Homeopathy

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Homeopathy (also spelled homœopathy or homoeopathy) from the Greek words όμοιος, hómoios (similar) and πάθος, páthos (suffering), is a controversial method of alternative medicine that attempts to treat "like with like." The term "homeopathy" was coined by the German physician Christian Friedrich Samuel Hahnemann (1755–1843) and first appeared in print in 1807, although he began outlining his beliefs of medical similars in a series of articles and monographs in 1796.

Homeopathy attempts to treat the sick with extremely diluted agents that, in undiluted doses, produce similar symptoms in the healthy. However, processes used cause the dose to be exactly zero in most cases, meaning there is not a single active molecule present in the solution. 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 diseases as morbid derangements of the organism, and states that instances of disease in different people differ fundamentally. Homeopathy views a sick person as having a dynamic disturbance in a hypothetical "vital force", a disturbance which, homeopaths claim, underlies standard medical diagnoses of named diseases.

Since its inception homeopathy has received criticisms on theoretical grounds, and has been subject to a number of studies aimed at testing its efficacy scientifically. The theory that extreme dilution makes drugs more powerful by enhancing their "spirit-like medicinal powers" is inconsistent with the laws of chemistry and physics and the observed dose-response relationships of conventional drugs; critics of homeopathy frequently describe it as pseudoscience and quackery. Placebo-controlled clinical trials have given some mixed results, but most showing positive results are shown to have methodological problems, and the better-quality trials (e.g. those using double-blind techniques and large numbers of people) give negative results. Several examples of publications in high ranking journals, that are later withdrawn, are known. Additionally, cases have been reported of life-threatening complications resulting from attempts to treat serious conditions solely with homeopathic remedies.

Homeopathy is particularly popular in Europe and India, although less so in the USA, where such therapies have been subject to tighter regulation. Stricter European regulations have also been implemented recently by the EDQM.

The principle of medical similars
Homeopathy is based on the 'Principle of Similars', first expressed by Hahnemann in the exhortation similia similibus curentur or 'let likes cure likes'. This is the 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, 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 in molecular doses, and the resulting physical, mental and spiritual symptoms are compiled by observers into a 'Drug Picture'.

Hahnemann says of the attitude his first proving inspired in him: "with this first trial broke upon me the dawn that has since brightened into the most brilliant day of the medical art; that it is only in virtue of their power to make the healthy human being ill that medicines can cure morbid states, and indeed, only such morbid states are composed of symptoms which the drug to be selected for them can itself produce in similarity on the healthy."

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.

Hahnemann first tested in homeopathic provings substances commonly used as medicines in his time, such as Antimony and Rhubarb, and also poisons like Arsenic, Mercury and Belladonna.

Hahnemann recorded his first provings of 27 drugs in the Fragmenta de viribus in 1805 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, 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 diluting 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 "captured" by alcohol or lactose (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 speculative knowledge independent of the law of similars. This modern approach also harks back to the ancient 'doctrine of signatures,' which Hahnemann definitely rejected as uncertain guesswork: "The ancients imagined that the yellow colour of the juice of... (Chelidonium, Yellow Poppy) was an indication (signature) of its utility in bilious diseases. The moderns from this extended its employment to hepatic diseases...the importance of human health does not admit of any such uncertain directions for the employment of medicines. It would be criminal frivolity to rest contented with such guesswork at the bedside of the sick. Only that which the drugs themselves unequivocally reveal of their peculiar powers in their effects on the healthy human body – that is to say, only their pure symptoms – can teach us loudly and clearly when they can be advantageously used with certainty; and this is when they are administered in morbid states very similar to those they are able to produce on the healthy body."

Examples of this impulse to expand the materia medica 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 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 substances based on their elemental classification (the periodic table or biological taxonomy). This approach may create neat systems for grouping remedies and classifying the ever-burgeoning Materia Medica, but its usefulness is questioned by some purists on the basis that it involves speculation about remedy action without provings.

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

Alternative modes of selecting remedies include medical dowsing or the use of other psychic powers. However, these methods are controversial and not accepted by most homeopathic practitioners.

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'. --JT Kent."

Succussion and dilution
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 progressively 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. This can be viewed at the Hahnemann Museum in Stuttgart. Insoluble solids, such as Quartz and Oyster shell, are diluted by grinding with lactose (trituration). 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 (LM or Q potencies). Higher 'potencies' 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 a 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, even homeopathic remedies of a high "potency" contain, with overwhelming probability, only water. Practitioners of homeopathy believe that this water retains some 'essential property' of one of the substances that it has contacted in the past.

