Homeopathy

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Homeopathy

Homeopathy (also spelled homœopathy or homoeopathy) from the Greek words όμοιος, hómoios (similar) and πάθος, páthos (suffering), is a system of alternative medicine that attempts to treat "like with like". The various forms of alternative medicine are used worldwide and homeopathy is particularly popular in Europe and India,Indian Ministry of Health and Family Welfare homeopathy pageFisher, P. Ward, A. "Medicine in Europe: Complementary medicine in Europe" BMJ 1994;309:107-111 although less so in the USA.Tindle HA, Davis RB, Phillips RS, Eisenberg DM "Trends in use of complementary and alternative medicine by US adults: 1997-2002" Altern. Ther. Health Med. 2005 Jan-Feb;11(1):42-9.

Homeopathy rests on the premise of treating sick persons with therapeutic agents remedies that are deemed to produce similar symptoms in a healthy individual. Its adherents and practitioners assert that the therapeutic potency of a remedy can be increased by serial dilution of the drug, combined with succussion or vigorous shaking. Homeopathy regards named diseases as misleading human constructs and instead treats each case of sickness as a strictly individual phenomenon. The term "homeopathy" was coined by the Saxon physician Christian Friedrich Samuel Hahnemann (1755–1843) and first appeared in print in 1807.Hahnemann, S. Fingerzeige auf den homöopathischen Gebrauch der Arzneien in der bisherigen Praxis. N. J. d. pract. Arzkd. (1807) 26:5-43), although he had previously outlined his theory of similars in a series of articles and monographs beginning in 1796.Hahnemann, S. Versuch über ein neues Prinzip zur Auffindung der Heilkräfte der Arzneisubstanzen, nebst einigen Blicken auf die bisherigen. [Hufeland's J. d. pract. Arzkd. (1796) 2(3):391-439) and 2(4):465-561 This article in English translation can be read here Essay on a New Principle, 1796

However, homeopathy is controversial for four reasons. Firstly, medical studies of its efficacy have not been clearly positive, and often are negative. Secondly, homeopathy is inconsistent with the known laws of chemistry since it states that dilution makes drugs more powerful by enhancing their undefined "spirit-like medicinal powers,"Christian Friedrich Samuel Hahnemann's "Organon Of Medicine" translated by Dudgeon Fifth Edition § 269 even at dilutions so high not even a molecule of the original ingredient is present. Thirdly, many homeopathic practitioners do not accept conventional diagnoses, preferring instead to view ill-health as when "the flow of energy is impeded"Karen Cohen, How Homeopaths Learn to Perceive http://www.homeopathways.com as a result of either the patient's lifestyle or shocks, mental traumas in their past and bad weather.Causation (AETIOLOGY) in homeopathy - its importance in case-takinghttp://www.lyghtforce.com/HomeopathyOnline/Issue3/sequence.html Rudolf Verspoor Taking Homeopathy into the Shadows: A Sequential Causal Approach to Treating Chronic Disease, Website: Homeopathy Online] Fourthly, people risk death if they attempt to prevent serious conditions such as malaria solely with homeopathic remedies.http://news.bbc.co.uk/2/hi/programmes/newsnight/5178122.stmPascal Delaunay "Homoeopathy may not be effective in preventing malaria" BMJ. 2000 November 18; 321(7271): 1288

Medical Similars

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

The 'law of similars' is an ancient medical maxim Website of The Center for Natural Medicine whonamedit.com, but its modern form is based on Hahnemann's conclusion that a constellation of symptoms induced by a given homeopathic remedy in a group of healthy individuals will cure a similar set of symptoms in the sick. Symptom patterns associated with various remedies are determined by 'provings', in which healthy volunteers are given remedies, often at non-homeopathic doses, and the resulting physical, mental and spiritual symptoms are compiled by observers into a 'Drug Picture'.

