Homeopathy | Wikipedia audio article

Homeopathy | Wikipedia audio article


Homeopathy or homœopathy is a system of alternative
medicine created in 1796 by Samuel Hahnemann, based on his doctrine of like cures like (similia
similibus curentur), a claim that a substance that causes the symptoms of a disease in healthy
people would cure similar symptoms in sick people. Homeopathy is a pseudoscience – a belief
that is incorrectly presented as scientific. Homeopathic preparations are not effective
for treating any condition; large-scale studies have found homeopathy to be no more effective
than a placebo, indicating that any positive effects that follow treatment are not due
to the treatment itself but instead to factors such as normal recovery from illness, or regression
toward the mean.Hahnemann believed the underlying causes of disease were phenomena that he termed
miasms, and that homeopathic preparations addressed these. The preparations are manufactured using a
process of homeopathic dilution, in which a chosen substance is repeatedly diluted in
alcohol or distilled water, each time with the containing vessel being struck against
an elastic material, commonly a leather-bound book. Dilution typically continues well past the
point where no molecules of the original substance remain. Homeopaths select homeopathics by consulting
reference books known as repertories, and by considering the totality of the patient’s
symptoms, personal traits, physical and psychological state, and life history.Homeopathy is not
a plausible system of treatment, as its dogmas about how drugs, illness, the human body,
liquids and solutions operate are contradicted by a wide range of discoveries across biology,
psychology, physics and chemistry made in the two centuries since its invention. Although some clinical trials produce positive
results, multiple systematic reviews have shown that this is because of chance, flawed
research methods, and reporting bias. Homeopathic practice has been criticized as
unethical because it discourages the use of effective treatments, with the World Health
Organization warning against using homeopathy to try to treat severe diseases such as HIV
and malaria. The continued practice of homeopathy, despite
a lack of evidence of efficacy, has led to it being characterized within the scientific
and medical communities as nonsense, quackery, and a sham.There have been four large scale
assessments of homeopathy by national or international bodies: the Australian National Health and
Medical Research Council; the United Kingdom’s House of Commons Science and Technology Committee;
the European Academies’ Science Advisory Council; and the Swiss Federal Health Office. Each concluded that homeopathy is ineffective,
and recommended against the practice receiving any further funding. The National Health Service in England has
announced a policy of not funding homeopathic medicine because it is “a misuse of resources”. They called on the UK Department of Health
to add homeopathic remedies to the blacklist of forbidden prescription items, and the NHS
ceased funding homeopathic remedies in November 2017.==History=====
Historical context===The concept of “like cures like” may have
been suggested by Hippocrates around 400 BC, when he prescribed a small dose of mandrake
root to treat mania, knowing it produces mania in much larger doses. Similarly, in the 16th century, Paracelsus
wrote “similia similibus curantur” (similar to the subjunctive form later used by Hahnemann),
often translated as “what makes a man ill also cures him”.In the late 18th and 19th
centuries, mainstream medicine used methods like bloodletting and purging, and administered
complex mixtures, such as Venice treacle, which was made from 64 substances including
opium, myrrh, and viper’s flesh. These treatments often worsened symptoms and
sometimes proved fatal. Hahnemann rejected these practices – which
had been extolled for centuries – as irrational and inadvisable;
instead, he advocated the use of single drugs at lower doses and promoted an immaterial,
vitalistic view of how living organisms function, believing that diseases have spiritual, as
well as physical causes.===Hahnemann’s concept===The term “homeopathy” was coined by Hahnemann
and first appeared in print in 1807.Hahnemann conceived of homeopathy while translating
a medical treatise by the Scottish physician and chemist William Cullen into German. Being sceptical of Cullen’s theory concerning
cinchona’s use for curing malaria, Hahnemann ingested some bark specifically to investigate
what would happen. He experienced fever, shivering and joint
pain: symptoms similar to those of malaria itself. From this, Hahnemann came to believe that
all effective drugs produce symptoms in healthy individuals similar to those of the diseases
that they treat, in accord with the “law of similars” that had been proposed by ancient
physicians. An account of the effects of eating cinchona
bark noted by Oliver Wendell Holmes, and published in 1861, failed to reproduce the symptoms
Hahnemann reported. Hahnemann’s law of similars is a postulate
rather than a scientific law. This led to the name “homeopathy”, which comes
from the Greek: ὅμοιος hómoios, “-like” and πάθος páthos, “suffering”. Subsequent scientific work showed that cinchona
cures malaria because it contains quinine, which kills the Plasmodium falciparum parasite
that causes the disease; the mechanism of action is unrelated to Hahnemann’s ideas.====”Provings”====
Hahnemann began to test what effects substances produced in humans, a procedure that would
later become known as “homeopathic proving”. These tests required subjects to test the
effects of ingesting substances by clearly recording all of their symptoms as well as
the ancillary conditions under which they appeared. He published a collection of provings in 1805,
and a second collection of 65 preparations appeared in his book, Materia Medica Pura,
in 1810.Because Hahnemann believed that large doses of drugs that caused similar symptoms
would only aggravate illness, he advocated extreme dilutions of the substances; he devised
a technique for making dilutions that he believed would preserve a substance’s therapeutic properties
while removing its harmful effects. Hahnemann believed that this process aroused
and enhanced “the spirit-like medicinal powers of the crude substances”. He gathered and published a complete overview
of his new medical system in his 1810 book, The Organon of the Healing Art, whose 6th
edition, published in 1921, is still used by homeopaths today.====Miasms and disease====In the Organon, Hahnemann introduced the concept
of “miasms” as “infectious principles” underlying chronic disease. Hahnemann associated each miasm with specific
diseases, and thought that initial exposure to miasms causes local symptoms, such as skin
or venereal diseases. If, however, these symptoms were suppressed
by medication, the cause went deeper and began to manifest itself as diseases of the internal
organs. Homeopathy maintains that treating diseases
by directly alleviating their symptoms, as is sometimes done in conventional medicine,
is ineffective because all “disease can generally be traced to some latent, deep-seated, underlying
chronic, or inherited tendency”. The underlying imputed miasm still remains,
and deep-seated ailments can be corrected only by removing the deeper disturbance of
the vital force.Hahnemann’s hypotheses for the direct or remote cause of all chronic
diseases (miasms) originally presented only three, psora (the itch), syphilis (venereal
disease) or sycosis (fig-wart disease). Of these three the most important was psora
(Greek for “itch”), described as being related to any itching diseases of the skin, supposed
to be derived from suppressed scabies, and claimed to be the foundation of many further
disease conditions. Hahnemann believed psora to be the cause of
such diseases as epilepsy, cancer, jaundice, deafness, and cataracts. Since Hahnemann’s time, other miasms have
been proposed, some replacing one or more of psora’s proposed functions, including tuberculosis
and cancer miasms.The law of susceptibility implies that a negative state of mind can
attract hypothetical disease entities called “miasms” to invade the body and produce symptoms
of diseases. Hahnemann rejected the notion of a disease
as a separate thing or invading entity, and insisted it was always part of the “living
whole”. Hahnemann coined the expression “allopathic
medicine”, which was used to pejoratively refer to traditional Western medicine.Hahnemann’s
miasm theory remains disputed and controversial within homeopathy even in modern times. The theory of miasms has been criticized as
an explanation developed by Hahnemann to preserve the system of homeopathy in the face of treatment
failures, and for being inadequate to cover the many hundreds of sorts of diseases, as
well as for failing to explain disease predispositions, as well as genetics, environmental factors,
and the unique disease history of each patient.===19th century: rise to popularity and early
criticism===Homeopathy achieved its greatest popularity
in the 19th century. It was introduced to the United States in
1825 by Hans Birch Gram, a student of Hahnemann. The first homeopathic school in the US opened
in 1835, and in 1844, the first US national medical association, the American Institute
of Homeopathy, was established. Throughout the 19th century, dozens of homeopathic
institutions appeared in Europe and the United States, and by 1900, there were 22 homeopathic
colleges and 15,000 practitioners in the United States. Because medical practice of the time relied
on ineffective and often dangerous treatments, patients of homeopaths often had better outcomes
than those of the doctors of the time. Homeopathic preparations, even if ineffective,
would almost surely cause no harm, making the users of homeopathic preparations less
likely to be killed by the treatment that was supposed to be helping them. The relative success of homeopathy in the
19th century may have led to the abandonment of the ineffective and harmful treatments