Water will have been in contact with millions of different substances in its history. According to this molecular paradigm, any glass of water must be regarded as an extreme dilution of almost any agent you care to mention. Thus, critics argue that by drinking water one receives homeopathic treatment for every imaginable condition. Proponents of homeopathy are unable to accept the molecular paradigm as a complete account of life phenomena and therapeutics. They believe that the methodical dilution of a particular substance, beginning with a 10% solution and working downwards, produces a therapeutically active 'remedy', in contrast to regular water which is therapeutically inert. However, in terms of chemistry, a dilution of anything at 30C is identical to water.

Alternative methods of preparation
"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 (1787-1849), General Korsakoff (1788-1853) 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 it is undefined "vibrations" that produce the healing effect and, when the correct vibration is selected, only water need be added to produce a remedy. Today, radionics potentising devices are used by many homeopaths to prepare remedies. These are based on the work of the British engineer, Malcom Rae (1913-1979) and the potentising devices he developed in the 1960s.

Yet another technique used by few homeopaths involves using "a paper remedy. Write the remedy and potency on a piece of paper and place the paper on the left hand side of the body with the writing towards the body." One homeopath, "finds out what they need, writes the remedy down on a piece of paper, they put it in their pocket and it works." In essence, this comprises an emerging alternative homeopathic tradition, "`paper remedies' i.e., a name of a remedy just written on a piece of paper." However, skeptics might observe that this procedure is essentially a textbook example of how to produce the Placebo Effect and that any success at using such a technique should be weighed carefully (and preferably with supporting experimental evidence in the form of a double-blind placebo-controlled study) against the possibility that nothing more than mental suggestion due to a placebo is at work.

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 sensitivity and previous reactions to remedies; and the practitioner's preferred posology (dosing 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 and 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.

Miasms as a cause of disease
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 (suppressed gonorrhoea), and Psora.

This miasm theory was first published in 1828. Though Hahnemann first suspected miasms in 1816, he took 12 years before he published his views. He adopted a reclusive lifestyle while residing in Koethen and his new inclination towards metaphysical pursuits may explain his sudden adoption of Olfaction (inhaling the remedy), which he continued to use until his death in Paris in 1843. Olfaction might derive from Arabian medicine and the art of Perfumery.

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 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. Today, some homeopathic practitioners 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 between the multitude of 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.

The miasm theory is not the only meaningful aspect of homeopathy. For example, Hahnemann strongly advocated good hygiene, fresh air, regular exercise, and good nutrition as precursors of good health (see his 1792 essay: The Friend of Health); he was also a pioneer in 1792-3 of humane treatment of the insane (1796, 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. Hahnemann's acceptance of the emerging idea of infectious disease before its final proof by Robert Koch and Louis Pasteur indicates some of his medical views incorporated ideas that were at the cutting-edge of contemporary science. These 17th-century epidemiological theories built on the ideas of Girolamo Fracastoro in the 16th century and the discovery of microbes by Anton van Leeuwenhoek one hundred years previously.

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 (by such methods as bloodletting and purging, laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms, such as by lowering the body temperature of patients who were feverish. By contrast, Hahnemann promoted an immaterial, vitalistic view of disease: "...homeopathy...can easily convince...that the diseases of man are not caused by any substance, any acridity...any disease matter, but that they are solely spirit-like (dynamic) derangements of the spirit-like power (the vital principle) that animates the human body."

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 (1789) 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.

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 (1731-1803), "in the 1760’s, who advocated treatment by cautious use of poisons." Indeed, Hahnemann had studied briefly in Vienna (1777) 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 admired, and whose Materia Medica he translated in 1806. It might be said the proving experiment came to Hahnemann from several previous sources.

For Hahnemann, the whole body and spirit was the focus of therapy, not just 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.

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. His most important contribution may be his repertory, which is still used today. Kent's attempt to rescue an idealized pure homeopathy from what he saw as its degenerate mongrel forms was authoritarian, as he sought to re-emphasize the metaphysical and clinical aspects of Hahnemann's teachings, in particular:


 * insistence on the core doctrines of miasm and vital force;
 * emphasis on case totality rather than rote prescribing for 'named diseases'
 * emphasis on psychological symptoms (to supplement physical pathology) in prescribing; and
 * regular use of very high potencies.

