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Homeopathy: coined in German from Greek hómoios- á��î�î¿î�î¿ς- "like-" + p�¡thos πî�î�î¿ς "suffering"

Homeopathy (also spelled homoeopathy or hom�opathy) is employed as form of alternative medicine, first proposed by German physician Samuel Hahnemann in 1796, in which practitioners use highly[1][2] diluted preparations. Based on an ipse dixit[3] axiom[4] formulated by Hahnemann, which he called the law of similars, preparations which cause certain symptoms in healthy individuals are given in diluted form to patients exhibiting similar symptoms. Homeopathic remedies are prepared by serial dilution with shaking by forceful striking, which homeopaths term succussion, after each dilution under the assumption that this increases the effect. Homeopaths call this process potentization. Dilution often continues until none of the original substance remains.[5]

Apart from the symptoms, homeopaths use aspects of the patient's physical and psychological state in recommending remedies.[6] Homeopathic reference books known as repertories are then consulted, and a remedy is selected based on the totality of symptoms. Homeopathic remedies are, with rare exceptions, considered safe[7] though homeopathy has been criticized for putting patients at risk due to advice against conventional medicine such as vaccinations,[8] anti-malarial drugs,[9] and antibiotics.[10]

Homeopathy's efficacy beyond the placebo effect is unsupported by the collective weight of scientific and clinical evidence.[1][11][12][13][14][2] While some individual studies have positive results, systematic reviews of published trials fail to demonstrate efficacy conclusively.[15][16][17][18][19] Furthermore, higher quality trials tend to report less positive results,[17][20] and most positive studies have not been replicated or show methodological problems that prevent them from being considered unambiguous evidence of homeopathy's efficacy.[1][13][21][22] A 2010 inquiry into the evidence base for homeopathy conducted by the United Kingdom's House of Commons Science and Technology Committee concluded that homeopathy is no more effective than placebo.[2]

Depending on the dilution, homeopathic remedies may not contain any pharmacologically active molecules,[23] and for such remedies to have pharmacological effect would violate fundamental principles of science.[14][24] Modern homeopaths have proposed that water has a memory that allows homeopathic preparations to work without any of the original substance; however, there are no verified observations nor scientifically plausible physical mechanisms for such a phenomenon.[24][25] The lack of convincing scientific evidence supporting homeopathy's efficacy[26] and its use of remedies lacking active ingredients have caused homeopathy to be described as pseudoscience, quackery,[27][28][29][30][31] and a "cruel deception".[32]

The regulation and prevalence of homeopathy is highly variable from country to country. There are no specific legal regulations concerning its use in some countries, while in others, licenses or degrees in conventional medicine from accredited universities are required. In several countries, homeopathy is covered by the national insurance coverage to different extents, while in some it is fully integrated into the national health care system. In many countries, the laws that govern the regulation and testing of conventional drugs do not apply to homeopathic remedies.[33]


[edit] General philosophy

A homeopathic remedy prepared from marsh Labrador tea. The "15C" dilution shown here contains no molecules of the original herb.

Homeopathy is a vitalist philosophy which interprets diseases and sickness as caused by disturbances in a hypothetical vital force or life force. It sees these disturbances as manifesting themselves as unique symptoms. Homeopathy maintains 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 implies that a negative state of mind can attract hypothetical disease entities called miasms to invade the body and produce symptoms of diseases.[34] However, Hahnemann rejected the notion of a disease as a separate thing or invading entity and insisted that it was always part of the "living whole".[35]

[edit] Hahnemann's "Law of similars"

Hahnemann observed from his experiments with cinchona bark, used as a treatment for malaria, that the effects he experienced from ingesting the bark were similar to the symptoms of malaria. He therefore decided that cure proceeds through similarity, and that treatments must be able to produce symptoms in healthy individuals similar to those of the disease being treated.[36] Through further experiments with other substances, Hahnemann conceived of the law of similars, otherwise known as "let like be cured by like" (Latin: similia similibus curentur)[37][38] as a fundamental healing principle. He believed that by inducing a disease through use of drugs, the artificial symptoms empowered the vital force to neutralise and expel the original disease and that this artificial disturbance would naturally subside when the dosing ceased.[36] It is based on the belief that a substance that in large doses will produce symptoms of a specific disease will, in extremely small doses, cure it.

