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Homeopathy
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Homeopathy
NCCAM classifications [1]
1. Alternative Medical Systems
2. Mind-Body Intervention
3. Biologically Based Therapy
4. Manipulative and body-based methods
5. Energy Therapy
Homeopathy (also homœopathy or homoeopathy; from the Greek, ὅμοιος, hómoios,
"similar" + πάθος, páthos, "suffering" or "disease") is a controversial form
of alternative medicine that aims to treat "like with like". Substances that
cause symptoms similar to the disease in large quantities are heavily
diluted, with shaking at each stage of the dilution. Homeopaths contend that
the shaking causes some imprint (or memory) of the diluted substance,
despite the fact that at many common homeopathic dilutions, no molecules of
the original substance are likely to remain.[1] Homeopathy is based on a
vitalist world view, which sees the underlying causes of sickness as
imbalances in a hypothetical vital force. Proponents claim that homeopathic
treatment can harmonize and re-balance the vital force in the body, so
restoring health. This claim is unsupported by modern biology or
medicine.[2][3][4][5][6]
Homeopathy traces its origins to the late 18th century when it was founded
by German physician Samuel Hahnemann, who noted some similarity of the
symptoms of undiluted cinchona bark in healthy individuals with those of
malaria, which it is used to treat. Hahnemann decided that an effective drug
must produce the symptoms in healthy individuals that are similar to the
symptoms of the sick patient which they are supposed to be treating.[7]
Based on later experiments, Hahnemann reasoned that using natural doses of
substances would generally not help patients because, if they produced
effects similar to those of the disease, they would only make symptoms
worse, and thus proposed the dilution of substances in water or alcohol,
with shaking (known as "succussion") after each dilution, in order to try
and imprint the liquid with the memory of the original substance. To account
for homeopathic remedies sometimes failing to produce lasting cures of
long-standing chronic diseases, Hahnemann proposed that the vital force in
the body has the ability to react or adapt to disturbances, referred to as
the "law of susceptibility", and that various causes can attract
hypothetical disease-causing entities called "miasms", which he claimed
could produce symptoms of disease within the body, and formed a deeper,
harder to treat cause of illness.[7]
The medical efficacy of homeopathic treatments is unconfirmed by scientific
and clinical studies.[8][9][10] The hypothesis that extreme dilution makes
any drug more powerful is antithetical to the principles of chemistry and
physics as well as the observed dose-response relationships of conventional
medicines. The scientific community asserts there is no scientific evidence
supporting the contention that water or alcohol retain any memory of a
substance. Researchers conclude that any positive effects of homeopathic
treatment are simply a placebo effect.[6] Homeopaths are also often accused
of giving 'false hope' to patients who might be better advised to seek
effective conventional treatments. Studies have shown homeopaths frequently
advise patients to avoid standard medical procedures including drugs which
can prevent diseases such as malaria.[11][12] The meta-analyses that have
been done on homeopathy have confirmed that its effects are unlikely to be
beyond that of placebo, and those studies that have shown positive results
for homeopathic treatments were flawed in design. These findings, along with
the proscription by homeopaths against conventional medicine and their
encouragement of a "holistic" approach to health, are in keeping with the
conclusion of many scientists that homeopathy is a sort of
quackery.[13][14][15]
History
Modern homeopathy was created by German physician Samuel Hahnemann during
the late 18th and early 19th century. The system of similars emphasized in
homeopathy was first described by doctors of the vitalist school of medicine
and one of the most prominent proponents of vitalism was the Renaissance
physician Paracelsus. Paracelsus subscribed to many of the same principles
as the modern founder of homeopathy, Samuel Hahnemann. Vienna physician
Anton Freiherr von Störck and Scottish physician John Brown also held
similar medical beliefs to Samuel Hahnemann prior to the conception of
homeopathy
18th century medicine
In Hahnemann's day, mainstream medicine was a degenerate form of Galenism,
with a theory of disease based upon the ancient Greek idea of four humours.
Medicine of the time professed to restore the balance of the humours, mostly
by employing such measures as bloodletting and purging, use of laxatives,
enemas and substances that induced vomiting, as well as suppressing symptoms
using complex mixtures of plant and mineral drugs in strong doses. Such
measures often made symptoms worse or proved fatal. By contrast, Hahnemann
rebelled against these methods, and the use of mixed drugs in strong doses,
favoring the use of single drugs in milder doses. He later came to promote
an immaterial, vitalistic view of how living organisms function and thought
that diseases have spiritual, as well as physical causes.[16][17] During the
18th century vitalism was part of mainstream science. However, in the
twentieth century, medicine discarded vitalism in favor of the germ theory
of disease, following the work of Robert Koch, Louis Pasteur, Alexander
Fleming, Joseph Lister and many others.
