Homeopathy/PreviousVersion: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Gareth Leng
imported>John Stephenson
({{PreviousVersion}})
 
(574 intermediate revisions by 13 users not shown)
Line 1: Line 1:
{{subpages}}
{{PreviousVersion}}
{{TOC|right}}
<div class="usermessage plainlinks">The Editorial Council has made a unanimous decision on December 17, 2010, to blank this draft article and to place a minimum of a one-year moratorium on any further edits to this article. The discussion concerning this decision may be found at [http://locke.citizendium.org/cz_ec/DR-2010-006].  The Talk page remains, but its present contents will be moved to an archive.  The Approved Main Article also remains in place. This page is now protected by the Constabulary and no further edits can be made to it. After one year has passed, Citizens may ask the Editorial Council to reconsider their decision but there is no guarantee that they will do so.  
'''Homeopathy''' or '''homoeopathy'''&mdash;from  the Greek ''hómoios'' (similar) and ''páthos'' (suffering)&mdash;is a system of [[Complementary and Alternative Medicine|alternative medicine]] based on the idea that substances known to ''cause'' particular combinations of symptoms in healthy people can also, in low and specially prepared doses, help to ''cure'' people whose disease has similar similar symptoms.
<br>
The Secretary of the Editorial Council, [[User:Hayford Peirce|Hayford Peirce]] 04:09, 17 December 2010 (UTC)


Homeopathic remedies are intended to stimulate the body's natural healing processes. Because homeopaths maintain a high respect for the "wisdom of the body," homeopathic medicines are prescribed for their ability to cause or mimic the similar symptoms that the sick person is experiencing, thereby aiding their own defenses. Hygiene and diet are also used by homeopaths in conjunction with the use of homeopathic remedies.  
==== Moratorium extended ====
The moratorium has been extended by another year. [http://ec.citizendium.org/wiki/EC:D-2012-002 EC:D-2012-002]. --[[User:Peter Schmitt|Peter Schmitt]] 01:20, 20 January 2012 (UTC)
</div>


Two basic ideas in homeopathy are the '''principle of similars''', sometimes stated as "like cures like", and the '''principle of infinitisimals''', the idea that remedies become ''more'' potent as they undergo a specific process called '''potentization,''' which includes serial dilution of the remedies with vigorous shaking in-between each dilution. '''Provings''' determine the indications for usage by administering small doses of substances to healthy volunteers and recording their symptoms.
<hr><br>
 
Homeopathy is well established worldwide; both homeopathic practitioners and over-the-counter homeopathic remedies are widely available. Many national health insurance schemes include homeopathic treatments among the things they will pay for, and some medical doctors sometimes prescribe homeopathic remedies. There have been national and international homeopathic associations since the 19th century. See our [[homeopathy/External_Links#Homeopathic_Organisations|external links]] for a list.
 
That said, the consensus of medical and scientific judgment is that homeopathy is unfounded.<ref>{{citation
| first = Simon | last = Singh
| first2 = Edzard | last2 = Ernst
| title = Trick or Treatment? Alternative Medicine on Trial
| publisher = Bantam Press| year = 2008}}</ref> Most importantly, there is little, if any, objective evidence that homeopathy is effective. Neither of the main homeopathic principles &mdash; similars and infinitisimals &mdash; makes sense to the critical scientific mind. The "principle of similars" appears to be merely an appeal to [[sympathetic magic]], or at best an over-generalisation of a principle that actually applies in only a few cases. The "principle of infinitisimals" contradicts both common sense and scientific results; there is no plausible mechanism to explain how the remedies might work, given that many of them are so dilute that they contain not a single molecule of the active ingredient. See our [[homeopathy/External_Links#Critical|external links]] for some strongly critical assessments.
 
To most physicians and scientists, it is utterly obvious that a patient whose body is infected with a microbe needs adequate doses of a medicine which kills that microbe. There is just no room in this worldview for the idea that miniscule doses of a substance chosen by criteria unrelated to the microbe could have any useful effect.
 
Homeopaths have rejoinders to all the above. In particular, they claim that many of the studies in which homeopathy appears no more effective than a [[placebo]] are methodologically flawed &mdash; they either did not follow proper homeopathic procedure in preparing the remedies or did not apply them properly, with due attention by a skilled practitioner to matching the remedy to the ailment. Of course, these arguments do not apply to over-the-counter products based on homeopathic remedies, but that case is often ignored in the discussion. If one accepts the homeopathic assertion &mdash; which is vigorously seconded by some of their patients though not by scientific studies &mdash; that their remedies, properly applied, ''do'' work, then their principles become credible as well. The idea of [[memory of water]] is used to explain the effects of tiny doses.
Homeopaths point to a long safety record for their very dilute remedies and even those skeptical of their claims do not doubt the safety of those remedies – an inert substance is not going to harm anyone. The concern is that people who use homeopathy as an alternative to medical care take additional risk when they forego conventional treatment for serious illness such as anti-inflammatories and bronchodilators for [[asthma]], or do not receive established preventive treatments, such as vaccines or anti-malarial drugs.<ref>BBC Newsnight, [http://news.bbc.co.uk/1/hi/programmes/newsnight/5178122.stm Malaria advice 'risks lives']</ref>
 
==Overview==
Homeopaths assert that the overall body of evidence for homeopathy, including trials of efficacy, basic sciences research, historical usage of homeopathic medicines in the treatment of people in various infectious disease epidemics and cost-effectiveness studies provide reasonable evidence for its benefits.<ref>Bell I (2005) All evidence is equal, but some evidence is more equal than others: can logic prevail over emotion in the homeopathy debate? ''J Alt Comp Med'' [http://www.jspshomeocollege.in/Research/Article-3%20JACM.pdf 11:763–9].</ref>  Generally, natural scientists and medical doctors doubt that homeopathic treatments have any efficacy. They regard the evidence in support of efficacy as extremely weak, and point out that the claims made regarding homeopathy's underlying mechanism require an extraordinary level of proof to overcome their inherent impplausibility.
 
Many famous people over the past 200 years have been users and advocates of homeopathy<ref>Dana Ullman (2007) ''The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy.'' Berkeley: North Atlantic, 2007; www.HomeopathicRevolution.com</ref>, and it is an important thread in the history of medicine. The growth of homeopathy in the 19th century influenced how conventional medicine organised and  how it came to formulate its present vision of evidence-based medicine, in contrast to practice based on individual clinical experience.
 
Homeopathic remedies are used by many people throughout the world, and homeopathy generally scores highly in "patient satisfaction" surveys. In the U.K. for instance, a survey cited by the British Homeopathic Association found that 15% of the public "trust" homeopathy. It also found higher percentages of trust in homeopathy in other countries: 58% Brazil, 53% Chile, 49% Saudi Arabia, 40% France, 28% Russia, 27% Germany, and 18% USA. That said, patient satisfaction and strength of public support for a treatment does not count as scientific evidence&mdash;just because a lot people believe something to work does not make it work (see [[argumentum ad populum]]).
 
Scientists and medical professionals are also often interested in homeopathy, especially in why homeopathy is so widely used when they regard it as having no rational foundation.<ref>Rothstein, W. Physicians in the Nineteenth Century. Baltimore: Johns Hopkins University Press, 1972.</ref> <ref>Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the German health interview and examination survey for children and adolescents (KiGGS). Pharmacoepidemiol Drug Saf. 2009 Feb 23.</ref> <ref>Nathanson I ''et al.'' (2007) Factors influencing complementary and alternative medicine use in a multisite pediatric oncology practice. ''J Pediatr Hematol Oncol'' 29:705-8.</ref> They are interested too in why some studies appear to have positive outcomes&mdash;do these reflect real efficacy, or can they be accounted for by flaws in study design or in statistical analysis, or "[[publication bias]]"&mdash;the tendency for small studies with chance positive outcomes to be published while studies with negative or inconclusive outcomes are not. They also are interested in whether positive results against expectation sometimes reflect manipulation of data or perhaps even fraud.
==Principles==
The principles of homeopathy were first methodically set out by a German physician, [[Samuel Hahnemann]] (1755–1843), who observed that a medicine sometimes evoked symptoms similar to those of the illness for which it was prescribed.
In traditional homeopathic theory, every person has a [[Vital force|"vital force"]], with the power to promote healing and/or maintain good health. Homeopaths believe that this "vital force" is akin to what [[physiology|physiologists]] would call the body's "defense systems" or to ''[[qi]]''<ref>See [[Qi#Romanization|the Romanization section on the Qi article]] for details of Romanization of the Chinese term ''qi''.</ref> in [[traditional Chinese medicine]].  In this theory, the signs and symptoms of a disease reflect efforts of the body to counter infection, or to resist damage from environmental toxins or from various stresses.  Homeopathic treatment – it is claimed – attempts to strengthen this "vital force" with the help of remedies that are chosen for their ability (in large doses) to provoke the very symptoms that the remedy is intended to heal by stimulating the natural healing processes with the help of sub-physiological doses of a remedy.
 
