Homeopathy ("home-ee-AH-pah-thy"), also known as homeopathic
medicine, is a form of health care that developed in Germany and has
been practiced in the United States since the early 19th century.
Homeopathic practitioners are commonly called homeopaths. This fact
sheet answers some frequently asked questions on homeopathy and reviews
scientific research on its use and effectiveness.
Key Points
In homeopathy, a key premise is that every person has energy
called a vital force or self-healing response. When this energy is
disrupted or imbalanced, health problems develop. Homeopathy aims to
stimulate the body's own healing responses.
Homeopathic
treatment involves giving extremely small doses of substances that
produce characteristic symptoms of illness in healthy people when given
in larger doses. This approach is called "like cures like."
Various
explanations have been proposed as to how homeopathy might work.
However, none of these explanations has been scientifically verified.
Research
studies on homeopathy have been contradictory in their findings. Some
analyses have concluded that there is no strong evidence supporting
homeopathy as effective for any clinical condition. However, others
have found positive effects from homeopathy. The positive effects are
not readily explained in scientific terms.
It is
important to inform all of your health care providers about any therapy
that you are currently using or considering, including homeopathic
treatment. This is to help ensure a safe and coordinated course of
care.
The term homeopathy comes from the Greek words homeo, meaning similar, and pathos,
meaning suffering or disease. Homeopathy is an alternative medical
system. Alternative medical systems are built upon complete systems of
theory and practice, and often have evolved apart from and earlier than
the conventional medical approach used in the United States.a Homeopathy takes a different approach from conventional medicine in diagnosing, classifying, and treating medical problems.
Key concepts of homeopathy include:
Homeopathy seeks to stimulate the body's defense mechanisms and processes so as to prevent or treat illness.
Treatment involves giving very small doses of
substances called remedies that, according to homeopathy, would produce
the same or similar symptoms of illness in healthy people if they were
given in larger doses.
Treatment in homeopathy is individualized (tailored to
each person). Homeopathic practitioners select remedies according to a
total picture of the patient, including not only symptoms but
lifestyle, emotional and mental states, and other factors.
a. Conventional medicine, as
defined by NCCAM, is medicine as practiced by holders of M.D. (medical
doctor) or D.O. (doctor of osteopathy) degrees and by their allied
health professionals, such as physical therapists, psychologists, and
registered nurses. Some conventional medical practitioners are also
practitioners of complementary and alternative medicine. To find out
more about these terms, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine?"
2. What is the history of the discovery and use of homeopathy?b
In the late 1700s, Samuel Hahnemann, a physician, chemist, and
linguist in Germany, proposed a new approach to treating illness. This
was at a time when the most common medical treatments were harsh, such
as bloodletting,c purging, blistering, and
the use of sulfur and mercury. At the time, there were few effective
medications for treating patients, and knowledge about their effects
was limited.
Hahnemann was interested in developing a less-threatening approach
to medicine. The first major step reportedly was when he was
translating an herbal text and read about a treatment (cinchona bark)
used to cure malaria. He took some cinchona bark and observed that, as
a healthy person, he developed symptoms that were very similar to
malaria symptoms. This led Hahnemann to consider that a substance may
create symptoms that it can also relieve. This concept is called the
"similia principle" or "like cures like." The similia principle had a
prior history in medicine, from Hippocrates in Ancient Greece--who
noted, for example, that recurrent vomiting could be treated with an
emetic (such as ipecacuanha) that would be expected to make it
worse--to folk medicine.14,15
Another way to view "like cures like" is that symptoms are part of the
body's attempt to heal itself--for example, a fever can develop as a
result of an immune response to an infection, and a cough may help to
eliminate mucus--and medication may be given to support this
self-healing response.
Hahnemann tested single, pure substances on himself and, in more
dilute forms, on healthy volunteers. He kept meticulous records of his
experiments and participants' responses, and he combined these
observations with information from clinical practice, the known uses of
herbs and other medicinal substances, and toxicology,d eventually treating the sick and developing homeopathic clinical practice.