Critics have labeled Hahnemann's law of similars an "ipse dixit" "axiom",[4] in other words an unproven assertion made by Hahnemann, and not a true law of nature.[3]

[edit] Miasms and disease

In 1828, Hahnemann introduced the concept of miasms; underlying causes for many known diseases.[39] A miasm is often defined by homeopaths as an imputed "peculiar morbid derangement of [the] vital force".[40] Hahnemann associated each miasm with specific diseases, with each miasm seen as the root cause of several diseases. According to Hahnemann, initial exposure to miasms causes local symptoms, such as skin or venereal diseases, but if these symptoms are suppressed by medication, the cause goes deeper and begins to manifest itself as diseases of the internal organs.[41] Homeopathy maintains that treating diseases by directly opposing their symptoms, as is sometimes done in conventional medicine, is ineffective because all "disease can generally be traced to some latent, deep-seated, underlying chronic, or inherited tendency".[42] The underlying imputed miasm still remains, and deep-seated ailments can only be corrected by removing the deeper disturbance of the vital force.[43]

Hahnemann's miasm theory remains disputed and controversial within homeopathy even in modern times. In 1978, Anthony Campbell, then a consultant physician at The Royal London Homeopathic Hospital, criticised statements by George Vithoulkas claiming that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system[10]. This conflicts with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases.[44] Campbell described this as "a thoroughly irresponsible statement which could mislead an unfortunate layman into refusing orthodox treatment".[10]

Originally Hahnemann presented only three miasms, of which the most important was "psora" (Greek for itch), described as being related to any itching diseases of the skin, supposed to be derived from suppressed scabies, and claimed to be the foundation of many further disease conditions. Hahnemann believed psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts.[39] Since Hahnemann's time, other miasms have been proposed, some replacing one or more of psora's proposed functions, including tubercular miasms and cancer miasms.[41]

The theory of miasms has been criticized as an explanation developed by Hahnemann to preserve the system of homeopathy in the face of treatment failures, and for being inadequate to cover the many hundreds of sorts of diseases, as well as for failing to explain disease predispositions as well as genetics, environmental factors and the unique disease history of each patient.[45]

[edit] Homeopathic remedies

Homeopathic remedy Rhus toxicodendron, derived from poison ivy.

Remedy is a technical term in homeopathy that refers to a substance prepared with a particular procedure and intended for treating patients; it is not to be confused with the generally-accepted use of the word, which means "a medicine or therapy that cures disease or relieves pain".[46]. Homeopathic practitioners rely on two types of reference when prescribing remedies: Materia medica and repertories. A homeopathic Materia medica is a collection of "drug pictures", organised alphabetically by remedy, that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms.[47]

Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include Arsenicum album (arsenic oxide), Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Homeopaths also use treatments called nosodes (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue.[48] Homeopathic remedies prepared from healthy specimens are called sarcodes.

Some modern homeopaths have considered more esoteric bases for remedies, 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-rays[49] and sunlight.[50] Recent ventures by homeopaths into even more esoteric substances include thunderstorms (prepared from collected rainwater).[51] Today there are about 3,000 different remedies commonly used in homeopathy.[citation needed] Some homeopaths also use techniques that are regarded by other practitioners as controversial. These include paper remedies, where the substance and dilution are written on a piece of paper and either pinned to the patient's clothing, put in their pocket, or placed under a glass of water that is then given to the patient, as well as the use of radionics to prepare remedies. Such practices have been strongly criticised by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.[52][53]

[edit] Preparation

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

In producing remedies for diseases, homeopaths use a process called dynamisation or potentisation whereby a substance is diluted with alcohol or distilled water and then vigorously shaken by ten hard strikes against an elastic body in a process called succussion. While Hahnemann advocated using substances which produce symptoms similar to those of the disease being treated, he found that material doses would intensify the symptoms and exacerbate the condition, sometimes causing what amounted to dangerous toxic reactions. He therefore specified that the substances be diluted. Hahnemann believed that the process of succussion activated the vital energy of the diluted substance.[54] For this purpose, Hahnemann had a saddle maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.[55][56] Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose (trituration).

[edit] Dilutions

Three logarithmic potency scales are in regular use in homeopathy. Hahnemann created the centesimal or C scale, diluting a substance by a factor of 100 at each stage. The centesimal scale was favored by Hahnemann for most of his life. A 2C dilution requires a substance to be diluted to one part in one hundred, and then some of that diluted solution diluted by a further factor of one hundred. This works out to one part of the original substance in 10,000 parts of the solution.[57] A 6C dilution repeats this process six times, ending up with the original material diluted by a factor of 100'6=10'12 (one part in one trillion)(1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.[58] The end product is often so diluted that it is indistinguishable from the dilutant (pure water, sugar or alcohol).[5][59][60]

Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060).[61] In Hahnemann's time it was reasonable to assume that remedies could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized. The greatest dilution that is reasonably likely to contain one molecule of the original substance is 12C.

This bottle contains arnica montana (wolf's bane) D6, i.e. the nominal dilution is one part in a million (10-6).

