Homeopathy/Draft

Homeopathy or homoeopathy is a system of alternative medicine. The term derives from the Greek hómoios (similar) and páthos (suffering). Homeopathy is based on "the principle of similars", which asserts that substances known to cause particular symptoms can also, in low and specially prepared doses help to cure diseases that cause similar symptoms. This principle is not accepted by mainstream medicine or by conventional scientists today.

Homeopathy's basic principles were first described by a German physician, Samuel Hahnemann (1755–1843), who observed that a medicine sometimes evoked symptoms similar to those of the illness for which it was prescribed. In homeopathic theory, every person has a "vital force", with the power to promote healing and maintain good health (the term "vital force" is akin to qi in traditional Chinese medicine). In this theory, the symptoms of a disease reflect efforts of the vital force to counter infection, or to resist damage from environmental toxins or from various stresses. Homeopathic treatment attempts to strengthen this "vital force" with the aid of remedies, which are extremely small doses of drugs diluted in water or ethanol and dispensed in pills or liquid form. Remedies are chosen according to their ability (in large doses) to provoke the very symptoms that the remedy is intended to heal. Homeopaths believe that this "vital force" is akin to what physiologists would call a person's overall "defense system".

"Classical homeopathy" refers to the original principles in which individual remedies are chosen according to the physical, emotional, and mental symptoms that the sick person is experiencing, rather than only the diagnosis of a disease. "Commercial" or "user-friendly" homeopathy refers to the use of a mixture of remedies in a single formula, generally chosen for their ability to treat a specific disease. Homeopathy is practiced worldwide by many licensed practitioners, including some conventional physicians.

Contrasting views of homeopathy and conventional medicine
The theory underlying homeopathy is not considered to be plausible by most scientists working in academic institutions in Europe and the USA, and in key respects, the treatment advice offered by homeopaths is in disagreement with conventional medicine.

Most homeopaths believe that the fundamental causes of disease are internal and constitutional, and that infectious disease is not just the result of infection but also of susceptibility. This leads them to seek to avoid conventional drug treatments that suppress symptoms. Mainstream physicians accept that some disease is indeed a disturbance in normal function, whether due to external, genetic, or internal reasons. However, they consider that most disease can be attributed to a combination of external causes (such as viruses, bacteria, toxins, dietary deficiency, physical injury) and physiological dysfunction (including genetic defects and mutations such as those which trigger cancers), all of which homeopaths consider to be co-factors to disease, not causes of them. Conventional physicians often use drugs simply to suppress the symptoms of a disease (to alleviate the pain, injury, and distress that they cause). However, the main goal of medical treatment is to eliminate the causes of the disease; drugs that address the causes of disease eliminate symptoms by removing the disease, not by merely opposing the symptoms.

The fact that there is no established mechanism of action for homeopathy remains a stumbling block to its acceptance by medical and scientific institutions, although, as homeopaths point out, there are some accepted medical treatments for which the mechanism of action remains unknown. Some materials scientists, physicists, and other scientists have investigated how homeopathic medicines might work,

The basics of homeopathy
The underlying concept of homeopathy is "like cures like"—a principle described by Hippocrates more than 2,000 years ago and that has been used in various medical systems since then in many diverse cultures. "Like cures like", the "Law of similars", and related maxims are common in anthropological literature.

Historical origins
For the early Greek physician Hippocrates of Cos (c. 450 BCE - 380 BCE), the four "humors" (blood, black bile, yellow bile and phlegm) were the key to understanding disease. His ideas persisted through the writings of Galen (131-201 CE) until at least 1858, and Rudolf Virchow's theories of cellular pathology. Diseases, it was thought, were the result of an "imbalance" of the humors, and physicians of the day focused on restoring that balance, either by trying to remove an excess of a humour, or by suppressing the symptoms. "Bloodletting, fever remedies, tepid baths, lowering drinks, weakening diet, blood cleansing and everlasting aperients and clysters (enemas) form the circle in which the ordinary German physician turns round unceasingly", wrote Hahnemann while translating into German the Treatise on Materia Medica (1789) by the Edinburgh physician William Cullen.