"[[Classical homeopathy]]" or "Hahnemannian homeopathy" refers to the original principles of this medical system in which a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing rather than only the diagnosis of a disease. "[[Commercial homeopathy|Commercial]]" or "user-friendly" homeopathy refers to the use of a mixture of remedies in a single formula containing individual ingredients that are generally chosen by the manufacturer for treating specific ailments.
===''Similia similibus curentur'' : the law of similars===
 
''Similia similibus curentur'' or "let likes cure likes", is the assertion that a disease can be cured by remedies that (in macroscopic, milligram doses) produce the same symptoms as those of the disease. This "law" is a guiding principle in homeopathy. Homeopaths consider that [[vaccination]], and [[hormesis]]
<ref>[[Hormesis]] describes the phenomenon that some chemicals at high concentrations have opposite biological effects to those at low concentrations. See: Calabrese EJ, Baldwin LA (1998) Hormesis as a biological hypothesis ''Environmental Health Perspectives Suppl'' [http://www.ehponline.org/members/1998/Suppl-1/357-362calabrese/full.html 106, S1].  A special issue of ''Human and Experimental Toxicology'' devoted itself to this body of research and its relationship to homeopathy, discussing the possibility that hormesis might help explain the mechanism for homeopathic low dose dilutions, though falling short of using it to explain the ultra-high dose dilutions of some remedies. See ''Human and Experimental Toxicology'' July 2010: 
http://het.sagepub.com/content/vol29/issue7/
To access free copies of these articles, see:  http://www.siomi.it/siomifile/siomi_pdf/BELLE_newsletter.pdf </ref>
are analogous to homeopathy's law of similars and the use of small doses. Scientists and medical doctors today do not think that this law is generally true or useful, and they explain the efficacy of vaccination without referring to it. Although homeopathic remedies and vaccinations both use low doses of ingedients, the doses in remedies are ''very'' much lower than those in vaccines. Vaccines produce a measurable immune response (e.g., [[immunoglobulin]] production); homeopathic remedies do not. Thus conventional treatments involve measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic remedies above the <math>24X</math> (<math>12C</math>) potencies do not contain enough molecules to activate any known metabolic or signalling pathway.<ref>Vaccine doses are calculated from the TCID<sub>50</sub> dose; the minimum dose required to infect 50% of tissue cultures tested in a laboratory assay. A single dose of measles vaccine will contain at least 1,000 x the TCID50 dose in 0.5 ml.[http://www.drugs.com/ppa/measles-mumps-and-rubella-vaccine-live.html Measles, Mumps, and Rubella Vaccine, Live]</ref>
Homeopaths also contend that the "principle of similars" (treating "like" with "like") also serves as the basis for vaccination and allergy desensitation shots, two of the few methods in modern medicine that augment immune response to either prevent or treat disease, while non-homeopaths assert that these modern medical treatments are not based on any homeopathic principle but on specific immunological and allergy research.  Related maxims such as the "principle of similars" are common in anthropological literature, and also are called [[sympathetic magic]].<ref name=Fraser>{{citation
| url = http://www.gutenberg.org/dirs/etext03/bough11h.zip
|first =James George | last = Frazer
| contribution = Chapter III: Sympathetic Magic; 1. The Principles of Magic
| title = The Golden Bough:  A study of magic and religion
| publisher = Project Gutenberg}}</ref><ref name=>{{citation
|title =Early Anthropology in the Sixteenth and Seventeenth Centuries
| first= Margaret Trabue | last =Hodgen
| publisher = University of Pennsylvania Press | year= 1964
| url = http://books.google.com/books?id=Wa12Spdp_WYC&pg=PA392&lpg=PA392&dq=%22like+cures+like%22+anthropology&source=bl&ots=ffDShkiaCD&sig=wNySoaO7B5gqz89DgEGQU7eCCrg&hl=en&sa=X&oi=book_result&resnum=3&ct=result}}, p. 392</ref><ref name=Scofield>{{citation |
| title = Homeopathy “Similia Similibus Curentur”
|first= Edward L.W. | last = Scofield
| journal = Innominate Society | date = June 20, 2001
| url = http://www.innominatesociety.com/Articles/Homepathy%20Similia%20Similibus%20Curentur.htm}}</ref>
 
==Historical origins ==
{{main|History of Homeopathy}}
The early Greek physician [[Hippocrates of Cos]] (c. 450 BCE - 380 BCE)<ref name=Hippo1>{{citation | url = http://www.iep.utm.edu/h/hippocra.htm | title = Internet Encyclopedia of Philosophy | contribution = Hippocrates (c. 450 BCE to 380 BCE) | first = M | last = Boylan | year = 2006}}</ref>, who is considered to be the "father of medicine", is also claimed by homeopaths as a pioneer in their own tradition — because he taught that "Natural forces within us are the true healers of disease," and because he thought that some diseases could be cured by the same things that caused them.<ref>'''Note:''' It would help to provide chapters and verses from the ''Hippocratic Corpus'' so that readers can pursue the issue and perhaps expand it, as well as evaluate it in context.</ref> In the late 18th century, this theory was coupled with a method to indicate what symptoms a substance causes and thereby what a particular medicine might cure. This method was developed by [[Samuel Hahnemann]] with his method of "provings"—studies of the effects, in humans, of high dosages. In 1783, disillusioned with the medicine of his time and the many toxic effects of its treatments, Hahnemann gave up his medical practice and devoted himself to translating medical books. Among them was the ''Treatise on [[Materia Medica]]'' (1789) by [[William Cullen]], the leading physician of the 18th century. Cullen had written that cinchona bark (which contains [[quinine]]) was effective in treating [[malaria]] because of its bitter and astringent properties. Hahnemann questioned this, because he knew that other substances were as bitter and astringent, but had no therapeutic value in this disease.<ref>{{citation
| author = Morrell P
| url = http://homeoint.org/morrell/articles/index.htm
| title = Articles on Homeopathy}}</ref><ref name=Timeline>{{citation
| title = Homeopathy Timeline
| journal = Whole Health Now: Homeopathy Information for the Professional
| url = http://www.wholehealthnow.com/homeopathy_pro/homeopathy_1825_1849.html}}</ref>
 
Hahnemann observed that the effects he experienced from ingesting cinchona bark were similar to the symptoms of malaria. He observed similar results with other substances, and so conceived of the ''law of similars'', or "let like be cured by like" (Latin: ''similia similibus curentur''). He believed that, by inducing symptoms similar to the disease, the [[vis medicatrix naturae]] or natural healing processes of the body would be stimulated enough to neutralise the disease. From these ideas, Hahnemann developed a new system of health care, which he named "homoeopathy" (meaning "like disease") - and coined the term "[[allopathy]]" ("different than disease") to refer to the ''conventional medicine of the day'', justifiably referred to as [[heroic medicine]] because its physicians used large doses of highly toxic compounds to combat disease, and procedures such as [[phlebotomy#Classic bloodletting|bloodletting]] and [[leeching]]. <ref>Hahnemann S (1796) translated into English as [http://www.minutus.org/library/article_read.asp?id=6 "Essay on a New Principle"]. Hahnemann's[http://www.homeopathyhome.com/reference/organon/organon.html
''Organon der Heilkunst''] in English translation</ref>
 
For the first two decades, Hahnemann used "crude" doses of medicinal substances ("crude", in homeopathic use, means doses that still contain some of the original ingredient). He strove to find the lowest doses at which his remedies would still be effective, and he concluded that his remedies worked better the more he diluted them as long as he “potentized” them, i.e. serial dilution followed by vigorous shaking (succussion). Homeopathy thus became inextricably linked with [[ultradilution]]—repeated dilution of substances - followed by succussion. Hahnemann had no clear explanation as to how or why these potentized remedies might have benefits; he distrusted all theoretical explanations and argued that all that mattered was whether a treatment was therapeutically effective.<ref>Dean ME (2001) [http://shpltd.co.uk/dean-homeopathy.pdf Homeopathy and the progress of science] ''Hist Sci''xxxix</ref>. He believed that diseases were caused by "spirit-like derangements of the spirit-like power that animates the human body", beginning with 'indispositions' and that effective healing called for treatments that would stimulate this life force.
 
