Homeopathy/Draft

Homeopathy, or homoeopathy, is a system of alternative medicine that uses extremely small doses of drugs diluted in water and/or ethanol that, in greater concentrations, would create symptoms similar to those which the patient is experiencing. According to homeopathic theory, these "remedies" stimulate the natural healing processes of the body, to restore health. The underlying concept is "like cures like"—a principle described by Hippocrates more than 2,000 years ago but rejected by today's mainstream medicine.

Homeopathy's basic principles were first described by Samuel Hahnemann (1755–1843), a physician who observed that a medicine sometimes evoked symptoms similar to those of the illness for which it was prescribed. "Classical homeopathy" refers to the original principles in which individual remedies are chosen according to the overall 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 the mixture of remedies in a single formula, generally chosen for their ability to treat a specific disease.

The premise of homeopathy is that the signs and symptoms are not simply the result of the breakdown of the organism, but are part of the organism's defenses. In homeopathic theory, every person has "life energy," sometimes called a "vital force," which today's homeopaths consider to include a person's immune system. Disturbing this force can, according to homeopaths, lead to health problems; homeopathic treatment intends to restore this vital force and stimulate the body's ability to heal itself.

Because of their "respect for the wisdom of the body", homeopaths do not try to inhibit symptoms or suppress disease. The extremely small and specially prepared doses of remedies that they use are chosen for what they consider to be their unique ability to mimic the body's own defenses and initiate the healing process.

Some materials scientists, physicists, and other scientists have investigated how homeopathic medicines might work, but the fact that there is no established mechanism of action for the preparations used in homeopathy makes it difficult to study. This remains a stumbling block to its acceptance by most medical and scientific institutions in the world.

Some randomized controlled trials that have tested the efficacy of all forms of homeopathic medicines have reported positive results, but, as mainstream physicians point out, large randomized controlled trials have generally not shown effectiveness beyond placebo effects. Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it.

Homeopathy is widely used throughout the world and the treatments themselves are considered relatively safe, though mainstream physicians often have strong reservations about primary treatment by inadequately trained practitioners, who might attempt to treat a serious condition without referring to a physician. Despite this skepticism, homeopathy is widely practised by a significant minority of conventional medical physicians through Europe and other continents, as well as other health care practitioners world-wide, with necessary licenses.

Historical origins of homeopathy
For the early Greek physician Hippocrates of Cos, who lived at about 400 BC, 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 AD) until at least 1858, and Rudolf Virchow's theories of cellular pathology. Diseases, it was thought, were the result of some "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 medicine and the many toxic effects of its cures, 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. Cullen had written that Cinchona bark (which contains quinine) was effective in the treatment of malaria because of its bitter and astringent properties. Hahnemann, himself an eminent physician and chemist as well as a prominent public health reformer, questioned these assertions because he knew that other substances were as bitter and astringent 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. For Hahnemann, this was a breakthrough, and it led him to formulate the 'Principle of Similars' on which homeopathy is based, expressed by him as similia similibus curentur or 'let likes cure likes'.

For the first two decades of Hahnemann's experimentation with the principle of similars, he used small but still physiological doses of medicines. Over time, he found that his therapeutic results were better the more he potentized the medicine, that is, the more he diluted it, in a 1:10 or 1:100 dilution, with vigorous succussion (shaking) in-between each dilution. As dilutions of this magnitude no longer had much in the way of the original product, he concluded, in much the same way as other vitalists of his time, that diseases are caused by "spirit-like derangements of the spirit-like power that animates the human body", and that effective and healing medicinal effects can only be created by medicines that match this similar spirit-like force.

Hahnemann named his system of health care "homeopathy" (meaning "like disease") and coined the term "allopathy" ("different than disease") to contrast it to the normal, conventional medicine that he believed was less humane and less effective. During the 19th century homeopathy grew in popularity. In 1830, the first homeopathic schools opened, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States. In 1844, the first US national medical association - the American Institute of Homoeopathy (AIH) was established.

Homeopathic "provings" and remedies
Homeopathic practitioners derive the use of their remedies from experiments that they call "provings," in which volunteers are given substances (usually in single-blind or double-blind trials), the effects of which are recorded in both books (called materia medica and repertories) and software programs. The symptom complexes or "similliums" that these substances cause are subsequently used to compare with a patient's symptoms in order to select, as a remedy, the substance whose effects are closest to the patient's symptoms.

