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Alternative medicine
Samuel Hahnemann
Samuel Hahnemann, originator of homeopathy
Claims "Like cures like", dilution increases potency, disease caused by miasms.
Related fields Alternative medicine
Year proposed 1796
Original proponents Samuel Hahnemann
Subsequent proponents James Tyler Kent, Constantine Hering, Royal S. Copeland, George Vithoulkas
MeSH D006705
See also Humorism, heroic medicine

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Homeopathy or homoeopathy—from the Greek hómoios (similar) and páthos (suffering)—is a system of alternative medicine based on the idea that substances known to cause particular combinations of symptoms in healthy people can also, in low and specially prepared doses, help to cure people whose disease has similar symptoms.

Homeopathy is used mainly by consumers who use it to treat common non-life-threatening acute conditions, by a relatively small number of licensed homeopaths, and by some medical doctors and other licensed health practitioners as an alternative or a complement to conventional treatment. Homeopathic medicines (referred to in this article as "remedies" to avoid confusion with conventional medicines) are widely available without a doctor's prescription. Some health insurers cover homeopathic treatment if it is provided by a medical doctor.

The consensus of medical and scientific judgment is that homeopathy is unfounded.[1] Although many studies have reported that remedies might be effective in particular conditions, these have mostly been small and poorly controlled. The main homeopathic principles make no sense to scientists. The "principle of infinitesimals" contradicts common sense and scientific results; there is no known mechanism by which remedies might work, given that many are so dilute that they contain not a single molecule of the active ingredient. Homeopaths reject these arguments and consider them to be evidence of medical arrogance.

Principles, and historical origins

According to homeopaths, their remedies stimulate the body's "natural healing processes" and invoke the "wisdom of the body". Remedies are derived from substances which, when given in overdose to healthy people, cause symptoms similar to those of the patient being treated; homeopaths claim that these augment the body's own defenses. Hygiene, diet, and other natural therapies are also often used in conjunction with remedies.

Two basic principles are the principle of similars ("like cures like"), and the principle of infinitesimals - the idea that remedies become more potent if they undergo a process called potentization, which consists of repeated dilutions with vigorous shaking (succusion) between each dilution. Individualization of treatment is essential in classical homeopathy, whereby a remedy is chosen based on the person's overall 'syndrome of symptoms', not just a generic disease diagnosis.


Hippocrates of Cos (c. 450–380 BCE),[2] sometimes called the "father of medicine", is also claimed by homeopaths as a pioneer in their own tradition because he taught that "Natural forces within us are the true healers of disease" and that some diseases could be cured by the same things that caused them. The principles of homeopathy were first methodically set out by a German physician, Samuel Hahnemann (1755–1843). Many famous people over the past 200 years have been users and advocates of homeopathy,[3] and it is an important thread in the history of medicine.


In the early 18th century, the conventional medicine was what is now called heroic medicine; its physicians often used large doses of toxic compounds as medicines, and used procedures such as bloodletting and purging indiscriminately. In 1783, disillusioned with heroic medicine, Hahnemann gave up his medical practice and turned to translating medical books. Among them was the Treatise on Materia Medica by William Cullen. Cullen had written that cinchona bark (which contains quinine) was effective in treating malaria because of its bitter and astringent properties. Hahnemann questioned this, because other substances were as bitter but had no therapeutic value.[4]

Hahnemann saw that the effects of ingesting cinchona were like the symptoms of malaria. He observed similar results with other substances, and so conceived of the law of similars (Latin: similia similibus curentur, "let like be cured by like" )— the assertion that a disease can be cured by remedies that (in milligram doses) produce the same symptoms as those of the disease. From these ideas, he developed a new system of health care, which he named "homoeopathy" (meaning "like disease"), and coined the term "allopathy" ("different than disease") for the heroic medicine of the day.[5] In his theory, every person has a "vital force", with the power to promote healing and/or maintain good health, and the symptoms of a disease reflect efforts of the body to defend itself against infection, environmental assault, or stresses. Homeopathy attempts to strengthen this "vital force" with remedies chosen for their ability (in large doses) to provoke the similar symptoms that the remedy is intended to heal. Hahnemann believed that, by inducing symptoms similar to the disease, the natural healing processes of the body would be stimulated.

At first, Hahnemann used "crude" doses of substances (doses that still contained some original ingredient).[6] He strove to find the lowest doses that would still be effective, and he concluded that remedies worked better the more he diluted them as long as he “potentized” them, i.e. by serial dilution followed by succussion. Homeopathy thus became inextricably linked with ultradilution. Hahnemann had no explanation as to how or why these potentized remedies might work; he distrusted theoretical explanations and argued that all that mattered was whether a treatment was effective.[7]. Hahnemann coupled his theory with a method of "provings" to determine what symptoms a substance causes and thence what a particular remedy might cure (see below).

Homeopathy in the U.S.A.

The first homeopathic school in the U.S.A. opened in 1835, and in 1844 the first U.S. national medical association, the American Institute of Homeopathy, was established.[8] By the end of the 19th century, 8% of American medical practitioners were homeopaths, with 20 homeopathic colleges and more than 100 homeopathic hospitals. One reason for the popularity of homeopathy was its relative success in combatting the epidemics of the time. Cholera, scarlet fever, typhoid fever, and yellow fever killed many, but death rates in hospitals that used heroic medicine were two- to eight-fold higher than in homeopathic hospitals.[9][10]

In the early 20th century, the "Flexner Report" triggered major changes in American medical education. Many medical schools, including those teaching homeopathy, were closed, while others turned to a new vision of a biochemical understanding of medicine to replace heroic medicine. The popularity of homeopathy revived after the 1960's, and a 1999 survey reported that over 6 million Americans had used homeopathy in the previous 12 months. The number of homeopathic practitioners in the U.S.A. increased from fewer than 200 in the 1970's to about 3,000 in 1996.

Conflict with conventional medicine

The theory underlying homeopathy is not considered plausible by most scientists, and the treatment advice offered by homeopaths is in disagreement with conventional medicine. The academic view is that homeopathy exploits the placebo effect — i.e. that the only benefits are those induced by suggestion, by arousing hope and alleviating anxiety.

Homeopaths believe that the fundamental causes of disease are internal and constitutional and that infectious disease is not just the result of infection but also of susceptibility. This respect for the body's own defense systems leads them to avoid conventional treatments that suppress symptoms. Physicians consider that most diseases are caused by a combination of external causes (such as viruses, bacteria, toxins, dietary deficiency, physical injury) and physiological dysfunction (including genetic defects and mutations such as those which trigger cancers). Conventional medicine aims to eliminate these causes, although physicians often also use drugs to suppress the discomfort of a disease (e.g., painkillers) or to supplement host resistance based on specific mechanisms, such as immunization.


