 eclectic.[63]

Criticism

Homeopathy has been criticized by those in the scientific community since it's inception. The extreme dilutions used in homeopathic preparations, which would often leave no molecules of the original substance, is inconsistent with with the laws of chemistry and physics as well as the observed dose-response relationships of conventional drugs. Critics contend that any positive results obtained from homeopathic remedies are purely due to the placebo effect, where the patients subjective improvement of symptoms is based solely on the power of suggestion, due to the individual expecting or believing that it will work. Critics cite the lack of viable scientific studies for the effectiveness of homeopathic remedies as evidence that they are not effective and that any alleged positive effects are due to the placebo effect. Critics also contend that homeopathy is inherently dangerous, because homeopaths offer a false hope to patients who could be getting proper treatment by a conventional medical doctor.

Criticism of high dilutions

The extremely high dilutions in homeopathy have been a main point of criticism. Homeopathy often dilutes remedies to the point there are no molecules from the original substance left in the final remedy, leading many critics to conclude that any effect that might have been present from the original substance is no longer in existence. Homeopathy contends that the higher the dilution (lower dose) actually equates to stronger effects of the medicine. This is inconsistent with modern sciences observations of dose-response relationships that has been demonstrated by pharmacologists.[64] According to the dose response relationship in modern medicine, smaller doses of chemicals produce smaller effects and larger doses produce larger effects generally. This has been confirmed in thousands of experiments on organisms as diverse as nematodes,[65] rats[66] and humans.[67] Critiques of the high dilutions in homeopathy date back to the early 19th century. Sir John Forbes, physician to Queen Victoria, said the extremely small doses of homeopathy were regularly derided as useless, laughably ridiculous and "an outrage to human reason."[68] 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."[69]. Nineteenth century American physician and author Oliver Wendell Holmes, Sr. was a also a vocal critic of homeopathy and published an essay in 1842 entitled Homeopathy and Its Kindred Delusions.[70]

Homeopaths believe that after vigorous shaking, water retains a memory of a substance that once existed in it, even if the substance is no longer present. Critics respond that water will have been in contact with millions of different substances in its history. According to this molecular paradigm, any glass of water must be regarded as an extreme dilution of almost any agent you care to mention. Thus, critics argue that by drinking water one receives homeopathic treatment for every imaginable condition.[71][72] Critics assert that proponents of homeopathy are unable to accept the molecular paradigm as a complete account of life phenomena and therapeutics. They believe that the methodical dilution of a particular substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active 'remedy', in contrast to regular water which is therapeutically inert. However, chemically, a dilution of anything at 30C is identical to water.

Medical efficacy

Homeopathy is considered to have paved the way for modern medical practices including experiments to determine value of medical remedies such as quantitative procedures and the use of statistics. Early scientists including Joseph Lister and Sidney Ringer stated that they were led by homeopathy to important pharmacological discoveries.[5] However despite the fact that some of the procedures in homeopathy were ahead of their time, the medical effectiveness of homeopathy has been a point of contention since it's inception. Early trials testing the efficiency of homeopathic treatments conducted by Haheneman himself were likely to lack the scientific rigor of modern scientific studies and the first modern studies investigating the effectiveness of homeopathy date back to 1906.[73] During the 1940's the British government tested the efficacy of homeopathy on soldiers during ww2 to determine whether troops using homeopathic treatments healed faster than those using placebo. Those using homeopathic remedies did exhibit increased healing patterns, however the methods of the studies have been questioned.[74]

More recent and controlled clinical trials done on homeopathy have shown mixed results, where some show no difference between homeopathic remedies and placebo while others show a slight difference. [75] Systematic reviews and meta-analysis which analyze large groups of studies and draw conclusions based on the results as a whole have been used to determine the effectiveness of homeopathy. Early meta-analyzes investigating homeopathic remedies have shown slightly positive results among the studies examined, however such studies have warned that it was impossible to draw conclusions due to low methodological quality and the unknown role of publication bias in the studies reviewed.[76] Recent meta-analysis of clinical trials on the effectiveness of homeopathy have shown that earlier clinical trials have shown signs of major weakness in methodology and reporting and that homeopathy trials were less randomized and reported less on dropouts than other types of trials.[77]

The medical effectiveness of homeopathy has been studied in detail since at least the 1980's, however there have been no large studies without methodological flaws that have shown homeopathy to be effective for medical purposes, and earlier studies showing positive results have been questioned.[76] There have also been numerous landmark studies which have brought into question the validity of homeopathic treatments. In 2005 The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched conventional-medicine trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The findings of the study concluded that it's findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.[10] Critics cite the numerous other studies which show no evidence of homeopathy being effective beyond placebo, including a European Journal of Cancer study done in 2006. The study was a meta-analysis of six trials of homeopathic treatments for recovery from cancer therapy, including radio and chemotherapy done since 1985. Three of the trials included were randomized double-blind placebo-controlled clinical trials. The conclusions of the study was that there was insufficient evidence to support clinical efficacy of homeopathic therapy in treating cancer.[78]

