Why Homeopathy

Homeopathy

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Samuel Hahnemann, the founder of homeopathy

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Homeopathy Listeni/ˌhmiˈɒpəθi/ (also spelled homoeopathy or homœopathy; from the Greek hómoios- ὅμοιος- “like-” + páthos πάθος “suffering”) is a system of alternative medicine originated in 1796 by Samuel Hahnemann, based on his doctrine of similia similibus curentur (“like cures like”), according to which a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people.[1]

Hahnemann believed that the underlying causes of disease were phenomena that he termed miasms, and that homeopathic remedies addressed these. The remedies are prepared by repeatedly diluting a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body, called succussion.[2] Each dilution followed by succussion is said to increase the remedy’s potency. Dilution usually continues well past the point where none of the original substance remains.[3] Homeopaths select remedies by consulting reference books known as repertories, considering the totality of the patient’s symptoms as well as the patient’s personal traits, physical and psychological state, and life history.[4]

Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible.[5][6][7][8] The scientific community regards homeopathy as a sham;[9] the American Medical Association considers homeopathy to be quackery,[10][11] and homeopathic remedies have been criticized as unethical.[12]

The low concentration of homeopathic remedies, which often lack even a single molecule of the diluted substance,[13] has been the basis of questions about the effects of the remedies since the 19th century. Modern advocates of homeopathy have suggested that “water has a memory” – that during mixing and succussion, the substance leaves an enduring effect on the water, perhaps a “vibration”, and this produces an effect on the patient. This notion has no scientific support.[14][15] Pharmacological research has found instead that stronger effects of an active ingredient come from higher, not lower doses.

Homeopathic remedies have been the subject of numerous clinical trials. Taken together, these trials showed at best no effect beyond placebo, at worst that homeopathy could be actively harmful.[16] Although some trials produced positive results,[17][18] systematic reviews revealed that this was because of chance, flawed research methods, and reporting bias.[7][19][20][21] The proposed mechanisms for homeopathy are precluded by the laws of physics from having any effect.[22] Patients who choose to use homeopathy rather than evidence based medicine risk missing timely diagnosis and effective treatment of serious conditions such as cancer.[23][24] The regulation and prevalence of homeopathy vary greatly from country to country.[25]

History

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the brutality of medicine of the 19th century

Historical context

Hippocrates, in about 400 BC, perhaps originated homeopathy when he prescribed a small dose of mandrake root – which in larger doses produced mania – to treat mania itself;[26] in the 16th century the pioneer of pharmacology Paracelsus declared that small doses of “what makes a man ill also cures him.”[27] Samuel Hahnemann (1755–1843) gave homeopathy its name and expanded its principles in the late 18th century. At that time, mainstream medicine used methods like bloodletting and purging, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper’s flesh.[28] These treatments often worsened symptoms and sometimes proved fatal.[29][30] Hahnemann rejected these practices – which had been extolled for centuries[31] – as irrational and inadvisable;[32] instead, he advocated the use of single drugs at lower doses and promoted an immaterial, vitalistic view of how living organisms function, believing that diseases have spiritual, as well as physical causes.[33]

Hahnemann’s concept

The term “homeopathy” was coined by Hahnemann and first appeared in print in 1807.[34]

Hahnemann conceived of homeopathy while translating a medical treatise by the Scottish physician and chemist William Cullen into German. Being skeptical of Cullen’s theory concerning cinchona‘s use for curing malaria, Hahnemann ingested some of the bark specifically to investigate what would happen. He experienced fever, shivering and joint pain: symptoms similar to those of malaria itself. From this, Hahnemann came to believe that all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they treat, in accord with the “law of similars” that had been proposed by ancient physicians.[35] An account of the effects of eating cinchona bark noted by Oliver Wendell Holmes, and published in 1861, failed to reproduce the symptoms Hahnemann reported.[36]:128

Hahnemann’s law of similars is an ipse dixit axiom,[37] in other words an unproven assertion made by Hahnemann, and not a true law of nature.[38]

Proving

Hahnemann began to test what effects substances produced in humans, a procedure that would later become known as “homeopathic proving”. These tests required subjects to test the effects of ingesting substances by clearly recording all of their symptoms as well as the ancillary conditions under which they appeared.[39] A collection of provings was published in 1805, and a second collection of 65 remedies appeared in his book, Materia Medica Pura, in 1810.[40]

Since Hahnemann believed that large doses of drugs that caused similar symptoms would only aggravate illness, he advocated extreme dilutions of the substances; he devised a technique for making dilutions that he believed would preserve a substance’s therapeutic properties while removing its harmful effects.[3] Hahnemann believed that this process aroused and enhanced “the spirit-like medicinal powers of the crude substances”.[41] He gathered and published a complete overview of his new medical system in his 1810 book, The Organon of the Healing Art, whose 6th edition, published in 1921, is still used by homeopaths today.[42]

A homeopathic remedy prepared from marsh tea: the “15C” dilution shown here exceeds the Avogadro constant, so contains no trace of the original herb.

