Homeopathy

Homeopathy (also spelled homœopathy or homoeopathy), from the Greek words homoios (similar) and pathos (suffering), is a system of alternative medicine, notable for its controversial practice of prescribing water-based solutions that do not contain chemically active ingredients. The theory of homeopathy was developed by the Saxon physician Samuel Hahnemann (1755–1843) and first published in 1796. It has a wide and growing popularity in areas where it is practiced today, but neither its empirical nor its theoretical foundation meets the minimum criteria of the scientific establishment.

Homeopathy calls for treating "like with like" (law of similars). The practitioner considers the totality of symptoms of a given case. He or she then chooses a remedy that has been reported in a homeopathic proving to produce a similar set of symptoms in healthy subjects. This remedy is usually given in extremely low concentrations prepared according to a procedure known as potentisation, because it is held that this process gives higher dilutions more therapeutic power.

Contents

1 Basic principles 1.1 Theory of disease 1.2 The law of similars 1.3 The theory of infinitesimals 2 The practice of homeopathy 2.1 History 2.2 Homeopathy around the world 2.3 Diversity 3 The appeal of homeopathy 3.1 Clinical Efficacy 3.2 Disaffection with the establishment 4 The skeptical view of homeopathy 4.1 Lack of a mechanism 4.2 Lack of evidence for therapeutic efficacy 4.3 Homeopathy may not be completely harmless 5 The applicability of traditional scientific procedures 6 Misconceptions about homeopathy 6.1 Composition of homeopathic remedies 6.2 Homeopathy and vaccination 7 References 8 External links 8.1 References 8.2 Even-handed 8.3 Supportive 8.4 Critical

Basic principles

Theory of disease

The conventional theory of disease in Hahnemann's time was based on the four humours. Mainstream medicine in those days focused on restoring the balance in the humours and thus the vital force by either removing an excess of a particular humour (through such things as bloodletting and purging, the use of laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humour(s) causing troubles, for instance giving patients substances associated with cold and dry if the patient was hot and wet (e.g. feverish).

The late 18th century was a time of intense exploration, and many new diseases were being identified. The model of internal humors was proving to be inadequate. For example, many new diseases were clearly associated with certain geographic locations, which was difficult to explain through totally internal mechanisms like humours. Instead, more scientists were considering a model of external causes. One variation was the idea of independent outside agents in the air, known as miasms or simply "bad airs". For example, malaria was thought to be caused by the bad airs found in southern swamps and jungles, explaining why it struck down people travelling in those areas.

Hahnemann's idea was that by suppressing or going against the humours, doctors were sabotaging the body's own efforts to heal itself. He considered symptoms to be the way the body fought disease; for example, fever was its attempt to make itself warmer to fight whatever was ailing it. Unlike the humour-based logic, which would attempt to cool the feverish patient, Hahnemann felt that if the body wanted to be warm, making it warmer would be the proper solution. From this he developed the expression of the "like-cures-like" principle.

Scientific medicine has discarded both the theory of the four humours and the theory of miasms (and similar ideas of that time), in favour of the germ theory of disease as part of a physiological model, based on the work of scientists like Louis Pasteur, Alexander Fleming, and Joseph Lister.

Beginning with his early work, Hahnemann rejected the prevailing physical model, in favour of seeing disease as more dynamic (spirit-like). He considered the spiritual factors as the root cause of all disease, what he termed the "highest disease." Most later homeopaths, in particular James Tyler Kent, have tended to put even more emphasis on spiritual factors.

Vitalism was more or less a part of mainstream science through the 18th century. Whereas modern medicine sees bacteria and viruses as the causes of many diseases, some modern homeopaths regard them as effects, not causes, of disease. Others have to some extent adapted to the views of modern medicine by referring to disturbances in and stimulation of the immune system, rather than the vital force.

In accordance with this view of disease, classical homeopathic treatment requires an interview, known as "anamnesis", which may take an hour or more, to determine the totality of the patient's symptoms. Hahnemann stated that a person could have more than one disease at a time, each of which might be contributing to the symptom picture of the patient. Hahnemann's approach was that the practitioner should first seek to treat the constant nature diseases, as these can more readily be identified in most cases (by cause, e.g. Arnica for contusion disease) and since they are fixed in nature, they are always treated with the same medicine, thus simplifying treatment. The homeopathic approach to the remaining pathic diseases could then more easily be used.

