what is homeopathy?
A homeopathy is a form of medical treatment in which extremely diluted preparations of medicines are ingested or applied to the skin. Homeopathic therapies are generally used as a form of alternative medicine that is not typically considered part of conventional medical practice.
History of homeopathy
Homeopathy is based on the principle that "like cures like," meaning that a substance which causes symptoms in a healthy person can cure similar symptoms in someone with an illness, such as pneumonia. Homeopathic methods were developed by Samuel Hahnemann and published in 1810, and have attracted many patients since then due to their claims for treating many diseases with substances most people would find unlikely to cause these ailments.
Homeopathy is largely considered ineffective by the scientific community and has been accused of being unscientific, as there is no evidence for the existence of homeopathic cures. However, homeopathy does have its proponents. The National Center for Complementary and Alternative Medicine has conducted a few trials investigating homeopathic treatments, but found no evidence that they were effective.
Adherents to homeopathy began to emerge in the United Kingdom by 1804. One of the earliest advocates was the British physician John Elliotson, who began treating patients with small doses of opium. Elliotson saw this practice as a form of homeopathy, and cited Hahnemann's "Materia Medica Pura" to support his practice. He is often referred to as the “Father of Homeopathy in England” for this reason.
Another early advocate was Austin Flint, an American homeopath known for his criticism and rejection of Hahnemann's approach that diseases should be treated with the most similar medicine. He believed that a milder version of a treatment would work better than more potent versions; therefore, he advocated diluting stronger medicines in order to make milder ones. Flint helped spread homeopathy in the United States when he wrote "Medical Uses of Hydro-Acids" in 1849.
Homeopathy was popularized even more by Mary Gove Nichols, and her husband Robert Curtis Newton. They were involved with the founding of the American Institute of Homeopathy, where they helped publish many early homeopathic texts and journals.
Homeopathy continued to gain popularity throughout the 19th century, particularly after the British Medical Association recognized it as a legitimate practice in 1930. In 1962, Britain’s National Health Service (NHS) began to reimburse patients for homeopathic treatments under the Hospital In-Patient Scheme for Non-Surgical Treatments (NST).
Homeopathy became more common in the United States when, in 1842, a commission of the American Medical Association approved the use of homeopathic treatments. The homeopathic practice of Samuel Chamberlain is particularly notable. He began by practicing conventional medicine and soon became disenchanted with it. In 1835, he published a treatise that proposed "homeopathy, materia medica and therapeutics" as a replacement for western medical practices commonly in use at that time. Chamberlain is referred to as "Father of American Homeopathy".
Homeopaths have also been involved with some product liability lawsuits centered around adverse reactions to alternative medicine treatments. The most notable of these is the case of Karen Ann Quinlan in which the family sued because she was left in a persistent vegetative state after her death.
Contemporary homeopathy
The American Institute of Homeopathy (AIH) was established in 1916 and is now the largest professional organization that represents practitioners of homeopathy. Its mission is to advance research and education, provide outreach services and raise awareness about homeopathic medicine. The organization offers many opportunities for its members to network, as well as continuing medical education programs for those practicing or interested in practicing homeopathy. It sponsors several conferences each year on homeopathic practice and research, including a major international conference that takes place every six years. The first of these was held in San Francisco in 2002.
The British Institute of Homeopathy is the largest professional organization for homeopathy in the UK. Its mission is to promote the use of homeopathic medicines through education, research and public awareness. The institute offers a wide range of services and educational programs to members, as well as many opportunities to network.
Homeopathy is still considered controversial by many people, and research into its usefulness continues. Although it has been used for over 200 years, there is no clear evidence that homeopathic treatments are effective beyond a placebo effect.
Recent studies have suggested that homeopathic practitioners can effectively treat patients with acute upper respiratory tract infections through the use of steam inhalations. The steam inhalation treatment was found to be more effective than a placebo control, and had fewer side effects.
A large-scale, double-blind and controlled study was conducted in India and published in the Lancet to examine the effectiveness of homeopathy for childhood diarrhea in India. The results suggested that it is as effective as a leading anti-diarrheal drug (loperamide) in reducing symptoms of acute diarrhea.
Some trials using homeopathic remedies have been conducted on patients with irritable bowel syndrome (IBS) with encouraging results. In one trial, 44% of patients given placebo reported improvement over 6 months, while 61% of patients given individualized homeopathic medicines reported improvement.
The National Health Service (NHS) in the UK has been heavily criticized for funding homeopathy. The NHS spends around £4 million a year on homeopathy, which is paid for by taxes. Proponents of homeopathy claim that the cost is modest, and that more conventional treatments are more expensive. However, others have taken the opposite approach and insisted that it is unethical to use taxpayers' money to fund something that has insufficient evidence behind it. Moreover, there has been public resistance to what some consider a misuse of NHS funding, and this resistance has only been further fueled in recent years by the financial crisis facing the NHS.