Concepts
Samuel Hahnemann conceived of homeopathy while translating a Materia Medica,
a treatise by Scottish physician and chemist William Cullen, into German. On
reading about cinchona bark, from which quinine is extracted and is used to
treat malaria, he noticed that Cullen described the mechanism of the
substance as having "stomach strengthening properties". Hahnemann was
skeptical of this explanation and decided to understand the effects of
Cinchona bark by taking it himself. Upon ingesting the bark, he noticed that
he experienced fever, shivering and arthralgia (joint pain). These symptoms
are similar to some of those of malaria, which the substance was supposed to
be treating, and from this he decided that all effective drugs must produce
the symptoms in healthy individuals that are similar to the diseases which
they are supposed to be treating. This later became known as the "Law of
similars", and the most important concept of homeopathy.[7] The term
"homeopathy" was coined by Hahnemann and first appeared in print in
1807,[18] although he began outlining his theories of 'medical similars' in
a series of articles and monographs in 1796.[19]
Hahnemann began to test which symptoms were produced by which substances,
which would later become known as "proving". The tests were time-consuming
and required subjects to clearly record all of their symptoms as well as
when they appeared. Hahnemann used them to decide which substances would be
used to treat which disease. The first collection of provings was published
in 1805 and a second collection of 65 remedies appeared in the Materia
Medica Pura in 1810. As Hahnemann believed that large doses of things that
caused similar symptoms would only aggravate illness, he advocated extreme
dilutions of the substances, and came up with a technique for these
dilutions that he believed would preserve the substance's essence while
removing its harmful effects. 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.[7]
During the 19th century homeopathy grew in popularity: In 1830 the first
homeopathic schools opened, and throughout the 19th century dozens of
homeopathic institutions appeared in Europe and the United States.[20]
Homeopathic hospitals also appeared and practitioners of homeopathy often
had better outcomes compared to those of their counterparts in mainstream
medicine, due to the then-common practices of blood-letting and use of
untested medicines that were often poisonous. Homeopathic treatments, even
if ineffective, would almost surely cause no harm, making the users of
homeopathic medicine less likely to be killed by the medicine which was
supposed to be helping them.[7]
The last school in the U.S. exclusively teaching homeopathy closed down in
1920, though the Hahnemann School of Medicine, now part of Drexel
University, continued to offer homeopathy electives until the 1940s.[7] A
few homeopathic courses are still taught in a few colleges, but usually
alongside other alternative medical treatments.[21]
General philosophy
Homeopathy is a vitalist philosophy in that it regards diseases and sickness
to be caused by disturbances in a hypothetical vital force or life force in
humans and that these disturbances manifest themselves as unique symptoms.
Homeopathy contends that the vital force has the ability to react and adapt
to internal and external causes, which homeopaths refer to as the "law of
susceptibility". The law of susceptibility states that a negative state of
mind can attract hypothetical disease entities called "miasms" to invade the
body and produce symptoms of diseases,[7] However, Hahnemann rejected the
notion of a disease as a separate thing or invading entity[22] and insisted
that it was always part of the "living whole".[23]
Miasms and disease
Miasms were proposed by Hahnemann to explain the failure of homeopathic
remedies to produce lasting cures for chronic diseases, in 1828,[24] with
hints of the idea found as early as 1816. Hahnemann associated various
miasms with specific diseases that have historically plagued mankind, with
each miasm causing several diseases. According to Hahnemann, miasmatic
infection caused local symptoms, usually in the skin, and if these are
suppressed by external medication, the cause goes deeper, and manifests
itself later as disease of the internal organs.[25] Homeopathy contends that
treating symptoms by directly opposing their actions, as is done in
conventional medicine, is not effective in treating diseases because the
miasms still remain, and that the only way to correct the ailments is to
correct the disturbance of the vital force.[26]
This controversial claim remains common even in modern times. In 1978,
Anthony Campbell, then a consultant physician at The Royal London
Homeopathic Hospital,[27][28] criticized 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. This conflicts with scientific studies, which indicate that
penicillin treatment produces a compete cure of syphilis in more than 90% of
cases.[29] Campbell described this as "a thoroughly irresponsible statement
which could mislead an unfortunate layman into refusing orthodox treatment"
and said that it was not an isolated case, but part of a lengthy section
arguing against conventional medicine.[30] This echoes the idea in
homeopathy that using medication to suppress the symptoms of a disease would
only drive the underlying disease deeper into the body.
