User:Homy/homeopathy

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This article is about homeopathy in general; for the different kinds of homeopathy, see classical homeopathy, Clinical homeopathy and Complex homeopathy.

Homeopathy (also spelled homœopathy or homoeopathy) from the Greek words όμοιος, hómoios (similar) and πάθος, páthos (suffering), is a system of alternative medicine that strives to treat "like with like" [the etymological origin of the word homeopathy: 'similar suffering']. ^[1]. Homeopathy is one type of alternative medicine, being particularly popular in Europe and India.^[2][3] In the USA,^[4] homeopathy is subject to regulation. In Europe regulations are tightened lately as a new pharmacopoeia (Pharmeuropa) is implemented and watched by the EDQM.

Homeopathy rests on the premise of treating sick persons with therapeutic agents [drugs, remedies] that are deemed to produce similar symptoms in a healthy individual. It is designed to stimulate or guide the patient's 'vital force' or 'Dynamis'.^[5] This re-balances the body's various systems to cure disease and prevent relapse. The side-effects are supposed to be negligible. Practitioners have found that the therapeutic potency of a remedy can be increased by serial dilution of the drug, usually combined with succussion or vigorous shaking. A video clip of succussion by DHU

Homeopathy regards named diseases as misleading human constructs and instead treats each case of sickness as a strictly individual phenomenon. The term "homeopathy" was coined by the Saxon physician Christian Friedrich Samuel Hahnemann (1755–1843) and first appeared in print in 1807,^[6] although he had previously outlined his axiom of medical similars in a series of articles and monographs commencing in 1796.^[7][8]

Other articles relating to homeopathy
Classical homeopathy Homeopath Samuel Hahnemann Materia Medica Homeopathic repertory

Alternative medical systems - edit
Ayurveda Chiropractic Herbalism Homeopathy Naturopathic Medicine Osteopathy Traditional Chinese Medicine Unani
NCCAM classifications [2]
1. Alternative Medical Systems 2. Mind-Body Intervention 3. Biologically Based Therapy 4. Manipulative and body-based methods 5. Energy Therapy
See also
Alternative medicine

Homy/homeopathy

Contents 1 About homeopathy 1.1 The homeopathy controversy 1.2 Why homeopaths often decline regular medicines 1.3 Medical Similars 1.4 The Minimum Dose 1.5 Early critiques of high dilutions 2 History 2.1 Theory of disease 2.2 Homeopathy around the world 2.3 Classical versus non-classical homeopathy 3 The popularity of homeopathy 3.1 Numbers of people receiving homeopathic treatment 3.2 Number of homeopaths 3.3 Sales of homeopathic medicine 3.4 Historical note 4 Scientific testing of homeopathic treatment 4.1 Mechanism of action of homeopathic preparations 4.2 European Journal of Cancer 2006 study 4.3 Lancet 2005 study 4.4 British Medical Journal 1991 study 4.5 Basophil stimulation 4.6 Evidence-based medicine 4.6.1 Medical organizations' attitudes towards homeopathy 4.7 Regulatory decisions 5 Misconceptions about homeopathy 5.1 Composition of homeopathic remedies 5.2 Homeopathy and vaccination 6 Safety of homeopathic treatment 7 Dangers in misguided advice 8 What is homeopathy 9 Notes 10 Sources 11 External links 11.1 Neutral 11.2 Advocacy 11.3 Critical

[edit] About homeopathy

[edit] The homeopathy controversy

Some arguments to consider:

• "Since homeopathy is administered in minute or potentially nonexistent material dosages, there is an a priori skepticism in the scientific community about its efficacy." ^[9]
• There is a strong anti-homeopathy movement in society which considers homeopathy quackery.
• Medical studies of its efficacy are ambiguous.^[10][11] The problem lies with the difficulty in carrying out reliable studies due to diverging orientation ^[12][13] of homeopathy from mainstream medicine.
• Argument: Statistics show homeopathic alternative medicine don't work enough.

Response: Most statistic research is oriented on regular medicine, which purpose is to reach the predestined goal, for example to influence a specific organ which could give the perception of health, instead of 'measuring' the total health of a patient which might not be reflected in statistics in which case main stream medicines don't perform better.

