Homeopathy

dilutions

Homeopathy [hoh-mee-op-uh-theeis a system of alternative medicine originated in 1796 by German physicist Samuel Hahnemann, based on the 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 that disease in sick people.

Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible.

Within the medical community homeopathy is generally considered quackery. Homeopathic remedies are prepared by repeatedly diluting a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body, called ‘succussion.’ 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. 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.

The low concentrations of homeopathic remedies, often lacking even a single molecule of the diluted substance, lead to an objection that has dogged homeopathy since the 19th century: how, then, can the substance have any effect? 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. However, nothing like water memory has ever been found in chemistry or physics. Pharmacological research has found, contrary to homeopathy, that stronger effects of an active ingredient come from higher doses, not lower doses. Homeopathic remedies have been the subject of numerous clinical trials, which test the possibility that they may be effective through some mechanism unknown to science. Taken together, these trials showed no effect beyond placebo. The proposed mechanisms for homeopathy are precluded by the laws of physics from having any effect.

Homeopathy is a vitalist philosophy that interprets diseases and sickness as caused by disturbances in an immaterial vital force or life force. Disturbances are believed to manifest themselves first in mental symptoms, and eventually progress to physical disease if untreated. Homeopathy rejects germ theory, viewing the presence of pathogens as a symptom, rather than cause, of disease. Homeopathy maintains that the vital force has the ability to react and adapt to internal and external causes, which homeopaths refer to as the ‘law of susceptibility’ (as with the ‘law of similars’ this is a term of art and not a natural law, and it lacks significant scientific acceptance). 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. However, Hahnemann rejected the notion of a disease as a separate thing or invading entity, and insisted it was always part of the ‘living whole.’ Hahnemann proposed homeopathy in reaction to the state of traditional Western medicine at that time, which often was brutal and more harmful than helpful. Hahnemann coined the expression ‘allopathic medicine,’ which was used to pejoratively refer to traditional Western medicine.

Hahnemann observed from his experiments with cinchona bark, used as a treatment for malaria, that the effects he experienced from ingesting the bark were similar to the symptoms of malaria. He therefore decided cure proceeds through similarity, and treatments must be able to produce symptoms in healthy individuals similar to those of the disease being treated. He believed that by using drugs to induce symptoms, the artificial symptoms would stimulate the vital force, causing it to neutralize and expel the original disease and that this artificial disturbance would naturally subside when the dosing ceased. It is based on the belief that a substance that in large doses will produce symptoms of a specific disease will, in extremely small doses, cure it.

In 1828, Hahnemann introduced the concept of ‘miasms’; underlying causes for many known diseases.[30] A miasm is often defined by homeopaths as an imputed ‘peculiar morbid derangement of [the] vital force.’ Hahnemann associated each miasm with specific diseases, with each miasm seen as the root cause of several diseases. According to Hahnemann, initial exposure to miasms causes local symptoms, such as skin or venereal diseases, but if these symptoms are suppressed by medication, the cause goes deeper and begins to manifest itself as diseases of the internal organs. 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.’ The underlying imputed miasm still remains, and deep-seated ailments can be corrected only by removing the deeper disturbance of the vital force.

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. Since Hahnemann’s time, other miasms have been proposed, some replacing one or more of psora’s proposed functions, including tuberculosis and cancer miasms. 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, criticized 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. 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.

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. 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. 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 and sunlight. Today, about 3,000 different remedies are commonly used in homeopathy. 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 criticized by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies. 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. Another example given by a critic of homeopathy states that a homeopathic solution is equivalent to a ‘pinch of salt the Atlantic Ocean,’ which is approximately correct. Not all homeopaths advocate extremely high dilutions. Many of the early homeopaths were originally doctors and generally used lower dilutions such as ‘3X’ or ‘6X,’ rarely going beyond “12X.’ The split between lower and higher dilutions followed ideological lines. Those favoring low dilutions stressed pathology and a strong link to conventional medicine, while those favoring high dilutions emphasized vital force, miasms, and a spiritual interpretation of disease. Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond that of a placebo.

