by Ronald D. Whitmont, M.D.
The World Health Organization (WHO) estimates that depression affects over 120 million people worldwide with women affected twice as frequently as men across all cultures. U.S. census data suggests that at least 20% of Americans have suffered from depression at one time in their life.
Depression is considered one of a group of mood disorders defined by specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference guide for mental health professionals. The group of mood disorders includes Major Depression, Depression, Dysthymia (a milder form of depression), Bipolar disorder, Cyclothymia (milder manic-depressive/bipolar illness), and others. Criteria for determining Major Depressive episodes must include at least five of the following symptoms: depressed mood, diminished interest in daily activities, weight loss or gain, insomnia (or excessive sleep, agitation (or retardation of activity), fatigue, feelings of worthlessness (or excessive guilt), diminished ability to concentrate (or indecisiveness), and recurrent thoughts of death (or suicidal ideation). To fit the criteria for classification as Major Depression these symptoms must cause significant distress or impairment in social or occupational functioning lasting for at least two weeks. There are no laboratory tests used to determine the presence of depression and there is no consensus regarding the cause of this illness. Even though the cause has not been elucidated there is a well documented familial tendency suggesting some form of genetic predisposition.
A multitude of diagnostic studies do demonstrate physical differences throughout the body (including the brain) in depressed individuals, but there is a great deal of confusion and controversy surrounding the meaning of these changes. So far, no one has been able to determine whether these changes are the cause or the effect of depression. Regardless, strong evidence does point toward an understanding that depression is a powerful force which is able to physically alter the body, making it more susceptible to developing physical illness and worsening the outcome when illness is already present. Depression is one of the risk factors for developing heart disease, hypertension, stroke and congestive heart failure. Depressed individuals are more likely to die after suffering a heart attack. Outcomes following stroke and cases of long term hypertension are much worse if depression is already present. Interestingly, treatment with antidepressant medication does not appear to alter survival statistics in these conditions, but interventions that provide psychosocial support and psychological therapies do appear to statistically improve survival outcomes. An example of this is found in the published work of cardiologist Dean Ornish, MD, who pioneered a program for reversing heart disease using life style changes and group therapy sessions. Ornish was able to show unequivically that the physical changes of heart disease could be reversed following behavioral therapies coupled with lifestyle changes. Ornish has also begun to test these same approaches in the treatment of cancer and other chronic illnesses with promising results.
Depression is a risk factor for developing irritable bowel disease and other common ailments of the gastrointestinal tract. It has been associated with significantly poorer outcomes in all of these ailments. According to the Epidemiologic Catchment Area Survey (ECA), depression is associated with an increased risk of developing Diabetes and a poorer outcome in existing cases of diabetes. In fact, the risk of developing Type 2 diabetes is twice as common in depressed individuals when other factors are controlled.
Depression is also associated with an increased likelihood of developing asthma and a poorer outcome in existing asthma. Improvement in depression scores following treatment aimed at depression have been associated with a secondary improvement in the underlying asthmatic condition. Unfortunately, many antidepressant medications worsen asthma, but the effects of psychological interventions have proven to be safe, effective and enduring.
An example of this is an interesting study that recently looked at the effects of emotional expression using journal writing in asthmatics. Researchers were able to identify improvement in asthmatic symptoms for several months following a series of simple exercises asking asthmatics to explore their own emotional reactions to past traumatic experiences in their lives.
Cancer has been found to be closely linked to depression. There are a number of studies demonstrating that effective, non-drug therapies (including psychoanalysis, group support therapy, hypnosis, and EMDR ?Eye Movement Desensitization and Reprogramming?[order changed, okay?] are associated with dramatic positive effects on life expectancy, survival, and cancer recurrence rates. Research with patients afflicted with breast cancer has revealed that group therapy support is associated with definite changes in the immune system and significant survival benefit many years later.
The mechanism by which depression effects the outcomes in these and other illnesses is not well understood. Depression is clearly associated with changes in the immune system and has been strongly correlated with inhibition of immune cell function in a number of different cell lines (including effects on T-Helper cells and Natural Killer cells). The effects of meaningful, emotive psychological and psychosocial interventions have also been correlated with improvement in these same indices in the immune system.
The treatment of depression and related mood disorders is a controversial topic today. The medical approach offers a potentially low cost, relatively quick form of therapy that can be quite effective in altering the symptoms and signs of depression, but perhaps not the underlying course of the disease. The gold standard of treatment among medically-oriented psychiatrists is electroconvulsive therapy (ECT). This modality involves delivering a relatively brief burst of electricity to the brain while the patient is sedated and paralyzed. This modality is actually quite effective, but it has fallen out of favor largely because it is socially unacceptable. Conventional psychopharmacology is one of the most widely utilized modalities for the treatment of depression in the world today.