Some homeopaths developed a decimal scale (D or X), diluting the substance to ten times its original volume each stage. The D or X scale dilution is therefore half that of the same value of the C scale; for example, "12X" is the same level of dilution as "6C". 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, Constantine Hering.[62] 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.[63] A given dilution on the Q scale is roughly 2.35 times its designation on the C scale. For example a remedy described as "20Q" has about the same concentration as a "47C" remedy.[64]

X Scale C Scale Ratio Note
Ø Ø 1:1 mother tincture [65] (undiluted)
1X ' 1:10 described as low potency
2X 1C 1:100 called higher potency than 1X by homeopaths
6X 3C 10'6
8X 4C 10'8 allowable concentration of arsenic in U.S. drinking water[66]
12X 6C 10'12
24X 12C 10'24 Has a 60% probability of containing one molecule of original material if one mole of the original substance was used.
60X 30C 10'60 Dilution advocated by Hahnemann for most purposes;[61] patient would need to consume 1041 pills (a billion times the mass of the Earth), or 1034 gallons of liquid remedy (10 billion times the volume of the Earth) to consume a single molecule of the original substance[67]
400X 200C 10'400 Dilution of popular homeopathic flu remedy Oscillococcinum
Note: the "X scale" is also called "D scale". 1X = 1D, 2X = 2D, etc.
Homeopathic remedy Oscillococcinum

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies.[68] Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times.[69][70] Another example given by a critic of homeopathy states that a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans",[69][70] which is approximately correct.[71] One third of a drop of some original substance diluted into all the water on earth would produce a remedy with a concentration of about 13C.[72][68][73] A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 more universes to simply have one molecule in the final substance.[74] The high dilutions characteristically used are often considered to be the most controversial and implausible aspect of homeopathy.[75]

[edit] Dilution debate

Not all homeopaths advocate extremely high dilutions. Many of the early homeopaths were originally doctors and generally used lower dilutions such as "3X" or "6X", rarely going beyond "12X". The split between lower and higher dilutions followed ideological lines. Those favoring low dilutions stressed pathology and a strong link to conventional medicine, while those favoring high dilutions emphasised vital force, miasms and a spiritual interpretation of disease.[76][77] Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond the placebo effect.[78][79]

[edit] Provings

Hahnemann experimented on himself and others for several years before using remedies on 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 these experiments. The method used for determining which remedies were suitable for specific diseases was called proving, after the original German word Prüfung, meaning "test". A homeopathic proving is the method by which the profile of a homeopathic remedy is determined.[80]

At first Hahnemann used material doses for provings, but he later advocated proving with remedies at a 30C dilution,[61] and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain.[81] During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a drug picture. The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers 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.

Provings have been described as important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine.[82] The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence that nitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time.[83] The first recorded provings were published by Hahnemann in his 1796 Essay on a New Principle.[84] His Fragmenta de Viribus (1805)[85] contained the results of 27 provings, and his 1810 Materia Medica Pura contained 65.[86] For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 remedies underwent provings and newer substances are continually added to contemporary versions.

[edit] Repertory

Homeopathic repertory by James Tyler Kent.

Homeopaths generally begin with detailed examinations of their patients' histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type.[87]

From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a homeopathic materia medica. But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the homeopathic repertory, which is an index of symptoms, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and 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 Therapeutic Pocket Book, another homeopathic repertory.[88] The first such homeopathic repertory was Georg Jahr's Symptomenkodex, published in German (1835), which was then first translated to English (1838) by Constantine Hering as the Repertory to the more Characteristic Symptoms of Materia Medica. This version was less focused on disease categories and would be the forerunner to Kent's later works.[48][89] It consisted of three large volumes. Such repertories increased in size and detail as time progressed.

Some diversity in approaches to treatments exists among homeopaths. Classical homeopathy generally involves detailed examinations of a patient's history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while clinical homeopathy involves combinations of remedies to address the various symptoms of an illness.[90]

[edit] Related modalities

[edit] Isopathy

Isopathy is a therapy derived from homeopathy and was invented by Johann Joseph Wilhelm Lux in the 1830s.[48] 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 a form of isopathy.[91]

[edit] Flower remedies

Flower remedies can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower remedies, which were developed by the physician and homeopath Edward Bach. Although the proponents of these remedies share homeopathy's vitalist world-view and the remedies are claimed to act through the same hypothetical "vital force" as homeopathy, the method of preparation is different. Bach flower remedies are prepared in "gentler" ways such as placing flowers in bowls of sunlit water, and the remedies are not succussed.[92] There is no convincing scientific or clinical evidence for flower remedies being effective.[93]