of bloodletting and purging and to have begun the move towards more effective, science-based
medicine. One reason for the growing popularity of homeopathy
was its apparent success in treating people suffering from infectious disease epidemics. During 19th-century epidemics of diseases
such as cholera, death rates in homeopathic hospitals were often lower than in conventional
hospitals, where the treatments used at the time were often harmful and did little or
nothing to combat the diseases.From its inception, however, homeopathy was criticized by mainstream
science. Sir John Forbes, physician to Queen Victoria,
said in 1843 that the extremely small doses of homeopathy were regularly derided as useless,
“an outrage to human reason”. James Young Simpson said in 1853 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.” 19th-century American physician and author
Oliver Wendell Holmes, Sr. was also a vocal critic of homeopathy and published an essay
in 1842 entitled Homœopathy and Its Kindred Delusions. The members of the French Homeopathic Society
observed in 1867 that some leading homeopathists of Europe not only were abandoning the practice
of administering infinitesimal doses but were also no longer defending it. The last school in the US exclusively teaching
homeopathy closed in 1920.===Revival in the 20th century===According to Paul Ulrich Unschuld, the Nazi
regime in Germany was fascinated by homeopathy, and spent large sums of money on researching
its mechanisms, but without gaining a positive result. Unschuld further argues that homeopathy never
subsequently took root in the United States, but remained more deeply established in European
thinking. In the United States, the Food, Drug, and
Cosmetic Act of 1938 (sponsored by Royal Copeland, a Senator from New York and homeopathic physician)
recognized homeopathic preparations as drugs. In the 1950s, there were only 75 pure homeopaths
practising in the U.S. However, by the mid to late 1970s, homeopathy
made a significant comeback and sales of some homeopathic companies increased tenfold. Some homeopaths give credit for the revival
to Greek homeopath George Vithoulkas, who performed a “great deal of research to update
the scenarios and refine the theories and practice of homeopathy”, beginning in the
1970s, but Ernst and Singh consider it to be linked to the rise of the New Age movement. Whichever is correct, mainstream pharmacy
chains recognized the business potential of selling homeopathic preparations. The Food and Drug Administration held a hearing
April 20 and 21, 2015, requesting public comment on regulation of homeopathic drugs. The FDA cited the growth of sales of over-the-counter
homeopathic medicines, which was $2.7 billion for 2007.Bruce Hood has argued that the increased
popularity of homeopathy in recent times may be due to the comparatively long consultations
practitioners are willing to give their patients, and to an irrational preference for “natural”
products, which people think are the basis of homeopathic preparations.===21st century===
Since the beginning of the 21st century a series of meta analysis has further shown
that therapeutic claims of Homeopathy lack scientific justification. In a 2010 report, the Science and Technology
Committee of the United Kingdom House of Commons recommended that homeopathy should no longer
be a beneficiary of NHS funding due its lack of scientific credibility; funding ceased
in 2017. In March 2015, the National Health and Medical
Research Council of Australia published an information paper on Homeopathy. The main findings of the report were ‘there
are no health conditions for which there is reliable evidence that homeopathy is effective”. Reactions to the report sparked world headlines
which suggested that the NHMRC had found that homeopathy is not effective for all conditions.In
2018, Australian pharmacies ignored recommendations for a homeopathic ban in the broader scope
of the federal government accepting only three of the 45 recommendations made by the review
of Pharmacy Remuneration and Regulation (which were delivered in September 2017 to Health
Minister Greg Hunt).In 2019, the Canadian government stopped funding homeopathic foreign
aid to Honduras. the Quebec charity, Terre Sans Frontières,
had gotten $200,000 over five years Global Affairs’ Volunteer Cooperation Program. TSF supports homeopathic ‘cures’ for Chagas
disease.==Preparations and treatment==Homeopathic preparations are referred to as
“homeopathics” or “remedies”. Practitioners rely on two types of reference
when prescribing: Materia Medica and repertories. A homeopathic materia medica is a collection
of “drug pictures”, organized alphabetically. These entries describe the symptom patterns
associated with individual preparations. A homeopathic repertory is an index of disease
symptoms that lists preparations associated with specific symptoms. In both cases different compilers may dispute
particular inclusions. The first symptomatic homeopathic materia
medica was arranged by Hahnemann. The first homeopathic repertory was Georg
Jahr’s Symptomenkodex, published in German in 1835, and translated into English as the
Repertory to the more Characteristic Symptoms of Materia Medica by Constantine Hering in
1838. This version was less focused on disease categories
and was the forerunner to later works by James Tyler Kent. Repertories, in particular, may be very large. Homeopathy uses animal, plant, mineral, and
synthetic substances in its preparations, generally referring to them using Latin or
faux-Latin names. Examples include arsenicum album (arsenic
oxide), natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of
the bushmaster snake), opium, and thyroidinum (thyroid hormone). Some homeopaths use so-called “nosodes” (from
the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary,
and respiratory discharges, blood, and tissue. Conversely, preparations made from “healthy”
specimens are called “sarcodes”. Some modern homeopaths use preparations they
call “imponderables” because they do not originate from a substance but some other phenomenon
presumed to have been “captured” by alcohol or lactose. Examples include X-rays
and sunlight.Other minority practices include paper preparations, where the substance and
dilution are written on pieces of paper and either pinned to the patients’ clothing, put
in their pockets, or placed under glasses of water that are then given to the patients,
and the use of radionics to manufacture preparations. Such practices have been strongly criticized
by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.===Preparation===Hahnemann found that undiluted doses caused
reactions, sometimes dangerous ones, so specified that preparations be given at the lowest possible
dose. He found that this reduced potency as well
as side-effects, but formed the view that vigorous shaking and striking on an elastic
surface – a process he termed Schütteln, translated as succussion – nullified this. A common explanation for his settling on this
process is said to be that he found preparations subjected to agitation in transit, such as
in saddle bags or in a carriage, were more “potent”. Hahnemann had a saddle-maker construct a special
wooden striking board covered in leather on one side and stuffed with horsehair. Insoluble solids, such as granite, diamond,
and platinum, are diluted by grinding them with lactose (“trituration”).The process of
dilution and succussion is termed “dynamization” or “potentization” by homeopaths. In industrial manufacture this may be done
by machine. Serial dilution is achieved by taking an amount
of the mixture and adding solvent, but the “Korsakovian” method may also be used, whereby
the vessel in which the preparations are manufactured is emptied, refilled with solvent, and the
volume of fluid adhering to the walls of the vessel is deemed sufficient for the new batch. The Korsakovian method is sometimes referred
to as K on the label of a homeopathic preparation, e.g. 200CK is a 200C preparation made using
the Korsakovian method.Fluxion and radionics methods of preparation do not require succussion. There are differences of opinion on the number
and force of strikes, and some practitioners dispute the need for succussion at all while
others reject the Korsakovian and other non-classical preparations. There are no laboratory assays and the importance
and techniques for succussion cannot be determined with any certainty from the literature.===Dilutions===Three main logarithmic potency scales are
in regular use in homeopathy. Hahnemann created the “centesimal” or “C scale”,
diluting a substance by a factor of 100 at each stage. The centesimal scale was favoured by Hahnemann
for most of his life. A 2C dilution requires a substance to be diluted
to one part in 100, and then some of that diluted solution diluted by a further factor
of 100. This works out to one part of the original
substance in 10,000 parts of the solution. A 6C dilution repeats this process six times,
ending up with the original substance diluted by a factor of 100−6=10−12 (one part in
one trillion or 1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute
is described as having a higher “potency”, and more dilute substances are considered
by homeopaths to be stronger and deeper-acting. The end product is often so diluted as to
be indistinguishable from the diluent (pure water, sugar or alcohol). There is also a decimal potency scale (notated
as “X” or “D”) in which the preparation is diluted by a factor of 10 at each stage.Hahnemann
advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060). Hahnemann regularly used potencies up to 300C
but opined that “there must be a limit to the matter, it cannot go on indefinitely”.In
Hahnemann’s time, it was reasonable to assume the preparations could be diluted indefinitely,
as the concept of the atom or molecule as the smallest possible unit of a chemical substance
was just beginning to be recognized. The greatest dilution reasonably likely to
contain even one molecule of the original substance is 12C. Critics and advocates of homeopathy alike