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

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

At first, Hahnemann tested in homeopathic provings, substances commonly used as medicines in his time as Antimony and Rhubarb and also poisons like Arsenic, Mercury and Belladonna. Perhaps in this he was mindful of Paracelsus: “poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.” Source for Paracelsus quote at en.thinkexist.com This subtle connection between poison and medicine, or 'what can kill can cure' was also observed by Shakespeare: "In the infant rind of this small flower, poison hath residence and medicine power:..." Romeo and Juliet: act 2, scene 3. Oxford Shakespeare complete works. Oxford: Oxford University Press, 1974: 774

Hahnemann recorded his first provings in the Fragmenta de viribus in 1805 drugs and later in his Materia Medica Pura, which contained 65 proven drugs. He was most heavily engaged in proving in the 1790s and early 1800s, but he never abandoned these experiments. Another phase of proving commenced with his Miasm theory and The Chronic Diseases Chronic Diseases - Samuel Hahnemann, published in 1828, and containing 48 freshly 'proven' drugs.

Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies, and new substances are continually added to contemporary versions. Homeopathy uses many animal, plant, mineral, and synthetic substances. Examples include Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other homeopathic remedies, ('isopathic' remedies') involve dilution of the agent or product of the disease. Rabies nosode, for example, is made by dilution the saliva of a rabid dog. Some modern homeopaths are exploring the use of more esoteric substances, known as "imponderables" because they do not originate from a material but from electromagnetic energy presumed to have been somehow "captured" by a substance (X-ray, Sol (sunlight), Positronium, and Electricitas (electricity) or through the use of a telescope (Polaris). Recent ventures by homeopaths into even more esoteric substances include Tempesta (thunderstorm), and Berlin wall.

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

More recently, homeopathy has embraced the use of substances based on their elemental classification (the periodic table or biological taxonomy). Douglas Hoff: Personal website Jan Scholten: Personal website This approach may well create systems for grouping remedies and classifying the ever-burgeoning Materia Medica, but it is rejected by some purists on the basis that inherently it involves speculation about remedy action without provings.Homoeopathic Online Education

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

The law of similars is more of a guiding principle than a 'scientific' law. It is not built on a hypothesis that can be falsified; a failure to cure homeopathically can always be attributed to incorrect selection of a remedy: I have often heard physicians tell me that it was due to suggestion that my medicines acted so well; but my answer to this is, that I suggest just as strongly with my wrong remedy as with the right one, and my patients improve only when they have received the similar or correct remedy. James Tyler Kent, New Remedies, Lesser Writings and Aphorisms & Precepts, Chicago: Ehrhart & Karl, 1926, quoted in Francis Treuherz, Origins of Kent's Homeopathy, Jnl Amer Inst Homeo, 77.4, 1984, 130-49; 140-1

The Minimum Dose

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and the side-effects diminished) by dilution, in a procedure known as dynamization or potentization. Liquids are successively diluted (with water, or alcohol) and shaken by ten hard strikes against an elastic body (succussion). For this purpose, Hahnemann had a saddlemaker construct a special wooden striking board covered in leather on one side and stuffed with horsehair. It can be viewed at the Hahnemann Museum in Stuttgart.Website of The Institute for the History of Medicine Insoluble solids are diluted by grinding them with lactose (trituration). Higher dilutions are considered to be stronger 'deep-acting' remedies.

The dilution factor at each stage is traditionally 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. As Avogadro's number is only 6.02 × 10²³ particles/mole, the chance of any molecule of the original substance being present in a 15C solution is small, and it is extremely unlikely that one molecule of the original solution would be present in a 30C dilution. For perspective on these numbers, there are in the order of 10³² molecules of water in an Olympic size swimming pool; to expect to get one molecule of a 15C solution, one would need to take 1% of the volume of such a pool, or roughly 25 metric tons of water. Thus homeopathic remedies of a high "potency," with overwhelming probability, contain only water, but this water is believed by practitioners of homeopathy to retain some 'essential property' of one of the substances that has contacted the water in the past. However, any water will, at some time in its history, have been in contact with millions of different substances. A glass of water is therefore an extreme dilution of almost any agent you care to mention. Thus, critics argue that we are all constantly receiving every imaginable homeopathic treatment for every imaginable condition. Proponents of homeopathy respond that the methodical dilution of a particular substance, beginning with a 10% solution and working downward, is different; exactly why this is different is not clear.

