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Homeopathy

Homeopathy, from the Greek words homoios (similar) and pathos (suffering),
is a controversial system of alternative medicine involving the use of
remedies without chemically active ingredients. The theory of homeopathy was
developed by the Saxon physician Samuel Hahnemann (1755-1843) and first
published in 1796.

Underlying theory

The theory of homeopathy holds that every symptom induced by a toxic dose of
a substance in a healthy person can be cured by a remedy prepared from that
same substance? in Hahnemann's own famous words: similia similibus curentur
("Let like cure likes.") Two example of substances used are Natrium
muriatricum (a.k.a. table salt), which is not terribly toxic and Lachesis
muta (the venom of the bushmaster snake), which is toxic.

The homeopathic concept of disease differs from that of conventional
medicine: The root cause of disease is believed to be spiritual rather than
physical, and a disease is thought to manifest itself first in emotional
symptoms (e.g. cravings, aversions) and if left untreated gradually progress
to mental, modal and finally physical symptoms. As the disease process is
thought to begin long before any physical manifestations appear, it
logically follows that bacteria and viruses must be effects, not causes, of disease.

Homeopathic remedies

A Materia Medica Pura is a listing of symptoms associated with each of a
number of substances, produced by homeopathic proving - i.e., the researcher
imbibes a toxic dose of the substance and records all physical, mental,
emotional and modal symptoms experienced. A homeopathic repertory is a
listing of remedies by symptom compiled therefrom, used to determine the
most appropriate remedy for a given case. Kent's Repertory (published 1905)
lists about 700 different remedies. Today, nearly 3000 different remedies
are used in homeopathy, of which approximately 150 are considered common.

The preparation of homeopathic remedies, known as dynamization or
potentiziation, consists of successive dilutions followed by shaking in 10
hard strikes against an elastic body at each dilution stage. The vigorous
agitation following eacht dilution is thought to transfer some of the
spiritual essence of the substance to the water. The dilution factor at each
stage is traditonally 1:10 (D or X potencies) or 1:100 (C potencies), though
recently LM potencies (dilution factor 1:50,000 at each stage) have been
used by some practitioners.

The choice of potency prescribed depends on how deep-seated a disease is
diagnosed to be, 12 being a typical starting point for acute conditions
compared to 30 for chronic conditions. The dilution factor is considered
much less important than the number of successive dilutions - D potencies
are generally preferred in Europe, while C potencies prevail in the United
States and India.

The Dilution Process

Homeopathy defines the potency of its remedies according to how diluted they
are; the more diluted, the stronger it considers them. The process of
dilution is called potentization. The potency is defined in terms of a
number, where the higher the number, the higher the dilution. 30X, for
example, is more diluted (and thus, according to homeopathy, more potent)
than 10X. This is in contrast to conventional medicine and biochemistry,
which hold that the more of an active ingredient is present in a drug, the
more effect (whether positive or negative) it will have.

Some supporters of homeopathy believe that while lower dilutions may have
more of a physiological effect, higher dilutions may have a greater effect
on the mental or emotional plane. Even critics would agree that a higher
dilution factor probably has its marketing advantages.

Much of the controversy surrounding homeopathy concerns the mechanism that
would lie behind the alleged effectiveness of highly diluted substances.
Critics argue that homeopathic substances are so diluted as to contain
nothing of any value: indeed, that no molecules of the "active" substance
remain in the most "potent" dilutions. Defenders of homeopathy, however,
argue that the mechanism is irrelevant, because it works; they cite the
example of aspirin, which was used for years without anyone knowing how it
worked. Critics return that there is a fundamental difference between not
understanding the mechanism of a proven medicine, and not understanding any
conceivable mechanism for an unproven one. While studies remain
controversial, they say, attempting to understand the underlying theory
remains important in determining whether homeopathy really has benefits.