Since 1997, the NHS NST has allowed homeopathic treatments to be reimbursed. However, this practice is subject to a number of strict conditions. For example, patients are not allowed to pay extra for homeopathic medicine as part of an insurance package that includes complementary medicine, and they must also first exhaust other conventional treatments before seeing a homeopath. The NHS has taken the view that since there is no direct evidence for homeopathy's effectiveness, it is not fair for medical treatment providers to profit from the treatments on the state's behalf.
In July 2013, a Department of Health spokesman said "Homeopathy involves treating disease by very dilute concentrated substances and so cannot be considered a treatment in its own right. Research has shown that it is no more effective than placebo and its use is unnecessary, potentially harmful and costly to the NHS."
In addition to homeopathy, other forms of alternative medicine are considered pseudoscience by mainstream medicine. These include acupuncture, chiropractic and herbalism.
Homeopathy is usually viewed as referring only to dilute medicines made from plants or animal parts; however, some homeopaths have studied the use of whole natural products such as foods, minerals and even physical products such as stones. Homeopathic medicines fall under the category of pharmacologically relevant substances (PRS) used by conventional medical practitioners in alternative medicine.
Homeopathic medicines are used to treat a range of conditions, and are typically used in conjunction with conventional medical treatment. Homeopathy can provide symptomatic relief in a variety of conditions, many of which are difficult or expensive to treat using conventional medicine. Homeopathic treatments may include remedies with no active ingredients (placebo effect), single active ingredient remedies such as homeopathic salts or vegetable products, or combinations of such remedies. Some practitioners use homeopathically prepared vitamins. Some patients use homeopathic medicines for a number of conditions that have been reported by peer-reviewed publications as effective and safe for treating various disease states. These include asthma, allergies, mental health disorders, and certain infections.
Homeopathy claims a wide variety of applications, including:
Before modern medicine, homeopathy was one of the primary systems of medicine in many countries. It declined after the development of scientific medicine and was regulated out of practice in most Western countries by the end of the 20th century. This decline is attributed to homeopathy's lack of plausibility, counterintuitive and un-falsifiable hypotheses, failure to reject the null hypothesis, and historic associations with quackery.
According to Ernst and Singh (2008), during most periods there have been small but committed groups who use it for serious conditions. They also describe three distinct phases of homeopathy's growth:
In the UK, homeopathy was institutionalised by the British government in the form of a special medical service provided by the National Health Service, and led to a substantial membership increase. From 1997–2007, £9 million was spent on homeopathy, but it is unclear what patients received.
Homeopathy was also included in the NHS's list of treatments not covered by the health service, despite evidence that it is ineffective.
In the United States, homeopathy is not officially recognized as a form of medicine by the U.S. Department of Veterans Affairs (VA); however, it is listed on the VA's drug formulary with an indication for treatment of anxiety and insomnia. In 2007, a survey was conducted on 1,100 veterans in which 22% responded that they had used homeopathic medicine within the past year. Its use has declined with many practitioners unwilling to recommend it because it lacks scientific plausibility or proof-of-concept studies (see also: cognitive biases). The American Cancer Society has condemned homeopathy as ineffective, stating that "many cancer patients use homeopathic medicines in place of proven medical treatments".
Homeopathy is regulated in most western countries but its regulation varies. In some countries, including France and Germany it is regulated as a form of complementary medicine; other countries, including the United Kingdom, do not regulate it as a medicinal practice. It is banned in most Muslim countries because it contradicts Islamic teaching which prohibits the consumption of alcohol and blood products. The European Council's Homeopathy Directive states that alternative therapies must meet the normal requirements for safety and effectiveness set forth by the European Union before being licensed for sale in Europe; however, there are no alternative medicine licensing requirements in any member country.
In the United States, homeopathic products are regulated under the Food, Drug and Cosmetic Act. They are defined as "drugs, devices, or other articles" if they come within a definition of a medicine that has been passed by the United States Congress. Homeopathic medicines are exempt from Food and Drug Administration (FDA) regulation for products used for their claimed health benefits rather than their toxicity. The FDA does not directly regulate homeopathic products because they meet its definition of "drugs" under federal law unless they have not been scientifically tested to determine whether they function as drugs or are marketed as drugs. However, the FDA encourages manufacturers of homeopathic drugs to conduct clinical trials in order to substantiate their safety and efficacy claims.
Some homeopathic products (such as Arnica) are regulated as a drug under the Federal Food, Drug and Cosmetic Act, which requires them to undergo FDA pre-market approval and post-market surveillance.
There are at least 2 reasons why there is no strong scientific evidence for health benefits from homeopathic treatments and remedies.
First, to the practicing clinician these results may indicate a positive effect that can be given proper name: placebo effect. Most often this refers to a patient's response to any treatment given or expected to have some benefit, irrespective of its likelihood of effectiveness. This notion has been confirmed in controlled clinical trials where it is not possible to identify the actual cause of response. It is most clearly seen when patients of a homeopath (or other alternative provider) are compared with patients of a practitioner using conventional medicine. In many cases the patient reports improvement in both groups, and sometimes to a similar degree, but rarely are the actual treatments given in these situations directly compared. An exception is the French report by the National Commission on Homoeopathy (2001).