Today, homeopaths use about 3,000 different remedies from animal, plant, mineral, and synthetic substances. Homeopaths often capitalize the names for their remedies.

A few homeopaths use more esoteric substances, known as "imponderables" because they are said to originate from electromagnetic energy "captured" by ethanol or lactose, such as "X-Ray" or "Magnetic North" (north pole of a magnet).

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. According to the FDA, FDA regulates homeopathic drugs in several significantly different ways from other drugs. 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 was passed and signed into law. The chief sponsor of this bill was Senator Royal Copeland, who was a homeopathic physician. This bill gave the FDA the power to regulate drugs, and 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.

Most homeopathic remedies are available over-the-counter and do not require a doctor's prescription. However, in most countries, a homeopathic remedy has a tendency to be a prescription drug, available only from a doctor's prescription, if the dosage is in a relatively non-potentized dose. In the USA, if a homeopathic remedy claims to treat a serious disease such as cancer it can be sold by prescription only. Only products sold for so-called self-limiting conditions--colds, headaches, and other minor health problems that 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 are placed in either pill form (in various sizes) or in 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 quartz or oyster shell are 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.

Hahnemann's explanation for how higher potencies could be more efficacious was that the friction involved in succussion might release some hidden curative power. He wrote in 1825: "The effect of friction is so great, that not only the physical properties, such as caloric, odour, etc., are thereby called into life and developed by it, but also the dynamic medicinal powers of natural substances are thereby developed to an incredible degree".

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
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."

Despite the fact that homeopathic remedies and vaccinations both use small doses of what might cause a problem in order to help to prevent and/or treat it, there are important differences between homeopathic remedies and vaccines. First, the doses used in homeopathic medicine are almost always much lower. Second, a homeopathic remedy is generally prescribed in a highly individualized fashion, not simply based on a person's conventional medical diagnosis, but based on the unique syndrome of symptoms that the person experiences.

In vaccination, small doses of antigens, sometimes from pathogenic organisms, are used to trigger an immune response. The human immune system has two functional branches that work together. One branch produces antibodies (also known as immunoglobulins) in the blood that recognize the presence of foreign antigens in the body. Antibodies contribute to immunity by preventing pathogens from entering or damaging cells by binding to them; by stimulating removal of a pathogen by macrophages and other cells by coating the pathogen; and by triggering pathogen destruction by stimulating other immune responses such as the complement pathway. The other branch is the cell-mediated immune system which destroys, digests and expels foreign antigens through the activity of cells in the thymus, tonsils, adenoids, spleen, lymph nodes and lymph system. This is known as "the acute inflammatory response" and is often accompanied by the classic signs of inflammation: fever, pain, malaise and discharge of mucus, pus, skin rash or diarrhea. Vaccination works by introducing an antigen in the body in sufficient amounts to stimulate the production of antibodies; the antigen is introduced in a form that has been rendered relatively harmless.

Some homeopaths might say these are applications of the principle of similars, but these conventional treatments involve application of small but measurable doses of substances, at levels known to activate mechanisms of cellular response, as opposed to externally observed symptoms in response to subphysiologic amounts of a substance (due regard must be given to the different uses of the terms symptom and sign in homeopathy and medicine). Homeopathic preparations above the 24X or 12C potencies do not contain physiologically relevant levels of molecules known to activate any given metabolic or signalling pathway, though other lower potency medicines, which are commonly available over-the-counter in pharmacies and health food stores, contain doses that might have physiological effects.

Some allergy treatments involve administration of small amounts of allergenic substances to desensitise the allergic response to large doses of an allergen. The American Academy of Allergies was originally called the American Association for the Study of Allergy, an organization that was started by three physicians, one of whom was a homeopathic doctor, Grant Selfridge, MD.

Mithridatization and hormesis
Mithridatization (which is not a term used in contemporary science or medicine) may be a better methaphor than vaccination for the process claimed to take place in the course of an 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. People repeatedly exposed to (for example) snake bites can become "tolerant" to the venom; in this case, this is usually the result of antibody production. However tolerance to drugs and toxins can develop in many different ways; for example, tolerance to morphine arises because of an alteration in the coupling of the opioid receptor at which morphine acts to intracellular pathways.