WHO findings on DMP (Disease Management Programmes): Strength of the evidence: The evidence was qualified as strong, because several studies of adequate design and good management found consistent results. Nevertheless, this recommendation is based only on improvements of validated surrogate outcomes, since evidence of effectiveness in reducing mortality or morbidity was insufficient.^[14][15]

• Homeopathy is inconsistent with the known laws of chemistry since it states that dilution makes drugs more powerful by enhancing their undefined spirit-like medicinal powers,^[16] even at dilutions so high not even a molecule of the original ingredient is present. The question is whether the homeopathic dilution process is subject to known laws only; homeopaths believe it is not.^[17]
• The use of hyperboles with reference to homeopathic dilutions makes it hard to approach the subject seriously.
• Many homeopathic practitioners do not accept conventional diagnoses, preferring instead to view ill-health as when "the flow of energy is impeded"^[18] as a result of either the patient's lifestyle, or shock, past mental trauma and bad weather.^[19][20]
• Cases have been reported in the medical literature of serious illness resulting from people attempting to prevent or treat serious conditions like malaria solely with homeopathic remedies.^[21][22]
• Critics might suggest homeopathy is just based on metaphysical laws. However for example, the main 'law' of homeopathy, the 'law of similars' can be seen as a version of Newton's third law: "For every action, there is an equal and opposite reaction."

[edit] Why homeopaths often decline regular medicines

Homeopathy is used to enhance the quality of life especially for chronic disease.^[23] They believe main stream medicines often don't have this ability.^[24] Recent studies of the WHO give these indications as well.^[25] They look at the patient for a longer time span than the clinical trials of certain pharmaceutical products.^[26][27]

[edit] Medical Similars

Homeopathy is based on the 'Principle of Similars', first expressed by Hahnemann in the exhortation similia similibus curentur or 'let likes cure likes'. This is the exact opposite of 'contraries' upon which the Galenic medicine of his day was based, which Hahnemann initially practised and in which he had been trained.

The 'law of similars' is an ancient medical maxim ^[28][29] 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 a similar set of symptoms in the sick. Symptom patterns associated with various remedies are determined by 'provings', in which healthy volunteers are given remedies, often in molecular doses, and the resulting physical, mental and spiritual symptoms are compiled by observers into a 'Drug Picture'.

Homeopathic practitioners rely on two types of reference in prescribing. The Homeopathic Materia Medicae comprise alphabetical indexes of Drug Pictures organized by remedy and describe the symptom patterns associated with individual remedies. The Homeopathic repertory consists of an index of sickness symptoms, listing all remedies associated with specific symptoms. The first such Homeopathic repertory was George Jahr's Repertory, published in 1835. ^[30]

Homeopathic remedies are prepared either by serial trituration [grinding] with lactose [usually 1 part in 10 or 1 part in 100] for insoluble substances, such as Quartz and Oyster shell, or by dilution of a substance with succussion (shaking between dilutions) for soluble substances. The original serial dilutions by Hahnemann were performed using a 1 part in 100 or centesimal scale, or 1 part in 50,000 or Quintamillesimal [LM or Q potencies]. Some practitioners then developed a decimal scale of 1 part in 10, which were extremely popular in 19th century Europe, but were replaced with even higher dilutions, especially in the U.S. and Britain, in the 20th century.

At first, Hahnemann tested in homeopathic provings, substances commonly used as medicines in his time [such as Antimony and Rhubarb] and also 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.” ^[31] 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:..." ^[32]

Hahnemann recorded his first provings in the Fragmenta de viribus in 1805 [27 drugs] and later in his Materia Medica Pura, which contained 65 proven 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,^[33] 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. Examples include Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other homeopathic remedies, ('isopathic' remedies') involve diluting of the agent or product of the disease. Rabies nosode, for example, is made by dilution the saliva of a rabid dog. Some modern homeopaths are exploring the use of "imponderables" because they do not originate from a material but from energy somehow "captured" by water, alcohol or lactose, for example X-ray, Sol (sunlight), Positronium, Gravity, and Electricitas (electricity), through the use of a telescope (Polaris) or universal principles such as conservation, entropy, symmetry or relativity which includesthe Doppler effect.Recent ventures by homeopaths into even more esoteric substances include Tempesta (thunderstorm), and Berlin wall.

Today, about 3000 remedies are used in homeopathy; about 300 are based on comprehensive Materia Medica information, about 1500 on relatively fragmentary knowledge and the rest are used experimentally in difficult cases based on the law of similars, either without knowledge of their homeopathic properties or through speculative knowledge independent of the law of similars. Examples include: the use of an isopathic (disease associated) agent as a first prescription in a 'stuck' case, 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. A good example of this is found in the Bowel Nosodes ^[34] which were introduced by the British homeopaths, Edward Bach (1886-1936), John Paterson (1890-1954) and Charles Edwin Wheeler (1868-1946) in the 1920s. Their use is based on the variable bowel bacterial flora thought to be associated with persons of different homeopathic constitutional types. Though receiving more attention today, the Bowel Nosodes are rarely used outside British homeopathy.

