| Homeopathic Medicine
The term homeopathy is derived from the Greek words homeo (similar) and
pathos (suffering from disease). The first basic principles of homeopathy
were formulated by the German physician Samuel Hahnemann in the late 1700s.
Curious about why quinine could cure malaria, Hahnemann ingested quinine
bark and experienced alternating bouts of chills, fever, and weakness,
the classic symptoms of malaria. From this experience he derived the principle
of similars, or "like cures like": that is, a substance that can cause
certain symptoms when given to a healthy person can cure those same symptoms
in someone who is sick. Hahnemann spent the rest of his life extensively
testing, or "proving," many common herbal and medicinal substances to
find out what symptoms they could cause. He also began treating sick people,
prescribing the medicine that most closely matched the symptoms of their
illness. The information from this experimentation has been carefully
recorded and ~makes up the homeopathic materia medica, a listing of medicines
and their indications for use. According to the Homeopathic Pharmacopoeia
of the United States, homeopathic medicines, or remedies, are made from
naturally occurring plant, animal, and mineral substances. By the end
of the 19th century, homeopathy was widely practiced in the United States,
when there were 22 homeopathic medical schools, more than 100 homeopathic
hospitals, and an estimated 15 percent of physicians practicing homeopathy.
The practice of homeopathy (along with other types of alternative medicine)
declined dramatically in the United States following the publication of
the Flexner Report in 1910, which established guidelines for the funding
of medical schools. These guidelines favored AMA-approved institutions
and virtually crippled competing schools of medicine. In the past 15 years,
however, there has been a resurgence of interest in homeopathy in this
country. It is estimated that approximately 3,000 physicians and other
health care practitioners currently use homeopathy, and a recent survey
showed that 1 percent of the general population, or approximately 2.5
million people, had sought help from a homeopathic doctor in 1990 ~(Eisenberg
et al., 1993). Those who are licensed to practice homeopathy in the United
States vary according to state-by-state "scope of practice" guidelines,
but they include M.D.s, D.O.s, dentists, naturopaths (N.D.s), chiropractors,
veterinarians, acupuncturists, nurse practitioners, and physician assistants.
Three states now have specific licensing boards for homeopathic physicians:
Arizona, Connecticut, and Nevada. Specialty certification diplomas for
those prescribing homeopathic drugs are established through national boards
of examination for M.D.s/D.O.s and N.D.s. Self-help as well as professional
training courses in homeopathy are offered through the National Center
for Homeopathy (NCH) in Alexandria, Virginia. NCH serves as an umbrella
organization for consumer support of homeopathy as well as a focus for
coordination among an increasing number of organizations and specialty
societies offering lay and professional training programs in homeopathy.
Homeopathic medicine also is currently widely practiced worldwide, especially
in Europe, Latin America, and Asia. In France, 32 percent of family physicians
use homeopathy, while ~42 percent of British physicians refer patients
to homeopaths (Bouchayer, 1990; Wharton and Lewith, 1986). In India, homeopathy
is practiced in the national health service, and there are more than 100
homeopathic medical colleges and more than 100,000 homeopathic physicians
(Kishore, 1983). In the United States today, the homeopathic drug market
has grown to become a multimillion-dollar industry; a significant increase
has occurred in the importation and domestic marketing of homeopathic
drugs. Homeopathic remedies are recognized and regulated by the FDA and
are manufactured by established pharmaceutical companies under strict
guidelines established by the Homeopathic Pharmacopoeia of the United
States. Products that are offered for the treatment of serious conditions
must be dispensed under the care of a licensed practitioner. Other products
offered for the use of self-limiting conditions such as colds and allergies
may be marketed as over-the-counter drugs. Homeopathy is used to treat
both acute and chronic health problems as well as for health prevention
and promotion in healthy people. Homeopathic medicines are prescribed
on the ~basis of a wide constellation of physical, emotional, and mental
symptoms. The one remedy that most closely fits all of the symptoms of
a given individual is called the similimum for that person. Thus, homeopathic
treatment is individualized, and two or more people with the same diagnosis
may be given different medicines, depending on the specific symptoms of
illness in each person. A person with a sore throat, for instance, may
need one of six or seven common remedies for sore throats, depending on
whether the pain is worse on the right or left side, what time of day
it is worse, what the person's mood is, and his or her body temperature,
thirst, and appetite (Jouanny, 1980). Hahnemann also discovered that if
the homeopathic remedies were "potentized" by diluting them in a water-alcohol
solution and then shaking, side effects could be diminished. He found
that after the medicines were potentized to high dilutions, there was
still a medicinal effect, and side effects were minimal. Some homeopathic
medicines are diluted to concentrations as low as 10-30 to 10-20,000.
