Synonym: alternative spelling = homoeopathy

The history of homeopathy

The concept of homeopathy is said to have originated with Hippocrates who thought of treating 'like with like'. It lay dormant until around 1790 when a German physician, Samuel Hahnemann, developed it further. He experimented on himself with quinine that was used to treat ague, the old term for malaria, and he found that he could reproduce the symptoms of the disease by increasing the dose. He concluded that it was the ability of quinine to mimic the symptoms of malaria that enabled it to cure the disease.

Homeopathy and the National Health Service

A number of homeopathic hospitals were incorporated into the NHS in 1948. NHS homeopathic treatment is still available within the NHS. There are four NHS homeopathic hospitals in the UK (in Bristol, Glasgow, Liverpool and London).¹ However, not all primary care trusts or GPs agree to fund such referrals.²

In July 2010, England's Department of Health rejected demands to stop funding the use of homoeopathy in the NHS, saying that local primary care trusts should decide the appropriate use of homeopathy.³

Use of complementary and alternative medicines

There has been considerable interest in complementary and alternative medicine (CAM) with a House of Lords' Select Committee Report in November 2000 and a subcommittee of the Royal College of Physicians set up to examine certain aspects.⁴

In the UK, a survey published in 2001 found that 47% of respondents had used CAM (which includes homeopathy) at some time in their lives and 10% used some form of CAM each year. Most of this was outside the NHS.⁵

It is estimated that the NHS spends £4 million on homoeopathy every year (excluding the maintenance and running costs of the four homoeopathic hospitals).²

Homeopathic medicines

There are a wide variety of homeopathic preparations, including ones made from belladonna (deadly nightshade), arnica, chamomile, mercury, sulphur, sepia (extracted from squid ink), snake venom and even compounds extracted from bodily fluids.

The basic ingredient used in a homeopathic medicine is one that, if given in large enough quantities, would cause the symptoms of the disease. For example, the homeopathic remedy allium cepa is made from an extract of onions. If a person chops onions, they make the eyes sting and water and the nose run. Using the homeopathic philosophy of 'like for like', this means that a disorder with these symptoms should be cured by a small dose of onion. Hence, allium cepa may be used to treat hay fever.

Homeopathic medicines are prepared by serial dilution in steps of 1:10 or 1:100, denoted by the latin numbers x and c respectively. At each step there is succussion, or vigorous shaking. The dilution most frequently sold in pharmacies is 6c, which is a 10^-12 dilution of the original mother tincture. Hence, it is likely that a 6c dilution will contain just a few molecules of the initial substance, but much higher dilutions, such as the 30c (10^-60) will contain even less.

Homeopathy uses the concept of holism and the totality of symptoms - meaning that treatment is more effective when selected on the total set of symptoms, not just the underlying diagnosis. For example, two patients with upper respiratory tract infection (the same medical diagnosis) but different symptoms might receive different homeopathic remedies.⁶ In prescribing such treatment, the homeopath will examine not just the symptoms and signs of the disease, but also constitutional factors peculiar to the patient, including their psychological state, environmental reactions and body type.

Mechanism of action

The mechanism of action of homeopathic drugs is unknown. The underlying philosophy is that the remedy will cause minimal symptoms of the disease and this will stimulate the body to begin the healing process.

If 6c preparations contain just a few molecules of the original substance and higher dilutions are unlikely to contain even a single molecule, the mode of action is difficult to explain. In 1988, a French group published a paper in Nature claiming to have found that basophils continue to release histamine even when exposed to ultra-diluted anti-IgE, using the human basophil degranulation test.⁷ Others failed to reproduce these results.⁸

One of the leading current proposals for how such 'ultramolecular' dilutions work is the 'information hypothesis'. This is the theory that water is capable of storing information relating to substances with which it has previously been in contact, and subsequently transmitting this information to biosystems.⁹ There is some research from the field of materials science suggesting that this is plausible.¹⁰ The shaking of the solutions (known as succussion) has been suggested as an important part of this process.