A 2003 review concluded that "the evidence suggests that homeopathic remedies perform no better than placebos." A 2006 systematic review found no good quality clinical trials for homeopathy; although good data were found for some specific effects, such as Belladonna, physical symptoms and ailments due to food intolerance. There is also no evidence that homeopathic treatments are more effective than more common treatments. Reviewing the literature, the Cochrane group concluded in 2008 that there was insufficient evidence to recommend for or against the effectiveness of homeopathy.
A 2003 review found that "there is insufficient evidence to determine whether homeopathy has any efficacy in treating any conditions." A 2003 review found that "there is insufficient evidence to determine whether homeopathy has any efficacy in treating any conditions." A 2005 review of clinical trials found insufficient evidence that homeopathic treatment had effects better than placebo. A 2007 systematic review concluded: "None of the existing reviews has shown convincingly that homeopathy, as a treatment for chronic conditions, is effective and safe. The existing reviews have found that homeopathy is of no better efficacy than placebo and may occasionally be harmful." A 2007 review found "no convincing evidence" that homeopathy is more effective than a placebo. A systematic review by the British Society of Allergy & Immunology (BSAAI) examined types of evidence to quantify the effectiveness, and found that there was no good evidence for the effectiveness of homeopathy.
The American Cancer Society has taken issue with a sustained argument that any type of cancer treatment should be able to demonstrate an effect equivalent, or at least comparable, to conventional medicine, as well as its claims about other conditions. A 2008 review of controlled clinical trials found that homeopathy was "cost-ineffective and possibly a waste of money." A 2010 systematic review concluded: "There is no evidence that the quality of life on subgroups with poorer prognoses such as women, people with multiple medical comorbidities, or patients with advanced cancer (including palliative care) has improved as a result of homeopathy."
A 2012 systematic review concluded: "Currently there is no convincing evidence and no evidence of harm which would indicate a need for regulatory action." A 2014 systematic review found that most research did not find homeopathic treatments to be effective. However, the study noted the studies it reviewed were designed to evaluate effectiveness rather than safety.
In 2014 the Australian National Health and Medical Research Council (NHMRC) (Australia's equivalent to the US National Institutes of Health) evaluated the research on homeopathic treatments. Their report concluded that "the available evidence does not support claims that homeopathy is effective for treating any medical condition... The limited published research indicates safety and tolerability of these medications, with no influence on test results or laboratory data."
According to Dr. Paul Offit, professor of pediatrics at the University of Pennsylvania's School of Medicine and director of the Vaccine Education Center, "There is no scientific evidence that homeopathy works."
In 1999 a systematic review found insufficient evidence to recommend for or against routine use of homeopathy.
In 2004, an influential report concluded that homeopathic interventions that are intended to treat side-effects and acute adverse effects of conventional cancer treatments have little or no value, and should not be used at all.
A 2011 systematic review found that there was insufficient evidence to determine whether homeopathy is more effective than conventional therapies for treating any medical conditions.
In 2013 the British Health Minister Lord Howe confirmed the government's stance on homeopathy, saying: "I can confirm that we believe there is insufficient evidence to show this treatment is effective or of benefit." According to a 2013 report published by the National Health and Medical Research Council (CHORUS), "inconclusive results were reported in most studies reviewed. CHORUS concluded that the evidence is not compelling enough to either support or dismiss homeopathy as a treatment for any specific condition. However, given the low cost of homeopathic preparations and lack of side effects, patients should have the opportunity to make informed decisions based on discussion with their health practitioner in the context of all other treatment options."
In a 2003 systematic review, Trisha Greenhalgh concluded that "the best available evidence does not support a preventive effect of homoeopathy for childhood infections." A 2008 review found that at least half of trials had serious methodological limitations which prevented them from drawing conclusions about whether homeopathy works. The same review found only a single trial which met academic standards, and it was of poor quality but was positive. A 2011 systematic review found "limited evidence that homeopathy is no more effective than placebo."
In 2013 the British Health Minister Lord Howe confirmed the government's stance on homeopathy, saying: "I can confirm that we believe there is insufficient evidence to show this treatment is effective or of benefit." According to a 2013 report published by the National Health and Medical Research Council (CHORUS), "inconclusive results were reported in most studies reviewed. CHORUS concluded that the evidence is not compelling enough to either support or dismiss homeopathy as a treatment for any specific condition. However, given the low cost of homeopathic preparations and lack of side effects, patients should have the opportunity to make informed decisions based on discussion with their health practitioner in the context of all other treatment options."
A 2017 systematic review found that homeopathy was ineffective for asthma not controlled by medication. A 2010 review stated: "It can be concluded that despite 200 years of research and clinical use, and numerous trials, there is still no evidence to prove homeopathy effective in treating or preventing any medical condition."
