A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE
Homeopathy, Naturopathy, Energy Medicine, and Other "Holistic" Approaches
Part 1: Homeopathy
Thomas J. Wheeler, Ph.D.
Associate Professor (retired), Department of Biochemistry and Molecular Biology,
University of Louisville School of Medicine, Louisville KY
thomas.wheeler@louisville.edu
Revised 2020
This original version of this material was part of a handout for an elective course given to medical students at the University of Louisville.
Copyright 2020. Permission to copy for non-profit uses is granted as long as proper citation of the source is given.
DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.
A pdf file containing all parts and references can be downloaded from ARTICLES or HOLISTIC.
CONTENTS OF PART 1
Homeopathy: Background Arguments in support
Principles Adverse effects
Practice and scope Scientific critique
Preparation of remedies Basic concepts
Avogadro's number and homeopathy Provings and practice
The homeopathic examination Clinical and preclinical trials
The homeopathic prescription The "memory of water"
Variants of homeopathy "Nanoparticles"
Regulation Critique of use in pharmacy
Reviews Characteristics of pseudoscience
Basic research Recent developments
Theoretical work
Hormesis References
HOMEOPATHY: BACKGROUND
Homeopathy was invented by Samuel Hahnemann in late 1700's. It was a mild alternative to the harsh medical treatments of the time. It became prominent in mid- to late 1800's before declining (most American homeopathic colleges were closed following the 1910 Flexner Report).
Homeopathy has significant support in England, France, India, and some other countries. The British royal family consults homeopaths. "In UK more than 400 general practitioners use homeopathy along with conventional medicine in their daily practice, and within the National Health Service there are five hospitals using integrated medicine which offer homeopathic treatments" (Viganò et al. 2015. J Med Pers. 13:7-17) (as noted below, the use of homeopathy in the NHS has recently decreased).
Usage in the U.S. was about 2.1% of adults in 2012. Retail sales of homeopathic products were over $400 million in 2018, about 40% for colds and flu.
Homeopaths may be trained at naturopathic schools in the U.S., or in homeopathic colleges abroad. Training can also be obtained in various short courses, seminar programs, and correspondence courses.
Homeopathy is not currently a licensed profession (except in Arizona, Connecticut, and Nevada, where it is available to MD’s and DO’s); rather, practitioners may be professionals in various areas ranging from MD's to physical therapists (they must be licensed in certain professions to prescribe homeopathic remedies).
The principles of homeopathy are so obviously absurd from a scientific standpoint that one can use homeopathy as a litmus test: practitioners, clinics, and programs that advocate homeopathy have demonstrated that they are not science-based.
PRINCIPLES
Diseases are disturbances in the body's ability to heal itself. "The underlying premise of homeopathic medicine is that symptoms are not simply something 'wrong' that needs fixing. Symptoms represent defensive and adaptive efforts of the body to deal with various disturbances, whether they be infectious disease, environmental poisons, or stress" (Ullman 2017 Feb 25. What homeopathic medicine offers to people with lead poisoning and other environmental exposures. Medium.com).
"Like cures like." Substances that produce symptoms characteristic of the disease are used, in small quantities, to stimulate the body to heal itself. These are not the actual causative agents, but rather agents that produce similar symptoms, or similia, in healthy individuals. Detecting such effects is referred to as "proving" the remedy.
Hahnemann “discovered this maxim while experimenting on himself. He noticed that consumption of the bark of the Peruvian Cinchona tree induced malaria-like symptoms and concluded that substances that replicate symptoms could be used to treat the disease that caused the original symptoms (Hahnemann was probably suffering from cinchonism caused by quinine in the bark)” (Erlewyn-Lajeunesse 2012. Arch Dis Child. 97(2):135-8). The original provings were done with undiluted substances, but Hahnemann later switched to using dilutions.
"In 19th century English 'prove' had the sense of try, test the qualities of, find out by experience. Provings are more accurately known as homeopathic pathogenetic trials (HPT)" (Dantas et al. 2007. Homeopathy 96(1):4-16).
"When he observed that his remedies worked better during house calls than in his office, he attributed it to jostling in his saddle bags, so he added the requirement of 'succussion,' specifying that remedies must be vigorously shaken (not stirred) by striking them against a leather surface at every step of dilution" (Hall 2014. Skeptical Inquirer. 38(5):54-8).
"Law of infinitesimals": The smaller the dose, the more powerful. Vigorous shaking (succussion or dynamization) is used at each dilution step to generate "memory" or "essence" of the molecules. Insoluble molecules are crushed and diluted with lactose (trituration). The number of dilutions is indicated by "X" (or "D") (10-fold) or "C" (100-fold). Thus, 6X = 106 dilution; 2C = 1002 = 104 dilution. Typical remedies are 6X to 30X; "high potencies" may range from 200C to 100,000C.
In Europe, "Several complex remedies contain herbal extracts of D1-D4 potencies (i.e. a 1 in 10 dilution carried out serially 1-4 times) or even the undiluted mother tincture" (Csupor et al. 2013. PLoS One. 8(9):e74181).
Hering's Law: healing progresses from internal organs outward; from the upper to the lower part of the body; and in reverse order of the original onset of symptoms.
Aggravation: "Homeopathic aggravation is a concept unique to homeopathy. The concept is understood as a temporary worsening of existing symptoms following the administration of a correctly chosen homeopathic remedy, which should be followed by improvement. It has many similarities with the concept of healing crisis that is common in other CAM therapies. A healing crisis is understood as a temporary exacerbation of symptoms on the way to more definite improvement" (Stub et al. 2015. Complement Ther Med. 23(4):535-43).
Body types, miasms: “Hahnemann believed that homeopathic remedies must be appropriately prescribed for individual body types and personalities, based on the ancient humoral theories of Galen. According to these theories, there were four body types and personalities, based on which body ‘humor’ predominated [blood, black bile, yellow bile, phlegm]...he also suggested that there are a corresponding few primary causes of acute and chronic illnesses, which he called ‘miasms.’ The first miasm, known as ‘psora’ (itch) refers to a general susceptibility to disease and may be considered the source of all chronic diseases. The other two miasms in homeopathic theory are the venereal diseases syphilis and sycosis (gonorrhea). Together, these three conditions were considered to be the cause of at least 80 per cent of all chronic diseases” (Ramey et al. 1999. Technology. 6(1-3):95-105).
"In Hahnemann’s view, a miasm affects the organism so profoundly as to render it insensitive to the action of homeopathic remedies selected according to the symptoms present at the time of the medical examination. These symptoms are only part of a more complex situation which must be seen in its totality if the patient is to be properly treated. From this point of view the various symptoms presented throughout the patient’s life are regarded as an evolution of an original 'infection,' which must be taken into consideration if a complete and lasting cure is to be effected" (Viganò et al. 2015. J Med Pers. 13:7-17).
"According to modern classical homeopathy, there are 4 groups (12 levels) of health. Group A consists of people possessing high reactivity and the strongest resistance of the body. Chronic diseases in this group are mild, with long-lasting remission periods...In group B, resistance decreases while organism reactivity increases. These patients suffer from deeper chronic diseases, with more frequent acute states, followed by complications requiring treatment...beginning with the seventh level of group C, one can observe a significantly different state of the organism. A number of deep chronic pathologies develop against the background of drastically lowered reactivity...Patients belonging to group D are those incurable sufferers with unfavorable treatment prognoses and the shortest life expectancies" (Chabanov et al. 2018. J Evid Based Integr Med. 23:2515690X18777995).
The concept of constitutions was developed in the 20th century. "Nowadays three fundamental constitutional types tend to be recognized: sulphuric, carbonic, phosphoric, with a further secondary type (fluoric) which according to many experts is not an independent type and can therefore be combined with the others" (ibid.).
"The notion of the 'sensitive typology' arose from experiments using various homeopathic remedies. During these provings the early homeopaths noticed that in some subjects a great number of clearly defined symptoms manifested. Clinical experience demonstrated that such individuals had certain characteristics in common (morphology, temperament, morbid tendencies, and so on), and that the pathologies they presented throughout their lives were often cured by the very substance to which they had shown particular sensitivity during the provings. From the practical point of view, knowing a patient’s sensitive typology helps to choose the right remedy to treat his/her chronic illness" (ibid.).
PRACTICE AND SCOPE: PREPARATION OF HOMEOPATHIC REMEDIES
"Potentization, also known as dynamization, is the process of trituration, succussion and dilution or fluxion of medicines, which Hahnemann claimed to transform their properties and develop dynamic powers, helping in healing many diseases when taken in minute doses. Trituration is the method of dilution of insoluble solid substances by grinding them with lactose in a particular ratio for preparation of homeopathic medicines ...Maximum 3rd potency can be reached via trituration and the subsequent steps should be carried out via liquid dilution. Succession is the first method of potentization used by Hahnemann where the bottle containing the medicine and the solvent in a particular ratio was taken upward, stopped momentarily and then pounded on a rubber pad. Succussion creates a highly turbulent regimen were vortices continuously form and disappear...Finally the energy gets dissipated from the fluid at the molecular level, which might be taken up by the substances and can increase their activity...For dilution of homeopathic medicines, Hahnemann mixed one part from the top of the previous dilution with 99 parts of 95% (v/v) ethanol in a new fresh bottle which is succussed thoroughly to make the new potency. Since the previous bottle contains the old dilution, it cannot be used for making new potencies...
"There is another type of dilution used in homeopathy and was discovered by Nikolai Korsakov...This approach is also known as the single vial method...Here in each step, instead of taking the top 1% volume, the vial is turned upside down or given a jerk. It is thought that due to this jerk, 99% of the fluid is removed. The remaining 1% of the fluid gets adhered to the walls as the vial drops, which is mixed with 99% of fresh solvent..." (Basu et al. 2017. Homeopathy. 106(4): 240-9). "Practising this method very high homeopathic potencies as e.g. 50MK, 10MK, or 500MK (e.g., 50MK means an abbreviation for 50,000 dilution steps and 50,000 x 10 succussion steps) can be produced..." (Lenger et al. 2014. Cell Biochem Biophys 68(2):321-34).
"Fluxion is another process of potentization, which was first discovered by B. Fincke. In this process, the turbulence is created by allowing a high speed fluid flow over the particles...According to various homeopathic pharmacopeias, however, the fluxion process is non-compliant, i.e. as per the pharmacopoeia, homeopathic medicines have to be made by succussion and not by fluxion" (Basu et al. 2017. Op. cit.).
The class of remedies known as imponderables "tend to be based on more abstract substances. They are usually created by exposing a vial of alcohol to the phenomenon the homeopath wants to capture - be it sunlight, electricity, or in the case described, eclipsed moonlight. The remedy can then be diluted and used according to the homeopathic principle of like cures like, so that, for example, 'Berlin Wall' is good for treating monomania...and 'Thunderstorm' (aka Tempesta) can address troubled emotions and lead to success in personal relationships and even marriage!" (Shapiro 2009 Oct 25. Healthfraud e-mail discussion list).
The final preparation may be in an alcohol-water mixture, or added to sucrose-lactose pellets. There are also are creams for topical use.
AVOGADRO'S NUMBER AND HOMEOPATHY
Discussions of the concentrations of homeopathic remedies frequently refer to Avogadro's number. This number, 6.02 x 1023, is the number of particles (atoms, molecules, or formula units) in one mole of a substance. A mole in turn is an amount of substance numerically equal in grams to the sum of the atomic masses of all the atoms in the formula. For example, for sodium chloride (NaCl), the atomic mass of sodium is 23.0 atomic mass units and that of chlorine is 35.5 atomic mass units. One mole of NaCl has a mass of 23.0 + 35.5 = 58.5 g and has 6.02 x 1023 formula units (6.02 x 1023 atoms of Na and 6.02 x 1023 atoms of Cl). Molarity is a concentration unit for substances in solution; a one molar (1 M) solution has one mole of a solute per liter of solution, so it would contain 6.02 x 1023 particles of solute per liter of solution.
A dilution by a factor of Avogadro's number, which is approximately equal to 24X or 12C, is sometimes described as the limit beyond which there is unlikely to be any of the original substance present, because 1 L of a 10-24 M solution would contain less than 1 particle of starting material. However, the situation is far worse than this for homeopathy, since the original material is likely to be at a far lower concentration than 1 M, and far less than 1 L would be ingested.
As an example, a paper described a clinical trial of homeopathic Melissa officinalis (Tavares-Silva et al. 2019. Phytomedicine. 58:152869). The most concentrated chemical in the mother tincture was rosemarinic acid at 1.15 g/L, corresponding to a concentration of 0.0032 M. This was diluted 1024 times in the 12C remedy, for a concentration of 3.2 x 10-27 M. The typical dose described in the paper was about 1 mL, which would contain on average 0.000002 molecules of rosemarinic acid. You would need to ingest 500 L to get a single molecule.