commonly attempt to illustrate the dilutions involved in homeopathy with analogies. Hahnemann is reported to have joked that a
suitable procedure to deal with an epidemic would be to empty a bottle of poison into
Lake Geneva, if it could be succussed 60 times. Another example given by a critic of homeopathy
states that a 12C solution is equivalent to a “pinch of salt in both the North and South
Atlantic Oceans”, which is approximately correct. One-third of a drop of some original substance
diluted into all the water on earth would produce a preparation with a concentration
of about 13C. A popular homeopathic treatment for the flu
is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 1080 atoms in the
entire observable universe, a dilution of one molecule in the observable universe would
be about 40C. Oscillococcinum would thus require 10320 more
universes to simply have one molecule in the final substance. The high dilutions characteristically used
are often considered to be the most controversial and implausible aspect of homeopathy.Not all
homeopaths advocate high dilutions. Preparations at concentrations below 4X are
considered an important part of homeopathic heritage. Many of the early homeopaths were originally
doctors and generally used lower dilutions such as “3X” or “6X”, rarely going beyond
“12X”. The split between lower and higher dilutions
followed ideological lines. Those favouring low dilutions stressed pathology
and a stronger link to conventional medicine, while those favouring high dilutions emphasized
vital force, miasms and a spiritual interpretation of disease. Some products with such relatively lower dilutions
continue to be sold, but like their counterparts, they have not been conclusively demonstrated
to have any effect beyond that of a placebo.===Provings===
A homeopathic “proving” is the method by which the profile of a homeopathic preparation is
determined.At first Hahnemann used undiluted doses for provings, but he later advocated
provings with preparations at a 30C dilution, and most modern provings are carried out using
ultra-dilute preparations in which it is highly unlikely that any of the original molecules
remain. During the proving process, Hahnemann administered
preparations to healthy volunteers, and the resulting symptoms were compiled by observers
into a “drug picture”. The volunteers were observed for months at
a time and made to keep extensive journals detailing all of their symptoms at specific
times throughout the day. They were forbidden from consuming coffee,
tea, spices, or wine for the duration of the experiment; playing chess was also prohibited
because Hahnemann considered it to be “too exciting”, though they were allowed to drink
beer and encouraged to exercise in moderation.After the experiments were over, Hahnemann made
the volunteers take an oath swearing that what they reported in their journals was the
truth, at which time he would interrogate them extensively concerning their symptoms. Provings are claimed to have been important
in the development of the clinical trial, due to their early use of simple control groups,
systematic and quantitative procedures, and some of the first application of statistics
in medicine. The lengthy records of self-experimentation
by homeopaths have occasionally proven useful in the development of modern drugs: For example,
evidence that nitroglycerin might be useful as a treatment for angina was discovered by
looking through homeopathic provings, though homeopaths themselves never used it for that
purpose at that time. The first recorded provings were published
by Hahnemann in his 1796 Essay on a New Principle. His Fragmenta de Viribus (1805) contained
the results of 27 provings, and his 1810 Materia Medica Pura contained 65. For James Tyler Kent’s 1905 Lectures on Homoeopathic
Materia Medica, 217 preparations underwent provings and newer substances are continually
added to contemporary versions. Though the proving process has superficial
similarities with clinical trials, it is fundamentally different in that the process is subjective,
not blinded, and modern provings are unlikely to use pharmacologically active levels of
the substance under proving. As early as 1842, Holmes noted the provings
were impossibly vague, and the purported effect was not repeatable among different subjects.===Consultation===Homeopaths generally begin with detailed examinations
of their patients’ histories, including questions regarding their physical, mental and emotional
states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this
information into a complex formula of mental and physical symptoms, including likes, dislikes,
innate predispositions and even body type.From these symptoms, the homeopath chooses how
to treat the patient using materia medica and repertories. In classical homeopathy, the practitioner
attempts to match a single preparation to the totality of symptoms (the simlilum), while
“clinical homeopathy” involves combinations of preparations based on the various symptoms
of an illness.===Pills and active ingredients===Homeopathic pills are made from an inert substance
(often sugars, typically lactose), upon which a drop of liquid homeopathic preparation is
placed and allowed to evaporate.The process of homeopathic dilution results in no objectively
detectable active ingredient in most cases, but some preparations (e.g. calendula and
arnica creams) do contain pharmacologically active doses. One product, Zicam Cold Remedy, which was
marketed as an “unapproved homeopathic” product, contains two ingredients that are only “slightly”
diluted: zinc acetate (2X=1/100 dilution) and zinc gluconate (1X=1/10 dilution), which
means both are present in a biologically active concentration strong enough to have caused
some people to lose their sense of smell, a condition termed anosmia. Zicam also listed several normal homeopathic
potencies as “inactive ingredients”, including galphimia glauca, histamine dihydrochloride
(homeopathic name, histaminum hydrochloricum), luffa operculata, and sulfur.===Related and minority treatments and practices
=======Isopathy====
Isopathy is a therapy derived from homeopathy, invented by Johann Joseph Wilhelm Lux in the
1830s. Isopathy differs from homeopathy in general
in that the preparations, known as “nosodes”, are made up either from things that cause
the disease or from products of the disease, such as pus. Many so-called “homeopathic vaccines” are
a form of isopathy. Tautopathy is a form of isopathy where the
preparations are composed of drugs or vaccines that a person has consumed in the past, in
the belief that this can reverse lingering damage caused by the initial use. There is no convincing scientific evidence
for isopathy as an effective method of treatment.====Flower preparations====
Flower preparations can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower
remedies, which were developed by the physician and homeopath Edward Bach. Although the proponents of these preparations
share homeopathy’s vitalist world-view and the preparations are claimed to act through
the same hypothetical “vital force” as homeopathy, the method of preparation is different. Bach flower preparations are manufactured
in allegedly “gentler” ways such as placing flowers in bowls of sunlit water, and the
preparations are not succussed. There is no convincing scientific or clinical
evidence for flower preparations being effective.====Veterinary use====The idea of using homeopathy as a treatment
for other animals termed “veterinary homeopathy”, dates back to the inception of homeopathy;
Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans. The FDA has not approved homeopathic products
as veterinary medicine in the U.S. In the UK, veterinary surgeons who use homeopathy
may belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic
Veterinary Surgeons. Animals may be treated only by qualified veterinary
surgeons in the UK and some other countries. Internationally, the body that supports and
represents homeopathic veterinarians is the International Association for Veterinary Homeopathy. The use of homeopathy in veterinary medicine
is controversial; the little existing research on the subject is not of a high enough scientific
standard to provide reliable data on efficacy. Given that homeopathy’s effects in humans
appear to be mainly due to the placebo effect and the counseling aspects of the consultation,
it is unlikely that homeopathic treatments would be effective in animals. Other studies have also found that giving
animals placebos can play active roles in influencing pet owners to believe in the effectiveness
of the treatment when none exists. The British Veterinary Association’s position
statement on alternative medicines says that it “cannot endorse” homeopathy, and the Australian
Veterinary Association includes it on its list of “ineffective therapies”. A 2016 review of peer-reviewed articles from
1981 to 2014 by scientists from the University of Kassel, Germany, concluded that there was
insufficient evidence to support the use of homeopathy in livestock as a way to prevent
or treat infectious diseases.The UK’s Department for Environment, Food and Rural Affairs (Defra)
has adopted a robust position against use of “alternative” pet preparations including
homeopathy.====Electrohomeopathy====Popular in the late nineteenth century, electrohomeopathy
has been described as “utter idiocy”.Electrohomeopathy is somewhat associated with an Spagyric medicine
in that the disease is usually multi-organic in cause or effect and calls for holistic
treatment that is both complex and natural.The Allahabad High Court in Kanpur handed down
a decree in 2012 which stated that electrohomeopathy was an unrecognized system of medicine which
was quackery.====Homeoprophylaxis====
The use of homeopathy as a preventive for serious infectious diseases is especially
controversial, in the context of ill-founded public alarm over the safety of vaccines stoked
by the anti-vaccination movement. Promotion of homeopathic alternatives to vaccines
has been characterized as dangerous, inappropriate and irresponsible. In December 2014, Australian homeopathy supplier