Hahnemann added two additional elements to homeopathy:
A concept that became "potentization," which holds that
systematically diluting a substance, with vigorous shaking at each step
of dilution, makes the remedy more, not less, effective by extracting
the vital essence of the substance. If dilution continues to a point
where the substance's molecules are gone, homeopathy holds that the
"memory" of them--that is, the effects they exerted on the surrounding
water molecules--may still be therapeutic.
A
concept that treatment should be selected based upon a total picture of
an individual and his symptoms, not solely upon symptoms of a disease.
Homeopaths evaluate not only a person's physical symptoms but her
emotions, mental states, lifestyle, nutrition, and other aspects. In
homeopathy, different people with the same symptoms may receive
different homeopathic remedies.
Hans Burch Gram, a Boston-born doctor, studied homeopathy in Europe
and introduced it into the United States in 1825. European immigrants
trained in homeopathy also made the treatment increasingly available in
America. In 1835, the first homeopathic medical college was established
in Allentown, Pennsylvania. By the turn of the 20th century, 8 percent
of all American medical practitioners were homeopaths, and there were
20 homeopathic medical colleges and more than 100 homeopathic hospitals
in the United States.
In the late 19th and early 20th centuries, numerous medical advances
were made, such as the recognition of the mechanisms of disease;
Pasteur's germ theory; the development of antiseptic techniques; and
the discovery of ether anesthesia. In addition, a report (the so-called
"Flexner Report") was released that triggered major changes in American
medical education. Homeopathy was among the disciplines negatively
affected by these developments. Most homeopathic medical schools closed
down, and by the 1930s others had converted to conventional medical
schools.
In the 1960s, homeopathy's popularity began to revive in the United
States. According to a 1999 survey of Americans and their health, over
6 million Americans had used homeopathy in the preceding 12 months.16
The World Health Organization noted in 1994 that homeopathy had been
integrated into the national health care systems of numerous countries,
including Germany, the United Kingdom, India, Pakistan, Sri Lanka, and
Mexico.7 Several schools of practice exist within homeopathy.17
Persons using homeopathy do so to address a range of health
concerns, from wellness and prevention to treatment of injuries,
diseases, and conditions. Studies have found that many people who seek
homeopathic care seek it for help with a chronic medical condition.18,19,20 Many users of homeopathy treat themselves with homeopathic products and do not consult a professional.13
b. Items 1-13 in the references served as general sources for this historical discussion.
c. Bloodletting was a healing
practice used for many centuries. In bloodletting, incisions were made
in the body to drain a quantity of blood, in the belief that this would
help drain out the "bad blood" or sickness.
d. Toxicology is the science of the effects of chemicals on human health.
3. What kind of training do homeopathic practitioners receive?
In European countries, training in homeopathy is usually pursued
either as a primary professional degree completed over 3 to 6 years or
as postgraduate training for doctors.14
In the United States, training in homeopathy is offered through
diploma programs, certificate programs, short courses, and
correspondence courses. Also, homeopathic training is part of medical
education in naturopathy.e Most homeopathy
in the United States is practiced along with another health care
practice for which the practitioner is licensed, such as conventional
medicine, naturopathy, chiropractic, dentistry, acupuncture, or
veterinary medicine (homeopathy is used to treat animals).
Laws about what is required to practice homeopathy vary among
states. Three states (Connecticut, Arizona, and Nevada) license medical
doctors specifically for homeopathy.
e. Naturopathy, also known as
naturopathic medicine, is an alternative medical system that emphasizes
natural healing approaches (such as herbs, nutrition, and movement or
manipulation of the body). Some elements of naturopathy are similar to
homeopathy, such as an intent to support the body's own self-healing
response.
4. What do homeopathic practitioners do in treating patients?
Typically, in homeopathy, patients have a lengthy first visit,
during which the provider takes an in-depth assessment of the patient.
This is used to guide the selection of one or more homeopathic
remedies. During followup visits, patients report how they are
responding to the remedy or remedies, which helps the practitioner make
decisions about further treatment.
Most homeopathic remedies are derived from natural substances that
come from plants, minerals, or animals. A remedy is prepared by
diluting the substance in a series of steps (as discussed in Question 2).
Homeopathy asserts that this process can maintain a substance's healing
properties regardless of how many times it has been diluted. Many
homeopathic remedies are so highly diluted that not one molecule of the
original natural substance remains.12,21 Remedies are sold in liquid, pellet, and tablet forms.