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 claimed psora to be the cause of such diseases as
epilepsy, cancer, jaundice, deafness, and cataracts.[31] 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.[25]
Law of similars
Hahnemann experimented with Cinchona bark, which is used as a treatment of
malaria, and observed that the side effects he experienced from the quinine
in the Cinchona bark were similar to the symptoms of malaria. He reasoned
that treatments for diseases must produce symptoms similar to of those
disease being treated when taken by healthy individuals. From this Hahnemann
conceived of the "law of similars", otherwise known as "like cures like"
(Latin: similia similibus curentur). Hahnemann believed that by inducing
artificial symptoms of a disease, the artificial symptoms would create
another disturbance in the vital force thus pushing out the old disturbance
and that the body would naturally recover from the artificially induced
disturbance. The basic idea is that to cure a person suffering from an
illness, one should administer a dilute dose of a substance that produces
the same symptoms of the illness being treated in healthy individuals.[32]
Development of remedies
Dilution and succussion
In producing treatments for diseases, homeopaths use a process called "dynamization"
or "potentization" where the remedy is diluted into alcohol or water and
then vigorously shaken by ten hard strikes against an elastic body in a
process called "succussion". Hahnemann thought that the use of remedies
which present symptoms similar to those of disease in healthy individuals
would only intensify the symptoms and exacerbate the condition, so he
advocated the dilution of the remedies to the point the symptoms were no
longer experienced. During the process of potentization, homeopaths believe
that the vital energy of the diluted substance is activated and its energy
released by vigorous shaking of the substance. For this purpose, Hahnemann
had a saddle maker construct a special wooden striking board covered in
leather on one side and stuffed with horsehair.[33] Insoluble solids, such
as quartz and oyster shell, are diluted by grinding them with lactose (trituration).
Three potency scales are in regular use in homeopathy. Hahnemann pioneered
and always favored the centesimal or "C scale", diluting a substance 1 part
in a 100 of diluent. Some homeopaths developed a decimal scale (D or X)
diluting the substance 1 part in 10 of diluent. Hahnemann never used this
scale but it was very popular throughout the 19th century and still is in
Europe. This potency scale appears to have been introduced in the 1830s by
the American homeopath, Dr. Constantine Hering.[34] 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.[35] Higher potencies in
homeopathy, which are more diluted, are considered to be stronger
deep-acting remedies. Hahnemann advocated 30C dilutions for most purposes,
i.e. dilution by a factor of 10030, and a common homeopathic treatment for
the flu is a 200c dilution of duck liver, called Oscillococcinum in
homeopathy. As Avogadro's number is only 6.022 × 1023 particles per mole,
the chance of any molecule of the original substance being present in a 15x
solution is very small, and the chances of a single molecule of the original
substance remaining in a 24x(12c) dilution would be roughly 1 in 2 billion.
For a perspective on these numbers, there are in the order of 1032 molecules
of water in an Olympic size swimming pool and if such a pool were filled
with a homeopathic substance, to expect to get a single molecule from the
original substance in a 15C solution, one would need to swallow 1% of the
volume of such a pool, or roughly 25 metric tons of water.[36]
For more perspective, 1ml of a solution which has gone through a 30C
dilution would have been diluted into a volume of water equal to that of a
cube of 1,000,000,000,000,000,000 meters per side, or about 105 light years.
Thus, homeopathic remedies of the standard dilutions contain, with
overwhelming probability, only water. Practitioners of homeopathy believe
that this water retains some 'essential property' of the original substance,
due to the shaking after each dilution.[37] Hahnemann believed that the
dynamization or shaking of the solution caused a "spirit like" healing force
to be released from within the substance. He thought that even after every
molecule of the previous substance has been removed from the water, the
spiritual healing force still remained.[36]
It should be noted however that not all homeopaths advocated extremely high
potencies. Many of the early homeopaths were originally doctors and
generally tended to use lower potencies such as "3x" or "6x", rarely going
beyond "12x". A good example of this approach is that of Dr. Richard Hughes,
who dismissed the extremely high potencies as unnecessary. This was the
dominant pattern in Europe throughout the 1820s to 1930s, but in America
many practitioners developed and preferred the higher dilutions. This trend
became especially exemplified by James Tyler Kent and dominated US
homeopathy from the 1850s until its demise in the 1940s. The split between
lower and higher dilutions also followed ideological lines with the former
stressing pathology and a strong link to conventional medicine, while the
latter emphasized vital force, miasms and a spiritual take on
sickness.[38][39]
Provings
In order to determine which specific remedies could be used to treat which
diseases, Hahnemann experimented on himself for several years as well as
with patients. His experiments did not initially consist of giving remedies
to the sick, because he thought that the most similar remedy, by virtue of
its ability to induce symptoms similar to the disease itself, would make it
impossible to determine which symptoms came from the remedy and which from
the disease itself. Therefore, sick people were excluded from the provings.
The method used for determining which remedies were suitable for specific
diseases was called "proving". A homeopathic proving is the method by which
the profile of a homeopathic remedy is determined. The word 'proving'
derives from the German word 'Prüfung' meaning 'test'.