It is clearly more socially acceptable than ECT (although significantly less effective) since it allows for the treatment of depression and other mood disorders in the privacy of one’s own home. Using conventional psychopharmacology one can keep knowledge of of one’s illness relatively private, thereby circumventing the social stigma which we place on mental illness in our society today. By optimistic estimates, conventional psychopharmacology is effective in removing symptoms of depression in about 30% of cases; of minimal benefit in about 40%, and a total failure in doing anything helpful the remaining 30% of patients. Over 50% of patients treated with psychopharmacology suffer from some form of physical or emotional side effect from the medication. These side effects range from the physically uncomfortable and emotionally unsettling to the potentially toxic and fatal. While drug-related benefits generally take several weeks to take effect, there have been numerous cases where depressive symptomatology was actually worsened, directly precipitating suicidal action or other violent behaviors. When drug treatment is discontinued a typical withdrawal syndrome commonly ensues. Following cessation of treatment, it is not uncommon for the original symptoms of depression to return.
In his recent book, Healing the Soul in the Age of the Brain, psychiatrist Elio Frattaroli, MD emphasizes that “psychiatry’s current emphasis on brain function ignores the emotional and spiritual dimensions of mental illness… that medication treats only the symptoms, not the underlying cause of depression, and that these medications enable patients to avoid true healing by avoiding full consciousness.”
The nonpharmacological approach to the treatment of depression may be more intensive in terms of human manpower. This approach is dependent not only on human interaction, but also the quality of that interaction and is a direct reflection on the level of expertise and training of those delivering this care. The effectiveness of this approach seems related to its ability to directly engage and stimulate individuals by offering perspective on and meaning to their lives. This is a difficult area to quantify and measure in scientific analysis and certainly impossible to manufacture in pill form. The problem with the non-drug approach in treating depression is that it is nearly impossible to standardize it in the same way that medications can be standardized. Non-drug treatment is almost entirely dependent upon the quality and the training of the mental health professionals delivering this care. Here lies the capacity for brilliant and effective healing, but also the risk of inadequate care, and failure. One of the ways to ensure effective progress using non-drug modalities is to use Homeopathic therapy as an adjunctive modality. In the words of Michael R. Glass, MD., a psychiatrist based in Ithaca, New York, in the foreword to the text “Prozac Free,” “Psychiatrists, psychologists, social workers, and other psychotherapists may discover an alternative to conventional drugs for those of their clientele who need medication. Homeopathic medicine does not replace psychotherapy . . . [it] removes depression, anxiety, delusions, dissociation and other symptoms so that therapy can do what it really does best: promote growth and development through self knowledge.” Many psychological interventions today embrace a holistic approach to the human mind, linking psychological and physical approaches to health and illness. Bioenergetics, body-oriented psychotherapy, dance and movement therapy, rolfing, hypnosis, EMDR and homeopathy are just a few of the modalities that bridge the gap between mind and body in the treatment of depression. In these and other modalities we find our greatest chance of shifting, not just the symptoms of depression, but the entire physical axis that depression and related mood disorders affect in their turn. There is clear and compelling evidence to support the use of these modalities to treat depression and to effect long lasting outcomes from a number of related physical conditions.
Ronald D. Whitmont, MD, DABIM, DABHM
Ravinder Mamtani, MBBS, MD, M Sc, FACPM
Homeopathy, Chapter 17 in Complementary and Integrative Medicine in Pain Management, editors: Weintraub MI, Mamtani R, Micozzi MS, Springer Publishing, NY, 2008
Homeopathy is a system of medicine that has been in continuous use worldwide for over two hundred years. It is based on principles outlined by Samuel Christian Hahnemann, MD, a German physician, in the late 18th Century. According to homeopathy (together with much of scientific thinking in the late 18th century) the body has a unifying energy, or “vital force,”, This vital energy when disordered causes illness and when harmonized, with the gentle assistance of the individualized homeopathic approach, heals the total person. The basic premise of homeopathy is that an illness with symptoms can be treated with a substance that produces similar symptoms in a healthy person. Homeopathic medicines consisting of such substances are given in diluted form to avoid any toxicity associated with these substances. Treatments are patient specific and individualized.