6. How does the U.S. Food and Drug Administration (FDA) regulate homeopathic remedies?
Because of their long use in the United States, the U.S. Congress
passed a law in 1938 declaring that homeopathic remedies are to be
regulated by the FDA in the same manner as nonprescription,
over-the-counter (OTC) drugs, which means that they can be purchased
without a physician's prescription. Today, although conventional
prescription drugs and new OTC drugs must undergo thorough testing and
review by the FDA for safety and effectiveness before they can be sold,
this requirement does not apply to homeopathic remedies.
Remedies are required to meet certain legal standards for strength,
quality, purity, and packaging. In 1988, the FDA required that all
homeopathic remedies list the indications for their use (i.e., the
medical problems to be treated) on the label.22,23 The FDA also requires the label to list ingredients, dilutions, and instructions for safe use.
The guidelines for homeopathic remedies are found in an official guide, the Homeopathic Pharmacopoeia of the United States, which is authored by a nongovernmental, nonprofit organization of industry representatives and homeopathic experts.24 The Pharmacopoeia
also includes provisions for testing new remedies and verifying their
clinical effectiveness. Remedies on the market before 1962 have been
accepted into the Homeopathic Pharmacopoeia of the United States based on historical use, rather than scientific evidence from clinical trials.
7. Have any side effects or complications been reported from the use of homeopathy?
The FDA has learned of a few reports of illness associated with the
use of homeopathic remedies. However, the FDA reviewed these reports
and decided that the remedies were not likely to be the cause, because
of the high dilutions.3
Here is some general information that has been reported about risks and side effects in homeopathy:
Homeopathic medicines in high dilutions, taken under the
supervision of trained professionals, are considered safe and unlikely
to cause severe adverse reactions.25
Some
patients report feeling worse for a brief period of time after starting
homeopathic remedies. Homeopaths interpret this as the body temporarily
stimulating symptoms while it makes an effort to restore health.
Liquid
homeopathic remedies can contain alcohol and are permitted to have
higher levels of alcohol than conventional drugs for adults. This may
be of concern to some consumers. However, no adverse effects from the
alcohol levels have been reported either to the FDA or in the
scientific literature.3
Homeopathic
remedies are not known to interfere with conventional drugs; however,
if you are considering using homeopathic remedies, you should discuss
this with your health care provider. If you have more than one
provider, discuss it with each one.
As with all medicinal products, a person taking a homeopathic remedy is best advised to:
Contact his health care provider if his symptoms continue unimproved for more than 5 days.
Keep the remedy out of the reach of children.
Consult a health care provider before using the product if the user is a woman who is pregnant or nursing a baby.
8. What has scientific research found out about whether homeopathy works?
This section summarizes results from (1) individual clinical trials
(research studies in people) and (2) broad analyses of groups of
clinical trials.
The results of individual, controlled clinical trials of homeopathy
have been contradictory. In some trials, homeopathy appeared to be no
more helpful than a placebo; in other studies, some benefits were seen
that the researchers believed were greater than one would expect from a
placebo.fAppendix I details findings from clinical trials.
Systematic reviews and meta-analyses take a broader look at collections of a set of results from clinical trials.g Recent examples of these types of analyses are detailed in Appendix II.
In sum, systematic reviews have not found homeopathy to be a
definitively proven treatment for any medical condition. Two groups of
authors listed in Appendix II found some positive
evidence in the groups of studies they examined, and they did not find
this evidence to be explainable completely as placebo effects (a third
group found 1 out of 16 trials to have some added effect relative to
placebo). Each author or group of authors criticized the quality of
evidence in the studies. Examples of problems they noted include
weaknesses in design and/or reporting, choice of measuring techniques,
small numbers of participants, and difficulties in replicating results.