This particular aspect of homeopathic theory and practice has caused many
modern scientists to reject homeopathic medicine outright. Critics of
homeopathy contend that such extreme dilutions of the medicines are beyond
the ~point at which any molecules of the medicine can theoretically still
be found in the solution (When to believe..., 1988). On the other hand,
scientists who accept the validity of homeopathic theory suggest several
theories to explain how highly diluted homeopathic medicines may act.
Using recent developments in quantum physics, they have proposed that
electromagnetic energy may exist in the medicines and interact with the
body on some level (Delinick, 1991). Researchers in physical chemistry
have proposed the "memory of water" theory, whereby the structure of the
water-alcohol solution is altered by the medicine during the process of
dilution and retains this structure even after none of the actual substance
remains (Davenas et al., 1988). Recent research accomplishments. Basic
science research in homeopathy has primarily involved investigations into
the chemical and biological activity of highly diluted substances. The
most thought-provoking research has involved observation of the physiological
responses of living systems to homeopathically potentized solutions. For
example, in the 1920s a German researcher conducted a series of studies
spanning 12 years in which he ~showed periodic variations in the growth
patterns of plants that had been exposed to a series of homeopathic dilutions
of metallic salts (Kolisko, 1932). With the focus of modern biological
laboratory research on cellular and organ function, homeopathic studies
have more recently been conducted in this area. Such laboratory studies
have shown positive effects of homeopathically prepared microdoses on
mouse white blood cells (Davenas et al., 1987), arsenic excretion in the
rat (Cazin et al., 1987), bleeding time with aspirin (Doutremepuich et
al., 1987), and degranulation of human basophils--blood cells that mediate
allergic reactions--(Davenas et al., 1988; Poitevin et al., 1988). Furthermore,
recent clinical trials in Europe have suggested a positive effect of homeopathic
medicines on such conditions as allergic rhinitis (Reilly et al., 1986),
fibrositis (Fisher et al., 1989), and influenza (Ferley et al., 1989),
while an earlier study showed no apparent effect in the treatment of osteoarthritis
by a homeopathic medicine (Shipley et al., 1983). The British Medical
Journal published a meta-analysis in 1992 of homeopathic clinical trials,
which found that 15 of 22 well-designed studies showed positive results.
This study concluded that more methodologically rigorous trials should
be done to address the question ~of efficacy of homeopathic treatment
(Kleijnen et al., 1991). A recent double-blind study comparing homeopathic
treatment with placebo in the treatment of acute childhood diarrhea found
a statistically significant improvement in the group receiving the homeopathic
treatment (Jacobs et al., 1993). Homeopathic research study design has
used different methodologies depending on the question being asked. One
of the earliest studies of homeopathy in a peer-reviewed conventional
medical journal asked the question, "Is the homeopathic medical system
taken as a whole more effective or less detrimental than another treatment
or placebo in the condition studied?" In this study, which focused on
rheumatoid arthritis, 195 patients who had previously been treated with
nonsteroidal anti-inflammatory drugs were allocated to placebo treatment
or active treatment. The active-treatment population then was divided
between aspirin and a homeopathic medication. The homeopathic doctors
were allowed to prescribe any medication at whatever interval, frequency,
or potency they considered appropriate. ~The trial was conducted for a
year, and by the end of the year almost 43 percent of the homeopathic
treatment group had stopped other treatments and were judged to have improved
since the beginning of the study. Another 24 percent of the homeopathic
group improved, but they continued on their conventional medications.
In contrast, only 15 percent of the aspirin group were maintained and
improved on the treatment. The entire placebo group had dropped out within
6 weeks. This study, however, was criticized on some methodological grounds--principally
that the homeopathic prescribers were more committed to the treatment
and the patients were easily able to determine who was in the placebo
group (Gibson et al., 1978). Subsequently, the same researchers conducted
another trial of this type, in which a specific disease was subjected
to homeopathic treatment by any one of a number of clinically indicated
homeopathic medications. This time, a placebo-controlled, double-blind
study showed that the improvements among the homeopathically treated patients
were statistically more significant than those of the placebo group (Gibson
et al., 1980). ~A second type of homeopathic study has been used to ask
a more specific question, namely, Is a particular homeopathic medication
more effective than another treatment or placebo for a particular disease?