Although modern homeopaths sometimes suggest that their art is especially effective against chronic diseases, Hahnemann himself recognized that homeopathy, like conventional medicine, has more difficulty with these than with acute sicknesses. In response, he developed his theory of miasms, which are supposed to cause all chronic disease (apart from that due to orthodox medicine or to faulty living habits). Hahnemann identified three types of miasm: syphilitic, sycotic, and psoric. Some later homeopaths have extended this list. Constantine Hering developed the psora doctrine by propounding that symptoms developed in a particular way:

• from less vital to more vital organs
• from the surface to the interior
• from the extremities to the upper part of the body

As the patient is cured, the symptoms are said to be relieved (or to temporarily reappear) in the opposite order.

The law of similars

The first and most important "natural law" expressed by Hahnemann, the one from which homeopathy derives its name, is similia similibus curentur—let like cure like. This means that the appropriate substance to treat a disease is one which induces similar symptoms in a healthy person. Homeopathy uses a wide variety of animal, plant, and inorganic substances, from sodium chloride (a.k.a. table salt) to lachesis muta (the venom of the bushmaster snake).

What symptoms are associated with various substances is determined by provings, in which the researcher imbibes the remedy and records all physical, mental, emotional and modal symptoms experienced. A homeopathic repertory is a listing of remedies by symptom, used to determine the most appropriate remedy for a given case. Hahnemann's finding are recorded in Materia Medica Pura. Kent's Repertory (published 1905) lists about 700 remedies. Today, nearly 3000 remedies are used in homeopathy, of which approximately 150 are considered common.

Other homeopaths during and after Hahnemann's time, notably Hering and Lux, further developed remedies such nosodes, which are homeopathic dilutions of the agent or the product of the disease in question. Rabies nosode, for example, is made by potentizing the saliva of a rabid dog. Although Hahnemann himself did not treat for the constitution, using it as a basis for assessing the patient's vitality, later homeopaths, notably from Kent onwards, developed an approach to treatment, trying to get at the essence of a case (often referred to as "essence prescribing) called constitutional prescribing and which focusses on the mental-emotional and physical generals of a case.

If symptoms become worse after starting a homeopathic treatment, this is referred to as an aggravation or healing crisis depending on when it occurs. When it occurs in the first few seconds or minutes of ingestion of the remedy, this is considered to be an "homeopathic aggravation," and generally occurs in acute cases or if the dose is too large. The idea of aggravation can be considered a consequence of the law of similars in that the medication initially adds to the symptoms of the disease and only gradually replaces it. If it occurs later, usually within 7-14 days of the remedy in chronic cases, this is considered to be a healing reaction of the body and a sign that the medication is taking effect. In some cases an aggravation does not occur but the symptoms improve immediately or after some time. It is also possible that the symptoms change or old symptoms reappear. Alternatively, the symptoms may be considered a response to the disease by the immune system, which is stimulated by the medication to overcome the damage created by the disease destroyed by the similar medicine.

The law of similars is a guiding principle in homeopathy, but calling it a "law" is perhaps misleading. There is no certain way to determine an effective remedy for a patient, and homeopaths will often disagree on the best one in any given case. The homeopath will not use all the symptoms of a patient, but will decide which are the most characterictic. Even then, there will be hundreds of entries in the repertory with most of these symptoms, and every entry will have symptoms listed that the patient does not exhibit.

The lack of definite predictions by the law of similars makes it difficult to test scientifically. There are certainly many apparent counterexamples: aspirin does not produce headaches in healthy people, decongestants do not cause congestion, and penicillin does not cause fever. Nevertheless, some homeopathy advocates have suggested a certain plausibility in cases where the symptom is an adaptive immune response. For example, it is generally accepted that fever or inflammation are induced by the immune system in an attempt to eradicate pathogens, rather than being caused directly by the pathogen. One homeopath (Dana Ullman, MPH) argues that a substance that induces a particular symptom (such as fever), might do so by directly inducing or stimulating that specific immune system response. Such an enhanced immune response could aid the body in fighting disease.Template:Ref

However it is also possible that a substance might induce a symptom by causing damage to the body in the same way that a pathogen does; and sometimes an immune response can itself cause damage (for example anaphylaxis). For these reasons, ingesting a substance to induce an immune response could be dangerous.