Homeopathy Plus! were found to have acted deceptively in promoting homeopathic alternatives
to vaccines.==Evidence and efficacy==
The low concentration of homeopathic preparations, which often lack even a single molecule of
the diluted substance, has been the basis of questions about the effects of the preparations
since the 19th century. Modern advocates of homeopathy have proposed
a concept of “water memory”, according to which water “remembers” the substances mixed
in it, and transmits the effect of those substances when consumed. This concept is inconsistent with the current
understanding of matter, and water memory has never been demonstrated to have any detectable
effect, biological or otherwise. Pharmacological research has found instead
that stronger effects of an active ingredient come from higher, not lower doses. James Randi and the 10:23 campaign groups
have highlighted the lack of active ingredients in most homeopathic products by taking large
‘overdoses’. None of the hundreds of demonstrators in the
UK, Australia, New Zealand, Canada and the US were injured and “no one was cured of anything,
either”.Outside of the alternative medicine community, scientists have long considered
homeopathy a sham or a pseudoscience, and the mainstream medical community regards it
as quackery. There is an overall absence of sound statistical
evidence of therapeutic efficacy, which is consistent with the lack of any biologically
plausible pharmacological agent or mechanism.Abstract concepts within theoretical physics have been
invoked to suggest explanations of how or why preparations might work, including quantum
entanglement, quantum nonlocality, the theory of relativity and chaos theory. Contrariwise, quantum superposition has been
invoked to explain why homeopathy does not work in double-blind trials. However, the explanations are offered by nonspecialists
within the field, and often include speculations that are incorrect in their application of
the concepts and not supported by actual experiments. Several of the key concepts of homeopathy
conflict with fundamental concepts of physics and chemistry. The use of quantum entanglement to explain
homeopathy’s purported effects is “patent nonsense”, as entanglement is a delicate state
that rarely lasts longer than a fraction of a second. While entanglement may result in certain aspects
of individual subatomic particles acquiring linked quantum states, this does not mean
the particles will mirror or duplicate each other, nor cause health-improving transformations.===Plausibility===
The proposed mechanisms for homeopathy are precluded from having any effect by the laws
of physics and physical chemistry. The extreme dilutions used in homeopathic
preparations usually leave not one molecule of the original substance in the final product. A number of speculative mechanisms have been
advanced to counter this, the most widely discussed being water memory, though this
is now considered erroneous since short-range order in water only persists for about 1 picosecond. No evidence of stable clusters of water molecules
was found when homeopathic preparations were studied using nuclear magnetic resonance,
and many other physical experiments in homeopathy have been found to be of low methodological
quality, which precludes any meaningful conclusion. Existence of a pharmacological effect in the
absence of any true active ingredient is inconsistent with the law of mass action and the observed
dose-response relationships characteristic of therapeutic drugs (whereas placebo effects
are non-specific and unrelated to pharmacological activity). Homeopaths contend that their methods produce
a therapeutically active preparation, selectively including only the intended substance, though
critics note that any water will have been in contact with millions of different substances
throughout its history, and homeopaths have not been able to account for a reason why
only the selected homeopathic substance would be a special case in their process. For comparison, ISO 3696:1987 defines a standard
for water used in laboratory analysis; this allows for a contaminant level of ten parts
per billion, 4C in homeopathic notation. This water may not be kept in glass as contaminants
will leach out into the water.Practitioners of homeopathy hold that higher dilutions―described
as being of higher potency―produce stronger medicinal effects. This idea is also inconsistent with observed
dose-response relationships, where effects are dependent on the concentration of the
active ingredient in the body. This dose-response relationship has been confirmed
in myriad experiments on organisms as diverse as nematodes, rats, and humans. Some homeopaths contend that the phenomenon
of hormesis may support the idea of dilution increasing potency, but the dose-response
relationship outside the zone of hormesis declines with dilution as normal, and nonlinear
pharmacological effects do not provide any credible support for homeopathy.Physicist
Robert L. Park, former executive director of the American Physical Society, is quoted
as saying: “since the least amount of a substance in
a solution is one molecule, a 30C solution would have to have at least one molecule of
the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000
[or 1060] molecules of water. This would require a container more than 30,000,000,000
times the size of the Earth.”Park is also quoted as saying that, “to expect to get even
one molecule of the ‘medicinal’ substance allegedly present in 30X pills, it would be
necessary to take some two billion of them, which would total about a thousand tons of
lactose plus whatever impurities the lactose contained”.The laws of chemistry state that
there is a limit to the dilution that can be made without losing the original substance
altogether. This limit, which is related to Avogadro’s
number, is roughly equal to homeopathic dilutions of 12C or 24X (1 part in 1024).Scientific
tests run by both the BBC’s Horizon and ABC’s 20/20 programmes were unable to differentiate
homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.In
May 2018, the German skeptical organization GWUP issued an invitation to individuals and
groups to respond to its challenge “to identify homeopathic preparations in high potency and
to give a detailed description on how this can be achieved reproducibly.” The first participant to correctly identify
selected homeopathic preparations under an agreed-upon protocol will receive €50,000.===Efficacy===No individual homeopathic preparation has
been unambiguously shown by research to be different from placebo. The methodological quality of the primary
research was generally low, with such problems as weaknesses in study design and reporting,
small sample size, and selection bias. Since better quality trials have become available,
the evidence for efficacy of homeopathy preparations has diminished; the highest-quality trials
indicate that the preparations themselves exert no intrinsic effect. A review conducted in 2010 of all the pertinent
studies of “best evidence” produced by the Cochrane Collaboration concluded that “the
most reliable evidence – that produced by Cochrane reviews – fails to demonstrate
that homeopathic medicines have effects beyond placebo.”====Government level reviews====
Government-level reviews have been conducted in recent years by Switzerland (2005), the
United Kingdom (2009), Australia (2015) and the European Academies’ Science Advisory Council
(2017). The Swiss programme for the evaluation of
complementary medicine (PEK) resulted in the peer-reviewed Shang publication (see Systematic
reviews and meta-analyses of efficacy) and a controversial competing analysis by homeopaths
and advocates led by Gudrun Bornhöft and Peter Matthiessen, which has misleadingly
been presented as a Swiss government report by homeopathy proponents, a claim that has
been repudiated by the Swiss Federal Office of Public Health. The Swiss Government terminated reimbursement,
though it was subsequently reinstated after a political campaign and referendum for a
further six-year trial period.The United Kingdom’s House of Commons Science and Technology Committee
sought written evidence and submissions from concerned parties and, following a review
of all submissions, concluded that there was no compelling evidence of effect other than
placebo and recommended that the Medicines and Healthcare products Regulatory Agency
(MHRA) should not allow homeopathic product labels to make medical claims, that homeopathic
products should no longer be licensed by the MHRA, as they are not medicines, and that
further clinical trials of homeopathy could not be justified. They recommended that funding of homeopathic
hospitals should not continue, and NHS doctors should not refer patients to homeopaths. The Secretary of State for Health deferred
to local NHS on funding homeopathy, in the name of patient choice. By February 2011 only one-third of primary
care trusts still funded homeopathy. By 2012, no British universities offered homeopathy
courses. In July 2017, as part of a plan to save £200m
a year by preventing the “misuse of scarce” funding, the NHS announced that it would no
longer provide homeopathic medicines. A legal appeal by the British Homeopathic
Association against the decision was rejected in June 2018.The Australian National Health
and Medical Research Council completed a comprehensive review of the effectiveness of homeopathic
preparations in 2015, in which it concluded that “there were no health conditions for
which there was reliable evidence that homeopathy was effective. No good-quality, well-designed studies with
enough participants for a meaningful result reported either that homeopathy caused greater
health improvements than placebo, or caused health improvements equal to those of another
treatment.”On September 20, 2017, the European Academies’ Science Advisory Council (EASAC)
published its official analysis and conclusion on the use of homeopathic products, finding
a lack of evidence that homeopathic products are effective, and raising concerns about