Some homeopaths believe that their remedies can prevent disease, a notion known as "'homeoprophylaxis". A 2006 survey in the U.K. revealed that homeopathic vendors were advising travelers against taking conventional antimalarial drugs, instead recommending a homeopathic remedy. 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"[11]

Homeopathy in practice


In homeopathic drug provings, volunteers are given repeated doses of substances (usually in single-blind or double-blind protocols), and keep a diary of symptoms. These are later recorded in textbooks, called Materia Medica [12] or nowadays in expert system software. These 'provings' provide, for homeopaths, evidence of what a substance causes in overdose and thence what it might cure. The symptom complexes from provings are compared with a patient's symptoms in order to select, for the appropriate remedy, the substance whose effects are closest to the patient's symptoms — the "simillimum". Homeopaths prescribe a remedy (in potentized doses) when a sick person has a syndrome of symptoms that resembles the symptoms that crude doses of the remedy cause in a proving.

In 2006, the U.K. Medicine and Healthcare Products Regulatory Agency altered their regulations to allow evidence from provings to support advertising claims for remedies (justifying phrasing such as “For the relief of...”). Scientists protested, calling this a departure from the principle that claims should be justified by evidence of efficacy.[13]


In the U.S.A., the federal Food, Drug, and Cosmetic Act (1938) sponsored by Senator Royal Copeland (a former homeopathic medical school dean) gave the Food and Drug Administration (FDA) the power to regulate drugs, and gave legal recognition to the Homœopathic Pharmacopœia of the United States[14] This describes how remedies (defined as "homeopathic drugs") are manufactured. They are subject to less stringent regulation than conventional drugs, which must demonstrate adequate evidence of safety and efficacy; by contrast any substance can become a homeopathic remedy. Remedies are also exempt from good manufacturing practice requirements related to expiration dating, and from finished product testing for identity and strength.[15] [16]

Homeopaths use about 3,000 remedies, made from plants, trees, and fungi[17] and from many mineral and animal sources. Some unusual substances, called imponderables, are also used, including electricity, X-ray, and magnetic poles. By convention, the first letter of the Latin-derived name of a remedy is capitalized, and the traditional name is preferred to the chemical or biological name - Natrum muriaticum rather than sodium chloride. Remedies for internal consumption come either as pills or as liquid, and most do not need a doctor's prescription, unless (in the U.S.A.) they are claimed to be for a serious disease such as cancer. Remedies for self-limiting conditions (minor health problems that are expected to go away on their own) can be sold without a prescription.

A principle of homeopathy is that the efficacy of a remedy can be enhanced by "dynamization" or "potentization". Liquids are diluted (with water or ethanol) and shaken by ten hard strikes against an elastic body ("succussion"), to get the next, higher, potency. Insoluble solids such as oyster shell are diluted by grinding with lactose ("trituration").[18] Hahnemann used dilutions of 1 part in 100 (centesimal; C potencies), or 1 in 50,000 (quintamillesimal; LM or L potencies); Constantine Hering later introduced Decimal (D or X) potencies, 1 part in 10. Hahnemann advocated 30C dilutions for most purposes; these are diluted by a factor of 10030 = 1060. Liquid remedies of high "potency"' contain just water (but according to homeopaths, the structure of the water has been altered); remedies in pill form contain just sugar.

In many countries, remedies are sold over-the-counter (OTC) in pharmacies and other retail outlets; many of these are "low potencies" which may contain at least some of the original substance. OTC remedies account for 0.3% of a global self-medication market estimated at 48.2 billion dollars.[19] The American Homeopathic Pharmaceutical Association estimated the 1995 retail sales of remedies in the U.S.A. at $201 million and growing at 20% per year. Almost 70% of OTC remedies are sold in Europe; France is the largest market, worth over 300 million euros in 2003, followed by Germany (200 million euros). In 2007, the U.K market was around £40 million.[20]

In Europe, remedies are occasionally prescribed by MDs, including by 30-40% of French and 20% of German doctors.[21] In France, 35% of the costs of remedies prescribed by an MD are reimbursed from health insurance.[22]

A typical homeopathic visit

  • "Homeopathy is designed to treat the whole person and can therefore be considered in almost any situation where a person's health is depleted" (British Homeopathic Association)[23]
  • "The physician must remember that he is treating a patient who has some disorder; he is not prescribing for a disease entity" (American Institute of Homeopathy "Standards of Practice")[24]

When patients consult homeopaths, it is usually because of a chronic problem that has not responded to conventional treatment; these include common ailments such as eczema, asthma, migraine, irritable bowel syndrome, arthritis, anxiety and depression, but sometimes they have serious diseases, including cancer.[25] and AIDS[26] Homeopaths view illness as a disturbance in the 'overall homeostasis of the total being', and believe that almost any sick person can benefit from homeopathic treatment. Most homeopaths are not medically qualified; those who are, after diagnosing a chronic condition that does not seem to require urgent medical attention, might prescribe a remedy rather than a conventional medicine (which they feel may be ineffective and/or likely to have side effects). Homeopaths recognize that trauma might require conventional medical attention, but may complement that with homeopathy.

When a homeopath interviews a patient to characterise his or her syndrome of symptoms, some "categories of change" are identified as important:[27]
  1. emotion
  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
  19. recall of past experiences

In "Classical ("Hahnemannian") homeopathy, a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing, rather than the diagnosis of a disease ("commercial" homeopathy uses a mixture of remedies containing various ingredients chosen by the manufacturer for treating specific ailments). Homeopaths gather this information from an interview, typically lasting from 15 minutes to two hours, with one or more follow-up consultations of 15 to 45 minutes. They assess how the patient experiences their disease—i.e. they give priority to the overall syndrome of symptoms and the unique symptoms, unlike the conventional medical approach of trying to identify the causes of the disease. Their goal is to determine factors that might predispose the patient to disease, and find a treatment that will strengthen that patient's "overall constitution". After the interview, the homeopath consults the references described on the right. Some homeopaths make quick prescriptions based on "keynotes" — the best known characteristics of a remedy. The real challenge of homeopathic practice is to find the remedy that best matches the patient's "syndrome of symptoms" — the "similimum".

The homeopathic treatment of acute problems does not need the same depth or breadth of interview as chronic conditions. According to homeopaths, because the symptoms of a common cold or a headache or an allergy vary from person to person, each may need a different remedy. However, they believe that people who experience an injury generally have similar symptoms, so they think that some remedies might be routinely useful in such cases. For some disease conditions, such as asthma, remedies are often prescribed not only to treat chronic symptoms, but also to treat acute attacks. Remedies might also be used after an asthmatic episode with the intent to prevent recurrences.

"Classical" homeopaths prescribe one remedy at a time — one that best fits the overall syndrome of the patient. The same remedy might thus be prescribed for patients with different diseases; conversely, patients suffering from the same disease may be prescribed different remedies. For example, hay fever might be treated with any of several remedies, based either on the specific symptoms or on the etiology of the allergy. Some common remedies are: Allium cepa (onion, which causes tears to flow and a clear burning nasal discharge that irritates the nostrils), Euphrasia (eyebright, which causes a clear and bland nasal discharge along with tears that burn and irritate), Ambrosia (ragweed) and Solidago (goldenrod); ragweed and goldenrod are herbs whose pollen is aggravating to some hay fever sufferers. These are commonly given during the acute symptoms of hay fever. At other times, a homeopath might prescribe a constitutional remedy based on the patient’s family history, health history and overall physical and/or psychological state.[28]

Scientific foundations?