After 1783, disillusioned with the medicine of the time and the many toxic effects of its treatments, the German physician Christian Friedrich Samuel Hahnemann (1755-1843) gave up his medical practice and devoted himself to the translation of medical books, as he was conversant in nine languages. In his lifetime, Hahnemann translated over 9,000 pages, including many of the leading medical and chemistry textbooks of the day. Cullen had written that cinchona bark (which contains quinine) was effective in the treatment of malaria because of its bitter and astringent properties. Hahnemann questioned these assertions because he knew that other substances were as bitter and astringent, but had no therapeutic value in this deadly disease. Being an avid experimenter, Hahnemann took cinchona bark himself and saw that the symptoms that it causes were similar to the symptoms of the diseases for which it was prescribed. Hahnemann then experimented with other substances and found that the symptoms that they caused were again similar to the symptoms of the diseases for which they were prescribed. These experiments led him to formulate the 'Principle of Similars', expressed by him as similia similibus curentur or 'let likes cure likes'. He used this principle to develop a new system of health care, which instead of the often toxic and ineffective drugs offered by conventional physicians, employed more gentle alternatives, at low doses, designed rationally to supplement the body’s natural healing powers. He believed that diseases were caused by "spirit-like derangements of the spirit-like power that animates the human body", and that effective healing called for medicines that would supplementing this vital force.

Hahnemann named his system of health care "homeopathy" (meaning "like disease") and coined the term "allopathy" ("different than disease") to refer to conventional medicine of the day, because its drugs were sometimes "similar," sometimes "opposite," but usually simply "different" to the symptoms of the sick person. .

For the first two decades of Hahnemann's use of the principle of similars, he used crude doses or just slightly potential doses of various medicinal substances. Hahnemann strove to find the lowest doses at which his remedies would still be effective, as he thought this the best way to avoid any adverse side-effects. To his surprise, it seemed that reducing the dose did not diminish the effectiveness of his treatments. Indeed, on the contrary, he concluded that his remedies worked better and better the more he diluted them as long as he “potentized” them between each stage of dilution by vigorous shaking (succussion). Homeopathy became inextricably linked with this process of ultradilution – dilution of substances to such an extreme degree that in most homeopathic remedies, that, by later understanding of molecular concentration, "not even a single molecule of the original substance remains." Although Hahnemann was an avid experimenter, he did not offer a specific model as to how or why these potentized medicines had therapeutic benefits. The full formulation of the molecular concentration law, however, did not come until 1865, well after Hahnemann's work.

In 1830, the first homeopathic schools opened, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the USA. Apart from his ventures into homeopathy, Hahnemann had been a prominent and respected public health reformer, and the Medical Society of the Country of New York had given him honorary membership. However, a few years later the society rescinded this when they realized the "ideological and financial threat" that homeopathic medicine posed. In 1844, the first US national medical association - the American Institute of Homoeopathy - was established.

One reason for the growing popularity of homeopathy was its relative success in treating people suffering from the infectious disease epidemics that raged at the time. Cholera, scarlet fever, typhoid fever, and yellow fever were rampant and killed large numbers of people. But death rates in homeopathic hospitals were commonly much lower than in the conventional medical hospitals, whose cures – purging, blood-letting and mercury treatments, were often worse than the diseases themselves, and did nothing to combat them.

Homeopathic "provings" and remedies
Homeopathic practitioners derive their remedies from provings, in which volunteers are given substances (usually in single-blind or double-blind trials), the effects of which are recorded

Homeopathic references for diagnosis and treatment
in two main types textbooks or software, called materia medica  and repertories ). The symptom complexes that these substances cause are subsequently used to compare with a patient's physical and psychological symptoms in order to select, as the appropriate remedy, the substance whose effects are closest to the patient's symptoms - the "similimum".

Homeopathic manufacture of remedies
A third basic reference complements the materia medical and repertory, and is a handbook on the manufacture of the preparations, by standard homeopathing methods. In the USA, the Homœopathic Pharmacopœia of the United States is the approved reference for homeopathic remedies. This reference is approved by the Food and Drug Administration (FDA), the governmental agency that regulates drugs, although having ever been listed in the HPUS puts the homeopathic drug in a different standard of regulation than conventional drugs and medical devices. A summary describes the principles: FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and indicates that the drug is homeopathic. In 1938, the federal Food, Drug, and Cosmetic Act became law in the USA. The chief sponsor of this bill was Senator Royal Copeland, a homeopathic physician, and the bill gave the FDA the power to regulate drugs. In this process, it gave legal recognition to the "Homeopathic Pharmacopeia of the United States" as a compendium of drugs. In contrast, non-homeopathic drugs for which a New Drug Application (NDA) is required must be accompanied by approved evidence of safety and efficacy; simple listing in a reference is not sufficient. Today, homeopaths use about 3,000 different remedies, from animal, plant, mineral, or synthetic sources.