Update 2024: This calculation assumes that the entire solution would be further diluted at each step. But actually only a small sample is taken and then diluted again (with succussion). After a few dilutions, it becomes unlikely that even a single molecule would be present in the small sample taken for the next step. Eventually one of those samples will contain no molecules from the starting material, and thus all subsequent dilutions will also contain none.
PRACTICE AND SCOPE: THE HOMEOPATHIC EXAMINATION
Treatments are highly individualized, with the homeopath looking for unusual symptoms in the design of treatment for a particular patient. The homeopath will then compare the spectrum of symptoms to the symptoms related to various remedies, and try to pick the most appropriate match. A development that came much later than Hahnemann is the prescribing of a constitutional remedy. Here, in taking a history the homeopath will ask about emotions, food preferences, and other traits, and the remedy is based largely on these rather than on the symptoms of the disease. Note that the emphasis is on subjective feelings of patients, in contrast to objective findings (e.g., lab tests) in scientific medicine.
"The homeopathic doctor’s objective during a clinical examination is to find a remedy whose own pathogenesis includes the symptoms presented by the patient during his illness. To reach this objective the doctor uses two instruments: the Materia Medica and the Repertory. The first is a collection of signs and symptoms (physical, psychological and sensory) caused by administration of a given substance in a high percentage of healthy subjects during proving, while the second is in practice a list of symptoms and the homeopathic remedies associated with them....It is important to find out not only which signs and symptoms are present, but also the conditions in which they improve or worsen (‘modality’), the mental states they cause, how they manifest throughout the day, and so on...In acute pathologies the patient usually presents a limited number of symptoms which do not vary much from one individual to another. For this reason application of the principle of similarity is simpler and the number of remedies from which to choose is reduced" (Viganò et al. 2015. Op. cit.).
"When a patient seeks out care from any homeopathic clinician, the most essential element of the consultation process is the actual case taking...[it is important] for the clinician to be alert, keenly attentive, allow the patient to 'express his disorders without any interruption,' and to refrain from asking leading questions. The intake should not be an interrogation with questions and answers, but rather should become a discussion and conversation so the patient does not feel compelled to answer any particular way. Moreover, the intake should ideally 'draw a picture of the suffering of a living individual and to try and understand the whole circumstance that has given rise to these symptoms'" (Prousky 2018. J Evid Based Integr Med. 23:2515690X18794379).
“The top 10 diagnoses treated by homeopaths surveyed were asthma, depression, otitis media, allergic rhinitis, headache, psychological complaints, allergy, dermatitis, arthritis, and high blood pressure” (Chapman EH 1999. Homeopathy. In Jonas and Levin (eds) Essentials of complementary and alternative medicine).
PRACTICE AND SCOPE: THE HOMEOPATHIC PRESCRIPTION
For patients with chronic symptoms and syndromes, "Some homeopaths will recommend a dose given just once, some will recommend a single dose repeated once a month for several months, and some will recommend several doses a day for a week or two, perhaps repeated a couple months later if some, but not full, benefit had been received. Dosage will depend primarily on the severity of the case" (Ullman 2017. Op. cit.).
There are over 2000 remedies, 200-300 of which are used most commonly. Certain remedies known as “polychrests” match so many symptoms that one of them is likely to end up as the prescribed remedy.
"Our everyday clinical experience suggests that homeopathy and conventional medicine can be integrated in the treatment of both acute and chronic illness. For acute pathologies we first try homeopathic remedies which are useful in treating the overall clinical picture, resorting to conventional medicine only if there is an inadequate response...When treating chronic or relapsing pathologies we intervene on various levels. In line with results in the literature, we find that the greatest demand is for treatment of relapsing respiratory infections. We use homeopathy as a first line therapy for these patients..." (Viganò et al. 2015. Op. cit.).
"...Computers have increasingly gained agency in the homeopathic consultation. They host software systems that assist therapists in matching symptoms with remedies, granting them scientific legitimacy through appeal to technology, saving precious time, and simultaneously maintaining professional authority by pointing out the occasional failure of technology in comparison with expert human judgment" (Rughinis et al. 2018. Am J Ther. 25(4):e447-52).
There are over-the-counter sales for heart disease, kidney disease, cancer, multiple sclerosis, as well as many minor diseases and conditions. However, according to FDA regulations, nonprescription homeopathic remedies are to be sold only for self-limiting conditions (see Regulation below).
"The Banerji Protocols reflect a multigenerational clinical system developed by homeopathic physicians in India who have treated thousands of patients with cancer" (Bell et al. 2014. Glob Adv Health Med. 3(1):36-53).
VARIANTS OF HOMEOPATHY
"During and after Hahnemann’s life, many variants of homeopathy were proposed, but like Hahnemann’s method they all lacked experimental proof...The most important innovations were isopathy, constitution theory, complex-homeopathy and so-called biochemistry" (Nienhuys 2016 Apr 16. Skepsis blog).
"It is worth noting that in the course of its history, homeopathy has seen many doctrinal debates and variations in the way it is applied. Two main divisions are currently recognized: unicism and pluralism...The unicist homeopath is more faithful to Hahnemann’s methods; he or she studies and treats the patient as a unique and organic whole. Only one remedy is prescribed at a time, to cover the overall picture of individual dysfunction. The pluralist form, which allows the prescription of more than one remedy at a time, is also called clinical homeopathy. It originated in France and has spread all over the world. It involves the prescription of one or more remedies chosen on the basis of the patient’s more important symptoms. Other therapies exist which, although they have many points in common and although they make use of homeopathic remedies, cannot be identified with true homeopathy; they include isotherapy, homotoxicology and anthroposophy. There are also homeopathic medicines produced with complex formulations, containing several components. These formulations are often sold over the counter (OTC) to treat specific symptoms like sore throat cough or insomnia, but their use does not constitute a true homeopathic treatment" (Viganò et al. 2015. Op. cit.).
Classical homeopathy "is the term used to describe the type of homeopathy that adheres to the principles, instructions and methods published by Hahnemann. As Hahnemann’s texts are by no means free of contradictions, classical homeopathy is not a well-defined concept. As it is practised today, it incorporates ideas that originate not from Hahnemann but also from other prominent homeopaths, such as Kent. Thus some might use the term ‘classical homeopathy’ to denote the highly individualised prescribing of Hahnemann and to contrast it with the symptom-orientated prescribing of ‘clinical homeopathy’. Others might employ it to differentiate those homeopaths who would practise no method other than homeopathy from those who regularly combine homeopathy with conventional medicine. Others again might take it to mean unicist homeopathy administering one single remedy at a time, the way Hahnemann mostly did" (Ernst 2019 Jul 16. Edzard Ernst blog).
In isopathy, extremely dilute doses of the causative agent, e.g., pollen for hayfever, are employed. "The idea of isopathy stems from the German-American homeopath Constantin Hering, who later abandoned it. It wasn’t until 1833 that the idea was developed further by veterinary surgeon Johan Joseph Wilhelm Lux...The collective name for high dilutions of secretions or excretions from patients and the causes of their diseases – pathogens or otherwise – as a remedy against the corresponding disease, is nosodes." (Nienhuys 2016. Op. cit.). Examples of sources include pus, cancerous tissue, bacteria in sputum, or stool cultures. This approach was condemned by Hahnemann.
Constitutional homeopathy "is an invention of Dr. Eduard von Grauvogl, who described it in Lehrbuch der Homöopathie (1866). The idea is that certain general characteristics of a person match a homeopathic remedy. The therapist first determines the patient’s constitution and then administers the matching remedy, irrespective of the patient’s actual complaints. Von Grauvogl distinguished hydrogenoid, oxygenoid and carbo-nitrogenoid groups of patients.
"Following von Grauvogl various other forms of homeopathic constitutions have been devised. A well-known example is the Pulsatilla constitution which refers to fickle blond women who cry easily, have a tendency toward varicose veins and problems with menstruation, who like fresh air, tepid tea and sweets, and dislike fatty food. The Natrum muriaticum constitution on the other hand describes highly sensitive, rancorous and mean personalities who are morose because of lack of motherly love, etc. (Natrum muriaticum is an old fashioned Latin name for kitchen salt.)
"Homeopaths don’t seem to agree among themselves what ‘constitution’ really means and have not been able to give a clear definition. The results of homeopathic provings give no indication as to which remedy corresponds to which constitution. Giving someone pulsatilla won’t change him or her into a weepy woman. However, the concept of ‘constitutional homeopathy’ enables homeopaths to give different remedies to different people all suffering from the same disease, thus creating the illusion of individual treatments. On the other hand, homeopaths often give the same remedy for totally different diseases: all ‘sulfur’ cases get Sulphur, regardless of their disease" (Nienhuys 2016. Op. cit.).
Schuessler Salts - "‘Biochemistry’ or Cell Salts [also known as tissue salts] refers to homeopathic remedies that were designed in 1873 by Wilhelm Heinrich Schüßler...Schüßler (also spelled Schuessler) studied the ashes of cremated people and discovered that they contained a dozen important salts. He simplified Virchow’s idea and claimed that diseases are caused by an imbalance of these salts within the cells. He also simplified homeopathy; to restore the imbalance in their cells, sick people should be given one of these salts diluted a million times or a million times a million times" (ibid.).
Clinical homeopathy "consists of the use of regular diagnoses alongside homeopathic diagnoses and is practiced by homeopathic physicians. They can hardly afford to do otherwise, because a doctor who ignores clear indications for a regular diagnosis risks serious trouble with a disciplinary court" (ibid.). It "resembles more the way drugs are prescribed in conventional medicine; it selects the appropriate remedy according to the condition of the patient, while largely disregarding the ‘like cure like’ principle. However, clinical and classical homeopathy are not mutually exclusive; in fact, there is considerable overlap between the two approaches, and they are often used in parallel by the same clinician. In other words, if the symptoms of a patient reveal a very clear indication for a certain homeopathic remedy, clinical homeopathy is used even by classical homeopaths" (Ernst 2019. Op. cit.).
Complex homeopathy "is the use of preparations which contain more than one homeopathic remedy. Even though it is not in line with Hahnemann’s teachings, complex homeopathy is currently highly popular and commercially successful. Homeopathic combination remedies can be bought over the counter and usually contain a range of different remedies which, according to the concepts of clinical homeopathy, are most likely to cure a given condition" (ibid.).
Homeoprophylaxis is a form of immunization using homeopathic material. "This normally entails the oral administration of homeopathic remedies, called nosodes. Such remedies are potentised remedies based on pathogenic material like bodily fluids or pus" (ibid.).
Agrohomeopathy, the agricultural application of homeopathic solutions, is alleged to enhance germination, control diseases, and decontaminate soil. "Agrohomeopathy, they say, can even treat a trauma retained in the ‘biological memory’ of the plant resulting from conditions such as forced hybridization, moving to places outside their natural habitats, or exaggerated fertilization" (Ernst 2019 Jul 16. Edzard Ernst blog).
Electrohomeopathy was invented by Cesare Mattei in the mid-1800s. His plant-based remedies supposedly provide healing electrical energy.
Homotoxicology "is a therapy developed by the German physician and homeopath Hans Reckeweg. It is strongly influenced by (but not identical with) homoeopathy...According to the assumptions of homotoxicology, any human disease is the result of toxins, which originate either from within the body or from its environment. Allegedly, each disease process runs through six specific phases and is the expression of the body’s attempt to cope with these toxins...Frequently used homotoxicological remedies are fixed combinations of homeopathically prepared remedies such as nosodes, suis-organ preparations and conventional drugs. All these remedies are diluted and potentised according to the rules of homoeopathy...The crucial difference between homotoxicology and homoeopathy is that the latter follows the ‘like cures like’ principle, while the former does not...Our systematic review purely of studies of homotoxicology included 7 studies, all of which had major flaws" (Ernst 2018 Oct 16. Edzard Ernst blog).
Sanum therapy "is based upon the medically disputed concept of pleomorphism, which holds that microorganisms can shift from one form to another in response to environmental influences. It was developed by Günther Enderlein (1872-1968), who theorized that tiny microorganisms called 'protits' normally circulate harmlessly throughout the body but can change into disease-producing bacteria or fungi if exposed to various internal or environmental triggers. Sanum remedies are dilutions of bacteria or fungi that are said to work homeopathically" (Barrett 2009. Sanum therapy: More homeopathic nonsense. Quackwatch).
Bach Flower Remedies are described in a separate section later in this article.
REGULATION
“Homeopathic remedies are covered under the federal Food, Drug, and Cosmetic Act, which was originally passed in 1938. The law established rules for the labeling and manufacture of products, it prohibited adulteration of products, and it set forth requirements that drugmakers undertake the approval process. The law also recognized the Homeopathic Pharmacopeia of the United States (HPUS) as an official compendium of homeopathic remedies and required that such products meet the compendium's standards as well. However, the FDA has chosen not to require preapproval for homeopathic products that meet the agency's requirements for labeling and manufacture...Only homeopathic products that are marketed for conditions for which treatment does not require physician supervision may be sold over the counter; others require prescriptions.
