Homeopathy/PreviousVersion

Homeopathy is a system of alternative medicine that uses extremely small doses of the drugs that cause a similar syndrome of symptoms as the person's illness, to treat that person. Homeopathy, by definition, "is a therapeutic method which stimulates the natural healing processes of the body, with the help of sub-physiological doses of medicines to bring about a natural healing and health restoration" - this is a definition first given by Dr.W.E.Boyd and now accepted by all Homeopaths.

Homeopathy is based on the principles, first laid down by Dr.Samuel Hahnemann (1755 – 1843), a physician who observed that some medicines evoked symptoms similar to those of the illnesses for which they were prescribed. The underlying premise of homeopathy is that symptoms of illness are not simply the result of breakdown of the organism but are its defenses in an effort to fight infection, adapt to stress, and/or respond to toxic insult. Rather than inhibit symptoms or suppress disease, the homeopathic method of treating sick people is, according to its practitioners, "oriented towards mimicking the body's wisdom and augmenting immune response", going further beyond in conditions like cancer and schizophrenia.

The terminology used by homeopaths, such as immune response, do not use the framework generally accepted in molecular models of immunology, making it difficult to evaluate their approach. Augmenting immune response causes conflict with current medical concepts of numerous diseases, where the pathologic mechanism can be associated with autoimmunity; a hyperactive immunologic mechanism attacking cells or releasing inflammatory substances.

Tests of the efficacy of homeopathy have frequently reported positive results, but large randomised controlled trials have generally not been supportive of any effectiveness beyond placebo effects. There is no clearly understood, generally accepted mechanism of action for the extremely small doses used in homeopathy and this remains a stumbling block to its acceptance from mainstream medicine and science.

Introduction

Homeopathic medicines treat an illness with an infinitesimally small dose of a substance that, at larger doses, can cause symptoms that are like those of the illness (treating 'like with like'). This "law of similars", as it is called, is an ancient principle that has been adopted by different cultures (the Oracle at Delphi was known to say "That which makes sick shall heal"). The Golden Bough by Sir James George Frazier is a treatise on the history of religion and magic, and one of its early chapters (pages 12-42) is entitled "Sympathetic or Homeopathic Magic").

Today, some conventional treatments, like vaccination, use small doses of antigens directly taken from pathogenic organisms, an immune response that can often be detailed at a molecular level. Some allergy treatments involve controlled administration of small amounts of allergenic substances to desensitise the allergic response

These are not applications of the principle of similars, but based on completely different principles, again often demonstrable on a molecular level. Hyperimmune responses, either at the initial challenge or in the amplification of immune response, can be observed in cellular mechanisms such as basophil degranulation, or at a molecular level with changes in the levels of substances such as prostaglandins or leukotrienes; reduction of the intensity of these mechanisms are described in terms of molecular pharmacology, such as selective or nonselective inhibitors ofcyclooxygenases, phosphodiesterases, or lipoxygenases. No similars were harmed in the production of these effects.

Homeopaths might say these are applications of the principle of similars, but this is not a term used in conventional medicine. These conventional treatments involve application of small but measurable doses of substances, at levels that activate known mechanisms of cellular response, as opposed to exclusively externally observed symptoms. Due regard must be given to the apparently different use of the terms symptom and sign in homeopathy and medicine.

Controversially, homeopaths believe that the 'potency' of a remedy can be increased by serial dilutions (repetatively adding water or alcohol) combined with vigorous shaking in-between each dilution, to the point where often little or none of the original solution remains as part of the final prepared remedy. Homeopaths assert that this process of dilution and vigorous shaking changes the structure of the water . The water or alcohol used for diluting, is imprinted by the medicinal substance due to the vigorous succussion (shaking in a particular way). Scientists at several universities and hospitals in France and Belgium have discovered that the vigorous shaking of the water in glass bottles causes small amounts of silica fragments or “chips” to fall into the water . The interaction of these silica fragments with the medicinal solution may help to change the structure of the water in a way.. Homeopaths, on the other hand, say that the remedies are not influenced by the silica.

The word 'homeopathy' was first used by the German physician Christian Friedrich Samuel Hahnemann (1755-1843). Hahnemann was an eminent physician and chemist as well as 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 with crude or powerful doses of drugs. Most homeopaths also accept the concept of 'miasms', a homeopathic concept of genetic disease in which the signs and symptoms of an organism’s imbalance indicate that a specific homeopathic medicine is needed for treatment.

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.

An international market research survey discovered relatively high levels of "trust" in homeopathy worldwide. Specifically, they found that 64% of people in India, 58% of Brazilians, 53% of Chileans, 49% of Saudi Arabians, 49% of United Arab Emirates, 40% of French, 35% of South Africans, 28% of Russians, 27% of Germans, 25% of Argentians, 25% of Hungarians, 18% of Americans, and 15% of British "trust homeopathy."

History

(see main article History of Homeopathy)

For the early Greek physician Hippocrates of Cos, who lived at about 400 BCE , 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 gave up his medical practice and devoted himself to the translation of Medical books, as he knew many languages. 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 for which it was prescribed. 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, which led to a system he later named Homoeopathy (now spelt Homeopathy).

Provings

(see main article homeopathic proving)

The indications for using homeopathic medicine are found by experiments called 'provings', in which volunteers are given substances (usually in single-blind or double-blind trials), the effects of which are recorded in books (called materia medica and repertories) and now in software programs. The symptom complexes or "drug pictures" that these substances are found to cause 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), 'Oscillococcinum' (a 200C product made from duck heart and liver that is prescribed for flu-like symptoms) and 'Arnica' . 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. A small number of homeopaths use more esoteric substances, known as 'imponderables' because they originate from electromagnetic energy 'captured' by alcohol or lactose, such as 'X-ray' or 'Magnetic North' (north pole of a magnet).