More recently, homeopathy has embraced the use of substances based on their elemental classification (the periodic table or biological taxonomy). ^{[35] [36]} This approach may well create neat systems for grouping remedies and classifying the ever-burgeoning Materia Medica, but its usefulness is questioned by some purists on the basis that inherently it involves speculation about remedy action without provings.^[37]

There are many methods for determining the most-similar remedy (the simillimum), and homeopaths sometimes disagree about the required remedy. This is partly due to the complexity of the 'totality of symptoms' concept; homeopaths do not use 'all' symptoms, but decide which are the most characteristic; this subjective evaluation of case analysis rests crucially on knowledge and experience. Finally, the Drug Picture in the Materia Medica is always more comprehensive than the symptomatology exhibited by any individual. These factors mean that a homeopathic prescription can remain presumptive until it is verified by testing the effect of the remedy on the patient.

The law of similars is more of a guiding principle than a 'scientific' law. It is not built on a hypothesis that can be falsified; a failure to cure homeopathically 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. ^[38]

See also: List of common homeopathic remedies

[edit] The Minimum Dose

See Main article

See also: Drug dynamization

Homeopathic potencies in decimals compared with physics ^[39]

Pot.	Ratio	Approximate physical similars qua magnitude (not same units)
		Level [40]	Physical constants
D1	1:10	Visible level	Muon mass in u: 0.113 428 9264 u[41]
D2	1:100		Second radiation constant: 1.438 7752 x 10-2 m K[42]
D3	1:1.000		Electron-muon mass ratio: 4.836 331 67 x 10-3[43]
D6	1:1 Million	Micro level and beyond	Magnetic constant: 12.566 370 614... x 10-7 N A-2[44]
D9	1:1 Billion		Bohr radius: 0.529 177 2108 x 10-10 m [45]
D12	1:1 Trillion		Electric constant: 8.854 187 817... x 10-12 F m-1[46]
D18	1:1 Quintillion		Hartree energy: 4.359 744 17 x 10-18 J[47]
D23	1:100 Sextillion	Limit QSPR[48]	Avogadro constant: 6.022 1415 x 1023 mol-1[49]
D30	1:1 Nonillion		Atomic unit of magnetizability: 7.891 036 60 x 10-29 J T-2[50]
D35	1:1 100 Decillion	Fermi point (dependant on particle)[51]	Planck length: 1.616 24 x 10-35 m[52]
D39	1:100 Duodecillion	Dimensionless constants[53]	Newtonian constant of gravitation: 6.7087 x 10-39 (GeV/c2)-2[54]
D51	1:1 Sexdecillion		Hertz-kilogram relationship: 7.372 4964 x 10-51 kg[55]
D65	1:100 Vigintillion		Atomic unit of 2nd hyperpolarizablity: 6.235 3808 x 10-65 C4 m4 J-3[56]
<D65		Just relativity/gravity/information[57][58]	Planck dimension,[59]special relativity

[edit] Early critiques of high dilutions

Sir John Forbes [1787-1861], physician to Queen Victoria [1841-61] said the extremely small doses were regularly derided as useless, laughably ridiculous and "an outrage to human reason."^[60] Although such homeopathic cures were accepted as valid by regular physicians at the time, they were ascribed entirely to the body's innate healing powers. And 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." ^[61]

[edit] History

[edit] Theory of disease

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 causing trouble, such as by lowering the body temperature of patients who were feverish. By contrast, Hahnemann promoted a view of psychosomatic and environment factors as the root cause of all disease.^[62] Some later homeopaths, in particular James Tyler Kent, put even more emphasis on spiritual factors.^[63]

"...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."

Vitalism was a part of mainstream science in the 18th century. In the twentieth century, medicine discarded vitalism in favour of the germ theory of disease, following the work of Louis Pasteur, Alexander Fleming, Joseph Lister and many 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, and stimulation of, the immune system, rather than the vital force.

As previously stated, homeopathy stemmed in part from the idea of medical similars, the idea that 'like cures like' while Hahnemann was translating into German the Materia Medica [1789] of William Cullen, the so-called Scottish Hippocrates. On reading that Cinchona bark (which contains quinine) was effective because it was bitter, Hahnemann felt this implausible because other substances were as bitter but had no therapeutic value. To understand the effects of Cinchona bark, he decided to take 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 that he may have had an allergic reaction.^[64]

Yet, this proving experiment by Hahnemann was by no means unique, as others before him had tried the same approach, such as, for example, Anton von Störck [1731-1803], "in the 1760’s, who advocated treatment by cautious use of poisons."^[65] Indeed, Hahnemann had studied briefly in Vienna [1777] where Störck eventually became head of the University. The proving idea had also been recommended by the great Swiss medical botanist, Albrecht von Haller, [1708-77], who Hahnemann hugely admired, and whose Materia Medica he translated in 1806. Therefore, it might be said, that the proving experiment came to Hahnemann from several previous sources.

