Homeopathy/PreviousVersion

Homeopathy is an Alternative Medicine system that tries to treat illnesses with miniscule doses of the drugs that cause the same symptom as the illness. Homeopathy is based on the ideas of Samuel Hahnemann, a 19th century physician who observed that some contemporary medicines evoked symptoms similar to those of the illnesses for which they were prescribed. There is no clear evidence to support the efficacy of homeopathic remedies, and it is likely that the reported effects are placebo effects.

Introduction

Homeopathic remedies involve treating an illness with an infinitesimally small dose of a substance that, at bigger doses, can cause symptoms that are like those of the illness (treating 'like with like'). Controversially, homeopaths believe that the 'potency' of a remedy can be increased by serial dilutions (repetatively adding water or alcohol) combined with vigorous shaking, to the point where little or none of the original solution remains as part of the final prepared remedy.

The word 'homeopathy' was first used by the German physician Christian Friedrich Samuel Hahnemann (1755-1843). Hahnemann was an eminent physician and a prominent public health reformer. He believed that his new system was more humane and effective than the conventional medicine of his time, but it was greeted by the establishment with derision and contempt. Today, homeopathy is not an accepted part of conventional medicine, and its theories are not generally regarded as scientifically credible, but nevertheless it has more than 100,000 practitioners worldwide, and 500 million users.

Homeopathy (from the Greek hómoios (similar) and páthos (suffering)) regards diseases as 'morbid derangements of the organism', that involve some disturbance in a 'vital force.' Today, most homeopaths still believe that the fundamental causes of disease are internal and constitutional and that it is contrary to good health to suppress symptoms. They also accept the concept of 'latent Psora', the early signs of an organism’s imbalance which indicate that treatment is needed.

The popularity of homeopathy

Homeopathy is popular in Europe and in India, but less so in the USA, where non-orthodox therapies are more tightly regulated. There are estimated to be more than 100,000 practitioners worldwide, and 500 million people receiving treatment. In Germany, homeopathy has been recognized as a 'special form of therapy' since 1978, meaning that its remedies do not have to have been shown to be efficacious, but since 2004, most are not covered by public health insurance. In Switzerland, homeopathic remedies were covered by the basic health insurance system, if prescribed by a physician, until June 2005, when the Government, after a 5-year trial, withdrew insurance coverage for homoeopathy and four other complementary treatments, as they did not meet efficacy and cost-effectiveness criteria. In the UK, homeopathic remedies are sold over the counter, and five homeopathic hospitals are funded by the National Health Service. Homeopathy is not practised by most of the medical profession, but is supported by the Prince of Wales and other members of the royal family.

History

(see Main article History of Homeopathy)

For the early Greek physician Hippocrates of Cos, who lived at about 400 BCE [8], the four 'humours' (blood, black bile, yellow bile and phlegm) were the key to understanding disease. His ideas persisted through the writings of Galen (131-201 CE) until at least 1858, and Rudolf Virchow's theories of cellular pathology. Diseases, it was thought, were the result of some 'imbalance' of the humours, and physicians of the day focused on restoring that balance, either by trying to remove an excess of a humour, or by suppressing the symptoms. "Bloodletting, fever remedies, tepid baths, lowering drinks, weakening diet, blood cleansing and everlasting aperients and clysters (enemas) form the circle in which the ordinary German physician turns round unceasingly", wrote Hahnemann while translating into German the Treatise on Materia Medica (1789) by the Edinburgh physician William Cullen.

After 1783, disillusioned with medicine and the many toxic effects of its cures, Hahnemann began to use smaller and smaller doses of drugs, trying to minimise their toxic effects while retaining their efficacy. Cullen had written that Cinchona bark (which contains quinine) was effective because it was bitter, and Hahnemann pondered about this; he felt that this explanation was implausible because other substances that were as bitter had no therapeutic value. Accordingly, he took Cinchona bark himself, and saw that its effects were similar to the symptoms of the diseases that it was prescribed for. For Hahnemann, this was a breakthrough, and it led him to formulate the 'Principle of Similars' on which homeopathy is based, expressed by him as similia similibus curentur or 'let likes cure likes'.

He had concluded that diseases are caused by "spirit-like derangements of the spirit-like power that animates the human body", and was searching for a way to harness this power for healing.

Provings

(see main article homeopathic proving)

Homeopathic remedies are found by 'provings', in which volunteers are given substances, the effects of which are recorded as a 'Drug Picture', these drug pictures are subsequently used to compare with a patient's symptoms in order to select, as a remedy, the substance whose effects are closest to the patient's symptoms. Today, homeopaths use about 3000 different remedies from animal, plant, mineral, and synthetic substances, including 'Natrum muriaticum' (sodium chloride or table salt)[9], 'Oscillococcinum' (a 200C product made from duck heart and liver that is prescribed for colds and flu-like symptoms) 'Roadrunner' (Geococcyx californianus) [10] and 'Arnica' [11]. Other 'isopathic' remedies involve diluting the agent or product of the disease; for example, Rabies nosode is made from the saliva of a rabid dog. Some homeopaths use more esoteric substances, known as 'imponderables' because they originate from electromagnetic energy 'captured' by alcohol or lactose ('X-ray', 'Sol' (sunlight), 'Positronium', and http://homeoint.org/clarke/e/elect.htm 'Electricitas'](electricity), or with a telescope ('Polaris'). Recent ventures into more esoteric remedies include 'Tempesta' (thunderstorm), and 'Berlin wall'.