“‘These policies were adopted to help the FDA direct its limited resources to enforcement actions that most protect the public health,’ said Rice in an e-mail. ‘Homeopathic remedies often - although not always - contain so little active ingredient that they are believed to present little direct risk to the consumer.’ (Kuehn 2009. JAMA. 302(15):1631-4).
The recognition of homeopathy in the 1938 act was the result of political pressure by a powerful senator who was a homeopath. Homeopathic remedies are included in the Medicare Act (1965).
"In the 1980s, discussions between members of the FDA's Compliance Office and homeopathic industry leaders led to the development of a formal FDA regulatory policy. The resultant Compliance Policy Guide CPG 7132.15 was implemented in 1990. This document states that homeopathic products can be marketed OTC [over the counter] for the treatment of 'self-limiting disease conditions amenable to self-diagnosis (of symptoms).' Homeopathic products intended for the treatment of more serious conditions must meet the standards applicable to all prescription drugs." One of the guides to usage cited by the Policy Guide was Clarke's Dictionary of Practical Materia Medica, published in 1900, which "contains more than 1,600 pages that describe 'characteristics' and symptoms associated with about 450 homeopathic substances that had been subjected to provings. The total number of symptoms described in the book appears to be well over 100,000" (Barrett 2015. FDA homeopathic product regulation. HomeoWatch).
"The U.S. Food and Drug Administration (FDA) does require that homeopathic remedies meet certain legal standards for strength, purity, and packaging. The labels on the remedies must include at least one major indication (i.e., medical problem to be treated), a list of ingredients, the dilution, and safety instructions" (National Center for Complementary and Alternative Medicine 2009. Homeopathy: An introduction).
In 2015, the Federal Trade Commission (FTC) called on the FDA to reconsider its regulation of homeopathy, since consumers did not understand the nature of homeopathic products and were being misled into buying products that they thought were effective.
In 2016 the FTC issued an "Enforcement Policy Statement on Marketing Claims for OTC Homeopathic Drugs." It noted that "The FTC Act does not exempt homeopathic products from the general requirement that objective product claims be truthful and substantiated...Efficacy and safety claims for homeopathic drugs are held to the same standards as similar claims for non-homeopathic drugs...For health, safety, or efficacy claims, the FTC has generally required that advertisers possess 'competent and reliable scientific evidence,' defined as 'tests, analyses, research, or studies that have been conducted and evaluated in an objective manner by qualified persons and [that] are generally accepted in the profession to yield accurate and reliable results.' In general, for health benefit claims, particularly claims that a product can treat or prevent a disease or its symptoms, the substantiation required has been well-designed human clinical testing...For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product's efficacy. Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading...However, the FTC has long recognized that marketing claims may include additional explanatory information in order to prevent the claims from being misleading. Accordingly, the promotion of an OTC homeopathic product for an indication that is not substantiated by competent and reliable scientific evidence may not be deceptive if that promotion effectively communicates to consumers that: (1) there is no scientific evidence that the product works and (2) the product's claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts. To be non-misleading, the product and the claims must also comply with requirements for homeopathic products and traditional homeopathic principles. Of course, adequately substantiated claims for homeopathic products would not require additional explanation...In light of the inherent contradiction in asserting that a product is effective and also disclosing that there is no scientific evidence for such an assertion, it is possible that depending on how they are presented many of these disclosures will be insufficient to prevent consumer deception...In summary, there is no basis under the FTC Act to treat OTC homeopathic drugs differently than other health products. Accordingly, unqualified disease claims made for homeopathic drugs must be substantiated by competent and reliable scientific evidence. Nevertheless, truthful, non-misleading, effective disclosure of the basis for an efficacy claim may be possible" (Homeowatch. 2016 Nov. 20. Enforcement Policy Statement on Marketing Claims for OTC Homeopathic Drugs).
In 2017 the FDA proposed new guidelines that "would update the FDA's existing policy to better address situations where homeopathic treatments are being marketed for serious diseases and/or conditions but where the products have not been shown to offer clinical benefits. It also covers situations where products labeled as homeopathic contain potentially harmful ingredients or do not meet current good manufacturing practices" (FDA News Release 2017 Dec 18). "What all this seems to be saying is that the FDA is putting the industry on notice (if they adopt these proposed new guidelines) that, without specific warning, any drug product labeled as homeopathic can be regulated like any other drug. That means it can be pulled from the market because it is not FDA approved or determined to be GRAS/E [generally recognized as safe and effective]. They are prioritizing high-risk products, but these guidelines apply to all drugs labeled homeopathic...They plan on starting with high-risk products, but are giving themselves permission, essentially, to work their way entirely through the industry" (Novella 2017 Dec 20. Science-Based Medicine blog).
In 2019, the FDA announced revision of the 2017 draft guidelines and withdrawal of the Compliance Policy Guide "Conditions Under Which Homeopathic Drugs May be Marketed." This may be a prelude to more strict regulation of homeopathic preparations.
"There are currently no uniform licensing or professional standards for the practice of homeopathy in the United States; the licensing of homeopaths varies from state to state. Usually, a homeopathic practitioner is licensed in a medical profession, such as conventional or osteopathic medicine. Homeopathy is also part of the medical education for naturopathy.
"Licensure as a homeopathic physician is available only to medical doctors and doctors of osteopathy in Arizona, Connecticut, and Nevada. Arizona and Nevada also license homeopathic assistants, who are allowed to perform medical services under the supervision of a homeopathic physician. Some states explicitly include homeopathy within the scope of practice of chiropractic, naturopathy, physical therapy, dentistry, nursing, and veterinary medicine.
"National certification may be obtained through organizations such as the Council for Homeopathic Certification, American Board of Homeotherapeutics, and the Homeopathic Academy of Naturopathic Physicians. The U.S. Department of Education, which officially recognizes some CAM organizations for certification purposes, has not recognized these organizations; however, members of the homeopathic community consider certification a way to help set education and competency standards for practicing homeopathy" (National Center for Complementary and Alternative Medicine 2009. Homeopathy: An introduction).
"In many countries, veterinary homeopaths have their own professional organisations. Elsewhere, however, veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are allowed to use homeopathy on animals (but anyone regardless of background can use it on human patients) and there is a British Academy of Veterinary Homeopathy. In the US, homeopathic vets are organised in the Academy of Veterinary Homeopathy" (Ernst 2019 Aug 26. Edzard Ernst blog).
REVIEWS
(* = review by Edzard Ernst and colleagues)
Multiple conditions (2011-2019 only)
Swiss report 2011. "There is sufficient evidence for the preclinical effectiveness and the clinical efficacy of homeopathy and for its safety and economy compared with conventional treatment." In criticizing the report, Shaw (2012. Swiss Med Wkly. 142:w1594) wrote: "It appears that their goal was not to provide an independent assessment but to choose criteria that would lead to their chosen conclusion that homeopathy is effective. To this end, they chose to adopt a highly questionable criterion of 'real-world' effectiveness, ignore negative findings concerning homeopathy in favour of implausible reinterpretation of results, and attack RCTs."
*Ernst. 2012. Skeptical Inquirer. 36(6):39-42. Reviewed publications from the group of Witt. "My evaluation suggests numerous flaws in the design, conduct, and reporting of clinical research in homeopathy recently published by the most prolific research unit in this area. It also reveals multiple publications of similar data, which might be regarded as ethically debateable. Most important, it points to a phenomenon that, according to my experience, seems to be common in this line of investigation (Ernst 2010): relatively weak data tend to be over- or misinterpreted to such an extent that the casual reader of such publications can be seriously misled. Consequently, homeopathy appears to have clinical effects which, with critical analysis, can be attributed to bias or confounding."
Mathie et al. 2014.Syst Rev. 3:142. "Medicines prescribed in individualised homeopathy may have small, specific treatment effects. Findings are consistent with sub-group data available in a previous 'global' systematic review. The low or unclear overall quality of the evidence prompts caution in interpreting the findings."
Australian National Health and Medical Research Committee 2015. "For some health conditions, studies reported that homeopathy was not more effective than placebo. For other health conditions, there were poor-quality studies that reported homeopathy was more effective than placebo, or as effective as another treatment. However, based on their limitations, those studies were not reliable for making conclusions about whether homeopathy was effective. For the remaining health conditions it was not possible to make any conclusion about whether homeopathy was effective or not, because there was not enough evidence. Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective."
Mathie 2015. Homeopathy. 104(4):328-32. "Despite important growth in research activity since 1994, concerns about study quality limit the interpretation of available RCT data. The question whether homeopathic intervention differs from placebo awaits decisive answer."
Mathie et al. 2017. Syst Rev. 24;6(1):63. "The quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusion." Ernst (2017 Apr 14. Edzard Ernst blog) restated this as: "the more reliable data show no difference between homeopathy and placebo." In another post (2018 Mar 19. Edzard Ernst blog) he pointed out that the few studies that were both positive and rigorous had not been independently replicated.
European Academies' Science Advisory Council 2017. "...We conclude that the claims for homeopathy are implausible and inconsistent with established scientific concepts...we acknowledge that a placebo effect may appear in individual patients but we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect."
Mathie et al. 2018. Homeopathy. 107(4):229-43. "Due to the low quality, the small number and the heterogeneity of studies, the current data preclude a decisive conclusion about the comparative effectiveness of IHT [individualized homeopathic treatment]."
Reisman et al. 2019. PeerJ. 23;7:e6318. Using a statistical analysis (p-curve), the authors found the data consistent with the idea that homeopathic remedies are placebos.
Mathie et al. 2019. Homeopathy. 108(2):88-101. "The current data preclude a decisive conclusion about the comparative effectiveness of NIHT [non-individualized homeopathic treatment]." However, Ernst (2019 Feb 19. Edzard Ernst blog) wrote, " I do disagree with their conclusions. In my view, at least two firm conclusions ARE possible: This dataset confirms yet again that the methodological quality of homeopathy trials is lousy. The totality of the trial evidence analysed here fails to show that non-individualised homeopathy is effective."
Multiple conditions, specific remedy - *Ernst 1998. Arch Surg 133(11):1187-90: reviewed studies of arnica, the most frequently used homeopathic remedy. “The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials.”
Allergic rhinitis - Banerjee et al. 2017. J Altern Complement Med. 23(6):426-44. "The low or uncertain overall quality of the evidence warrants caution in drawing firm conclusions about intervention effects. Use of either Galphimia glauca or a homeopathic nasal spray may have small beneficial effects on the nasal and ocular symptoms of AR. The efficacy of isopathic treatment of AR is unclear." Ernst (2017 May 5. Edzard Ernst blog) pointed out that the positive findings with Galphimia glauca were not independently replicated.
Asthma
McCarney et al. 2004. Cochrane Database Syst Rev. CD000353. “There is not enough evidence to reliably assess the possible role of homeopathy in asthma.”
Qutubuddin et al. 2019. Complement Med Res. 26(2):111-7. "Due to both qualitative and quantitative inadequacies, proofs supporting individualized homeopathy remained inconclusive. The trials were positive (evidence level A), but inconsistent, and suffered from methodological heterogeneity, 'high' to 'uncertain' risk of bias, incomplete study reporting, inadequacy of independent replications, and small sample sizes." Ernst (2019 Apr 25. Edzard Ernst blog) found many flaws in this review.
Attention deficit/hyperactivity disorder - Coulter and Dean 2007. Cochrane Database Syst Rev. CD005648. "There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD."
Cancer treatment adverse effects - Kassab et al. 2009. Cochrane Database Syst Rev. CD004845. "This review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis. These trials need replicating. There is no convincing evidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments."
Depression - Viksveen et al. 2018. Eur J Integrative Med. 22:22-36. "Limited evidence from two placebo-controlled double-blinded trials suggest that HMPs [homeopathic medicinal products] may be comparable to antidepressants and superior to placebo." Ernst (2018 Sep 7. Edzard Ernst blog) found the conclusions "far too optimistic and not justified. In fact, I find them misleading, dangerous, unethical and depressing."
Fibromyalgia - Boehm et al. 2014. Complement Ther Med. 22(4):731-42. "Given the low number of included trials and the low methodological quality, any conclusion based on the results of this review have to be regarded as preliminary."
Headache
*Ernst 1999. J Pain Symptom Manage. 18(5):353-7. “It is concluded that the trial data available to date do not suggest that homeopathy is effective in the prophylaxis of migraine or headache beyond a placebo effect.”
Owen and Green 2004. J Chiropr Med. 3(2):45-52. "There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache."
Induction of labor - Smith 2003. Cochrane Database Syst Rev. CD003399. "There is insufficient evidence to recommend the use of homoeopathy as a method of induction."
Influenza - Mathie et al. 2015. Cochrane Database Syst Rev. CD001957. "There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling.“
Irritable bowel syndrome - Peckham et al. 2019. Cochrane Database Syst Rev. CD009710. "...no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn." Ernst (2019 Oct 23. Edzard Ernst blog) disagreed with the phrasing; he wrote that "a firm conclusion can very well be drawn," that there is no good evidence that homeopathy is effective.