In 1830, the first homeopathic schools opened (the first in the U.S.A. opened in 1835), and through the 19th century dozens more appeared in Europe and the U.S.A. In 1844, the first U.S. national medical association - the [[American Institute of Homeopathy]] - was established.<ref>[http://www.homeopathyusa.org/ American Institute of Homeopathy]
:Winston, J (2006) "[http://www.wholehealthnow.com/homeopathy_pro/homeopathy_1825_1849.html Homeopathy Timeline]". The Faces of Homoeopathy. Whole Health Now.</ref>
By the end of the 19th century, 8% of American medical practitioners were homeopaths, and there were 20 homeopathic medical colleges and more than 100 homeopathic hospitals in the U.S.A. One reason for the growing popularity of homeopathy was its relative success in combatting the  epidemics that raged at the time.<ref>Coulter HL (1973) ''Divided Legacy'' (vol. II, pp 544-6; III, pp 267-70, 298-305). Berkeley: North Atlantic</ref> [[Cholera]], [[scarlet fever]], [[typhoid fever]], and [[yellow fever]] killed many people, but death rates in hospitals that used heroic medicine were typically two- to eight-fold higher than in homeopathic hospitals.<ref> Bradford TL (1900) ''The logic of figures: The comparative results of homeopathic and other treatments.'' Philadelphia: Boericke and Tafel</ref>
 
In the early 20th century, the "[[Flexner Report]]"  triggered major changes in American medical education. Many medical schools and colleges, including those teaching homeopathy were closed down, while others became devoted to a new vision of science-based medicine that replaced the discredited heroic medicine. Nevertheless, in the 1960's, the popularity of homeopathy began to revive in the U.S.A, and a 1999 survey reported that over 6 million Americans had used homeopathy in the previous 12 months.
 
===Homeopathic "provings"===
{{main|Homeopathic proving}}
Homeopathic practitioners determine the therapeutic indications for their remedies from ''provings,'' in which volunteers are given repeated doses of substances (usually in single-blind or double-blind protocols), and keep a diary of any apparent symptoms. The effects  are recorded in textbooks, called ''Materia Medica''<ref name=Boericke-Materia>{{citation
| title = Homeopathic Materia Medica
| first = WE | last = Boericke
| url =http://www.homeoint.org/books/boericmm/index.htm
}}</ref>
and ''Repertory'',<ref name=Boericke-Repertory>{{citation
| title = Repertory
| first = OE | last = Boericke
| url = http://www.homeoint.org/books4/boerirep/index.htm
}}</ref>
or nowadays in expert system software. [[Homeopathic proving]]s provide the basis to determine what a substance causes in overdose and thereby what it is thought to cure. The symptom complexes that these substances cause are used to compare with a patient's symptoms in order to select, as the appropriate most similar ''remedy'', the substance whose effects are closest to the patient's symptoms—called the "simillimum". Homeopaths prescribe a remedy (in potentized doses) when a sick person has a syndrome of symptoms that resembles the syndrome of symptoms that it causes in drug proving.
 
In 2006, the U.K.’s licensing body, the ''Medicine and Healthcare Products Regulatory Agency'', altered their regulations to permit homeopathic remedies to be advertised using homeopathic provings to support their claims (justifying phrasing such as “For the relief of...”. This elicited protests from scientists, who called it a departure from the principle that such claims should be justified by evidence of efficacy.<ref>[http://www.senseaboutscience.org.uk/index.php/site/project/86 New regulations on licensing of homeopathy] The Medicines for Human Use (National Rules for Homeopathic Products) Regulations 2006, ''Sense about Science''</ref>
 
===Homeopathic manufacture of remedies===
In the U.S.A., the ''Homœopathic Pharmacopœia of the United States''<ref name=HPUS>{{citation
| title = The Homœopathic Pharmacopœia of the United States (HPUS)
| author = Homeopathic Pharmacopoeia Convention of the United States
| url = http://www.hpus.com/whatishpus.php
}}</ref> is a handbook that describes how to manufacture homeopathic remedies, and which is approved by the [[Food and Drug Administration]] (FDA), the governmental agency that regulates drugs. Remedies listed in the HPUS are defined as "homeopathic drugs", which grants them a different standard of regulation<ref name=21CFR>{{citation
| journal = U.S. Code of Federal Regulations (CFR)
|title = Part 210 - Current good manufacturing practice in manufacturing, processing, packing, or holding of drugs; General Part 211 - Current good manufacturing practice for finished pharmaceuticals
| url = http://www.fda.gov/cder/dmpq/cgmpregs.htm
| author = Center for Drug Evaluation and Research, U.S. [[Food and Drug Administration]]
| contribution = § 211.137 Expiration dating.
}}</ref>
than conventional drugs. Manufacturers of homeopathic remedies do not have to submit [[new drug application]]s to the FDA, and their products are exempt from [[good manufacturing practice]] requirements related to expiration dating, and from finished product testing for identity and strength. Homeopathic remedies in solid oral dosage form must have an imprint that identifies the manufacturer and which indicates that it is homeopathic. <ref name=FDA-HP>{{citation
| title = Homeopathy: Real Medicine or Empty Promises?
| first = Isadora Stehlin
| publisher = [[Food and Drug Administration]]
| url = http://www.fda.gov/fdac/features/096_home.html
}}</ref>
 
In 1938, the federal [[Food, Drug, and Cosmetic Act]], sponsored by New York Senator [[Royal Copeland]], a former homeopathic medical school dean, gave the FDA the power to regulate drugs and granted legal recognition to the HPUS.  Conventional medicines for which a [[New Drug Application]] is required must be accompanied by approved evidence of safety and efficacy.<ref name=FDA-HP /> In contrast, ''any'' substance can become a homeopathic remedy if "provings" are first conducted to determine what it causes in overdose and therefore, according to homeopathic theory, what it can cure in potentized doses. Today, homeopaths use about 3,000 remedies, made from plants, trees, fungi, and algae,<ref>[http://www.nhm.ac.uk/research-curation/research/projects/homeopathy/index.html Plants and fungi used in homeopathy] Natural History Museum</ref> and from a wide variety of mineral and animal sources. Even some unusual substances, called imponderables, are made into remedies, including electricity, X-ray, and magnetic north and south poles. By convention, the first letter of the Latin-derived name of a remedy is capitalized. When the source is well-defined, the traditional name rather than [[chemical name|chemical]], [[International Nonproprietary Name]] or biological nomenclature, is preferred, such as ''Natrum muriaticum'' rather than ''sodium chloride''.
 
Homeopathic remedies are available in several forms (single medicine, homeopathic formula or complex medicines, and a limited number of external applications). Remedies for internal consumption come either in pill form or as liquid. Most do not require a doctor's prescription, unless the dosage is in a non-potentized or low potency dose and if the original substance is potentially toxic (in Europe, a substance must be diluted at least 1:1000 to be deemed homeopathic). In the U.S.A., if a remedy is claimed to treat a serious disease such as cancer, it can be sold only by prescription. Only remedies for “self-limiting conditions”—colds, coughs, fever, headaches, and other minor health problems that are expected to go away on their own—can be sold without a prescription.
 
===Preparation of homeopathic remedies ===
The most characteristic principle of homeopathy is that the efficacy of a remedy can be enhanced by  "dynamization" or "potentization". In this process, liquids are diluted (with water or ethanol) and shaken by ten hard strikes against an elastic body ("succussion"), to get the next, higher, potency. For this, Hahnemann had a saddlemaker construct a wooden "striking board", covered in leather on one side and stuffed with horsehair.<ref>Hahnemann's "striking board" is displayed by the [http://www.igm-bosch.de/english/f10.htm Hahnemann Museum] at the Institute for the History of Medicine (IGM), Stuttgart</ref> When insoluble solids such as oyster shell<ref>[http://www.homeoint.org/morrell/articles/pm_calc.htm Calcarea Carbonica - The Collector of Days and Fossils] by Peter Morrell</ref> are used for remedies, they are diluted by grinding them with [[lactose]] ("[[trituration]]"). The original dilutions by Hahnemann used a 1 part in 100 (centesimal; "C" potencies), or 1 part in 50,000 (quintamillesimal; "LM" or "L" potencies). Dr Constantine Hering later introduced the Decimal potencies ("D" or "X" potencies). The dilution factor at each stage is 1:100 ("C" potencies), 1:50,000 ("LM" potencies) or 1:10 ("D" or "X" potencies) ; Hahnemann advocated <math>30C</math> dilutions for most purposes (i.e. dilution by a factor of 100<sup>30</sup> = 10<sup>60</sup>). It is extremely unlikely that even one molecule of the original substance would be present in a <math>30C</math> dilution. Thus, remedies of a high "potency"' contain just water, but according to homeopaths, the structure of the water has been altered (see [[memory of water]]).
 
In "[[Classical homeopathy]]" or "Hahnemannian homeopathy", a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing rather than only the diagnosis of a disease. "[[Commercial homeopathy|Commercial]]" or "user-friendly" homeopathy refers to the use of a mixture of remedies in a formula containing individual ingredients chosen by the manufacturer for treating specific ailments.
 
Many homeopathic remedies sold in health food stores and pharmacies are "low potencies," that is, doses that are 3X, 3C, 6X, 6C, 12X, and 12C, all of which, except the last dose, have material doses of the original substances in the medicine.
 