quality control.====Publication bias and other methodological
problems====The fact that individual randomized controlled
trials have given positive results is not in contradiction with an overall lack of statistical
evidence of efficacy. A small proportion of randomized controlled
trials inevitably provide false-positive outcomes due to the play of chance: a “statistically
significant” positive outcome is commonly adjudicated when the probability of it being
due to chance rather than a real effect is no more than 5%―a level at which about 1
in 20 tests can be expected to show a positive result in the absence of any therapeutic effect. Furthermore, trials of low methodological
quality (i.e. ones that have been inappropriately designed, conducted or reported) are prone
to give misleading results. In a systematic review of the methodological
quality of randomized trials in three branches of alternative medicine, Linde et al. highlighted
major weaknesses in the homeopathy sector, including poor randomization. A separate 2001 systematic review that assessed
the quality of clinical trials of homeopathy found that such trials were generally of lower
quality than trials of conventional medicine.A related issue is publication bias: researchers
are more likely to submit trials that report a positive finding for publication, and journals
prefer to publish positive results. Publication bias has been particularly marked
in alternative medicine journals, where few of the published articles (just 5% during
the year 2000) tend to report null results. Regarding the way in which homeopathy is represented
in the medical literature, a systematic review found signs of bias in the publications of
clinical trials (towards negative representation in mainstream medical journals, and vice versa
in alternative medicine journals), but not in reviews.Positive results are much more
likely to be false if the prior probability of the claim under test is low.====Systematic reviews and meta-analyses
of efficacy====Both meta-analyses, which statistically combine
the results of several randomized controlled trials, and other systematic reviews of the
literature are essential tools to summarize evidence of therapeutic efficacy. Early systematic reviews and meta-analyses
of trials evaluating the efficacy of homeopathic preparations in comparison with placebo more
often tended to generate positive results, but appeared unconvincing overall. In particular, reports of three large meta-analyses
warned readers that firm conclusions could not be reached, largely due to methodological
flaws in the primary studies and the difficulty in controlling for publication bias. The positive finding of one of the most prominent
of the early meta-analyses, published in The Lancet in 1997 by Linde et al., was later
reframed by the same research team, who wrote: The evidence of bias [in the primary studies]
weakens the findings of our original meta-analysis. Since we completed our literature search in
1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality
trials … have negative results, and a recent update of our review for the most “original”
subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that
more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis
at least overestimated the effects of homeopathic treatments. Subsequent work by John Ioannidis and others
has shown that for treatments with no prior plausibility, the chances of a positive result
being a false positive are much higher, and that any result not consistent with the null
hypothesis should be assumed to be a false positive.A systematic review of the available
systematic reviews confirmed in 2002 that higher-quality trials tended to have less
positive results, and found no convincing evidence that any homeopathic preparation
exerts clinical effects different from placebo.In 2005, The Lancet medical journal published
a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical
trials based upon the Swiss government’s Programme for Evaluating Complementary Medicine, or
PEK. The study concluded that its findings were
“compatible with the notion that the clinical effects of homeopathy are placebo effects”. This was accompanied by an editorial pronouncing
“The end of homoeopathy”, which was denounced by the homeopath Peter Fisher.Other meta-analyses
include homeopathic treatments to reduce cancer therapy side-effects following radiotherapy
and chemotherapy, allergic rhinitis, attention-deficit hyperactivity disorder and childhood diarrhoea,
adenoid vegetation, asthma, upper respiratory tract infection in children, insomnia, fibromyalgia,
psychiatric conditions and Cochrane Library systematic reviews of homeopathic treatments
for asthma, dementia, attention-deficit hyperactivity disorder, induction of labour, upper respiratory
tract infections in children, and irritable bowel syndrome. Other reviews covered osteoarthritis, migraines,
postoperative ecchymosis and edema, delayed-onset muscle soreness, preventing postpartum haemorrhage,
or eczema and other dermatological conditions.A 2017 systematic review and meta-analysis found
that the most reliable evidence did not support the effectiveness of non-individualized homeopathy. The authors noted that “the quality of the
body of evidence is low.”The results of these reviews are generally negative or only weakly
positive, and reviewers consistently report the poor quality of trials. The finding of Linde et. al. that more rigorous
studies produce less positive results is supported in several and contradicted by none. Some clinical trials have tested individualized
homeopathy, and there have been reviews of this, specifically. A 1998 review found 32 trials that met their
inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio
of 1.17 to 2.23 in favour of individualized homeopathy over the placebo, but no difference
was seen when the analysis was restricted to the methodologically best trials. The authors concluded that “the results of
the available randomized trials suggest that individualized homeopathy has an effect over
placebo. The evidence, however, is not convincing because
of methodological shortcomings and inconsistencies.” Jay Shelton, author of a book on homeopathy,
has stated that the claim assumes without evidence that classical, individualized homeopathy
works better than nonclassical variations. A 2014 systematic review and meta-analysis
found that individualized homeopathic remedies may be slightly more effective than placebos,
though the authors noted that their findings were based on low- or unclear-quality evidence. The same research team later reported that
taking into account model validity did not significantly affect this conclusion.A 2017
review found that homeopathic medicines did not prevent or treat acute respiratory tract
infections in children.====Statements by major medical organizations
====Health organizations such as the UK’s National
Health Service, the American Medical Association, the FASEB, and the National Health and Medical
Research Council of Australia, have issued statements of their conclusion that there
is “no good-quality evidence that homeopathy is effective as a treatment for any health
condition”. In 2009, World Health Organization official
Mario Raviglione criticized the use of homeopathy to treat tuberculosis; similarly, another
WHO spokesperson argued there was no evidence homeopathy would be an effective treatment
for diarrhoea.The American College of Medical Toxicology and the American Academy of Clinical
Toxicology recommend that no one use homeopathic treatment for disease or as a preventive health
measure. These organizations report that no evidence
exists that homeopathic treatment is effective, but that there is evidence that using these
treatments produces harm and can bring indirect health risks by delaying conventional treatment.===Explanations of perceived effects===
Science offers a variety of explanations for how homeopathy may appear to cure diseases
or alleviate symptoms even though the preparations themselves are inert:
The placebo effect – the intensive consultation process and expectations for the homeopathic
preparations may cause the effect. Therapeutic effect of the consultation – the
care, concern, and reassurance a patient experiences when opening up to a compassionate caregiver
can have a positive effect on the patient’s well-being. Unassisted natural healing – time and the
body’s ability to heal without assistance can eliminate many diseases of their own accord. Unrecognized treatments – an unrelated food,
exercise, environmental agent, or treatment for a different ailment, may have occurred. Regression towards the mean – since many
diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care
when discomfort is greatest; they may feel better anyway but because of the timing of
the visit to the homeopath they attribute improvement to the preparation taken. Non-homeopathic treatment – patients may
also receive standard medical care at the same time as homeopathic treatment, and the
former is responsible for improvement. Cessation of unpleasant treatment – often
homeopaths recommend patients stop getting medical treatment such as surgery or drugs,
which can cause unpleasant side-effects; improvements are attributed to homeopathy when the actual
cause is the cessation of the treatment causing side-effects in the first place, but the underlying
disease remains untreated and still dangerous to the patient.===Purported effects in other biological
systems===While some articles have suggested that homeopathic
solutions of high dilution can have statistically significant effects on organic processes including
the growth of grain, histamine release by leukocytes, and enzyme reactions, such evidence
is disputed since attempts to replicate them have failed. A 2007 systematic review of high-dilution
experiments found that none of the experiments with positive results could be reproduced
by all investigators.In 1987, French immunologist Jacques Benveniste submitted a paper to the
journal Nature while working at INSERM. The paper purported to have discovered that
basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution
of anti-immunoglobulin E antibody. The journal editors, sceptical of the results,
requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories
the study was published. Still sceptical of the findings, Nature assembled
an independent investigative team to determine the accuracy of the research, consisting of
Nature editor and physicist Sir John Maddox, American scientific fraud investigator and
chemist Walter Stewart, and sceptic James Randi. After investigating the findings and methodology
of the experiment, the team found that the experiments were “statistically ill-controlled”,
“interpretation has been clouded by the exclusion of measurements in conflict with the claim”,
and concluded, “We believe that experimental data have been uncritically assessed and their
imperfections inadequately reported.” James Randi stated that he doubted that there
had been any conscious fraud, but that the researchers had allowed “wishful thinking”
to influence their interpretation of the data.In 2001 and 2004, Madeleine Ennis published a
number of studies that reported that homeopathic dilutions of histamine exerted an effect on
the activity of basophils. In response to the first of these studies,
Horizon aired a programme in which British scientists attempted to replicate Ennis’ results;
they were unable to do so.===Ethics and safety===
The provision of homeopathic preparations has been described as unethical. Michael Baum, Professor Emeritus of Surgery
and visiting Professor of Medical Humanities at University College London (UCL), has described
homoeopathy as a “cruel deception”.Edzard Ernst, the first Professor of Complementary
Medicine in the United Kingdom and a former homeopathic practitioner, has expressed his
concerns about pharmacists who violate their ethical code by failing to provide customers
with “necessary and relevant information” about the true nature of the homeopathic products
they advertise and sell: “My plea is simply for honesty. Let people buy what they want, but tell them
the truth about what they are buying. These treatments are biologically implausible
and the clinical tests have shown they don’t do anything at all in human beings. The argument that this information is not
relevant or important for customers is quite simply ridiculous.”Patients who choose to
use homeopathy rather than evidence-based medicine risk missing timely diagnosis and
effective treatment of serious conditions such as cancer.In 2013 the UK Advertising
Standards Authority concluded that the Society of Homeopaths were targeting vulnerable ill
people and discouraging the use of essential medical treatment while making misleading
claims of efficacy for homeopathic products.In 2015 the Federal Court of Australia imposed
penalties on a homeopathic company, Homeopathy Plus! Pty Ltd and its director, for making false
or misleading statements about the efficacy of the whooping cough vaccine and homeopathic
remedies as an alternative to the whooping cough vaccine, in breach of the Australian
Consumer Law.====Adverse effects====
Some homeopathic preparations involve poisons such as Belladonna, arsenic, and poison ivy,
which are highly diluted in the homeopathic preparation. In rare cases, the original ingredients are
present at detectable levels. This may be due to improper preparation or
intentional low dilution. Serious adverse effects such as seizures and
death have been reported or associated with some homeopathic preparations.On September
30, 2016 the FDA issued a safety alert to consumers warning against the use of homeopathic
teething gels and tablets following reports of adverse events after their use. The agency recommended that parents discard
these products and “seek advice from their health care professional for safe alternatives”
to homeopathy for teething. The pharmacy CVS announced, also on September
30, that it was voluntarily withdrawing the products from sale and on October 11 Hyland’s
(the manufacturer) announced that it was discontinuing their teething medicine in the United States
though the products remain on sale in Canada. On October 12, Buzzfeed reported that the
regulator had “examined more than 400 reports of seizures, fever and vomiting, as well as
10 deaths” over a six-year period. The investigation (including analyses of the
products) is still ongoing and the FDA does not know yet if the deaths and illnesses were
caused by the products. However a previous FDA investigation in 2010,
following adverse effects reported then, found that these same products were improperly diluted
and contained “unsafe levels of belladonna, also known as deadly nightshade” and that
the reports of serious adverse events in children using this product were “consistent with belladonna
toxicity”.Instances of arsenic poisoning have occurred after use of arsenic-containing homeopathic
preparations. Zicam Cold remedy Nasal Gel, which contains
2X (1:100) zinc gluconate, reportedly caused a small percentage of users to lose their
sense of smell; 340 cases were settled out of court in 2006 for 12 million U.S. dollars. In 2009, the FDA advised consumers to stop
using three discontinued cold remedy Zicam products because it could cause permanent
damage to users’ sense of smell. Zicam was launched without a New Drug Application
(NDA) under a provision in the FDA’s Compliance Policy Guide called “Conditions under which
homeopathic drugs may be marketed” (CPG 7132.15), but the FDA warned Matrixx Initiatives, its
manufacturer, via a Warning Letter that this policy does not apply when there is a health
risk to consumers.A 2000 review by homeopaths reported that homeopathic preparations are
“unlikely to provoke severe adverse reactions”. In 2012, a systematic review evaluating evidence
of homeopathy’s possible adverse effects concluded that “homeopathy has the potential to harm
patients and consumers in both direct and indirect ways”. One of the reviewers, Edzard Ernst, supplemented
the article on his blog, writing: “I have said it often and I say it again: if used
as an alternative to an effective cure, even the most ‘harmless’ treatment can become life-threatening.” A 2016 systematic review and meta-analysis
found that, in homeopathic clinical trials, adverse effects were reported among the patients
who received homeopathy about as often as they were reported among patients who received
placebo or conventional medicine.====Lack of efficacy====
The lack of convincing scientific evidence supporting its efficacy and its use of preparations
without active ingredients have led to characterizations as pseudoscience and quackery, or, in the
words of a 1998 medical review, “placebo therapy at best and quackery at worst”. The Russian Academy of Sciences considers
homeopathy a “dangerous ‘pseudoscience’ that does not work”, and “urges people to treat
homeopathy ‘on a par with magic'”. The Chief Medical Officer for England, Dame
Sally Davies, has stated that homeopathic preparations are “rubbish” and do not serve
as anything more than placebos. Jack Killen, acting deputy director of the
National Center for Complementary and Alternative Medicine, says homeopathy “goes beyond current
understanding of chemistry and physics”. He adds: “There is, to my knowledge, no condition
for which homeopathy has been proven to be an effective treatment.” Ben Goldacre says that homeopaths who misrepresent
scientific evidence to a scientifically illiterate public, have “… walled themselves off from
academic medicine, and critique has been all too often met with avoidance rather than argument”. Homeopaths often prefer to ignore meta-analyses
in favour of cherry picked positive results, such as by promoting a particular observational
study (one which Goldacre describes as “little more than a customer-satisfaction survey”)
as if it were more informative than a series of randomized controlled trials.Referring
specifically to homeopathy, the British House of Commons Science and Technology Committee
has stated: In our view, the systematic reviews and meta-analyses
conclusively demonstrate that homeopathic products perform no better than placebos. The Government shares our interpretation of
the evidence. In the Committee’s view, homeopathy is a placebo
treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the
appropriateness and ethics of prescribing placebos to patients, which usually relies
on some degree of patient deception. Prescribing of placebos is not consistent
with an informed patient choice – which the Government claims is very important – as
it means patients do not have all the information needed to make choice meaningful. Beyond ethical issues and the integrity of
the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable
and cannot form the sole basis of any treatment on the NHS. The National Center for Complementary and
Alternative Medicine of the United States’ National Institutes of Health states: Homeopathy is a controversial topic in complementary
medicine research. A number of the key concepts of homeopathy
are not consistent with fundamental concepts of chemistry and physics. For example, it is not possible to explain
in scientific terms how a preparation containing little or no active ingredient can have any
effect. This, in turn, creates major challenges to
the rigorous clinical investigation of homeopathic preparations. For example, one cannot confirm that an extremely
dilute preparation contains what is listed on the label, or develop objective measures
that show effects of extremely dilute preparations in the human body. Ben Goldacre noted that in the early days
of homeopathy, when medicine was dogmatic and frequently worse than doing nothing, homeopathy
at least failed to make matters worse: During the 19th-century cholera epidemic,
death rates at the London Homeopathic Hospital were three times lower than at the Middlesex
Hospital. Homeopathic sugar pills won’t do anything
against cholera, of course, but the reason for homeopathy’s success in this epidemic
is even more interesting than the placebo effect: at the time, nobody could treat cholera. So, while hideous medical treatments such