Otitis media - Fixsen 2013. Homeopathy. 102(2):145-50. "The results are encouraging, but the volume of research is small and insufficient to draw definitive conclusions."
Post-operative ileus - Barnes et al. 1997. J Clin Gastroenterol. 25(4):628-33. “There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment.”
Psychiatry - Davidson et al. 2011. J Clin Psychiatry. 72(6):795-805. "The database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the possibility of some benefit."
Respiratory tract infections in children - Hawke et al. 2018. Cochrane Database Syst Rev. CD005974." We found no evidence to support the efficacy of homeopathic medicinal products for ARTIs in children."
BASIC RESEARCH
Basic research in homeopathy has focused on trying to support the "memory of water" concept, in which some type of "information" is retained in ultradilute solutions even though no solute particles remain. Thus, researchers attempt to find differences between homeopathic dilutions and pure water. Examples include spectroscopy and measurements of thermoluminescence, pH, and electrical conductivity. The alleged differences reported by some researchers "have been attributed to the formation of specific molecular 'clusters' or 'coherence domains' induced by dynamisation, which alter the molecular structure of the water itself" (Viganò et al. 2015. J Med Pers. 13:7-17).
Another line of research looks at "nanoparticles" of silica, nanobubbles (very small gas bubbles), or metal contaminants produced by the succession process, with the implication that these can explain the properties of homeopathic remedies. As Fisher (2012. Homeopathy. 104(2):67-8) wrote, "Homeopathic manufacturing procedures generate nanobubbles, these have many unusual properties including low buoyancy, longevity and high energy is released when they burst or collapse. They are associated with superstructures which seemed to increase with size with increasing dilutions well into the 'ultramolecular' range."
Bell et al (2013. Eur J Integr Med. 5(2):126-40) wrote, "Homeopathic medicines likely contain source particles adsorbed onto lactose particles in lower potencies or silica nanoparticles at higher potencies. Variations in dilution and succussion procedures may contribute to the variability in manufacturing results. The nanoparticles would include any metal or mineral-derived source materials or organic plant or animal source materials, as well as lactose, silica or polypropylene nanocrystals with any plant or animal source proteins and/or nucleic acids adsorbed. Lactose can even adsorb biologically-active animal protein nanoparticles created by electrospraying. Alternatively, modern homeopathic manufacturing methods sometimes rely on vortexing or sonication rather than manual shaking to accomplish the mixing and succussion, as well using polypropylene tubes rather than the traditional glass vials. The type of succussion and the type of material in the walls of the vial in which the remedy is succussed would measurably affect the properties of the resultant homeopathic medicine. In addition, nanoparticles undergo spontaneous aggregation into larger particles (which would alter their properties) if left undisturbed for periods of time, a thermodynamic process termed Ostwald ripening."
Other studies examine the effects of homeopathic remedies on cells or whole organisms. Cell culture experiments examine growth, protection from toxic compounds, and gene expression. Whole organism studies include effects on immune response and other physiological events, as well as germination of seeds and growth of plants.
THEORETICAL WORK
Advocates of homeopathy have attempted to explain how homeopathy works by invoking concepts from quantum physics. For example, Lionel Milgrom (2007. J Altern Complement Med. 13(2):186-9) wrote: "In chemical terms, the memory of water might be considered a supramolecular phenomenon involving trillions of water molecules. Thus, it is an emergent dynamic property of bulk liquid water (i.e., the whole is more than the sum of the parts) and, as such, defies explanation simply in terms of static bonding and additive behavior of individual water molecules. Certainly, water molecules' ability to switch hydrogen bonding to each other dynamically is of crucial importance here, as are other weak intermolecular interactions (e.g., van der Waals forces)" and "Using quantum theory, Del Guidici, Preparata, and Vitiello predicted that, given a large enough number of water molecules...the sum total of all the hydrogen-bonded interactions between the water molecules leads to a correlated state in which they all resonate together, spontaneously ordering themselves into a so-called 'coherent domain'...the physicists went on to show that such 'coherent domains' could not only be triggered by homeopathy's potentization process...but they would survive removal of all traces of the original dissolved substance." Later, Milgrom (2011. J Altern Complement Med. 17(7):573-5) wrote that "the interaction between patient, practitioner, and therapeutic modality may be explained using the mathematical discourse of three-way quantum entanglement." There has also been reference to resonance transfer of energy from patient to be absorbed by the homeopathic dilution. Critics find these ideas to be highly speculative and fanciful.
HORMESIS
"Classical hormesis can be defined as a non-linear, homeostatic biological response to toxins or stressors, such as ionizing radiation, that is biphasic in the sense that opposite effects are seen when different exposure levels are applied. With low-dose exposure...a biological response is observed that is opposite to the effects seen with high doses. The data plot as inverted U- or J-shaped curves that contact the control value at two points...Hormesis is a more powerful and useful concept when it is used to refer to special cases of adaptive biochemistry or physiology where low-dose exogenous toxins or radiation exposure increases the expression of defense and repair mechanisms that protect against higher level exposures" (Moffett 2010. Hum Exp Toxicol. 29(7):539-43).
Hormesis, which is a genuine phenomenon, has been invoked as if it supported homeopathy. However, this argument is flawed; there are important differences:
Hormesis involves real quantities of substance or radiation at both the low and high levels. If one were to continue the plot of effect vs. dose to sufficiently low doses, the curve would eventually return to control values. As noted by Bernardini (2010. Hum Exp Toxicol. 29(7):537-8): "...Hormesis is believed to be effective only in a concentration range consistent with the quantization of matter. Indeed up to date no hormetic effects have been detected for ultra low-doses of xenobiotics..." Smith (2012. Bioethics. 26(9):508-12) added: "The fact that the homeopathic dilution process removes all molecules of the original active substance renders hormesis (and all non-linear pharmacological effects) irrelevant to homeopathy. Regardless of the nature of the dose-response curve of the original substance, no molecules equals no effect."
Hormesis "occurs over a very limited range of concentrations...in most cases the reversal of the effect with increasing concentration occurs over less than a 10-fold range...and hormesis rarely extends over two orders of magnitude...let alone the many orders of magnitude over which homeopathic products are alleged to become more potent with increasing dilution. In addition, the shape of the dose response curve differs from that of the monotonic negative 'dose response' relationship claimed for homeopathic remedies. Finally, hormesis is a spontaneous natural phenomenon, which does not require homeopathic 'potentisation' in order to occur" (Doehring and Sundrum 2016. Vet Rec. 179(24):628).
"Since the low-dose exposure is administered prior to the high-dose-induced injury, it does not relate to the normal clinical situation in which treatment is sought following the onset of illness/injury" (Calabrese and Jonas 2010. Hum Exp Toxicol. 29(7):531-6).
"In homeopathy, remedies can be either toxic or inert in pharmacological, non-homeopathic doses...The hormetic agent, on the other hand, must have noxious properties to reveal its hormetic properties" (Oberbaum and Gropp 2015. Homeopathy. 104(4):227-33).
"The hormetic response is non-specific in nature, as opposed to the specific response of homeopathy" (ibid.).
The effect of a homeopathic remedy "is unique and frequently non-repeatable. It is usually complex, with unpredictable sequence, size, and duration. A hormetic effect, on the other hand, is simple, repeatable and easily predicted" (ibid.).
"Preparation of remedies and agents in homeopathy and hormesis also differs markedly. That of the hormetic agent is a straightforward procedure, albeit precise, feasible and familiar to any basic chemistry lab. In contrast, preparation of homeopathic remedies is a complex and fundamentally inexplicable process" (ibid.).
Oberbaum et al. (2015. Homeopathy. 104(2):97-100) summarized: "According to current knowledge, all that homeopathy and hormesis have in common is that homeopathy's Law of Similars is reminiscent of hormesis's biphasic principle. To claim that they are similar is akin to claiming that bicycles and cars are similar vehicles because both have wheels."
ARGUMENTS IN SUPPORT
The primary argument in favor of homeopathy is anecdotal evidence, with many satisfied patients. "Multiple peer-reviewed observational research studies on thousands of homeopathic patients demonstrate an average rate of 70%-80% favorable outcomes and excellent safety profiles in real-world practice" (I. Bell, in Novella et al. 2008. J Altern Complement Med. 14(1):9-15).
"Patients found the initial homeopathic consultation, which tended to last one to two hours, unusual when viewed against the background of their experience in the traditional healthcare sector, which was characterized by a lack of time...A further component of the 'fit' was that patients felt no inhibitions in relating everything that was important to them, i.e. with no fear of not begin taken seriously" (Schmacke et al. 2014. Qual Prim Care. 22(1):17-24).
Patients also perceive value in that homeopathic remedies will have no side effects, unlike conventional medicines.
Some reviews of research studies support effectiveness (see above).
There are also laboratory and animal studies considered to be supportive of homeopathy.
Homeopathy is alleged to work on unconscious people, infants, animals, and even plants, ruling out placebo effects.
It is claimed that in historical epidemics, patients treated with homeopathy fared better than those treated with conventional medicine.
ADVERSE EFFECTS
"As the typical homeopathic remedy is devoid of active molecules, it is unlikely to cause serious adverse effects. However, even a placebo can cause harm, if it replaces an effective therapy; in the words of the Australian report: 'People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.' Yet homeopaths continue to advocate their treatments for many life threatening conditions; some even backed homeopathy for treating patients with Ebola. Others recommend their remedies as a replacement for conventional immunisations" (Ernst, in Fisher and Ernst 2015. BMJ. 351:h3735). In 2017 an Italian boy died from an ear infection after being treated with homeopathic remedies instead of antibiotics. The parents were convicted of manslaughter.
As noted above, homeopathic products are commonly presumed to be safe. However, in the case of remedies with lesser degrees of dilution, some of the original material may remain, possibly causing adverse effects. This is especially true of "complex homeopathy," which sometimes uses undiluted mother tinctures. In addition, failure to meet manufacturing standards can result in bacterial contamination. In 2018 King Bio recalled several products due to microbial contamination.
"Preparations of heavy metals, such as arsenic, cadmium, mercury or iron, which are frequently used in homeopathy can be toxic, if not highly diluted. Other poisons regularly employed in homeopathy include aconitum, kerosene or thallium, which also can lead to serious health problems in sufficiently low dilution" (Posadzki et al. 2012. Int J Clin Pract. 66(12):1178-88).
Some regulatory actions include:
Sales of some Zicam cold remedies were stopped. Numerous users complained of loss of the sense of smell (2009).
The FDA warned of potential risks of using homeopathic asthma products instead of medication known to be effective (2015).
The FDA issued warnings about risks of homeopathic teething tablets and gels. There were over 400 reports of adverse effects, including 10 deaths. Some products contained belladonna (2016).
The FDA warned against potentially harmful products, including ones containing snake venom, and lack of safety testing in products for children (2019).
SCIENTIFIC CRITIQUE: BASIC CONCEPTS
The axioms of homeopathy "are not only out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics, chemistry, and pharmacology must be incorrect. To put it more strongly, in the parallel universe of homeopathy, life as we know it, would be inconceivable..." (Baum and Ernst 2009. Am J Med. 122(11):973-4).
The basic theory does not make sense. If the body already has symptoms, and these do not provoke the proper healing response, why should adding a tiny dose of something producing similar symptoms do so? The body is already receiving whatever signal it is that is connected with the symptoms; against the background of this relatively large signal, how could the minute signal of the homeopathic remedy produce an altered (and beneficial) effect? Smith (2012. Op. cit.) wrote that "there are no logical grounds for believing that 'like treats like', and the concept is not supported by basic empirical research. Furthermore, the principle of homeopathic similitude is simply a category mistake: it cannot be applied to modern medicine. The principle was conceived 200 years ago when it was unknown that disease exists in fundamentally different forms, each caused by a specific malfunction of a tissue or an organ. In light of this knowledge, we now know that diseases cannot be treated according to a common rule such as 'similitude'."
Grams (2019. EMBO Rep. 20(3):e47761) wrote: "the principle of similarity is a pre-scientific premise that today has no scientific evidence or support. Hahnemann, like his entire generation of physicians, was strongly influenced by various forms of the ancient principle of similarity, beginning with a primitive 'magic of similarity' up to the signature doctrine of Middle Age medicine and the early modern period. In essence, similarity is a teleological-anthropocentric concept: External similarities of things occurring in nature were 'sensuously' related to corresponding human categories."
Homeopathy interprets all symptoms as results of body's attempts to heal itself, which is inconsistent with medical knowledge. While consideration of the whole person is an important part of good medicine, scientific medicine also recognizes that not all aspects of the mind and body relate in a significant way to every problem. Homeopathy, in contrast, seems to be wholly indiscriminate, unable to distinguish factors that are significant from those that are not.