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. This biphasic dose-response relationship can arise in many different ways; for example the hormone cortisol at low concentrations binds specifically to a single receptor type (the mineralocorticoid receptor) but at high concentrations also binds to a second receptor (the glucocorticoid receptor). As these receptors are expressed in different cells and are coupled differently to effector processes, the effects of high concentrations are different to those that would be expected from the response at low concentrations.

Dynamisation
While the law of similars was re-introduced by Hahnemann after centuries of oblivion, the principle of dynamization (or potentiation/potentization), was discovered (or invented) by pure chance. Hahnemann saw that the efficacy of his remedies was greater in patients he had met in their homes. In Hahnemann's time, the mode of transportation was horseriding. He hypothesised that the agitation during the travel was responsible for the enhanced efficacy. Thus the notion of dynamization was born.

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

Homeopathy (from the Greek hómoios (similar) and páthos (suffering)) regards diseases as "morbid derangements of the organism" that involve some disturbance in natural healing processes (homeopaths call it the "vital force"). Stll today, most homeopaths believe that the fundamental causes of disease are internal and constitutional, and that it is contrary to good health to suppress symptoms with large doses of drugs. Most also accept the concept of "miasms", a homeopathic concept of disease in which the symptoms of an organism’s imbalance indicate that a specific anti-miasmatic remedy is sometimes needed.

Professional homeopaths: who are they?
There are no universal standards for homeopathic education, so licensing and regulation varies from country to country, and state to state. 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 countries have naturopathic medicine colleges in which students are taught homeopathy as part of their curriculum (Germany has its "heilpraktica"/health practitioners; the US, Canada, and Australia have naturopathic schools that include homeopathy along with their usual studies) and some countries certify "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant them "certification" as homeopaths. In the US, MDs and DOs are eligible for this certification, though there is also a separate certification process available only to MDs and DOs (there are similar choices of certification available in the UK for medical doctors).

A typical homeopathic visit
As homeopathic remedies can be prescribed by such a varied array of practitioners, from naturopaths, acupuncturists, chiropractors, homeopaths to medical doctors, 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 in choosing a homeopathic remedy. Practitioners of classical homeopathy gather this information from what they call a comprehensive interview with the patient. Generally, a typical homeopathic interview will last approximately 15 minutes to two hours with 5 to 45 minute follow-up consultations.

Medical and other health professionals who practice homeopathy perform medical history taking, which will be supplemented with homeopathic history taking. They also perform a basic physical examination, with additional examination of body parts or systems that may be associated with a symptom. Diagnostic imaging and tests from the clinical pathology laboratories will be performed as suggested by the differential diagnosis, questions raised by the history and physical examination. Investigations like blood and urine analysis and imaging studies like X-rays, ultrasonography, X-ray computed tomography, and magnetic resonance imaging, are generally not essential for selecting a homeopathic remedy, but may be used for medical disease diagnosis.

To determine which remedy to prescribe, classical homeopaths place more emphasis on the way a person experiences whatever disease they have more than the name of the disease s/he has. They thus give higher priority to the unique syndrome of symptoms of the patient than the objective results of conventional medical tests.


 * 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, though homeopathic medicines can be used adjunctively.
 * There is disagreement in the role of immunization and chemoprophylaxis for infectious diseases.
 * Situations for which complementary teamwork between allopathic and homeopathic practitioners is particularly useful include asthma and bronchitis, where immediate and certain temporary relief from inhalers, nebulizers, or parenteral drugs is sometimes necessary, because homeopathic remedy selection may take time; homeopathic remedies might be used after an asthmatic episode with the intent to optimize the immune system and prevent recurrences.
 * 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 level, and preferably an automatic external defibrillator and advanced cardiac life support resources generally accepted as appropriate for an office.

When considering the person's symptoms for constitutional treatments, some categories of change are identified as being 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."

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 require medical supervision, though homeopathic medicines can be prescribed concurrently. Whereas 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 generally need the same healing process to deal with a sprain, strain, or fracture and clinical experience has led homeopaths to believe that some homeopathic remedies might help people recover from certain injuries.

Once a case-taking has been conducted, the homeopath may use a detailed index of symptoms called "repertories," and "materia medica" which detail the symptoms that each remedy is thought to cause or cure. Many homeopathic textbooks have now been integrated into software and most homeopaths world-wide use some such software. Some make quick prescriptions based on "keynotes" -the highlights of the best known characteristics of a remedy.