By convention, the first letter of the Latin-derived name of such preparations is capitalized. When the source is well-defined, the traditional name rather than chemical, pharmacologic designation or biological nomenclature, is preferred, such as Natrum muriaticum rather than sodium chloride. A few homeopaths use more esoteric substances, known as "imponderables", said to originate from electromagnetic energy "captured" by ethanol or lactose, such as "X-Ray" or "Magnetic North" (north pole of a magnet).

Most homeopathic remedies do not require a doctor's prescription. However, some may need a doctor's prescription if the dosage is in a non-potentized or low potency dose if the substance is deemed potentially toxic (in Europe, a medicine has to be diluted at least 1:10 three times to be deemed homeopathic). In the USA, if a homeopathic remedy claims to treat a serious disease such as cancer, it can only be sold by prescription. Only products sold for so-called “self-limiting conditions”--colds, coughs, fever, headaches, and other minor health problems that will eventually go away on their own--can be sold without a prescription (over-the-counter).

Homeopathic remedies can be purchased or used in several different ways (single medicine, homeopathic formula or complex medicines, and a limited number of external applications). Remedies for internal consumption come either in pill form or as liquid.

Preparation of homeopathic remedies
The most characteristic &mdash; and controversial &mdash; principle of homeopathy is that the efficacy of a remedy can be enhanced and its side-effects reduced by a process known as 'dynamization' or 'potentization', whereby liquids are diluted (with water or ethanol) and shaken by ten hard strikes against an elastic body ('succussion'), to get the next, succeeding higher potency. For this, Hahnemann had a saddlemaker construct a wooden 'striking board', covered in leather on one side and stuffed with horsehair (it is displayed at the Hahnemann Museumin Stuttgart). When insoluble solids such as oyster shellare used for remedies, they are diluted by grinding them with lactose ('trituration'). The original serial dilutions by Hahnemann used a 1 part in 100 (centesimal; $$'C'$$ potencies), or 1 part in 50,000 ( Quintamillesimal; $$'LM' or  'Q'$$ potencies). The dilution factor at each stage is 1:10 ('D' or 'X' potencies) or 1:100 ('C' potencies); Hahnemann advocated $$30C$$ dilutions for most purposes (i.e. dilution by a factor of 10030 = 1060). The number of molecules in a given weight of a substance can be calculated by Avogadro's number; the chance that there is even one molecule of the original substance in a 15C solution is small, and it is very unlikely that one molecule would be present in a $$30C$$ dilution. Thus, homeopathic remedies of a high 'potency' contain just water, but water that, according to homeopaths, retains some essential property of one of the substances that it has contacted in the past.

Similia similibus curentur: the law of similars
Today, two notions, vaccination, and hormesis, are used as analogies for homeopathy's law of similars and the use of small doses.

Vaccination
In current medical usage, a vaccine produces detectable immune reaction, such as a rise in a specific immunoglobulin, that assists the body in preventing infection. "Therapeutic" vaccines are administered in the presence of active disease, but do not directly have an effect on the pathogen. Therapeutic vaccines augment bodily response.

Emil Adolph von Behring (1854-1917), who won the first Nobel Prize in medicine in 1901 for discoveries that led to vaccines against tetanus and diphtheria, and who some consider to be the father of immunology, asserted that vaccination is, in part, derived from the homeopathic principle of similars.

In spite of all scientific speculations and experiments regarding smallpox vaccination, Jenner’s discovery remained an erratic blocking medicine, till the biochemically thinking Pasteur, devoid of all medical classroom knowledge, traced the origin of this therapeutic block to a principle which cannot better be characterized than by Hahnemann’s word: homeopathic.