During the process of proving, Hahnemann used healthy volunteers who were
given remedies, often in molecular doses, and the resulting symptoms were
compiled by observers into a "Drug Picture". During the process the
volunteers were observed for months at a time and were made to keep
extensive journals detailing all of their symptoms at specific times during
the day. During the tests volunteers were forbidden from consuming coffee,
tea, spices, or wine. They were also not allowed to play chess, because
Hahnemann considered it to be "too exciting", however they were allowed to
drink beer and were encouraged to moderately exercise. After the experiments
were over, Hahnemann made the volunteers offer their hands and take an oath
swearing that what they reported in their journals was the truth, at which
time he would interrogate them extensively concerning their symptoms.[40]
The first recorded 'proven' drugs were published by Hahnemann in his 1796
Essay on a New Principle and later in his Materia Medica Pura which
contained 27 and 65 proven drugs respectively. In his Lectures on
Homoeopathic Materia Medica published in 1905, James Tyler Kent listed 217
remedies, and newer substances are continually added to contemporary
versions.
Repertory
A compilation of reports of many homeopathic provings is known as a
homeopathic materia medica. In practice the usefulness of such a compilation
is limited because a practitioner does not need to look up the symptoms for
a particular remedy, but rather to explore the remedies for a particular
symptom. This need is filled by the homeopathic repertory, which is an index
of symptoms, listing after each symptom those remedies that are associated
with it. Repertories are often very extensive and may include data from
clinical experience in addition to provings. There is often lively debate
among the compilers of a repertory and interested practitioners over the
veracity of a particular inclusion. The first symptomatic index of the
homeopathic materia medica was arranged by Hahnemann. Soon after, one of his
students Clemens von Bönninghausen, created the Therapautic Pocket Book,
another homeopathic repertory. The first such Homeopathic Repertory was Dr.
George Jahr's Repertory, published in 1835 in German and then again in 1838
in English and edited by Dr. Constantine Hering. This version was less
focused on disease categories and would be the forerunner to Kent's later
works. It consisted of three large volumes. Such Repertories increased in
size and detail as time progressed.[41]
Treatments
Homeopathic treatments of patients generally begin with detailed
examinations of the patient's history including questions regarding one's
physical, mental and emotional state, one's life circumstances and
presenting physical/emotional illness. Homeopaths then translate a patient's
entire health status into a complex formula of mental and physical symptoms,
including likes, dislikes, innate predispositions and even body type.[31]
The goal is to develop a comprehensive representation of the individual's
overall health. This information can then be compared with similar
established data in the drug provings found in the homeopathic materia
medica. Assisted by further dialogs with the patient, the homeopath then
aims to find the one drug most closely matching the 'symptom totality' of
the patient. There are many methods for determining the most-similar remedy
(the simillimum), and homeopaths sometimes disagree. This is partly due to
the complexity of the "totality of symptoms" concept. That is, homeopaths do
not use all symptoms, but decide which are the most characteristic. This
subjective evaluation of case analysis relies on knowledge and experience of
the homeopath doing the diagnosis.[31]
Some diversity in approaches to treatments exists among homeopaths. So
called "Classical" homeopathy generally involves detailed examinations of a
patient's history and infrequent doses of a specific remedy as the patient
is monitored for improvements in symptoms. On the other hand "clinical"
homeopathy uses combinations of remedies to "cover" the various symptoms of
an illness, similar to conventional drug treatments.[42]
Remedies
"Remedy" is a technical term used in homeopathy to refer to a substance
prepared with a particular procedure and intended for treating patients.
Homeopathic practitioners rely on two types of reference when prescribing
remedies. The Homeopathic Materia Medicae which is comprised of alphabetical
indexes of "drug pictures" organized by remedy and describe the symptom
patterns associated with individual remedies. They also rely on homeopathic
repertories which consist of indexes of symptoms of diseases and listing
remedies associated with specific symptoms.[43]
Homeopathy uses many animal, plant, mineral, and synthetic substances in its
remedies. Examples include Natrum muriaticum (sodium chloride or table
salt), Lachesis muta (the venom of the bushmaster snake), Opium, and
Thyroidinum (thyroid hormone). Homeopaths also use treatments called nosodes
(from the Greek nosos, disease) made from diseased or pathological products
such as fecal, urinary, and respiratory discharges, blood, and tissue.[44]
Homeopathic remedy prepared from healthy specimens are called Sarcodes.
Some modern homeopaths have also considered more esoteric substances, known
as "imponderables" because they do not originate from a material but from
electromagnetic energy presumed to have been "captured" by alcohol or
lactose. Examples include X-rays, sunlight,[45] and electricity.[46] Recent
ventures by homeopaths into even more esoteric substances include
thunderstorms (prepared from collected rainwater)[47] and even samples of
the Berlin wall.[48] Today there are about 3,000 different remedies commonly
used in homeopathy.[49]
Isopathy
Isopathy is a therapy derived from homeopathy and was invented by Johann
Joseph Wilhelm Lux in the 1830s.[50] Isopathy differs from homeopathy in
general in that the remedies are made up either from things that cause the
disease, or from products of the disease, such as pus. Many so-called
"homeopathic vaccines" are in fact a form of isopathy.[51]
Tautopathy
Tautopathy is a practice of alternative medicine that is similar to
homeopathy in that it uses very diluted substances to treat illness.