High potency remedies were first produced in the 1830s. Though Hahnemann wished to see 30c as standard potency in homeopathy, the majority of his contemporaries preferred tinctures and 3x, while others, like the powerfully-built horse-trainer, Caspar Julius Jenichen ^*" target="_blank" >and Dr N Schreter [1803-1864, were busy raising potency to heights beyond his wildest dreams.

"Jenichen sat or stood stripped naked to the waist, holding the bottle in his fist in an oblique direction from left to right, and shook it in a vertical direction. The fluid, at every stroke, emitted a sound like the ringing of silver coins. He paused after every 25th potency, and the muscles of his naked arm vibrated...he was latterly able to give 8400 strokes in an hour." ^*

Such high potencies could not be made by traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which integrate dilution and succussion into a continuous process (Korsakoff). Such a Korsakoff potentising machine can be seen (here) and (here). Some old potentising devices can be seen (here). Such machines are still on sale today and some manufacturers claim that it is the vibrations themselves that produce the healing effect and, when the correct vibration is selected, only water need be added to produce a remedy."Homöo Plus" from www.bioenergetik.com

The practitioner's choice of what potency is appropriate derives in part from a judgement as to whether the disease is acute and superficial or 'deeper' and more chronic in nature; whether it is primarily physical or more mental/emotional; the patient's general sensitivity and previous reactions to remedies; and the practitioner's preferred posology regimen, e.g. low potency repeated often, vs. high potency repeated seldom. For example, French and German homeopaths generally prefer to use lower potencies than their American & British counterparts. Most homeopaths assert that the choice of potency is secondary to the choice of remedy: i.e. that a well-chosen remedy will act in a variety of potencies, but an approximately matched remedy might act only in certain potencies, or not at all. Alternative modes of selecting remedies are through medical dowsing"Diagnostic dowsing machines" www.homeoinfo.com or the use of other psychic powers. "Medical dowsing" www.homeoinfo.com Philip A.M. Rogers "Psychic methods of diagnosis and treatment in acupuncture and homeopathy." However, these methods are controversial and not accepted by all homeopathic practitioners.

Early critiques of high dilutions.

Sir John Forbes physician to Queen Victoria [1841-61 said the extremely small doses were regularly derided as useless, laughably ridiculous and "an outrage to human reason."Sir John Forbes, Homeopathy, Allopathy and Young Physic, London, 1846 Although such homeopathic cures were accepted as valid by regular physicians at the time, they were ascribed entirely to the body's innate healing powers. And Professor Sir James Young Simpson said of the highly diluted drugs: "no poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly." James Y Simpson, Homoeopathy, Its Tenets and Tendencies, Theoretical, Theological and Therapeutical, Edinburgh: Sutherland & Knox, 1853, 11

Miasms

By 1816, Hahnemann was concerned at the failure of his homeopathic remedies to produce lasting cures for chronic diseases. He found that "...the non-venereal chronic diseases, after being time and again removed homoeopathically … always returned in a more or less varied form and with new symptoms." To explain this, Hahnemann introduced the miasmatic theory, that three fundamental "miasms" are the underlying root causes of all the chronic diseases of mankind: Syphilis, Sycosis gonorrhoea, and Psora.