[edit] Veterinary use

The idea of using homeopathy as a treatment for other animals, termed veterinary homeopathy, dates back to the inception of homeopathy; Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans.[94] The FDA has not approved homeopathic products as veterinary medicine in the U.S. In the UK, veterinary surgeons who use homeopathy belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons. 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. The use of homeopathy in veterinary medicine is controversial, as there has been little scientific investigation and current research in the field is not of a high enough standard to provide reliable data.[95] Other studies have also found that giving animals placebos can play active roles in influencing pet owners to believe in the effectiveness of the treatment when none exists.[95]

[edit] Medical and scientific analysis

Pseudoscientific concepts
Proponents claim that illnesses can be treated with specially prepared extreme dilutions of a substance that produces symptoms similar to the illness. Homeopathic remedies rarely contain any atom or molecule of the substance in the remedy.
Related scientific disciplines
Chemistry, Medicine
Year proposed
Original proponents
Samuel Hahnemann
Subsequent proponents
Organizations: Boiron, Heel, Miralus Healthcare, Nelsons, Zicam

Individuals: Paul Herscu, Robin Murphy, Rajan Sankaran, Luc De Schepper, Jan Scholten, Jeremy Sherr, George Vithoulkas

Homeopathy's efficacy is unsupported by the collective weight of modern scientific research. The extreme dilutions used in homeopathic preparations usually leave none of the original material in the final product. The modern mechanism proposed by homeopaths, water memory, is considered implausible in that short-range order in water only persists for about 1 picosecond.[96][97] Pharmacological effect without active ingredients is inconsistent with the observed dose-response relationships of conventional drugs,[98] leaving only non-specific placebo effects[11][99][100] or various novel explanations. The proposed rationale for these extreme dilutions ' that the water contains the "memory" or "vibration" from the diluted ingredient ' is counter to the laws of chemistry and physics, such as the law of mass action.[96] The lack of convincing scientific evidence supporting its efficacy[26] and its use of remedies without active ingredients have led to characterizations as pseudoscience and quackery,[27][29][30][101] or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst."[31] Use of homeopathy may delay or replace effective medical treatment, worsening outcomes or exposing the patients to increased risk.[8][9][10][13][102]

Referring specifically to homeopathy, the British House of Commons Science and Technology Committee has stated:

In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice-which the Government claims is very important-as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.[2]

The National Center for Complementary and Alternative Medicine of the United States' National Institutes of Health states:

Homeopathy is a controversial area of CAM because a number of its key concepts are not consistent with established laws of science (particularly chemistry and physics). Critics think it is implausible that a remedy containing a miniscule amount of an active ingredient (sometimes not a single molecule of the original compound) can have any biological effect'beneficial or otherwise. For these reasons, critics argue that continuing the scientific study of homeopathy is not worthwhile. Others point to observational and anecdotal evidence that homeopathy does work and argue that it should not be rejected just because science has not been able to explain it. [103]

[edit] High dilutions

The extremely high dilutions in homeopathy have been a main point of criticism. Homeopathic remedies are usually diluted to the point where there are no molecules from the original solution left in a dose of the final remedy.[97] Homeopaths believe that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active "remedy", in contrast to therapeutically inert water. Since even the longest-lived noncovalent structures in liquid water at room temperature are only stable for a few picoseconds,[104] critics have concluded that any effect that might have been present from the original substance can no longer exist.[105] No evidence of stable clusters of water molecules was found when homeopathic remedies were studied using NMR.[106]

Furthermore, since water will have been in contact with millions of different substances throughout its history, critics point out that water is therefore an extreme dilution of almost any conceivable substance. By drinking water one would, according to this interpretation, receive treatment for every imaginable condition.[107]

Practitioners of homeopathy contend that higher dilutions produce stronger medicinal effects. This idea is inconsistent with the observed dose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body.[98] This dose-response relationship has been confirmed in multitudinous experiments on organisms as diverse as nematodes,[108] rats,[109] and humans.[110]

Physicist Robert L. Park, former executive director of the American Physical Society, has noted that

' since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.[99] '

Park has also noted that "to expect to get even one molecule of the 'medicinal' substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained".

The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether.[23] This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 1024).[68][99][111]

Scientific tests run by both the BBC's Horizon and ABC's 20/20 programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.[56][112]

[edit] Research on medical effectiveness

Old bottle of Hepar sulph made from calcium sulfide

The effectiveness of homeopathy has been in dispute since its inception. One of the earliest double blind studies concerning homeopathy was sponsored by the British government during World War II in which volunteers tested the effectiveness of homeopathic remedies against diluted mustard gas burns.[113] The methodological quality of the research base is generally low, with such problems as weaknesses in design or reporting, small sample size, and selection bias. No individual preparation has been unambiguously demonstrated to be different from a placebo.[1][114] Further, as the quality of the trials become better, the evidence for homeopathy preparations being effective diminishes, and the highest-quality trials show that the remedies themselves have no effect.[115][17][20] Abstract concepts within theoretical physics have been invoked to suggest explanations of how or why remedies might work, including quantum mechanics, the theory of relativity and chaos theory. However, the explanations are offered by nonspecialists within the field, and often include speculations which are incorrect in their application of the concepts and not supported by actual experiments.[116]