Preparation of Homeopathic remedies

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) [4]

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. Homeopaths respond to these concerns by asserting that homeopathic manufacturers, who in each country are regulated as drug companies, use a double-distilled water which may clear the "memory" of past water history.

Scientific Research Testing Homeopathic Medicines

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

Despite the wide popularity of homeopathy, the general view of academic researchers in medicine and biology is that the efficacy of homeopathy is confined to the placebo effect. The main reasons for this skepticism are a) lack of a plausible explanation for the cellular effects of homeopathic remedies and b)lack of a plausible theory of how a physiological mechanism to respond to such remedies might have evolved, even if a mechanism exists. No studies have been conducted that fully meet the current standards of high quality clinical trials (large, multi-centre randomised, double blind placebo-controlled trials); homeopaths have argued that, because homeopathic remedies are individualised to particular patients, such trials are an inappropriate test. Some trials have been performed however that partially meet these criteria, and some of these have reported positive effects. These have not been considered as providing compelling evidence, partly because of deficiencies in trial design, but mainly because of the possibility of "publication bias" - the phenomenon whereby trials that happen by chance to appear to show a positive outcome are more likely to be published that those which are inconclusive or appear to show a negative outcome.

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 analyzed 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 recognize the absence of real curative powers in homeopathic medicine. The Lancet subsequently published a selection of critical correspondence.

Several of these published responses remarked (incorrectly) that the researchers evaluated only those studies that met certain criteria for “high quality” scientific investigations. Of the original 110 trials, 21 of the homeopathic studies fit this definition but only nine of the conventional studies did so. The researchers then considered only those trials that had a large number of patients, as trials with a larger sample size have greater statistical power. The researchers thus compared eight homeopathic trials with six conventional medical trials, even though these trials were only matched as being of large size and good quality. The results of this subanalysis was that the effects observed in the homeopathic trials were no greater than the placebo effects observed in the clinical trials. The authors suggested that no further research on homeopathy is necessary, while advocates of homeopathy assert that almost all of the eight homeopathic trials used only a single homeopathic medicine given to every subject without the typical individualization of treatment that is commonly used in homeopathic practice. Advocates of homeopathy assert that this study's emphasis on certain large homeopathic trials lacked external validity, that is, the trials were not consistent with the homeopathic methodology, thereby reducing the meaning of the study's conclusions.

Some meta-analyses reviewing the broad field of homeopathy have found that the placebo response is an inadequate explanation for the positive responses in some trials and several meta-analyses evaluating the homeopathic treatment of specific diseases has also found positive results. However, there are also several meta-analyses that have suggested that the effect from a homeopathic medicine was no better than a placebo , but homeopaths say that the homeopathic principles were not used in selecting the remedy and that is why results are flawed.

Many homeopathic medicines sold in health food stores and pharmacies today are "low potencies," that is, at doses that do contain tiny amounts of the original medicine, while homeopathic medicines at potencies higher than about 24X, D24, or 12C (10^-24) contain no detectable ingredients apart from the diluent (water, alcohol or sugar). There is considerable scientific doubt about whether these doses can have any biological or therapeutic effect. .

There has been meta-analysis of animal studies evaluating the use of homeopathic medicines in the treatment of environmental toxicology, as well as a review of 67 in vitro studies, three-fourths of which have been replicated with positive results by independent investigators. The researchers concluded, "Even experiments with a high methodological standard could demonstrate an effect of high potencies". However, "No positive result was stable enough to be reproduced by all investigators".

Medical organizations' attitudes towards homeopathy

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.

Historically, the American Medical Association (AMA) was founded in 1847, three years after the forming of the American Institute of Homeopathy. In the AMA's charter, it was in part formed to slow the growth of the homeopaths. From 1860s to the early 20th century, the AMA's ethic code disallowed its members to consult with fellow medical doctors who practiced homeopathy. Although the AMA didn't typical enforce many of its ethical guidelines, the "consultation clause" was one of the few ethical violations that was enforced. Today, the AMA is no longer antagonistic to homeopathy, though they recommend that more research is needed.[5] the American Medical Association. Their current policy statement says: "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 UK National Health Service (NHS), homeopathy is one of the most popular alternative and complementary treatment modalities. The NHS recognizes that there have been about 200 randomised controlled trials evaluating homeopathy, some of which shows efficacy of treatment and some which doesn't. They conclude, "Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works" .

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 European Union allows homeopathic medicinal products, provided they are prepared according to the European Pharmacopoeia or the pharmacopoeias currently used officially in the Member States. Further the products must be diluted sufficiently so that there is no risk for the patient. In particular, the homeopathic product may not contain either more than one part per 10 000 of the mother tincture or more than 1/100th of the smallest dose of an active substance that requires doctor's prescription. No specific therapeutic indication may be given on the label of the product.

The U.S. Food & Drug Administration's view of homeopathy is that there is no real concern about the safety of most homeopathic products, due to the long history of safety in their use and because its dosages "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 possibly 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." [6].

A particular concern is that homeopaths discourage the use of vaccines. 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, some homeopaths believe that vaccination has the potential to create serious health consequences, in part because of the mercury in them and in part because they believe that some childhood diseases (i.e. measles, chicken pox) may have certain immunological benefits that should not prevented.