See also: List of common homeopathic remedies

The theory of infinitesimals

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and side effects diminished) by dilution in a particular procedure known as dynamization or potentization. Liquids are successively diluted (with water or occasionally alcohol) and shaken by 10 hard strikes against an elastic body, a process called succussion. Insoluble solids are diluted by grinding them with lactose, a process known as trituration. Homeopathic practitioners believe the vigorous agitation following each dilution transfers some of the "essential property" of the substance to the water, which fits in with the concept of disease as a disturbance in the "vital force" of the patient. The dilution factor at each stage is traditionally 1:10 (D or X potencies) or 1:100 (C potencies). Hahnemann advocated the use of 30C dilutions for most purposes, i.e. dilution by a factor of 100³⁰ = 10⁶⁰. Some later homeopaths, in particular Kent, have advocated the use of much higher potencies, which can no longer be practically achieved by the traditional method, but require succussion without dilution (Jenichen), much higher dilution factors (LM potencies dilute by 1:50,000 at each stage), or machines which in some way integrate dilution and succussion into a continuous process (Kent). Higher dilutions are generally considered stronger. This is in contrast to conventional medicine and biochemistry, which hold that the effects of a substance are always due to its physical and biochemical activity in the patient's body, and therefore that generally the more of an active ingredient is present in a drug, the more effect (whether positive, negative, or both) it will have.

The choice of potency will depend on a number of factors depending on the homeopath. These can range from how deep seated the disease seems to be to how the patient has reacted to previous remedies. As a general (although not exclusive) rule, European homeopaths will use lower potencies than their American counterparts. Some homeopaths believe that, while lower dilutions may have more of a physiological effect, higher dilutions may have a greater effect on the mental or emotional plane.

Some homeopaths have suggested that hormesis, whereby a substance harmful at high doses can become beneficial at low doses, provides a rationale for the Law of Infinitesimals. However such a mechanism could operate only at low dilution factors, and provides no rationale for higher dilutions where no molecules of the original substance remain.

The practice of homeopathy

History

Hahnemann began developing the homeopathic method after coming upon the idea that "like cures like" while translating a work on malaria. Upon reaching a passage stating that quinine was an effective treatment because it was bitter and astringent, Hahnemann felt this implausible because there were many other substances that were equally bitter yet lacked any therapeutic value. To better understand the effects of quinine, he decided to take it himself and observed that his reactions were similar to the symptoms of the disease it was used to treat. This was the birth of the homeopathic principle and is known as "The First Proving".

Hahnemann and his students approached their treatments in a holistic way, meaning that the whole of the body and spirit becomes the focus of therapy, not just the localised disease. Hahnemann himself spent extended periods of time with his patients, asking them questions that dealt not only with their particular symptoms or illness, but also with the details of their daily lives. It is also suggested that the gentle approach of homeopathy was a reaction to the violent forms of heroic medicine common at the time, which included techniques such as bleeding as a matter of course.

Homeopathy was brought to America in 1825 and rapidly gained in popularity, partly due to the fact that the excesses of conventional medicine were especially extreme there, and partly due to the efforts of Constantine Hering. Hering developed the psora doctrine by propounding that symptoms always move in a particular way: from the surface to the interior, from the extremities to the upper part of the body, and from less vital to more vital organs. His "Laws of Cure" state that the cure must take place in the reverse order of the appearance of the symptoms (first in, last out). Homeopathy reached its peak of popularity in America in the decades 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 himself to the development and popularization of homeopathy was the American physician James Tyler Kent (1849 – 1921). His most important contribution may be his repertory, which is still widely used today. Kent's approach to homeopathy was decidedly authoritarian and unscientific, emphasizing the metaphysical aspects of Hahnemann's teachings, in particular

• insistence on the doctrines of miasm and vitalism,
• rejection of modern scientific and pathological knowledge as a guide to prescribing,
• emphasis on psychological symptoms in prescribing, and
• insistence on the use of very high potencies.