[edit] Meta-analyses

Meta-analyses, in which large groups of studies are analysed and conclusions drawn based on the results as a whole, have been used to evaluate the effectiveness of homeopathy. Early meta-analyses investigating homeopathic remedies showed slightly positive results among the studies examined, but such studies have warned that it was impossible to draw firm conclusions due to low methodological quality and difficulty in controlling for publication bias in the studies reviewed.[15][22][16] One of the positive meta-analyses, by Linde, et al.,[16] was later qualified by the authors, who wrote:

The evidence of bias [in homeopathic trials] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials...have negative results, and a recent update of our review for the most "original" subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.[17]

In 2001, a meta-analysis of clinical trials on the effectiveness of homeopathy concluded that earlier clinical trials showed 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.[22]

In 2002, a review of systematic reviews found that higher-quality trials tended to have less positive results, to the point that those results were clinically irrelevant. Also, when taking collectively all the systematic reviews, there was no convincing evidence that any homeopathic remedy had better effects than placebo, and current evidence did not allow to recommend its usage in clinical treatment.[1]

In 2005, a systematic review of the representation of homeopathy in the medical literature suggested that mainstream journals had a publication bias against clinical trials of homeopathy that showed positive results, and the opposite was the case for complementary and alternative medicine journals. The authors suggested that this could be due to an involuntary bias, or otherwise a submission bias, in which positive trials tend to be sent to CAM journals and negatives ones to mainstream journals.[20] Reviews in all journals approached the subject in an apparently impartial manner, though most of the reviews published in CAM journals made no mention of the plausibility of homeopathy, whereas 9 out of 10 reviews in mainstream journals mentioned a lack of plausibility of homeopathy in the introduction.[20]

In 2005, The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.[14]

A 2006 meta-analysis of six trials evaluating homeopathic treatments to reduce cancer therapy side effects following radiotherapy and chemotherapy found "encouraging but not convincing" evidence in support of homeopathic treatment. Their analysis concluded that there was "insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care".[117]

A 2007 systematic review of homeopathy for children and adolescents found that the evidence for attention-deficit hyperactivity disorder and childhood diarrhea was mixed. No difference from placebo was found for adenoid vegetation, asthma, or upper respiratory tract infection. Evidence was not sufficient to recommend any therapeutic or preventative intervention.[13]

The Cochrane Library found insufficient clinical evidence to evaluate the efficacy of homeopathic treatments for asthma[118] dementia,[119] or for the use of homeopathy in induction of labor.[120] Other researchers found no evidence that homeopathy is beneficial for osteoarthritis,[121] migraines[122] or delayed-onset muscle soreness.[90]

Health organisations such as the UK's National Health Service,[123] the American Medical Association,[12] and the FASEB[105] have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine.

Clinical studies of the medical efficacy of homeopathy have been criticised by some homeopaths as being irrelevant because they do not test "classical homeopathy".[124] There have, however, been a number of clinical trials that have tested individualized homeopathy. A 1998 review[125] found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials. The authors concluded "that the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies." Jay Shelton, author of a book on homeopathy, has stated that the claim assumes without evidence that classical, individualized homeopathy works better than nonclassical variations.[126]

Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy "goes beyond current understanding of chemistry and physics." He adds: "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment."[26]

[edit] Mainstream explanations for any effects

Mainstream science offers a variety of explanations for how homeopathy, if the preparations themselves are ineffective, may appear to cure diseases or alleviate symptoms:[127]

  • Unassisted natural healing - time and the body's ability to heal without assistance can eliminate many diseases of their own accord
  • Unrecognized treatments - an unrelated food, exercise, environmental agent or treatment for a different ailment, may have occurred
  • Regression toward the mean - since many diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care when discomfort is greatest, they may feel better anyway but because the timing of the visit to the homeopath they attribute improvement to the remedy taken
  • Non-homeopathic treatment - patients may also receive non-homeopathic care simultaneous with homeopathic treatment, and this is responsible for improvement though a portion or all of the improvement may be attributed to the remedy
  • Cessation of unpleasant treatment - often homeopaths recommend patients stop getting conventional treatment such as surgery or drugs, which can cause unpleasant side effects; improvements are attributed to homeopathy when the actual cause is the cessation of the treatment causing side effects in the first place
  • Lifestyle changes - homeopaths often recommend diet and exercise, as well as limitations in alcohol or coffee consumption and stress reduction, all of which can increase health and decrease symptoms
  • The placebo effect - the intensive consultation process and expectations for the homeopathic preparations can result in the release of endorphins or other body-effecting chemicals which alleviate pain or other symptoms, or otherwise affect an individual's biology
  • Psychological healing - the care, concern and reassurance provided by a homeopath as part of the consultation can assure the patient the symptoms are minor and easily treated, or alleviate tension that could exacerbate a preexisting condition. This caring engagement can prove particularly effective when conventional physicians have limited time with the patient or cannot provide a diagnosis or treatment.