Homeopathy says that treatments may make symptoms worse before they get better, increasing the chance that the natural course of disease may be interpreted as a positive result (and allowing negative results in clinical trials to be rationalized). (Another rationalization: remedies in the wrong potency can give adverse rather than favorable responses.)
"Another prediction homeopaths believe in is that of homeopathic aggravations. These are acute exacerbations of the patient's presenting symptoms after receiving the optimal remedy. Homeopaths expect these phenomena to occur in ~20% of all patients. When we scrutinized placebo-controlled trials of homeopathy, however, we found that aggravations did not occur more frequently in the verum than in the control group" (Ernst 2008. Br J Clin Pharmacol. 65(2):163-4).
Homeopathy does not make sense from an evolutionary perspective. Its remedies do not resemble anything occurring in nature, and thus were not available until the last instant of human history. How, then, is it possible that our bodies evolved the remarkable ability to respond to the information putatively transmitted by homeopathic preparations?
SCIENTIFIC CRITIQUE: PROVINGS AND PRACTICE
In the original compilations of "provings," "the common accidents of sensations, the little bodily inconveniences to which all of us are subject, are seriously and systematically ascribed to whatever medicine may have been exhibited, even in the minute doses I have mentioned, whole days or weeks previously" (Oliver Wendell Holmes). Presumably the subject would be eating and drinking many other things, and be subject to many environmental conditions, during this period. Also, the subjects knew what they were taking, which could have influenced the reported symptoms. Extensive lists of symptoms were even reported in response to inert substances like salt and charcoal. Many of the provings apparently were done in violation of Hahnemann’s own principles, using symptoms of ill patients and also in response to highly dilute remedies. Some remedies were not established by provings, but simply by their apparent success in treatment.
In his article “Homeopathy’s ‘Law of Similars’” (Homeowatch. 2002) Stephen Barrett noted the following:
“A Dictionary of Practical Materia Medica,” a widely used 3-volume set authored by John Henry Clarke, M.D., illustrates the foolishness involved in provings. The book contains about 2,500 pages that describe the symptoms that supposedly were reported following administration of about 1200 substances. Most descriptive pages contain more than 100 claims, which means that total number of symptoms exceeds 200,000. The book does not indicate when or how the original “provings” were done or who reported most of the specific findings. Thus it would be impossible to examine whether the studies were properly done, who did them, and whether the findings were accurately reported.
Many of the listed symptoms are odd. Lac felinum includes “Cannot bear the smell of clams, of which she is naturally fond.” Lacrodectus mactans includes “Screams fearfully, exclaiming that she wold lose her breath and die.” Magnesia sulphurica includes “stupidity.” Oleum animale includes “Singing, tinkling, and buzzing in ears.” Natrum carbonicum includes “hurries out of bed in the morning.” Some listings include symptoms that occur predominantly on one side of the body, such as “sickening sensation in left testicle.” All are supposedly useful in determining whether the patient might “fit” a particular remedy.
"In a homeopathic Materia Medica almost none of the symptoms of any remedy state what level of dilution, if any, was used. Moreover, if a remedy was used for a sick person and that person was cured afterwards, this patient’s symptoms were also added to the Materia Medica. Many of these ‘symptoms’ are absurdly subjective. One example may suffice, symptom 546 of Anacardium in Hahnemann’s book on chronic diseases: ‘After playing on the piano he feels heavy and full in the body’" (Nienhuys 2016. Op. cit.).
"Even if the similia principle were correct (quod non), even if high dilutions had some effect (quod non), and even if the Materia Medica were correct and reliable (quod non), it would still be impossible to treat patients correctly due to the overwhelming number of `symptoms' in both patients and homeopathic books. It is evident that homeopathic practice does not correspond with homeopathic theory, and this in fact means that the way homeopaths make their treatment decisions is completely arbitrary" (ibid.).
SCIENTIFIC CRITIQUE: CLINICAL, PRECLINICAL, AND VETERINARY TRIALS
Bayesian statistical analysis takes into account the prior probability that a hypothesis is true. For the effectiveness of a homeopathic remedy, basic scientific knowledge indicates that the prior probability is near zero. Thus, apparent positive results in clinical trials are most likely false positives.
Placebo effects and observer bias may explain many anecdotal reports of success. The presence of a comforting person might even account for effects in infants and animals. A review by Antonelli and Donelli (2019. Health Soc Care Community. 27(4):824-47) found that effects of homeopathy were comparable to those of open-label placebos.
Linde and Melchart (J Altern Complement Med. 1998. 4(4):371-88) noted that “If the claims of classic homeopaths - that striking responses to homeopathic treatment occur quite frequently, that overall homeopathy is a clearly effective therapy, and that the remedy is the main cause of induced changes - are correct, it should be much easier to obtain more convincing and consistent results, even under the problematic conditions of double-blind placebo-controlled clinical trials.”
Ernst (in Fisher and Ernst 2015. BMJ. 351:h3735) wrote: "Numerous trials have tested the clinical efficacy of homeopathic remedies. Their results depend critically on the study design: uncontrolled studies almost invariably yield positive findings...whereas this is not true for the most rigorous of the 250 or so controlled clinical trials...The explanation seems obvious: the perceived benefits of homeopathy are caused by non-specific effects. Once these are adequately controlled for in trials, the results tend to show that highly dilute homeopathic remedies are indistinguishable from placebos...Because the risk-benefit balance of homeopathy is clearly not positive, even its use as 'benign placebo' for self limiting conditions is problematic. In such cases, it would be preferable to reassure patients rather than to deceive them with placebos."
Ernst (2018 Jul 19. Edzard Ernst blog) pointed out that not only is replication necessary, but results must be independently reproduced by another research group with no connection to the original group. "I know from many years of experience that a researcher who strongly believes in homeopathy or any other subject in question, will inadvertently introduce all sorts of biases into a study, even if its design is seemingly rigorous."
Most published studies are in homeopathic journals rather than in regular medical or scientific journals.
It is possible that in some clinical studies the homeopathic remedies have been adulterated to contain pharmacologically active substances. There is a need for independent analysis (more recent studies include such analyses).
Epidemiological studies supposedly showing the benefits of homeopathy during major infectious disease outbreaks are retrospective studies and cannot demonstrate cause and effect. Ernst (2017 Feb 5. Edzard Ernst blog) pointed out that in such a study " the result might have been due to a range of circumstances, for instance: group A might have been less ill than group B, group A might have been richer and therefore better nourished, group A might have benefitted from better hygiene in the homeopathic hospital, group A might have received better care, e. g. hydration, group B might have received treatments that made the situation not better but worse."
Loeb and others (2018. Vaccine. 36(48):7423-9) found that homeopathic vaccines (nosodes) do not produce any antibody responses.
Vickers (Forsch Komplementarmed. 1999 Dec;6(6):311-20), in a review of pre-clinical research in homeopathy, wrote: “There is a lack of independent replication of any pre-clinical research in homoeopathy. In the few instances where a research team has set out to replicate the work of another, either the results were negative or the methodology was questionable.” Witt et al. (2007. Complement Ther Med. 15(2):128-38) reviewed in vitro studies of high potency effects. "No positive result was stable enough to be reproduced by all investigators."
Lees et al. (2017. Vet Rec. 181(8):198-207) notes that some studies of physical properties of homeopathic solutions "involved technically complex analytical methods and lacked important control measures and other safeguards against error," such as blinding the investigators and having control solutions subjected to the same dilution and succussion procedures. "The use of complex methods in the absence of control measures predisposes to false-positive findings, especially if the experiments were carried out by believers in homeopathy, and such false positive findings may be more likely to be published by journals specifically concerned with homeopathy or other complementary and alternative therapies, if the journal editors and peer reviewers do not fully understand the methodology...Such factors are why independent replication is so important - not just for homeopathy-related experiments, but for any new experimental result...Furthermore, it is notable that, for the phenomena so far reported in such studies, there is no indication of how the phenomena - if genuine - might contribute to the claimed medicinal effects of the remedies."
Similarly, Grams (2019. Op. cit.) pointed out that "high-dilution research" "does not address the basic problem, namely the lack of proof of a specific medical effect. What is the value of measuring a small thermoluminescence deviation between pure solvent and a solution diluted beyond the Avogadro limit for the assertion that a globule, sprayed with 0.001 g of this solution, is an efficient malaria prophylaxis? There is neither a causal nor logical connection between this measurement and the homeopathic postulate. High-dilution research is a logical impasse, because it cannot prove the physiological effectiveness of high potencies in the human body, nor addresses the false premise of the principle of similarity, nor the arbitrariness of homeopathic drug testing. The desire to achieve scientific recognition in particular seems to obscure this."
A review of homeopathy use with livestock found "no study was repeated under comparable conditions. Consequently, the use of homeopathy currently cannot claim to have sufficient prognostic validity where efficacy is concerned" (Doehring and Sundrum 2016. Vet Rec. 179(24):628).
A review "concluded that homeopathic treatments are not efficient for management of clinical mastitis" (Francoz et al. 2017. J Dairy Sci. 100(10):7751-70).
SCIENTIFIC CRITIQUE: THE "MEMORY OF WATER"
Some homeopathic remedies are so dilute that they cannot contain any of the original molecules. Homeopathic explanations for this in terms of dynamizing the solution (causing the solution to retain its electromagnetic pattern, etc.) are inconsistent with knowledge of chemistry and physics. Why should water retain a "memory" of the homeopathic ingredient and not of the many other substances with which it had contact? It is not clear how such a "memory" would be retained when the agent enters the body (e.g., in crossing epithelial cell membranes). Also, in many cases the remedy is transferred from an alcohol or water solution to a lactose pill, a dramatically different physical structure which somehow retains the "memory."
If the extremely dilute homeopathic preparation contains some type of imprint or memory of the specific molecules added originally, why doesn't water in general contain such memories? As water flows through geological formations, it is exposed to numerous chemical and biological entities, which will be dissolved in minute quantities and subsequently diluted to homeopathic levels. The homeopath might argue that these processes do not involve succession. However, agitation of water occurs in many natural processes, such as waterfalls and rapids. Why should the highly artificial procedure of Hahnemann impart special properties to solutions which natural dilution and agitation do not?
"Everything we know about water suggests that water restructures itself within small fractions of a second (it is, after all, a liquid) and that any memory of an initial configuration is lost almost instantly. Why would things change with homeopathic preparations? Moreover...Why would the changed structure of the water have curative properties? Why would those curative properties become enhanced by further dilution of the substance? Why would those curative properties happen to match the symptoms caused by the original ingredient when taken in higher doses?" (Sehon and Stanley 2010. J Eval Clin Pract. 16(2):276-81).
Ball (2007 Aug 3. Water in Biology blog) wrote: "if we are to suppose the ‘memory’ to be somehow encoded in water’s structure, then we must accept that there should be many thousands of such stable structures, each accounting for a specific remedy – for several thousand distinct remedies are marketed by homeopathic companies, each allegedly distinct in its action. Yet another difficulty, seldom admitted by homeopaths, is that the dilutions of the mother tincture must allegedly be made by factors of ten and not any other amount."
"Moreover, homeopathic medicines are frequently taken as pills. These sugar pills are prepared by the addition of a drop of the ultra-diluted solution, which then dries out. Thus, for homeopathic pills to have any activity, it would be necessary for the 'memory' of the long-since-vanished molecules to be transferred from the water onto the sugar pill. Again, neither physics nor chemistry provides any support whatsoever for such a mechanism. Finally, the 'memory' must pass into the patient's body and exert physiological or biochemical effects: biological science offers no explanations as to how such 'information' could possibly alter bodily functions" (Smith. 2012. Op. cit.). There is no plausible mechanism proposed by which the body could receive the signal and act on it.
Ball (2007. Op. cit.) discussed the proposal that "water molecules can form long-ranged ‘quantum coherent domains’ by quantum entanglement, a phenomenon that makes the properties of quantum particles co-dependent over long ranges. Entanglement certainly exists, and it does do some weird stuff – it forms the basis of quantum computing, for example. But can it make water organize itself into microscopic or even macroscopic information-bearing domains? Well, these ‘quantum coherent domains’ have never been observed, and the theory is now widely disregarded."
Continuing, he noted "you can find an ‘explanation’ at this level for water’s memory from just about any physical phenomenon you care to imagine – dissipative non-equilibrium structures, nanobubbles, epitaxial ordering, gel-like thixotropy, oxygen free radical reactions…In each case the argument leaps from vague experiments (if any at all) to sweeping conclusions that typically take no account whatsoever of what is known with confidence about water’s molecular-scale structure, and which rarely address themselves even to any specific aspect of homeopathic practice. The tiresome consequence is that dissecting the idea of the memory of water is like battling the many-headed Hydra, knowing that as soon as you lop off one head, another will sprout."