History of homeopathy

At its core, homeopathy is a method of treating diseases and medical
conditions invented by the German physician Samuel Hahnemann (1755-1843) in
the late 18th and early 19th centuries and significantly refined as well as
poularized by the American James Tyler Kent, M.D. It is based on the theory
that each naturally occurring element, plant, and mineral compound will,
when ingested or applied, result in certain symptoms. Hahnemann believed
that, by diluting these substances in a standardized manner, one could reach
the true essence of that substance. Hahnemann described this process of
dilution as "potentizing" (German: "potenziert") the substance. These dilute
amounts could then be used to treat the very symptoms they were known to produce.

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

According to homeopaths, conventional (or allopathic) medicine views
symptoms as signs of illness (though some modern scientists would see this
as an overly simplistic view). Modern treatments are intended to fight
disease by targeting the pathogen causing the symptoms. According to
homeopathy, however, symptoms are actually the body's way of fighting
"dis-ease" (verb not noun.) Homeopathy teaches that symptoms are to be
encouraged, by prescribing a "remedy" in minuscule doses that in large doses
would produce the same symptoms seen in the patient. These remedies are
intended to stimulate the immune system, helping to cure the illness.

Current acceptance status of homeopathy

Homeopathy has attracted practitioners for more than a century and a half,
many of whom have put forth claims of evidence for its efficacy. Homeopathy
is rejected as pseudoscience (functioning to some extent through the placebo
effect) by the majority of the scientific and medical establishment in the
United States and Western Europe. Nevertheless, there is a large market for
homeopathic treatments in parts of Europe and in some other nations like
India; in Germany, homeopathy and other forms of alternative medicine are
covered by health insurance (approval of such remedies does not depend on
proven efficacy).

Homeopathy in much of Europe is generally unregulated, prompting suggestions
that homeopathic doctors could potentially cause more harm than good.

In the United States, homeopathic remedies are subject to regulation by the
Food and Drug Administration. Although regulated, the FDA treats homeopathic
drugs significantly differently from other drugs. Homeopathic drugs are not
required to be approved by the FDA prior to sale, not required to prove
either safety or effectiveness prior to being sold, not required to label
their products with expiration dates, and not required to undergo finished
product testing to verify contents and strength. Homeopathic drugs have
their own imprints that, unlike conventional drugs, do not have to identify
their active ingredients on the grounds that they have little or no active
ingredients. Homeopathic medicines that claim to treat a serious disease can
be sold by prescription only, while homeopathic medicines that claim to
treat self-limiting conditions may be sold over the counter.

Proponents of conventional medicine charge that patients who rely fully on
homeopathic techniques, denying any conventional medicine, are at risk of
leaving some easily treatable diseases (such as some early skin cancers)
until they become untreatable. It should be mentioned that in many countries
(e.g. the United Kingdom), so-called homeopathic medicines are sold over the
counter. These medicines rely on the basic theory of treating a symptom with
its cause; however, they in no other way resemble the treatments offered by
traditional homeopaths. Traditional homeopathy is arguably more recognized
and accepted in continental Europe, perhaps because there its practitioners
rely on more tradition and treatment with the "potentized" formulae
recommended by Hahnemann.

Proponents and opponents of homeopathy disagree over whether scientific
randomized controlled trials with the use of placebos have shown success
with homeopathic methods. Some clinical trials have produced results
supporting homeopathy, but critics contend that these trials are flawed. In
1997, the British medical journal Lancet published a meta-analysis of 89
clinical trials, resulting in an ambiguous conclusion that served as fodder
for both supporters and critics of homeopathy.

Criticism of Homeopathy

Lack of evidence for therapeutic efficacy

Many consider homeopathy to be a pseudoscientific remnant from the age of
alchemy. The primary results attributed to homeopathy can be explained by
the placebo effect. They claim that homeopathic remedies have been
scientifically tested (in what is called a "double blind" study to control
for placebo effects) many times, and a few of these tests produced slightly
positive results. Most scientists easily attribute these to random chance,
as the results are only barely measurable, not reliably reproducible, and
overwhelmed by the quantity of failed tests. Moreover, the basic way in
which tests are carried out means that a small proportion of tests will give
false positives. Generally this is statistically protected against, but
where lots of tests are done, one or two will appear positive by random chance.