[edit] Research on effects in other biological systems

Old homeopathic belladonna remedy.

While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain,[128] histamine release by leukocytes,[129] and enzyme reactions, such evidence is disputed since attempts to replicate them have failed.[130][131][132][133][134]

In 1987, French immunologist Jacques Benveniste submitted a paper to the journal Nature while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody. The journal editors, sceptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published. Still sceptical of the findings, Nature assembled an independent investigative team to determine the accuracy of the research, consisting of Nature editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic and magician James Randi. After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported."[25][135][136] James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data.[135]

[edit] Methodological and publication issues

Ben Goldacre published an article on homeopathy in The Lancet, stating the research on homeopathy is problematic for a variety of reasons. These included the high publication biases of alternative therapy journals, with very few articles reporting null results; ignoring meta-analytic studies in favour of cherry picked positive results; and the promotion of an observational study (that Goldacre described as "little more than a customer-satisfaction survey") as if it were more informative than a series of randomized trials. Goldacre also states that homeopaths who misrepresent scientific evidence to a scientifically illiterate public, have "...walled themselves off from academic medicine, and critique has been all too often met with avoidance rather than argument."[137]

[edit] Ethical and safety issues

As homeopathic remedies usually contain only water and/or alcohol, they are thought to be generally safe. Only in rare cases are the original ingredients present at detectable levels. This may be due to improper preparation or intentional low dilution. Instances of arsenic poisoning have occurred after use of arsenic-containing homeopathic preparations.[7] Zicam Cold Remedy Nasal Gel, which contains 2X (1:100) zinc gluconate, reportedly caused a small percentage of users to lose their sense of smell;[138] 340 cases were settled out of court in 2006 for 12 million U.S. dollars.[139] In 2009, the FDA advised consumers to stop using three discontinued cold remedy products manufactured by Zicam because it could cause permanent damage to users' sense of smell.[140] Zicam was launched without a New Drug Application (NDA) under a provision in the FDA's Compliance Policy Guide called "Conditions Under Which Homeopathic Drugs May be Marketed" (CPG 7132.15), but the FDA warned Zicam via a Warning Letter that this policy does not apply when there is a health risk to consumers.[141]

Critics of homeopathy have cited other concerns over homeopathic medicine, most seriously cases of patients of homeopathy failing to receive proper treatment for diseases that could have been easily diagnosed and managed with conventional medicine and who have died as a result[142] and the "marketing practice" of criticizing and downplaying the effectiveness of mainstream medicine.[137] Homeopaths claim that use of conventional medicines will "push the disease deeper" and cause more serious conditions, a process referred to as "suppression".[143][144] Some homeopaths (particularly those who are non-physicians) advise their patients against immunisation.[8][145][146] Some homeopaths suggest that vaccines be replaced with homeopathic "nosodes", created from biological material such as pus, diseased tissue, bacilli from sputum or (in the case of "bowel nosodes") feces.[147] While Hahnemann was opposed to such preparations, modern homeopaths often use them although there is no evidence to indicate they have any beneficial effects.[148][149] Cases of homeopaths advising against the use of anti-malarial drugs have been identified.[9][150][151] This puts visitors to the tropics who take this advice in severe danger, since homeopathic remedies are completely ineffective against the malaria parasite.[9][150][151] Also, in one case in 2004, a homeopath instructed one of her patients to stop taking conventional medication for a heart condition, advising her on 22 June 2004 to "Stop ALL medications including homeopathic", advising her on or around 20 August that she no longer needed to take her heart medication, and adding on 23 August, "She just cannot take ANY drugs ' I have suggested some homeopathic remedies ... I feel confident that if she follows the advice she will regain her health." The patient was admitted to hospital the next day, and died eight days later, the final diagnosis being "acute heart failure due to treatment discontinuation".[152][153]

In 1978, Anthony Campbell, then a consultant physician at The Royal London Homeopathic Hospital, criticised statements made by George Vithoulkas to promote his homeopathic treatments. Vithoulkas stated that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. Campbell described this as a thoroughly irresponsible statement which could mislead an unfortunate layman into refusing conventional medical treatment.[10] This claim echoes the idea that treating a disease with external medication used to treat the symptoms would only drive it deeper into the body and conflicts with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases.[44]