Influenced by Swedenborgianism, Kent reputedly emphasized 'spiritual factors' as the root cause of disease. "'...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.'"

See also: List of important homeopaths

Homeopathy around the world
There are estimated 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.

Britain
Homeopathy was first established in Britain by Dr Frederick Quin (1799-1878) around 1827, though two Italian homeopathic doctors (Drs Romani and Roberta) had been employed two years previously by the Earl of Shrewsbury based at Alton Towers in North Staffordshire; however, they soon returned to Naples as they could not tolerate the cool damp English climate. Homeopathy in the UK quickly became the preferred medical treatment of the upper classes: Regarding Dr Quin, "...with his connections, he was quickly established among the well-known and wealthy. Quin counted the Dukes of Edinburgh and Beaufort among his patients, and became physician to the household of the Duchess of Cambridge." Furthermore, "the principal supporters of the (homeopathic) hospital, until Quin's death in 1878, were members of the aristocracy." Homeopathy in Britain "...retained an elite clientele, including members of the royal family." and "...homeopathy still had much support from people in high places in the mid-nineteenth century..." At its peak in the 1870s Britain had numerous homeopathic dispensaries and small hospitals as well as large busy hospitals in Liverpool, Birmingham, Glasgow, London and Bristol, almost exclusively funded and run by members of the local gentry. For example, the Bristol hospital Image was funded and run by several generations of the W.D. & H.O. Wills tobacco family, while the Hahnemann Hospital Liverpool Image was built by members of the Tate family of sugar importers, who also funded the Tate Gallery in London.

In Britain, homeopathic remedies are sold over the counter. Today Britain has five homeopathic hospitals, funded by the National Health Service, which together with many regional clinics make free homeopathic treatment available on the health service. Homeopathy is not practised by most of the medical profession, but there is public support for it, including from the Prince of Wales and many other members of the royal family. Rumour has it that it was after homeopathy was used in treating King George V for seasickness in the 1920s or 1930s that the British royal family became firm devotees of this medical system.

The largest organisation of homeopaths in Britain, 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. The medically qualified homeopaths in Britain 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."

India
Homeopathy arrived in India with Dr John Martin Honigberger (1795-1869) in Lahore, in 1829-30, and is officially recognized. "The first doctor who brought homeopathy to India was Dr. Martin Honigburger, who first came to the Punjab...in 1829." India has the largest homeopathic infrastructure in the world, with 300,000 qualified homeopaths, 180 colleges, 7500 government clinics, and 307 hospitals. The Association of Qualified Homoeopaths in India (IHMA) is the largest of its kind.

USA
Homeopathy was first established in the USA by Dr Hans Burch Gram (1787-1840) in 1825 and rapidly gained popularity, partly because the excesses of conventional medicine were extreme there, and partly due to the efforts of Dr Constantine Hering (1800-1880): "Dr. Hering immigrated to America in 1833 and later became known as the father of American homeopathy." Homeopathy in the US rose to great prominence. "By 1826 homeopathy had taken root in France, Italy, England and the Scandinavian countries....the doctrine arrived in New York in 1825." "Homeopathy spread first in Germany, then France, and England. Its greatest popularity, however, was in America." "Nowhere did (homeopathy) flourish as luxuriantly as in the United States." "...by the early 1840s American homeopathic practitioners were gaining considerable influence and prestige." The use of homeopathy in America increased still further in the next decade, ''In the period 1880-1900 they were at the height of their influence. Hardly any city numbering over 50,000 souls was without a homeopathic hospital and many smaller communities could claim them. In 1890 there were 93 regular schools, 14 homeopathic and 8 eclectic. In 1900, there were 121 regular schools, 22 homeopathic and 10 eclectic." "Homeopathy enjoyed wide popularity after 1841...many orthodox physicians gradually embraced homeopathy."''

Historical note
In the 1930s homeopathy's popularity waned, especially in the USA and Europe, due in part due to advances in conventional medicine, skepticism, and the active advocacy against homeopathy by the American Medical Association. This led to the closure of virtually all medical schools teaching alternative medicine in the USA.