Lack of logical consistency

Another criticism of homeopathy is that it is not logically consistent. This
theory assumes that water somehow "remembers" the chemical properties of
molecules that it once came in contact with. In this practice one dilutes
the original solution to the point where one removes all molecules, yet is
is claimed that the water retains some chemical properties of the molecule.
If this were so, then where did the pure water used in this process come
from? The water that homeopaths themselves use once was in contact with
other chemicals, including chemical wastes, urine, radioactive metals and
various poisons. According the homeopathic theory, all water in the world
should "remember" its contact with millions of chemical substances. Yet in
practice we find that the homeopathic water remembers absolutely nothing at
all, except for the properties of the chemicals that the homeopath claims
will be useful.

Magical thinking

Although the claims of homeopathy have not been justified by scientific
testing, many people widely accept homeopathy due to magical thinking. As
Dr. Phillips Stevens points out "Many of today's complementary or
alternative systems of healing involve magical beliefs, manifesting ways of
thinking based in principles of cosmology and causality that are timeless
and absolutely universal. So similar are some of these principles among all
human populations that some cognitive scientists have suggested that they
are innate to the human species, and this suggestion is being strengthened
by current scientific research....Some of the principles of magical beliefs
described above are evident in currently popular belief systems. A clear
example is homeopathy...The fundamental principle of its founder, Samuel
Hahnemann (1755-1843), similia similibus curentur ('let likes cure likes'),
is an explicit expression of a magical principle."

Over-dilution leaves nothing but water

Diluting substances as much as homeopathy does would not only vastly
decrease any effects the substance in question has, but in fact completely
destroy the healing agent. Robert L. Park, Professor of Physics and director
of the Washington office of the American Physical Society, writes in his
book "Voodoo Science: The Road from Foolishness to Fraud":

     [Samuel] Hahnemann [the 18/19th century "inventor" of homeopathy]
     used a process of sequential dilution and to prepare his
     medications. He would dilute an extract of some "natural" herb or
     mineral, one part medicine to ten parts water, or 1:10, shake the
     solution, and then dilute it another factor of ten, resulting in a
     total dilution of 1:100. Repeating that a third time gives 1:1000,
     etc. Each sequential dilution would add another zero. He would
     repeat the procedure many times. Extreme dilutions are easily
     achieved by this method. The dilution limit is reached when a
     single molecule of the medicine remains. Beyond that point, there
     is nothing left to dilute. In over-the-counter homeopathic
     remedies, for example, a dilution of 30X is fairly standard. The
     notation 30X means the substance was diluted one part in ten and
     shaken, and then this was repeated sequentially thirty times. The
     final dilution would be one part medicine to
     1,000,000,000,000,000,000,000,000,000,000 parts of water. That
     would be far beyond the dilution limit. To be precise, at a
     dilution of 30X you would have to drink 7,874 gallons of the
     solution to expect to get just one molecule of the medicine.
     Compared to many homeopathic preparations, even 30X is
     concentrated. Oscillococcinum, the standard homeopathic remedy for
     flu, is derived from duck liver, but its widespread use in
     homeopathy poses little threat to the duck population -- the
     standard dilution is an astounding 200C. The C means the extract
     is diluted one part per hundred and shaken, repeated sequentially
     two hundred times. That would result in a dilution of one molecule
     of the extract to every 10400 molecules of water -- that is, 1
     followed by 400 zeroes. But there are only about 1080 (1 followed
     by 80 zeroes) atoms in the entire universe. A dilution of 200C
     would go far, far beyond the dilution limit of the entire visible universe!

Park points out that Hahnemann was likely unaware of exceeding the dilution
limit because he did not know about Avogadro's number, a physical constant
which makes it possible to calculate the number of molecules in a given mass
of a substance. Park explains the early success of homeopathy by comparing
it with the use of actually harmful remedies at the same time: "Physicians
still treated patients with bleeding, purging, and frequent doses of mercury
and other toxic substances. If Hahnehmann's infinitely diluted nostrums did
no good, at least they did no harm, allowing the patient's natural defenses
to correct the problem."