There is rarely a specific remedy for a disease or ailment in homeopathy, instead, remedies are chosen based on the overall syndrome of the patient, not the just the disease. The homeopath seeks to find the "simillimum," that is, the remedy that will cause, in overdose in experimental subjects, the most similar syndrome of symptoms that the sick person is experiencing.

Homeopathy as a form of Complementary and Alternative Medicine
Specific studies of homeopathy as a complementary technique, has 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 first considered a "whole system" that is an alternative to the entire medical mode, although it can be complementary to conventional care. The funded studies include:


 * An important study on fibromyalgia, published in Rheumatology, the journal of the British Society for Rheumatology, that showed clinical benefits from individually chosen homeopathic medicines as well as objective differences in EEG readings in homeopathic and placebo subjects.


 * Homeopathy for mild traumatic brain injury, conducted at a Harvard-affiliated hospital. The results of this randomized double-blind placebo controlled trial indicate a significant improvement from the homeopathic treatment versus the control and translate into clinically significant outcomes.


 * Homeopathy for brain deterioration and damage in animal models for stroke and dementia.


 * The homeopathic remedy cadmium, to find out whether it can prevent damage to the cells of the prostate when those cells are exposed to toxins.

Scientific basis of homeopathy
See articles on solitons, clathrates, nanobubbles and The memory of water.

At present, there is no scientifically acceptable explanation for how homeopathic remedies might work. Some homeopaths and a few scientists have proposed that research on solitons, clathrates and nanobubbles might suggest how homeopathic remedies might differ from pure water. Some think that better understanding of hormesis might help also in understanding biological responses.

The memory of water is a phrase mostly associated with homeopathy and the controversial research of Jacques Benveniste and his colleagues. They reported that particular solutes subjected to sequential physical processing and dilution appeared to have some biological effects that were different from the "control" effects of the water used for the dilutions. The work resulted in considerable controversy, and some other labs were unable to reproduce the reported effects.

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 significant and variable trace amounts of contaminating ions, and different samples will differ in the contaminants that they contain.

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" are 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. It may be contaminated by material that adheres to the surfaces of glassware, for example by bacterial material. There might also be some effects of successive shaking on water structure - "clustering" of water molecules. For homeopaths, only the memory of the original medicinal substance is important.

These mechanisms are not mechanisms of memory in any cognitiove sense; the term memory here is used as a metaphor, implying only that the past history has a discernible influence on the present properties.

Empirical research

 * It is not a matter of theory or belief or opinion … Homoeopathy must rest upon facts (James Tyler Kent, homeopath)

In vitro
A systematic review of the in vitro evidence of homeopathic high potencies evaluated 67 experiments (mostly performed on basophils) in 75 publications (1/3 of them replications. Nearly 3/4 of them found a high potency effect, including 12 of 18 studies that scored 6 points or more for study quality and which controlled for contamination. Nearly 3/4 of all replications were positive. The authors concluded that even experiments with a high methodological standard could demonstrate an effect of high potencies, but no positive result was stable enough to be reproduced by all investigators.

In vivo
A meta-analysis of 105 animal trials evaluated the use of homeopathic medicines in the treatment of environmental toxicology. Of these, 28 studies were considered high quality, and positive effects from homeopathic doses were reported 50% more often than no effects. The authors also noted, "experiments using the 'high' dilution range (by our definition those preparations diluted beyond the presence of original substance) had higher quality evaluations than experiments in lower dilution ranges, making their validity more likely. Second, our reevaluation of results from these studies using the raw data showed that over 70% had positive effects."

One group of researchers tested the effects of heavy metals on mice who were given homeopathic doses of these toxic substances after exposure. Using Arsenicum album (arsenic oxide) 6C, 30C and/or 200C to treat mice who were exposed to crude doses of arsenic, they found that it significantly reduced the cytotoxic effects of arsenic, including the levels of two liver enzymes which are indicators of liver toxicity and both of which are increased as a result of arsenic poisoning.

Trials in humans
Despite the wide popularity of homeopathy internationally, the general view of academic researchers in medicine and biology is that the efficacy of homeopathy is confined to the placebo effect. The main reasons for this are a) lack of a plausible explanation for the cellular effects of homeopathic remedies and b) lack of a plausible theory of how a physiological mechanism to respond to such remedies might have evolved, even if a mechanism exists.