Homeopathy reached a peak of popularity in 1865–1885 and thereafter declined due partly to recognition by the establishment of the dangers of large doses of drugs and bleeding, and via dissent between different schools of homeopathy. The Carnegie Foundation issued the Flexner Report sponsored by the American Medical Association in 1910 that supported conventional medical schools while condemning homeopathic schools.

The Federation of State Medical Boards voluntarily agreed to base its accreditation policies for all medical schools on academic standards determined by the AMA's Council on Medical Education. Consequently, the CME's decisions "came to have the force of law." By the 1930s, the combined efforts of state licensing boards, philanthropic foundations, and the AMA's CME resulted in the eradication of America's proprietary medical colleges including homeopathic schools.

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 practitioners 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 criteria based on various systems. Many members of the public are unfamiliar 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
Homeopathy is much more popular in Europe and India than in the USA. Surveys taken between 1985 and 1992 found that the percentage of the population that reported having used homeopathy at some time for various countries was:

A more recent study indicates that the percentage of people seeking homeopathic treatment in the United States significantly declined from 3.4% in 1997 to 1.7% in 2002.

Early critiques of high dilutions
Sir John Forbes (1787-1861), physician to Queen Victoria (1841-61) said the extremely small doses were regularly derided as useless, laughably ridiculous and "an outrage to human reason." 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." . Nineteenth century American physician and author Oliver Wendell Holmes, Sr. was a vocal critic of homeopathy and published an essay in 1842 entitled Homeopathy and Its Kindred Delusions.

Mechanism of action of homeopathic preparations
Since homeopathic remedies at potencies higher than about D23 (10-23) contain no detectable ingredients apart from the diluent (water, alcohol or sugar), there is no known basis for them to have medicinal action. Some tests suggest that potentized solutions up to D120 can have statistically significant effects on organic processes, including the growth of grain, histamine release by leukocytes, and enzyme reactions. These publications are very controversial since attempts to replicate some of these studies on leukocytes and enzymes have failed, even when using the potentization method. A recent review of tests of high potencies summarized the situation as follows: "...there are some hints from experimental research that homeopathic substances diluted and succussed beyond Avogadro’s number are biologically active but there are no consistent effects from independently reproducible models." , although the referenced journal is not generally regarded as being of high scientific quality.

These positive studies are unusual since no effects of high dilutions are seen in the huge number of similar studies on other 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 hundreds of thousands of experiments on organisms as diverse as nematodes, rats and humans.

Although some patients report benefits from homeopathic preparations, the large majority of scientists attribute this to the Placebo Effect, the regression fallacy and/or the Forer effect. Ideally, drugs are tested in large, multi-centre, randomised, placebo-controlled double-blind clinical trials, to test whether the drug has an effect that is significantly better than a placebo or an alternative treatment. Many clinical trials that partially meet these criteria have investigated homeopathy, and some have indicated efficacy above placebo. However, many of the trials are open to technical criticism or involve samples that are too small to allow firm conclusions to be drawn.

Some homeopathic apologists claim that orthodox double-blind trials are inherently insufficient for deriving evidence for the technique. For example, a spokeswoman from the UK Society of Homeopaths has said: "It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy" since homeopathy is positioned as a holistic treatment, incorporating psychological/spiritual concerns as well as an active ingredient. Some critics have noted that homeopathy includes falsifiable claims, even if that is only part of the homeopathic process, or simply that such claimed immunity from orthodox scientific scrutiny is reminiscent of pseudoscience.

European Journal of Cancer 2006 study
In January 2006 the European Journal of Cancer published a meta-analysis of six trials of homeopathic treatments for recovery from cancer therapy, including radio- and chemo-therapy. 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 recovery.

Lancet 2005 study
In August 2005, The Lancet published a meta-analysis of 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 design, as another "global" meta analysis of homeopathy, not an analysis of particular effects, i.e. it tested the global hypothesis that the reported effects of homeopathy are placebo effects. If this is accurate, then the reported positive effects are due to 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 conventional medicine trials for identical analysis. These were matched for study disease and sample size, but not for trial quality which was significantly better in the homeopathic trials than the randomly chosen biomedical trials. 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 Lancet accompanied the meta-analysis with invited editorials. The Lancet rejected the majority of criticisms submitted for publication. Some of the correspondence rejected by the Lancet was subsequently published in the Journal of Alternative and Complementary Medicine.

British Medical Journal 1991 study
In 1991, three professors of medicine from the Netherlands, 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. Still, 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.