In brief, for homeopathy to receive serious scientific consideration, there must be plausible explanations for:

  • how an ultradiluted solution can have any specific biological activity
  • by what biological mechanism could the specific nature of a remedy be recognised

These demands are often summarised by the maxim "Extraordinary claims require extraordinary proof".[29]

Homeopathy arose when important concepts of modern chemistry and biology, such as molecules and germs, were understood poorly, if at all. In Hahnemann's day, many chemists believed that matter was infinitely divisible, so that it was meaningful to talk about dilution to any degree. The size of atoms was calculated in 1865 (by Josef Loschmidt); we now know that a 12C dilution will have only about one molecule of that drug per litre. Thus, a remedy diluted to more than 12C is virtually certain to contain not a single molecule of the original substance. However, homeopaths assert that the healing power is not in the action of molecules, but in some change in the structure of the water — the presumed "memory of water".

Widely different explanations are proposed.[30] For instance, water contains isotopologues (molecules with different isotopic compositions). Mass spectroscopy can detect these, but the concentration ratios can only be changed by nuclear reactions — they are not affected by homeopathic treatment. The molecules H2O appear in two proton-spin forms (ortho and para) in a ratio 3:1; these are chemically indistinguishable and very difficult to interconvert. Even if a treatment could give rise to different ratios, it requires a massive leap of imagination to envisage how this might result in specific healing qualities. Succussive shaking might lead to "clustering" of water molecules, but motions in liquid water are on the picosecond (10−12 s) timescale and such clusters could not live longer than a few picoseconds. Double-distilled water contains trace amounts of contaminating ions; after vigorous shaking, it might also include dissolved atmospheric gases as nanobubbles, ions produced from reactions with airborne contaminants, and silicates—tiny glass "chips"; such contamination is very likely, but it is hard to see how it could have therapeutic value[31]

Homeopaths contend that the "principle of similars" is analagous to hormesis(the phenomenon that some chemicals at high concentrations have opposite biological effects to those at low concentrations)[32] and is the basis for vaccination and allergy desensitation. Scientists do not think that this 'principle' is generally true or useful, and they explain vaccination without it. Although remedies and vaccinations both use low doses, the doses in remedies are very much lower. Vaccines produce a measurable immune response (e.g., immunoglobulin production); remedies do not.

Homeopaths assert that they are up against a 'double standard'. Many conventional treatments were used before any knowledge of their mechanism of action; only recently, for instance, has it been understood how aspirin works, although it was introduced at the turn of the 20th century. However, if aspirin was a new drug, it would require clinical trials; Institutional Review Boards demand that the mechanism of action be known before authorizing these.


Homeopaths assert that trials of efficacy, basic sciences research, historical use of remedies in infectious disease epidemics, and cost-effectiveness studies all show the benefits of homeopathy.[33][34]. They favour the evidence of their experience in treating patients; they also (correctly) state that most published trials have reported evidence for some benefits, including for postoperative ileus[35], allergic rhinitis[36], and childhood diarrhoea[37] Homeopathy also scores more highly in "patient satisfaction" surveys than conventional primary care; this is attributed to the greater empathy shown by homeopaths towards their patients, and to the existence of "effectiveness gaps", chronic conditions where conventional therapies are not available or not effective, and which are then overrepresented among patients of homeopaths. [38]

According to academic critics, trials of homeopathy have mostly been small and flawed, lacking adequate controls and objective outcome measures.[39] A 1991 meta-analysis in the British Medical Journal of 105 homeopathic trials recognised that most showed positive results, but warned that "most trials are of low methodological quality."[40] A 1997 meta-analysis in the Lancet also noted the preponderance of positive trial results, stating that the results were "not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo."[41] However, the same authors went on to show that larger high-quality trials tend to show little or no significant effects[42] The most recent meta-analyses, which take study quality into account, suggest that remedies are no different to placebos.[43][44]

Why small trials tend to report positive outcomes while large trials tend to report small or no effects is generally attributed to "publication bias"; small trials with negative or inconclusive outcomes are less likely to be written up for publication, and if submitted are less likely to be accepted for publication, because they are thought to be uninteresting. In 1999, the Swiss Government, for 5 years, allowed costs for treatment with homeopathy and four other CAM modalities to be reimbursed by the country’s health insurance scheme, and set out to evaluate their cost-effectiveness[45]. A team of scientists and practitioners, including a homeopath, conducted a meta-analysis that aroused a storm of protest from homeopaths. The study, published in the Lancet by Shang et al. took a novel approach; while traditional meta-analyses combine studies of a single condition, this analysis tested the hypothesis that all effects of homeopathy are placebo effects.[46] If so, the authors reasoned, then the predominance of positive reports reflects publication bias, and hence the magnitude of effects should diminish with sample size and study quality. They analyzed 110 placebo-controlled homoeopathy trials and 110 matched conventional trials. In both, effect size declined with improved study quality; however, some effect was still present in the largest and best conventional trials, but not in the largest and best homeopathy trials. The authors concluded that homeopathy was no better than placebo, and that no further research on homeopathy was necessary. The article was accompanied by two editorials, one titled “The end of homeopathy”.[47].

Homeopathic response

Homeopaths believe that, because homeopathy does not lend itself to controlled trials, those with a negative outcome may be false negatives. They also claim that many studies in which homeopathy appears ineffective are methodologically flawed— they either did not follow proper homeopathic procedure in the selection of remedies or they did not adequately repeat the remedy.

The Lancet published critical correspondence, and received an open letter from the 'Swiss Association of Homoeopathic Physicians'[48]:

"The meta-analysis may be statistically correct. But its validity and practical significance can be seen at a glance: not one single qualified homoeopath would ever treat one single patient in clinical practice as presented in any of the 110 analysed trials! The study cannot give the slightest evidence against homoeopathy because it does not measure real individual (classical) homoeopathy. It confounds real homoeopathic practice with distorted study forms violating even basic homeopathic rules."

In the meta-analysis, the 8 largest trials of homeopathy showed that no benefits, but of these, only one used an individualized approach to treatment, and one tested a rarely used remedy (Thyroidinum) to treat weight-loss in a previously untested treatment protocol.

Several studies that had been defined as "high quality" by Linde et al. (1997) were not defined as high quality by Shang et al., and most of these showed an effect of homeopathic treatment. Shang et al. also excluded a relatively large study of chronic polyarthritis because no matching trial could be found. An article in the Journal of Clinical Epidemiology noted that four of the 21 'best' trials dealt with muscle soreness; these found no benefits to homeopathy, but the other 17 trials show an overall significant effect, mainly determined by two trials on influenza-like diseases. Thus, they argued, homeopathy might be effective for some conditions but not others.[49]

Government and institutional assessments

In 2010, a U.K. House of Commons 'Science and Technology Committee' report on homeopathy concluded that the principle of "like-cures-like" is theoretically weak, and "fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science." [50] It described the use of ultra-dilution as scientifically implausible, and on the effectiveness of homeopathy said:

"In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos"

The report rejected evidence presented by the British Homeopathic Association on systematic reviews and accepted Professor Edzard Ernst's account of the weaknesses of that evidence. It stated that advocates of homeopathy had chosen "to rely on, and promulgate selective approaches to the evidence base". It rejected calls for further research:

"There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious. Competition for research funding is fierce and we cannot see how further research on the efficacy of homeopathy is justified"

It recommended against the use of homeopathy on the NHS even as a placebo treatment: for a placebo to be effective, the patient must not know it is a placebo, but medical ethics requires that a patient must make an informed choice. It also advised that, if the NHS appears to endorse homeopathy, there is a danger that patients might neglect conventional medicine, with serious health consequences. The report recommended that NHS funding of homeopathic hospitals should stop, and that NHS doctors should not refer patients to homeopaths.