Four large independently conducted double-blind trials have been conducted testing Oscillococcinum in the treatment of influenza with statistically significant results. A Cochrane Review referred to these results as "promising."

Homeopaths assert that homeopathic remedies generally have to be individually prescribed to a sick person based on his/her totality of symptoms, not just the disease that he/she has been diagnosed to have. Homeopaths acknowledge that there are sometimes exceptions to the need for individualization (the experience above with Oscillococcinum is one such exception). Therefore, homeopaths argued that many clinical trials are inappropriate tests for homeopathic treatment. Some trials have been performed that partially meet these criteria, and some of these have reported positive effects. These have not been considered as providing compelling evidence, partly because of deficiencies in trial design, but mainly because of the possibility of "publication bias" - the phenomenon whereby trials that happen by chance to appear to show a positive outcome are more likely to be published than those which are inconclusive or appear to show a negative outcome.

In 2005, The Lancet published a meta-analysis of 110 placebo-controlled homoeopathy trials and 110 matched conventional-medicine trials. The outcome suggested that the clinical effects of homeopathic remedies might all be placebo effects. The Lancet study is notable as a "global" meta-analysis of homeopathy, not an analysis of particular remedies, i.e. it tested the hypothesis that all of the reported effects of homeopathic remedies are placebo effects. If so, then reports of positive effects reflect publication bias (the tendency to publish results when they show a positive effect but not when they are negative), and the magnitude of such effects should diminish with sample size and study quality. They analyzed an equal number of conventional medicine trials similarly; these showed a real effect of treatment, in that the size of the reported effect was independent of sample size, but the trials of homeopathy remedies did not. The study does not prove that homeopathy is never effective, but is consistent with the interpretation that all reported effects are placebo effects. The Lancet article was accompanied by an editorial entitled "The end of homeopathy" which argued that doctors should recognize the absence of real curative powers in homeopathic medicine. The Lancet subsequently published a selection of critical correspondence.

Several of these published responses remarked (incorrectly) that the researchers evaluated only those studies that met certain criteria for “high quality” scientific investigations. Of the original 110 trials, 21 of the homeopathic studies fit this definition but only nine of the conventional studies did so. The researchers then considered only those trials that had a large number of patients, as trials with a larger sample size have greater statistical power. They thus compared eight homeopathic trials with six conventional medical trials, even though these trials were only matched as being of large size and good quality. The results of this subanalysis was that the effects observed in the homeopathic trials were no greater than the placebo effects observed in the clinical trials. They suggested that no further research on homeopathy is necessary, while advocates of homeopathy assert that almost all of the eight homeopathic trials used only a single homeopathic medicine given to every subject without the typical individualization of treatment that is commonly used in homeopathic practice. Advocates of homeopathy assert that this study's emphasis on certain large homeopathic trials lacked external validity, that is, the trials were not consistent with the homeopathic methodology, thereby reducing the meaning of the study's conclusions.

Some meta-analyses have found that the placebo response is an inadequate explanation for the positive responses in some trials and several meta-analyses evaluating the homeopathic treatment of specific diseases has also found positive results. However, other meta-analyses have suggested that the effect from a homeopathic medicine was no better than a placebo ,

but homeopaths say that the homeopathic principles were not used in selecting the remedy and that is why results are flawed.

Many homeopathic remedies sold in health food stores and pharmacies today are "low potencies," that is, at doses that do contain tiny amounts of the original substance, while remedies at potencies higher than about 24X, D24, or 12C (10-24) contain no detectable ingredients apart from the diluent (water, ethanol or lactose). There is considerable scientific doubt about whether these doses can have any biological effect. .

The popularity of homeopathy
Homeopathy is popular in Europe and in India, but less so in the USA and Great Britain. There are estimated to be more than 100,000 practitioners worldwide, and 500 million people receiving Homeopathic treatment. In Germany, homeopathy has been recognized as a "special form of therapy" since 1978, meaning that its remedies do not have to have been shown to be efficacious, but since 2004, most are not covered by public health insurance. In Switzerland, homeopathic remedies were covered by the basic health insurance system, if prescribed by a physician, until June 2005, when the Government, after a 5-year trial, withdrew insurance coverage for homoeopathy and four other complementary treatments, as they did not meet efficacy and cost-effectiveness criteria. In the UK, homeopathic remedies are sold over the counter, and five homeopathic hospitals are funded by the National Health Service.