== Homeopathy in practice ==
In some countries, homeopathic remedies are sold over-the-counter in both pharmacies and health food or other retail outlets for self-treatment of common self-limiting ailments and injuries; the global self-medication market is estimated at 48.2 billion dollars (13.4% of the world pharmaceuticals market), of which sales of homeopathic remedies account for 0.3%. <ref>[http://www.boiron.com/en/htm/01_homeo_aujourdhui/realite_eco_homeo.htm Economic reality of homeopathy] 2003 figures ''Homeopathy Today''</ref>. Some medical doctors in Europe, also occasionally prescribe homeopathic remedies for a variety of mainly self-limiting conditions. In India, homeopathy has more than 200,000 registered practitioners and is recognised as one of the Indian "National Systems of Medicine" under the Department of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy)<ref>[http://indianmedicine.nic.in/html/homoeopathy/homoe.htm Indian Ministry of Health and Family Welfare]</ref>. About 10% of the Indian population depends ''solely'' on homeopathy for their health care needs. In India, it is illegal to practice as a homeopath without a license and professional qualifications.
 
Some countries allow homeopaths to describe themselves in equivalent ways to doctors, with a system of qualification and oversight, but there are no universal standards for homeopathic education. In some countries, all (or virtually all) professionals that prescribe homeopathic remedies are MDs (such as [[France]], [[Spain]], [[Argentina]], [[Colombia]])<ref name=Knipschild1990>{{citation
| author = Knipschild P ''et al.''
| year = 1990
| title = Belief in the efficacy of alternative medicine among general practitioners in the Netherlands
| journal = Soc Sci Med.
| volume = 31
| pages = 625-6}}</ref><ref name="Fisher1994">{{citation
| author = Fisher P ''et al.''
| year = 1994
| title = Medicine in Europe: complementary medicine in Europe
| journal = Brit Med J
| url = http://bmj.bmjjournals.com/cgi/content/full/309/6947/107
| volume = 309
| pages =107-11}}</ref>. Some countries have exclusively homeopathic medical schools (India, Pakistan, Mexico etc.), some have naturopathic medicine colleges in which students are taught homeopathy as part of their curriculum (Germany has its "heilpraktica"/health practitioners; the U.S.A., Canada, and Australia have naturopathic medicine schools that include homeopathy), and some countries certify "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant "certification" as homeopaths. In the U.S.A., there is also a separate certification process available only to MDs and DOs (there are similar choices of certification available in the U.K. for medical doctors, who've done at least MBBS). Also in the U.S.A., naturopathic physicians have their own homeopathic certifying agency.
According to the [[American Homeopathic Pharmaceutical Association]], the 1995 retail sales of homeopathic remedies in the U.S.A. were estimated at $201 million and growing at 20% per year; the number of homeopathic practitioners in the U.S.A. increased from fewer than 200 in the 1970s to approximately 3,000 in 1996.
 
In Europe, homeopathic remedies are occasionally prescribed by MDs (often as placebos), including by 30-40% of French and 20% of German doctors. Some of this  is partly covered by public funds; in France, 35% of the costs of homeopathic remedies prescribed by a medical doctor are reimbursed from health insurance. In the U.K., five homeopathic hospitals are funded by the [[National Health Service]] (NHS) and homeopathic remedies are sold over the counter. In 2007, the over-the-counter market in homeopathy was around £40million in the U.K. <ref>[http://www.trusthomeopathy.org/media_centre/facts_about_homeopathy/popularity_and_market_place.html Popularity and the market place] British Homeopathic Association)</ref>; the total over-the-counter market was £1.2 billion in 1994. Family doctors in the U.K. issued 796 million prescriptions in 2007, of which 49,300 were for homeopathic remedies, down from 83,000 in 2005. <ref>([http://www.timesonline.co.uk/tol/news/uk/health/article4390216.ece Fall in homeopathy prescriptions hailed as sign of changed attitudes] ''The Times'' July 28th 2008)</ref> In January 2008, it was reported that the NHS was progressively withdrawing funding for homeopathic treatments because of doubts about their efficacy <ref>([http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/homeopathy-in-crisis-as-nhs-trusts-drop-services-775699.html Homeopathy 'in crisis' as NHS trusts drop services] ''The Independent'' January 30, 2008)</ref>. Of 248,000 registered practitioners of medicine in the U.K., about 400 are members of the Faculty of Homeopathy. However, in the U.K., anyone can declare themselves to be a homeopath and practice without any qualification ("common law" that allows freedom of choice in medical care in England has a long history) <ref>Morrell P (2000) [http://homeoint.org/morrell/british/background.htm British Homeopathy during two centuries] </ref>
 
In France and Denmark, licenses are required to diagnose any illness or to dispense any product whose purpose is to treat illness.<ref name=WHO>
{{cite web
|url=http://whqlibdoc.who.int/hq/2001/WHO_EDM_TRM_2001.2.pdf
|title=Legal status of traditional medicine and complementary/alternative medicine: A worldwide review
|accessdate=2007-09-12
|year=2001
|format=PDF
|work=World Health Organization
|publisher=[[World Health Organization]]
}}</ref> In many countries, there are no specific legal regulations concerning homeopathy. In Austria, the public health service generally requires proof of effectiveness to reimburse medical treatments, but makes an exception for homeopathy.<ref name="WHO" /> Almost 70% of all over-the-counter homeopathic remedies are sold in Western Europe. France is the largest market for homeopathic remedies in the world, worth over 300 million euros in 2003 (in a total over-the-counter drug market of over 770 billion euros), followed by Germany (200 million euros).
 
===A typical homeopathic visit===
Homeopaths view illness as a systemic condition, a disturbance in the overall homeostasis of the total being and accordingly, consider that almost ''any'' sick person, may benefit from proper homeopathic treatment. <blockquote>"homeopathy is designed to treat the whole person and can therefore be considered in almost any situation where a person's health is depleted." <ref>[http://www.trusthomeopathy.org/about_homeopathy/which_conditions_is_it_used_for/ British Homeopathic Association]</ref></blockquote>
 
As the [[American Institute of Homeopathy]] puts it in their "Standards of Practice": ''"The physician must remember that he is treating a patient who has some disorder; he is not prescribing for a disease entity."'' <ref>[http://homeopathyusa.org/home/standards-of-practice.html American Institute of Homeopathy Standards of Practice]</ref>.
 
Patients often come to homeopaths with chronic problems that have not responded to conventional treatment. Some common ailments for which patients seek homeopathic care are [[eczema]], [[chronic fatigue syndrome]], [[asthma]], [[migraine]], [[irritable bowel syndrome]], allergic disorders, [[arthritis]], [[fibromyalgia]], [[hypertension]], [[Crohn's disease]], [[premenstrual syndrome]], [[rhinitis]], [[anxiety]] and [[depression]], but they also treat patients with serious diseases, including [[multiple sclerosis]], [[chronic obstructive pulmonary disease]], and [[cancer]].<ref>[http://www.cancerhelp.org.uk/help/default.asp?page=251 Cancer Research UK]</ref> and AIDS<ref>[http://www.amishhospital.com/aids.htm Amish Hospital and Research Center]</ref> For [[gangrene]], for example, homeopathic remedies are prescribed in the belief that they will strengthen a person's defenses and to initiate healing; a very different approach than medical therapy. Some of many homeopathic remedies for gangrene include Arsenicum Album, Secale (from [[rye/ergot]]), and Carbo vegetabilis (from charcoal)<ref>[http://www.hpathy.com/diseases/gangrene-symptoms-treatment-cure.asp Homeopathy for everyone]</ref>.
 
{|align="right" cellpadding="10" style="background-color:#FFFFCC; width:30%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|When a homeopath is conducting an interview to characterise a patient's syndrome of symptoms, some "categories of change" are identified as important:
:(1) [[emotion]]
:(2) mentation
:(3) specific physical functioning
:(4) general physical changes
:(5) perception of self
:(6) relationships
:(7) [[spirituality]]
:(8) [[lifestyle]]
:(9) [[energy]]
:(10) [[dreaming|dream]] content and tone
:(11) well-being
:(12) perceptions by others
:(13) life relationships
:(14) a sense of freedom or feeling less "stuck"
:(15) [[sleep]]
:(16) coping
:(17) ability to adapt
:(18) [[creativity]]
:(19) recall of past experiences<ref name="pmid12676034">{{cite journal |author=Bell IR ''et al.'' |title=Homeopathic practitioner views of changes in patients undergoing constitutional treatment for chronic disease |journal=J Alt Complement Med |volume=9 |pages=39–50 |year=2003 |pmid=12676034 |doi=10.1089/10762800360520785 |url=}}</ref>
|}
 