A 2006 review by W. Steven Pray of the College of Pharmacy at Southwestern Oklahoma State University recommends that pharmacy colleges include a required course in unproven medications and therapies, that ethical dilemmas inherent in recommending products lacking proven safety and efficacy data be discussed, and that students should be taught where unproven systems such as homeopathy depart from evidence-based medicine.[154]

Edzard Ernst, the first Professor of Complementary Medicine in the United Kingdom and a former homeopathic practitioner,[155][156][157] has expressed his concerns about pharmacists who violate their ethical code by failing to provide customers with "necessary and relevant information" about the true nature of the homeopathic products they advertise and sell:

"My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous."[158]

Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities at University College London (UCL), has described homoeopathy as a 'cruel deception'.[32]

In an article entitled "Should We Maintain an Open Mind about Homeopathy?"[159] published in the American Journal of Medicine, Michael Baum and Edzard Ernst'writing to other physicians'wrote that "Homeopathy is among the worst examples of faith-based medicine... These axioms [of homeopathy] are not only out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics, chemistry, and pharmacology must be incorrect...".

[edit] Regulation and prevalence

Hampton House, the former site of Bristol Homeopathic Hospital, one of four homeopathic hospitals run by the NHS.[2]

Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others. It is practised worldwide and professional qualifications and licences are needed in most countries.[33] Regulations vary in Europe depending on the country. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licences or degrees in conventional medicine from accredited universities are required. In Germany, no specific regulations exist, while France, Austria and Denmark mandate licences to diagnose any illness or dispense of any product whose purpose is to treat any illness.[33] Some homeopathic treatment is covered by the public health service of several European countries, including France, the United Kingdom, Denmark, and Luxembourg. In other countries, such as Belgium, homeopathy is not covered. In Austria, the public health service requires scientific proof of effectiveness in order to reimburse medical treatments and homeopathy is listed as not reimbursable[160] but exceptions can be made;[161] private health insurance policies sometimes include homeopathic treatment.[33] The Swiss government, after a 5-year trial, withdrew homeopathy and four other complementary treatments in 2005, stating that they did not meet efficacy and cost-effectiveness criteria.[162] The Indian government recognises homeopathy as one of its national systems of medicine,[163] and a minimum of a recognised diploma in homeopathy and registration on a state register or the Central Register of Homoeopathy is required to practice homeopathy in India.[164]

In the United Kingdom, MPs inquired into homeopathy to assess the Government's policy on the issue, including funding of homeopathy under the National Health Service and government policy for licensing homeopathic products. The decision by the House of Commons Science and Technology Committee follows a written explanation from the Government in which it told the select committee that the licensing regime was not formulated on the basis of scientific evidence. "The three elements of the licensing regime (for homeopathic products) probably lie outside the scope of the ... select committee inquiry, because government consideration of scientific evidence was not the basis for their establishment," the Committee said. The inquiry sought written evidence and submissions from concerned parties.[165][166]

In February 2010 the House of Commons Science and Technology Committee concluded that:

... the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA.

The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.

The Committee concluded - given that the existing scientific literature showed no good evidence of efficacy - that further clinical trials of homeopathy could not be justified.

In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice-which the Government claims is very important-as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.[2]

The Committee also stated:

' We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals ' hospitals that specialise in the administration of placebos ' should not continue, and NHS doctors should not refer patients to homeopaths.[167] '

In July 2010 the newly elected UK Secretary of State for Health deferred to local NHS on funding homeopathy. A nineteen page document details the Government–s response, and it states that "our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients - including complementary or alternative treatments such as homeopathy - and provide accordingly for those treatments." The response also stated that "the overriding reason for NHS provision is that homeopathy is available to provide patient choice".[168]

[edit] History

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

[edit] Historical context

In the 16th century the pioneer of pharmacology Paracelsus declared that small doses of 'what makes a man ill also cures him", anticipating homeopathy,[169] but it was Hahnemann who gave it a name and laid out its principles in the late 18th century. At that time, mainstream medicine employed such measures as bloodletting and purging, used laxatives and enemas, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper's flesh.[170][171] Such measures often worsened symptoms and sometimes proved fatal.[172][173] While the virtues of these treatments had been extolled for centuries,[174] Hahnemann rejected such methods as irrational and inadvisable.[175] Instead, he favored the use of single drugs at lower doses and promoted an immaterial, vitalistic view of how living organisms function, believing that diseases have spiritual, as well as physical causes.[35][176] (At the time, vitalism was part of mainstream science. In the 20th century, however, medicine discarded vitalism, with the development of microbiology, the germ theory of disease,[177] and advances in chemistry.[178][179]) Hahnemann also advocated various lifestyle improvements to his patients, including exercise, diet, and cleanliness.[175][180]