Homeopathy is safe and effective in a wide range of illnesses and conditions. Its acceptance in the U.S. has been the subject of extensive challenge over the last 200 years due to debate over the healing paradigm.
This chapter describes the history of homeopathy and outlines its fundamental premises. Next, it considers issues of legality and certification. It then examines the scientific evidence concerning effectiveness in the treatment of various health problems and pain management syndromes. Finally, it looks at practical issues including the limits of homeopathic practice.
It is beyond the scope of this chapter to examine all details of the art and science of homeopathy. Discussion of various topics will be brief, giving the reader an overview of the subject matter in the hope of stimulating clinical interest in what is otherwise an unexplored, underutilized and largely misunderstood field of complementary and alternative medicine (CAM).
Homeopathy is a branch of Western medicine, interest in which has undergone a renaissance in recent years. According to the World Health Organization (WHO), it is the most widely used form of alternative medicine in the world today. The use of homeopathy around the world is widespread and growing. It is practiced in nearly every country in the world. There are active state, national, and international homeopathic medical societies.
Many reports indicate a high level of patient satisfaction and clinical improvement using homeopathy. In one study performed at the Royal London Homeopathic Hospital, over 80 % of patients reported an improvement in their well-being and 90 % expressed satisfaction with the care they had received from homeopaths.1
More than 500 million people worldwide receive homeopathic treatment on an annual basis. Although homeopathy was developed in Germany in the late 18th Century, it is most prevalent today on the Indian subcontinent, where an estimated 300,000 homeopathic physicians and more than 300 homeopathic hospitals exist.
Homeopathy is also popular in the United Kingdom, and the rest of Europe. In France, an estimated 40% of the population use it on a regular basis. In the Netherlands nearly 50% of physicians consider homeopathy effective. In South America it is highly regarded and utilized by a large percentage of the poplulation.2 Over 10,000 medical doctors in Latin America are trained in homeopathy and use it in their practices.3
In the United States Homeopathy is one of the fastest growing forms of Complementary and Alternative Medicine (CAM). In 1997 alone, there were an estimated 4.8 million visits to Homeopathic practitioners in the U.S., while sales of homeopathic medicines have increased by 150% over the last decade.4
Hahnemann’s Discovery of Homeopathy
Homeopathic principles may have been utilized before the 18th century, but it was the German physician Samuel Christian Hahnemann (1755-1843) who was responsible for the first scientific study, systematic investigation, organized development, and documentation of its effects. Hahnemann’s work led directly to the definition of homeopathy as an organized medical specialty, its worldwide dissemination, use and acceptance.
The philosophical and theoretical roots of homeopathy can be traced to the writings of Paracelsus5 and other alchemical physicians of the Middle Ages. Before that, references to its principles are found in the medical writings of Hippocrates, the ancient Greek “Father of Medicine”.6
Homeo, homion, homoios and homoeo are prefixes derived from the Greek language. They are variations that mean “similar”. The suffix pathos or patheia means “suffering” in Greek. Thus, Homeopathy is the medical specialty which recognizes the relationship between health and illness based upon the healing principle of “similarity with suffering.”
Homeopathic physicians select medicines that match individual illnesses and maladies based on the principle of similarity. This means that the medicine whose effects most closely resemble the symptoms of the disease is that which is most capable of alleviating or curing the condition. For example, fevers might be treated with homeopathic preparations of Belladonna, a plant containing an atropine like substance capable of producing febrile states. This principle of healing is known as “The Law of Similars”. It is the fundamental principle underlying the homeopathic method of prescription (see below).
“Allopathic Medicine”, a term also coined by Hahnemann, derives from the Greek words “alloion” and “pathos”, meaning “heterogeneous” (or “unlike”) and “suffering”. This word describes the orthodox practice of prescribing medicines for illnesses based on the doctrine of contraries. This is the practice of administering pharmaceutical agents whose mode of action is opposite to that of the symptoms of the body. For example, fevers are treated with antipyretics, chemical compounds that act on parts of the brain that lower body temperature.
When homeopathic medicines are administered on the basis of similarity something entirely different from orthodox treatment seems to take place. Instead of the medicine working against the body systems, there appears to be some form of a paradoxical reaction that stimulates the body to heal itself.