The meta-analysis on homeopathy concluded, "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials." (Publication bias, also called the "file-drawer effect", refers to the tendency of scientists and journal editors to prefer to report and publish positive results, while negative or inconclusive results are more likely to end up buried in the bottom of the proverbial file drawer; it can cause a meta-analysis to report positive results when there is no underlying effect.)

Basophil stimulation
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 they 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). However, other investigators failed to find any effect from these ultra-dilute solutions and suggested that methodological problems accounted for the positive results.

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 health-care practices, for it is "the expression of the scientific method in clinical medicine." 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.

Systematic reviews conducted by 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 appears to shorten the duration of the disease. Systematic reviews conducted by other researchers found insufficient evidence that homeopathy is beneficial for osteoarthritis, migraine prophylaxis, delayed-onset muscle soreness, or symptoms of menopause.

Medical organizations' attitudes towards homeopathy

 * The National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, states that:
 * Results of individual, controlled clinical trials have been contradictory, with some saying it was no better than a placebo, with other trials having results "the researchers believed were greater than one would expect from a placebo." However, this implies a placebo was not actually used.
 * "Systematic reviews have not found homeopathy to be a definitively proven treatment for any medical condition."
 * A number of its key concepts defy chemistry, physics, and other sciences.
 * It is uncertain how a remedy with so little, "perhaps not even one molecule" of its active ingredient could have any biological effect.
 * Effects might be due to the placebo effect or similar non-specific effects.
 * It is still largely untested whether it actually works for some of the diseases it's claimed to work for, and if it did work, how it would.
 * NCAAM says that "there is a point of view" that it works, but is unexplained how, and that a lack of explanation is "not unique to homeopathy." It also says that some feel, as long as it seems "helpful and safe", no scientific explanation is necessary.
 * It continues to fund research into homeopathy.


 * The UK National Health Service's "Health Encyclopedia" entry on homeopathy includes the following:
 * Around 200 randomised controlled trials evaluating homeopathy have been conducted, and there are also several reviews of these trials. Despite the available research, no clinical evidence has shown that homeopathy works. Many studies suggest that any effectiveness that homeopathy may have is due to the placebo effect, where the act of receiving treatment is more effective than the treatment itself.
 * Medical doctors and scientists do not generally accept homeopathy because its claims have not been verified to the standards of modern medicine and scientific method. Scientists argue that homeopathy cannot work because the remedies used are so highly diluted that in many there can be none of the active substance remaining.


 * 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 Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy states that:
 * 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.
 * Homeopathy 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." 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"

United States
In the United States, homeopathic remedies are, like all health-care products, regulated by the Food and Drug Administration. However, the FDA treats homeopathic remedies very differently than conventional medicines. Homeopathic products do not need FDA approval before sale; they do not have to be proven 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.

A memorandum written in 1985 by attorneys for the American Association of Homeopathic Manufacturers, describes a meeting between the AAHP attorneys and high-ranking FDA officials to discuss whether homeopathic products must be proven effective to remain legally marketable.

Such negotiations led to the issuance in 1988 (revised in 1995) of an FDA Compliance Policy Guide that permits homeopathic products "intended solely for self-limiting disease conditions amenable to self-diagnosis (of symptoms) and treatment" to be marketed as nonprescription drugs.

An extensive history of the FDA regulation of homeopathic drugs in the USA has been written by Suzanne White Junod, Ph.D.

Germany
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. Most private health insurers continue to cover homeopathy.

Switzerland
In Switzerland, homeopathic medications were formerly covered by the basic health insurance system, if prescribed by a physician. This ended in June 2005. 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 change applied only to compulsory insurance; homeopathy and other complementary medicine is covered by additional insurance, if the treatment is provided by a medical doctor.

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, for example Dr. Schüssler's biochemic cell salts) and components of animal origin, such as duck liver in the remedy oscillococcinum.

In herbology, measurable amounts are used, while in homeopathy the active ingredient is diluted until it is no longer detectable, or 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 based only 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 therapies. For example, some companies combine homeopathic with non-homeopathic substances such as herbs or vitamins, and some preparations marketed as such 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 protect. Hahnemann interpreted the introduction of vaccination applied nowadays as such: But to use a human morbific matter (a Psorin taken from the itch in man) as a remedy for the same itch or for evils arisen therefrom, stay away from it! Nothing can result from this but trouble and aggravation of the disease. Roberts: giving the identical instead of the similar means the difference between isopathy and homoeopathy.