Kent's influence in America was somewhat limited, but his ideas were reimported into the United Kingdom, where they became the homeopathic orthodoxy by the end of the First World War.Template:Ref

In the 1930s the popularity of homeopathy began to wane, especially in Europe and the United States, partly due to advances in biology and conventional medicine and partly due to a decline in coherence in the homeopathic community. Homeopathy experienced a renaissance in the 1970s that continues to this day. George Vithoulkas, who studied in India, where the homeopathic tradition had remained strong, was instrumental in resurrecting homeopathy in Europe, but this phenomenon must also be seen as part of a general increase in interest in alternative medicine.Template:Ref

The ease with which large databases can be manipulated has brought about profound changes in the way homeopathy is practised. Today many homeopaths use personal computers to sift through hundreds of thousands of pages of provings and case studies. Because the information about lesser known remedies is more accessible, it is now more common for homeopaths to prescribe them, which in turn has lead to an increase in the number of new provings. Database technology has also encouraged researchers to reorganize and restructure existing information. For example, Rajan Sankaran has been very influential in placing the use of mineral remedies within the context of the periodic table.

See also: List of important homeopaths

Homeopathy around the world

There are estimatedTemplate:Ref to be over 100,000 physicians practising homeopathy world wide, with an estimated 500 million people receiving treatment. Over twelve thousand medical doctors and licensed health care practitioners administer homeopathic treatment in the United Kingdom, France, and Germany. Since 2001 homeopathy is regulated in the European Union by Directive 2001/83/EC. The latest amendments to this directive make it compulsory for all member states to implement a special registration procedure for homeopathic drugs.

In the United Kingdom, as in most countries, homeopathic remedies may be sold over the counter. The UK has five homeopathic hospitals where treatment, funded by the National Health Service, can be obtained. Homeopathy enjoys more official recognition in the United Kingdom than in any other country, largely due to a tradition of royal patronage. The only other countries that come close in this respect are India and Pakistan.

Homeopathy has been used in India since the middle of the 19th century and is today a widely practised and officially recognized system of medicine there. India has the largest homeopathic infrastructure in the world in terms of manpower, institutions and drug manufacturing industry. There are 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals.Template:Ref

In the United States, homeopathic remedies are, like all healthcare products, subject to regulation by the Food and Drug Administration. However, the FDA accords homeopathic remedies a treatment significantly different from that accorded to other drugs. Homeopathic products are not required to be approved by the FDA prior to sale, not required to be proven either safe or effective prior to being sold, not required to be labeled with an expiration date, and not required to undergo finished product testing to verify contents and strength. Homeopathic remedies have their own imprints that, unlike conventional drugs, do not have to identify their active ingredients on the grounds that they have few or no active ingredients. In the United States only homeopathic medicines that claim to treat self-limiting conditions may be sold over the counter, while homeopathic medicines that claim to treat a serious disease can be sold only by prescription. Neither the American Medical Association nor the American Academy of Pediatrics has an official policy for or against homeopathy.

Homeopathy's popularity in the United States is growing. The 1995 retail sales of homeopathic medicines in the United States were estimated at $201 million and growing at a rate of 20 percent a year, according to the American Homeopathic Pharmaceutical Association. The number of homeopathic practitioners in the United States has increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.

In Germany, about 6,000 physicians specialize in homeopathy. In 1978 homeopathy, along with 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, albeit with some exceptions, are no longer covered by the country's public health insuranceTemplate:Ref. Most private health insurers continue to cover homeopathy.

In Austria homeopathy has been a recognized part of the medical system since 1983.

In Switzerland homeopathy is one of the five classes of complementary medicine. At one time, homeopathic medications were covered by the basic health insurance system, as long as they were prescribed by a physician. This practice ended in June 2005.

In Mexico the Instituto Politécnico Nacional (IPN) has a school of Homeopaty since 1936. This school has both bachelor and master degrees.