This miasm theory was first published in 1828. The Chronic Diseases, their Nature and Homoeopathic Treatment, Dresden and Leipsic, Arnold. Vols. 1, 2, 3, 1828; vol. 4, 1830 Though Hahnemann first suspected miasms in 1816, he took 12 years before he published his views. It is possible that the study of Freemasonry under the guidance of his Patron, the Grand Duke Ferdinand of Anhalt-Coethen influenced his thinking.Website of Homéopathe International He adopted a reclusive lifestyle while residing in Koethen and his new inclination towards metaphysical pursuits may explain his sudden adoption of Olfaction the remedy, which he continued to use until his death in Paris in 1843.Website of The Homeopathic Academy of Naturopathic Physicians Olfaction might derive from Arabian medicine and the art of Perfumery.Manouchehr Saadat Noury "First Iranians who introduced perfumery" Persian Journal May 9, 2005

The miasm of Psora, he concluded, underpinned most of the chronic diseases known to medicine. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". The sense of this is indicated by Hahnemann's Note 2 to §11 of the Organon: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..."

According to Hahnemann, miasmatic infection causes local symptoms, usually in the skin. If these are suppressed by external medication, the hidden sickness cause goes deeper, and manifests itself later as organ pathologies. In §80 of the Organon he asserted Psora to be the cause of such diseases as epilepsy, cyphosis, cancer, jaundice, deafness, and cataract.

Even in his own time, many followers of Hahnemann, including Hering, made almost no reference to Hahnemann’s concept of chronic diseases. Perhaps they lacked Hahnemann's deep knowledge of cases from which the theory was distilled? Today, some homeopathic practitioners Website of The Canadian Academy of Homeopathy find Hahnemann’s theory difficult to reconcile with current knowledge of immunology, genetics, microbiology and pathology, as it seems to ignore the importance of genetic, congenital, metabolic, nutritional, and degenerative factors in sickness; the theory also fails to differentiate the multitude of different infectious diseases. However, most insist that the key elements of his theory are valid. For instance, most of them believe that the fundamental cause of disease is internal and constitutional (i.e. the susceptibility to becoming ill), and that it is contrary to good health to suppress symptoms, especially skin eruptions and discharges. They also accept Hahnemann's concept of latent Psora, the early signs of an organism’s imbalance, which indicate that treatment is needed to prevent the development of more advanced disease.

However, we should not regard the miasm theory as the 'be all and end all' of homeopathy. For example, these criticisms ignore the fact that Hahnemann strongly advocated good hygiene, fresh air, regular exercise, good nutrition as precursors of good health his 1792 essay: The Friend of Health; he was also a pioneer in 1792-3 of humane treatment of the insane Description of Klockenbring During his Insanity a year before William Tuke and Philippe Pinel, and he published tracts in which he described the cause of Cholera as "excessively minute, invisible, living creatures" Asiatic Cholera, 1831. That makes him a pioneer of microbiology a good fifty years before Koch or Pasteur. These considerations clearly indicate a modern feel to his medical views that may be justly regarded as advanced for his times.

History

Theory of disease

In Hahnemann's day, the conventional theory of disease was based on the four humours. Mainstream medicine focused on restoring the balance in the humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours causing trouble, such as by lowering the body temperature of patients who were feverish. By contrast, Hahnemann promoted a view of 'spiritual factors' as the root cause of all disease. Some later homeopaths, in particular James Tyler Kent, put even more emphasis on spiritual factors.Peter Morrell "Kent's influence on British homeopathy." Personal website "...for it goes to the very primitive wrong of the human race, the very first sickness of the human race that is the spiritual sickness... which in turn laid the foundation for other diseases."
Vitalism was a part of mainstream science in the 18th century. In the twentieth century, medicine discarded vitalism in favour of the germ theory of disease, following the work of Louis Pasteur, Alexander Fleming, Joseph Lister and many others. Modern medicine sees bacteria and viruses as the causes of many diseases, but Kent, and some modern homeopaths regard them as effects, not causes, of disease. Others have adapted to the views of modern medicine by referring to disturbances in, and stimulation of, the immune system, rather than the vital force.