as blood-letting were actively harmful, the homeopaths’ treatments at least did nothing
either way.====In lieu of standard medical treatment
====On clinical grounds, patients who choose to
use homeopathy in preference to normal medicine risk missing timely diagnosis and effective
treatment, thereby worsening the outcomes of serious conditions. Critics of homeopathy have cited individual
cases of patients of homeopathy failing to receive proper treatment for diseases that
could have been easily diagnosed and managed with conventional medicine and who have died
as a result, and the “marketing practice” of criticizing and downplaying the effectiveness
of mainstream medicine. Homeopaths claim that use of conventional
medicines will “push the disease deeper” and cause more serious conditions, a process referred
to as “suppression”. Some homeopaths (particularly those who are
non-physicians) advise their patients against immunization. Some homeopaths suggest that vaccines be replaced
with homeopathic “nosodes”, created from biological materials such as pus, diseased tissue, bacilli
from sputum or (in the case of “bowel nosodes”) faeces. While Hahnemann was opposed to such preparations,
modern homeopaths often use them although there is no evidence to indicate they have
any beneficial effects. Cases of homeopaths advising against the use
of anti-malarial drugs have been identified. This puts visitors to the tropics who take
this advice in severe danger, since homeopathic preparations are completely ineffective against
the malaria parasite. Also, in one case in 2004, a homeopath instructed
one of her patients to stop taking conventional medication for a heart condition, advising
her on June 22, 2004 to “Stop ALL medications including homeopathic”, advising her on or
around August 20 that she no longer needed to take her heart medication, and adding on
August 23, “She just cannot take ANY drugs – I have suggested some homeopathic remedies
… I feel confident that if she follows the advice she will regain her health.” The patient was admitted to hospital the next
day, and died eight days later, the final diagnosis being “acute heart failure due to
treatment discontinuation”.In 1978, Anthony Campbell, then a consultant physician at the
Royal London Homeopathic Hospital, criticized statements by George Vithoulkas claiming that
syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis
with involvement of the central nervous system, saying that “The unfortunate layman might
well be misled by Vithoulkas’ rhetoric into refusing orthodox treatment”. Vithoulkas’ claims echo the idea that treating
a disease with external medication used to treat the symptoms would only drive it deeper
into the body and conflict with scientific studies, which indicate that penicillin treatment
produces a complete cure of syphilis in more than 90% of cases.A 2006 review by W. Steven
Pray of the College of Pharmacy at Southwestern Oklahoma State University recommends that
pharmacy colleges include a required course in unproven medications and therapies, that
ethical dilemmas inherent in recommending products lacking proven safety and efficacy
data be discussed, and that students should be taught where unproven systems such as homeopathy
depart from evidence-based medicine.In an article entitled “Should We Maintain an Open
Mind about Homeopathy?” published in the American Journal of Medicine, Michael Baum and Edzard
Ernst – writing to other physicians – wrote that “Homeopathy is among the worst examples
of faith-based medicine… These axioms [of homeopathy] are not only
out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics,
chemistry, and pharmacology must be incorrect…”. In 2013, Mark Walport, the UK Government Chief
Scientific Adviser and head of the Government Office for Science, had this to say: “My view
scientifically is absolutely clear: homoeopathy is nonsense, it is non-science. My advice to ministers is clear: that there
is no science in homoeopathy. The most it can have is a placebo effect – it
is then a political decision whether they spend money on it or not.” His predecessor, John Beddington, referring
to his views on homeopathy being “fundamentally ignored” by the Government, said: “The only
one [view being ignored] I could think of was homoeopathy, which is mad. It has no underpinning of scientific basis. In fact, all the science points to the fact
that it is not at all sensible. The clear evidence is saying this is wrong,
but homoeopathy is still used on the NHS.”==Regulation and prevalence==Homeopathy is fairly common in some countries
while being uncommon in others; is highly regulated in some countries and mostly unregulated
in others. It is practised worldwide and professional
qualifications and licences are needed in most countries. In some countries, there are no specific legal
regulations concerning the use of homeopathy, while in others, licences or degrees in conventional
medicine from accredited universities are required. In Germany, to become a homeopathic physician,
one must attend a three-year training programme, while France, Austria and Denmark mandate
licences to diagnose any illness or dispense of any product whose purpose is to treat any
illness.Some homeopathic treatment is covered by the public health service of several European
countries, including France, Scotland, Luxembourg and England (though the latter will cease
in February 2019). In other countries, such as Belgium, homeopathy
is not covered. In Austria, the public health service requires
scientific proof of effectiveness in order to reimburse medical treatments and homeopathy
is listed as not reimbursable, but exceptions can be made; private health insurance policies
sometimes include homeopathic treatment. The Swiss government, after a 5-year trial,
withdrew coverage of homeopathy and four other complementary treatments in 2005, stating
that they did not meet efficacy and cost-effectiveness criteria, but following a referendum in 2009
the five therapies have been reinstated for a further 6-year trial period from 2012. The Indian government recognizes homeopathy
as one of its national systems of medicine; it has established AYUSH or the Department
of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy under the Ministry
of Health & Family Welfare. The south Indian state of Kerala also has
a cabinet-level AYUSH department. The Central Council of Homoeopathy was established
in 1973 to monitor higher education in homeopathy, and National Institute of Homoeopathy in 1975. A minimum of a recognized diploma in homeopathy
and registration on a state register or the Central Register of Homoeopathy is required
to practise homeopathy in India.On September 28, 2016 the UK’s Committee of Advertising
Practice (CAP) Compliance team wrote to homeopaths in the UK to “remind them of the rules that
govern what they can and can’t say in their marketing materials”. The letter highlights that “homeopaths may
not currently make either direct or implied claims to treat medical conditions” and asks
them to review their marketing communications “including websites and social media pages”
to ensure compliance by November 3, 2016. The letter also includes information on sanctions
in the event of non-compliance including, ultimately, “referral by the ASA to Trading
Standards under the Consumer Protection from Unfair Trading Regulations 2008”.In February
2017, Russian Academy of Sciences declared homeopathy to be “dangerous pseudoscience”
and “on a par with magic”.==Public opposition==
In the April 1997 edition of FDA Consumer, William T. Jarvis, the President of the National
Council Against Health Fraud, said “Homeopathy is a fraud perpetrated on the public with
the government’s blessing, thanks to the abuse of political power of Sen. Royal S. Copeland
[chief sponsor of the 1938 Food, Drug, and Cosmetic Act].”Mock “overdosing” on homeopathic
preparations by individuals or groups in “mass suicides” have become more popular since James
Randi began taking entire bottles of homeopathic sleeping pills before giving lectures. In 2010 The Merseyside Skeptics Society from
the United Kingdom launched the 10:23 campaign, encouraging groups to publicly overdose as
groups. In 2011 the 10:23 campaign expanded and saw
sixty-nine groups participate; fifty-four submitted videos. In April 2012, at the Berkeley SkeptiCal conference,
over 100 people participated in a mass overdose, taking coffea cruda, which is supposed to
treat sleeplessness.In 2011, the non-profit, educational organizations Center for Inquiry
(CFI) and the associated Committee for Skeptical Inquiry (CSI) have petitioned the U.S. Food
and Drug Administration (FDA) to initiate “rulemaking that would require all over-the-counter
homeopathic drugs to meet the same standards of effectiveness as non-homeopathic drugs”
and “to place warning labels on homeopathic drugs until such time as they are shown to
be effective”. In a separate petition, CFI and CSI request
FDA to issue warning letters to Boiron, maker of Oscillococcinum, regarding their marketing
tactic and criticize Boiron for misleading labelling and advertising of Oscillococcinum. In 2015, CFI filed comments urging the Federal
Trade Commission to end the false advertising practice of homeopathy. On November 15, 2016, FTC declared that homeopathic
products cannot include claims of effectiveness without “competent and reliable scientific
evidence”. If no such evidence exists, they must state
this fact clearly on their labeling, and state that the product’s claims are based only on
18th-century theories that have been discarded by modern science. Failure to do so will be considered a violation
of the FTC Act. CFI in Canada is calling for persons that
feel they were harmed by homeopathic products to contact them.In July 2018 the Center for
Inquiry filed a lawsuit against CVS for consumer fraud over its sale of homeopathic medicines. According to Nicholas Little, CFI’s Vice President
and General Counsel: Homeopathy is a total sham, and CVS knows
it. Yet the company persists in deceiving its