According to homeopathy, the body could become susceptible to "morbific noxious agents". The challenge of the homeopath is to prevent disease in the first place with the first sign of symptoms. This could be imminent long before an acute disease appears. Hahnemann classified succeeded vaccination of smallpox due to the interaction of two similar diseases (the law of similars). When an epidemic is near, one or a few remedies could be chosen to treat a population in order to prevent the epidemic. Hahnemann gave this the description of acute collective diseases. When the epidemic is there, according to Hahnemann, the homeopath observes a complete picture of the epidemic and can constitute from a small box of remedies the fitting remedy to each individual patient. In contrast, modern scientists and doctors see the two practices as fundamentally different. A vaccine is usually a preparation made from a bacterium or virus that cannot cause disease, 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 prevent or cure it with dilutions. Another important difference is that vaccine contains measurable amounts of antigen, usually proteins or carbohydrates from the disease-causing organism, whereas homeopathic remedies have been diluted to such an extent they are unlikely to contain any detectable active ingredients. The predominant view of homeopaths is that vaccination is not consistent with the principles of homeopathy, even if it is an application of the law of similars, they also believe that vaccination holds serious short and long-term (health) consequences and that vaccination may potentially arouse latent inherited and constitutional weaknesses. However, their main objection is that vaccination is a mass-applied technique based on the germ theory of disease, a view homeopaths reject, instead preferring to individualize each case of sickness.

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 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  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.

Dangers in misguided advice
Opponents of homeopathy argue that since homeopathy is ineffective, it could indirectly result in harm to patients who refuse medical care (see opportunity costs). For example, a 2006 survey by the UK charitable trust "Sense About Science," revealed homeopathic practices that were advising travelers against taking conventional anti-malarial drugs, instead providing them with a homeopathic dilution of quinine. Even the director of the The Royal London Homeopathic Hospital condemned this 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.".

Professional organizations

 * Alliance of Registered Homeopaths - UK
 * The Council of Organisations Registering Homeopaths - UK
 * North American Society of Homeopaths
 * The Society of Homeopaths - UK
 * The Irish Society of Homeopaths - Ireland
 * List of homeopathic initials Common abbreviations used in homeopathy (association memberships, certifications, et cetera).

Neutral

 * A recent article on homeopathy testing from the Annals of Internal Medicine
 * BBC's Horizon on homeopathy (transcripts, discussion, etc.)
 * Can homeopathy withstand scientific testing? 30 November 2004 by F.J. van Sluijs A recent Dutch overview.
 * Columbia-Presbyterian Hospital's presentation of homeopathic medicine
 * Complementary Medicine - Therapies: Homeopathy BBC's "Complementary Medicine" article on Homeopathy
 * Copeland's Cure: Homeopathy and the War between Conventional and Alternative medicine by Natalie Robins Alfred A. Knopf, publishers, 2005
 * FDA's view of homeopathy
 * Homeopathy National Institute of Health - Fact Sheet
 * Homeopathy In Perspective &mdash; critical online book, covering the history and present state of homeopathy
 * Water Structure and Behaviour&mdash; balanced and up-to-date references to current scientific understanding of water, with specific entries on "memory effects" and homeopathy
 * Christian Friedrich Samuel Hahnemann A historical overview
 * "Reporting Data on Homeopathic Treatments (RedHot): A Supplement to CONSORT"

Advocacy

 * All About Homeopathy
 * Homéopathe International &mdash; The English language version of Homéopathe International
 * Webhomeopath - An on-line homeopathic repertory
 * Online Repertory Version 2.0
 * A condensed history of homeopathy
 * Australasian College of Health Sciences College specializing in online holistic health education

Critical

 * An Overview By Steven Novella
 * Are the clinical effects of homoeopathy placebo effects?.pdf. A 2005 study published in The Lancet.
 * HomeoWatch &mdash; A Skeptical Guide to Homeopathic History, Theories, and Current Practices
 * Magical Thinking in Complementary and Alternative Medicine
 * The British Veterinary Voodoo Society
 * Malaria Risk of Homeopathic Advice
 * "The Scientific Evidence on Homeopathy" - American Council on Science and Health
 * The Skeptics Dictionary
 * James Randi Explains Homeopathy - Video