As previously stated, homeopathy stemmed in part from the idea of medical similars, the idea that 'like cures like' while Hahnemann was translating into German the Materia Medica of William Cullen, the so-called Scottish Hippocrates. On reading that Cinchona bark (which contains quinine) was effective because it was bitter, Hahnemann felt this implausible because other substances were as bitter but had no therapeutic value. To understand the effects of Cinchona bark, he decided to take it himself, and saw that his reactions were similar to the symptoms of the disease it was used to treat. At least one writer has suggested that Hahnemann was hypersensitive to quinine, and that he may have had an allergic reaction.[http://www.angelfire.com/mb2/quinine/allergy.html William.E.Thomas "The basis of homeopathy" Personal website.

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

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

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

Nearly as important as Hahnemann to the development of homeopathy was James Tyler Kent (1849 – 1921). Kent's influence in the USA was limited, but in the UK, his ideas became the homeopathic orthodoxy by the end of the First World War.A. Campbell, Kentian Homeopathy, Chapter 8 of Homeopathy in Perspective His most important contribution may be his repertory, which is still used today. Kent's approach was authoritarian, emphasizing the metaphysical and clinical aspects of Hahnemann's teachings, in particular

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

Homeopathy around the world

There are estimatedHomeopathy Seeks More Acknowledgement from Deutsche Welle to be more than 100,000 physicians practising homeopathy worldwide, with an estimated 500 million people receiving treatment. More than 12,000 medical doctors and licensed health care practitioners administer homeopathic treatment in the UK, France, and Germany. Homeopathy was regulated by the European Union in 2001, by Directive 2001/83/EC.

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

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

Homeopathy arrived in India with Dr Martin Honigberger in Lahore, in 1829-30 Website of Homeopathy for Everyone, and is officially recognized. India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals.Dr. Raj Kumar Manchanda & Dr. Mukul Kulashreshtha, Cost Effectiveness and Efficacy of Homeopathy in Primary Health Care Units of Government of Delhi- A study

In the USA, homeopathic remedies are, like all healthcare products, regulated by the Food and Drug Administration. However, the FDA treats homeopathic remedies very differently to conventional medicines. Homeopathic products do not have to be approved by the FDA before sale, they do not have to be proved to be either safe or effective, they do not have to be labeled with an expiration date, and they do not have to undergo finished product testing to verify contents and strength. Unlike conventional drugs, homeopathic remedies do not have to identify their active ingredients on the grounds that they have few or no active ingredients. In the USA, only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter; homeopathic medicines that claim to treat a serious disease can be sold only by prescription.

In Germany, about 6,000 physicians specialize in homeopathy. In 1978 homeopathy, anthroposophically extended medicine and herbalism, were recognized as "special forms of therapy", meaning that their medications are freed from the usual requirement of proving efficacy. Since January 1, 2004 homeopathic medications, with some exceptions, are no longer covered by the country's public health insurance.Gesundheitssystem: Was bringt das neue Gesetz? (in German) Most private health insurers continue to cover homeopathy.

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

Classical versus non-classical homeopathy

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

The popularity of homeopathy

Numbers of people receiving homeopathic treatment

Homeopathy is much more popular in Europe and India than in the USA. A study exploring the use of complementary medicine found the following percentages of various countries' population to be using homeopathy for some of their health needs (data from 1985-92):Fisher, P. Ward, A. "Medicine in Europe: Complementary medicine in Europe" BMJ 1994;309:107-111

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

whereas in India, 10% of the population are estimated to use homeopathy exclusively for their medical treatment.Indian Ministry of Health and Family Welfare homeopathy page

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

Number of homeopaths

In Britain, the number of homeopaths registered with the Society of Homeopaths increased from 15 to 708 between 1979 and 1999.Registers of Society of Hom.; Society of homeopaths Annual Report 1989-93; Society of Homeopaths Newsletter 25 p.5; Society of Homeopaths Newsletter 24 p.5; Society of Homeopaths Newsletter 21 p.5 More recent data from the same source shows currently 1300 homeopaths, over 3/4 of whom are women.