Miasms and disease

In The Organon of the Healing Art, Hahnemann introduced the concept of “miasms” as “infectious principles” underlying chronic disease.[43] Hahnemann associated each miasm with specific diseases, and thought that initial exposure to miasms causes local symptoms, such as skin or venereal diseases; if however these symptoms were suppressed by medication, the cause went deeper and began to manifest itself as diseases of the internal organs.[44] Homeopathy maintains that treating diseases by directly opposing their symptoms, as is sometimes done in conventional medicine, is ineffective because all “disease can generally be traced to some latent, deep-seated, underlying chronic, or inherited tendency”.[45] The underlying imputed miasm still remains, and deep-seated ailments can be corrected only by removing the deeper disturbance of the vital force.[46]

Hahnemann originally presented only three miasms, of which the most important was psora (Greek for “itch”), described as being related to any itching diseases of the skin, supposed to be derived from suppressed scabies, and claimed to be the foundation of many further disease conditions. Hahnemann believed psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts.[47] Since Hahnemann’s time, other miasms have been proposed, some replacing one or more of psora’s proposed functions, including tuberculosis and cancer miasms.[44]

The law of susceptibility implies that a negative state of mind can attract hypothetical disease entities called “miasms” to invade the body and produce symptoms of diseases.[48][dead link] Hahnemann rejected the notion of a disease as a separate thing or invading entity, and insisted it was always part of the “living whole”.[49] Hahnemann coined the expression “allopathic medicine“, which was used to pejoratively refer to traditional Western medicine.[50]

Hahnemann’s miasm theory remains disputed and controversial within homeopathy even in modern times. In 1978, Anthony Campbell, then a consultant physician at the Royal London Homeopathic Hospital, criticised statements by George Vithoulkas claiming that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. This conflicts with scientific studies, which indicated penicillin treatment produces a complete cure of syphilis in more than 90% of cases.[51] Campbell described this as “a thoroughly irresponsible statement that could mislead an unfortunate layman into refusing orthodox treatment”.

The theory of miasms has been criticized as an explanation developed by Hahnemann to preserve the system of homeopathy in the face of treatment failures, and for being inadequate to cover the many hundreds of sorts of diseases, as well as for failing to explain disease predispositions, as well as genetics, environmental factors, and the unique disease history of each patient.[52]:148-9

19th century: rise to popularity and early criticism

Homeopathy achieved its greatest popularity in the 19th century. Dr. John Franklin Gray (1804–1882) was the first practitioner of homeopathy in the United States, beginning in 1828 in New York City. The first homeopathic schools opened in 1830, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States.[53] By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States.[54] Because medical practice of the time relied on ineffective and often dangerous treatments, patients of homeopaths often had better outcomes than those of the doctors of the time.[55] Homeopathic remedies, even if ineffective, would almost surely cause no harm, making the users of homeopathic remedies less likely to be killed by the treatment that was supposed to be helping them.[42] The relative success of homeopathy in the 19th century may have led to the abandonment of the ineffective and harmful treatments of bloodletting and purging and to have begun the move towards more effective, science-based medicine.[30] One reason for the growing popularity of homeopathy was its apparent success in treating people suffering from infectious disease epidemics.[56] During 19th century epidemics of diseases such as cholera, death rates in homeopathic hospitals were often lower than in conventional hospitals, where the treatments used at the time were often harmful and did little or nothing to combat the diseases.[57]

From its inception, however, homeopathy was criticized by mainstream science. Sir John Forbes, physician to Queen Victoria, said in 1843 that the extremely small doses of homeopathy were regularly derided as useless, “an outrage to human reason”.[58] James Young Simpson said in 1853 of the highly diluted drugs: “No poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly.”[59] 19th century American physician and author Oliver Wendell Holmes, Sr. was also a vocal critic of homeopathy and published an essay in 1842 entitled Homœopathy, and its kindred delusions.[36] The members of the French Homeopathic Society observed in 1867 that some of the leading homeopathists of Europe not only were abandoning the practice of administering infinitesimal doses but were also no longer defending it.[60] The last school in the U.S. exclusively teaching homeopathy closed in 1920.[42]