Teixeira (2007. Homeopathy. 96(3):158-62) pointed out "Water, in all its forms (crystal, liquid, gas and amorphous forms) is certainly the most studied of all substances. All its properties have bene measured with extremely high accuracy in very different conditions, including metastable states and 'extreme' conditions" and "In particular, it is certain that: (a) There are no water clusters in pure liquid water, but only density fluctuations. (b) The longest life of any structure observed in liquid water is of the order of 1 ps (10-12 s). This is why any interpretation calling for 'memory' effects in pure water must be totally excluded."
Timmer and others (2007 Sep 18. Ars Technica) analyzed theoretical arguments presented in a special issue of Homeopathy (2007. 96:3) devoted to "The Memory of Water." Among their points:
Concerning Milgrom's ideas about entanglement: "This is a serious misuse of scientific terms; 'quantum mechanics,' 'entanglement,' and 'coherence' do not imply anything of the sort. The amount of time particles remain entangled is reduced by every interaction with other particles. As a result, at any particular moment, most particles in the universe are not entangled with anything."
"Apart from misunderstanding what constitutes an observer, Milgrom also misuses the concepts of entanglement and wave function collapse to create a system that sounds scientific but has absolutely no basis in the field where these scientific terms apply."
"Milgrom proposes that the information is not actually carried by a structure of water molecules but is an emergent behavior of the whole. Exactly what emerges and how it emerges are, apparently, left as an exercise for the reader."
"Some stock used in homeopathy is insoluble (for instance Berlin Wall). Such stock is not diluted but its concentration in the remedy is initially lowered by a process called ‘trituration’, a process which consists in grinding the source material in another solid material, usually lactose...But how is information transferred from one solid material to another?" (Ernst 2018 Feb 7. Edzard Ernst blog).
SCIENTIFIC CRITIQUE: "NANOPARTICLES"
Concerning the proposal that silicate particles form "nanostructured" particles around the template of the active ingredient, Ball (2007. Op. cit.) wrote, "The template is in general encapsulated by the silica, and so doesn’t act as a catalyst for the formation of many replicas. And for this idea to work, the polysilicate structure has to be capable of reproducing itself once the template has been diluted away – and at just the right level of replicating efficiency to keep its concentration roughly constant on each dilution. The last of these requirements elicits the greatest degree of fantastical invention from the authors: during the momentary high pressures caused by succussion, the silicate particles act as templates that impose a particular clathrate structure on water, which then itself acts as a template for the formation of identical silicate particles, all in the instant before water returns to atmospheric pressure."
"These 'nanoparticles' are almost certainly nothing more than contaminants and show no real evidence of being 'highly-reactive' or 'remedy-modified.' More importantly, they show no evidence of actually doing anything therapeutic" (Gorski 2012 Dec. 17. Science-Based Medicine blog).
If "nanoparticles" were introduced into the homeopathic solution at each step of succession, their concentration would reach a constant amount, not increase in concentration as required by homeopathic theory (Wheeler 2013. Nanoparticles. Kentucky Council Against Health Fraud). If it is alleged that the original homeopathic material acts as a catalyst for organizing the nanoparticles into a characteristic structure, how is it possible that every one of the thousands of homeopathic remedies has this property?
Ernst (2017 Jun 17. Edzard Ernst blog) wrote: "The nano-particles have been shown by just 1 or 2 research groups. I would like to see independent confirmations of their findings because I am not convinced that this is not simply an artefact without real meaning. Even if we accept the ‘nano-theory’ for a moment, there are numerous other issues. What about the many homeopathic remedies that use stock which is not material by nature, for instance, X-ray, luna, etc.? Do we need to assume that there are also nano-particles of non-materials? And for remedies that are based on a material stock (like arnica or nux vomica, or Berlin Wall, for instance), how do the nano-particles generate heath effects? How do a few nano-particles of arnica make cuts and bruises heal faster? How do nano-particles of nux vomica stop a patient from vomiting? How do nano-particles of the Berlin Wall do anything at all? If the ‘nano-theory’ were true (which I doubt very much), it totally fails to provide an explanation as to how homeopathy works. This explanation would still need to be identified for each of the thousands of different remedies in separate investigations. If nano-particles are truly generated during the potentisation process, it proves almost nothing. All it would show is that shaken water differs from unshaken water. The water in my kitchen sink also differs from pure water; this, however, does not mean that it has healing properties."
CRITIQUE OF USE IN PHARMACY
Pray (2010. Focus Altern Complement Ther. 15(4):280-3) summarized "Why pharmacists should not sell homeopathic products." Among his points:
"The efficacy of homeopathic products is unproved..."
"The safety of homeopathic products is unknown..."
"When pharmacists misuse their professional reputation to recommend products that are not known to be effective, patients may feel that they can forego legitimate therapy...serious medical conditions may go undiagnosed and untreated."
"The labelled ingredients of most homeopathic products are in Latin, which obscures their sources and forestalls legitimate questions on the part of the medical professional and the purchaser."
"Selling homeopathic products dishonours the professional relationship with the patient and yields a dishonest profit. This practice reduces pharmacists to the level of hucksters and predators..."
"Selling homeopathic products is, at best, legally questionable."
"Selling homeopathic products violates the 'oath of a pharmacist'..."
"Selling homeopathic products betrays a lack of intellectual honesty and rigour in thinking."
CHARACTERISTICS OF PSEUDOSCIENCE
Reliance on anecdotal evidence rather than controlled clinical studies (although there are some such studies, as described above).
"It is paradoxical that homeopaths repeatedly challenge the scientific community to prove that their products lack efficacy whereas it should really be up to them to provide evidence of the supported efficacy" (Garattini et al. 2014. Eur J Intern Med. 25(5):e68).
Violation of well-established principles of chemistry.
The basic theory and methodology has remained unchanged in more than 200 years. It is essentially a dogma established by a founding charismatic leader. (However, several auxiliary ideas, some of them contradictory, were added by various schools over the years.)
Medical science, like all areas of science, is characterized by many false leads and preliminary findings which are not verified in subsequent investigations. If, as it appears, it is the case the none of the original homeopathic remedies have been rejected upon more thorough investigation, it would be a good sign that we are dealing with a pseudoscience rather than a field of critical scientific inquiry.
Homeopathy claims to be able to cure a wide range of diseases and emotional conditions with a single curative principle. Diseases can be caused by such events as infection, mutation (cancer, developmental abnormalities), blockage of arteries, destruction of cellular components by ingested compounds or free radicals, inappropriate activation of the immune system, accidents, and other causes. It is highly unlikely that a single principle could result in an effective treatment for all of these.
"Homeopathic practice implies the belief that there is some property - an 'essence' - in each of the substances or objects they make their remedies from; it is that essence which gives rise, via potentisation (dilution, succussion, etc), to the specific curative properties of the remedy" (Lees et al. 2017. Vet Rec. 181(7):170-6).
False claim that the field of immunology supports the principles of homeopathy. The resemblance is only superficial:
While small quantities of antigens do stimulate the immune system, these are discrete molecules, and are not more potent at greater dilution.
Antigens used in vaccines are related to the actual causative agents of diseases they prevent, unlike classical homeopathic remedies.
Vaccines prevent diseases, rather than curing them or relieving the symptoms.
Vaccines involve stimulation of antibody production, but homeopathic remedies do not.
Vaccines take many days to produce their effect, while homeopathic remedies supposedly often work much faster.
Homeopathy invokes a vague, undefined vital force in allowing healing; it cannot identify any particular part of the body which is affected.
Hahnemann "claimed that chronic diseases were manifestations of a suppressed itch (psora), a kind of miasma or evil spirit" (Barrett 2016. Homeopathy: The Ultimate Fake. Quackwatch). "For him, every action at a distance was something spiritual. Magnetism, gravity, the effect of the tides, contagion by smallpox or measles, it was all ‘dynamic’ or ‘virtual’ or ‘spiritual’" (Nienhuys 2016. Op. cit.).
Homeopathy contains elements of primitive sympathetic magic, involving superficial similarities (e.g., a delicate flower for treating a delicate woman).
"Perhaps the clearest theme running through many areas of pseudoscience, however, is the attempt to make a whole that is far, far greater than the sum of its parts. Enlarging a collection of terminally-flawed trivia does not somehow strengthen its scientific significance. This is especially true when many of the components of the argument don't form a coherent whole. For example, quantum entanglement, structured water, and silica are essentially unrelated explanations, and any support for one of them makes no difference to the others. Yet, somehow, presenting them all at once is supposed to make the case for water's memory harder to dismiss" (Timmer et al. 2007. Op. cit.).
Smith (2012. Op. cit.) pointed out: "Scientifically tenable theories generate increasingly clear and accurate observations over time. By contrast, invalid theories, where pursued, accumulate negative results interspersed with rare positive results. The latter pattern is displayed by the body of published work on homeopathy. Moreover, the isolated positive reports of homeopathy are generally inferior studies. Regrettably, the existence of a few 'positive' publications has allowed biased reviewers to claim justification for homeopathy by cherry-picking isolated favourable studies, and ignoring their manifest weaknesses."
Refuting the claim that homeopathy is like Galileo's revolutionary changes, Gorski (2010 Aug 31. Respectful Insolence blog) wrote, "While science is continually changing, it's far more common for science to build on what has come before. New science tends to replace incomplete understanding with more complete understanding, not complete misunderstanding with understanding." He also noted, "It's hard to imagine a theory that would make homeopathy a plausible modality."
RECENT DEVELOPMENTS
2015 - After the review by the Australian National Health and Medical Research Council (see above, Reviews - Multiple Conditions), the Royal Australian College of General Practitioners issued a position statement, specifying that "1. Medical practitioners should not practice homeopathy, refer patients to homeopathic practitioners, or recommend homeopathic products to their patients. 2. Pharmacists should not sell, recommend, or support the use of homeopathic products. 3. Homeopathic alternatives should not be used in place of conventional immunisation. 4. Private health insurers should not supply rebates for or otherwise support homeopathic services or products."
2015 - A class-action lawsuit against homeopathic company Hyland's failed. The jury was instructed by the judge that plaintiffs had to prove that the products "cannot" work.
2016 - The British Advertising Standards Authority wrote that it had not "seen robust evidence that homeopathy works. Practitioners should therefore avoid making direct or implied claims that homeopathy can treat medical conditions."
2017 - Scientists exposed "homeopathy in disguise," a series of papers by a Russian group concerning their so-called "released-active drugs" (Dueva and Panchin 2017. J Mol Virol. 89(7):1125-6; Panchin et al. 2019. BMJ Evid Based Med. 24(2):48-52). These are in fact homeopathic preparations. They have been marketed in many countries for numerous conditions.
2017 - The Russian Academy of Sciences declared that homeopathy has "no scientific basis" and recommended that it should not be part of the national health system.
2017 - The British National Health Service decided to stop paying for homeopathic drugs, among other drugs considered "relatively ineffective, unnecessary, inappropriate, or unsafe for prescription."
2017 - The Royal Pharmaceutical Society (2017 Feb. Homeopathy: Quick reference guide) declared that it "does not endorse homeopathy as a form of treatment because there is no scientific basis for homeopathy nor any evidence to support the clinical efficacy of homeopathic products beyond a placebo effect."
2017 - The British Royal College of Veterinary Surgeons declared that "Homeopathy exists without a recognised body of evidence for its use. Furthermore, it is not based on sound scientific principles...It is vital to protect the welfare of animals committed to the care of the veterinary profession and the public's confidence in the profession that any treatments not underpinned by a recognised evidence base or sound scientific base or sound scientific principles do not delay or replace those that do" (Edzard Ernst blog. 2017 Nov 3).
2017 - "An independent review of Australian pharmacy practices has recommended that homeopathic products should be kept out of pharmacies that provide government-funded medications to patients" (Gavura 2017 Jul 13. Science-Based Medicine blog).
2017 - A new integrative medicine center at University of California, Irvine was criticized for apparently planning to include homeopathy.
2018 - After much criticism, the government of Ontario cancelled plans to offer a homeopathy diploma program at Georgian College.
2018 - The Spanish Health Ministry announced that in the case of some homeopathic remedies, manufacturers would need to apply for licensing, which would require evidence that the remedies are effective. For the majority of remedies, the products could no longer be sold and licenses could not be issued.
2018 - The Ninth Circuit Court affirmed a jury verdict in support of homeopathic manufacturer Boiron, which had been the subject of a class action lawsuit claiming deceptive advertising.
2018 - The Royal London Hospital for Integrated Medicine will no longer prescribe homeopathic remedies.
2019 - The Center for Inquiry filed a lawsuit against Walmart for selling homeopathic remedies. An earlier suit had targeted CVS.
2019 - The French Academies of Medicine and Pharmacy stated that French universities should not give degrees in homeopathy and that homeopathy should not be funded by the government. The government announced that it will end reimbursement for homeopathy by 2021.
2019 - "Senior NHS [National Health Service] leaders have called for the UK's largest group of registered homeopaths to have its accreditation revoked amid concerns that some practitioners are spreading misinformation about vaccines" (Iacobucci 2019. BMJ. 367:16248).
