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Overview of Homeopathy

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Homeopathy was invented by Samuel Christian Hahnemann (1755-1843), a German physician who had become dissatisfied with the medicine of his day. Hahnemann lived in a time before the rudiments of modern medicine had been developed, before the germ theory of infectious disease, before the first antibiotic, before systematic testing of drugs for safety and efficacy, before surgical procedures were performed with anesthesia or sterile technique.

For many years Hahnemann’s search was unsuccessful, until he stumbled upon what he thought was an amazing observation: he took a small amount of cinchona bark, which contains quinine, the drug used to treat malaria, and developed the symptoms of malaria. From this observation he developed homeopathy’s first law, “similia similibus curentur,” or let likes be cured by likes. In other words, drugs which cause specific symptoms can be used to cure diseases which cause the same symptoms.

As homeopathy evolved, other “laws” were also discovered. The law of infinitesimal doses was actually a late development by Hahnemann, but today is often thought of as the primary characteristic of homeopathy. This law states that when drugs are diluted in either water or alcohol, they actually increase in therapeutic potency. Today, serial dilutions of 1:100 repeated 6 or 30 times are commonly used. Between each dilution the substance is violently shaken, which is thought to be necessary to activate the properties of the drug.

Hahnemann also developed, as the underpinning of homeopathy, his own theory of disease, called the miasm theory. According to this theory there are three miasms which are responsible for all human disease, and homeopathic remedies are directed towards treating these offending miasms.

The goal of a homeopathic consultation is to find the “totality of symptoms,” physical, mental, and spiritual. They accomplish this goal by taking a “homeopathic history” which includes questions such as: do you feel sad when you hear piano music, are you excessively tidy, or do you have a chilly personality? This information is combined with the patient’s symptoms and their physical “constitution,” which may depend on such facts as hair color. The homeopath then decides on what single remedy will treat the patient’s “totality.” The remedy is then prescribed, and is usually given in either a single dose or only a few doses.

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The principles of homeopathy run contrary to modern science and have never been empirically established.

Homeopathic “provings” are a method of establishing what a homeopathic remedy contains and how diluted it should be. It is a sort of “in-house” scientific method, and a poor one: provings contains no controls for bias or any method for separating the ordinary experiences of daily life from true symptoms caused by the substance being tested. Many of the provings used to guide homeopathic treatment today were conducted by Samuel Hahneman himself. Subsequent efforts to demonstrate consistency or reproducibility of homeopathic provings have been unsuccessful.

The so-called law of similars, for example, is little more than an ancient and common superstition known as sympathetic magic — that things have an essence or essential quality that can be transferred. There is no scientific knowledge about biology or chemistry to support the notion that a small dose of a drug or substance will necessarily cause the symptoms it treats at higher doses.

Modern homeopaths have tried to justify the law of similars by comparing it to the effectiveness of vaccines — which involve giving small doses of an infectious pathogen to prevent a later infection. However, this analogy is not apt. Vaccines involve measurable doses of attenuated or killed organisms or their proteins, and operate by a known mechanism — they trigger an immune response. There is no analogy to homeopathic treatments.

The law of  infinitesimal doses also runs contrary to chemistry, pharmacology, and thermodynamics. Homeopaths today use dilutions of substances which essentially remove all traces of the substance from the final dilution. There is not likely to be even a single molecule of the original drug in the final remedy which is given to the patient. Homeopaths conclude from this fact that the substance is transferring its essence to the water into which it is diluted. The more it is diluted, the more potent is the water. They offer, however, no possible explanation for how simple water molecules can contain the essence of far more complex substances.

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Modern homeopaths have also tried to rescue the notion of infinitessimals by invoking the concept of water memory. They claim that water molecules can form a structure that contains the information of the homeopathic remedy. However, such claims are fanciful to the point of invoking magic and are devoid of any evidence. Water structure is very transient and ephemeral. They last moments and could not survive repeated dilution, let alone ingestion, absorption into the body, and transport to whatever their alleged site of action is.

Other theories for how ultradilute remedies could have biological effects include the effects of nanoparticles supposedly detected in homeopathic solutions. However, the experiments purporting to identify these particles have been poorly conducted and subject to contamination and other sources of error, and only proponents of homeopathy believe this theory to have any substance. Similarly, homeopaths sometimes refer to the strange and counterintuitive theories of quantum mechanics as validating the implausible foundations of homeopathy. Unlike the “laws” of homeopathy, however, the fundamental theories of quantum physics have been demonstrated scientifically. The fact that some strange ideas have turned out to be true does not validate the theories of homeopathy, which have failed to produce convincing experimental evidence for 150 years.

Hahnemann developed his ideas before the disease theory of illness was fully developed. In other words, during his time physicians did not yet understand that illnesses were caused by specific diseases; that a given disease, such as diabetes, has a common underlying pathophysiology — a specific malfunction of a specific tissue, organ, or organ system leading to a specific disorder with recognizable signs and symptoms. This modern theory of illness has lead, for instance, to the treatment of diabetes with insulin replacement, vastly improving the quality and duration of life of patients suffering from this disease.

At this point many defenders of homeopathy would argue, “Who cares how it works, as long as it works.” There is a kernel of legitimacy to this argument (although it does not save homeopathy from being a pseudoscience) in that even in conventional medicine, treatments are often used before their mechanism of action is fully understood. There is a difference, however, between not fully understanding a mechanism and, as with homeopathy, violating basic laws of physics.  In such cases it is necessary to demonstrate using carefully controlled clinical trials that such treatments do in fact work.

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There has been mixed results from clinical studies of homeopathy, but a clear trend when all the evidence is reviewed — the better designed the study the less likely there is to be any effect, and the best designed studies are negative. Homeopathy, it turns out, is no more effective than placebo (an inactive treatment).

Therefore, according to everything we currently understand about biology, chemistry, and physics homeopathy is highly implausible and should not work. And, when we carefully study homeopathic remedies they in fact do not work.

Given that most homeopathic remedies contain little if any actual ingredients beyond water and sometimes sugar, it is unlikely that any direct harm could come from taking them. Improper preparation of remedies made from toxic or infectious material could pose some risk, and there have been reports of toxic contamination of homeopathic products.

However, the most significant risk of homeopathy is that it often delays the use of accurate scientific diagnosis and truly effective medical treatment. Unnecessary injury, disability, and even death can result from the delusion that homeopathy is an effective treatment for any medical condition.

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