Homeopaths match medicines with individuals by comparing the symptom picture of the patient with libraries of data that have been carefully collected and cataloged over the last two centuries. This is information which has been gathered by many clinicians and investigators (homeopathic and allopathic) who have studied the properties of each medicinal substance listed in the pharmacopoeia: their symptom-producing characteristics, how individuals have responded to medical treatment with each of these substances, data pooled from treatment responses in various epidemics and information gathered from poisonous ingestion and toxic exposures. The data retained on each medicinal substance is only that which has been repeatedly confirmed by clinical experience or scientific report. Sources used include pharmacologic research, toxicologic accounts, and reports made in carefully observed and controlled studies of the medicines with healthy volunteers not suffering from disease.
These latter studies, called “provings”, provide reliable information relating to the disease-promoting and disease-healing effects of each substance. Every medicinal substance in the homeopathic pharmacopoeia has been meticulously studied in this regard to document its ability to both disturb and reestablish health.
The genius in Hahnemann’s discovery of homeopathy consists of the finding that each particular medicine has a fundamental relationship with the illness that it treats. This relationship is expressed in the similarity between the symptoms the medicine will cause and those it will cure. The connection does not seem to be related to the physical or chemical characteristics of the medicine itself, or to the pathological changes of the illness. The fundamental bridge appears to reside in its capacity to create a similar state of suffering in the host. This basic principle was first described by Hippocrates more than two thousand years ago, however, it was not taken up and put into practice until Hahnemann introduced it as the formal practice of Homeopathy in 18th Century Germany.
Hahnemann was a gifted scholar and a master of many languages who translated medical texts to support his growing family. While translating a pharmaceutical treatise by the Scottish physician William Cullen on the properties of Peruvian bark (cinchona, also known in Europe as “Spanish bark” or “Jesuit bark”) in 1789, Hahnemann reached a turning point. He found that he did not agree with the author’s statement that Peruvian bark (which was later found to contain quinine) cured intermittent fever because of its “astringent and bitter qualities”. Hahnemann believed that successful cure must rest in some other intrinsic relationship between the medicine and the illness.7 He set out to discover what this was.
To test a hypothesis Hahnemann devised the unique strategy of ingesting small amounts of raw Peruvian bark and observing its effects on his own health. When the bark was taken internally for several days, he began to develop clear symptoms of bark poisoning:
“My feet and finger tips, etc., at first became cold; I became languid and drowsy; then my heart began to palpitate; my pulse became hard and quick; and intolerable anxiety and trembling (but without rigor); prostration in all the limbs; then pulsation in the head, redness of the cheeks, thirst; briefly , all the symptoms usually associated with intermittent fever, as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body- all made their appearance. This paroxysm lasted from two to three hours every time, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once again in good health.”8
Hahnemann observed that the symptoms he experienced from taking the bark were exceedingly similar to the symptoms of the intermittent fever which the bark cured. He recognized this as a demonstration of one of the fundamental laws of healing described by Hippocrates. Because Hahnemann had the mind of a scientist he knew that a single case was not enough proof. He decided to further test his theory by observing other cases. This would show if his initial finding was a coincidence or if in fact there was some consistent principle at work which governed these phenomena.
After verifying the effects of Peruvian bark on numerous subjects he enlarged the theory by conducting trials on many other drugs and substances. These types of tests were later called “provings”, which was a corruption of the German word “pruefing”, which means “to test”. Hahnemann’s did not intend to “prove” anything with these tests. His intent was to discover the action and understand the effects of various drugs on healthy subjects so he could later match them with cases of illness whose symptoms resembled these same patterns and thereby effect a cure.
He conducted these drug tests or “provings” on himself, family members, friends and colleagues. He was careful to observe and record the findings in meticulous detail. Over his lifetime he studied and cataloged the results of testing nearly 100 medicinal substances in this way. The results of these empirical studies were organized as the “Materia Medica Pura”, published in 6 volumes beginning in 1830.9 When he later applied the findings of his provings to the process of treating cases of illness he found that his hypothesis, that like cures like; that the same substance can both cause and cure a disorder, was borne out again and again.
After Hahnemann completed the “provings” of drugs in his early pharmacopoeia he administered them to the sick. He selected his remedies by comparing the “proven” symptoms he knew the drugs could produce with the actual symptoms suffered by the patient. He selected those drugs that matched most closely and when he did so he was frequently able to effect a cure.
He had hypothesized that there was a fundamental relationship between medicines and disease observable in the parallel between the effects that a medicinal substance has disordering a healthy body and its ability to stimulate a cure in a diseased body. This principle was repeatedly tested when substances were administered with careful scrutiny and their effects followed with meticulous scientific observation.