The report is endorsed by the British Medical Association[51], which voted in favour of stopping any use of any NHS funds for homeopathy, and proposed that pharmacists should remove homeopathic remedies from their shelves to prevent them from being confused with medicines.

The Royal Pharmaceutical Society of Great Britain suggested that patients ought to be made aware that there is no scientific basis for the use of homeopathy, and that unless homeopathy can be shown to be efficacious "using appropriate methodology (as for conventional medicines)" any claims of efficacy should be removed from the label. It also concluded that "homeopathic remedies should be reviewed by the National Institute for Clinical Excellence (NICE) if they are to be used within the NHS" – historically, homeopathy has not been subject to review by NICE.[52] The U.K. Government continues to allow doctors to prescribe homeopathic treatment on the NHS in line with the principle that they should be free to decide whatever treatment they think appropriate in individual cases.[53]

Medical organizations' attitudes

From the 1860s to the early 20th century, the American Medical Association forbade its members to consult with MDs who practiced homeopathy.[9] Today, their policy states: "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."[54] The National Center for Complementary and Alternative Medicine funds research into alternative medicine in the U.S.A.[55]. Their views on homeopathy are detailed here; in 2008, their acting deputy director said "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment."[56]

In the U.K., the NHS recognizes that there have been about 200 randomised controlled trials evaluating homeopathy, and concludes "it has proven difficult to produce clear clinical evidence that homeopathy works".[57] Its doctors are free to decide what treatment is best for each patient, and a few do sometimes prescribe homeopathic remedies. The NHS supports four hospitals that provide homeopathic treatment in outpatient clinics, and over 400 general practitioners (out of more than 30,000) use homeopathy in their everyday practice.[58] In 2007, doctors in the U.K. issued 49,300 prescriptions for homeopathic remedies out of a total of 796 million prescriptions (down from 83,000 in 2005).[59] In 2008, it was reported that the NHS was progressively withdrawing funding for homeopathic treatments because of doubts about efficacy.[60]


"The highest ideal of cure is the speedy, gentle, and enduring restoration of health by the most trustworthy and least harmful way" (Samuel Hahnemann)

In the U.S.A., the FDA determines what drugs are safe for OTC sale; its view is that there is no real concern about the safety of homeopathic remedies because of the extremely small dosages, and the vast majority do not need a doctor's prescription. However, some physicians maintain that homeopathic treatment is unsafe, because it might delay other treatment/s. The concern is greatest when patients forego conventional treatment for serious illness (such as anti-inflammatories and bronchodilators for asthma), or do not receive established preventive treatments (such as vaccines or anti-malarial drugs).[61]

Most drugs of the 19th century were at best ineffective and often dangerous; even in 1860 Oliver Wendell Holmes declared that, (with a few exceptions) "if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be better for mankind—and all the worse for the fishes."[62] However, some homeopaths question whether modern medicines are safe and effective, and remind patients and physicians of the Hippocratic aphorism "First, do no harm".

Many homeopaths think that vaccination for diseases such as measles is unnecessary, and that vaccines can be damaging, because of the mercury and aluminum in them, because the virus in the vaccine may neither be dead nor weak enough, and/or because some childhood infections may strengthen immune responsiveness. Such advice is considered irresponsible by public health professionals who assess the benefits of vaccination as vastly outweighing the risks. Measles is not a major killer in the western world, where most children are vaccinated, but in 1999 it caused 875,000 deaths worldwide, mostly in Africa. In 2001, a "Measles Initiative" was begun by the American Red Cross, UNICEF and the World Health Organization; by 2005 more than 360 million children had been vaccinated, and the death toll had dropped to 345,000.[63][64]


There are no universal standards for homeopathic education. Some countries allow homeopaths to describe themselves in equivalent ways to doctors, with a system of qualification and oversight; in others (including France, Spain and Argentina) most professionals that prescribe remedies are MDs [65][66] Some countries (including India and Pakistan) have exclusively homeopathic medical schools, some (including Germany) have naturopathic colleges with homeopathy as part of the curriculum, and some certify "professional homeopaths" who have attended homeopathic schools and then pass examinations that grant "certification". [22] In the U.S.A., there is also a separate certification process available only to MDs and DOs, and naturopathic physicians also have a homeopathic certifying agency. To join the American Institute of Homeopathy today, a mainstream medical license (MD, DO, DDS) is required as well as homeopathic training.

In India, homeopathy has more than 200,000 registered practitioners and is one of the "National Systems of Medicine" under the Department of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy); it is illegal to practice as a homeopath without a license and professional qualifications.[67] Every primary health care centre has one or more conventional doctors and a doctor from the Department of AYUSH. About 10% of the population, over 100 million people, depend solely on homeopathy for their health care needs.[68]

In the UK, anyone can declare themselves to be a homeopath and practice without any qualification [69] Most homeopaths are not medically-trained, and many of these belong to the Society of Homeopaths, a European-wide organisation. The Society keeps a register of professionally trained and insured homeopaths who agree to abide by the Society's Code of Ethics and Practice. Unlike other major CAM professions, homeopathy still has no statutory regulation process.[70] Some laws apply: for example, by the 1939 Cancer Act it is illegal to falsely claim to have an effective treatment for cancer, and this is enforced by the Trading Standards Office. Beyond that, the same regulations apply to homeopaths as to any commercial operation—such as the Sale of Goods Act, and the Advertising Standards Authority. Advertisments for homeopathy must include the instruction to "to consult a doctor if symptoms persist".

In the UK, the Faculty of Homeopathy regulates medical professionals who practice homeopathy. It publishes the journal Homeopathy, and is a founding member of the 'European Committee for Homeopathy' which has developed a code of professional conduct. Of 248,000 registered practitioners of medicine in the U.K., only about 400 are members of the Faculty. Homeopaths with medical qualifications have, on occasion, been disciplined by the General Medical Council for using homepathic remedies inappropriately[71][72] but not by the Faculty, which has no means of enforcing its code.