When deciding which remedy to prescribe, classical homeopaths place emphasis on the patient's unique symptoms and their psychological state. They gather this information from an interview, typically lasting from 15 minutes to two hours, with one or more follow-up consultations of 15 to 45 minutes. They assess how the patient experiences their disease—i.e. they give priority to the overall syndrome of symptoms and the unique and idiosyncratic symptoms, in contract to the conventional medical approach of trying to identify the causes of the disease. Their goal is to determine factors that might predispose the patient to disease, and find a treatment that will strengthen that patient's "overall constitution". After the interview, the homeopath consults the [[#Homeopathic references for diagnosis and treatment|references]] described in the table on the right. Some homeopaths make quick prescriptions based on "keynotes"—the highlights of the best known characteristics of a remedy. The real challenge of homeopathic practice, though, is to find the remedy that best matches the patient's syndrome of physical and/or psychological symptoms—the "[[#Homeopathic_.22provings.22|similimum]]". A fundamental reason for conflict between conventional medicine and homeopathy is that homeopathy rejects the concept of treatments that target ''mechanisms'' of disease, and instead uses remedies that target ''syndromes of symptoms'' that they believe strengthen a person's overall constitution. Some homeopathic protocols might look like the following:
 
#A physician qualified in both homeopathy and conventional medicine, after diagnosing a chronic condition that does not indicate the need for medical urgency, might prescribe a homeopathic remedy rather than a conventional drug which he feels may be ineffective and/or likely to have side effects. Most physicians, however, are not homeopathically trained, and most homeopaths are not medically qualified.
#Homeopaths recognize that trauma might require conventional medical attention but may complement the conventional treatment with homeopathy.
#Homeopaths disagree with conventional medicine about the role of immunization and chemoprophylaxis for infectious diseases and prefer to prescribe remedies that they believe will strengthen a person's immune and defense system.
#For some disease conditions, such as [[asthma]] and [[acute bronchitis]], homeopathic remedies are often prescribed not only to alleviate chronic symptoms, but also to treat acute attacks. Remedies might also be used after an asthmatic episode with the intent to prevent recurrences.
 
The homeopathic treatment of acute problems does not need the same depth or breadth of interview as chronic conditions. According to homeopaths, because the symptoms of a common cold or a headache or an allergy vary from person to person, each may need a different remedy. However, they believe that people who experience an injury generally have similar symptoms, so they think that some homeopathic remedies might be routinely useful in such cases.
 
Homeopaths who practice "classical homeopathy" prescribe one remedy at a time—a remedy that best fits the overall syndrome of the patient. The same remedy might thus be prescribed for patients with very different diseases; conversely, patients suffering from the same disease may be prescribed different remedies. For example, hay fever would be treated with any of several remedies, usually based on the specific symptoms, but sometimes on the etiology of the allergy. Some common remedies are: Allium cepa (''onion'', which causes tears to flow and a clear burning nasal discharge that irritates the nostrils), Euphrasia (''eyebright'', which causes a clear and bland nasal discharge along with tears that burn and irritate the skin where the tears flow), Ambrosia (''ragweed'') and Solidago (''goldenrod''); ragweed and goldenrod are herbs whose pollen is aggravating to some hay fever sufferers. These remedies are commonly given during the ''acute'' symptoms of hay fever. At other times, a homeopath might treat these patients with a constitutional remedy based on the patient’s family history, health history, and present overall physical and/or psychological state, with the intent to strengthen the person’s general health.<ref>Dennis Chernin (2006) ''The Complete Homeopathic Resource for Common Illnesses.'' Berkeley: North Atlantic. Stephen Cummings and Dana Ullman (2004). ''Everybody's Guide to Homeopathic Medicines.'' New York: Jeremy Tarcher/Putnam.</ref>
 
==Conflict with conventional medicine==
The theory underlying homeopathy is not considered plausible by most  academic scientists in Europe and the U.S.A., and the treatment advice offered by homeopaths is in disagreement with conventional medicine. Their view is that homeopathy exploits the [[placebo effect]] - i.e. that the only benefits are those induced by the power of suggestion, by arousing hope, and by alleviating anxiety. Placebos have played a large part in conventional medicine since their first deliberate use by [[William Cullen]] in the 18th century.
 
<blockquote>...we all recognise the strong placebo effect in, probably, all aspects of medical treatment, whether they are conventional or not" - Professor Tom Mead<ref>[http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12305.htm House of Lords Select Committee on Science and Technology Sixth Report. Complementary and Alternative Medicine]
Chapter 3: Patient satisfaction, the role of the therapist and the placebo response.</ref></blockquote>
 
Cullen used regular drugs as placebos, but at much lower doses than he expected to be effective, and "to comfort and please the patient" rather than with any hope of a specific effect.<ref> Kerr CE ''et al.''(2007) [http://www.jameslindlibrary.org/trial_records/17th_18th_Century/cullen/cullen-commentary.html William Cullen and a missing mind-body link in the early history of placebos.]In: The James Lind Library (www.jameslindlibrary.org).</ref>. Many modern physicians consider it unethical to mislead their patients<ref>[http://www.medpagetoday.com/MeetingCoverage/AMA/3555 AMA: Ethics Council's Stance on Placebo Therapy Stirs Unease] MedPage Today 16th June 2006</ref>; rather than prescribing placebos themselves, some prefer to refer patients to regulated practitioners of alternative medicine.
 
Most homeopaths believe that the fundamental causes of disease are internal and constitutional and that infectious disease is not just the result of infection but also of susceptibility. This leads them to avoid conventional treatments that suppress symptoms. [[medicine|Physicians]] consider that most diseases are caused by a combination of external causes (such as viruses, bacteria, toxins, dietary deficiency, physical injury) and physiological dysfunction (including genetic defects and mutations such as those which trigger cancers). The main goal of conventional medicine is to eliminate these [[etiology|causes]], although physicians often also use drugs to suppress the symptoms of a disease (to alleviate the pain, injury, and distress that they cause).
 
Whereas homeopaths emphasize that they provide remedies tailored to the individual patient, conventional medicine focuses on treatments that have been demonstrated (in [[randomised clinical trials]])to be effective when given in a standard form to many patients with a given disease. Clinical trials also seek to identify subgroups of patients (identifiable by age, gender, comorbidities etc.) that are "responders" or "non responders" to a treatment, to provide a rational basis for individualization of treatments. Physicians have access to a very large repertoire of prescription drugs for this purpose (11,706 in the U.S. [[Food and Drug Administration]] ''Approved Drug Products with Therapeutic Equivalence Evaluations 26th Edition Electronic Orange Book (EOB)4'' ) <ref name=Maayan>{{citation
| journal =Mt Sinai J Med
| date = 2007
| volume = 74
| pages = 27–32.
| doi = 10.1002/msj.20002.
| title =Network Analysis of FDA Approved Drugs and their Targets
| author = Ma’ayan A ''et al.''}}</ref>, a repertoire that is constantly changing as less effective drugs are replaced by better drugs.
 
Some homeopaths also believe that their treatments can ''prevent'' disease, a notion known as "'[[homeoprophylaxis]]".
Homeoprophylaxis has not received support from systematic trials and has no place in conventional medicine. Suggestions that homeopathic treatments are an effective alternative to vaccination are regarded as irresponsible by many public health professionals, and also by some professional homeopathic organizations; in the U.K., The Faculty for Homeopathy recognizes the importance of childhood vaccination and does not support the common use of homeopathic remedies in place of conventional travel vaccinations and for malaria prevention, warning travellers "that there is no evidence that these provide any degree of protection." <ref>[http://www.trusthomeopathy.org/export/sites/bha_site/hh_article_bank/first_aid_and_travel/summer_2005.5_first_aid_on_holiday.pdf The travelling homeopath] Travel advice from The Faculty of Homeopathy and the British Homeopathic Association</ref>
 
==Attempts to provide a scientific foundation for homeopathy==
{{main|Memory of water}}
Homeopathy arose when important concepts of modern [[chemistry]] and [[biology]], such as molecules and germs, were understood poorly, if at all. In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree. The size of atoms was not calculated until 1865 (by [[Josef Loschmidt]]), but we now know that, for example, a teaspoon of seawater (roughly 5 ml) contains about 160 mg of [[table salt|NaCl]]. The molecular weight of NaCl is 58.4, and by [[Avogadro's number]], <ref>(or, in German-speaking countries, Loschmidt's number)</ref>, 58.4 g of NaCl (one [[mole]]) contains 6.02×10<sup>23</sup> molecules, so our teaspoon contains about 2×10<sup>21</sup> molecules of NaCl. A 12''C'' dilution of seawater will have about one molecule of NaCl ''per litre''.  Thus remedies diluted to more than about 12''C'' are virtually certain to contain not a single molecule of the initial substance. This is recognized by advocates of homeopathy, who assert that the healing power is not in the action of molecules, but perhaps in some way that the water itself has been changed - the presumed "[[memory of water]]". 
 