He proved that the curative power of a medicine lay in something other than its chemical actions. He found that the essential ability to bring about a cure was linked with a medicines ability to impair health by producing a state of similar suffering. Before this time, Hippocrates, Paracelsus and others had suggested the existence of this unique relationship between medicine and disease, but none had thoroughly worked out the logic or tested the theory scientifically with systematic objective observation and proof in human subjects.
Hahnemann was one of the first physicians to devise and apply the concept of a ‘drug trial’ to study the effects of medicines in healthy individuals. He also used “quantitative and systematic procedures, clinical trials with control groups, and … statistics in medicine” for the first time ever in his analytical explorations.10
Homeopathy is based on these demonstrated logical principles and on the clinically observed phenomena of provings and cure. This means that, at its foundation, homeopathy is rational and empirical, and scientific. It is based upon objective observation and subjective reporting of experience. Explaining the mechanism behind the phenomenon of homeopathy did not concern Hahnemann. He recognized that this task would be left to others. It was enough for him to prove the existence of the relationship and provide a means to apply it to the sick.
Physicians around the world quickly confirmed the soundness of Hahnemann’s work. His reputation spread until today the practice of homeopathy extends from Germany throughout Europe, Asia, Australia and into the Americas.
Homeopathy was first introduced to the U.S. in 1825, starting in the state of New York. It spread with the movement of German immigrant physicians into Pennsylvania and Virginia, gaining a wide following as they spread out. Homeopathic medical kits even accompanied many early American settlers in their migrations across the continent where there were few regular physicians to be found.
The first homeopathic medical school in the US was founded in Philadelphia in 1848 (Hahnemann School of Medicine). It grew so rapidly that in 1850 it relocated to a larger facility and the old building was occupied by the first womens’ medical school (Womens Medical College of Pennsylvania). The Hahnemann School of Medicine and the Womens Medical College of Pennsylvania merged in the 1990’s and shortly thereafter their charter was acquired by Drexel University. After several decades of neglect, homeopathy is once again being taught at Hahnemann Medical College of Pennsylvania in the new Drexel University CAM curriculum. [The original 1848 site is now the location of WHYY public television]
By the late 19th century there were 110 homeopathic hospitals, 145 homeopathic dispensaries, 62 homeopathic orphanages, over 30 homeopathic nursing homes and 16 homeopathic insane asylums in the U.S.11 In the early days of the 20th century 8% of U.S. physicians used homeopathy. There were 20 homeopathic medical schools and over 140 homeopathic hospitals in the U.S., including New York Opthalmic Hospital and Flower and Fifth Avenue Hospital, which later became New York Medical College.12 Homeopathy gained further footing through its effectiveness (and the ineffectiveness of regular medical treatments) during epidemic outbreaks, including the yellow fever (1793, 1798) and cholera epidemics in the late 18th to late 19th centuries and the influenza pandemic in the early twentieth century (1918-1919) [the last yellow fever epidemic in the US was in 1907 in New Orleans, Charity Hospital]. In the U.S., homeopathic physicians served on the boards of state and local health agencies in New Jersey, California, Pennsylvania, Indiana, Illinois, Nebraska, Delaware, Florida, Kentucky, and other states.13
During the 1930’s the only physician serving in the US Senate was S. Royal Copeland, a homeopath. He introduced the US homeopathic pharmacopiea which has remained in effect ever since.
Shortly after its introduction into the American medical scene many able medical practitioners adopted homeopathy. At the same time, there were a great many others who opposed its principles, and fought against it. The ensuing battle between homeopathy and allopathy raged for nearly a century. This battle was punctuated by the founding of the American Institute of Homeopathy (AIH) in 1844 and then the American Medical Association (AMA) in 1847. The founding charter of the AMA forbade its members and its member state organizations from including, socializing or consulting with homeopathic physicians under the threat of expulsion with loss of professional status and licensure.
Each camp was bitterly opposed to the practices and philosophies of the other. Both of these societies remain in existence today, but the overwhelming support of the nation was eventually thrown in behind the AMA. The AIH remains the oldest extant medical society in the United States, predating the AMA by three years, but it continues to be dwarfed by the AMA in both budget and membership.
Homeopathy reached its zenith in the U.S. during the late 19th century, and began its decline in the early twentieth century. Some of the reasons why homeopathy faded from the American medical scene in the 20th century included the efforts of the AMA, but other factors including internal conflict within the ranks of homeopathic physicians themselves lead to its demise. Within the field of homeopathy a battle raged between classical Hahnemanian practitioners and those who adopted a more eclectic orientation which integrated homeopathic treatments with other therapeutic modalities. This internal conflict between homeopaths eventually divided their ranks and weakened their social and political clout, ultimately leading to the dissolution of the profession.