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  14. Homeopathic Pharmacopoeia of the United States<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  15. Center for Drug Evaluation and Research, FDA, "Current good manufacturing practice", U.S. Code of Federal Regulations (CFR) |contribution= ignored (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  16. Homeopathy: Real Medicine or Empty Promises?, FDA |first1= missing |last1= in Authors list (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  17. Plants and fungi in homeopathy Natural History Museum
  18. Morrell P "Calcarea Carbonica - The collector of days and fossils"
  19. Economic reality of homeopathy 2003 Homeopathy Today
  20. Popularity and the market place British Homeopathic Association
  21. Fisher P, Ward A (1994) Complementary medicine in Europe BMJ 309:107-10
  22. 22.0 22.1 "Legal status of traditional medicine and complementary/alternative medicine: A worldwide review" (PDF). World Health Organization. 2001.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  23. British Homeopathic Association
  24. Standards of Practice American Institute of Homeopathy
  25. Homeopathy Cancer Research UK
  26. Amish Hospital and Research Center
  27. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  28. Chernin D (2006) The Complete Homeopathic Resource for Common Illnesses Berkeley: North Atlantic. Cummings S, Ullman D (2004) Everybody's Guide to Homeopathic Medicines New York: Jeremy Tarcher/Putnam
  29. Coined by Marcello Truzzi (On Pseudo-Skepticism Zetetic Scholar 12-13, 1987)
  30. A special issue of Homeopathy 96:141-230 (2007) is dedicated to The Memory of Water. Copies of the articles, with discussion, are available at Homeopathy Journal Club, a blog by Ben Goldacre
  31. Anick DJ, Ives JA (2007) The silica hypothesis for homeopathy: physical chemistry Homeopathy 96:189-95
  32. Calabrese EJ, Baldwin LA (1998) Hormesis as a biological hypothesis Envir Health Persp 106:S1 A 2010 issue of Human and Experimental Toxicology is devoted to this (copies here)
  33. Bell I (2005) All evidence is equal, but some evidence is more equal than others: can logic prevail over emotion in the homeopathy debate? J Alt Comp Med 11:763–9
  34. Van Wassenhoven, M (2008), "Scientific framework of homeopathy: evidence-based homeopathy", Int J High Dilution<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  35. Barnes J et al. (1997) Homeopathy for postoperative ileus? A meta-analysis J Clin Gastroenterol 25:628–33 PMID 9451677
  36. Taylor MA et al. (2000) Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series BMJ 321:471–6 PMID 10948025
  37. Jacobs J et al. (2003) Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials Ped Infect Disease J 22:229–34); these were studies of individualised single homeopathic remedies. Later trials using combinations of the most commonly used single remedies showed no effect, Jacobs et al. (2006) J Alt Complement Med 12:723-32 PMID 17034278
  38. Marian F et al. (2008) Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine BMC Complement Altern Med 8:52 PMID 18801188
  39. Questions and Answers About Homeopathy National Center for Complemenatary and Alternative Medicine
  40. Kleijnen J et al. (1991) Clinical trials of homeopathy BMJ 302:316–23 PMID 1825800
  41. Linde K et al. (1997) Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials? Lancet 350: 834–43 PMID 9310601
  42. Linde K et al. (1999) Impact of study quality on outcome in placebo controlled trials of homeopathy J Clin Epidemiol 52:631–6 PMID 10391656
  43. Cucherat M et al. (2000) Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials Eur J Clin Pharmacol 56:27-33 PMID 10853874
  44. Ernst E (2002). "A systematic review of systematic reviews of homeopathy". Br J Clin Pharmacol. 54: 577–82. PMID 12492603.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  45. The Complementary Medicine Evaluation Programme Programm Evaluation Komplementärmedizin
  46. Shang A et al. (2005) Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy Lancet 366:726–32 PMID 16125589
  47. Editorial. The end of homeopathy Lancet 2005; 366:690 PMID 16125567; Vandenbroucke JP (2005) Homoeopathy and the growth of truth Lancet 366:691–2 PMID 16125568
  48. Open letter to The Lancet from the Swiss Association of Homoeopathic Physicians
  49. Ludtke R, Rutten ALB (2008) The conclusions of the effectiveness of homeopathy highly depend on the set of analyzed trials J Clin Epidemiol 61:1197-204 PMID 18834714
  50. House of Commons Science and Technology Committee, Evidence Check 2: Homeopathy, 2010.
  51. Doctors call for NHS to stop funding homeopathy BBC News
  52. Response to the House of Commons Science and Technology Committee Royal Pharmaceutical Society of Great Britain Nov 2009
  53. Homeopathy will not be banned by NHS despite critical report
  54. AMA Council on Scientific Affairs (June 1997), Alternative theories including homeopathy, Report 12<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  55. NCCAM, "What has scientific research found out about whether homeopathy works?", Questions and Answers About Homeopathy<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  56. Adler, J (4 Feb 2008), "No Way to Treat the Dying", Newsweek<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  57. NHS Direct, "Health Encyclopedia", Homeopathy<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  58. NHS homeopathic treatment British Homeopathic Association
  59. Fall in homeopathy prescriptions hailed as sign of changed attitudes Times 28 July 2008
  60. Homeopathy 'in crisis' as NHS trusts drop services Independent 30 Jan 2008
  61. Malaria advice 'risks lives' BBC
  62. Quoted in Am J Med Sci 40:467
  63. Vaccine drive cuts measles deaths BBC 19 Jan 2007
  64. Harpaz IR et al. (2008) Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices Morbidity and Mortality Weekly Report 57:1-30
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  66. Fisher P; et al. (1994), "Medicine in Europe: complementary medicine in Europe", Brit Med J, 309: 107–11 <templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  67. Indian Ministry of Health and Family Welfare
  68. Prasad R (2007) Homoeopathy booming in India Lancet 370:1679-80
  69. Morrell P (2000) British homeopathy during two centuries
  70. Society of Homeopaths: Independent regulation
  71. Three-month ban for homeopathy GP BBC News January 2003
  72. Alternative cure doctor suspended "for a year after advising a patient to stop heart medication which led to her death. Dr Marisa Viegas, 50, who operated from a private clinic in London, had asked the patient, known as Ms A, to follow only her "homeopathic remedies" BBC News June 2007

Government level reviews

Government-level reviews have been conducted in recent years by Switzerland (2005), the United Kingdom (2009) and Australia (2015).

The Swiss programme for the evaluation of complementary medicine (PEK) resulted in the peer-reviewed Shang publication (see Systematic reviews and meta-analyses of efficacy) and a controversial competing analysis[1] by homeopaths and advocates led by Gudrun Bornhöft and Peter Matthiessen, which has been presented as a Swiss government report by homeopathy proponents, a claim that has been repudiated by the Swiss Federal Office of Public Health.[2] The Swiss Government terminated reimbursement, though it was subsequently reinstated after a political campaign and referendum for a further six-year trial period.[3]

The United Kingdom's House of Commons Science and Technology Committee sought written evidence and submissions from concerned parties[4][5] and, following a review of all submissions, concluded that there was no compelling evidence of effect other than placebo and recommended that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims, that homeopathic products should no longer be licensed by the MHRA, as they are not medicines, and that further clinical trials of homeopathy could not be justified.[6] They recommended that funding of homeopathic hospitals should not continue, and NHS doctors should not refer patients to homeopaths.[7] The Secretary of State for Health deferred to local NHS on funding homeopathy, in the name of patient choice.[8] By February 2011 only one third of primary care trusts still funded homeopathy.[9] By 2012, no British universities offered homeopathy courses.[10]

The Australian National Health and Medical Research Council completed a comprehensive review of the effectiveness of homeopathic preparations in 2015, in which it concluded that "there were no health conditions for which there was reliable evidence that homeopathy was effective. No good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment."[11]