In the homeopathic literature<ref name="Homeopathy2007">A special issue of ''Homeopathy'' 96:141-230 (2007) is dedicated to this, see the URL [http://www.sciencedirect.com/science/journal/14754916 The Memory of Water]. Copies of the articles in this issue, with discussion, are available at [http://www.badscience.net/?p=490 Homeopathy Journal Club] ''Bad Science'', a blog by [[Ben Goldacre]].</ref> widely differing (and mutually inconsistent) explanations are proposed for this alleged memory. For instance, homeopaths point out that water is not simply a collection of molecules of H<sub>2</sub>O, but contain [[isotopologue]]s (molecules with different isotopic compositions such as HDO, D<sub>2</sub>O and H<sub>2</sub><sup>18</sup>O). [[Mass spectroscopy]] can detect these different isotopologues, but the concentration ratios can only be changed by nuclear reactions - they are  not affected by homeopathic treatment, so their presence cannot explain its "memory". The fact that the molecules H<sub>2</sub>O appear in two proton-spin forms (''ortho'' and ''para'') has also been suggested as a possible source of memory of water. These two spin forms, which appear in a ratio 3:1, are chemically non-distinguishable and are very difficult to separate or to convert into each other, so it is highly unlikely that a homeopathic treatment could change this ratio. Even if homeopathic tinctures could give somehow rise to  ''ortho'':''para'' ratios other than 3:1, it requires a massive leap of imagination to envisage how changes in these ratios could result in different, specific healing qualities. 
 
Some homeopaths believe that successive shaking might lead to "clustering" of water molecules. This contradicts current scientific understanding that motions in liquid water are on the picosecond (10<sup>&minus;12</sup> second) timescale and that such clusters could not live longer than a few picoseconds. Another suggestion is that double-distilled and deionized water contains trace amounts of contaminating ions: water, after vigorous shaking, might include dissolved atmospheric gases in the form of nanobubbles, molecular ions produced from water reacting with airborne contaminants, and [[silicate]]s&mdash;tiny glass "chips"; it's easy to see that such contamination is very likely to occr, but rather hard to see how it could have specific therapeutic value<ref>Anick DJ, Ives JA (2007) The silica hypothesis for homeopathy: physical chemistry ''Homeopathy'' 96:189-95  [http://dx.doi.org/doi:10.1016/j.homp.2007.03.005 doi]</ref> <ref> Demangeat JL ''et al.'' (2004) Low-field NMR water proton longitudinal relaxation in ultrahighly diluted aqueous solutions of silica-lactose prepared in glass material for pharmaceutical use ''Applied magnetic resonance'' 26:465-71</ref> <ref>Demangeat J-L (2009) NMR water proton relaxation in unheated and heated ultrahigh aqueous dilutions of histamine: Evidence for an air-dependent supramolecular organization of water ''J Mol Liquids'' 144:32-9[http://dx.doi.org/doi:10.1016/j.molliq.2008.07.013 doi]</ref>  In 2009, [[Luc Montagnier]], the Nobel Laureate virologist, claimed that the DNA of [[pathogenic]] bacteria and viruses massively dissolved in water emit radio waves. This, he claimed, can also be used to detect the medicine in a homeopathic remedy. The claim has been received with deep skepticism by the scientific community.<ref name=montagnier>Montagnier sources: 
- *{{Citation 
- |title=Nobel laureate gives homeopathy a boost 
- |newspaper=[[The Australian|The Australian]] 
- |date=July 5, 2010 
- |url=http://www.theaustralian.com.au/news/health-science/nobel-laureate-gives-homeopathy-a-boost/story-e6frg8y6-1225887772305}} 
- *{{citation 
- |title= Top 6 unconventional post-Nobel Prize claims 
- |author= Alexey Kovalev 
- |date= 07 June 2010 
- |work= [[Wired (magazine)|Wired]] 
- |url= http://www.wired.co.uk/wired-magazine/archive/2010/07/start/top-6-unconventional-post-nobel-prize-claims?page=all }}</ref>.
 
In brief, for homeopathy to receive serious scientific consideration, there must be plausible explanations for the following:
*how the process of manufacturing a homeopathic remedy could yield a biologically active substance
*why the principle of similars might apply in the case of homeopathic remedies
*how a biological mechanism could have evolved to recognize the specific nature of homeopathic remedies
 
There also needs to be
*compelling evidence for the efficacy of homeopathic remedies, evidence that cannot be explained by placebo effects
 
These stringent demands are often summarised by the maxim "Extraordinary claims require extraordinary proof".<ref>Coined by [[Marcello Truzzi]] and popularized in slightly different form by [[Carl Sagan]].</ref>
 
Homeopaths complain that they are up against a double standard in medicine and science. They point out that there is a long history of conventional medical treatments that have been used long before any knowledge of their mechanism of action. Only relatively recently, for instance, has it been understood how aspirin works, but medical standards of evidence grow more strict. It is much less likely that a clinical trial will be approved, of a new medical drug, unless there is substantial knowledge of a plausible mechanism. In the U.S., homeopathic remedies are exempt from the clinical trial requirement.
 
==Safety and efficacy==
In conventional medicine (see [[New Drug Application]]), the basic phases of evaluating a drug determine: if it causes dangerous effects in healthy volunteers; if it is [[bioavailability|adequately present in the body to achieve an effect]]; and if it is more effective than established treatments. [[Randomized controlled trial]]s use statistical analysis of large groups of patients to determine whether a treatment given in a standardised form to one subgroup is safer and more effective than a different standardised treatment given to another. This conflicts with an approach that believes that treatments must be individually tailored to each patient. Clinical trial specialists have proposed protocols to test "low responding" or individualized therapies in statistically valid clinical trials. For homeopathy, by having a group of people who identify as ill and asking a qualified homeopath to diagnose them - then having a remedy given to a subset of them, and medicines that share the same physical properties but are ''homeopathically'' inert (for instance, by using ordinary water rather than homeopathically diluted water in preparing the substance). This method thus tests the standard diagnostic method as the experimental treatment, rather than the specific medications. There have not been, however, many homeopathic trials using this method.
 
===Clinical trials==={{Main|Tests of the efficacy of homeopathy}}
The "balance of evidence" as to whether homeopathy has any effects other than placebo effects depends on who is balancing the evidence. Homeopaths favour the evidence of their own experience in treating patients, supported by the satisfaction reported by their patients in surveys; they also state that most published trials have shown some beneficial effects, including for childhood diarrhoea, <ref>Jacobs J ''et al.'' (2003) Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials. ''Ped Infect Disease J'' 22:229–34)</ref> some post-surgical conditions <ref>Barnes J ''et al.'' (1997). Homeopathy for postoperative ileus? A meta-analysis. ''J Clin Gastroenterol'' 25:628–33</ref> and respiratory allergies <ref>Taylor MA ''et al.'' (2000) Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ 321:471–6)</ref>. Other meta-analyses suggest that homeopathic remedies are no different to placebos <ref name="pmid12492603">{{cite journal |author=Ernst E |title=A systematic review of systematic reviews of homeopathy |journal=Br J Clin Pharmacol |volume=54 | pages=577–82 |year=2002 |pmid=12492603 |doi= |url= http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2125.2002.01699.x/full?cookieSet=1|accessdate=2008-02-12}}</ref> The [[Cochrane Collaboration]] publishes meta-analyses of trial results, and most of their analyses of homeopathy indicate no significant benefit. Their most supportive analyses is of [[Oscillococcinum]] for influenza. <ref name=Vickers2006>{{citation
| journal = Cochrane Database Syst Rev
| date = 2006
| url = http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001957/frame.html
| title = Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes.
| author = Vickers AJ, Smith C.
| doi = DOI: 10.1002/14651858.CD001957.pub3 }}</ref> This found no evidence of benefits in preventing influenza, but evidence of a small effect on the duration of symptoms.
 
A 1991 global meta-analysis in the ''British Medical Journal'' of 105 homeopathic trials, 81 with positive outcomes, concluded that "we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action were more plausible<ref> Kleijnen J ''et al.'' (1991) Clinical trials of homeopathy ''BMJ'' 302:316–23</ref> A 1997 meta-analysis in the ''Lancet'' similarly concluded that the results "were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo."<ref>Linde K ''et al.'' (1997) Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials? ''Lancet'' 350: 834–43 PMID 9310601</ref> However, larger high-quality trials have tended to show little or no significant effects, as later concluded by the authors of the''Lancet'' study <ref>“There is increasing evidence that more rigorous trials tend to yield less optimistic results than trials with less precautions against bias.” Linde K ''et al.'' (1999) Impact of study quality on outcome in placebo controlled trials of homeopathy. ''J Clin Epidemiol'' 52:631–6</ref> In the U.K., the [[NHS]] recognizes that there have been about 200 randomised controlled trials evaluating homeopathy; some show efficacy and some don't. They conclude, "Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works".<ref name=NHSdirect>{{citation
| url = http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=197&sectionId=27#
| author = NHS Direct
| contribution = Homeopathy
| title = Health Encyclopedia}}</ref> Homeopaths believe that such attitudes reflect bias, and that because homeopathy does not lend itself to controlled trials, those with a negative outcome may be false negatives.
 