Although homeopathic remedies and vaccinations both use low doses of active ingedients, there are important differences. First, the doses used in homeopathic remedies are always very much lower than used in vaccines. Second, vaccines produce a measurable immune response (e.g., immunoglobulin production). Homeopathic drugs do not routinely produce a mesurable immune response.

Some homeopaths might say these are applications of the principle of similars, but these conventional treatments involve application of measurable doses of substances, at levels known to activate mechanisms of cellular response. Homeopathic preparations above the $$24X$$ ($$12C$$) potencies do not contain enough molecules to activate any known metabolic or signalling pathway.

Mithridatization and hormesis
Mithridatization (which is not a term used in contemporary science or medicine) may be a better metaphor than vaccination, for homeopathic treatment. Mithridatization is the chronic administration of subtoxic doses of a toxin, in an attempt to strengthen the defenses of an individual, in prevention of an actual intoxication. It is believed that the Roman emperor Mithridate used this technique to protect himself from his enemies.

There are multiple mechanisms of tolerance, although the effects of frequent small doses can vary. A herpetologist who receives many small doses of snake venom may indeed become tolerant to them. A beekeeper, however, may become hypersensitive to the venom and, after receiving a sting, go into anaphylaxis. This type of response to small, not necessarily precisely measured, dose is not predictable on an individual basis. Allergic desensitization uses tightly controlled doses, increased based on clinical results.

Both mithridatization and homeopathy might be considered as instances of hormesis, which describes the phenomenon that many chemicals at high concentrations have opposite biological effects to those at low concentrations.

Professional homeopaths: who are they?
There are no universal standards for homeopathic education, so licensing and regulation varies from country to country, (and from state to state within the USA). In some countries, all (or virtually all) professionals that use homeopathic treatments are MDs (such as France, Spain, Argentina, Colombia). . Some countries have exclusively homeopathic medical schools (India, Pakistan, Mexico), some have naturopathic medicine colleges in which students are taught homeopathy as part of their curriculum (Germany has its "heilpraktica"/health practitioners; the USA, Canada, and Australia have naturopathic medicine schools that include homeopathy), and some certify "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant "certification" as homeopaths. In the USA, MDs and DOs are eligible for this certification

Some homeopathic treatment is covered by some European public health services, including in France and Denmark. In the UK, five homeopathic hospitals are funded by the NHS and homeopathic remedies are sold over the counter. Two countries which formerly offered homeopathy under their public health services no longer do so: from 2004, homeopathic remedies, with some exceptions, were no longer covered by the German public health service, and in 2005, the Swiss Government withdrew homeopathy and four other complementary treatments, stating that they did not meet efficacy and cost-effectiveness criteria.

In France and Denmark licenses are required to diagnose any illness or to dispense any product whose purpose is to treat illness. In many countries, however, there are no specific legal regulations concerning homeopathy. In Austria, the public health service generally requires proof of effectiveness to reimburse medical treatments, but makes an exception for homeopathy.

A typical homeopathic visit
As homeopathic remedies can be prescribed by such a varied array of practitioners, from pure homeopath, naturopaths, acupuncturists, chiropractors, to MDs with additional homeopathic trainng, the gathering of information may be different depending on the professional. Trained homeopaths place emphasis on the patient's symptoms as well as the person's psychological state. Classical homeopaths gather this information from an interview with the patient, typically lasting from 15 minutes to two hours, with 5-45 minute follow-up consultations.

Conventioal physicians take a medical history according to medical principles, classical homeopaths will take a history only using homeopathic priciples, and homeopaths with both medical and homeopathic training will then take additional history according to homeopathic principles, Classical homeopaths do not use medical physical examination, diagnostic imaging and tests from the clinical pathology laboratories as suggested by the differential diagnosis, and questions raised by the history and physical examination. Homeopaths that are licensed to perform these additional studies do not practice classic homeopathy, but rather a an alternative or "mixed" form.

Classical homeopaths place more emphasis on the way a person experiences their disease than on diagnosing the disease - i.e. they give priority to the syndrome of symptoms rather than to the results of conventional medical tests. This differs strongly from the conventional medical approach to finding the etiology of the disease proper, not its syndrome of symptoms.