Publication bias and other methodological issues

The fact that individual randomized controlled trials have given positive results is not in contradiction with an overall lack of statistical evidence of efficacy. A small proportion of randomized controlled trials inevitably provide false-positive outcomes due to the play of chance: a "statistically significant" positive outcome is commonly adjudicated when the probability of it being due to chance rather than a real effect is no more than 5%―a level at which about 1 in 20 tests can be expected to show a positive result in the absence of any therapeutic effect.[12] Furthermore, trials of low methodological quality (i.e. ones which have been inappropriately designed, conducted or reported) are prone to give misleading results. In a systematic review of the methodological quality of randomized trials in three branches of alternative medicine, Linde et al. highlighted major weaknesses in the homeopathy sector, including poor randomization.[13] A separate 2001 systematic review that assessed the quality of clinical trials of homeopathy found that such trials were generally of lower quality than trials of conventional medicine.[14]

A related issue is publication bias: researchers are more likely to submit trials that report a positive finding for publication, and journals prefer to publish positive results.[15][16][17][18] Publication bias has been particularly marked in alternative medicine journals, where few of the published articles (just 5% during the year 2000) tend to report null results.[19] Regarding the way in which homeopathy is represented in the medical literature, a systematic review found signs of bias in the publications of clinical trials (towards negative representation in mainstream medical journals, and vice versa in alternative medicine journals), but not in reviews.[20]

Positive results are much more likely to be false if the prior probability of the claim under test is low.[18]

Systematic reviews and meta-analyses of efficacy

Both meta-analyses, which statistically combine the results of several randomized controlled trials, and other systematic reviews of the literature are essential tools to summarize evidence of therapeutic efficacy.[21] Early systematic reviews and meta-analyses of trials evaluating the efficacy of homeopathic preparations in comparison with placebo more often tended to generate positive results, but appeared unconvincing overall.[22] In particular, reports of three large meta-analyses warned readers that firm conclusions could not be reached, largely due to methodological flaws in the primary studies and the difficulty in controlling for publication bias.[23][24][25] The positive finding of one of the most prominent of the early meta-analyses, published in The Lancet in 1997 by Linde et al.,[25] was later reframed by the same research team, who wrote:

The evidence of bias [in the primary studies] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials ... have negative results, and a recent update of our review for the most "original" subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.[26]

Subsequent work by John Ioannidis and others has shown that for treatments with no prior plausibility, the chances of a positive result being a false positive are much higher, and that any result not consistent with the null hypothesis should be assumed to be a false positive.[18][27]

In 2002, a systematic review of the available systematic reviews confirmed that higher-quality trials tended to have less positive results, and found no convincing evidence that any homeopathic preparation exerts clinical effects different from placebo.[28]

In 2005, The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were "compatible with the notion that the clinical effects of homeopathy are placebo effects".[29] This was accompanied by an editorial pronouncing "The end of homoeopathy",[30] which was denounced by the homeopath Peter Fisher.[31]

Other meta-analyses include homeopathic treatments to reduce cancer therapy side-effects following radiotherapy and chemotherapy,[32] allergic rhinitis,[33] attention-deficit hyperactivity disorder and childhood diarrhea, adenoid vegetation, asthma, upper respiratory tract infection in children,[34] insomnia,[35] fibromyalgia,[36] psychiatric conditions[37] and Cochrane Library reviews of homeopathic treatments for asthma,[38] dementia,[39] attention-deficit hyperactivity disorder,[40] induction of labor,[41] and irritable bowel syndrome.[42] Other reviews covered osteoarthritis,[43] migraines[44] delayed-onset muscle soreness,[45] or eczema[46] and other dermatological conditions.[47]

The results of these reviews are generally negative or only weakly positive, and reviewers consistently report the poor quality of trials. The finding of Linde et. al. that more rigorous studies produce less positive results is supported in several and contradicted by none.

Some clinical trials have tested individualized homeopathy, and there have been reviews of this, specifically. A 1998 review[48] found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials. The authors concluded that "the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies." Jay Shelton, author of a book on homeopathy, has stated that the claim assumes without evidence that classical, individualized homeopathy works better than nonclassical variations.[49]:209 A systematic review and meta-analysis of trials of individualised homeopathy published in December 2014 concluded that individualised homeopathy may have small effects, but that caution was needed in interpreting the results because of study quality issues - no study included was assessed as being at low risk of bias.[50]

Statements by major medical organisations

Health organisations such as the UK's National Health Service,[51] the American Medical Association,[52] the FASEB,[53] and the National Health and Medical Research Council of Australia,[54] have issued statements of their conclusion that there is "no good-quality evidence that homeopathy is effective as a treatment for any health condition".[51] In 2009, World Health Organization official Mario Raviglione cricitized the use of homeopathy to treat tuberculosis; similarly, another WHO spokesperson argued there was no evidence homeopathy would be an effective treatment for diarrhea.[55]

The American College of Medical Toxicology and the American Academy of Clinical Toxicology recommend that no one use homeopathic treatment for disease or as a preventive health measure.[56] These organizations report that no evidence exists that homeopathic treatment is effective, but that there is evidence that using these treatments produces harm and can bring indirect health risks by delaying conventional treatment.[56]

Explanations of perceived effects

Science offers a variety of explanations for how homeopathy may appear to cure diseases or alleviate symptoms even though the preparations themselves are inert:[49]:155–167

  • 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.[57]
  • 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 of the timing of the visit to the homeopath they attribute improvement to the preparation taken.
  • Non-homeopathic treatment ― patients may also receive standard medical care at the same time as homeopathic treatment, and the former is responsible for improvement.
  • 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.

Purported effects in other biological systems

Old homeopathic belladonna preparation.

While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain,[58] histamine release by leukocytes,[59] and enzyme reactions, such evidence is disputed since attempts to replicate them have failed.[60][61][62][63][64][65] A 2007 systematic review of high-dilution experiments found that none of the experiments with positive results could be reproduced by all investigators.[66]

In 1987, French immunologist Jacques Benveniste submitted a paper to the journal Nature while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody. The journal editors, skeptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published. Still sceptical of the findings, Nature assembled an independent investigative team to determine the accuracy of the research, consisting of Nature editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic James Randi. After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported."[67][68][69] James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data.[68]

In 2001 and 2004, Madeleine Ennis published a number of studies which reported that homeopathic dilutions of histamine exerted an effect on the activity of basophils.[70][71] In response to the first of these studies, Horizon aired a program in which British scientists attempted to replicate Ennis' results; they were unable to do so.[72]

Ethics and safety

The provision of homeopathic preparations has been described as unethical.[73] Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities at University College London (UCL), has described homoeopathy as a "cruel deception".[74]

Edzard Ernst, the first Professor of Complementary Medicine in the United Kingdom and a former homeopathic practitioner,[75][76][77] has expressed his concerns about pharmacists who violate their ethical code by failing to provide customers with "necessary and relevant information" about the true nature of the homeopathic products they advertise and sell:

"My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous."[78]

Patients who choose to use homeopathy rather than evidence-based medicine risk missing timely diagnosis and effective treatment of serious conditions such as cancer.[34][79]

In 2013 the UK Advertising Standards Authority concluded that the Society of Homeopaths were targeting vulnerable ill people and discouraging the use of essential medical treatment while making misleading claims of efficacy for homeopathic products.[80]