However, tautopathy does not rely on the law of similars, as homeopathy
does. According to practitioners of Tautopathy, dilute solutions of lead and
arsenic can cause the body to secrete excess amounts of these toxic
metals.[52]
Veterinary homeopathy
Veterinary homeopathy is the term used to describe the treatment of animals
with homeopathy. Hahnemann himself however did none of his work on animals
and classical homeopathic principles would seem to conflict with the idea of
homeopathic treatments for non humans as syphilis and gonorrhea are not
conditions that are recognized in animals.[31] In the USA veterinary
homeopathy is used by veterinarian members of the Academy for Veterinary
Homeopathy and/or the American Holistic Veterinary Medical Association.[53]
In the UK, veterinary surgeons who use homeopathy belong to the Faculty of
Homeopathy and/or to the British Association of Homeopathic Veterinary
Surgeons or BAHVS. Animals may only be treated by qualified veterinary
surgeons in the UK and some other countries. Internationally, the body that
supports and represents homeopathic veterinarians is the International
Association for Veterinary Homeopathy or IAVH. There have been no rigorous
scientific demonstrations of therapeutic effects of homeopathy in veterinary
medicine and a German review of homeopathy in veterinary medicine has stated
that the medical effectiveness of homeopathy in higher dilutions is not
verified and that giving an animal a placebo can play an active role in
influencing the owner to believe in the effectiveness of the treatment when
none exists.[31]
Medical and scientific analysis
Homeopathy has been criticized by those in the scientific community since
its inception. The extreme dilutions used in homeopathic preparations, which
would often leave none of the active ingredient (no atoms, ions or
molecules), is inconsistent with the well observed dose-response
relationships of conventional drugs. The idea that the water contains the
'memory' or 'vibration' from the diluted ingredient is also counter to the
accepted laws of chemistry and physics. Thus critics contend that any
positive results obtained from homeopathic remedies are purely due to the
placebo effect, where the patients subjective improvement of symptoms is
based solely on the power of suggestion, due to the individual expecting or
believing that it will work. Critics cite the lack of viable scientific
studies for the effectiveness of homeopathic remedies as evidence that they
are not effective and that any positive effects are due to the placebo
effect. Critics also contend that homeopathy is inherently dangerous,
because homeopaths offer a false hope to patients who could be getting
proper treatment by a conventional medical doctor.
High dilutions
The extremely high dilutions in homeopathy have been a main point of
criticism. Homeopathy often dilutes remedies to the point there are no
molecules from the original substance left in the final remedy, leading many
critics to conclude that any effect that might have been present from the
original substance is no longer in existence. Homeopathy contends that the
higher the dilution (lower dose) actually equates to stronger effects of the
medicine. This is inconsistent with modern sciences observations of
dose-response relationships that has been demonstrated by
pharmacologists.[54] According to the dose response relationship in modern
medicine, smaller doses of chemicals produce smaller effects and larger
doses produce larger effects generally. This has been confirmed in thousands
of experiments on organisms as diverse as nematodes,[55] rats[56] and
humans.[57] Critiques of the high dilutions in homeopathy date back to the
early 19th century. Sir John Forbes, physician to Queen Victoria, said the
extremely small doses of homeopathy were regularly derided as useless,
laughably ridiculous and "an outrage to human reason."[58] 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."[59] Nineteenth century American
physician and author Oliver Wendell Holmes, Sr. was also a vocal critic of
homeopathy and published an essay in 1842 entitled Homeopathy and Its
Kindred Delusions.[60]
Homeopaths believe that after vigorous shaking, water retains a memory of a
substance that once existed in it, even if the substance is no longer
present. Critics respond that water will have been in contact with millions
of different substances in its history. According to this molecular
paradigm, any glass of water must be regarded as an extreme dilution of
almost any agent you care to mention. Thus, critics argue that by drinking
water one receives homeopathic treatment for every imaginable
condition.[61][31] Critics assert that proponents of homeopathy are unable
to accept the molecular paradigm as a complete account of life phenomena and
therapeutics. They believe that the methodical dilution of a particular
substance, beginning with a 10% or lower solution and working downwards,
with shaking after each dilution, produces a therapeutically active
'remedy', in contrast to regular water which is therapeutically inert.
However, chemically, a dilution of anything at 30C is identical to water.