Since homeopathic remedies at dilutions higher than about D23 (10-23) contain no ingredients apart from the diluent (water, alcohol or sugar), there is no chemical basis for them to have any medicinal action. While some tests have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain[79],histamine release by leukocytes[80],and enzyme reactions, such studies are disputed since attempts to replicate them have almost always failed.[13][14][15][81][82] Newer randomized, double-blind, placebo-controlled trials using high dilutions of substances such as Belladona also fail to find clinical effects of the substances.[83]

Critics assert that the best standard for assessing efficacy and safety of health-care practices is evidence-based medicine because it is the expression of the scientific method in clinical medicine.[84] They contend that systematic reviews with strict protocols are essential to establish the substantion of various therapies and that when homeopathy is tested in this way against specific diseases, it has failed to show any medical effectivness. Systematic reviews conducted by the Cochrane Collaboration found no evidence that homeopathy is beneficial for asthma[85], dementia[86], or induction of labor.[87] Systematic reviews conducted by other researchers found no evidence that homeopathy is beneficial for osteoarthritis[88], migranes[89] or delayed-onset muscle soreness[90].

Numerous health organizations such as UK's National Health Service[8], the American Medical Association[9], and the FASEB[91] also contend that there is no scientific evidence supporting the validity of homeopathic treatments.

Safety of homeopathic treatments

While homeopathic remedies contain often only water and/or alcohol, they are often thought to be generally safe. However critics of homeopathy have cited numerous concerns over homeopathic remedies including patients of homeopathy failing to receive proper treatment for diseases which could be diagnosed or cured with modern medicine. For instance there have even been numerous surveys showing that homeopathic practitioners frequently advise their patients against receiving immunization for diseases.[11][12] Modern homeopathic practitioners also use their own vaccines, which they refer to as "nosodes", and are created from dilutions of highly infectious agents including material such as vomit, fecal matter or infected human tissues. While Hahnemann was opposed to such preparations, modern homeopaths frequently use them and there is no evidence to suggests such vaccines have any effectiveness.[5]Homeopaths in advising against the use of anti-malarial drugs may often help to contribute in the spread of malaria due to the ineffectiveness of homeopathic remedies used to treat malaria.[92][93][94]

Critics contend that it is inherently unethical to provide homeopathic remedies to patients or to owners of animals when the effectiveness of homeopathy is clearly unproven. Critics also assert that all homeopathic patients or clients should be fully informed of the lack of experimental basis for the effectiveness of homeopathy prior to being provided the remedies. Critics say that it would be obviously unethical to employ unsupported and unproven remedies such as homeopathy when alternative remedies in modern medicine have been proven to be effective.[5]

Due to the controversial status and lack of scientific evidence supporting homeopathy, is regulated in some countries including strict regulations in Europe which have been implemented recently by the European Directorate for the Quality of Medicines & Healthcare.[95]

United States

In the United States, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration - the CFSAN (Center for Food Safety and Applied Nutrition) sector of the FDA deals with the dietary supplements, as well as cosmetics and food. However, the FDA treats homeopathic remedies very differently than conventional medicines. Homeopathic products do not need FDA approval before sale; they do have to be proven safe since the Dietary Supplement Health and Education Act of 1994, any products prior to 1994 may or may not have been tested for safety, but they do not have to prove efficacy; they do not have to be labeled with an expiration date; and they do not have to undergo finished product testing to verify contents and strength, all of these are voluntary actions done by the manufacturer. The manufacturer is required to have all ingredients on the label; however, it might not specify which ones are active. In the USA, 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.[96]

A memorandum written in 1985 by attorneys for the American Association of Homeopathic Manufacturers, describes a meeting between the AAHP attorneys and high-ranking FDA officials to discuss whether homeopathic products must be proven effective to remain legally marketable.[97] Such negotiations led to the issuance in 1988 (revised in 1995) of an FDA Compliance Policy Guide that permits homeopathic products "intended solely for self-limiting disease conditions amenable to self-diagnosis (of symptoms) and treatment" to be marketed as nonprescription drugs.[98]

In 2001, the FDA published a comprehensive review of mercury compounds in homeopathic drugs. This report indicated that nearly all examined compounds derived from the use of mercury. However, due to the extreme dilution of materials, the presence of mercury in the finished product would be minimal.[99]

At present the FDA Health Fraud Division only pursues claims which may cause direct harm to consumers through their use. Homeopathic drugs, largely regarded as equivalent to placebos, are not considered under these guidelines. Due to the significant dilution of the products, the agents become practically immeasurable: the harmful effects of homeopathic drugs is more likely to be that patients avoid conventional treatments.[100]

Germany

In Germany about 6,000 physicians specialize in homeopathy. In 1978 homeopathy, anthroposophically extended medicine and herbalism, were recognized as "special forms of therapy", 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.[101]

Switzerland

In Switzerland, homeopathic medications were formerly covered by the basic health insurance system, if prescribed by a physician. This ended in June 2005. The Swiss Government, after a 5-year trial, withdrew insurance coverage for homeopathy and four other complementary treatments, claiming 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.[102]

See also

References

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