Similarly, the number of homeopathic doctors in the UK was for most of the 20th century static at about 100-150. For example, it leapt from 185 in 1932 to 244 in 1972, Data derived from print-copy Faculty Lists 1932-1990 an increase of 3.3% per annum, but in the 1980s it began to grow faster: for example, from 1972 to 1988 it grew from 244 to 586, a real increase of 15% per annum. Today, "the Faculty, which was incorporated by an Act of Parliament in 1950, has over 1,400 members throughout the world and is poised for growth as interest in homeopathy increases both among the public and within the health care sector." ^* Most of these 1400 medically qualified homeopaths live and work in the UK. Clearly, therefore, the trade for all these homeopathic practitioners must be increasing or their numbers would not be growing in real terms in an almost static population. Therefore, the growth in the numbers of UK homeopaths at a rate of some 15-30% per annum can be safely regarded as an accurate, though indirect, measure of the growth of interest in homeopathy in society at large.

Sales of homeopathic medicine

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

Historical note

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

Scientific testing of homeopathic treatment

Lack of known mechanism

Since homeopathic remedies contain no detectable ingredients apart from the diluent (water, alcohol or sugar), there is no known basis for these preparations having medicinal action. Although, some patients do report benefits,Website of The Society of Homeopaths the large majority of scientists attribute these effects to the Placebo Effect, the regression fallacy and/or the Forer effect.

The placebo effect can be large — with an average 35% improvement rate and a considerably greater range.Beecher, H. K. 1955. The powerful placebo. Journal of the American Medical Association, 159:1602-1606. PMID 13271123 To counter this, conventional drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind clinical trials, these test whether the drug has an effect that is significantly better than either a placebo or an alternative treatment. Many clinical trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo.Wayne B. Jonas, Ted J. Kaptchuk, and Klaus Linde, "A Critical Overview of Homeopathy" Ann. Intern. Med.. 2003;138:393-399. However, many of the trials are open to technical criticism or involve samples that are too small to allow firm conclusions to be drawn.

European Journal of Cancer 2006 study

In January 2006 the European Journal of Cancer published a meta-analysis of six trials of homeopathic cancer treatments.Milazzo S, Russell N, Ernst E Efficacy of homeopathic therapy in cancer treatment. Eur J Cancer. 2006 Feb;42(3):282-9. Three of the trials included were randomised double-blind placebo-controlled clinical trials. The authors were from the Department of Complementary Medicine at the Universities of Exeter and Plymouth. Their analysis found insufficient evidence to support the use of homeopathic remedies in cancer treatment. They wrote that "In conclusion, the evidence emerging from this systematic review is encouraging but not convincing. Further research should attempt to answer the many open questions related to homeopathy."

Lancet 2005 study

In August 2005, The Lancet published a meta-analysis of eight trials of homeopathy selected from 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The outcome of this meta-analysis suggested that the clinical effects of homeopathy are likely to be placebo effects. The Lancet paper is notable not least for its unique design, as a "global" meta analysis of homeopathy, not an analysis of particular effects, i.e. it tested the global hypothesis, that ALL reported effects of homeopathy are placebo effects. If this is true, then the reported positive effects are placebo effects, publication bias, observer effects etc, and if so, then the magnitude of reported effects should diminish with sample size and study quality, and with the best studies there should be consistently no effect, and this is the prediction that the study sought to test. For comparison, they subjected an equal set of matched conventional medicine trials for identical analysis. The prediction was supported by the study - whereas the conventional tests showed a real effect independent of sample size, the homeopathy studies did not. The study does not prove that homeopathy is never effective or that all its findings are placebo effects, but does show that the totality of tests analysed show outcomes consistent with the interpretation that all of the reported effects are placebo effects.

British Medical Journal 1991 study

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

The professors concluded, "The amount of positive results came as a surprise to us." They found evidence for successful treatment of respiratory and other infections, diseases of the digestive system, hay fever, rheumatological disease, mental or psychological problems and other ailments. In addition, they found evidence that homeopathic treatment helped patients recover after abdominal surgery and to address pain or trauma.