Fisher and colleagues (1989) asked this question in a study of primary
fibromyalgia, a type of inflammation; patients who met recognized diagnostic
criteria for fibromyalgia were further stratified as patients for whom
a particular homeopathic medicine, rhus toxicodendron 6C, was homeopathically
indicated. Patients with the active treatment were better on all variables,
and a number of their tender points were reduced by 25 percent at the
end of 4 weeks of active treatment in comparison with controls. In a similar
study, Reilly and colleagues (1986) used homeopathic medications with
hay fever patients to address the issue of whether homeopathic medications
are in fact placebos. The researchers directly treated matched groups
of approximately 70 patients with a homeopathic medication made from mixed
grass pollens at the dilution of one part in 1060. This was done to address
the assertion that a potency lacking in any of the original substances
could act as more than a placebo. Patients took one tablet twice daily
of either placebo or the test drug and were free to use a standard antihistamine
at any time during the ~5-week study. Only the homeopathically treated
group showed a clear reduction in symptoms, and in comparison with the
placebo-treated group, twice as many of the homeopathically treated patients
had discontinued their antihistamines. This study also demonstrated that
even a simple study design requires careful analysis of potential confounding
variables, including the clinical observations that some homeopathically
treated patients experience temporary aggravation of their symptoms before
achieving a sustained improvement. A third type of study simply looks
at comparative utilization figures for homeopathic practitioners in a
health care system with or without attention to the comparative clinical
outcomes. For example, in France, research on cost-effectiveness has shown
that the annual cost to the social security system for a homeopathic physician
is 54 percent lower than the cost for a conventional physician. Moreover,
the same study found that the price of the average homeopathic medicine
is one-third that of standard drugs (CNAM, 1991). Research opportunities.
Research into the basic science areas of quantum physics, physical ~chemistry,
and biochemistry may determine whether a homeopathic medicine's mechanism
of action can be elucidated. Existing studies of the effects of the succussion
process on the physical-energetic nature of medicinal dilutions should
be repeated and extended (Smith and Boericke, 1967). Moreover, modern-day
herbal, biological, or pharmaceutically synthesized agents should be subjected
to homeopathic "provings." This scientific documentation of effects and
side effects in healthy people would enable new homeopathic drug development.
Evaluating the clinical efficacy of homeopathy using randomized, double-blind
clinical trials for the treatment of acute problems such as diarrhea,
otitis media, and postoperative pain as well as for chronic illnesses
is a fertile area for research. Existing studies should be repeated with
different investigators, giving attention to rigorous methodology. Special
emphasis should be given to research in areas where modern medicine does
not have an established, satisfactory solution, such as arthritis, AIDS,
asthma, headaches, and inflammatory bowel disease. More clinical research
also needs to be directed toward analyzing and improving the ~accuracy
of the clinical data in the homeopathic literature, much of which is currently
at least a century old. Indeed, homeopaths in Great Britain are currently
establishing a system using a modern, computerized medical database and
standardized subjective and objective outcome measures to analyze the
outcomes of patients treated with various homeopathic medications (van
Haseln and Fisher, 1990). This sort of study will help homeopathic clinicians
to investigate the differential efficacy of various homeopathic medications
and allow for an updating of the prescribing criteria for various medications
in the homeopathic materia medica. In addition to clinical trials on conditions
with specific diagnoses, studies also need to be done to evaluate the
possible benefits of long-term treatment with the system of homeopathic
medicine. Since proponents of this discipline claim that homeopathy improves
overall physical and mental health, health status indicators should be
used to evaluate changes in health in patients treated this way for several
months or years. Recent surveys in the United States found that most homeopathic
patients seek care for ~chronic illnesses (Jacobs and Crothers, 1991)
and that homeopathic physicians spend twice as much time with their patients,
order half as many laboratory tests and procedures, and prescribe fewer
drugs (Jacobs, 1992). Since treatment of chronic illness accounts for
a large proportion of health care expenditures in the United States, the
cost-effectiveness of homeopathic medicine should be investigated by comparing
homeopathy with conventional treatments for specific chronic illnesses
such as recurrent childhood ear infections, allergies, arthritis, headaches,
depression, and asthma. Clinical outcomes should be measured as well as
such factors as utilization of health services, number of missed days
of work or school, patient satisfaction, and overall cost of health care.
This research will help determine whether incorporating homeopathy into
the national health care scheme would significantly reduce health care
costs.
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