The evidence surrounding homeopathy

There have been many publications and much debate and controversy about the evidence for homeopathy. On the whole, meta-analyses of homeopathy are inconclusive and don't provide sufficient information for conclusions to be drawn about homeopathy in general. Certain randomised controlled trails and clinical outcome studies have, however, shown some benefit. ^1,11,12,6. It has also been suggested that the benefits of homeopathy are due to the quality and holistic nature of the homeopathic consultation, rather than to the remedies themselves.¹³

Another systematic review commented that most trials of homeopathy do not represent homeopathic practice (for example, if treatment in the trial is standardised rather than individualised). It concluded that "the available systematic reviews on homeopathy provide little guidance for patients and doctors. They rather reflect the ongoing fundamental controversy on this therapy and strengthen the perception that, on one side, positive evidence from clinical trials will not convince skeptics, and that on the other side negative results from trials not representing actual practice will not have any impact on homoeopaths."¹⁴

There have been a number of Cochrane and other reviews relating to homeopathy over the years. These include:

• Tissue trauma and postoperative use - a review of homeopathic arnica for scenarios involving tissue trauma showed no benefit.¹⁵ Another study looked at whether homeopathic treatment following knee surgery (including arnica) reduced the morphine consumption, and found that it did not.¹⁶
• Dementia - a 2003 Cochrane review concluded that it was impossible to assess the poor-quality evidence about dementia.¹⁷
• Labour - the evidence about caulophyllum to induce labour is inadequate.¹⁸
• Asthma - a Cochrane review in 2000 did not show enough evidence to support the use of homeopathy for asthma and it concluded that more research was needed.¹⁹ Another review found no benefit from homeopathy for asthma.²⁰
• Influenza - a Cochrane review about the use of homeopathy to treat and prevent influenza showed some promising results but data were not strong enough to support/make a general recommendation.²¹
• Weight loss - a review of complementary medicine for weight loss found no benefit from homeopathy.²²
• Depression - there is insufficient evidence to assess the effect of homeopathy.²³
• Anxiety - a systematic review of homeopathy for anxiety disorders could not draw any firm conclusions.²⁴
• Cancer treatment side-effects - a Cochrane review found evidence in favour of using topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel® S mouthwash in the treatment of chemotherapy-induced stomatitis. No convincing evidence was found for the efficacy of homeopathic medicines for other adverse effects of cancer treatments.²⁵
• Attention deficit hyperactivity disorder (ADHD) - a Cochrane review found overall no evidence of benefit from homeopathy on core symptoms.²⁶

Positive support for homeopathy

The British Homeopathic Association and Faculty of Homeopathy does, however, have a number of studies published on their website which they believe have been shown to support homeopathy by showing positive effects. They include studies looking at the treatment of asthma, influenza, glue ear, pain and upper respiratory tract infection.^27,28,29,30 However, they do also state that new, high-quality studies in homeopathy are needed. They point out that because of the individualised approach that homeopathy takes to treatment, where two patients with the same condition may be treated in different ways, this does make research more difficult;¹ this difficulty has been noted by Cochrane reviewers too.¹⁹

A clinical outcome survey was conducted by Bristol Homeopathic Hospital between 1997-2003. It looked at clinical outcome in over 6,500 patients treated with homeopathy, of whom more than 70% reported clinical improvement after homeopathic treatment.³¹

Safety³²

It would seem reasonable to believe that even arsenic, diluted to the level of just a few molecules, is unlikely to be toxic and the evidence relating to homeopathy does seem to suggest that it is as safe as may be expected. Homeopathic medicines may provoke adverse effects but these are thought to be rare; temporary aggravation of symptoms may occur (see under 'Some homeopathic terms and concepts', below). However, adverse outcomes can result if an ineffective treatment is used for a serious and treatable condition.