OTHER POINTS
French scientist Jacques Benveniste (died 2004) received much publicity for his studies allegedly showing in vitro effects of extremely high dilutions (Davenas et al. 1988. Nature 333(6176):816-8). Serious flaws were found in this research (Maddox et al. 1988. Nature 334(6180):287-90). Later, Benveniste claimed that homeopathic "memory" consists of electromagnetic waves, which can be recorded on a computer and transmitted electronically. An effort to reproduce his effects of digital signals found no evidence in support (Jonas 2006. FASEB J. 20(1):23-8).
Nobel prize winner Luc Montagnier claimed that "DNA emits weak electromagnetic waves that cause structural changes in water that persist even in extremely high dilutions. Montagnier considers himself an intellectual heir" to Benveniste (Enserink 2014 Sep 23. UNESCO to host meeting on controversial 'memory of water' research. Science).
Smith (2012. Bioethics. 26(8):398-409) pointed out that "insofar as homeopathy is recognized as an 'alternative' form of medicine, the risk is that credence lent towards this and other antiscientific forms of medicine may contribute to a general weakening of support for science-based medicine."
The organization "Homeopaths Without Borders" attempts to provide medical relief around the world. A critique by Shaw (2013. BMJ. 347:f5448) pointed out "Indeed providing homeopathic treatments might actually harm patients by making them think they do not need to seek conventional treatment for their injuries or diseases" and "Homeopaths Without Borders may well be diverting money away from genuinely humanitarian organisations such as Médicins sans Frontières, whose name Homeopaths Without Borders has also appropriated." After criticism in 2019, the Canadian government announced that it would discontinue funding the group.
It has been argued that it is impossible to practice homeopathy ethically, since patients are not told that there is no good evidence that it is effective, and therefore cannot give informed consent.
An analysis by Ostermann, Reinhold, and Witt (2015. PLoS One. 10(7):e0134657) found that "Compared with usual care, additional homeopathic treatment was associated with significantly higher costs."
Some have advocated the ethical use of homeopathy as a placebo. "When revisiting the therapeutic potential of homeopathy as a psychotherapeutic technique, an honest and ethical approach would involve telling patients that they are receiving a placebo or 'sugar pill' that is inert and contains no medication" (Prousky 2018. J Evid Based Integr Med. 23:2515690X18794379). However, the idea that one can provide placebos without deception has been challenged.
The remedy Oscillococcinum has attracted attention because of its absurdity. It "is one of the ten top-selling drugs in France, and it brings in $15 million a year in the United States. This one is particularly illogical, since the original substance never actually existed. A French doctor looked through a microscope at blood samples from victims of the 1918 Spanish flu epidemic and observed the phenomenon known as Brownian motion, where visible particles are jostled by collisions with water molecules. He didn’t recognize it as Brownian motion but imagined he had discovered a hitherto-unknown oscillating bacterium. He christened it Oscillococcus; then he imagined he saw the same bacteria in a sample of duck liver. The Oscillococcinum sold today is a 200C dilution of a smidgen of a Muscovy duck’s heart and liver" (Hall 2014. Op. cit.). The official name is "Anas Barbariae Hepatis et Cordis," and it is an example of isopathy rather than true homeopathy. It is marketed for relief of flu-like symptoms.
REFERENCES
Note - see text for additional references for research studies and reviews
Homeopathy - overview
National Center for Complementary and Integrative Health. 2019. Homeopathy
Barrett S. 2015. Homeopathic glossary. Homeowatch
Relton C, Cooper K, Viksveen P, Fibert P, Thomas K. 2017. Prevalence of homeopathy use by the general population worldwide: a systematic review. Homeopathy. 106(2):69-78
Homeopathy - principles
Thomas WE. 2000. Hahnemann’s homeopathy
Barrett S. 2002. Homeopathy's "Law of Similars." Homeowatch
Homeopathy - practice and scope
Lee ACC, Kemper KJ. 2000. Homeopathy and naturopathy: Practice characteristics and pediatric care. Arch Pediatr Adolesc Med 154(1):75-80
Barrett S. 2009. Sanum therapy: More homeopathic nonsense. Quackwatch
Nienhuys JW. 2016 Apr 16. Critical considerations on homeopathy. Skepsis Blog
Ernst E. 2017 Dec 3. Schuessler Salts: “Any expenditure on the purchase of these salts will be money wasted.” Edzard Ernst
Ernst E. 2017 Dec 20. Electrohomeopathy … endangering lives since almost 200 years. Edzard Ernst
Ernst E. 2017 Dec 20. Homotoxicology: "the best kept detox secret"? No, it’s even worse than homeopathy! Edzard Ernst
Ernst E. 2019 Jul 16. Homeopathy? Which one? Edzard Ernst
Homeopathy - regulation
Barrett S. 2015. FDA homeopathic product regulation. Homeowatch
De Dora M. 2015. Homeopathy "unsupported, ineffective, dangerous": CFI testimony to FDA. Skeptical Inquirer. 39(4):32-33
Bellamy J. 2015 Sep 3. Battle of the feds: FTC tells FDA to do its job regulating homeopathy. Science-Based Medicine
Gorski D. 2016 Jan 21. Will 2016 be the year when the FDA and FTC finally crack down on homeopathy? Respectful Insolence
Gorski D. 2016 Nov 16. A rare win for science: The FTC issues its enforcement policy on homeopathic remedies. Respectful Insolence
Novella S. 2016 Nov 16. FTC homeopathy win. Science-Based Medicine
U.S. Food and Drug Administration. 2017 Dec. 18. FDA proposes new, risk-based enforcement priorities to protect consumers from potentially harmful, unproven homeopathic drugs
Novella S. 2017 Dec 20. FDA proposes changes to homeopathy regulation. Science-Based Medicine
Ernst E. 2017 Dec 21. FDA on homeopathy: a "risk-based" enforcement is on the horizon. Edzard Ernst
Gorski D. 2017 Dec 22. Will 2018 be the year that the FDA finally regulates homeopathic remedies as drugs? Respectful Insolence
Sharpless NE, Woodcock J. 2019 Oct 24. Statement on the agency’s efforts to protect patients from potentially harmful drugs sold as homeopathic products. FDA Statement
Bellamy J. 2019 Nov 7. FDA strengthens homeopathic drug enforcement (but falls short of actually enforcing the law). Science-Based Medicine
Homeopathy and hormesis
Moffett JR. 2010. Miasmas, germs, homeopathy and hormesis: commentary on the relationship between homeopathy and hormesis. Hum Exp Toxicol. 29(7):539-43 [abstract]
Oberbaum M, Gropp C. 2015. Update on hormesis and its relation to homeopathy. Homeopathy. 104(4):227-33 [abstract]
Homeopathy - adverse effects
Posadzki P, Alotaibi A, Ernst E. 2012. Adverse effects of homeopathy: a systematic review of published case reports and case series. Int J Clin Pract. 66(12):1178-88
U.S. Food and Drug Administration. 2015 Mar 20. FDA warns consumers about the potential health risks of over-the-counter asthma products labeled as homeopathic
Gavura S. 2016 Jun 30. A systematic review about nothing. Science-Based Medicine
Novella S. 2016 Oct 5. FDA warns about homeopathic teething products. Science-Based Medicine
Abbasi J. 2017. Amid reports of infant deaths, FTC cracks down on homeopathy, while FDA investigates. JAMA. 317(8):793-5 [first paragraph]
Kaplan S. 2017 Feb 21. Homeopathic remedies harmed hundreds of babies, families say, as FDA investigated for years. STAT
Gavura S. 2018 Sep 6. Not just water! This homeopathy is contaminated with bacteria. Science-Based Medicine
Ernst E. 2019 Jun 8. Another child has died because of homeopathy. Edzard Ernst
Homeopathy - scientific critiques (general)
Barrett S. 2020. Homeowatch
Barrett S. 2016. Homeopathy: The ultimate fake. Quackwatch
Ramey D, Wagner M, Imrie RH, Stenger V. Homeopathy and science: a closer look
Holmes OW. 1842. Homeopathy and its kindred delusions. Quackwatch [classic analysis]
Reyburn R. 1890. Curiosities of homeopathic pharmacy. Homeowatch
Browning WW. 1894. Modern homeopathy: Its absurdities and inconsistencies. Homeowatch
BBC. 2002 Nov 26. Homeopathy: The test. Summary Transcript
Tyler C. 2006. Homeopathy. Sense About Science [link to pdf file]
Baum M, Ernst E. 2009. Should we maintain an open mind about homeopathy? Am J Med. 122(11):973-4
Sehon S, Stanley D. 2010. Evidence and simplicity: Why we should reject homeopathy. J Eval Clin Pract. 16(2):276-81 [abstract]
Shaw D. 2011. Homeopathy and medical ethics. Focus Altern Complement Ther. 16(1):17-21 [abstract]
Smith K. 2012. Against homeopathy: A utilitarian perspective. Bioethics. 26(8):398-409 [abstract]
Smith K. 2012. Homeopathy is unscientific and unethical. Bioethics. 26(9):508-12 [abstract]
Hall H. 2014. An introduction to homeopathy. Skeptical Inquirer. 38(5):54-8 [abstract]
Fisher P, Ernst E. 2015. Should doctors recommend homeopathy? BMJ. 351:h3735 [abstract]
Shaw D. 2015. A strong remedy to a weak ethical defence of homeopathy. J Bioeth Inq. 12(4):549-53 [abstract]
Bellamy J. 2016 Mar 17. American Journal of Public Health article touts “potential public health benefits” of homeopathy. Science-Based Medicine
Novella S. 2016 Aug 17. Deconstructing homeopathy propaganda. Science-Based Medicine
Gorski D. 2016 Aug 17. "What Doctors Don't Tell You" about homeopathy. Respectful Insolence
Gorski D. 2018 Apr 16. Homeopathy Awareness Week shows that homeopathy is still a problem. Science-Based Medicine
Gorski D. 2018 Apr 24. Only a homeopath has a belief system bizarre enough to defend a remedy based on spit from a rabid dog. Respectful Insolence
Ernst E. 2018 Jun 2. Doctor homeopaths violate fundamental rules of ethics when practising homeopathy. Edzard Ernst
Ernst E. 2018 Aug 3. There is no better treatment than homeopathy – at least for the homeopath! Edzard Ernst
Grams N. 2019. Homeopathy - where is the science? EMBO Rep. 20(3):e47761 [first page preview]
Homeopathy - scientific critiques: basic concepts
Pandolfi M. Homeopathy: Ex nihilo fit nihil. Eur J Intern Med. 21(3):147-8 [first paragraph]
Loeb M, Russell ML, Neupane B, Thanabalan V, Singh P et al. 2018. A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students. Vaccine. 36(48):7423-9
Gavura S. 2019 Apr 4. Randomized controlled trial of homeopathic nosodes finds, not surprisingly, that they are useless. Science-Based Medicine
Ernst E. 2019 Apr 15. Homeopathic vaccines do not evoke antibody responses. Edzard Ernst
Homeopathy - scientific critiques: clinical, preclinical, and veterinary trials
Ernst E. 2005. Is homeopathy a clinically valuable approach? Trends Pharmacol Sci. 26(11):547-8 [abstract]
Gorski D. 2007 Mar 13. Studying homeopathy in Third World countries. Respectful Insolence
Gorski D. 2007 Jul 2. Homeopathy in the - cringe - ICU. Respectful Insolence
Ernst E. 2008. The truth about homeopathy. Br J Clin Pharmacol. 65(2):163-4
Gorski D. 2010 Mar 4. A "homeopathic" bit of breast cancer "science," or: Who knew alcohol was so toxic? Respectful Insolence
Shaw DM. 2012. The Swiss report on homeopathy: a case study of research misconduct. Swiss Med Wkly. 142:w13594
Novella S. 2012 Jun 27. The Swiss report on homeopathy. Science-Based Medicine
Ernst E. 2012. Homeopathy: A critique of current clinical research. Skeptical Inquirer. 36(6):39-42
Australian Govenment National Health and Medical Research Council. 2015. Homeopathy
Gorski D. 2015 Aug 3. Is there a role for homeopathy in cancer care? I think you know the answer to that question… Respectful Insolence
Ernst E. 2015 Nov 25. Prof Frass' remarkable studies of homeopathy. Edzard Ernst