Park further explains how modern homeopathologists agree that there is no
actual molecule of medication in their medicine, but that the liquid
"remembers" the substance after the process of dilution. How this substance
memory is attained has never been explained. Critics also point out that
water spontaneously dissociates into acid and alkali (which is why it has a
pH of 7). The quantity of acid in a homeopathic remedy, although tiny, is
generally higher than the quantity of active agent.

Position of the National Council Against Health Fraud

The NCAHF Position Paper on Homeopathy was adopted February 1994 by The
National Council Against Health Fraud, a private non-profit organization.
Permission to reprint is granted with proper citation. Below are excerpts
from the paper, followed by a link to the complete article.

     Homeopathy's principles have been refuted by the basic sciences of
     chemistry, physics, pharmacology, and pathology. Homeopathy meets the
     dictionary definitions of a sect and a cult--the characteristics of
     which prevent advances that would change Hahnemann's original
     principles. Most homeopathic studies are of poor methodological
     quality, and are subject to bias. Homeopathic product labels do not
     provide sufficient information to judge their dosages. Although
     homeopathic remedies are generally thought to be nontoxic due to their
     high dilutions, some preparations have proved harmful. The ostensible
     value of homeopathic products can be more than a placebo effect because
     some products have contained effective amounts of standard medications
     or have been adulterated.

     Only about half of the 300 homeopaths listed in the Directory of the
     National Center for Homeopathy are physicians. Others include
     naturopaths, chiropractors, acupuncturists, dentists, veterinarians,
     nurses or physician assistants. Homeopathy's appeal lies in its
     personal attention to patients. Homeopathy is a magnet for
     untrustworthy practitioners who pose a threat to public safety. A
     perverse belief in the "healing crisis" causes practitioners to ignore
     adverse reactions, or to value them as "toxins being expelled."

     The marketing of homeopathic products and services fits the definition
     of quackery established by a United States House of Representatives
     committee which investigated the problem (i.e., the promotion of
     "medical schemes or remedies known to be false, or which are unproven,
     for a profit"). The United States Food, Drug, and Cosmetic Act lists
     the Homeopathic Pharmacopeia of the United States as a recognized
     compendium, but this status was due to political influence, not
     scientific merit. The FDA has not required homeopathic products to meet
     the efficacy requirements applied to all other drugs, creating an
     unacceptable double standard for drug marketing. The Federal Trade
     Commission has not taken action against homeopathic product advertising
     although it clearly does not meet the standards of truthful advertising
     generally applied to drugs. Postal authorities have not prosecuted
     mail-order product promoters that make unproven claims for mail fraud.
     Three states have established homeopathic licensing boards. Some of
     these have been administered by medical mavericks with a history of
     difficulties with former medical licensing boards.

     The NCAHF advises consumers not to buy homeopathic products or to
     patronize homeopathic practitioners. Basic scientists are urged to be
     proactive in opposing the marketing of homeopathic remedies because of
     conflicts with known physical laws. Those who study homeopathic
     remedies are warned to beware of deceptive practices in addition to
     applying sound research methodologies. State and federal regulatory
     agencies are urged to require homeopathic products to meet the same
     standards as regular drugs, and to take strong enforcement actions
     against violators, including the discipline of health professionals who
     practice homeopathy. States are urged to abolish homeopathic licensing
     boards.

NCAHF Position Paper on Homeopathy

Arguments by Supporters of Homeopathy

The pragmatic view

Proponents of homeopathic treatment point to the fact that the vast majority
of people who do seek out professional homeopathic treatment are satisfied
with the results. It is further argued that any treatment which makes a
patient better is a valid, regardless of whether or not it conflicts with
the currently accepted model of the molecular composition of matter.
Discussion of whether or not the placebo effect is involved are likewise
considered academic, as a cured patient is a cured patient either way. The
most potent examples of cases in which the placebo effect could not be used
to explain the results are those involving infants and young children, or animals.