Diversity

There is, and always has been, considerable diversity in the theory and practice of homeopathy. The major distinction may be between what can be called the pragmatic and the mystical approach, but it should be remembered that there are not two distinct groups, but a spectrum of attitudes and practices. An early advocate of pragmatism was Richard Hughes, while the most influential mystic was James Tyler Kent. The pragmatists tend to be open to "whatever works", whereas the mystics tend to rely on the research of one or more authorities. There is still considerable diversity in both camps because the pragmatists usually define "working" based on personal experience and the mystics use various sources as authorities. The pragmatists tend to see homeopathy as complementary medicine and are more willing to co-exist with conventional doctors. Many in fact are conventional doctors. The mystics, some of whom are also conventional doctors, see homeopathy as alternative medicine and have more confidence that homeopathy can be used effectively against all diseases, with the caveat that many potential remedies have not yet been proven. The pragmatists are more likely to be interested in proving homeopathy in the framework of mainstream science. They will talk about the "memory of water" and stimulation of the immune system. The mystics see less need to justify their methods with conventional criteria. For them, homeopathy acts on a vital force that is, so far, not accessible to science. The pragmatists are more likely to prescribe (relatively) low dilutions in multiple doses, and sometimes use more than one remedy at a time. The mystics often use higher dilutions, but generally prefer a single remedy and sometimes a single dose. In the extreme form, pragmatists will even accept over-the-counter homeopathic remedies, but the mystics will always insist on an individual prescription. The mystics may see themselves as "classical" homeopaths, although the historical accuracy of the term may be questionable. The pragmatists see themselves as "scientific", even though they are not accepted by the scientific establishment.

The appeal of homeopathy

Clinical Efficacy

Homeopathy is popular among patients and practitioners for several reasons. The most important is that patients have personally found it to be effective or heard from friends, colleagues, and the press of many cases, some of them spectacular, in which a sickness was healed after a homeopathic treatment. Some reinforce their favorable judgement with selective reference to positive scientific reports. Though they are aware that science has found no adequate explanation for the mechanism of homeopathy, they tend to subsrcibe to an empirical view of the matter: whatever works is good enough for them. This pragmatic attitude arguably characterizes most health consumers nowadays, whose main concern is for clinical efficacy rather than scientific sanction of their treatment choice.

Disaffection with the establishment

Another reason that many people embrace homeopathy is that they reject the medical establishment, which is perceived to place too much emphasis on machines and chemicals and to treat the disease, not the person. Homeopathic practitioners do, in fact, often spend much more time dealing with their patients than do conventional practitioners. Furthermore, homeopathic preparations have few if any side effects and are generally much cheaper than conventional medications.

The skeptical view of homeopathy

Lack of a mechanism

Many scientific skeptics consider homeopathy to be a pseudoscientific remnant from the age of alchemy. Others consider the belief in homeopathy to be a form of magical thinking.Template:Ref In fact 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 or not 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 actual size was not calculated until 1865 (by Loschmidt). It is now known that there are 6.02×10²³ particles in a mole (Avogadro's number), so that homeopathic dilutions greater than about 24X or 12C are virtually certain to contain not even a single molecule of the initial substance. This fact is recognized by advocates of homeopathy, who assert that the essential healing power of their preparations is not 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 slowly given up 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 more and more focused on the failure of particular organs and processes in the body. This process began with the synthesis of urea by Friedrich Wöhler in 1828. The consensus among modern scientists is all of chemistry and biology can ultimately be explained in principle by the basic interactions of molecules, even if many processes are far too complex to be understood at this time. In short, the skeptic sees no evidence of a plausible mechanism by which homeopathic dilutions can possibly act.

Closely related to the question of the mechanism is, in the eyes of critics, logical inconsistencies in 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 this were so, then where did the pure water used in this process come from? The water that homeopaths themselves use was once in contact with other chemicals, including chemical wastes, radioactive metals, dinosaur urine, and various poisons. According to this skeptical interpretation of homeopathic theory, all water in the world should remember its contact with millions of chemical substances and not just the properties of the chemicals that the homeopath claims will be useful. The answer of the homeopaths, that dynamization involves succussion as well as dilution, is not satisfying, first because it seems improbable that one can amplify order in a solution by shaking it, secondly because a lot of shaking goes on in the natural world as well. Why does a waterfall not dynamize the substances dissolved in the stream? It is not possible to prove that no consistent theory of potentization exists, but none is obvious and advocates have not been able to produce one.

Homeopaths occasionally invoke the unusual properties of water to explain the memory effect. In addition to the problems above, a theory of homeopathy would also have to explain why dynamization works not only with water but also with alcohol and lactose, which have very different properties.

Even if a homeopathic preparation somehow preserves information from the original substances, there is absolutely no plausible mechanism by which that should effect a cure.