For Hahnemann, the whole body and spirit was the focus of therapy, not just the localised disease. Hahnemann spent a lot of time with his patients, asking them not only about their symptoms or illness, but also about their daily lives. This gentle approach contrasted with the violent forms of heroic medicine common at the time, which included techniques such as bleeding as a matter of course.

Homeopathy came to the USA in 1825 and rapidly gained popularity, partly because the excesses of conventional medicine were extreme there, and partly due to the efforts of Constantine Hering. Homeopathy reached a peak of popularity in 1865–1885 and thereafter declined due to a combination of the recognition by the establishment of the dangers of large doses of drugs and bleeding, and dissent between different schools of homeopathy.

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 the homeopathic orthodoxy by the end of the First World War.^[66] His most important contribution may be his repertory, which is still used today. Kent's approach was authoritarian, emphasizing the metaphysical and clinical aspects of Hahnemann's teachings, in particular

• insistence on the doctrines of miasm and vitalism;
• emphasis on psychological symptoms (as opposed to physical pathology) in prescribing; and
• regular use of very high potencies.

See also: List of important homeopaths

[edit] Homeopathy around the world

There are estimated^[67] to be more than 100,000 physicians practising homeopathy worldwide, with an estimated 500 million people receiving treatment. 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.

Homeopathy was brought to Britain by Dr Frederick Quin around 1827, though two Italian homeopathic doctors Drs Romani and Roberta had been employed 2 years previously by the Earl of Shrewsbury based in North Staffordshire; however, they soon returned to Naples as they could not tolerate the English climate. Homeopathy in the UK quickly became the preferred medical treatment of the upper classes. At its peak in the 1870s Britain had numerous homeopathic dispensaries and small hospitals as well as large busy hospitals in Liverpool, Birmingham,^[68] Glasgow, London and Bristol, almost exclusively funded and run by members of the local gentry.^[69] For example, the Bristol hospital Image was funded and run by several generations of the W.D. & H.O. Wills tobacco family, while the Hahnemann Hospital Liverpool Image was built by members of the Tate family of sugar importers, who also funded the Tate Gallery in London.^[70]

In the UK, homeopathic remedies are sold over the counter. Today the UK has five homeopathic hospitals, funded by the National Health Service, and many regional clinics. Homeopathy is not practised by most of the medical profession, but there is public support, including the Prince of Wales. All members of the Royal family use homeopathy, as can be seen from the royal warrants displayed at the head of Ainsworth's Homeopathic Pharmacy in London who are the Chemists Royal.^[71] The largest organisation of homeopaths in the UK, the Society of Homeopaths, was founded in 1978 and has been growing steadily since then; it now has 1300 members, an increasing proportion of whom are women.^[72] The medically qualified homeopaths in the UK are represented by the Faculty of Homeopathy based in London: "The Faculty, which was incorporated by an Act of Parliament in 1950, has over 1,400 members throughout the world and is poised for growth as interest in homeopathy increases both among the public and within the health care sector." ^[73]

Homeopathy arrived in India with Dr Martin Honigberger in Lahore, in 1829-30 ^[74], and is officially recognized. India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals.^[75]

In the USA, homeopathic remedies are, like all healthcare products, regulated by the Food and Drug Administration. However, the FDA treats homeopathic remedies very differently than conventional medicines. Homeopathic products do not have to be approved by the FDA before sale, they do not have to be proved to be either safe or effective, 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. Unlike conventional drugs, homeopathic remedies do not have to identify their active ingredients on the grounds that they have few or no active ingredients. 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.

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.^[76] Most private health insurers continue to cover homeopathy.

In Switzerland homeopathic medications were formerly covered by the basic health insurance system, if prescribed by a physician. This ended in June 2005^[77]. The Swiss Government, after a 5-year trial, withdrew insurance coverage for homoeopathy and four other complementary treatments, claiming that they did not meet efficacy and cost-effectiveness criteria. (This evoked some controversy since part of the government's own study showed that three of the therapies, including homeopathy, did in fact meet these criteria.^{[citation needed]}) This change applies only to compulsory insurance; homeopathy and other complementary medicine is covered by additional insurance, if the treatment is provided by a medical doctor.