Reconciliation with molecular chemistry

Recent research indicates that in certain situations the further diluted a
substance, the more its molecules tend to clump together [2]. Some would
like to see this as evidence supporting homeopathic therapies. However this
data doesn't explain why the substances need to be diluted, just that they
might remain active after this preparation (not in the non-concentrations of
homeopathic medicine, though). Further, this phenomenon has no connection to
homeopathy because in these cases there is no attempt to dilute the molecule
away to nothing. Homeopathy attempts to dilute molecules away until none are
left, while these experiments always maintained measurable amounts of
molecules in their solutions. These experiments merely examined the
difference in properties that molecules have when clumped together in
aggregates and polymers, rather than as smaller polymemers and monomers.

Controlled studies and clinical trials

Dana Ullman, in his 1995 book, "The Consumer's Guide to Homeopathy", devotes
an entire chapter to "Scientific Evidence for Homeopathic Medicine". For
example, he cites a 1991 study, in which he writes:

     three professors of medicine from the Netherlands, none of them
     homeopaths, performed a meta-analysis of twenty-five years of
     clinical studies using homeopathic medicines and published their
     results in the journal British Medical Journal. This meta-analysis
     covered 107 controlled trials, of which 81 showed that homeopathic
     medicines were effective, 24 showed they were ineffective, and 2
     were inconclusive. The professors concluded, "The amount of
     positive results came as a surprise to us." [3]

Critics of homeopathy held that these so-called "effective" results were
tiny, unrepeatable, and poorly controlled.

Some homeopathic practitioners may ascribe the lack of definitive support
from controlled trials to the the absence of an emotional doctor-patient
bond that is necessary in order for treatment to be successful (an argument,
opponents claim, that is common to religion and pseudosciences and
contradicts the scientific method). Other homeopathic practitioners,
however, believe that research does justify the effectiveness of homeopathy,
and Ullman has argued that clinical research need not be invalidated by the
need for a tailored remedy for a given individual. For example, he cites an
article published in the December 10, 1994, issue of Lancet ("Is Evidence
for Homeopathy Reproducible?"), which documents a clinical trial concerning
the use of homeopathic remedies to treat asthma. He also cited several other
trials, such as one involving children with diarrhea, documented in the May,
1994 issue of Pediatrics ("Treatment of Acute Childhood Diarrhea with
Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua"). This
approach, with its willingness to make falsifiable predictions, is more
characteristic of protoscience than pseudoscience.

Ullman, in fact, argues that studies have confirmed that homeopathic
remedies are effective even without personalized treatment in a
practitioner-patient relationship. He cites two studies, including one
published in the March, 1989 issue of British Journal of Clinical
Pharmacology ("A Controlled Evaluation of a Homeopathic Preparation for the
Treatment of Influenza-like Syndrome"), to bolster this position. So-called
"combination remedies", in which several homeopathic preparations are
combined, are often sold over-the-counter in the United States, and
traditional homeopathic theory tends to frown on this approach, but Ullman
cites trials that suggest otherwise.

Ullman argues, in fact, "to ignore the body of experimental data that
presently exist on homeopathic medicines and to deny the body of clinical
experience of homeopaths and homeopathic patients, one would have to be
virtually blind. One can only assume that this blindness is a temporary
affliction, one that will soon be cured." Scientists looking at the same
data deny that these were properly controlled experiments.

"In 1988, a French scientist [Jacques Benveniste] working at that country's
prestigious INSERM institute claimed to have found that high dilutions of
substances in water left a 'memory,' providing a rationale for homeopathy's
Law of Infinitesimals. His findings were published in a highly regarded
science journal, but with the caveat that the findings were unbelievable,
and that the work was financed by a large homeopathic drug manufacturer
(Nature, 1988). Subsequent investigations, including those by James Randi,
disclosed that the research had been inappropriately carried out. T he
scandal resulted in the suspension of the scientist." (Source: National
Council Against Health Fraud position paper on Homeopathy; Permission to
reprint is granted with proper citation.)

Despite these claims, debate continues on the results of further trials, as
it likely will as long as homeopathy is a flourishing business.

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