Lack of evidence for therapeutic efficacy

Most of the published studies into homeopathy are of poor scientific quality, and that the higher quality studies tend to report less positive results.Template:Ref,Template:Ref A 2003 evaluation of the whole of homeopathic research over the previous 10 years reportedTemplate:Ref:

RESULTS: Clinical studies and in vitro research indicate the inefficacy of homeopathy. Some few studies with positive results are questionable because of problems with the quality and lack of appropriate experimental controls in these studies. The most recent meta-analyses on the topic yielded negative results. One of the few previous meta-analyses with positive results had serious publication bias problems, and its results were later substantially reconsidered by the main authors. The sparse in vitro homeopathic research with positive results has not been replicated by independent researchers, had serious methodological flaws, or when replicated, did not confirm the initial positive results. A plausible mechanism for homeopathic action is still nonexistent, and its formulation, by now, seems highly unlikely.

CONCLUSIONS: As a result of the recent scientific research on homeopathy, it can be concluded that ample evidence exists to show that the homeopathic therapy is not scientifically justifiable.

Skeptics point out that there are very few studies that meet the highest standards of scientific research, and there is a tendency for the better studies to show less effect. Many high quality studies have been published that showed no effect. The few high quality studies that show a positive effect could be the result of statistical fluctuations, that is, if many studies are made, some will by chance appear to support homeopathy. The situation is aggravated by publishing bias—A positive result will probably be published but a negative result is more likely to be suppressed by the initiators of the study, or not written up by the researchers, or rejected by the referees or editors of the journals.

The skeptics tend to reject the evidence of any study that is not double-blind, randomized, and placebo-controlled, since it has been shown many times that the results can otherwise be biased by the placebo effect, or through post hoc reasoning applied to the regressive fallacy.

Skeptic James Randi has offered an award of one million dollars (U.S.) to anyone who can prove the existence of anything supernatural or paranormal. The million dollars is also available to anyone who can, by any means of their choosing, tell the difference between plain water and any homeopathic remedy of their choosing. A recent attempt to win the prize was aired on the BBC science program Horizon.Template:Ref This test, like all others to date, failed.

Having concluded that the controlled studies of homeopathy are too weak to be convincing, the skeptics must still address the widespread reports of successful treatments. They begin by pointing out that anecdotal evidence of controversial phenomena is nearly useless as scientific evidence. Without control cases, it is impossible to distinguish between efficacy of a treatment and spontaneous remission. Without double blinding it is impossible to rule out observer bias and the placebo effect. Without reproduction in a separate study, it is difficult to rule out chance, fraud, or poorly understood systematic effects.

Homeopathy may not be completely harmless

The skeptical view is that homeopathic dilutions have no direct effect at all, so the skeptic naturally will not claim that the remedies themselves have any harmful side effects. The main potential harm from homeopathic treatment, therefore, arises not from the remedies per se but from the withholding of arguably more efficacious treatment or from misdiagnosis of dangeous conditions (a general criticism that can be applied in any situation of negligent practice due either to medical negligence or the proferring of medical opinion by the non-medically qualified). Moreover, even proponents of homeopathy caution that improper homeopathic treatment of conditions such as asthma, eczema, and penumonia can cause harm.

The applicability of traditional scientific procedures

While skeptics tend to reject borderline results from scientific studies because they are, due to the lack of a plausible mechanism, predisposed to believing that there can be no effect, proponents of homeopathy tend to accept these results due to the opposite predisposition based on their personal experience. In addition, they criticize an unwillingness of the establishment to invest the resources needed to test their hypothesis more thoroughly and what they see as weaknesses in the traditional methodologies.

It is often said that homeopathy cannot be tested in objective studies because it is a principle that each patient and each illness be treated individually and an emotional doctor-patient bond is necessary for successful treatment. Aside from the fact that homeopathy is often not practiced this way, with many patients taking over-the-counter preparations according to the recommendations on the label, this objection has no sound basis. While it may be difficult to objectively study some aspects of homeopathic treatment, e.g., the role played by the relationship between practitioner and patient, the efficacy of homeopathic preparations in high dilution is easily studied. One could, for example, let a practitioner prescribe whatever he wants for whatever patients come to him, and then give half the patients authentic homeopathic preparations and the other half plain water, alcohol or sugar. If the two groups cannot be distinguished at a statistically significant level on the basis of the judgement of the practitioner, the reports of the patients, or objective medical tests, then the hypothesis of efficacy can be rejected.