customers about the effectiveness of homeopathic products. Homeopathics are shelved right alongside scientifically-proven
medicines, under the same signs for cold and flu, pain relief, sleep aids, and so on. If you search for “flu treatment” on their
website, it even suggests homeopathics to you, CVS is making no distinction between
those products that have been vetted and tested by science, and those that are nothing but
snake oil. The filing in part contends that apart from
being a waste of money, choosing homeopathic treatments to the exclusion of evidence-based
medicines can result in worsened or prolonged symptoms, and in some cases, even death. It also claimed that CVS was selling homeopathic
products on an easier-to-obtain basis than standard medication; for example on the CVS
website Oscillococcinum could be purchased as a “Flu remedy”, whereas the Tylenol brand
could only be purchased by visiting a physical pharmacy.In August 2011, a class action lawsuit
was filed against Boiron on behalf of “all California residents who purchased Oscillo
at any time within the past four years”. The lawsuit charged that it “is nothing more
than a sugar pill”, “despite falsely advertising that it contains an active ingredient known
to treat flu symptoms”. In March 2012, Boiron agreed to spend up to
$12 million to settle the claims of falsely advertising the benefits of its homeopathic
preparations.In July 2012, CBC News reporter Erica Johnson for Marketplace conducted an
investigation on the homeopathy industry in Canada; her findings were that it is “based
on flawed science and some loopy thinking”. Center for Inquiry (CFI) Vancouver skeptics
participated in a mass overdose outside an emergency room in Vancouver, B.C., taking
entire bottles of “medications” that should have made them sleepy, nauseous or dead; after
45 minutes of observation no ill effects were felt. Johnson asked homeopaths and company representatives
about cures for cancer and vaccine claims. All reported positive results but none could
offer any science backing up their statements, only that “it works”. Johnson was unable to find any evidence that
homeopathic preparations contain any active ingredient. Analysis performed at the University of Toronto’s
chemistry department found that the active ingredient is so small “it is equivalent to
5 billion times less than the amount of aspirin … in a single pellet”. Belladonna and ipecac “would be indistinguishable
from each other in a blind test”.Homeopathic services offered at Bristol Homeopathic Hospital
in the UK ceased in October 2015, partly in response to increased public awareness as
a result of the 10:23 Campaign and a campaign led by the Good Thinking Society. University Hospitals Bristol confirmed that
it would cease to offer homeopathic therapies from October 2015, at which point homeopathic
therapies would no longer be included in the contract. Homeopathic services in the Bristol area were
relocated to “a new independent social enterprise” at which Bristol Clinical Commissioning Group
revealed “there are currently no (NHS) contracts for homeopathy in place.” Following a threat of legal action by the
Good Thinking Society campaign group, the British government has stated that the Department
of Health will hold a consultation in 2016 regarding whether homeopathic treatments should
be added to the NHS treatments blacklist (officially, Schedule 1 of the National Health Service
(General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004), that specifies
a blacklist of medicines not to be prescribed under the NHS.In March 2016, the University
of Barcelona cancelled its master’s degree in Homeopathy citing “lack of scientific basis”,
after advice from the Spanish Ministry of Health stated that “Homeopathy has not definitely
proved its efficacy under any indication or concrete clinical situation”. Shortly afterwards, in April 2016, the University
of Valencia announced the elimination of its Masters in Homeopathy for 2017.In June 2016,
blogger and sceptic Jithin Mohandas launched a petition through Change.org asking the government
of Kerala, India, to stop admitting students to homeopathy medical colleges. Mohandas said that government approval of
these colleges makes them appear legitimate, leading thousands of talented students to
join them and end up with invalid degrees. The petition asks that homeopathy colleges
be converted to regular medical colleges and that people with homeopathy degrees be provided
with training in scientific medicine.In Germany, physician and critic of alternative medicine
Irmgard Oepen was a relentless critic of homeopathy.==United States Food and Drug Administration
(FDA) 2015 hearing==On April 20–21, 2015, the FDA held a hearing
on homeopathic product regulation. Invitees representing the scientific and medical
community, and various pro-homeopathy stakeholders, gave testimonials on homeopathic products
and the regulatory role played by the FDA. Michael de Dora, a representative from the
Center for Inquiry (CFI), on behalf of the organization and dozens of doctors and scientists
associated with CFI and the Committee for Skeptical Inquiry (CSI) gave a testimonial
which summarized the basis of the organization’s objection to homeopathic products, the harm
that is done to the general public and proposed regulatory actions:The CFI testimonial stated
that the principle of homeopathy is at complete odds with the basic principles of modern biology,
chemistry and physics and that decades of scientific examination of homeopathic products
shows that there is no evidence that it is effective in treating illnesses other than
acting as a placebo. Further, it noted a 2012 report by the American
Association of Poison Control Centers which listed 10,311 reported cases of poison exposure
related to homeopathic agents, among which 8,788 cases were attributed to young children
five years of age or younger, as well as examples of harm – including deaths – caused to
patients who relied on homeopathics instead of proven medical treatment.The CFI urged
the FDA to announce and implement strict guidelines that “require all homeopathic products meet
the same standards as non-homeopathic drugs”, arguing that the consumers can only have true
freedom of choice (an often used argument from the homeopathy proponents) if they are
fully informed of the choices. CFI proposed that the FDA take these three
steps: Testing for homeopathic products The FDA will
mandate that all homeopathic products on the market to perform and pass safety and efficacy
tests equivalent to those required of non-homeopathic drugs. Labelling for homeopathic products To avert
misleading label that the product is regulated by the FDA, all homeopathic products will
be required to have prominent labels stating: (1) the product’s claimed active ingredients
in plain English, and (2) that the product has not been evaluated by the FDA for either
safety or effectiveness. Regular consumer warnings Encouraged by the
FDA’s recent warning of the ineffectiveness of homeopathic products, CFI urged the FDA
to issue regular warning to the consumers in addition to warning during public health
crises and outbreaks.In December 2017, the FDA announced it would strengthen regulation
of homeopathic products focusing on “situations where homeopathic treatments are being marketed
for serious diseases or conditions but have not been shown to offer clinical benefits”
and where “products labeled as homeopathic contain potentially harmful ingredients or
do not meet current good manufacturing practices.”==Official conclusions and recommendations
==In March 2015, the National Health and Medical
Research Council of Australia issued the following conclusions and recommendations:
There is no reliable evidence that homeopathy is effective for treating health conditions. Homeopathy should not be used to treat health
conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their
health at risk if they reject or delay treatments for which there is good evidence for safety
and effectiveness. People who are considering whether to use
homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their
health practitioner and should keep taking any prescribed treatments.In November 2016,
The United States FTC issued an “Enforcement Policy Statement Regarding Marketing Claims
for Over-the-Counter Homeopathic Drugs” which specified that the FTC will hold efficacy
and safety claims for OTC homeopathic drugs to the same standard as other products making
similar claims. A November 15, 2016, FTC press release summarized
the policy as follows: “The policy statement explains that the FTC
will hold efficacy and safety claims for OTC homeopathic drugs to the same standard as
other products making similar claims. That is, companies must have competent and
reliable scientific evidence for health-related claims, including claims that a product can
treat specific conditions. The statement describes the type of scientific
evidence that the Commission requires of companies making such claims for their products… For the vast majority of OTC homeopathic drugs,
the policy statement notes, ‘the case for efficacy is based solely on traditional homeopathic
theories and there are no valid studies using current scientific methods showing the product’s
efficacy.’ As such, the marketing claims for these products
are likely misleading, in violation of the FTC Act.”In conjunction with the 2016 FTC
Enforcement Policy Statement, the FTC also released its “Homeopathic Medicine & Advertising
Workshop Report”, which summarizes the panel presentations and related public comments
in addition to describing consumer research commissioned by the FTC. The report concluded: “Efficacy claims for traditional OTC homeopathic
products are only supported by homeopathic theories and homeopathic provings, which are
not accepted by most modern medical experts and do not constitute competent and reliable
scientific evidence that these products have the claimed treatment effects.”==
See also==Fringe science
List of topics characterized as pseudoscience

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