Homeopathy 
i/ˌhoʊmiˈɒpəθi/ (also spelled homoeopathy or homœopathy; from the Greek hómoios- ὅμοιος- "like-" + páthos πάθος "suffering") is a form of alternative medicineoriginated by Samuel Hahnemann (1755–1843), based on the idea that a substance that causes the symptoms of a disease in healthy people will cure that disease in sick people.[1]This axiom is known as "the law of similars" or "like cures like". Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible.[2][3][4] Within the medical community homeopathy is generally consideredquackery.[5]
i/ˌhoʊmiˈɒpəθi/ (also spelled homoeopathy or homœopathy; from the Greek hómoios- ὅμοιος- "like-" + páthos πάθος "suffering") is a form of alternative medicineoriginated by Samuel Hahnemann (1755–1843), based on the idea that a substance that causes the symptoms of a disease in healthy people will cure that disease in sick people.[1]This axiom is known as "the law of similars" or "like cures like". Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible.[2][3][4] Within the medical community homeopathy is generally consideredquackery.[5]
In addition to symptoms, homeopaths consider a patient's physical and psychological state and life history,[6] before consulting homeopathic reference books known as "repertories" to select a "remedy" based on the "totality of symptoms" as well as personal traits. Homeopathic remedies are prepared by serial dilution of a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body, called "succussion". Each dilution followed by succussion is supposed to increase the remedy's potency. Homeopaths call this process "potentization". Dilution usually continues well past the point where none of the original substance remains.[7]
The low concentrations of homeopathic remedies, often lacking even a single molecule of the diluted substance,[8] lead to an objection that has dogged homeopathy since the 19th century: how, then, can the substance have any effect? Modern advocates of homeopathy have suggested that "water has a memory"—that during mixing and succussion, the substance leaves an enduring effect on the water, perhaps a "vibration", and this produces an effect on the patient. However, nothing like water memory has ever been found in chemistry or physics.[9][10] Furthermore, the claims of homeopathy contradict pharmacological science, which shows that higher doses of an active ingredient exert stronger effects.
Homeopathic remedies have been the subject of numerous clinical trials, which test the possibility that they may be effective through some mechanism unknown to science. While some individual studies have positive results,[11][12] systematic reviews of published trials have failed to demonstrate efficacy.[4][13][14][15][16] Because of the extremely high dilutions, most homeopathic remedies are, at least, harmless. However, patients who choose to use homeopathy rather than normal medicine risk missing timely diagnosis and effective treatment of serious conditions.[17] The regulation and prevalence of homeopathy vary greatly from country to country.[18]
pathology and a strong link to conventional medicine, while those favoring high dilutions emphasised vital force, miasms and a spiritual interpretation of disease.[62][63] Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond that of a placebo.[64][65]
Provings
Hahnemann experimented on himself and others for several years before using remedies on patients. His experiments did not initially consist of giving remedies to the sick, because he thought that the most similar remedy, by virtue of its ability to induce symptoms similar to the disease itself, would make it impossible to determine which symptoms came from the remedy and which from the disease itself. Therefore, sick people were excluded from these experiments. The method used for determining which remedies were suitable for specific diseases was called "proving", after the original German word Prüfung, meaning "test". A homeopathic proving is the method by which the profile of a homeopathic remedy is determined.[66]
At first Hahnemann used undiluted doses for provings, but he later advocated provings with remedies at a 30C dilution,[48] and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain.[67]During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a "drug picture". The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms.
Provings have been described as important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine.[68] The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence thatnitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time.[69] The first recorded provings were published by Hahnemann in his 1796 Essay on a New Principle.[70] His Fragmenta de Viribus (1805)[71] contained the results of 27 provings, and his 1810 Materia Medica Puracontained 65.[72] For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 remedies underwent provings and newer substances are continually added to contemporary versions.
Though the proving process has superficial similarities with clinical trials, it is fundamentally different in that the process is subjective, not blinded, and modern provings are unlikely to use pharmacologically active levels of the substance under proving.[73] As early as 1842, Holmes noted the provings were impossibly vague, and the purported effect was not repeatable among different subjects.[74]
Physical, mental, and emotional state examination; Repertories
Homeopaths generally begin with detailed examinations of their patients' histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type.[75]
From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a "homeopathic materia medica". But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the "homeopathic repertory", which is an index of symptoms, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and practitioners over the veracity of a particular inclusion.
The first symptomatic index of the homeopathic materia medica was arranged by Hahnemann. Soon after, one of his students, Clemens von Bönninghausen, created theTherapeutic Pocket Book, another homeopathic repertory.[76] The first such homeopathic repertory was Georg Jahr's Symptomenkodex, published in German (1835), which was then first translated to English (1838) by Constantine Hering as the Repertory to the more Characteristic Symptoms of Materia Medica. This version was less focused on disease categories and would be the forerunner to Kent's later works.[35][77] It consisted of three large volumes. Such repertories increased in size and detail as time progressed.