A third factor contributing to the demise of homeopathy in America was the simultaneous rise of the pharmaceutical industry and the emergence of entirely new classes of medications that were increasingly safe and effective.
When the Flexner report (1910)on American medical education, sponsored by the new Rockefeller Foundation, appeared in the early 20th century it described homeopathy as a medical specialty already in decline. That report further eroded homeopathic medical education and lead to the closing of many homeopathic medical schools and hospitals. This contributed to a trend which allowed homeopathy to nearly disappear from the American medical scene during the 20th century. Homeopathy was barely kept alive in the U.S. by a small handful of physicians and an emerging group of lay practitioners.
The late 20th century was marked by an expansion of public interest in all forms of alternative medicine. The practice of homeopathy was rediscovered on the American scene and it has since reemerged as a system of medicine that is user-friendly, safe, inexpensive and effective.
Legal Status of Homeopathy in the U.S.
Homeopathy has been in continuous use in the United States since 1825 when it was first introduced by Dr. Hans Burch Gram in New York City. These medicines were used safely and effectively throughout the country for more than one hundred years before they were incorporated into the U.S. Food, Drug and Cosmetic Act of 1938 (21 U.S.C. Section 301).14
Section 201(g)(1) of this Act defines homeopathic medicines or remedies as “drugs”. These include articles recognized in the official United States Pharmacopeia (USP), the official Homeopathic Pharmacopeia of the United States (HPUS), or the official National Formulary (NF) or any supplement to them.
The Federal Food, Drug, and Cosmetic Act recognizes as official, the drugs and standards in the Homeopathic Pharmacopeia of the United States (HPUS) and its supplements (Sections 201 (g)(1) and 501 (b), respectively). The manufacture of homeopathic medicines accepted by the HPUS must meet the standards for strength, quality, and purity set forth in the Homeopathic Pharmacopeia according to Section 501(b) of the Act (21 U.S.C. 351). Each new medicine undergoes a thorough clinical proving in a double-blinded setting prior to its acceptance into the HPUS.
Homeopathic drug product labeling must comply with the labeling provisions of Sections 502 and 503 of the Act and Part 201 Title 21 of the Code of Federal Regulations (CFR), with certain provisions applicable to extemporaneously compounded over the counter (OTC) products.
Consumers should look for the USP and HPUS seals when purchasing homeopathic medicines to ensure that they are fully monitored for sanitary manufacturing processes and correct ingredients within these strict guidelines. Manufacturers are required to list all ingredients on their labels.
In the USA, only homeopathic medicines that claim to treat self-limiting conditions may be sold over-the-counter and homeopathic medicines that claim to treat more serious diseases can be sold only by a physicians prescription.15 Although the production of homeopathic materials is quite inexpensive, the delivery of homeopathic care can be both time and personnel intensive, since individuation of prescription is usually required.
Regulation of the practice of homeopathy is not uniform within the U.S., but varies somewhat by state. Only four states (Arizona, Connecticut, Nevada and Washington) currently offer specific medical licensure in Homeopathy. Many other states provide legislation that allows physicians to practice it, and some have no measures pertaining to its use. Many states with “Health Freedom” legislation allow non-medically trained lay-persons to practice homeopathy without medical licensure. Questions pertaining to practice guidelines and regulation of homeopathy should be addressed to individual state medical societies and, if applicable, state homeopathic medical societies (See appendices).
The Federation of State Medical Boards has passed model guidelines for practitioners of complementary and alternative medicine (CAM). These guidelines are not binding, but do reflect a trend toward integration of various CAM disciplines, including homeopathy. These guidelines recognize that “patients have a right to seek any kind of care for their health problems.”16
Certification of homeopathic training is currently not recognized by the American Board of Medical Specialties of the United States. Certification for physicians is offered by the American Board of Homeotherapeutics, which confers the Diplomate in Homeotherapeutics (DHt) certification in Classical Homeopathy. Certification is highly recommended, but not required by any licensing authorities.17
Various state and national professional organizations for physicians who practice homeopathy do exist. These groups are active regionally and nationally promoting legislative action, education and health care reform.
There is no doubt that the practice of homeopathy requires a thorough knowledge of its principles and methods. Homeopathic practitioners must also be thoroughly grounded in the fundamentals of medicine, and have expert clinical training in differential diagnosis and appropriate referral strategies. Experts also recommend that the principles and ethics of informed consent be incorporated, documented and observed at all times.