Rather than insist that all studies be double-blind and randomized, some proponents of homeopathy downplay the importance of the placebo effect by pointing to reports of successful treatment of infants and animals. Scientists answer that even in these cases double-blinding is necessary because (1) the rate of spontaneous remission must be determined, (2) the person evaluating the healing can be influenced by knowing which subjects received the active treatment, and (3) the subjects can respond to the expectations of the person administering the treatment.

Misconceptions about homeopathy

Composition of homeopathic remedies

Many producers of homeopathic remedies also produce other types of alternative remedies, under the same brand name, which can create some confusion for the general public. A common misconception is that homeopathic remedies use only natural, and thus presumed by some to be safe, herbal components (akin to herbology. While herbs are used in homeopathy, there is also use of non-biological substances (such as salts) and components of animal origin, such as duck liver in the popular remedy oscillococcinum. Homeopathy also uses substances of human origin, which are called nosodes. Another difference is that though both do use herbs, in herbology measurable amounts of the herb(s) are in the remedy, while in homeopathy the active ingredient is diluted to the point where it is no longer measurable.

Some people have the opposite misconception, that homeopathic remedies are only based on toxic substances like snake venom or mercury.

Since the term homeopathy is well known and has good marketing value, the public can be further confused by people who have adopted the term for other forms of therapy. For example, some companies have combined homeopathic remedies with less benign substances. Classical homeopaths claim only remedies prepared and prescribed in accordance with the principles established by Hahnemann can be called homeopathic.

Homeopathy and vaccination

The practice of mainstream medicine that most closely resembles homeopathy is vaccination. The vaccine must be closely related to the disease against which it is to protect and must be given in a very small dose to be effective. These characteristics are reminiscent of the law of similars and the law of infinitesimals. In fact, Hahnemann himself interpreted the introduction of vaccination by Edward Jenner in 1798 as a confirmation of the law of similars. Modern homeopaths view vaccination and homeopathy as fundamentally different.

Although Hahnemann originally introduced low dosages in order to reduce side effects, he later believed, as do most homeopaths today, that remedies are most effective if they have been dynamized to such a degree that they have no direct chemical effect. From this point of view, the need to keep the dosage of vaccine low is simply the standard requirement to avoid consuming an excessive amount of any conventional drug. The dosage of a vaccine is still much higher than typical homeopathic dosage, and the vaccine has been diluted but not dynamized.

Homeopathic critics of vaccination also consider the resemblance to the law of similars to be superficial. In most cases a vaccine is not intended to cure a disease at all, but rather to prevent it by preparing the immune system of a healthy organism to meet an attack by a pathogen in the future. Furthermore, the vaccine is usually a bacterium or virus whose capability to produce symptoms has deliberately been weakened while still providing enough information to the immune system. The "similarity" of the vaccine and the disease in terms of symptoms is thus reduced.

The difference between homeopathy and vaccination is best illustrated by a comparison with nosodes, which are made from active (not deactivated) pathogens, are applied after the onset of a disease to cure it (not before to prevent it), and are administered at zero (not merely low) dosage in a chemical sense.