Some diversity in approaches to treatments exists among homeopaths. "Classical homeopathy" generally involves detailed examinations of a patient's history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while "clinical homeopathy" involves combinations of remedies to address the various symptoms of an illness.[78]
Homeopathic pills
Homeopathic pills are made from an inert substance (often sugars, typically lactose), upon which a drop of liquid homeopathic preparation is placed.[8][79]
"Active" ingredients
The list of ingredients seen on remedies may confuse consumers into believing the product actually contains those ingredients. According to normal homeopathic practice, remedies are prepared starting with active ingredients that are often serially diluted to the point where the finished product no longer contains any biologically "active ingredients" as that term is normally defined.
James Randi and the 10:23 campaign groups have demonstrated the lack of active ingredients in homeopathic products by taking large overdoses.[80] None of the hundreds of demonstrators in the UK, Australia, New Zealand, Canada and the US were injured and "no one was cured of anything, either".[81]
While the lack of active compounds is noted in most homeopathic products, there are some exceptions such as Zicam Cold Remedy, which is marketed as an "unapproved homeopathic" product.[82] It contains a number of highly diluted ingredients that are listed as "inactive ingredients" on the label. Some of the homeopathic ingredients used in the preparation of Zicam are galphimia glauca,[83]histamine dihydrochloride (homeopathic name, histaminum hydrochloricum),[84] luffa operculata,[85] and sulfur. Although the product is marked "homeopathic", it does contain two ingredients that are only "slightly" diluted: zinc acetate (2X = 1/100 dilution) and zinc gluconate (1X = 1/10 dilution),[82] which means both are present in a concentration that contains biologically active ingredients. In fact, they are strong enough to have caused some people to lose their sense of smell,[86] a condition termed anosmia. This illustrates why taking a product marked "homeopathic", especially an overdose,[80] can still be dangerous because it may contain biologically active ingredients, though as discussed previously, most homeopathic preparations contain no active ingredients. Because the manufacturers of Zicam label it as a homeopathic product (despite the relatively high concentrations of active ingredients), it is exempted from FDA regulation by the Dietary Supplement Health and Education Act of 1994 (DSHEA).
Related practices
Isopathy
Isopathy is a therapy derived from homeopathy invented by Johann Joseph Wilhelm Lux in the 1830s. Isopathy differs from homeopathy in general in that the remedies, known as "nosodes", are made up either from things that cause the disease or from products of the disease, such as pus.[35][87] Many so-called "homeopathic vaccines" are a form of isopathy.[88]
Flower remedies
Flower remedies can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower remedies, which were developed by the physician and homeopath Edward Bach. Although the proponents of these remedies share homeopathy's vitalist world-view and the remedies are claimed to act through the same hypothetical "vital force" as homeopathy, the method of preparation is different. Bach flower remedies are prepared in "gentler" ways such as placing flowers in bowls of sunlit water, and the remedies are not succussed.[89] There is no convincing scientific or clinical evidence for flower remedies being effective.[90]
Veterinary use
The idea of using homeopathy as a treatment for other animals, termed "veterinary homeopathy", dates back to the inception of homeopathy; Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans.[91] The FDA has not approved homeopathic products as veterinary medicine in the U.S. In the UK, veterinary surgeons who use homeopathy belong to theFaculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons. Animals may be treated only by qualified veterinary surgeons in the UK and some other countries. Internationally, the body that supports and represents homeopathic veterinarians is the International Association for Veterinary Homeopathy. The use of homeopathy in veterinary medicine is controversial; the little existing research on the subject is not of a high enough scientific standard to provide reliable data on efficacy.[92] Other studies have also found that giving animals placebos can play active roles in influencing pet owners to believe in the effectiveness of the treatment when none exists.[92]
Electrohomeopathy
Electrohomeopathy was a 19th century practice combining homeopathy with electric treatment.