When considering the person's symptoms for constitutional treatments, some categories of change are identified as important: "(1) emotions; (2) mentation; (3) specific physical functioning; (4) general physical changes; (5) perception of self; (6) relationships; (7) spirituality; (8) lifestyle; (9) energy; (10) dream content and tone; (11) well-being; (12) perceptions by others; (13) life relationships; (14) a sense of freedom or feeling less 'stuck'; (15) sleep; (16) coping; (17) ability to adapt; (18) creativity; and (19) recall of past experiences."

After the interview, the homeopath consults thereferences described above". Some homeopaths make quick prescriptions based on "keynotes" -the highlights of the best known characteristics of a remedy, but the real challenge of homeopathic practice is to find the remedy that best matches the patient's symptoms - the "similimum". A fundamental reasons for conflict between mainstream medicine and homeopathy is that homeopathy rejects the concept of treatments that target common mechanisms of disease, but seeks individualised treatment.

Conflict as to when conventional medicine may be necessary

 * A physician qualified in homeopathic and allopathic methods, after diagnosing a chronic condition that does not have consistently effective allopathic treatments, may prescribe a homeopathic remedy which he feels may be more effective and is likely to have fewer side effects than allopathic drugs.
 * Homeopaths recognize that trauma can be a surgical emergency, but may use homeopathic remedies adjunctively.
 * Homeopaths disagree with mainstream medicine about the role of immunization and chemoprophylaxis for infectious diseases.
 * Situations for which homeopathic practitioners commonly prescribe remedies include asthma and acute bronchitis. For these conditions, homeopathic remedies are often prescribed not only to alleviate chronic symptoms, but also to treat acute attacks.

This practice is controversial. Asthma and other respiratory disorders with a seemingly mild initial presentation can actually be a life-threatening condition, and acute attacks, if not treated effectively, can lead to sudden death. According to conventional medical opinion, prescribing homeopathic remedies in these cases may delay the delivery of effective conventional treatment, with potentially serious consequences. Medical organisations advise that there is no evidence that homeopathic remedies are effective in these circumstances, and recommend that they should only ever be used in conjunction with conventional medical treatment. Homeopaths state they heal asthma and bronchitis, and point to studies on asthma

Homeopaths also cite a study where "a homeopathic remedy" has been used to shorten the duration of acute bronchitis and heal a person. This study, however, is from the journal Phytomedicine, which is not specific to homeopathy, and the word "homeopathy" does not appear in the MEDLINE abstract, although it does in the body, since it was funded by a German homeopathic pharmaceutical company. The abstract and MEDLINE indexing terms reference "plant extract", defined in Medical Subject Headings as "Concentrated pharmaceutical preparations of plants obtained by removing active constituents with a suitable solvent, which is evaporated away, and adjusting the residue to a prescribed standard", which is called a homeopathic mother tincture. Concentrated plant extracts may be used as mother tinctures, or the starting point for dilution, but such use is not mentioned in the Phytomedicine article, because it did not go into the use of dilutions.

These homeopathic studies deal with small test populations, in the order of tens to hundreds, while conventional trials deal with thousands, and surveillance on the actual use in practice gives data from millions. Conventional medicine also has consistent clinical and pathological definitions of asthma, with considerable customization for individual patient needs but still enough common criteria to allow significant retrospective analysis in large populations. Large studies are difficult because individualized remedy selection is a must in homeopathy; this causes conflict with physicians who expect the statistical power of large studies.

Homeopaths also assert that corticosteroids are immunosuppressant drugs that may provide temporary relief of asthma symptoms but may lead to more serious chronic disease and to increased chances of death. Physicians have learned that life, itself, increases the chance of death. The medical use of corticosteroids is not for symptom relief, but to prevention of inflammation that leads to symptoms. Inhaled corticosteroids, which do not spread through the body and cause widespread effects, but stay on the breathing passages and prevent inflammation, are medically preferred to systemic corticosteroid therapy.

Homeopathic remedies might also be used after an asthmatic episode with the intent to prevent recurrences by improving the natural healing processes of the body.


 * An adequately trained homeopath is expected to recognize symptoms that indicate an acute and potentially fatal condition. Such symptoms as unexplained chest pain of sudden onset, especially with other symptoms suggestive of a major cardiovascular event, ethically will activate EMS for immediate transfer to an appropriate staffed and equipped medical facility. The practitioner is expected to have emergency medical training and equipment appropriate to his or her level of medical training in the place of practice (e.g., dressings and basic airway management tools for an individual with training at the Emergency Medical Technician (EMT) of Basic or higher level, and preferably an automatic external defibrillator and advanced cardiac life support resources generally accepted as appropriate for an office.