Revival in the late 20th century

In the United States the Food, Drug, and Cosmetic Act of 1938 (sponsored by Royal Copeland, a Senator from New York and homeopathic physician) recognized homeopathic remedies as drugs. In the 1950s, there were only 75 pure homeopaths practicing in the U.S.[61] However, by the mid to late 1970s, homeopathy made a significant comeback and sales of some homeopathic companies increased tenfold.[62] Greek homeopath George Vithoulkas performed a “great deal of research to update the scenarios and refine the theories and practice of homeopathy” beginning in the 1970s, and it was revived worldwide;[63][64] in Brazil during the 1970s and in Germany during the 1980s.[65] The medical profession started to integrate such ideas in the 1990s[66] and mainstream pharmacy chains recognized the business potential of selling homeopathic remedies.[67]

Remedies and treatment

Homeopathic remedy Rhus toxicodendron, derived from poison ivy.

Homeopathic practitioners rely on two types of reference when prescribing remedies: materia medica and repertories. A homeopathic materia medica is a collection of “drug pictures”, organised alphabetically by “remedy,” that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms.[68]

Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include arsenicum album (arsenic oxide), natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), opium, and thyroidinum (thyroid hormone). Homeopaths also use treatments called “nosodes” (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue.[69] Homeopathic remedies prepared from healthy specimens are called “sarcodes”.

Some modern homeopaths have considered more esoteric bases for remedies, known as “imponderables” because they do not originate from a substance, but from electromagnetic energy presumed to have been “captured” by alcohol or lactose. Examples include X-rays[70] and sunlight.[71] Today, about 3,000 different remedies are commonly used in homeopathy.[citation needed] Some homeopaths also use techniques that are regarded by other practitioners as controversial. These include “paper remedies”, where the substance and dilution are written on pieces of paper and either pinned to the patients’ clothing, put in their pockets, or placed under glasses of water that are then given to the patients, as well as the use of radionics to prepare remedies. Such practices have been strongly criticised by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.[72][73]

Preparation

Mortar and pestle used for grinding insoluble solids, including quartz and oyster shells, into homeopathic remedies

In producing remedies for diseases, homeopaths use a process called “dynamisation” or “potentisation”, whereby a substance is diluted with alcohol or distilled water and then vigorously shaken by 10 hard strikes against an elastic body in a process homeopaths call “succussion”.[74] Hahnemann advocated using substances that produce symptoms like those of the disease being treated, but found that undiluted doses intensified the symptoms and exacerbated the condition, sometimes causing dangerous toxic reactions. He therefore specified that the substances be diluted, due to his belief that succussion activated the “vital energy” of the diluted substance[75] and made it stronger. To facilitate succussion, Hahnemann had a saddle-maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.[76][77] Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose (“trituration“).

Dilutions

Main article: Homeopathic dilutions

Three logarithmic potency scales are in regular use in homeopathy. Hahnemann created the “centesimal” or “C scale”, diluting a substance by a factor of 100 at each stage. The centesimal scale was favored by Hahnemann for most of his life. A 2C dilution requires a substance to be diluted to one part in 100, and then some of that diluted solution diluted by a further factor of 100. This works out to one part of the original substance in 10,000 parts of the solution.[78] A 6C dilution repeats this process six times, ending up with the original substance diluted by a factor of 100−6=10−12 (one part in one trillion or 1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.[79] The end product is often so diluted as to be indistinguishable from the dilutant (pure water, sugar or alcohol).[3][80][81] There is also a decimal potency scale (notated as “X” or “D”) in which the remedy is diluted by a factor of 10 at each stage.[82]

Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060).[2] In Hahnemann’s time, it was reasonable to assume the remedies could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized. The greatest dilution reasonably likely to contain even one molecule of the original substance is 12C.

This bottle contains arnica montana (wolf’s bane) D6, i.e. the nominal dilution is one part in a million (10-6).

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies.[83] Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times.[84][85] Another example given by a critic of homeopathy states that a 12C solution is equivalent to a “pinch of salt in both the North and South Atlantic Oceans”,[84][85] which is approximately correct.[86] One-third of a drop of some original substance diluted into all the water on earth would produce a remedy with a concentration of about 13C.[87][83][88] A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum w

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