[edit] Classical versus non-classical homeopathy

Main article: Classical homeopathy

Hahnemann's formulation of homeopathy is often referred to as classical homeopathy. Classical homeopaths use one remedy at a time, and base their prescription also on incidental or constitutional symptoms. However, homeopathic remedies are often used both by professionals and by the public based on formulations marketed for specific medical conditions. Some formulations use a 'shotgun' approach of the most commonly indicated single remedies in mixture form, while others, such as those by Heel and Reckeweg, are proprietary mixtures marketed for specific diagnostic critera based on various diagostic systems. Many members of the public are not familiar with classical homeopathy, and equate these practices with homeopathy; others are familiar with the classical approach but regard these as legitimate variants; while others consider it a misuse of the term. Use of non-classical approaches is confined mainly to places where over-the-counter preparations are popular and where many doctors use natural medicines in a conventional clinical setting.

[edit] The popularity of homeopathy

[edit] Numbers of people receiving homeopathic treatment

Homeopathy is much more popular in Europe and India than in the USA. A study exploring the use of complementary medicine found the following percentages of various countries' population to be using homeopathy for some of their health needs (data from 1985-92):^[78]

Country	Percentage of population using homeopathy
Belgium	56%
Denmark	28%
France	32%
Netherlands	31%
Sweden	15%
UK	16%
USA	3%

whereas in India, 10% of the population are estimated to use homeopathy exclusively for their medical treatment.^[79]

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.^[80]

An online source also estimates that, "in Europe where homeopathy is one of the leading alternative medicines, it has been estimated that over 30% of French physicians and 20% of German physicians prescribe homeopathic medicines (Fisher and Ward, 1994), that over 40% of British physicians refer patients to homeopathic doctors (Wharton and Lewith, 1986), and that 45% of Dutch physicians consider homeopathic medicines to be effective (Kleijnen, Knipschild and ter Riet, 1991)." The Education of Homeopaths by Dana Ullman

[edit] Number of homeopaths

In Britain, the number of homeopaths registered with the Society of Homeopaths increased from 15 to 708 between 1979 and 1999.^[81] More recent data from the same source shows currently 1300 homeopaths, over 3/4 of whom are women.

Similarly, the number of homeopathic doctors in the UK was for most of the 20th century static at about 100-150. For example, it leapt from 185 in 1932 to 244 in 1972, ^[82] an increase of 3.3% per annum, but in the 1980s it began to grow faster: for example, from 1972 to 1988 it grew from 244 to 586, a real increase of 15% per annum. Today, "the Faculty, which was incorporated by an Act of Parliament in 1950, has over 1,400 members throughout the world and is poised for growth as interest in homeopathy increases both among the public and within the health care sector." ^[83]

Most of these 1400 medically qualified homeopaths live and work in the UK. Clearly, therefore, the trade for all these homeopathic practitioners must be increasing or their numbers would not be growing in real terms in an almost static population. Therefore, the growth in the numbers of UK homeopaths at a rate of some 15-30% per annum can be safely regarded as an accurate, though indirect, measure of the growth of interest in homeopathy in society at large.

[edit] Sales of homeopathic medicine

In the USA, in 1995, retail sales of homeopathic medicines were estimated at US$201 million, and growing at 20% per year, according to the American Homeopathic Pharmaceutical Association, and the number of homeopathic practitioners increased from fewer than 200 in the 1970's to approximately 3,000 in 1996. The increased popularity of homeopathy since the 1970's was accompanied by a rise in interest in other alternative medicines.^[84]

[edit] Historical note

In the 1930s the popularity of homeopathy waned, especially in the USA and Europe, partly due to advances in conventional medicine and partly due to the Flexner Report (1910), which led to the closure of virtually all medical schools teaching alternative medicine in the USA. Homeopathy in the West had a renaissance in the 1970s, largely because of George Vithoulkas, that continues to this day.

[edit] Scientific testing of homeopathic treatment

[edit] Mechanism of action of homeopathic preparations

Since homeopathic remedies at potencies higher than about D23 (1 in 10²³) 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,^[85] histamine release by leukocytes,^[86][87] and enzyme reactions.^[88] These publications are controversial since attempts to replicate some of these studies on leukocytes and enzymes have failed, even when using the potentization method.^{[89][90][91][92]} A recent review of tests of high potencies 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."^[93]

These positive studies are unusual since no effect of high dilutions are seen in the huge number of similar studies on other biological systems. Here, low doses of chemicals give small effects and high doses large effects. This simple dose-response relationship has been confirmed in many hundreds of thousands of experiments on organisms as diverse as nematodes, ^[94] rats ^[95] and humans. ^[96]

Although some patients report benefits from homeopathic preparations,^[97] the large majority of scientists attribute these effects to the Placebo Effect, the regression fallacy and/or the Forer effect. 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 significantly better than either a placebo or an alternative treatment. Many clinical trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo.^[98] However, many of the trials are open to technical criticism or involve samples that are too small to allow firm conclusions to be drawn.^[99]

[edit] European Journal of Cancer 2006 study

In January 2006 the European Journal of Cancer published a meta-analysis of six trials of homeopathic treatments for recovery from cancer therapy, including radio- and chemo-therapy.^[100] Three of the trials included were randomised double-blind placebo-controlled clinical trials. The authors were from the Department of Complementary Medicine at the Universities of Exeter and Plymouth. Their analysis found insufficient evidence to support the use of homeopathic remedies in cancer treatment recovery. They wrote that "In conclusion, the evidence emerging from this systematic review is encouraging but not convincing. Further research should attempt to answer the many open questions related to homeopathy."