Clinical trials
Homeopathy is considered to have paved the way for modern medical practices
including experiments to determine the value of medical remedies, systematic
and quantitative procedures, and the use of statistics. Early scientists
including Joseph Lister and Sidney Ringer stated that they were led by
homeopathy to important pharmacological discoveries.[31] However, despite
the fact that some of the procedures in homeopathy were ahead of their time,
the medical effectiveness of homeopathy has been a point of contention since
its inception. Early trials testing the efficacy of homeopathic treatments
conducted by Hahnemann himself lacked the scientific rigor of modern
scientific studies, and the first modern studies investigating the
effectiveness of homeopathy date back to 1906.[62] During the 1940s the
British government tested the efficacy of homeopathy on soldiers during
World War II to determine whether troops using homeopathic treatments healed
faster than those using placebo. Those using homeopathic remedies did
exhibit increased healing patterns, however the methods of the studies have
been questioned.[63]
More recent and controlled clinical trials done on homeopathy have shown
poor results, with some showing no difference between homeopathic remedies
and placebo and others showing only a slight difference.[64] Systematic
reviews and meta-analyses which analyze large groups of studies and draw
conclusions based on the results as a whole have been used to determine the
effectiveness of homeopathy. Early meta-analyses investigating homeopathic
remedies showed slightly positive results among the studies examined,
however such studies have warned that it was impossible to draw conclusions
due to low methodological quality and the unknown role of publication bias
in the studies reviewed.[65] A recent meta-analysis of clinical trials on
the effectiveness of homeopathy has shown 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.[10]
The medical effectiveness of homeopathy has been studied in detail since at
least the 1980s, however all large studies showing homeopathy to be
effective for medical purposes have been methodologically flawed, and
earlier studies showing positive results have been questioned.[65] There
have also been numerous landmark studies which have brought into question
the validity of homeopathic treatments. In 2005 The Lancet medical journal
published a meta-analysis of 110 placebo-controlled homeopathy trials and
110 matched conventional-medicine trials based upon the Swiss government's
Program for Evaluating Complementary Medicine, or PEK. The study concluded
that its findings were compatible with the notion that the clinical effects
of homeopathy are nothing more than placebo effects.[6] Critics cite the
numerous other studies which show no evidence of homeopathy being effective
beyond placebo, including a European Journal of Cancer study done in 2006.
The study was a meta-analysis of six trials of homeopathic treatments for
recovery from cancer therapy, including radio and chemotherapy done since
1985. Three of the trials included were randomized double-blind
placebo-controlled clinical trials. The conclusions of the study was that
there was insufficient evidence to support clinical efficacy of homeopathic
therapy in treating cancer.[66]
Since homeopathic remedies at dilutions higher than about D23 (10-23)
contain no ingredients apart from the diluent (water, alcohol or sugar),
there is no chemical basis for them to have any medicinal action. While some
tests have suggested that homeopathic solutions of high dilution can have
statistically significant effects on organic processes including the growth
of grain,[67] histamine release by leukocytes,[68] and enzyme reactions,
such studies are disputed since attempts to replicate them have
failed.[13][14][15][69][70] Newer randomized, double-blind,
placebo-controlled trials using high dilutions of substances such as
Belladona also fail to find clinical effects of the substances.[2]
Critics assert that the best standard for assessing efficacy and safety of
health-care practices is evidence-based medicine because it is the
expression of the scientific method in clinical medicine.[71] They contend
that systematic reviews with strict protocols are essential to establish the
substantion of various therapies and that when homeopathy is tested in this
way against specific diseases, it has failed to show any medical
effectiveness. Systematic reviews conducted by the Cochrane Collaboration
found no evidence that homeopathy is beneficial for asthma,[3] dementia,[4]
or induction of labor.[72] Systematic reviews conducted by other researchers
found no evidence that homeopathy is beneficial for osteoarthritis,[5]
migranes[73] or delayed-onset muscle soreness.[42]
Numerous health organizations such as UK's National Health Service,[8] the
American Medical Association,[9] and the FASEB[74] also contend that there
is no scientific evidence supporting the validity of homeopathic treatments.
Safety issues
While homeopathic remedies contain often only water and/or alcohol, they are
often thought to be generally safe. However, critics of homeopathy have
cited numerous concerns over homeopathic remedies including patients of
homeopathy failing to receive proper treatment for diseases which could be
diagnosed or cured with modern medicine. For instance there have even been
numerous surveys showing that homeopathic practitioners frequently advise
their patients against receiving immunization for diseases.[11][12] Modern
homeopathic practitioners also use their own vaccines, which they refer to
as "nosodes", and are created from dilutions of highly infectious agents
including material such as vomit, fecal matter or infected human tissues.
While Hahnemann was opposed to such preparations, modern homeopaths
frequently use them and there is no evidence to suggests such vaccines have
any effectiveness.[31] Homeopaths in advising against the use of
anti-malarial drugs may often help to contribute in the spread of malaria
due to the ineffectiveness of homeopathic remedies used to treat
malaria.[75][76][77]
In 1978, Anthony Campbell, then a consultant physician at The Royal London
Homeopathic Hospital,[27][78] criticised statements by George Vithoulkas
made about 'miasms'. 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 orthodox treatment.[79] This claim echos 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 compete cure of syphilis
in more than 90% of cases.[80]
Critics also contend that it is inherently unethical to provide homeopathic
remedies to patients or to owners of animals when the effectiveness of
homeopathy is clearly unproven. Critics also assert that all homeopathic
patients or clients should be fully informed of the lack of experimental
basis for the effectiveness of homeopathy prior to being provided the
remedies. Critics say that it would be obviously unethical to employ
unsupported and unproven remedies such as homeopathy when alternative
remedies in modern medicine have been proven to be effective.[31]
As well, in one unusual case, a low-potency (2X)[81] solution of zinc
gluconate, marketed as Zicam Nasal Spray, allegedly caused a small
percentage of users to lose their sense of smell. 340 cases were settled out
of court for 12 million U.S. dollars.[82][83]
Prevalence of use
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represent a worldwide view of the subject.