Conditions where individualization may not be needed
The treatment of acute ailments or injuries does not need the same depth or breadth of the interview process as homeopathic constitutional treatment. The homeopathic treatment of minor acute ailments still requires individualized treatment. Potentially serious acute ailments may require medical supervision, though homeopathic medicines can be prescribed concurrently/alternatively. One person's symptoms of a common cold or a headache or an allergy will have his/her own unique syndrome of symptoms that will require an individually chosen medicine. People who experience an injury, however, generally need the same healing process to recover from trauma, so clinical experience has led homeopaths to believe that some homeopathic remedies might be routinely useful for trauma.

Conflict on individualization
Another area of conflict is the insistence that only homeopaths provide remedies tailored to the individual. Classical homeopathy frowns on the use of multiple concurrent remedies; a major repertory contained approximately 3,000 remedies, presumably used singly. In comparison, the The U.S. Food and Drug Administration Approved Drug Products with Therapeutic Equivalence Evaluations 26th Edition Electronic Orange Book (EOB)4 lists 11,706 approved prescription drugs (RX) with therapeutic equivalence evaluations, [ and] 390 approved over-the-counter (OTC) drugs. They contain 1323 chemically distinct ingredients in measurable quantities, not infrequently used in combination. Since medicine is quite willing to use rational combinations, it is fairly straightforward mathematics shows that there is considerably more potential to individualize medical treatment from the permutation and combination of 1323 chemicals, rather than homeopathic treatment based on largely single use of 3000.

As an indication that medicine constantly reevaluates and rejects things with undue risk and inadequate benefit, the Orange book also contains 8820 approved products that have been discontinued.

As far as defining individualized remedies, the increasingly important field of pharmacogenetics individualizes, but based on reproducible criteria from the patient's genome. While this is a very new branch of medicine, a 2007 study created a network of connections of FDA approved drugs and their active ingredients with known human gene targets. This resulted 1052 drugs targeting 485 proteins, the proteins identifiable from genomic data rather than subjective assessments of symptoms.

Homeopathy in injuries
Homeopaths view injuries in a different manner than they view diseases, because they believe that everybody needs the same type of healing response to injuries, whereas a single disease may produce very different symptoms in different people. Homeopathic treatment of trauma is adjunctive to conventional first aid measures. Some clinical research has shown efficacy of homeopathic medicines in the treatment of select injuries, including mild traumatic head injuries and sprains and strains

Safety and efficacy of homeopathy
In conventional medicine (see New Drug Application), the basic phases of evaluating a drug are determining if it causes dangerous effects in healthy volunteers, if it is adequately present in the body to achieve an effect, and if it is more effective, against a disease, than conventional treatment.

Homeopathic provings are somewhat analogous to safety tests, with the caveat that only the safety of the drug is being evaluated, whether another drug might be more effective. There appears to be no equivalent of bioavailability testing, since the ultradiluted homeopathic drugs are not detectable in vivo.

Efficacy tests are difficult, because medical randomized controlled trials rely on statistical analysis of increasingly larger groups of patients to determine efficacy against disease of a standard treatment. This conflicts with an approach that does not have a comparable constant of diseases and believes most treatments should be individualized, not standardized. In reality, there is some customization in medical testing and some homeopathic tests do use some standardization, but not to the extent of the other discipline.

Scientific basis of homeopathy
See articles on solitons, clathrates, nanobubbles and The memory of water. To begin even a medical safety test, the Institutional Review Board that approves trials in human subject usually requires some laboratory, or experimental animal, data on the presumed means of effectiveness of the drug; how it affects a pathologic process.

Homeopaths, with the support of a few scientists, suggest that dilution and vigorous succussion (shaking in a particular way) makes the substance "imprint" the water or ethanol used for diluting. The vigorous shaking of the water in glass bottles can cause small amounts of silica fragments or “chips” to fall into the water, and some have suggested that these fragments might interact with the solution , but homeopaths generally believe that the remedies are not influenced by the silica.