[edit] Lancet 2005 study

In August 2005, The Lancet published a meta-analysis of eight trials of homeopathy selected from 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials ^[101] based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The outcome of this meta-analysis suggested that the clinical effects of homeopathy are likely to be placebo effects. The Lancet paper is notable not least for its unique design, as a "global" meta analysis of homeopathy, not an analysis of particular effects, i.e. it tested the global hypothesis, that ALL reported effects of homeopathy are placebo effects. If this is true, then the reported positive effects are placebo effects, publication bias, observer effects etc, and if so, then the magnitude of reported effects should diminish with sample size and study quality, and with the best studies there should be consistently no effect, and this is the prediction that the study sought to test. For comparison, they subjected an equal set of matched conventional medicine trials for identical analysis. The prediction was supported by the study - whereas the 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 does show that the totality of tests analysed show outcomes consistent with the interpretation that all of the reported effects are placebo effects.

[edit] British Medical Journal 1991 study

In 1991, three professors of medicine from the Netherlands, none of them homeopaths, performed a meta-analysis of 25 years of clinical studies using homeopathic medicines and published their results in the British Medical Journal. This meta-analysis covered 107 controlled trials, of which 81 showed that homeopathic medicines were effective, 24 showed they were ineffective, and 2 were inconclusive.

The professors concluded, "The amount of positive results came as a surprise to us." The proportion of positive results may be biased by the so-called 'drawer effect,' where studies with positive results are more easily and more readily published than studies with negative results (which tend to end up in the desk drawer). They found evidence for successful treatment of respiratory and other infections, diseases of the digestive system, hay fever, rheumatological disease, mental or psychological problems and other ailments. In addition, they found evidence that homeopathic treatment helped patients recover after abdominal surgery and to address pain or trauma.

Despite the high percentage of studies that provided evidence of success with homeopathic medicine, most of these studies were flawed in some way or another. Still, the researchers found 22 high-caliber studies, 15 of which showed that homeopathic medicines were effective. Of further interest, they found that 11 of the best 15 studies showed efficacy of these natural medicines, suggesting that the better designed and performed the studies were, the higher the likelihood that the medicines were found to be effective.

The meta-analysis on homeopathy concluded, "The evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications."^[102]

[edit] Basophil stimulation

Madeleine Ennis, a pharmacologist at Queen's University, Belfast, and her team looked at the effects of ultra-dilute solutions of histamine on human white blood cells involved in inflammation. These cells, called basophils, release histamine when the cells are stimulated. However, exposure to histamine stops these cells releasing any more, an example of negative feedback regulation. Three of the four participating groups observed this inhibitory effect with homeopathic solutions of histamine, solutions so dilute that they probably didn't contain a single histamine molecule. These low-dilution effects were seen in six of the 24 independent sets of experiments (Table 1 of paper).^[103] However, other investigators failed to find any effect from these ultra-dilute solutions and suggested that methodological problems accounted for the positive results.^[104]

[edit] Evidence-based medicine

There is widespread consensus in the medical community that evidence based medicine is the best standard for assessing efficacy and safety of healthcare practices, for it is "the expression of the scientific method in clinical medicine." ^[105] Therefore, systematic reviews with strict protocols are essential to establish proof for various therapies. While committed to this principle, much of modern medicine is subject to ongoing efforts to comply with evidence-based standards.

Systematic reviews conducted by the Cochrane Collaboration found insufficient evidence that homeopathy is beneficial for asthma, ^[106] dementia, ^[107] and induction of labor.^[108] They also found no evidence that homeopathic treatment can prevent influenza^[109], but reported that it appears to shorten the duration of the disease. Systematic reviews conducted by other researchers found insufficient evidence that homeopathy is beneficial for osteoarthritis ^[110], migraine prophylaxis^[111], delayed-onset muscle soreness ^[112], or symptoms of menopause.^[113]

[edit] Medical organizations' attitudes towards homeopathy

• The National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, states that:^[114]
  • 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.
  • A common theme in the reviews of homeopathy trials is that because of these problems and others, it is difficult or impossible to draw firm conclusions about whether homeopathy is effective for any single clinical condition.
  • There is a point of view that homeopathy does work, but that modern scientific methods have not yet explained why. The failure of science to provide full explanations for all treatments is not unique to homeopathy.
  • 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.
  • The National Center for Complementary and Alternative Medicine continues to fund research into homeopathy.