Adverse reactions

Some homeopathic preparations involve poisons such as Belladonna, arsenic, and poison ivy which are highly diluted in the homeopathic preparation. Only in rare cases are the original ingredients present at detectable levels. This may be due to improper preparation or intentional low dilution. Serious adverse effects such as seizures and death have been reported or associated with some homeopathic preparations.[81][82] Instances of arsenic poisoning have occurred after use of arsenic-containing homeopathic preparations.[83] Zicam Cold remedy Nasal Gel, which contains 2X (1:100) zinc gluconate, reportedly caused a small percentage of users to lose their sense of smell;[84] 340 cases were settled out of court in 2006 for 12 million U.S. dollars.[85] In 2009, the FDA advised consumers to stop using three discontinued cold remedy Zicam products because it could cause permanent damage to users' sense of smell.[86] Zicam was launched without a New Drug Application (NDA) under a provision in the FDA's Compliance Policy Guide called "Conditions Under Which Homeopathic Drugs May be Marketed" (CPG 7132.15), but the FDA warned Matrixx Initiatives, its manufacture, via a Warning Letter that this policy does not apply when there is a health risk to consumers.[87]

A 2000 review reported that homeopathic preparations are "unlikely to provoke severe adverse reactions".[88] In 2012, a systematic review evaluating evidence of homeopathy's possible adverse effects concluded that "homeopathy has the potential to harm patients and consumers in both direct and indirect ways".[81] One of the reviewers, Edzard Ernst, supplemented the article on his blog, writing: "I have said it often and I say it again: if used as an alternative to an effective cure, even the most 'harmless' treatment can become life-threatening."[89]

Lack of efficacy

The lack of convincing scientific evidence supporting its efficacy[90] and its use of preparations without active ingredients have led to characterizations as pseudoscience and quackery,[91][92][93][94] or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst".[95] The Chief Medical Officer for England, Dame Sally Davies, has stated that homeopathic preparations are "rubbish" and do not serve as anything more than placebos.[96] Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy "goes beyond current understanding of chemistry and physics". He adds: "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment."[90] Ben Goldacre says that homeopaths who misrepresent scientific evidence to a scientifically illiterate public, have "...walled themselves off from academic medicine, and critique has been all too often met with avoidance rather than argument".[19] Homeopaths often prefer to ignore meta-analyses in favour of cherry picked positive results, such as by promoting a particular observational study (one which Goldacre describes as "little more than a customer-satisfaction survey") as if it were more informative than a series of randomized controlled trials.[19]

Referring specifically to homeopathy, the British House of Commons Science and Technology Committee has stated:

In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. The Government shares our interpretation of the evidence.[97]

In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice - which the Government claims is very important - as it means patients do not have all the information needed to make choice meaningful.

Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS.[6]

The National Center for Complementary and Alternative Medicine of the United States' National Institutes of Health states:

Homeopathy is a controversial topic in complementary medicine research. A number of the key concepts of homeopathy are not consistent with fundamental concepts of chemistry and physics. For example, it is not possible to explain in scientific terms how a preparation containing little or no active ingredient can have any effect. This, in turn, creates major challenges to rigorous clinical investigation of homeopathic preparations. For example, one cannot confirm that an extremely dilute preparation contains what is listed on the label, or develop objective measures that show effects of extremely dilute preparations in the human body.[98]

Ben Goldacre noted that in the early days of homeopathy, when medicine was dogmatic and frequently worse than doing nothing, homeopathy at least failed to make matters worse:

During the 19th-century cholera epidemic, death rates at the London Homeopathic Hospital were three times lower than at the Middlesex Hospital. Homeopathic sugar pills won't do anything against cholera, of course, but the reason for homeopathy's success in this epidemic is even more interesting than the placebo effect: at the time, nobody could treat cholera. So, while hideous medical treatments such as blood-letting were actively harmful, the homeopaths' treatments at least did nothing either way.[99]

In lieu of standard medical treatment

On clinical grounds, patients who choose to use homeopathy in preference to normal medicine risk missing timely diagnosis and effective treatment, thereby worsening the outcomes of serious conditions.[34][79][100][101] Critics of homeopathy have cited individual cases of patients of homeopathy failing to receive proper treatment for diseases that could have been easily diagnosed and managed with conventional medicine and who have died as a result[102][103] and the "marketing practice" of criticizing and downplaying the effectiveness of mainstream medicine.[19][103] Homeopaths claim that use of conventional medicines will "push the disease deeper" and cause more serious conditions, a process referred to as "suppression".[104] Some homeopaths (particularly those who are non-physicians) advise their patients against immunisation.[100][105][106] Some homeopaths suggest that vaccines be replaced with homeopathic "nosodes", created from biological materials such as pus, diseased tissue, bacilli from sputum or (in the case of "bowel nosodes") feces.[107] While Hahnemann was opposed to such preparations, modern homeopaths often use them although there is no evidence to indicate they have any beneficial effects.[108][109] Cases of homeopaths advising against the use of anti-malarial drugs have been identified.[101][110][111] This puts visitors to the tropics who take this advice in severe danger, since homeopathic preparations are completely ineffective against the malaria parasite.[101][110][111][112] Also, in one case in 2004, a homeopath instructed one of her patients to stop taking conventional medication for a heart condition, advising her on 22 June 2004 to "Stop ALL medications including homeopathic", advising her on or around 20 August that she no longer needed to take her heart medication, and adding on 23 August, "She just cannot take ANY drugs – I have suggested some homeopathic remedies ... I feel confident that if she follows the advice she will regain her health." The patient was admitted to hospital the next day, and died eight days later, the final diagnosis being "acute heart failure due to treatment discontinuation".[113][114]

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, saying that "The unfortunate layman might well be misled by Vithoulkas' rhetoric into refusing orthodox treatment".[115] Vithoulkas' claims echo the idea that treating a disease with external medication used to treat the symptoms would only drive it deeper into the body and conflict with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases.[116]

A 2006 review by W. Steven Pray of the College of Pharmacy at Southwestern Oklahoma State University recommends that pharmacy colleges include a required course in unproven medications and therapies, that ethical dilemmas inherent in recommending products lacking proven safety and efficacy data be discussed, and that students should be taught where unproven systems such as homeopathy depart from evidence-based medicine.[117]

In an article entitled "Should We Maintain an Open Mind about Homeopathy?"[118] published in the American Journal of Medicine, Michael Baum and Edzard Ernst – writing to other physicians – wrote that "Homeopathy is among the worst examples of faith-based medicine... These axioms [of homeopathy] are not only out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics, chemistry, and pharmacology must be incorrect...".