While the lack of active compounds is noted in most homeopathic products, there are some exceptions such as Zicam Cold Remedy, which is marketed as an ‘unapproved homeopathic’ product. It contains a number of highly diluted ingredients that are listed as ‘inactive ingredients’ on the label. Although the product is marked ‘homeopathic,’ it does contain two ingredients that are only ‘slightly’ diluted: zinc acetate (2X = 1/100 dilution) and zinc gluconate (1X = 1/10 dilution), which means both are present in a concentration that contains biologically active ingredients. In fact, they are strong enough to have caused some people to lose their sense of smell, a condition termed anosmia. This illustrates why taking a product marked ‘homeopathic,’ especially an overdose, can still be dangerous. Because the manufacturers of Zicam label it as a homeopathic product (despite the relatively high concentrations of active ingredients), it is exempted from FDA regulation by the Dietary Supplement Health and Education Act of 1994 (DSHEA).

Flower remedies can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower remedies, which were developed by the physician and homeopath Edward Bach. Although the proponents of these remedies share homeopathy’s vitalist world-view and the remedies are claimed to act through the same hypothetical ‘vital force’ as homeopathy, the method of preparation is different.

There is an overall absence of sound statistical evidence of therapeutic efficacy of homeopathic medicine, which is consistent with the lack of any biologically plausible pharmacological agent or mechanism. Abstract concepts within theoretical physics have been invoked to suggest explanations of how or why remedies might work, including quantum entanglement, the theory of relativity, and chaos theory. However, the explanations are offered by nonspecialists within the field, and often include speculations that are incorrect in their application of the concepts and not supported by actual experiments.

Science offers a variety of explanations for how homeopathy may appear to cure diseases or alleviate symptoms even though the remedies themselves are inert: The placebo effect (the intensive consultation process and expectations for the homeopathic preparations may cause the effect); Therapeutic effect of the consultation (the care, concern and reassurance a patient experiences when opening up to a compassionate caregiver can have a positive effect on the patient’s well-being); Unassisted natural healing (time and the body’s ability to heal without assistance can eliminate many diseases of their own accord); Unrecognized treatments (an unrelated food, exercise, environmental agent or treatment for a different ailment, may have occurred); Regression toward the mean (since many diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care when discomfort is greatest, they may feel better anyway but because the timing of the visit to the homeopath they attribute improvement to the remedy taken); and Cessation of unpleasant treatment (often homeopaths recommend patients stop getting medical treatment such as surgery or drugs, which can cause unpleasant side-effects; improvements are attributed to homeopathy when the actual cause is the cessation of the treatment causing side-effects in the first place, but the underlying disease remains untreated and still dangerous to the patient.)

An early assertion that like cures like was made by Hippocrates about 400 BCE, when he prescribed mandrake root, which produced mania, to treat mania, by prescribing a dose smaller than what would produce mania. In the 16th century the pioneer of pharmacology Paracelsus declared that small doses of ‘what makes a man ill also cures him.’ but it was Hahnemann who gave it a name and laid out its principles in the late 18th century. At that time, mainstream medicine employed such measures as bloodletting and purging, used laxatives and enemas, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper’s flesh. Such measures often worsened symptoms and sometimes proved fatal. While the virtues of these treatments had been extolled for centuries, Hahnemann rejected such methods as irrational and inadvisable. Instead, he favored 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. (At the time, vitalism was part of mainstream science; it wasn’t completely discarded until the 20th century, with the development of microbiology, the germ theory of disease, and advances in chemistry). Hahnemann also advocated various lifestyle improvements to his patients, including exercise, diet, and cleanliness.

Homeopathy achieved its greatest popularity in the 19th century. The first homeopathic schools opened in 1830, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States. By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States. 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. 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. 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.

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