A common theme in the reviews of homeopathy trials is that because of
these problems and others, it is difficult or impossible to draw firm
conclusions about whether homeopathy is effective for any single
clinical condition.
f. A placebo is designed to
resemble as much as possible the treatment being studied in a clinical
trial, except that the placebo is inactive. An example of a placebo is
a pill containing sugar instead of the drug or other substance being
studied. By giving one group of participants a placebo and the other
group the active treatment, the researchers can compare how the two
groups respond and get a truer picture of the active treatment's
effects. In recent years, the definition of placebo has been expanded
to include other things that could have an effect on the results of
health care, such as how a patient and a health care provider interact,
how a patient feels about receiving the care, and what he or she
expects to happen from the care.
g. In a systematic review, data
from a set of studies on a particular question or topic are collected,
analyzed, and critically reviewed. A meta-analysis uses statistical
techniques to analyze results from individual studies.
9. Are there scientific controversies associated with homeopathy?
Yes. Homeopathy is an area of complementary and alternative medicine
(CAM) that has seen high levels of controversy and debate, largely
because a number of its key concepts do not follow the laws of science
(particularly chemistry and physics).
It is debated how something that causes illness might also cure it.
It
has been questioned whether a remedy with a very tiny amount (perhaps
not even one molecule) of active ingredient could have a biological
effect, beneficial or otherwise.
There have been some research studies published on the use of
ultra-high dilutions (UHDs) of substances, diluted to levels compatible
with those in homeopathy and shaken hard at each step of dilution.h
The results are claimed to involve phenomena at the molecular level and
beyond, such as the structure of water, and waves and fields. Both
laboratory research and clinical trials have been published. There have
been mixed results in attempts to replicate them. Reviews have not
found UHD results to be definitive or compelling.i
There have been some studies that found effects of UHDs on isolated organs, plants, and animals.15 There have been controversy and debate about these findings as well.
Effects in homeopathy might be due to the placebo or other non-specific effect.
There
are key questions about homeopathy that are yet to be subjected to
studies that are well-designed--such as whether it actually works for
some of the diseases or medical conditions for which it is used, and if
so, how it might work.
There is a point of view
that homeopathy does work, but that modern scientific methods have not
yet explained why. The failure of science to provide full explanations
for all treatments is not unique to homeopathy.
Some
people feel that if homeopathy appears to be helpful and safe, then
scientifically valid explanations or proofs of this alternative system
of medicine are not necessary.
Yes, NCCAM supports a number of studies in this area. For example:
Homeopathy for physical, mental, and emotional symptoms of
fibromyalgia (a chronic disorder involving widespread musculoskeletal
pain, multiple tender points on the body, and fatigue).
Homeopathy for brain deterioration and damage in animal models for stroke and dementia.
The
homeopathic remedy cadmium, to find out whether it can prevent damage
to the cells of the prostate when those cells are exposed to toxins.
The NCCAM Clearinghouse provides information on CAM and on NCCAM.
Services include fact sheets, other publications, and searches of
Federal databases of scientific and medical literature. The
Clearinghouse does not provide medical advice, treatment
recommendations, or referrals to practitioners.
CAM on PubMed, a database on the Internet developed jointly by NCCAM
and the National Library of Medicine, offers citations to (and in most
cases, brief summaries of) articles on CAM in scientifically based,
peer-reviewed journals . CAM on PubMed also links to many publisher Web
sites, which may offer the full text of articles.
FDA's mission is to promote and protect the public health by helping
safe and effective products to reach the market in a timely way, and
monitoring them for safety after they are in use. On homeopathy, see
especially a 1996 article from FDA Consumer magazine at www.fda.gov/fdac/features/096_home.html.
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Lewith,
G.T., Watkins, A.D., Hyland, M.E., Shaw, S., Broomfield, J.A., Dolan,
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Treat Asthmatic People Allergic to House Dust Mite: Double Blind
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Bell,
I.R., Lewis, D.A., Brooks, A.J., Lewis, S.E., and Schwartz, G.E. "Gas
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Seven
trials were included in the review (three prevention and four treatment
trials); only two studies had sufficient information for complete data
extraction.
The homeopathic remedy oscillococcinum appears safe and effective in reducing the duration of influenza, but has no effect on prevention.
Randomized, double-blinded, placebo-controlled trial of 242 participants aged 18 to 55 years.
Trial compared an oral homeopathic treatment to placebo in asthmatic people allergic to house dust.
Authors found the homeopathic treatment "no better than placebo." They
noted "some differences between the homeopathic immunotherapy and
placebo for which we have no explanation."