[edit] Hahnemann's concept

Samuel Hahnemann, considered to be the father of homeopathy

Hahnemann conceived of homeopathy while translating a medical treatise by Scottish physician and chemist William Cullen into German.[36] Being skeptical of Cullen's theory concerning cinchona's action in malaria, Hahnemann ingested some of the bark specifically to see if it cured fever "by virtue of its effect of strengthening the stomach".[181] Upon ingesting the bark, he noticed few stomach symptoms, but did experience fever, shivering and joint pain, symptoms similar to some of the early symptoms of malaria, the disease that the bark was ordinarily used to treat. From this, Hahnemann came to believe that all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they treat. This later became known as the "law of similars", the most important concept of homeopathy.[36] The term "homeopathy" was coined by Hahnemann and first appeared in print in 1807, although he began outlining his theories of "medical similars" or the "doctrine of specifics" in a series of articles and monographs in 1796.[182][183]

Hahnemann began to test what effects substances produced in humans, a procedure which would later become known as "homeopathic proving".[184] These time-consuming tests required subjects to clearly record all of their symptoms as well as the ancillary conditions under which they appeared. Hahnemann saw these data as a way of identifying substances suitable for the treatment of particular diseases.[184] The first collection of provings was published in 1805 and a second collection of 65 remedies appeared in his book, Materia Medica Pura, in 1810.[185] Hahnemann believed that large doses of drugs that caused similar symptoms would only aggravate illness, so he advocated extreme dilutions of the substances; he devised a technique for making dilutions that he believed would preserve a substance's therapeutic properties while removing its harmful effects,[5] proposing that this process aroused and enhanced "spirit-like medicinal powers held within a drug".[186] He gathered and published a complete overview of his new medical system in his 1810 book, The Organon of the Healing Art, whose 6th edition, published in 1921, is still used by homeopaths today.[36]

[edit] 19th century: rise to popularity and early criticism

Homeopathy achieved its greatest popularity in the 19th century. Dr. John Franklin Gray (1804'1882) was the first practitioner of Homeopathy in the United States, beginning in 1828 in New York City. The first homeopathic schools opened in 1830, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States.[187] By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States.[21] Because medical practice of the time relied on ineffective and often dangerous treatments, patients of homeopaths often had better outcomes than those of the doctors of the time.[188] Homeopathic remedies, even if ineffective, would almost surely cause no harm, making the users of homeopathic remedies less likely to be killed by the treatment that was supposed to be helping them.[36] The relative success of homeopathy in the 19th century may have led to the abandonment of the ineffective and harmful treatments of bloodletting and purging and to have begun the move towards more effective, science based medicine.[173] One reason for the growing popularity of homeopathy was its apparent success in treating people suffering from infectious disease epidemics.[189] During 19th century epidemics of diseases such as cholera, death rates in homeopathic hospitals were often lower than in conventional hospitals, where the treatments used at the time were often harmful and did little or nothing to combat the diseases.[190]

From its inception, however, homeopathy was criticized by mainstream science. Sir John Forbes, physician to Queen Victoria, said in 1843 that the extremely small doses of homeopathy were regularly derided as useless, "an outrage to human reason".[191] James Young Simpson said in 1853 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."[192] 19th century American physician and author Oliver Wendell Holmes, Sr. was also a vocal critic of homeopathy and published an essay in 1842 entitled Hom�opathy, and its kindred delusions.[193] The members of the French Homeopathic Society observed in 1867 that some of the leading homeopathists of Europe were not only abandoning the practice of administering infinitesimal doses, but were also no longer defending it.[194] The last school in the U.S. exclusively teaching homeopathy closed in 1920.[36]

[edit] Revival in the late 20th century

The Food, Drug, and Cosmetic Act of 1938 (sponsored by New York Senator and Homeopathic Physician Royal Copeland) recognized homeopathic remedies as drugs. By the 1950s there were only 75 pure homeopaths practicing in the U.S.[195] However, in the mid to late 1970s, homeopathy made a significant comeback and sales of some homeopathic companies increased tenfold.[196] Greek homeopath George Vithoulkas performed a "great deal of research to update the scenarios and refine the theories and practice of homeopathy" beginning in the 1970s, and it was revived worldwide;[90][197] in Brazil during the 1970s and in Germany during the 1980s.[198] The medical profession started to integrate such ideas in the 1990s[199] and mainstream pharmacy chains recognized the business potential of selling homeopathic remedies.[200]

[edit] See also

[edit] References

[edit] Footnotes

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