Homeopathic immunisations are available and some parents opt for these for their children, as they believe that they are safer than the conventional vaccines. However, they do not produce any antibody response and so, presumably, the children remain at risk of those serious diseases. Some non-medical practitioners claim that homeopathy is an effective substitute for immunisation but the Faculty of Homeopathy supports the Department of Health immunisation guidelines and provides an information sheet for parents.^1,4 The faculty also supports steps to inform the public of the dangers of malaria.¹ Homeopathic pharmacies have been reprimanded for selling homeopathic travel remedies to customers instead of conventional malaria prophylaxis.³³

The World Health Organization (WHO) has stated that homoeopathy should not be used to treat several serious diseases such as HIV, tuberculosis, and malaria, after doctors highlighted the continuing promotion of such complementary therapies in many developing countries. WHO also said that it does not recommend homoeopathy for treating diarrhoea in infants or for influenza.³⁴

Regulation of homeopathy^32,35

The Faculty of Homeopathy regulates the training and practice of homeopathy by medically qualified doctors. There is a published list of doctors who are members of the faculty:

• The most experienced homeopaths have the qualifications FFHom or MFHom.
• The qualification LFHom indicates a doctor who may use homeopathy in a limited way for minor ailments.

For homeopaths who are not doctors, there is no one single registering body. The Society of Homeopaths is the largest professional organisation registering homeopaths in Britain. It has more than 2,300 members who must satisfy the Society's code of practice.

Since September 2006 the Medicines and Healthcare products Regulatory Agency (MHRA) has been allowed to grant licences to traditional therapies if their use "is plausible on the basis of long-standing use and experience" and no evidence shows that they cause harm. In 2009, 'Arnica pillules' became the first product in the UK to be given such a licence by the agency, amid criticism from the medical profession.³⁶

Some homeopathic terms and concepts^6,32,37

Types of homeopathy

• Classical homeopathy - typically a single homeopathic medicine is selected on the basis of the total symptom picture of a patient, including mental, general and constitutional features. Also known as individualised prescribing.
• Clinical homeopathy - one or more homeopathic medicines are administered for 'conventional' clinical situations/diagnoses.
• Complex homeopathy - several medicines are combined in a standard mixture to treat a particular illness.

Terms used

• Constitution - this includes build, personality, and general physical symptoms, such as tendency to feel the heat or the cold.
• Idiosyncrasy - what is unusual or atypical about the patient or their condition.
• Aggravation - a temporary increase in severity or worsening of symptoms, followed by improvement. It is considered a favourable prognostic sign.
• Homeopathic medicine (or remedy) - medicine produced according to an homeopathic pharmacopoeia.

Taking and storing homeopathic medicines

• Homeopathic medicines should be taken separately (at least twenty minutes away) from strongly flavoured food or drink, including smoking, toothpaste and other medication.
• They should be stored away from direct sunlight and away from strong-smelling substances (e.g. soaps, eucalyptus and perfumes).