According to critics, trials of homeopathy have been mostly small and flawed in design and/or reporting, with poor measuring techniques and difficulties in replicating results. <ref> [http://nccam.nih.gov/health/homeopathy/#q8 Questions and Answers About Homeopathy] National Center for Complemenatary and Alternative Medicine (NCCAM)</ref> Why small trials should have more strongly positive outcomes than large trials is generally attributed to "publication bias" – the tendency of trials to be reported only if the outcome is positive; many small trials with negative or inconclusive outcomes go unreported because they are thought to be uninteresting. Conversely, homeopaths argue that most of the larger high-quality trials tested a single homeopathic remedy, without the appropriate individualization of treatment.
 
In 1999, the Government of [[Switzerland]], for 5 years, allowed costs for treatment with homeopathy and four other CAM modalities to be reimbursed under the country’s health insurance scheme, and set out to evaluate their cost-effectiveness (the Complementary Medicine Evaluation Programme (Programm Evaluation Komplementärmedizin, PEK). A team of scientists and practitioners, including a homeopath, conducted a meta-analysis that became the single most cited study of homeopathy, arousing considerable media attention and a storm of protest from homeopaths. The study, published in the ''Lancet'' by Shang ''et al.'' <ref>Shang A ''et al.'' (2005) Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. ''Lancet'' 366:726–32</ref> took a novel approach; whereas traditional meta-analyses combine studies of a single, given condition, this was a "global" meta-analysis testing the hypothesis that ''all'' effects of homeopathy are placebo effects. If so, the authors reasoned, then the predominance of positive homeopathy trial reports reflects publication bias, and hence the magnitude of effects should diminish with sample size and study quality. They analyzed 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials. In both, effect size declined with improved study quality; however, some effect was still present in the largest and best conventional medicine trials, but not in the largest and best homeopathy trials. The authors concluded that homeopathy was no better than placebo, and suggested that no further research on homeopathy is necessary. The article was accompanied by an unsigned editorial titled “The end of homeopathy”<ref> Editorial. The end of homeopathy ''Lancet'' 2005; 366:690 </ref>" and another, signed, editorial <ref>Vandenbroucke JP (2005) Homoeopathy and ‘the growth of truth’ ''Lancet'' 366:691–2</ref>.
The ''Lancet'' subsequently published critical correspondence, and received an open letter from the Swiss Association of Homoeopathic Physicians (SVHA). <ref> [http://www.homeopathy.org/research/editorials/Rutten.pdf Open letter] to the Editor of The Lancet from the Swiss Association of Homoeopathic Physicians (SVHA)</ref> which declared:
 
''“The meta-analysis may be statistically correct. But its validity and practical significance can be seen at a glance: not one single qualified homoeopath would ever treat one single patient in clinical practice as presented in any of the 110 analysed trials! The study cannot give the slightest evidence against homoeopathy because it does not measure real individual (classical) homoeopathy. It confounds real homoeopathic practice with distorted study forms violating even basic homeopathic rules.”''<ref>In the Shang ''et al.'' review, 21 homeopathic trials were judged of “high quality”; these, overall, showed a benefit of homeopathic treatment. In the final analysis, the researchers included only the 8 largest studies; these showed that homeopathic treatment was comparable with a placebo, while 6 similarly large conventional trials were not compatible with a placebo effect. Of these 8 homeopathic trials, only one used an individualized approach to treatment, the other seven used a single remedy prescribed to homeopathic treated subjects. Such non-individualized treatment is common in the larger clinical trials (one of the trials even tested a rarely used homeopathic medicine, Thyroidinum, in the treatment of weight-loss, in a previously untested treatment protocol).</ref>
 
Critics of the Shang ''et al.'' analysis noted that several studies defined as "high quality" by Linde ''et al.'' (1997) were not defined by high quality by Shang ''et al.'',and most of these showed a positive effect of homeopathic treatment. The Shang ''et al.'' analysis also excluded a relatively large study of chronic polyarthritis (N=176) because no matching trial could be found.  An article in the ''Journal of Clinical Epidemiology'' <ref>Ludtke R, Rutten ALB (2008) The conclusions of the effectiveness of homeopathy highly depend on the set of analyzed trials. ''J Clin Epidemiol'' doi: 10.1016/j.jclinepi.2008.06.015 and Rutten ALB & Stolper CF (2008) The 2005 meta-analysis of homeopathy: the importance of post-publication data. ''Homeopathy'' doi: 10.1016/j.homp.2008.09.008 </ref> stated "This result can be interpreted differently. Following Shang's perspective it can be explained by small study bias (which includes publication bias). In contrast, one may hypothesize that Shang's result is falsely negative." The authors noted that four of the 21 best trials selected by Shang ''et al.'' dealt with preventing or treating muscle soreness; these found no benefits to homeopathy, but the remaining 17 trials show an overall significant effect, mainly determined by two trials on influenza-like diseases. Thus, they argue, it is possible that homeopathy might be effective for some conditions and not others.
 
===Safety===
:''The highest ideal of cure is the speedy, gentle, and enduring restoration of health by the most trustworthy and least harmful way'' (Samuel Hahnemann)
 
In the U.S.A., the [[F.D.A.]] determines what dose is safe for over-the-counter sale, and its [http://www.fda.gov/fdac/features/096_home.html view] is that there is no real concern about the safety of homeopathic remedies because of the extremely small dosages, and that the vast majority are [[over-the-counter drugs]] that do not need a doctor's prescription. In the U.S.A., homeopathic remedies must have at least one indication for usage for a disease or condition that is self-limiting and that does not require medical diagnosis or medical monitoring. The [[European Union]] allows homeopathic medicinal products, <ref>....provided they are prepared according to the European Pharmacopoeia or the pharmacopoeias currently used officially in the Member States</ref> if they are at least 3X, that is, they may not contain either more than one part per 10,000 of the mother tincture or more than 1/100th of the smallest dose of an active substance. No specific therapeutic indication may be given on the label of the product.<ref>[http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32001L0083:EN:HTML Directive of the European Parliament and of the Council] relating to medicinal products for human use.</ref> Some physicians, however, maintain that homeopathic treatment is ''relatively'' unsafe, because it might delay other treatment/s, if it fails to work. Homeopaths respond by claiming that using homeopathic remedies can delay or reduce the use of conventional medicines that are ineffective and dangerous.
 
Probably every modern pharmacologist would agree with Hahnemann that the drugs of the 19th century were at best ineffective and often dangerous. However, some homeopaths question whether modern drugs are safe and effective, and recommend homeopathic remedies instead. A 2006 survey by the U.K. charity [[Sense About Science]] revealed that homeopaths were advising travelers against taking conventional anti-[[malaria]]l drugs, instead recommending a homeopathic remedy. Even the director of the the [[Royal London Homeopathic Hospital]] condemned this:
<blockquote>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. <ref>{{citation
| url = http://news.bbc.co.uk/1/hi/uk/5178488.stm
| title = Homeopathic practices 'risk lives'
| first = P | last = Ghosh
| date = 13 July 2006
| journal = BBC}}</ref></blockquote>
Another concern is that many homeopaths think that vaccination for common diseases, such as [[measles]] and [[chicken-pox]], is unnecessary, and even that vaccines can be damaging to health, because of the [[mercury]] and [[aluminum]] in them, because the bacterium or virus in the vaccine may neither be dead nor weak enough, and/or because some childhood infectious diseases may strengthen immune responsiveness. Such advice is considered irresponsible by public health professionals, who assess the benefits of vaccination as vastly outweighing the risks. [[Measles]] is not a major killer in the western world, where most children are vaccinated at about two years old. However, in 1999 there were 875,000 deaths from measles worldwide, mostly in Africa. In 2001, a "Measles Initiative" was initiated involving the [[American Red Cross]], [[UNICEF]] and the [[World Health Organization]], By 2005 more than 360 million children had been vaccinated, and the death toll had dropped to 345,000. <ref>[http://news.bbc.co.uk/1/hi/health/6276139.stm Vaccine drive cuts measles deaths], BBC 19th January 2007</ref> Adult [[herpes zoster]] infection is a reactivation of childhood chickenpox, affects 1 in 3 adults, and can cause chronic, severe [[neuralgia|nerve pain]] ("postherpetic neuralgia"} in 10-18% of cases, and eye involvement in 10-25%. Chickenpox immunization prevents this; a herpes zoster vaccine is now recommended for all adults 60 years and older.<ref>[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm Childhood immunization against chickenpox prevents herpes zoster.] Harpaz IR ''et al.'' (2008) Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP) ''Morbidity and Mortality Weekly Report'' 57:1-30 - see for explanation of the risks associated with measles and chicken-pox.</ref>
 
Homeopaths discourage the public from using homeopathic high potency remedies (the 200th potency and higher) unless the person is adequately trained in homeopathy. They advise that repeated doses of high potency remedies can lead the person to experience a "drug proving," a situation in which the person experiences symptoms akin to an overdose (the apparent symptoms are said to resolve themselves shortly after the person stops taking the remedy).
 
