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Samuel Hahnemann,  1755-1843, the father of homeopathyHomeopathy

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V What is homeopathy?
V Published evidence for and against homeopathy
V Homeopathic solutions
V Does homeopathy work?

 

      "The greatest enemy of knowledge is not ignorance,

           it is the illusion of knowledge"                                       Stephen Hawking

What is homeopathy?

Homeopathy is a branch of alternative medicine, b , i created in 1796 by the disillusioned doctor Samuel Hahnemann, that is based around the surmise that an individual may be treated using minute doses d of natural materials which in larger doses would be expected to cause the same symptoms (the 'like cures like' principle). h Remedies start with such a natural material that is diluted and then subjected to a sequence of further dilutions in purified water or aqueous ethanol with considerable agitation (called succussion, see below) between dilution steps. Each dilution (as shown) results in about a 100-fold dilution and many cycles (e.g. 20, 50, 200) are performed before the remedy is used. a,g

 

Preparation of a homeopathic product by a sequence of dilutionsThe initial popularity of homeopathy was partially due to the unhygienic crudeness of medical procedures in the 19th century, such as bloodletting. However, 200 years later, homeopathy is still gaining popularity even if its efficacy is often disputed. The cornerstone of homeopathy that the whole clinical picture is considered, on an individual basis with generally long consultations, is not in dispute. In fact, consideration of the 'whole' person is clearly becoming more important as information concerning an individual's genome becomes clearer. However criticism is leveled at homeopathic 'drugs', particularly as it appears to be 'just water'. Belief in whether or not dilution and shaking can have any effect on the health benefits of water (for an overview of homeopathy see for example, [484a], for a review of homeopathy research see [484b] and for a recent debate concerning Homeopathy see [1363]) depends on the presence of an acceptable working hypothesis for the mode of action (see also magnetic effects) of such shaken and overly diluted material. Certainly, a confounding aspect of any examination of the efficacy of homeopathic treatments seems to be the highly variable nature of supposedly similar homeopathic remedies from different manufacturing sources. [Back to Top to top of page]

Published evidence

In spite of many (most?) people knowing of success stories (and the opposite) concerning the use of homeopathy where it is practiced [120], scientists have difficulty in regarding this form of alternative medicine as any more than a placebo effect. e The ‘memory of water’ is a popular phrase that is mostly associated with homeopathy [1211] following his and others’ allergy research work [132]. These research teams reported that solutes subjected to sequential physical processing and dilution show biological effects different from those apparent using just the water employed for the dilutions. The subject has drawn a lot of controversy with many 'scientists' simply rejecting it outright without studying the evidence. Whether or not this work is correctly interpreted, the value of homeopathy depends on whether it can treat ailments not on whether water has 'memory'.

 

Meta-analysis of 89 placebo-controlled trials failed to prove either that homeopathy was efficacious for any single clinical condition or that its positive clinical effects could entirely be due to a placebo effect [121a], thus leaving the scientific door open both ways. A further analysis of this data, however, indicated that some of these studies may have failed to avoid bias and that studies using better methodology yielded the less positive effects [121b]. A recent analytical review has reinforced the, more negative, view concerning the clinical effectiveness of homeopathic remedies [527]. Further, a recent quality assessment of published experiments on homeopathic preparations has concluded that many were performed with inadequate controls [651]. Although a scientific trial of homeopathy conducted for the BBC and similar work reported on ABC News' 20/20 program both failed to show any homeopathic effect, the experiments they reported have been subject to serious criticism including that of careless scientific methodology. The Lancet Vol. 366 No 9487

 

In August 2005 [840], the medical journal 'The Lancet' controversially argued for halting any further research into homeopathy concluding it has no effect other than as a placebo. This judgment was based on its simultaneous publication of a comparative study of 110 matched placebo-controlled trials of homeopathy and conventional medicine [841]. The conclusion was reached, however, in spite of the study apparently showing little evidence of differences between the two groups (homeopathy and conventional) when all the data was considered. There were differences when a tiny percentage of unmatched larger trials were cherry-picked for further analysis (that is, 102/110 of the homeopathy studies and 104/110 of the conventional studies were discarded, even though these studies had been carefully chosen before the study using a priori inclusion and exclusion criteria). c The remaining 6% of the studies, however, still showed positive (if not conclusive, possibly as the number of trials left in this final grouping was so small and unmatched) evidence in favor of a homeopathic effect over placebo. The more negative nature of the eight chosen homeopathy papers were mainly influenced by one single trial Although Shang's study [841] has come in for considerable and rightful criticism, and there is a strong case for its retraction, as above and [1381, 1382, [1524], it is often put forward in support of the view that homeopathy works no better than as a placebo; a fact that it clearly does not deliver. 