Although not expressly required by law, many attorneys specializing in CAM matters recommend that each case receive a thorough discussion (and documentation of this discussion in the medical record) which should include informed consent and assumption of risk.
The basis of homeopathic medicine rests upon its empirically tested clinical effectiveness. The concepts and principles underlying our understanding of homeopathy only evolved after the phenomena were observed.
The key concepts that distinguish homeopathic from allopathic practice include the nature of disease, the nature of medicine, individualization, the psychosomatic totality of symptoms, the law of similars, the single remedy and the minimum dose.
The Nature of Disease
According to homeopathic principles, all diseases arise as secondary phenomena following a disruption or imbalance of the “vital force”.
The vital force is Hahnemann’s designation for the proposed fundamental energy system operating within all living beings. It is a non-physical, energetic and spiritually coherent force that underlies all living biological function. The state of the vital force governs health. Disturbances of this energy system are believed to be the fundamental causes of illness. Pathological changes seen in many diseases are believed to be secondary events that take place only after the vital force is disturbed.
Hahnemann believed that the vital force acts as a governor, or central directing agency in the balance between health and illness. If this system of energy is disturbed (by either physical, emotional, or energetic events), then the biological machinery can become disturbed, leading to illness or greater susceptibility to illness. Illness is an event that involves the energy of a system before it is apparent as any outward expression or symptoms of sickness.
Since the vital force is not physical, and it can never be directly observed through physical means, its existence can only be inferred though the symptoms and sensations present in an individual. These symptoms are, at best, only an approximation of the vital force, like a shadow cast on the physical plane. Thus, the pattern of symptoms constitutes the closest possible understanding of the fundamental disturbance of the vital force underlying physical illness. These symptoms of illness represent the translation of the vital force into the language of the body. Once the symptoms of the vital force are translated into the language of the body, the homeopath can address the fundamental disturbance of the vital force by utilizing a medicine that acts at the same level.
Hahnemann’s study of illness showed him that the dynamics of the body’s vital force, i.e. the way it energetically changes over time, can be described with the words, vis medicatrix naturae. This means that it exhibits a natural tendency for these energies to move toward homeostatic balance and equilibrium; there is an innate drive to restore health. If the physician helps this process along by moving it past the points where it may be “stuck”, then the path to restored health will be opened. This process entails using medicines that match symptoms of the illness and stimulates the body at the same level that was initially disturbed, ie, at the level of the vital force.
Homeopathy is not alone in expounding this theory of energy that underlies health. Similar concepts and paradigms can be recognized in many other forms of CAM, non-western, and prayer based healing practices. Clinical research into many of these systems suggests that there may be more to health and healthy functioning than just mechanical and biochemical factors.
The Nature of Medicine
The drugs in the Homeopathic Pharmacopoeia of the United States are derived from many sources, starting with the three kingdoms of nature: plant, mineral and animal. In addition, some are derived from diseased tissues, from conventional allopathic medicines and some from “imponderable” nonphysical sources, such as magnetic fields, electrical currents, electromagnetic radiation, color and sound.
Homeopathic medicines can be developed from virtually any source. The Pharmacopoeia Convention of the United States specifies the manner and method by which these medicines must be prepared and tested prior to use in order to qualify for inclusion.A
Preparation of a homeopathic medicine typically begins by taking one part of a crude substance, then pulverizing, grinding (if it is a solid) or dissolving it (if it is liquid), so it can be diluted in a solvent, whether alcohol, water or sugar. Immaterial phenomena may be gathered and fixed by other means.
Next, the substance undergoes a process of successive dilutions in the same solvent, until the desired attenuation (“potency”) is obtained. This dilution process frequently reduces the material presence of the substance up to and beyond the point where there may be no mathematical probability of finding even a trace of the original material substance in the homeopathic medicine. In other words, most homeopathic medicines are made so dilute that they contain none or nearly none of the original material substance.B This is called “the infinitesimal dose” or “minimal dose” (see below).
Medicines prepared with only a few dilutions will still have some material amount of the original substance present. These are termed “material doses”. When the dilution process exceeds a certain point, then the potency is considered “non-material” or infinitesimal. Such infinitesimal potencies have been found to have a capacity to cure that is even greater than their material counterparts.
Hahnemann postulated that by preparing a non-material dose a medicine became capable of stimulating the non-material vital force. Material doses, on the other hand, appeared to have less effect, if any, at the level of the vital force. This suggests that homeopathic medicines are “energy medicines” and their mode of action reside at some energetic level.