While homeopathy is not practised by most of the medical profession it is supported by some physicians and scientists, by the Prince of Wales and other members of the British Royal Family and many other well known people.

The skeptical view of homeopathy

 * As I understand it, the claim is that the less you use Homeopathy, the better it works. Sounds plausible to me (David Deutsch, physicist)

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, skeptics 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 Loschmidt). There are 6.02×1023 particles in a mole (Avogadro'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'. This concept is closely related to the belief in a 'vital force', which was common in Hahnemann's day, but 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 failure of particular organs and processes in the body. .

For critics, a closely related question is that of logical consistency of the theory. The theory assumes that water is imprinted by the properties of molecules that it once came in contact with, even when the molecules are diluted away. If so, then where did the pure water used in this process come from? The water that homeopaths use was once in contact with other chemicals, including chemical wastes, radioactive metals, dinosaur urine, and various poisons. According to this skeptical interpretation of homeopathic theory, all water in the world should remember its contact with millions of chemical substances and not just the properties of the chemicals that the homeopath claims will be useful. Homeopaths respond to these concerns by asserting that homeopathic manufacturers, who in each country are regulated as drug companies, use a double-distilled water which may clear the "memory" of past water history.

Medical organizations' attitudes towards homeopathy
In the USA, the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, funds research into homeopathy. According to its statement on homeopathy,controlled clinical trials of homeopathy have produced mixed results; in some, homeopathy appeared to be no more helpful than a placebo, but in others, more benefits were seen than expected from a placebo.

Historically, the American Medical Association (AMA) was founded in 1847, three years after the forming of the American Institute of Homeopathy ,in part to slow the growth of homeopathy. From 1860's to the early 20th century, the AMA's ethic code disallowed its members to consult with fellow medical doctors who practiced homeopathy. Although the AMA didn't enforce many of its ethical guidelines, the "consultation clause" was one of the few that was. 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"

Homeopathy is practiced by large numbers of conventional medical physicians through Europe, including 30-40% of French doctors and 20% of German doctors, while 45% of Dutch GPs consider homeopathy efficacious in the treatment of upper respiratory tract infections or hay fever, and 42% of British doctors refer patients to homeopaths. According to the UK National Health Service (NHS), homeopathy is one of the most popular alternative and complementary treatment modalities. The NHS recognizes that there have been about 200 randomised controlled trials evaluating homeopathy, some show efficacy of treatment and some don't. They conclude, "Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works".

Homeopathy is one of the National Systems of Medicine in India, and it plays an important role in health care for many people. "Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels."

Safety of homeopathic remedies

 * 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 European Union allows homeopathic medicinal products, provided they are prepared according to the European Pharmacopoeia or the pharmacopoeias currently used officially in the Member States. Further the products must be diluted sufficiently so that there is no risk for the patient. In particular, the product 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 that requires doctor's prescription. No specific therapeutic indication may be given on the label of the product.

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 its dosages "have little or no pharmacologically active ingredients". The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of possibly more efficacious treatment, or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. 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 providing them with a homeopathic dilution of quinine. 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."

A particular concern is that homeopaths discourage the use of vaccines. Homeopathy is superficially like vaccination, in that vaccines contain a small dose of the 'disease' against which they offer protection (a vaccine is usually made from a bacterium or virus that is either dead or weakened so that it cannot produce symptoms, while still providing enough information to the immune system to generate antibody production).

However, some homeopaths believe that vaccination has the potential to create serious health consequences, in part because of the mercury in them, in part because the bacterium or virus in the vaccine may neither be dead nor weak enough and in part because they believe that some childhood diseases (i.e. measles, chicken pox) may have certain immunological benefits that should not be prevented. Such advice is generally considered irresponsible by public health professionals. Measles is not a major killer in the western world, where the vast majority of children are vaccinated against the disease at about two years old. However, in less developed countries the death toll is much higher, and in 1999 there were 875,000 deaths from measles worldwide, mostly in Africa. In 2001, a "Measles Initiative" was initiated involving organisations such as the American Red Cross, Unicef and the World Health Organisation, and between 1999 and 2005 more than 360 million children across the world were vaccinated. By 2005 the death toll had dropped by 60% to 345,000.