Document references

1. British Homeopathic Association and Faculty of Homeopathy website
2. Kmietowicz Z; NHS should stop funding homoeopathy, MPs say. BMJ 2010; 340:c1091
3. White C; Local bodies should decide whether to fund homoeopathy, says government. BMJ 2010; 341:c4073
4. Lewith GT, Breen A, Filshie J, et al; Complementary medicine: evidence base, competence to practice and regulation. Clin Med. 2003 May-Jun;3(3):235-40. [abstract]
5. Thomas KJ, Nicholl JP, Coleman P; Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med. 2001 Mar;9(1):2-11. [abstract]
6. Jonas WB, Kaptchuk TJ, Linde K; A critical overview of homeopathy. Ann Intern Med. 2003 Mar 4;138(5):393-9. [abstract]
7. Davenas E, Beauvais F, Amara J, et al; Human basophil degranulation triggered by very dilute antiserum against IgE.; Nature. 1988 Jun 30;333(6176):816-8. [abstract]
8. Hirst SJ, Hayes NA, Burridge J, et al; Human basophil degranulation is not triggered by very dilute antiserum against human IgE.; Nature. 1993 Dec 9;366(6455):525-7. [abstract]
9. Lewith GT et al; Complementary medicine: evidence base, competence to practice and regulation. Clinical Medicine, Journal of the Royal College of Physicians, Volume 3, Number 3, 1 May 2003 , pp. 235-240(6)
10. Rao ML, Roy R, Bell IR, et al; The defining role of structure (including epitaxy) in the plausibility of Homeopathy. 2007 Jul;96(3):175-82. [abstract]
11. Shang A, Huwiler-Muntener K, Nartey L, et al; Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.; Lancet. 2005 Aug 27-Sep 2;366(9487):726-32. [abstract]
12. Nuhn T, Ludtke R, Geraedts M; Placebo effect sizes in homeopathic compared to conventional drugs - a systematic Homeopathy. 2010 Jan;99(1):76-82. [abstract]
13. Hartog CS; Elements of effective communication--rediscoveries from homeopathy. Patient Educ Couns. 2009 Nov;77(2):172-8. Epub 2009 Apr 15. [abstract]
14. Linde K et al; Systematic reviews of complementary therapies - an annotated bibliography. Part 3: Homeopathy. BMC Complementary and Alternative Medicine (2001) 1:4
15. Ernst E, Pittler MH; Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials.; Arch Surg. 1998 Nov;133(11):1187-90. [abstract]
16. Paris A, Gonnet N, Chaussard C, et al; Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study. Br J Clin Pharmacol. 2008 Feb;65(2):180-7. [abstract]
17. McCarney R, Warner J, Fisher P, et al; Homeopathy for dementia.; Cochrane Database Syst Rev. 2003;(1):CD003803. [abstract]
18. Smith CA; Homoeopathy for induction of labour.; Cochrane Database Syst Rev. 2003;(4):CD003399. [abstract]
19. McCarney RW, Linde K, Lasserson TJ; Homeopathy for chronic asthma.; Cochrane Database Syst Rev. 2004;(1):CD000353. [abstract]
20. White A, Slade P, Hunt C, et al; Individualised homeopathy as an adjunct in the treatment of childhood asthma: a Thorax. 2003 Apr;58(4):317-21. [abstract]
21. Vickers AJ, Smith C; Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev. 2004;(1):CD001957. [abstract]
22. Pittler MH, Ernst E; Complementary therapies for reducing body weight: a systematic review.; Int J Obes (Lond). 2005 Sep;29(9):1030-8. [abstract]
23. Pilkington K, Kirkwood G, Rampes H, et al; Homeopathy for depression: a systematic review of the research evidence.; Homeopathy. 2005 Jul;94(3):153-63. [abstract]
24. Pilkington K, Kirkwood G, Rampes H, et al; Homeopathy for anxiety and anxiety disorders: a systematic review of the research. Homeopathy. 2006 Jul;95(3):151-62. [abstract]
25. Kassab S, Cummings M, Berkovitz S, et al; Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD004845. [abstract]
26. Coulter MK, Dean ME; Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005648. [abstract]
27. Ferley JP, Zmirou D, D'Adhemar D, et al; A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes. Br J Clin Pharmacol. 1989 Mar;27(3):329-35. [abstract]
28. Harrison H, Fixsen A, Vickers A; A randomized comparison of homoeopathic and standard care for the treatment of glue ear in children. Complement Ther Med. 1999 Sep;7(3):132-5. [abstract]
29. Stam C, Bonnet MS, van Haselen RA; The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial. Br Homeopath J. 2001 Jan;90(1):21-8. [abstract]
30. de Lange de Klerk ES, Blommers J, Kuik DJ, et al; Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. BMJ. 1994 Nov 19;309(6965):1329-32. [abstract]
31. Spence DS, Thompson EA, Barron SJ; Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med. 2005 Oct;11(5):793-8. [abstract]
32. NHS Evidence - CAM, NHS library information on complementary and alternative medicine information, homeopathy webpage; (a helpful summary of homeopathy and its use)
33. Mayor S; Regulator drops cases against pharmacies offering homoeopathic malaria prophylaxis. BMJ 2011; 342:d338
34. Mashta O; WHO warns against using homoeopathy to treat serious diseases. BMJ 2009; 339:b3447
35. Complementary medicine: information for primary care clinicians, Dept of Health, June 2000
36. Cohen D; Drugs agency grants its first licence to homoeopathic product. BMJ 2009; 338:b2055
37. Royal London Hospital for Integrated Medicine, Homeopathy webpage. Accessed January 2011

Internet and further reading

• Complementary and Alternative Medicine Library Information Service (CAMLIS); an open-access reference library and website with research resources

Acknowledgements