• The UK National Health Service statement on homeopathy includes the following:
  • Around 200 randomised controlled trials evaluating homeopathy have been conducted, and there are also several reviews of these trials. Despite the available research, 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.
  • Medical doctors and scientists do not generally accept homeopathy because its claims have not been verified to the standards of modern medicine and scientific method. Scientists argue that homeopathy cannot work because the remedies used are so highly diluted that in many there can be none of the active substance remaining.
  • Supporters of homeopathy counter the scientific arguments with claims for a high success rates in babies, infants, and animals. Others argue that much of the research conducted into the effectiveness of homeopathy is not representative of routine homeopathic practice and that homeopathic treatment cannot be properly tested through standard clinical means. See anti-intellectualism.

• In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies including homeopathy:^[115]
  • 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:^[116]
  • Homoeopathy today is a rapidly growing system and is being practiced almost all over the world. In India it has become a household name due the safety of its pills and gentleness of its cure.
  • [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.

[edit] Regulatory decisions

In 2006 Australia's Therapeutic Goods Advertising Code Council (TGACC) found that a homeopathic Hangover Relief Oral Spray marketed by Brauer Natural Medicine P/L was "in breach of section 4(1)(b) of the Therapeutic Goods Advertising Code 2005 ( the Code ), which states that an advertisement must contain correct and balanced statements only and claims which the sponsor has already verified , and section 4(2)(c) which prohibits misleading advertisements."^[117] The TGACC is established under Australian law and the Therapeutic Goods Advertising Code is generally consistent with the World Health Organisation's "Ethical Criteria For Medicinal Drug Promotion 1988"

[edit] Misconceptions about homeopathy

[edit] Composition of homeopathic remedies

It is a common misconception that homeopathic remedies use only natural herbal components (akin to herbology). Herbs are used, but homeopathy also uses non-biological substances (such as salts) and components of animal origin, such as duck liver in the remedy oscillococcinum.

In herbology, measurable amounts of herbs are used, while in homeopathy the active ingredient is diluted until it is no longer detectable, or to the point that they do not contain any of the original active ingredient at all (when the dilution exceeds the Avogadro's number). Homeopathy also uses substances of human origin, called nosodes. Some people have the opposite misconception, that homeopathic remedies are based only on toxic substances like snake venom or mercury.

As the term homeopathy is well known and has good marketing value, the public can be confused by people who have adopted the term for other forms of therapy. For example, some companies combine homeopathic with non-homeopathic substances such as herbs or vitamins, and some preparations marketed as homeopathic contain no homeopathic preparations at all. Classical homeopaths argue that only remedies prepared and prescribed in accordance with the principles of Hahnemann can be called homeopathic. Many producers of homeopathic remedies also produce other types of alternative remedies under the same brand name, which can create confusion for the public.

[edit] Homeopathy and vaccination

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 by Edward Jenner in 1798 as a confirmation of the law of similars, but the two practices are fundamentally different. A vaccine is usually a bacterium or virus whose ability to produce symptoms has been deliberately weakened, while still providing enough information to the immune system to afford protection. By preparing the immune system of a healthy organism to meet a future attack by the pathogen, vaccination hopes to prevent disease, in contrast to homeopathy's hope, which is to cure it. Another important difference between homeopathic preparations and vaccine, is that vaccine contains measurable amounts of the disease-causing organism, whereas homeopathic remedies have been diluted to such an extent that they are unlikely to contain any active substance at all.

[edit] Safety of homeopathic treatment

The United States Food & Drug Administration 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 the medical literature contains a few case reports of poisoning by heavy metals such as arsenic^[118] and mercury^{[119][120][121]} found in homeopathic remedies. However, in cases that they reviewed, the FDA concluded the homeopathic product was not the cause of the adverse reactions. In one case, arsenic was implicated, although FDA analysis revealed that the concentration of arsenic was too low to cause concern. Perhaps 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.^[122]

[edit] Dangers in misguided advice

Opponents of homeopathy argue that since homeopathy is ineffective, it could indirectly result in harm to patients who refuse medical care. 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 practice:

"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." ^[123].

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." ^[124]. Homeopathy can also lead individuals to forgo effective treatments (opportunity costs).