Evidence
| Claims | Proponents claim that illnesses can be treated with specially prepared extreme dilutions of a substance that produces symptoms similar to the illness. Homeopathic remedies rarely contain any atom or molecule of the substance in the remedy. |
|---|---|
| Related scientific disciplines | Chemistry, Medicine |
| Year proposed | 1807 |
| Original proponents | Samuel Hahnemann |
| Subsequent proponents | Organizations: Boiron, Heel,Miralus Healthcare, Nelsons,Zicam Individuals: Deepak Chopra,Paul Herscu, Robin Murphy,Rajan Sankaran, Luc De Schepper, Jan Scholten,Jeremy Sherr, Dana Ullman,George Vithoulkas |
| Pseudoscientific concepts | |
The medicinal claims of homeopathy are unsupported by the collective weight of modern scientific research. There is an overall absence of sound statistical evidence of therapeutic efficacy, which is consistent with the lack of any biologically plausible pharmacologicalagent or mechanism.[2] Abstract concepts within theoretical physics have been invoked to suggest explanations of how or why remedies might work, including quantum entanglement,[93] the theory of relativity and chaos theory. However, the explanations are offered by nonspecialists within the field, and often include speculations that are incorrect in their application of the concepts and not supported by actual experiments.[33]:255-6
Plausibility
The extreme dilutions used in homeopathic preparations usually leave none of the original substance in the final product. The modern mechanism proposed by homeopaths, water memory, is considered implausible in that short-range order in water only persists for about 1 picosecond.[94][95] Existence of a pharmacological effect in the absence of any true active ingredient is inconsistent with the observed dose-response relationshipscharacteristic of therapeutic drugs[96] (whereas placebo effects are non-specific and unrelated to pharmacological activity[97]). The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics, such as the law of mass action.[94]
- High dilutions
The extremely high dilutions in homeopathy preclude a biologically plausible mechanism of action. Homeopathic remedies are usually diluted to the point where there are no molecules from the original solution left in a dose of the final remedy.[95] Homeopaths contend that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active remedy, in contrast to therapeutically inert water. Since even the longest-lived noncovalent structures in liquid water at room temperature are stable for only a few picoseconds,[98] critics have concluded that any effect that might have been present from the original substance can no longer exist.[99] No evidence of stable clusters of water molecules was found when homeopathic remedies were studied using nuclear magnetic resonance.[100]
Furthermore, since water will have been in contact with millions of different substances throughout its history, critics point out that water is therefore an extreme dilution of almost any conceivable substance. By drinking water one would, according to this interpretation, receive treatment for every imaginable condition.[101] For comparison, ISO 3696: 1987 defines a standard for water used in laboratory analysis; this allows for a contaminant level of ten parts per billion, 4C in homeopathic notation. This water may not be kept in glass as contaminants will leach out into the water.[102]
Practitioners of homeopathy contend that higher dilutions produce stronger medicinal effects. This idea is inconsistent with the observeddose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body.[96] This dose-response relationship has been confirmed in myriad experiments on organisms as diverse as nematodes,[103]rats,[104] and humans.[105]
Physicist Robert L. Park, former executive director of the American Physical Society, is quoted as saying,
"since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 [or 1060] molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth."[106]
Park is also quoted as saying that, "to expect to get even one molecule of the 'medicinal' substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained".[106]
The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether.[8] This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 1024).[54][106][107]
Scientific tests run by both the BBC's Horizon and ABC's 20/20 programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.[43][108]
Efficacy
The effectiveness of homeopathy has been in dispute since its inception. One of the earliest double blind studies concerning homeopathy was sponsored by the British government during World War II in which volunteers tested the efficacy of homeopathic remedies against diluted mustard gas burns.[109]
No individual preparation has been unambiguously demonstrated to be different from placebo.[2][110] The methodological quality of the primary research was generally low, with such problems as weaknesses in study design and reporting, small sample size, andselection bias. Since better quality trials have become available, the evidence for efficacy of homeopathy preparations has diminished; the highest-quality trials indicate that the remedies themselves exert no intrinsic effect.[15][12][33]:206 A review conducted in 2010 of all the pertinent studies of "best evidence" produced by the Cochrane Collaboration concluded that "the most reliable evidence – that produced by Cochrane reviews – fails to demonstrate that homeopathic medicines have effects beyond placebo."[111]
- Publication bias and other methodological issues
The fact that individual randomized controlled trials have given positive results is not in contrast with an overall lack of statistical evidence of efficacy. A small proportion of randomized controlled trials inevitably provide false-positive outcomes due to the play of chance: a "statistically significant" positive outcome is commonly adjudicated when the probability of it being due to chance rather than a real effect is no more than 5%—a level at which about 1 in 20 tests can be expected to show an effect even though there is none.[112] Furthermore, trials of low methodological quality (ie ones which have been inappropriately designed, conducted or reported) are prone to give misleading results. In a systematic review of the methodological quality of randomized trials in three branches of alternative medicine, Linde et al. highlighted major weaknesses in the homeopathy sector, including poor randomization.[113]