Preparation of similars

The most characteristic — and controversial — principle of homeopathy is that the efficacy of a remedy can be enhanced and its side-effects reduced by diluting it, in a process known as 'dynamization' or 'potentization'. Liquids are diluted (with water or alcohol) and shaken by ten hard strikes against an elastic body ('succussion'). For this, Hahnemann had a saddlemaker construct a special, wooden, 'striking board', covered in leather on one side and stuffed with horsehair (the board is displayed at the Hahnemann Museum in Stuttgart). When insoluble solids are used as the basis of remedies, such as quartz or oyster shell, they are diluted by grinding them with lactose ('trituration'). The original serial dilutions by Hahnemann used a 1 part in 100 (centesimal; 'C' potencies), or 1 part in 50,000 ( Quintamillesimal; 'LM' or 'Q' potencies). The dilution factor at each stage is 1:10 ('D' or 'X' potencies) or 1:100 ('C' potencies); Hahnemann advocated 30C dilutions for most purposes (i.e. dilution by a factor of 100³⁰ = 10⁶⁰). The number of molecules in a given weight of a substance can be calculated by Avogadro's number; the chance that there is even one molecule of the original substance in a 15C solution is small, and it is very unlikely that one molecule would be present in a 30C dilution. Thus, homeopathic remedies of a high 'potency' contain just water, but water that, according to homeopaths, retains some essential property of one of the substances that it has contacted in the past.

Hahnemann's explanation for how higher potencies could be more efficacious was that the friction involved in succussion might release some hidden curative power of substances. He wrote in 1825: "The effect of friction is so great, that not only the physical properties, such as caloric, odour, etc., are thereby called into life and developed by it, but also the dynamic medicinal powers of natural substances are thereby developed to an incredible degree".

The skeptical view of homeopathy

As I understand it, the claim is that the less you use Homeopathy, the better it works. Sounds plausible to me (David Deutsch, physicist) [12]

Homeopathy was developed at a time when many of the most important concepts of modern chemistry and biology, such as molecules and germs, were understood poorly if at all. While proponents may consider the mechanism of homeopathy to be an interesting side issue, skeptics consider the lack of any plausible mechanism to be a serious problem, raising the bar on the quality of evidence required before accepting the existence of the phenomenon under the motto 'Extraordinary claims require extraordinary proof'.

In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree. Although the hypothesis of atoms can be traced back to the ancient Greeks, their size was not calculated until 1865 (by Loschmidt). There are 6.02×1023 particles in a mole (Avogadro's number), so homeopathic dilutions greater than about 24X or 12C are virtually certain to contain not even a single molecule of the initial substance. This is recognized by advocates of homeopathy, who assert that the essential healing power of their preparations is not to be found in the chemical action of molecules, but perhaps in the arrangement of the water molecules, giving rise to the expression 'the memory of water'. This concept is closely related to the belief in a 'vital force', which was common in Hahnemann's day, but was discarded by the scientific community as more and more life processes came to be describable in purely materialistic terms, and as the medical model of disease came to be focused on the failure of particular organs and processes in the body. .

For critics, a closely related question is that of logical consistency of the theory. The theory assumes that water is imprinted by the properties of molecules that it once came in contact with, even when the molecules are diluted away. If so, then where did the pure water used in this process come from? The water that homeopaths use was once in contact with other chemicals, including chemical wastes, radioactive metals, dinosaur urine, and various poisons. According to this skeptical interpretation of homeopathic theory, all water in the world should remember its contact with millions of chemical substances and not just the properties of the chemicals that the homeopath claims will be useful. The answer of the homeopaths, that dynamization involves succussion as well as dilution, is unconvincing, because it seems improbable that one can amplify order in a solution by shaking it, and because a lot of shaking goes on in the natural world as well.

Scientific testing of remedies

It is not a matter of theory or belief or opinion … Homoeopathy must rest upon facts (James Tyler Kent)

In the USA, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration, but unlike conventional medicines, they need not be approved by the FDA before sale, nor do they need to be proved either safe or effective, nor to be labeled with an expiry date, or undergo finished product testing. Unlike conventional medicines, homeopathic remedies do not have to identify their active ingredients as they have few or no active ingredients.