In 2013, Sir Mark Walport, the new UK Government Chief Scientific Adviser and head of the Government Office for Science, had this to say about homeopathy: "My view scientifically is absolutely clear: homoeopathy is nonsense, it is non-science. My advice to ministers is clear: that there is no science in homoeopathy. The most it can have is a placebo effect – it is then a political decision whether they spend money on it or not."[119] His predecessor, Professor Sir John Beddington, referring to his views on homeopathy being "fundamentally ignored" by the Government, said: "The only one [view being ignored] I could think of was homoeopathy, which is mad. It has no underpinning of scientific basis. In fact all the science points to the fact that it is not at all sensible. The clear evidence is saying this is wrong, but homoeopathy is still used on the NHS."[120]

Regulation and prevalence

Hampton House, the former site of Bristol Homeopathic Hospital,one of three Homeopathic Hospitals in NHS.[6]

Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others. It is practised worldwide and professional qualifications and licences are needed in most countries.[121] In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licences or degrees in conventional medicine from accredited universities are required. In Germany, to become a homeopathic physician, one must attend a three-year training program, while France, Austria and Denmark mandate licences to diagnose any illness or dispense of any product whose purpose is to treat any illness.[121]

Some homeopathic treatment is covered by the public health service of several European countries, including France, the United Kingdom and Luxembourg. In other countries, such as Belgium, homeopathy is not covered. In Austria, the public health service requires scientific proof of effectiveness in order to reimburse medical treatments and homeopathy is listed as not reimbursable,[122] but exceptions can be made;[123] private health insurance policies sometimes include homeopathic treatment.[121] The Swiss government, after a 5-year trial, withdrew coverage of homeopathy and four other complementary treatments in 2005, stating that they did not meet efficacy and cost-effectiveness criteria,[30] but following a referendum in 2009 the five therapies have been reinstated for a further 6-year trial period from 2012.[124]

Homeopathics at a homeopathic pharmacy in Varanasi, India.

The Indian government recognises homeopathy as one of its national systems of medicine;[125] it has established AYUSH or the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy under the Ministry of Health & Family Welfare.[126] The south Indian state of Kerala also gives the final nod for AYUSH department where homeopathy and Ayurveda are the main streams along with Sidha, Unani and Yoga.[127] The Central Council of Homoeopathy was established in 1973 to monitor higher education in homeopathy, and National Institute of Homoeopathy in 1975.[128] A minimum of a recognised diploma in homeopathy and registration on a state register or the Central Register of Homoeopathy is required to practice homeopathy in India.[129]

Public opposition

In the April 1997 edition of FDA Consumer, William T. Jarvis, the President of the National Council Against Health Fraud said "Homeopathy is a fraud perpetrated on the public with the government's blessing, thanks to the abuse of political power of Sen. Royal S. Copeland [chief sponsor of the 1938 Food, Drug, and Cosmetic Act]."[130]

Mock "overdosing" on homeopathic preparations by individuals or groups in "mass suicides" have become more popular since James Randi began taking entire bottles of homeopathic sleeping pills before giving lectures.[131][132][133][134] In 2010 The Merseyside Skeptics Society from the United Kingdom launched the 10:23 campaign encouraging groups to publicly overdose as groups. In 2011 the 10:23 campaign expanded and saw sixty-nine groups participate, fifty-four submitted videos.[135] In April 2012, at the Berkeley SkeptiCal conference, over 100 people participated in a mass overdose, taking coffea cruda which is supposed to treat sleeplessness.[136][137]

In 2011, the non-profit, educational organizations Center for Inquiry (CFI) and the associated Committee for Skeptical Inquiry (CSI) have petitioned the U.S. Food and Drug Administration (FDA) to initiate 'rulemaking that would require all over-the-counter homeopathic drugs to meet the same standards of effectiveness as non-homeopathic drugs' and 'to place warning labels on homeopathic drugs until such time as they are shown to be effective'. In a separate petition, CFI and CSI request FDA to issue warning letters to Boiron, maker of Oscillococcinum, regarding their marketing tactic and criticize Boiron for misleading labeling and advertising of Oscillococcinum.[138] CFI in Canada is calling for persons that feel they were harmed by homeopathic products to contact them.[139]

In August 2011, a class action lawsuit was filed against Boiron on behalf of "all California residents who purchased Oscillo at any time within the past four years".[140] The lawsuit charged that it "is nothing more than a sugar pill", "despite falsely advertising that it contains an active ingredient known to treat flu symptoms".[141] In March 2012, Bioron agreed to spend up to $12 million to settle the claims of falsely advertising the benefits of its homeopathic preparations.[142]

In July 2012, CBC News reporter Erica Johnson for Marketplace conducted an investigation on the homeopathy industry in Canada; her findings were that it is "based on flawed science and some loopy thinking". Center for Inquiry (CFI) Vancouver skeptics participated in a mass overdose outside an emergency room in Vancouver, B.C., taking entire bottles of "medications" that should have made them sleepy, nauseous or dead, after 45 minutes of observation no ill effects were felt. Johnson asked homeopaths and company representatives about cures for cancer and vaccine claims. All reported positive results but none could offer any science backing up their statements, only that "it works". Johnson was unable to find any evidence that homeopathic preparations contain any active ingredient. Analysis performed at the University of Toronto's chemistry department found that the active ingredient is so small "it is equivalent to 5 billion times less than the amount of aspirin... in a single pellet". Belladonna and ipecac "would be indistinguishable from each other in a blind test".[143][144]

Following a threat of legal action by the Good Thinking Society campaign group, the British government has stated that the Department of Health will hold a consultation in 2016 regarding whether homeopathic treatments should be added to the NHS treatments blacklist (officially, Schedule 1 of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004), that specifies a blacklist of medicines not to be prescribed under the NHS.[145][146][147]

United States Food and Drug Administration (FDA) 2015 hearing

On April 20–21, 2015, the FDA held a hearing on homeopathic product regulation. Invitees representing the scientific and medical community, and various pro-homeopathy stakeholders, gave testimonials on homeopathic products and the regulatory role played by the FDA.[148] Michael de Dora, a representative from the Center for Inquiry (CFI), on behalf of the organization and dozens of doctors and scientists associated with CFI and the Committee for Skeptical Inquiry (CSI) gave a testimonial which summarized the basis of the organization's objection to homeopathic products, the harm done to the general public and proposed regulatory actions:[149]

The CFI testimonial stated that the principle of homeopathy is at complete odds with the basic principle of modern biology, chemistry and physics and that decades of scientific examination of homeopathic products shows that there is no evidence that it is effective in treating illnesses other than acting as a placebo. Further, it noted a 2012 report by the American Association of Poison Control Centers which listed 10,311 reported cases of poison exposure related to homeopathic agents, among which 8,788 cases were attributed to young children five years of age or younger,[150] as well as examples of harm - including deaths - caused to patients who relied on homeopathics instead of proven medical treatment.[149][151]

The CFI urged the FDA to announce and implement strict guidelines that 'require all homeopathic products meet the same standards as non-homeopathic drugs', arguing that the consumers can only have true freedom of choice (an often used argument from the homeopathy proponents) if they are fully informed on the choices. CFI proposed that the FDA take these three steps:

  1. Testing for homeopathic products The FDA will mandate that all homeopathic products on the market to perform and pass safety and efficacy tests equivalent to those required of non-homeopathic drugs.
  2. Labeling for homeopathic products To avert misleading label that the product is regulated by the FDA, all homeopathic products will be required to have prominent labels stating: 1) the products claimed active ingredients in plain English, and 2) the product has not been evaluated by the FDA for either safety or effectiveness.
  3. Regular consumer warnings Encouraged by the FDA's recent warning of the ineffectiveness of homeopathic products, CFI urged the FDA to issue regular warning to the consumers in addition to warning during public health crises and outbreaks.[149]

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