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

The meta-analysis on homeopathy concluded, "The evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications."J. Kleijnen, P. Knipschild, G. ter Riet, "Clinical Trials of Homoeopathy," British Medical Journal, February 9, 1991, 302:316-323.

Belfast Study

Madeleine Ennis, a pharmacologist at Queen's University, Belfast, and her team looked at the effects of ultra-dilute solutions of histamine on human white blood cells involved in inflammation. These cells, called basophils, release histamine when the cells are stimulated. However, exposure to histamine stops these cells releasing any more, an example of negative feedback regulation. Three of the four participating groups observed this inhibitory effect with homeopathic solutions of histamine, solutions so dilute that they probably didn't contain a single histamine molecule. These low-dilution effects were seen in six of the 24 independent sets of experiments (Table 1 of paper).Belon P, Cumps J, Ennis M, Mannaioni PF, Roberfroid M, Sainte-Laudy J, Wiegant FA. Histamine dilutions modulate basophil activation. Inflamm Res. 2004 May;53(5):181-8. This immunology study has attracted attention since no similar results have been seen in the huge number of papers published on different biological systems. Here, low doses of chemicals give small effects and high doses large effects. This simple dose-response relationship has been confirmed in many thousands of experiments on organisms as diverse as nematodes, Boyd WA, Williams PL. "Comparison of the sensitivity of three nematode species to copper and their utility in aquatic and soil toxicity tests." Environ Toxicol Chem. 2003 Nov;22(11):2768-74 rats Goldoni M, Vettori MV, Alinovi R, Caglieri A, Ceccatelli S, Mutti A. "Models of neurotoxicity: extrapolation of benchmark doses in vitro." Risk Anal. 2003 Jun;23(3):505-14. and humans. Yu HS, Liao WT, Chai CY. "Arsenic Carcinogenesis in the Skin." J Biomed Sci. 2006 Jun 29;

Evidence-based medicine

There is widespread consensus in the medical community that evidence based medicine is the best standard for assessing efficacy and safety of healthcare practices, for it is "the expression of the scientific method in clinical medicine." "Declaration of Helsinki should be strengthened" BMJ 2000;321:442-445 ( 12 August ) Therefore, systematic reviews with strict protocols are essential to establish proof for various therapies. While committed to this principle, much of modern medicine is subject to ongoing efforts to comply with evidence-based standards.

Organisations such as the Cochrane Collaboration and Bandolier publish reviews of evidence-based inquiries. The Cochrane Collaboration found insufficient evidence that homeopathy is beneficial for asthma , dementia and induction of labor. They also found no evidence that homeopathic treatment can prevent influenza, but reported that it might shorten the duration of the disease. Bandolier found insufficient evidence that homeopathy is beneficial for osteoarthritis , migrane prophylaxis, delayed-onset muscle soreness , migraine or symptoms of menopause.

Medical organizations' attitudes towards homeopathy

The U.S. National Institutes of Health's official statement on homeopathy states that:NIH statement on homeopathy
- The results of individual, controlled clinical trials of homeopathy have been contradictory. In some trials, homeopathy appeared to be no more helpful than a placebo; in other studies, some benefits were seen that the researchers believed were greater than one would expect from a placebo.
- A common theme in the reviews of homeopathy trials is that because of these problems and others, it is difficult or impossible to draw firm conclusions about whether homeopathy is effective for any single clinical condition.
- There is a point of view that homeopathy does work, but that modern scientific methods have not yet explained why. The failure of science to provide full explanations for all treatments is not unique to homeopathy.
- Some people feel that if homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine are not necessary.
- The NIH's National Center for Complementary and Alternative Medicine continues to fund research into homeopathy.

In 1997, the following statement was adopted as policy of the American Medical Association (AMA) after a report on a number of alternative therapies including homeopathy:
- There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.''