As homeopathic remedies at potencies higher than about D23 (10^-23) contain no detectable ingredients apart from the diluent (water, alcohol or sugar), there is no known basis for these preparations having medicinal action. A recent review concluded that some experimental research has offered hints that some substances diluted and succussed beyond Avogadro’s number might be biologically active but overall, independently reproducible models have found no consistent effects. Many patients report benefits from some homeopathic remedies[13], but scientists usually attribute these to the Placebo Effect, the regression fallacy and/or the Forer effect.

There is wide agreement that evidence based medicine is the best way to assess the efficacy and safety of health-care practices. Ideally, a drug should be tested in large, multi-centre, randomised, placebo-controlled, double-blind trials, to test whether it has an effect that is better than either a placebo or a different treatment. Some trials of homeopathy have indicated that some remedies might be more efficacious than placebos, but many are technically flawed, or involve samples too small to draw firm conclusions. Systematic reviews byThe Cochrane Collaboration found insufficient evidence that homeopathy is beneficial for asthma, dementia, or induction of labor. They also found no evidence that homeopathic treatment prevents influenza, but reported some evidence that it appears to shorten the duration of the disease. Overall, systematic reviews have found no clear evidence of the efficacy of homeopathic remedies..

In 2005, The Lancet published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials. The outcome suggested that the clinical effects of homeopathic remedies might all be placebo effects. The Lancet study is notable as a 'global' meta-analysis of homeopathy, not an analysis of particular remedies, i.e. it tested the hypothesis that all of the reported effects of homeopathic remedies are placebo effects. If so, then reports of positive effects reflect publication bias (the tendency to publish results when they show a positive effect but not when they are negative), and the magnitude of such effects should diminish with sample size and study quality. They analysed an equal number of conventional medicine trials similarly; these showed a real effect of treatment, in that the size of the reported effect was independent of sample size, but the trials of homeopathy remedies did not. The study does not prove that homeopathy is never effective, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet article was accompanied by an editorial entitled 'The end of homeopathy' which argued that doctors should recognise the absence of real curative powers in homeopathic medicine. The Lancet subsequently published a selection of critical correspondence.

Medical organizations' attitudes towards homeopathy

People use homeopathy because they believe it works. Although homeopathy, like other placebos, does not work in a clinical sense, it can induce physiological changes. It can also coincide with getting better anyway. (Sense About Science)

In the USA, the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, funds research into homeopathy. According to its statement on homeopathy, controlled clinical trials of homeopathy had produced mixed results; in some, homeopathy appeared to be no more helpful than a placebo, but in others, more benefits were seen than expected from a placebo. Despite the lack of clear empirical support for homeopathy, the statement concluded that "Some people feel that if homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine are not necessary."

According to The UK National Health Service there have been about 200 randomised controlled trials evaluating homeopathy, many of which suggest that any effectiveness that homeopathy may have is due to the placebo effect. In 1997, the American Medical Association(AMA) adopted the following policy statement after a report on several alternative therapies including homeopathy: "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies"

According to the Indian Ministry of Health and Family Welfare, homeopathy is one of the National Systems of Medicine in India, and it plays an important role in health care for many people. "Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels."

Safety of homeopathic remedies

The highest ideal of cure is the speedy, gentle, and enduring restoration of health by the most trustworthy and least harmful way (Samuel Hahnemann)

The U.S. Food & Drug Administration's view of homeopathy is that there is no real concern about the safety of most homeopathic products, as they "have little or no pharmacologically active ingredients". There have been some reports of illness associated with the use of homeopathic products, but in cases that they reviewed, the FDA concluded that the homeopathic product was not the cause of the adverse reactions. The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. For example, a 2006 survey by the UK charitable trust 'Sense About Science' revealed that homeopaths were advising travelers against taking conventional anti-malarial drugs, instead providing them with a homeopathic dilution of quinine. Even the director of the The Royal London Homeopathic Hospital condemned this:

"I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice." [14].

Professor Pasvol, a tropical medicine expert at Imperial College, London was reported as saying "Medical practitioners would be sued, taken to court and found guilty for far less. What this investigation has unearthed is appalling."

A particular concern is that homeopaths discourage the use of vaccines. This attitude dates back to Hahnemann, who said "...to use a human morbific matter (a Psorin taken from the itch in man) as a remedy for the same itch or for evils arisen therefrom, stay away from it! Nothing can result from this but trouble and aggravation of the disease." Homeopathy is superficially like vaccination, in that vaccines contain a small dose of the 'disease' against which they offer protection (a vaccine is usually made from a bacterium or virus that is either dead or weakened so that it cannot produce symptoms, while still providing enough information to the immune system to generate antibody production). However, most homeopaths believe that vaccination has serious health consequences, and might arouse latent inherited and constitutional weaknesses.

External links

• 'Complementary Medicine - Therapies: Homeopathy'[15] BBC's 'Complementary Medicine' article on Homeopathy
• 'Homeopathy In Perspective' — critical online book, covering the history and present state of homeopathy