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Document Summary) Homeopathy is a 200-year-old therapeutic system that uses small doses of various substances to stimulate autoregulatory and self-healing processes. Homeopathy selects substances by matching a patient's symptoms with symptoms produced by these substances in healthy individuals. Medicines are prepared by serial dilution and shaking, which proponents claim imprints information into water. Although many conventional physicians find such notions implausible, homeopathy had a prominent place in 19th-century health care and has recently undergone a worldwide revival. In the United States, patients who seek homeopathic care are more affluent and younger and more often seek treatment for subjective symptoms than those who seek conventional care. Homeopathic remedies were allowed by the 1939 Pure Food and Drug Act and are available over the counter. Some data-both from randomized, controlled trials and laboratory research-show effects from homeopathic remedies that contradict the contemporary rational basis of medicine. Three independent systematic reviews of placebo-controlled trials on homeopathy reported that its effects seem to be more than placebo, and one review found its effects consistent with placebo. There is also evidence from randomized, controlled trials that homeopathy may be effective for the treatment of influenza, allergies, postoperative ileus, and childhood diarrhea. Evidence suggests that homeopathy is ineffective for migraine, delayed-onset muscle soreness, and influenza prevention. There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles, but it should not be substituted for proven therapies. Full Text (4203 words) Copyright American College of Physicians Mar 4, 2003 [Headnote] Homeopathy is a 200-year-old therapeutic system that uses small doses of various substances to stimulate autoregulatory and self-healing processes. Homeopathy selects substances by matching a patient's symptoms with symptoms produced by these substances in healthy individuals. Medicines are prepared by serial dilution and shaking, which proponents claim imprints information into water. Although many conventional physicians find such notions implausible, homeopathy had a prominent place in 19th-century health care and has recently undergone a worldwide revival. In the United States, patients who seek homeopathic care are more affluent and younger and more often seek treatment for subjective symptoms than those who seek conventional care. Homeopathic remedies were allowed by the 1939 Pure Food and Drug Act and are available over the counter. Some data-both from randomized, controlled trials and laboratory research-show effects from homeopathic remedies that contradict the contemporary rational [Headnote] basis of medicine. Three independent systematic reviews of placebo-controlled trials on homeopathy reported that its effects seem to be more than placebo, and one review found its effects consistent with placebo. There is also evidence from randomized, controlled trials that homeopathy may be effective for the treatment of influenza, allergies, postoperative ileus, and childhood diarrhea. Evidence suggests that homeopathy is ineffective for migraine, delayed-onset muscle soreness, and influenza prevention. There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles, but it should not be substituted for proven therapies. Ann Intern Med. 2003;138:393-399, www.annals.org Document View http://proquest.umi.com/pqdweb?index=1&sid=6&srchmode=1&vinst... 2 de 8 01-12-2005 12:31 For author affiliations, see end of text. The increasing use and reported success of homeopathy worldwide suggest that we should take a serious look at it. This article describes the history and principles of homeopathy, its practice patterns, and current research. THE ORIGIN AND PRINCIPLES OF HOMEOPATHY The "Principle of Similars" A German physician, Samuel Christian Hahnemann (1755-1843), developed homeopathy at the end of the 18th century (1). As the story goes, Hahnemann was translating an herbal text from English to German when he found that Cinchona bark (China officalis) cured malaria because it was bitter. He thought this explanation was preposterous and took repeated doses of Cinchona to personally determine its effects, which appeared remarkably similar to the symptoms of malaria. Hahnemann hypothesized that one may select therapies on the basis of how closely a patient's toxicologic symptoms matched the symptoms of the patient's disease. He called this the "Principle of Similars." He subsequently gave repeated doses of many common remedies to healthy volunteers and carefully recorded the symptoms they produced. This procedure is called a 11 proving" or, in modern homeopathy, a "human pathogenic trial." Hahnemann then attempted to select his treatments for sick patients by matching these drug symptom pictures to symptoms in sick patients (2). The Minimum Dose and Avagadro's Number The second and most controversial tenet in homeopathy is that remedies retain biological activity if they are diluted in a series (usually in a 1:10 or 1:100 diluent-volume ratio) and agitated or shaken between each dilution. Hahnemann began this process to reduce toxicity, but later he claimed that this "potenization" process extracted the "vital" or "spirit-like" nature of these substances (2). The limit of molecular dilution (Avagadro's number) was not discovered until the later part of Hahnemann's life; by then homeopaths all over the world were reporting that even very high potencies (dilutions lower than Avagadro's number) produced clinical effects. The implausibility of such claims has led many to dismiss any evidence of homeopathy's effectiveness as artifact or delusion (3). Holism and the Totality of Symptoms The third principle in homeopathy is that remedies are most effective when they are selected on the "total" characteristic set of symptoms, not just those of the disease (4). For example, a homeopath would treat a patient with a cold whose primary symptoms are lacrimation, stinging and irritation of the eyes, and thin, clear nasal discharge with a potency prepared from onion extracts (Allium cepa) because these symptoms mimic those produced by onions. However, another patient with a cold might have thick, yellow nasal discharge, have lost all thirst, and want cool, fresh air. That person would be treated with a potency of the purple cone flower (Pulsatilla) because these symptoms are more characteristic of those produced by this plant. Both patients have the same diagnosis (upper respiratory tract infection), but each is treated with a different homeopathic drug based on their characteristic symptoms. This situation can complicate clinical research in homeopathy when the experimental sample is selected according to conventional criteria but the therapy is based on homeopathic criteria (5). In addition, homeopathy has developed numerous approaches to this matching process over the last 200 years, further complicating establishment of a uniform prescribing standard. THE RISE, FALL, AND RISE OF HOMEOPATHY IN THE UNITED STATES Soon after its discovery, homeopathy spread rapidly across Europe and to other countries, especially the United States. Its rise is partly attributed to the barbaric practices in orthodox medicine of the time, such as bloodletting, high-dose cathartics, and heavy metals (6). By the turn of the century, 8% of all medical practitioners in the United States were homeopaths and there were 20 homeopathic medical colleges, including Boston University School of Medicine, New York Medical College, and Hahnemann Medical College (7,8).