Despite various theories about how homeopathic remedies might work, there is no widely accepted scientific explanation. There are observations about the alteration of water by homeopathic preparations, but no generally accepted theories on how those altered properties would affect biological systems. Some have proposed that research on the 'silica hypothesis' (see Memory of water, solitons, clathrates, and nanobubbles might inicate ways in which homeopathic remedies might differ from pure water, and some think that better understanding of hormesis might help also.

Water is not simply a collection of molecules of H2O, it contains several molecular species including ortho and para water molecules, and water molecules with different isotopic compositions such as HDO and H218O. These water molecules as part of weakly-bound but partially-covalently linked molecular clusters containing one, two, three or four hydrogen bonds, and hydrogen ion and hydroxide ion species. In addition, there are always adventitious solutes in liquid water. Even double-distilled and deionized water always contains trace amounts of contaminating ions.

There is some support for the notion that water can have properties that depend on how it has previously been processed (that is, water has, in some sense, a kind of "memory"). The experimental evidence indicates that the "memory" is due primarily to solute and surface changes occurring during this processing. In particular, water, as a result of repeated vigorous shaking, might include redox molecules produced from water, dissolved atmospheric gases and airborne contaminants, silicates - tiny glass "chips", nanobubbles and their material surfaces, dissolved ions, including from the glassware, apart from the original medicinal substance it was diluting. It is theorized that each medicinal substance that is placed in the double-distilled water will interact with the silicate fragments in differing ways, thereby changing the structure of the water. There might also be some effects of successive shaking on water structure - "clustering" of water molecules.

These mechanisms are not mechanisms of memory in any cognitive sense; the term memory here is used as a metaphor, implying only that the past history has a discernible influence on the present properties, but homeopaths believe that, through these or other mechanisms, water can form and retain some "memory" of the original medicinal substance. Many homeopathic remedies are however available as solid preparations -"pillules" of lactose and/or sucrose, intended as inert cores which are transformed into homeopathic drugs by impregnating them with a dilution of homeopathic stock solutions, or in powder form (impregnated lactose), and these preparations contain no water.

Tests of the efficacy of homeopathic remedies
Some studies of homeopathy have been funded by the U.S. National Center for Complementary and Alternative Medicine (NCCAM). In NCCAM's taxonomy of complementary and alternative medicine, homeopathy is a "whole system" that is an alternative to the entire medical mode, although it can be complementary to conventional care. The funded studies include:


 * A study on fibromyalgia, which showed clinical benefits from individually chosen homeopathic remedies as well as objective differences in EEG readings in homeopathic and placebo subjects.


 * A study on homeopathy for mild traumatic brain injury. This pilot study indicate a significant benefit from the homeopathic treatment but requires large-scale, independent replication.

Cochrane Reviews did a meta-analysis of seven randomized controlled trials, three prevention trials (number of participants, $$N = 2265$$) and four treatment trials, $$(N = 1194)$$. The authors considered only two were statistically adequate, but data from the prevention trials showed no effect. Data from the treatment trials showed enough efficacy that further trials were recommended, but that the remedy could not be recommended for first-line therapy. No homeopathic counterarguments to these specific meta-analyses have been published, but homeopaths often consider large trials invalid because they do not reflect the individualized nature of homeopathic treatment.

Homeopathic theory; current scientific status
Homeopathy was developed at a time when many of the most important concepts of modern chemistry and biology, such as molecules and germs, were understood poorly if at all. While proponents may consider the mechanism of homeopathy to be an interesting side issue, others consider the lack of any plausible mechanism to be a serious problem; they raise the bar for the quality of evidence required before accepting the existence of the phenomenon by citing the common phrase, "Extraordinary claims require extraordinary proof".

In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree. Although the hypothesis of atoms can be traced back to the ancient Greeks, their size was not calculated until 1865 (by Josef Loschmidt). There are 6.02×1023 particles in a mole (Avogadro's number, or, in German-speaking countries, Loschmidt's number), so homeopathic dilutions greater than about $$24X$$ or $$12C$$ are virtually certain to contain not even a single molecule of the initial substance. This is recognized by advocates of homeopathy, who assert that the essential healing power of their preparations is not to be found in the chemical action of molecules, but perhaps in the arrangement of the water molecules, giving rise to the expression 'the memory of water'.