Randomized, double-blinded, placebo-controlled trial in 32 children; 30 completed the study.
Traumeel S, a homeopathic skin cream, may significantly reduce the severity and length of pain and inflammation of the tissues lining the inside of the mouth from chemotherapy in children being treated with bone marrow transplantation.
Randomized, double-blinded, placebo-controlled trial of 51 participants aged 17 years or older (50 completed the study).
Team
tested the hypothesis that homeopathy is a placebo by examining effects
of an oral homeopathic preparation in patients with perennial allergic rhinitis.
They found a "significant objective improvement in nasal airflow"
compared with the placebo group. However, both groups reported
subjective improvement in "nasal symptoms" (with no statistically
significant difference between groups). Authors concluded that the
objective evidence supports that "homeopathic dilutions differ from
placebo."
Randomized, double-blinded, placebo-controlled trial of 126 children; 116 completed the study.
Individualized homeopathic treatments improved digestive problems in children with acute childhood diarrhea. Results are consistent with findings of a previous study.
Randomized, double-blinded, placebo-controlled trial of 100 people between 18 and 50 (71 percent male/29 percent female).
A subgroup of patients with HIV
in the symptomatic phase, receiving treatment, had increased levels of
CD4 cells at the end of the trial; the placebo subgroup did not.
Randomized, double-blinded, controlled trial of 119 people; 105 completed the study.
The
homeopathic treatment vertigoheel, and the standard treatment of
betahistine, are equally effective in reducing the frequency, duration,
and intensity of vertigo attacks.
j. Due to the large number of
trials, these studies have been selected to give a representative
overview of the findings published in peer-reviewed scientific and
medical journals in English and indexed in the National Library of
Medicine's MEDLINE database.
Analyzed 17 systematic reviews (including meta-analyses) of controlled clinical trials for homeopathy.
Author
found that the reviews failed to provide strong evidence in favor of
homeopathy. No homeopathic remedy was proven by convincing evidence to
yield clinical effects that are different from placebo or from other
control intervention for any medical condition. Positive
recommendations for use of homeopathy in clinical practice are not
supported, and "homeopathy cannot be viewed as an evidence-based form
of therapy" until more convincing results are available.
Analyzed
the methodological quality of 207 randomized trials collected for 5
previously published reviews on homeopathy, two herbal medicines (St.
John's wort and echinacea), and acupuncture.
Authors
found that the majority of trials had major weaknesses in methodology
and/or reporting. Homeopathy trials were "less frequently
randomized...and reported less details on dropouts and withdrawals"
than the other types.
Analyzed
16 randomized, controlled trials (17 comparisons were made) comparing
homeopathic treatment to placebo. Work was part of a report prepared
for the European Union on the effectiveness of homeopathy.
Authors
found that the "strength of evidence remains low" because of trial
flaws and other limitations. They added that "at least one [of the
tested homeopathic treatments] shows an added effect relative to
placebo." Group recommended that homeopathy be studied further using
the same methods used to study conventional medicine.
Analyzed
89 trials. Each trial was controlled; compared homeopathy to a placebo;
was either randomized or double-blinded; and yielded a written report.
Authors
concluded that their results were not compatible with a hypothesis that
the clinical effects of homeopathy are completely due to placebo.
However, they found insufficient evidence that homeopathy is clearly
efficacious for any single clinical condition. They stated that further
research is warranted if it is rigorous and systematic.
Assessed 105 controlled trials of homeopathy, 68 randomized.
Authors
found a positive trend in the evidence, regardless of the quality of
the trial or the method of homeopathy used. They cautioned, however,
that definitive conclusions about homeopathy could not be drawn,
because many of the trials were not of good quality and the role of
publication bias was unknown.
Systematic Reviews of Clinical Trials on Single Medical Conditions
Systematic review of four osteoarthritis clinical trials.
Research on homeopathic treatment for osteoarthritis is insufficient to reliably assess the clinical effectiveness of homeopathic treatment of osteoarthritis.
Controlled clinical trials indicate that homeopathic remedies appear to work better than a placebo in studies of rheumatic syndromes, but there are too few studies to draw definitive conclusions, and efficacy results are mixed.
k. Systematic reviews and meta-analyses are defined in note g.
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