===Government and institutional assessments===
In the [[United Kingdom]], the House of Commons Science and Technology Committee produced a report in 2010 on the evidence for homeopathy with reference to its use in the NHS.<ref name=evcheck>House of Commons Science and Technology Committee, [http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm Evidence Check 2: Homeopathy], 2010.</ref> It concluded that the principle of "like-cures-like" is "theoretically weak" and  "fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science."<ref name="evcheck"/> The report also expresses considerable doubt as to the effectiveness of ultra-dilution in homeopathy and describes it as "scientifically implausible". It found that there was no good evidence of effectiveness of homeopathy:
 
<blockquote>In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.<ref name="evcheck"/></blockquote>
 
The report rejected evidence presented by the [[British Homeopathic Association]] on systematic reviews and accepted Professor [[Edzard Ernst]]'s account of the failings in the systematic reviews and other evidence presented by the BHA. It stated that advocates of homeopathy had chosen "to rely on, and promulgate selective approaches to the evidence base".<ref name="evcheck" />
It also rejected calls for further research:
 
<blockquote>There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified in the face of competing priorities.<ref name="evcheck" /></blockquote>
 
It recommended against the use of homeopathy on the NHS because of the ethical problems in prescribing a placebo (as they concluded homeopathy to be): in particular, for a placebo to be effective, the patient must not know it is a placebo, but medical ethics requires that a patient must be able to make an informed choice. It also advised that, if the NHS appears to endorse homeopathy, there is a danger that patients will neglect conventional medicine, with potentially serious health consequences. The report concludes that homeopathy should not be funded by the NHS, that funding of homeopathic hospitals should not continue and  that NHS doctors should not refer patients to homeopaths.<ref name="evcheck" />
 
The report conclusions have been supported by the [[British Medical Association]]<ref>BBC News, [http://www.bbc.co.uk/news/10449430 Doctors call for NHS to stop funding homeopathy]</ref>. The [[Royal Pharmaceutical Society of Great Britain]] suggested that patients ought to be "made aware of the fact that there is no scientific basis for the use of homeopathy", and that unless homeopathy can be shown to be efficacious "using appropriate methodology (as for conventional medicines)" any "claims of efficacy should be removed from the label". It also concluded that "homeopathic remedies should be reviewed by [[National Institute for Clinical Excellence|NICE]] if they are to be used within the NHS to ensure that they give value for money" – historically, homeopathy has not been subject to review by NICE.<ref>[[Royal Pharmaceutical Society of Great Britain]], [http://www.rpsgb.org/pdfs/homeopathyrpsgbresphoc.pdf Response to the House of Commons Science and Technology Committee], November 2009.</ref> The British Government has decided to continue funding homeopathy (at a very low level) on the NHS.
 
 
=== Medical organizations' attitudes towards homeopathy ===
The [[American Medical Association]] (AMA) was founded in 1847,<ref name=AMA-12>{{citation
| author =American Medical Association Council on Scientific Affairs
| id = Report 12
| url=http://www.ama-assn.org/ama/pub/category/13638.html
| date = June 1997
|title=alternative theories including homeopathy
}}</ref> and from the 1860s to the early 20th century, its ethical code forbade its members to consult with MDs who practiced homeopathy.<ref>Harris Coulter, ''Divided Legacy: The Conflict Between Homoeopathy and the American Medical Association.'' Berkeley: North Atlantic, 1975</ref> Today, the AMA is not overtly antagonistic to homeopathy, but their current policy states: "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."<ref name=AMA-12 />
 
In the U.K., some homeopathic treatment is available on the NHS. The NHS funds homeopathic hospitals in Glasgow, Liverpool, Bristol and London and there are several NHS homeopathic clinics in Scotland, treating approximately 55,000 patients per year by some 600 doctors.<ref name="urlDoctors Vote for NHS to Stop Funding Homeopathy">{{cite web |url=http://news.suite101.com/article.cfm/doctors-vote-for-nhs-to-stop-funding-homeopathy-a256071 |title=Doctors Vote for NHS to Stop Funding Homeopathy |format= |work= |accessdate=2010-06-30}}</ref>  In 2010 the [[British Medical Association]] voted in favour of stopping any use of NHS funds for homeopathy, and proposed that pharmacists should remove homeopathic remedies from their shelves  to prevent them from being confused with medicines.<ref>Flavia Munn, [http://web2.bma.org.uk/nrezine.nsf/wp/ESML-86VGUX?OpenDocument&C=3+July+2010 Medics vote to ban homeopathy from NHS] (June 29, 2010)</ref>  However, the British health minister declared that doctors should be free to decide whatever treatment they think appropriate in individual cases, and so homeopathic care remains a (very small) part of the NHS.<ref>http://www.telegraph.co.uk/health/healthnews/7910948/Homeopathy-will-not-be-banned-by-NHS-despite-critical-report.html</ref>
 
{|align="centre" cellpadding="10" style="background-color:#FFFFCC; width:80%; border: 1px solid #aaa; margin:20px; font-size: 92%;"
|
In the U.S.A.,The [[National Center for Complementary and Alternative Medicine]] (NCCAM) administers public-funded research into alternative medicine <ref name=NCCAM-HQ8>{{citation | url = http://nccam.nih.gov/health/homeopathy/#q8
| contribution = What has scientific research found out about whether homeopathy works?
| title = Questions and Answers About Homeopathy
| author = [[National Center for Complementary and Alternative Medicine]]}}</ref>. Their 2003 report on homeopathy ([http://en.citizendium.org/wiki/Homeopathy/Signed_Articles/NCCAM here]) asks: "Are there scientific controversies associated with homeopathy?", and replies:
 
"Yes. Homeopathy is an area of complementary and alternative medicine (CAM) that has seen high levels of controversy and debate, largely because a number of its key concepts do not follow the laws of science (particularly chemistry and physics).
*It is debated how something that causes illness might also cure it.
*It has been questioned whether a remedy with a very tiny amount (perhaps not even one molecule) of active ingredient could have a biological effect, beneficial or otherwise.
*There have been some research studies published on the use of ultra-high dilutions (UHDs) of substances, diluted to levels compatible with those in homeopathy and shaken hard at each step of dilution.<ref>For some examples, see the report's references 26–29.</ref> The results are claimed to involve phenomena at the molecular level and beyond, such as the structure of water, and waves and fields. Both laboratory research and clinical trials have been published. There have been mixed results in attempts to replicate them. Reviews have not found UHD results to be definitive or compelling.<ref>
For examples of debates on UHDs and reviewers’ papers, see especially the reports references 13, 15, and 30–33.</ref>
*There have been some studies that found effects of UHDs on isolated organs, plants, and animals. There have been controversy and debate about these findings as well.
*Effects in homeopathy might be due to the placebo or other non-specific effect.
*There are key questions about homeopathy that are yet to be subjected to studies that are well-designed--such as whether it actually works for some of the diseases or medical conditions for which it is used, and if so, how it might work.
*There is a point of view that homeopathy does work, but that modern scientific methods have not yet explained why. The failure of science to provide full explanations for all treatments is not unique to homeopathy.
 
Some people feel that if homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine are not necessary."
 
In 2008, NCCAM's acting deputy director, Jack Killen, said, in a ''Newsweek'' article, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." <ref name=Newsweek>{{citation
| url = http://www.newsweek.com/id/105581
| journal = Newsweek
| first = Jerry | last = Adler
| title = No Way to Treat the Dying
| date = February 4, 2008}}</ref>.
|}
 
== References ==
{{reflist|2}}

Latest revision as of 08:28, 14 February 2021

This is an out-of-date version of the article that was created separately (possibly in error). It is retained here to preserve the edit history.
Do not edit this version: see 'Homeopathy' for the latest one.
The Editorial Council has made a unanimous decision on December 17, 2010, to blank this draft article and to place a minimum of a one-year moratorium on any further edits to this article. The discussion concerning this decision may be found at [1]. The Talk page remains, but its present contents will be moved to an archive. The Approved Main Article also remains in place. This page is now protected by the Constabulary and no further edits can be made to it. After one year has passed, Citizens may ask the Editorial Council to reconsider their decision but there is no guarantee that they will do so.


The Secretary of the Editorial Council, Hayford Peirce 04:09, 17 December 2010 (UTC)

Moratorium extended

The moratorium has been extended by another year. EC:D-2012-002. --Peter Schmitt 01:20, 20 January 2012 (UTC)


Retrieved from "https://citizendium.org/wiki/index.php?title=Homeopathy/PreviousVersion&oldid=16566"