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Homeopathy is fairly common in Europe, where about 25% to 50% of the
population report use of homeopathy,[84] as well as India, where 10% of the
population use only homeopathy for medical treatment.[85][86] It is much
less common in the USA,[87] where the percentage of people seeking
homeopathic treatment declined from 3.4% in 1997 to 1.7% in 2002.[88]
Australia
According to one study about 4.4% of Australian adults have used Homeopathic
remedies at least once in their lives and only about 1.2% sought help
exclusively from homeopathic practitioners.[89]
Brazil
According to one study in Brazil found that 51% of medical students had
personal experience using homeopathic therapies.[90]
Britain
Homeopathy was first established in Britain by Dr. Frederick Quin around
1827, although two Italian homeopathic doctors (Drs Romani and Roberta) had
been employed two years previously by the Earl of Shrewsbury based at Alton
Towers in North Staffordshire. Homeopathy in Britain quickly became the
preferred medical treatment of the upper classes,[91] as well as the
aristocracy[92] and retained an elite clientele, including members of the
royal family.[93] At its peak in the 1870s, Britain had numerous homeopathic
dispensaries and small hospitals as well as large busy hospitals in
Liverpool, Birmingham,[94] Glasgow, London and Bristol. The largest
organization of homeopaths in Britain, the Society of Homeopaths, was
founded in 1978 and the Faculty of Homeopathy, which is based in London, has
over 1,400 members and was incorporated by an Act of Parliament in 1950.[95]
According to a 2006 study, forty nine percent of Scottish medical practices
prescribed homeopathic remedies, with sixteen percent of children were
prescribed homeopathic remedies. The study concluded that critical review of
Homeopathy's role in the Scottish branch of the national health care system
was needed.[96]
Canada
A study detailing the use of alternative medicines by children in Quebec
Canada found that 11% of the sample of 1911 children used alternative
medicines and 25% of those who did use alternative medicines used
homeopathy. The study also pointed out that Homeopathy is more commonly used
in Children in Canada than in Adults, 19% of whom used alternative medicine
used homeopathy.[97]
India
Homeopathy arrived in India with Dr John Martin Honigberger in Lahore, in
1829–1830.[98][99] India has the largest homeopathic infrastructure in the
world, with low estimates at about 64,000, but going as high as 300,000
practicing homeopaths. In addition, there are 180 colleges teaching courses,
and 7500 government clinics and 307 hospitals which dispense homeopathic
remedies.[100][101]
United States
Homeopathy was first established in the United States by Dr Hans Burch
Gram[102] in 1825 and rapidly gained popularity, partly because of the fact
that conventional medicine of the time was inherently dangerous and
risky.[103] The height of its influence was the end of the 19th century
where hardly any city with over 50,000 people was without a homeopathic
hospital. In 1890 there were 93 regular schools, 14 of them were fully
homeopathic and 8 of them were eclectic and in 1900 there were 121 regular
schools and 22 of them were homeopathic and 10 eclectic.[104] The use of
homeopathy in the United States among adults is about 0.3%. According to one
study, in 1990, 0.7% of individuals used homeopathy in the past year of
being questioned; in 1997, 3.4% had used homeopathy at least once in the
previous year. According to the same study, 31.7% had seen a homeopathic
practitioner in the past year in 1990 and the number dropped to 16.5 by
1997.[105]
Legal trends
Globe icon The examples and perspective in this article or section may not
represent a worldwide view of the subject.
Please improve this article or discuss the issue on the talk page.