The idea of the memory of water is parallel to the idea of vital force. Homeopathic preparations change properties of the water such that they can affect vital force, but, since neither vital force nor the means of affecting it are measurable, the process is not compatible with current scientific testing. Vital force was discarded by the scientific community as more and more life processes came to be describable in purely materialistic terms, and as the medical model of disease came to be focused on the interactions of physiological mechanisms, and external factors, in the body.

There have been occasional reports of effects of highly diluted solutions on organic processes, including on histamine release by basophils. However, attempts to replicate these studies failed. . An extremely biologically active substance such as a specific immunoglobulin, in a modern purified form, may or may not be a reasonable surrogate for a preparation prepared with the chemistry available in the early 19th century.

Medical organizations' attitudes towards homeopathy
The American Medical Association (AMA) was founded in 1847, three years after the American Institute of Homeopathy. From 1860's to the early 20th century, the AMA's ethical code disallowed its members to consult with fellow MDs who practiced homeopathy. Although the AMA didn't enforce many of its ethical guidelines, the "consultation clause" was one of the few that it did. Today, the AMA is no longer overtly antagonistic to homeopathy. Their current policy statement says: "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies".

In Europe, homeopathy is practiced by many conventional physicians, including 30-40% of French doctors and 20% of German doctors. According to the UK National Health Service (NHS), homeopathy is one of the most popular alternative and complementary treatment modalities.

In India, homeopathy is formally recognised by the Government (along with Ayurveda, Yoga & Naturopathy, Unani, Siddha) as one of the 'Indian Systems of Medicine'. About 10% of the Indian population depends solely on homeopathy for their health care needs.

Safety

 * The highest ideal of cure is the speedy, gentle, and enduring restoration of health by the most trustworthy and least harmful way (Samuel Hahnemann)

The U.S. Food and Drug Administration's view of homeopathy is that there is no real concern about the safety of most homeopathic products because of the extremely small dosages. The F.D.A. has deemed that the vast majority of homeopathic medicines are over-the-counter drugs (OTC), that is, drugs that do not need a doctor's prescription and that are safe enough for home care. In the U.S., homeopathic medicines must have at least one indication for usage for an disease or condition that is self-limiting and that doesn't require medical diagnosis or medical monitoring.

The European Union allows homeopathic medicinal products, if they are at least 3X, that is, they may not contain either more than one part per 10&thinsp;000 of the mother tincture or more than 1/100th of the smallest dose of an active substance. No specific therapeutic indication may be given on the label of the product.

However, some physicians maintain that homeopathic treatment is relatively unsafe, because it might delay effective, conventional medical treatment.

Probably every modern pharmacologist would agree with Hahnemann that the drugs prescribed by conventional physicians of the 19th century were at best ineffective and often dangerous. However, some homeopaths question whether even modern medical drugs are safe and effective, and recommend homeopathic remedies instead. For example, a 2006 survey by the UK charitable trust 'Sense About Science' revealed that homeopaths were advising travelers against taking conventional anti-malarial drugs, instead recommending they take a homeopathic remedy. Even the director of the The Royal London Homeopathic Hospital condemned this:

I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.

Another concern is that some homeopaths discourage the use of vaccines. Many homeopaths think that vaccination for common diseases, such as measles and chicken-pox, is unneccessary, and some believe that vaccines can even be damaging to health, in part because of the mercury and aluminum in them, in part because the bacterium or virus in the vaccine may neither be dead nor weak enough, and in part because some childhood infectious diseases may strengthen immune responsiveness. Such advice is generally considered irresponsible by public health professionals. Measles is not a major killer in the western world, where most children are vaccinated at about two years old. However, in 1999 there were 875,000 deaths from measles worldwide, mostly in Africa. In 2001, a "Measles Initiative" was initiated involving the American Red Cross, UNICEF and the World Health Organization, By 2005 more than 360 million children had been vaccinated, and the death toll had dropped to 345,000. Adult herpes zoster infection is a reactivation of childhood chickenpox, affects 1 in 3 adults, and can cause chronic, severe nerve pain in 10-18% of cases, and eye involvement in 10-25%. Chickenpox immunization prevents this; a herpes zoster vaccine is now recommended for all adults 60 years and older. Childhood immunization against chickenpox prevents herpes zoster.