References

1. Template:NoteHomeopathic Medicine and the Immune System (http://www.homeopathic.com/articles/intro/immune_system.php) by Dana Ullman
2. Template:NoteKentian Homeopathy (http://www.accampbell.uklinux.net/homeopathy/homeopathy-html/chapter08.html), Chapter 8 of Homeopathy in Perspective by A. Campbell
3. Template:NoteThe Evolution of Homoeopathy (http://www.thespiritofhomoeopathy.com/evolution.html)
4. Template:NoteHomeopathy Seeks More Acknowledgement (http://www.dw-world.de/dw/article/0,1564,1575855,00.html) from Deutsche Welle
5. Template:NoteCost Effectiveness and Efficacy of Homeopathy in Primary Health Care Units of Government of Delhi- A study (http://www.delhihomeo.com/paperberlin.html) by Dr. Raj Kumar Manchanda and Dr. Mukul Kulashreshtha
6. Template:NoteGesundheitssystem: Was bringt das neue Gesetz? (http://www.dhu.de/wc_800/archiv/GMG.shtml) (in German)
7. Template:NoteMagical Thinking in Complementary and Alternative Medicine (http://www.findarticles.com/p/articles/mi_m2843/is_6_25/ai_79794372) from the Skeptical Enquirer
8. Template:Note Klaus Linde and Dieter Melchart "Randomized Controlled Trials of Individualized Homeopathy: A State-of-the-Art Review", Journal of Alternative and Complementary Medicine 4 (1998): 371-88 (structured abstract (http://nhscrd.york.ac.uk/online/dare/990167.htm))
9. Template:Note M. Cucherat et al. "Evidence of Clinical Efficacy of Homeopathy: A Meta-Analysis of Clinical Trials", European Journal of Clinical Pharmacology 56 (2000): 27-33 (structured abstract (http://nhscrd.york.ac.uk/online/dare/20001151.htm))
10. Template:Note A critical review of the possible benefits associated with homeopathic medicine (http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0041-87812003000600007&tlng=es&lng=en&nrm=iso), Renan Moritz V. Rodrigues Almeida, Rev. Hosp. Clin. vol.58 no.6 São Paulo 2003
11. Template:NoteHomeopathy: The Test - programme summary (http://www.bbc.co.uk/science/horizon/2002/homeopathy.shtml) from BBC

External links

References

• Online etext of Hahnemann's Organon der Heilkunst: German original (http://www.homeoint.org/books4/organon/) and English translation (http://www.homeopathyhome.com/reference/organon/organon.html)

Even-handed

• A recent article on homeopathy testing from the Annals of Internal Medicine (http://www.annals.org/cgi/content/full/138/5/393/)
• BBC's Horizon on homeopathy (http://www.bbc.co.uk/science/horizon/2002/homeopathy.shtml) (transcripts, discussion, etc.)
• Homeopathy In Perspective (http://www.acampbell.org.uk/homeopathy/index.html) — critical online book, covering the history and present state of homeopathy
• FDA's view of homeopathy (http://www.fda.gov/fdac/features/096_home.html)

Supportive

• Introduction and Information on Homeopathy (http://www.arnica.com/homeo/homeo.html)
• North American Society of Homeopaths (http://www.homeopathy.org/)
• Extensive Homeopathy Links from The Holistic Medicine Resource Center (http://www.holisticmed.com/www/homeopathy.html)
• Information and Discussion Forum (http://www.hpathy.com/)
• Complementary Medicine - Therapies: Homeopathy (http://www.bbc.co.uk/health/healthy_living/complementary_medicine/therapies_homeopathy.shtml) BBC's "Complementary Medicine" article on Homeopathy
• Referrals to Certified Classical Homeopaths (http://www.homeopathy-cures.com/html/referrals_to_homeopaths.html)
• Alliance of Registered Homeopaths (http://www.a-r-h.org)
• Homéopathe International (http://www.homeoint.org/english/index.htm) — The English language version of Homéopathe International
• Homeopathy Timeline (http://www.wholehealthnow.com/homeopathy_pro/homeopathy_1825_1849.html) with a wealth of historical and biographical information

Critical

• A skeptic's view of homeopathy (http://www.randi.org/jr/02-02-2001.html)
• Magical Thinking in Complementary and Alternative Medicine (http://www.csicop.org/si/2001-11/alternative.html)
• Quackwatch on homeopathy (http://www.quackwatch.org/01QuackeryRelatedTopics/homeo.html)
• HomeoWatch (http://www.homeowatch.org/) — A Skeptical Guide to Homeopathic History, Theories, and Current Practices, operated by Stephen Barrett, M.D. (founder of Quackwatch)
• H2G2 entry on homeopathy (http://www.bbc.co.uk/dna/h2g2/alabaster/A954740).
• The Skeptics Dictionary (http://www.skepdic.com/homeo.html)
• "The Scientific Evidence on Homeopathy" (http://www.acsh.org/search/txtQuickSearch.homeopathy/health_result.asp) - American Council on Science and Health
• A close look at homeopathy (http://www.skepticreport.com/health/hahnemann.htm)
• Dilution or Delusion? (http://www.skepticreport.com/health/dilutiondelusion.htm)
• National Council Against Health Fraud Position Paper on Homeopathy (http://www.ncahf.org/pp/homeop.html)bg:Хомеопатия

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