Ernst E. 2016 Apr 10.Homeopathic duck liver prevents common colds…in your dreams! Edzard Ernst
Ernst E. 2016 Aug 17. Homeopathy = a dangerous and unethical branch of pseudo-medicine that is impervious to progress. Edzard Ernst [dengue fever]
Novella S. 2016 Oct 12. Researching the magic of homeopathy. Science-Based Medicine
Ernst E. 2016 Oct 13. Another flawed trial of homeopathy reports positive findings. Edzard Ernst [upper respiratory tract infections]
Jones C. 2016 Nov 18. Homeopathic syrup for the treatment of pediatric colds: Randomized controlled nonsense is still nonsense. Science-Based Medicine
Ernst E. 2016 Dec 16. Homeopathy for the common cold: is this another case of scientific misconduct? Edzard Ernst
Ernst E. 2016 Dec 22. And again: no good evidence that homeopathy works in animals. Edzard Ernst
Ernst E. 2017 Jan 12. Homeopathy for infectious diseases: it is time for homeopaths to stop lying. Edzard Ernst
Ernst E. 2017 Feb 5. HOMEOPATHS LOVE IT: the epidemiological evidence suggesting that homeopathy works. Edzard Ernst
Gorski D. 2017 Feb 17. Homeopathy for breast cancer surgery? Isn’t it bad enough that the patient has cancer and needs a mastectomy? Respectful Insolence
Ernst E. 2017 Feb 27. Lies, damned lies, and Dana Ullman. Edzard Ernst [treatment of poisoning]
Ernst E. 2017 Mar 11. Homeopathic estrogen for endometriosis? Let’s wait for an independent replication! Edzard Ernst
Ernst E. 2017 Apr 11. Influenzinum: the homeopathic flu prevention that does not prevent flu. Edzard Ernst
Ernst E. 2017 Apr 14. New meta-analysis confirms that the clinical effects of homeopathic remedies do not differ from placebos. Edzard Ernst
Ernst E. 2017 Sep 26. Homeopathy is effective for anxiety and depression disorders!!! Or isn’t it? Edzard Ernst
Ernst E. 2017 Nov 7. Is Boiron (the world’s biggest manufacturer of homeopathics) telling the truth? What do you think? Edzard Ernst
Ernst E. 2017 Dec 27. "Homeopathy Works for the Flu"… and if Dana Ullman says so, it must be true!!! Edzard Ernst
Aust N. 2018 Mar 21. Prof Frass’ criticism of the Lancet meta-analysis of homeopathy: a rebuttal of a rebuttal. Edzard Ernst
Ernst E. 2018 Mar 6. Homeopathy works? … Yes, provided the trial has enough flaws to produce a false-positive result. Edzard Ernst [urinary tract infections]
Ernst E. 2018 Mar 15. Homeopathy for cancer: Dr Wurster and the "Clinica Sta Croce" in Switzerland. Edzard Ernst
Ernst E. 2018 Mar 19. I smell a rat: something extremely odd about the "positive" studies of homeopathy. Edzard Ernst
Ernst E. 2018 Mar 23. A new RCT of homeopathy … and, guess what, it reports a positive result (but are we being misled or not?) Edzard Ernst [dry cough]
Ernst E. 2018 Apr 12. Homeopathy: from the bizarre to the outright bewildering. Edzard Ernst [plant-based test systems]
Ernst E. 2018 Apr 16. A new Cochrane Review of homeopathy: “no evidence to support the efficacy of homeopathic medicinal products.” Edzard Ernst
Ernst E. 2018 Apr 18. Even the 3 "best" studies of homeopathy are far from convincing. Edzard Ernst
Chirumbolo S, Bjørklund G. 2018. Homeopathic Arnica from Boiron and post-operative bleeding in mastectomized women in Milan: Statistical flaws and bias to be addressed. J Tradit Complement Med. 8(1):1-3
Ernst E. 2018 Jun 8. The HOMEOPATHY RESEARCH INSTITUTE: bringing unreliable information to a wide international audience. Edzard Ernst
Ernst E. 2018 Jun 9. An analysis of Hahn’s critique of my homeopathy papers: YES, IDEOLOGY DOES SEEM TO PLAY A PART. Edzard Ernst
Ernst E. 2018 Jun 15. Another attempt by the UK "Faculty of Homeopathy" to mislead the public. Edzard Ernst
Ernst E. 2018 Jul 12. Homeopathy in the age of antimicrobial resistance: Is it a viable treatment for upper respiratory tract unfections? Edzard Ernst
Ernst E. 2018 Jul 14. Homeopathy for psychiatric patients? Yes, apparently, it is "advisable," even in severe cases! Edzard Ernst
Ernst E. 2018 Jul 15. Homeopathy for cancer? No, most definitely not! Edzard Ernst
Novella S. 2018 Jul 18. Homeopathic Arnica in plastic surgery. Science-Based Medicine
Ernst E. 2018 Jul 19. “Non-reproducible single occurrences are of no significance to science.” The example of the homeopathic diarrhoea trials. Edzard Ernst
Ernst E. 2018 Sep 7. Homeopathy is not helpful for depression – on the contrary, it depresses me! Edzard Ernst
Ernst E. 2018 Sep 9. Is 2018 the year when research into homeopathy died a natural death? Edzard Ernst
Ernst E. 2018 Sep 14. Homeopathy: yet another systematic review fails to prove its effectiveness. Edzard Ernst
Ernst E. 2018 Sep 17. Homeopathy for preventing complications of immunisation: another study and another negative result. Edzard Ernst
Ernst E. 2018 Sep 29. Another homeopathic product by Boiron has just been shown to be "effect-free." Edzard Ernst
Ernst E. 2018 Nov 26. A new, comprehensive review: HOMEOPATHY = PLACEBO THERAPY. Edzard Ernst
Ernst E. 2018 Oct 11. Is the latest "proof" of homeopathy fraudulent? Edzard Ernst
Ernst E. 2018 Dec 8. HOMEOPATHY WORKS! It is as effective as Ibuprofen for pain control … No, no, no – just joking. Edzard Ernst
Ernst E. 2018 Dec 12. Homeopathy for polycystic ovary syndrome: more homeopathic pseudoscience. Edzard Ernst
Ernst E. 2018 Dec 17. Homeopathy for urticaria? No! Edzard Ernst
Ernst E. 2019 Jan 5. Homeopathy for benign prostate hypertrophy (BPH)? No, afraid not! Edzard Ernst
Ernst E. 2019 Jan 31. Homeopathy: a new study proves efficacy (according to Dana Ullman). Edzard Ernst [upper respiratory infections in COPD patients]
Ernst E. 2019 Feb 19. Another meta-analysis of homeopathy shows how devastatingly negative the evidence truly is. Edzard Ernst
Ernst E. 2019 Feb 23. SCAM for animals. Part 1: homeopathy. Edzard Ernst
Ernst E. 2019 Mar 4. A p-curve analysis confirms: ultramolecular homeopathic remedies are placebos. Edzard Ernst
Ernst E. 2019 Mar 27. More dodgy research on homeopathy for Dengue fever. Edzard Ernst
Ernst E. 2019 Apr 5. Homeopathy for sleep bruxism? In your dreams! Edzard Ernst
Ernst E. 2019 Apr 20. Some people claim that we can save money with homeopathy – well, they are wrong! Edzard Ernst
Ernst E. 2019 Apr 25. A new, positive systematic review of homeopathy – confusion or fraud? Edzard Ernst
Ernst E. 2019 Jul 9. The two essential principles of homeopathy research. Edzard Ernst
Ernst E. 2019 Jul 10. A new example of "excellence in homeopathic research." Edzard Ernst [irritable bowel syndrome]
Ernst E. 2019 Sep13. Homeopathy for pre-menstrual syndrome? A critical assessment of a recent trial. Edzard Ernst
Ernst E. 2019 Oct 23. Homeopathy for treatment of irritable bowel syndrome: no good evidence for effectiveness. Edzard Ernst
Ernst E. 2020 Jan 9. Homeopathy for chronic peridontitis? I have my doubts! Edzard Ernst
Ernst E. 2020 Jan 15. "Homeopathic treatment … synergise the effect of antibiotics" – Really? Or is this a case of scientific misconduct or even fraud? Edzard Ernst
Ernst E. 2020 Jan 17. Homeopathy has greater effects than placebo – BUT ONLY IF YOU CHEAT QUITE HEAVILY. Edzard Ernst
Ernst E. 2020 Jan 22. Homeopathics can replace antibiotics! Yes, some deluded homeopaths believe this, but that does not make it true. Edzard Ernst
Homeopathy - scientific critiques: the "memory of water"
Ball P. 2007 Aug 3. A bad memory. Water in Biology
Teixeira J. 2007. Can water possibly have a memory? A sceptical view. Homeopathy. 96(3):158-62 [abstract]
Timmer J, Lee C, Gitlin JM, Ford M. 2007 Sep 11. Diluting the scientific method: Ars looks at homeopathy. Ars Technica
Ernst E. 2018 Feb 7. My challenge to the homeopaths of this world. Edzard Ernst
Homeopathy - scientific critiques: "nanoparticles"
Gorski D. 2010 Nov 18. Heavy metal contaminants: “Evidence” that homeopathy works. Respectful Insolence
Bal HS. 2010 Dec 24. The science and stupidity of homeopathy. Open
Hall H. 2012 May 8. Homeopathy and nanoparticles. Science-Based Medicine
Gorski D. 2012 Dec 17. A truly homeopathic defense of homeopathy. Science-Based Medicine
Wheeler TJ. 2013. Do nanoparticles provide a possible explanation for homeopathy? Kentucky Council Against Health Fraud
Ernst E. 2017 Jun 17. Is homeopathy "nano-medicine"? Edzard Ernst
Homeopathy - critique of use in pharmacy
Pray, WS. 2010. Why pharmacists should not sell homeopathic products. Focus Altern Complement Ther. 15(4):280-3
Gavura S. 2016 Aug 11. Pharmacy and homeopathy: Will the profession change, or will change be forced upon it? Science-Based Medicine
Bellamy J. 2017 Mar 30. CVS selling homeopathic remedies: It gets personal. Science-Based Medicine
Gavura S. 2017 July 13. Australian review: Get homeopathy out of pharmacies. Science-Based Medicine
Ernst E. 2018 Jul 31. Pharmacists put themselves at risk by selling homeopathic remedies. Edzard Ernst
Ernst E. 2018 Sep 20. The Royal Pharmaceutical Society's verdict on homeopathy. Edzard Ernst
Homeopathy - recent developments
Pakpoor J. 2015. Homeopathy is not an effective treatment for any health condition, report concludes. BMJ. 350:h1478 [abstract]
Iacobucci G. 2017. NHS to stop funding homeopathy and some drugs in targeted savings drive. BMJ. 358:j3560 [abstract
Bellamy J. 2017 Jan 19. Junk science helps homeopathic remedy company win class action. Science-Based Medicine
Dearden L. 2017 Feb 7. Russian Academy of Sciences says homeopathy is dangerous 'pseudoscience' that does not work. Independent
Ernst E. 2017 Sep 22. The European Academies’ Science Advisory Council’s verdict on homeopathy. Edzard Ernst
Gorski D. 2017 Sep 26. Homeopathy at UC-Irvine: The administration can run but it can’t hide from its history of embracing quackery. Respectful Insolence
Novella S. 2017 Sep 27. Homeopathy embarrassing to integrative medicine. Science-Based Medicine Insolence
Ernst E. 2017 Nov 3. Good news regarding homeopathy for animals: RCVS [Royal College of Veterinary Surgeons] POSITION ON CAM. Edzard Ernst
Ernst E. 2017 Nov 21. Homeopathy on trial. Edzard Ernst
O'Connor J. 2018 Feb 9. In wake of criticism, Ontario's Georgian College scraps planned homeopathy diploma program. National Post
Gallagher J. 2018 Mar 13. NHS homeopathy ending in London. BBC
Bellamy J. 2018 Jul 19. CVS sued for deceiving consumers in sale of homeopathic remedies. Science-Based Medicine
Anon. 2018 Oct 31. Spain wages war on dubious homeopathy meds. The Local
Gorski D. 2018 Dec 7. Boiron, oscillococcinum and homeopathy: Why courts do not decide science. Respectful Insolence
Salzberg S. 2018 Dec 10. Russian homeopathy, hiding in plain sight. Forbes ["release-active drugs"]
Panchin A. 2019. Homeopathy's new clothes: Release active drugs. Skeptic. 24(3):43-5
Gavura S. 2019 Jan 24. Pharmacies continue to sell sugar pills as flu remedy. Science-Based Medicine
Novella S. 2019 Mar 6. Canada is sending homeopaths to Honduras. Science-Based Medicine
Ireland N. 2019 Mar 18. Stronger action urged against homeopathic products touted as alternatives to vaccines. CBC News [Canada]
Anon. 2019 May 20. Walmart sued for fraud: Nation's largest retailer deceives and endangers consumers with homeopathic fake medicine. Center for Inquiry
Bellamy J. 2019 Jun 6. Walmart sued for deceiving customers in selling homeopathic remedies. Science-Based Medicine
Fourcade M. 2019 Jun 18. France’s 200-year-old love affair with homeopathy is under siege. Bloomberg
Novella S. 2019 Jul 10. France to end reimbursement for homeopathy. Science-Based Medicine
MAIN PAGE HOLISTIC
OTHER PARTS:
Part 2: Naturopathy Holistic Part 2
Part 3: Other "holistic" approaches: aromatherapy, bodywork, iridology, reflexology, and others Holistic Part 3
Part 4: Energy medicine and "New Age" healing Holistic Part 4