 

There has been several quality studies that support the effectiveness of homeopathy. In one, thirty doctors in six clinical sites in four countries enrolled patients with acute respiratory problems. 281 patients were treated with homeopathy and 175 patients treated by conventional medicine, both with mostly 5-15 minutes consultation times. After 14 days, 83 % of the homeopathy-treated reported a positive response compared with 68% of the conventionally-treated, with 22% of conventionally-treated reporting adverse events compared with 8 % for the homeopathy-treated [2450].

Homeopathy in healthcare [2457]

 

An independent report commissioned by the Swiss health authorities [2457], concluded in 2011, “There is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment.” However, a 2013 review concluded that “There is a paucity of good - quality studies of sufficient size that examine the effectiveness of homeopathy as a treatment for any clinical condition in humans”, there remains questions over the clinical effectiveness of homeopathy with neither proof for nor proof against being conclusively proven. Nevertheless, a 2014 systematic review of randomized placebo-controlled trials of individualized homeopathic treatments concluded that they may have small, specific treatment effects [2276].

 

Some of the most convincing evidence promoted in favor of homeopathy has been its use with animals. It is very difficult to propose how animal studies can show any placebo effect, especially if the study is double blinded. For example, the homeopathic preparation from the Cocculus indicus plant (cocc 30c) has been shown, in a randomized double-blinded trial, to ameliorate the effects of sleep deprivation in rats [2374]. However, systematic reviews of homeopathy used in veterinary conditions studied by randomized trials have been published with the conclusion that although there is some very limited evidence that such clinical intervention is distinguishable from placebo, evidence concerning the effective use of homeopathy in animals remains indecisive [2447].

 

The debate continues certainly, with an excellent overview of this area [2449] concluding 'Plausibility bias has introduced more heat than light into the debate around homeopathy: it has fired the debate without illuminating its information content. We do not deny that homeopathy raises major scientific issues, but we remain convinced that these will eventually be resolved by application of authentic scientific method, especially in the context of further in vitro experiments'.

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Arnica homeopathic pharmaceuticalHomeopathic solutions

A thorough investigation into the structural differences previously reported between homeopathically potentized (that is, succussed and extremely diluted) and unpotentized nitric acid solutions showed that the effect was lost or changed if different glassware was used [495]. Changes in the thermoluminescence of ice produced from ultra-diluted water have been noted [500 a] but can be explained by remaining trace amounts of material (due to poor mixing, impurities, absorption, nanobubbles (that is, nanocavities) [500d] or other causes) being concentrated between ice crystals [500b]; an explanation supported by later work [500c]. A series of papers from Academician Konovalov has proposed that physical and biological effects of highly diluted aqueous solutions differ from those expected from simple dilution and may be due to the formation of nano-sized (up to 400 nm) molecular assemblies [2207]. Also, maxima in the biological activity at very diluted concentrations (~ 10-15 - 10-18 M), below measurable concentrations, have been widely reported [2232]. It has been shown that surface active nanoparticles may be formed during the early succussion/dilution steps. As they concentrate in the solution-air interface, they are not diluted as expected and may still be present in solutions even diluted by factors of 10400 far greater than the Avogadro limit (1023) [2375]. Thus it is probable that nanoparticles remain in homeopathic dilutions and possible that even such low concentrations have biological effects.

 

Changes in the NMR relaxation times [1620a, 1620c], thermochemistry [1644] and UV absorption [1620b] of water in some homeopathic preparations remain unexplained and require confirmation. A systematic assessment of the in vitro research on high potency effects has shown positive, if only partially reproducible, effects [2238]. This may indicate a stochastic influence similar to that occurring in the (now accepted) Mpemba effect.

 

A key feature of any difference between water before and after its use in preparing homeopathic dilutions is likely to be the vigorous shaking (succussion) that must be carried out between successive dilutions, and which may produce significantly increased concentrations of silicate, sodium and bicarbonate ions [335, 1207] by dissolution of the glass tubes and increases in nanobubbles, and changes in their size [1771], and redox molecules [1066, 1751] from the atmosphere, respectively. Nanobubbles may be important due to their extremely high surface area/volume ratio as it is well known that organic molecules prefer to lie at aqueous interfaces [1889] allowing such solutions to absorb greater amounts of organics from the laboratory atmosphere. Certainly, there is now a body of evidence that dilute salt solutions containing nanobubbles, formed by vigorous stirring, can have clinical effects on immunological diseases [2002] and can promote growth in plants [2014] and animals [2015]. Some molecules (e.g. detergents) preferentially partition there by many orders of magnitude. Recently, a paper from Nobel prize-winning Luc Montagnier has declared that quite dilute solutions (of DNA) show entirely different properties from the less diluted solutions, that the authors propose depend on interactions with the ambient electromagnetic field [1602]. f How water may show a memory is explored further in the 'memory of water' page.

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Does homeopathy work?