A related issue is publication bias: researchers are more likely to submit trials that report a positive finding for publication, and journals prefer to publish positive results.[114][115][116][117] Publication bias has been particularly marked in complementary and alternative medicine journals, where few of the published articles (just 5% during the year 2000) tend to report null results.[118] Regarding the way in which homeopathy is represented in the medical literature, a systematic review found signs of bias in the publications of clinical trials (towards negative representation in mainstream medical journals, and vice-versa in complementary and alternative medicine journals), but not in reviews. [12]
- Systematic reviews and meta-analyses of efficacy
Both meta-analyses, which statistically combine the results of several randomized controlled trials, and other systematic reviews of the literature are essential tools to summarize evidence of therapeutic efficacy.[119] Early systematic reviews and meta-analyses of trials evaluating the efficacy of homeopathic remedies in comparison with placebo more often tended to generate positive results, but appeared unconvincing overall.[120] In particular, reports of three large meta-analyses warned readers that firm conclusions could not be reached, largely due to methodological flaws in the primary studies and the difficulty in controlling for publication bias.[13][14][11] The positive finding of one of the most prominent of the early meta-analyses, published in The Lancet in 1997 by Linde et al.,[14] was later reframed by the same research team, who wrote:
The evidence of bias [in the primary studies] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials ... have negative results, and a recent update of our review for the most "original" subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.[15]
In 2002, a systematic review of the available systematic reviews confirmed that higher-quality trials tended to have less positive results, and found no convincing evidence that any homeopathic remedy exerts clinical effects different from placebo.[2]
In 2005, The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.[4]
A 2006 meta-analysis of six trials evaluating homeopathic treatments to reduce cancer therapy side-effects following radiotherapy andchemotherapy found that there was "insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care".[121]
A 2007 systematic review of homeopathy for children and adolescents found that the evidence for attention-deficit hyperactivity disorder and childhood diarrhea was mixed. No difference from placebo was found for adenoid vegetation, asthma, or upper respiratory tract infection. Evidence was not sufficient to recommend any therapeutic or preventative intervention, and the delay in medical treatment may be harmful to the patient.[17]
The Cochrane Library found insufficient clinical evidence to evaluate the efficacy of homeopathic treatments for asthma[122]dementia,[123] or for the use of homeopathy in induction of labor.[124] Other researchers found no evidence that homeopathy is beneficial for osteoarthritis,[125] migraines[126][127][128] or delayed-onset muscle soreness.[78]
Health organisations such as the UK's National Health Service,[129] the American Medical Association,[130] and the FASEB[99] have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine.
Clinical studies of the medical efficacy of homeopathy have been criticised by some homeopaths as being irrelevant because they do not test "classical homeopathy".[131] There have, however, been a number of clinical trials that have tested individualized homeopathy. A 1998 review[132] found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials. The authors concluded "that the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies." Jay Shelton, author of a book on homeopathy, has stated that the claim assumes without evidence that classical, individualized homeopathy works better than nonclassical variations.[33]:209
Explanations of perceived effects
Science offers a variety of explanations for how homeopathy may appear to cure diseases or alleviate symptoms even though the remedies themselves are inert:[33]:155-167
- The placebo effect — the intensive consultation process and expectations for the homeopathic preparations may cause the effect
- Therapeutic effect of the consultation — the care, concern and reassurance a patient experiences when opening up to a compassionate caregiver can have a positive effect on the patient's well-being.
- Unassisted natural healing — time and the body's ability to heal without assistance can eliminate many diseases of their own accord
- Unrecognized treatments — an unrelated food, exercise, environmental agent or treatment for a different ailment, may have occurred
- Regression toward the mean — since many diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care when discomfort is greatest, they may feel better anyway but because the timing of the visit to the homeopath they attribute improvement to the remedy taken
- Non-homeopathic treatment — patients may also receive standard medical care simultaneous with homeopathic treatment, and the former is responsible for improvement
- Cessation of unpleasant treatment — often homeopaths recommend patients stop getting medical treatment such as surgery or drugs, which can cause unpleasant side-effects; improvements are attributed to homeopathy when the actual cause is the cessation of the treatment causing side-effects in the first place, but the underlying disease remains untreated and still dangerous to the patient
- Lifestyle changes — homeopaths often recommend diet and exercise, as well as limitations in alcohol or coffee consumption andstress reduction, all of which can increase health and decrease symptoms[citation needed]
Effects in other biological systems
While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain,[133] histaminerelease by leukocytes,[134] and enzyme reactions, such evidence is disputed since attempts to replicate them have failed.[135][136][137][138][139]
In 1987, French immunologist Jacques Benveniste submitted a paper to the journal Nature while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody. The journal editors, sceptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published. Still sceptical of the findings, Nature assembled an independent investigative team to determine the accuracy of the research, consisting of Nature editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic James Randi. After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported."[10][140][141]James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data.[140]
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