The Indian Ministry of Health and Family Welfare states that:Indian Ministry of Health and Family Welfare homeopathy page
- Homoeopathy today is a rapidly growing system and is being practiced almost all over the world. In India it has become a household name due the safety of its pills and gentleness of its cure.
- ^* has been recognised as one of the National Systems of Medicine and plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels.

Regulatory decisions

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

Misconceptions about homeopathy

Composition of homeopathic remedies

It is a common misconception that homeopathic remedies use only natural herbal components (akin to herbology). Herbs are used, but homeopathy also uses non-biological substances (such as salts) and components of animal origin, such as duck liver in the remedy oscillococcinum. In herbology, measurable amounts of herbs are used, while in homeopathy the active ingredient is diluted until it is no longer detectable, or to the point that they do not contain any of the original active ingredient at all (when the dilution exceeds the Avogadro's number). Homeopathy also uses substances of human origin, called nosodes. Some people have the opposite misconception, that homeopathic remedies are only based on toxic substances like snake venom or mercury.

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

Homeopathy and vaccination

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

Safety of homeopathic treatment

The United States Food & Drug Administration considers that there is no real concern over the safety of most homeopathic products "because they have little or no pharmacologically active ingredients". There have been a few reports of illness associated with the use of homeopathic products but the medical literature contains a few case reports of poisoning by heavy metals such as arsenic and mercury Article in Spanish. found in homeopathic remedies. However, in cases that they reviewed, the FDA concluded the homeopathic product was not the cause of the adverse reactions. In one case, arsenic was implicated, although FDA analysis revealed that the concentration of arsenic was too low to cause concern. Perhaps the main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath.Science and Technology - Sixth Report Science and Technology Committee Publications.

Dangers in misguided advice

A 2006 survey by the BBC revealed homeopathic practices which were advising travelers against taking conventional anti-malarial drugs, instead providing them with a homeopathic dilution of quinine. Even the director of the The Royal London Homeopathic Hospital condemmed this practice "I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice."^*.

Several scientists said the homeopaths' advice was reprehensible and likely to endanger lives. Professor Geoffrey Pasvol, a tropical medicine expert at Imperial College in London was reported as saying "Medical practitioners would be sued, taken to court and found guilty for far less. What this investigation has unearthed is appalling." ^*. Homeopathy can also lead individuals to forgo effective treatments (opportunity costs).

References

Sources

Magical Thinking in Complementary and Alternative Medicine from the Skeptical Enquirer
Homeopathy: The Test - programme summary from BBC
Walach H "Unspezifische Therapie-Effekte. Das Beispiel Homöopathie" Thesis. Freiburg, Germany: Psychologische Institut, Albert-Ludwigs-Universität Freiburg, (1997)
Ernst E. "Classical homeopathy versus conventional treaments: a systematic review" Perfusion, (1999); 12: 13-15
Bandolier Homeopathy - dilute information and little knowledge ^*
James Randi Educational Foundation. "The JREF Million Dollar Paranormal Challenge 'FAQ'". ^* Retrieved 13 September, 2005.
footnote to pp.12-13, Hahnemann's Chronic Diseases, ed. P. Dudley, B. Jain Publishers, 1998 reprint

External links

Online etext of Hahnemann's Organon der Heilkunst: German original (other format) and English translation

Neutral

A recent article on homeopathy testing from the Annals of Internal Medicine
BBC's Horizon on homeopathy (transcripts, discussion, etc.)
Homeopathy In Perspective — critical online book, covering the history and present state of homeopathy
FDA's view of homeopathy
Homeopathic product manufacture
Water Structure and Behaviour— balanced and up-to-date references to current scientific understanding of water, with specific entries on "memory effects" and homeopathy
Columbia-Presbyterian Hospital's presentation of homeopathic medicine
Can homeopathy withstand scientific testing? 30 November 2004 by F.J. van Sluijs A recent Dutch overview.

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