Many ridicule homeopathy out of serious consideration as a clinical practice, sometimes resorting to unscientific, unbalanced and unrefereed editorial diatribe. One of the main reasons concerning this disbelief in the efficacy of homeopathy lies in the difficulty in understanding how it might work [2065]. If an acceptable theory was available then more people would consider it more seriously. However, it is difficult at present to sustain a theory as to why a truly infinitely diluted aqueous solution, consisting of just H2O molecules, should retain any difference from any other such solution. It is even more difficult to put forward a working hypothesis as to how small quantities of such 'solutions' can act to elicit a specific response when confronted with large amounts of complex solution in a subject. A major problem in this area is that, without a testable hypothesis for the generally acknowledged potency of homeopathy (except, perhaps, flawed dilution assumptions [2375]) , there is a growing possibility of others making fraudulent claims in related areas, as perhaps evidenced by the increasing use of the internet to advertise 'healthy' water concentrates using dubious (sometimes published but irreproducible) scientific and spiritual evidence. [Back to Top to top of page]

 


Footnotes

a Note that 'memory of water' effects (if proven) not only require the solution to retain information on dilution but clearly require this information to be amplified to negate the effect of the dilution. [Back]

 

b Homeopathy is one of a wide range of historical health care practices like traditional Chinese medicine, acupuncture, yoga, faith healing, chiropractic manipulation, aromatherapy, massage, hypnotherapy and folk medicines such as ginseng. Although there is much testimonial evidence supporting the efficacy of each of these practices, they all remain contentious due to lack of sufficient scientifically-rigorous proof. [Back]

 

c The 'cherry-picking' is clear as (although a rationale for some sort of selection is presented post hoc) the study does not appear to have used a pre-determined rationale (or pre-determined parameters) in discarding trials, completes no sensitivity analysis and ends up apparently 'dredging' the data in an unbalanced manner, to falsify the conclusions [1524]. Further analysis of the data, provided post publication, shows that the conclusions would have been different for almost all alternative cut-off points [1524]; that is, they would not support the conclusions that homeopathy is no more than a placebo effect or that homeopathy trials are less good than conventional trials. [Back]

 

d This 'dilution' is usually so extreme that no molecules of the starting material are expected to be found in the final 'solution'. In spite of this, the efficacy (and cost) of the homeopathic remedies are often thought to be greater, the greater the dilution. [Back]Placebo tablets

 

e It should also be noted that placebo (from latin 'I will do good') effects constitute real clinical effects [121c] even though they contain just filler, such as lactose, and no active ingredients. They are widely used as control medication in medical trials. Placebos should be judged positively and probably account for a significant proportion of the success of prevailing established medicine [1474]. They may act primarily by relieving anxiety. Curiously, placebos have greater effect in trials that do not inform patients about the possible placebo intervention, unless the placebo is presented in a positive manner. The cheerfulness and interest of the doctor in the patient also increases the placebo's effectiveness. Additionally, there must be a range of 'placebo effects' of different potencies and having different effects in different situations. As such, they surely overlap with true clinical effects. As an example, it seems clear that antidepressant medications used for many years are not efficacious and any perceived difference from placebo is due to the reduced responsiveness to placebo in the severely depressed [1455]. It seems strange to this writer that so many of those that dispute homeopathy's efficacy, saying without proof that they believe there is nothing there, are quite happy to accept that there exists a 'placebo' effect where it is known absolutely that there is nothing there. [Back]

 

f The extraordinary results given in this paper have yet to be independently confirmed. [Back]

 

g Another dilution method utilizes a clean glass vessel for each dilution step with each step involving a 10-fold dilution. [Back]Arnica montana L

 

h An example is the common onion (Allium cepa), well known to cause stinging of the eyes and as a cause of tears to form. Because of this and the 'like cures like' homeopathic principle, it is thought of as a treatment for the common cold and hay fever when used at a wide range of homeopathic dilutions between 103 - 10400 fold.

 

Another example is mountain arnica (Arnica montana, Leopard's bane), a daisy-like mountain flower (see right). By itself it can cause skin irritation and can be fatal if eaten. Because of this and the 'like cures like' homeopathic principle, it is thought of as a treatment for bruising and muscle pain, often by athletes. Typically, medium dilutions of between 1012 - 1060 are used as tablets or in creams.

 

Arsenic poisoning causes severe vomiting and diarrhea. Because of this and the 'like cures like' homeopathic principle, it is thought of as a treatment for gastroenteritis and food poisoning. The homeopathic derivative (Arsenicum album) is used at a wide range of dilutions between 103 - 10400 fold. [Back]

 

i Some supposedly scientific sites concerning homeopathy are governed by irrational dogmatists. For example, Wikipedia states that it specifically encourages mention of studies that show that homeopathy does not work but also states that it does not allow mention of any peer-reviewed published double-blind study that shows homeopathy works. Many authors have been hounded off their pages for trying to present a balanced view but on this site I do this by looking carefully at the evidence. [Back]

 

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This page was established in 2001 and last updated by Martin Chaplin on 19 October, 2016


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