The legal status of homeopathy varies widely in different countries. In many
countries homeopathy is regulated and licenses or accreditation are required
to practice homeopathy or prescribe homeopathic products. In other parts of
the world homeopathy has been integrated into national health care systems,
this has occurred in India, Mexico, Pakistan, Sri Lanka, and the United
Kingdom. In contrast, it is illegal to practice homeopathy as a homeopath in
several countries including Armenia, Belarus, Bulgaria, Italy, Latvia,
Lithuania, Luxembourg, Austria, and Germany.[citation needed] This means
that individuals trained only in homeopathy but not conventional medicine
are prohibited from practicing homeopathy in such countries; however, in
many countries, conventional doctors are allowed to use homeopathic
treatments. According to the same study, many countries have little or no
regulations on who may practice homeopathy. Such countries include Ireland,
Israel, Iceland, Greece, Bosnia, Poland and Estonia. In Iceland, in order to
be included one must have a basic health education and must be insured.[106]
Europe
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, licenses or degrees in conventional medicine from
accredited universities are required. In Austria and Germany, no specific
regulations exist, while France and Denmark mandate licenses to diagnose any
illness or dispense of any product whose purpose is to treat any
illness.[107]
Some homeopathic treatment is covered by the national insurance coverage of
several European countries, including France, the United Kingdom, Denmark,
and Luxembourg. In other countries, such as Belgium, homeopathy is not
covered. In Austria, public insurance requires scientific proof of
effectiveness in order to reimburse medical treatments, but exceptions are
made for homeopathy.[107]
Two countries which formerly offered homeopathy under their public health
insurance schemes have withdrawn this privilege. At the start of 2004,
homeopathic medications, with some exceptions, were no longer covered by
German public health insurance,[108] and in June 2005, the Swiss Government,
after a 5-year trial, withdrew insurance coverage for homeopathy and four
other complementary treatments, claiming that they did not meet efficacy and
cost-effectiveness criteria, though additional insurance can be bought to
cover such treatments provided by a medical doctor.[109]
South Africa
In South Africa, homeopathy is regulated by the Associated Health Service
Professions Act of 1982, which was set up to provide a registration and
licensing framework for health professions. During the 1960s, all
homeopathic colleges were closed by the South African Medical Council.
However, conventional medical doctors retained the right to use homeopathic
treatments.[107]
Americas
United States
In the United States, homeopathic remedies are, like all health-care
products, regulated by the Food and Drug Administration. However, the FDA
treats homeopathic remedies very differently than conventional medicines.
Homeopathic products do not need FDA approval before sale; they do have to
be proven safe since the Dietary Supplement Health and Education Act of
1994, any products prior to 1994 may or may not have been tested for safety,
but they do not have to prove efficacy; they do not have to be labeled with
an expiration date; and they do not have to undergo finished product testing
to verify contents and strength, all of these are voluntary actions done by
the manufacturer. The manufacturer is required to have all ingredients on
the label; however, it might not specify which ones are active. In the USA,
only homeopathic medicines that claim to treat self-limiting conditions may
be sold over the counter; homeopathic medicines that claim to treat a
serious disease can be sold only by prescription.[110]
A memorandum, written in 1985 by attorneys for the American Association of
Homeopathic Manufacturers, describes a meeting between the AAHP attorneys
and high-ranking FDA officials to discuss whether homeopathic products must
be proven effective to remain legally marketable.[111] Such negotiations led
to the issuance in 1988 (revised in 1995) of an FDA Compliance Policy Guide
that permits homeopathic products "intended solely for self-limiting disease
conditions amenable to self-diagnosis (of symptoms) and treatment" to be
marketed as nonprescription drugs.[112]
In 2001, the FDA published a comprehensive review of mercury compounds in
homeopathic drugs. This report indicated that nearly all examined compounds
derived from the use of mercury. However, due to the extreme dilution of
materials, the presence of mercury in the finished product would be
minimal.[113]
At present the FDA Health Fraud Division only pursues claims which may cause
direct harm to consumers through their use. Homeopathic drugs, largely
regarded as equivalent to placebos, are not considered under these
guidelines. Due to the significant dilution of the products, the agents
become practically immeasurable: the harmful effects of homeopathic drugs is
more likely to be that patients avoid conventional treatments.[114]
Canada
Homeopathy is not officially recognized by Federal Food and Drug Act in
Canada and physicians who choose to use alternative medicines such as
Homeopathy must follow guidelines set by their providence's College of
Physicians and Surgeons. Provincial health care generally doesn't cover
homeopathy.[107]
Mexico
Homeopathy is currently integrated into the national health care system of
Mexico and in 1985, a presidential decree established the first homeopathic
school as well as regulations specifiying training requirements for
homeopathic doctors.[107]
South America
Some countries in South America, such as Argentina, allow only professional
doctors who are qualified and have graduated from a recognized medical
school to practice homeopathy. Homeopathy has been regulated in other South
American countries, such as Colombia, since the beginning of the 20th
century. In Brazil, Homeopathy is included in the national health system and
since 1991, physicians who want to practice homeopathy must complete 2,300
hours of education prior to receiving the proper licenses.[107]
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Memorandum, February 12, 1985
112. ^ Compliance Policy Guide (CPG 7132.15). Conditions Under Which
Homeopathic Drugs May be Marketed. Revised March 1995
113. ^ Report on Mercury Compounds in DrugsMERCURY COMPOUNDS IN DRUGS AND
FOOD FDA/Center for Drug Evaluation and Research Last Updated: August 09,
2001
114. ^ Internet Health and Fraud Site, US Food and Drug AdministrationUS FDA
Internet Site, 2007
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