[edit] What is homeopathy

[edit] Notes

[edit] Sources

• About Bandolier and us (Bandolier Homeopathy - dilute information and little knowledge). Boundolier Journal, [Electronic] [3]
• Almeida RM (2003). "A critical review of the possible benefits associated with homeopathic medicine". Rev Hosp Clin Fac Med Sao Paulo 58 (6): 324-31. PMID 14762492. 
• Cucherat M, Haugh MC, Gooch M, Boissel JP (2000). "Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group". Eur J Clin Pharmacol 56 (1): 27-33. PMID 10853874. 
• Ernst, E., Classical homeopathy versus conventional treaments: a systematic review, Perfusion, (1999); 12: 13-15
• Kleijnen J, Knipschild P, ter Riet G (1991). "Trials of homeopathy". BMJ 302 (6782): 960. PMID 1827743. 
• Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB (1997). "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials". Lancet 350 (9081): 834-43. PMID 9310601. 
• Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB (1999). "Impact of study quality on outcome in placebo-controlled trials of homeopathy". J Clin Epidemiol 52 (7): 631-6. PMID 10391656. 
• Linde K, Melchart D (1998). "Randomized controlled trials of individualized homeopathy: a state-of-the-art review". J Altern Complement Med 4 (4): 371-88. PMID 9884175. 
• Phillips Stevens Jr., (Nov-Dec, 2001), Magical Thinking in Complementary and Alternative Medicine [Electronic version]. Skeptical Inquirer. [4]
• Randi, J., An interview with James Randi: Homeopathy: The Test - programme summary [Electronic version]. BBC. [5]
• Randi, J., Educational Foundation. "The JREF Million Dollar Paranormal Challenge 'FAQ'". [6] Retrieved 13 September, 2005.
• Yutar, G., Dr, (April 16, 2006), Homeopathy - Why and when? Yatar's bolg on blogspot.com [Electronic version].[7]
• Walach, H., Unspezifische Therapie-Effekte. Das Beispiel Homöopathie [PhD Thesis]. Freiburg, Germany: Psychologische Institut, Albert-Ludwigs-Universität Freiburg, (1997)

• footnote to pp.12-13, Hahnemann's Chronic Diseases, ed. P. Dudley, B. Jain Publishers, 1998 reprint

[edit] External links

[edit] Neutral

• BBC's Horizon on homeopathy (transcripts, discussion, etc.)
• Complementary Medicine - Therapies: Homeopathy BBC's "Complementary Medicine" article on Homeopathy
• Water Structure and Behaviour— balanced and up-to-date references to current scientific understanding of water, with specific entries on "memory effects" and homeopathy
• Columbia-Presbyterian Hospital's presentation of homeopathic medicine

[edit] Advocacy

• A condensed history of homeopathy
• American Institute of Homeopathy
• Extensive Homeopathy Information and Discussion Forum
• North American Society of Homeopaths
• The Society of Homeopaths - UK Organisation Representing Professional Homeopaths
• Homeopathy Links from The Holistic Medicine Resource Center
• Referrals to Certified Classical Homeopaths
• Alliance of Registered Homeopaths
• Homéopathe International — The English language version of Homéopathe International
• Homeopathy Timeline with historical and biographical information
• Adjuvant homeopathic treatment in breast cancer, a pilot study [8] (in German)
• Oxford Homeopathy - Research articles by Oxford Homeopath, Steven Cartwright
• Webhomeopath - an on-line homeopathic repertory
• An Association of Qualified Homoeopathic Medical Practitioners in India
• What is homeopathy

[edit] Critical

• FDA's view of homeopathy
• Homeopathy: The Ultimate Fake
• HomeoWatch (Homeopathy Watch) — A Skeptical Guide to Homeopathic History, Theories, and Current Practices
• H2G2 entry on homeopathy.
• The Skeptics Dictionary
• "The Scientific Evidence on Homeopathy" - American Council on Science and Health
• A close look at homeopathy
• Dilution or Delusion?
• National Council Against Health Fraud Position Paper on Homeopathy
• Are the clinical effects of homoeopathy placebo effects? A 2005 study published in The Lancet.
• The Danger Of Homoeopathic prescribing
• A recent article on homeopathy testing from the Annals of Internal Medicine
• Can homeopathy withstand scientific testing? 30 November 2004 by F.J. van Sluijs A recent Dutch overview.

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Topics in Homoeopathy
Philosophy:	Organon - Homeopathic proving - Drug dynamization - Succussion - Nosode - Psora
Reference material:	Homeopathic repertory - Materia Medica
Homoeopaths:	List of homeopaths - Samuel Hahnemann - J.T. Kent - C. von Bönninghausen - J.H.Clarke - L. De Schepper - E. B. Nash - R.Sankaran - G.Vithoulkas
Branches:	Veterinary homeopathy
Related:	Allopathy - Alternative medicine - Bach flower remedies - Jacques Benveniste - Isopathy