Since homeopathic medicines do not appear to act through physical means (because they are so dilute) they are believed to act energetically through means that remain unexplained and unexplored by most physical models. Their mode of action is certainly not a matter of biochemical or biomechanical activity. These substances appear to act at some energetic level through some process, as yet only vaguely understood and largely unexplained by current medical theory.
Hahnemann did not believe that homeopathy could be explained by any mechanistic model known during his lifetime.
“As this natural law of cure manifests itself in every pure experiment and every true observation in the world, the fact is consequently established; it matters little what may be the scientific explanation of how it takes place; and I do not attach much importance to the attempts made to explain it.”18
Homeopaths have shown that medicines chosen using homeopathic principles and delivered in infinitesimal doses help the body restore healthy functioning. Their theory postulates that the medicines act energetically to assist the “vital force” of the organism in the process of self-healing, but there is no generally accepted explanation for how this process takes place.
Hahnemann considered knowledge of the patient’s subjective experience of illness to be a critical element in case analysis leading directly to the determination of the proper medicinal treatment. Using this algorithm different individuals with the same diagnosis might receive different homeopathic treatments if their subjective experience of illness was different enough. Extending this view further, individuals with different diseases who shared similar subjective experiences of their illnesses might be treated with the same medicine. Successful homeopathic treatment requires the individualization of each case as a unique and particular disturbance of a unique and particular individual. Treatment relies upon matching the unique characteristics of that individual disturbance with the unique characteristics of the correspondingly similar medicine. This process is akin to fitting a key to it’s corresponding lock, and sometimes like searching for a needle in a haystack.
As the example above suggests, homeopaths are only secondarily concerned with differences in disease pathology and the subtleties of different diagnostic categories. Understanding these objective factors may be helpful in tracking the progress of cases, but it does not directly assist in the process of selecting the correct treatment or healing the case. The most important information for the homeopath is the subjective experience of the afflicted individual. The subjective experience provides indirect data on how the vital force has been deranged, and how it can be assisted. Understanding of the unique symptoms of the afflicted individual is the primary basis of the homeopathic prescription that allows medicines to be administered in a “lock-and-key” manner to treat each individual.
Thus, the practice of homeopathy is, by definition, based upon an individualized approach to individuals. The symptoms of illness in each individual constitutes the “signature” of the disease as it is expressed uniquely by that individuals vital force. That signature must be carefully studied so that it can be matched with the unique “signature” of the corresponding medicine.
The Law of Similars
Hahnemann’s initial work uncovered and proved the Law of Similars. That law states: “Similia Similibus Curentur.” Translated from Latin this means: “Let likes be cured by likes”. This means that an illness may be cured by an agent that is related to the illness by virtue of its ability to produce a similar state of suffering when administered to a healthy host.
The Law of Similars is the fundamental healing law at the center of homeopathy. It was first mentioned by Hippocrates nearly 2,400 years ago. This law was suggested by Hahnemann only after its veracity was realized by his painstaking investigation and testing.
The Psychosomatic Totality of Symptoms
Since symptoms are the closest possible description of the disturbance of the vital force, analysis of the entire psychosomatic pattern of symptoms that develop in an individual is necessary to approximate the nature of the disturbance in the vital force.
Hahnemann advised his followers to include all the symptoms of the patient in analysis of the case, a process known as “repertorization”.
“He told the homeopathic physician to take down in writing every single observable symptom of the disease together with anything else the patient could be persuaded to tell. For greater accuracy, this should be written down in the patient’s own words whenever possible.”19
Most substances, not just homeopathically prepared medicines, have demonstrated an ability to produce psychological as well as physical effects in the organism. When substances are “proven” in healthy individuals, so that they can be used as a homeopathic medicines, a wide spectrum of symptoms are usually elicited. These symptoms range from highly specific to very general; from physical to emotional and cognitive in nature. There is no substance known whose effects are solely limited to one organ system or one local reaction. All medicines of the homeopathic pharmacopea have demonstrated both physical as well as emotional and mental symptoms in their provings.
Classically trained homeopaths take advantage of these psychosomatic effects when prescribing. The most effective prescriptions are based on physical, emotional and cognitive symptoms of the individual. As a result, homeopathic treatment is known to be effective in treating a wide range of conditions, encompassing psychological as well as physical disturbances.
The Single Remedy
Homeopathic theory suggests that the vital force is akin to a vibration within the body. It suffuses the entire organism and interconnects the entire system in a unified field effect. The vital force may be acted upon by different factors that disrupt or change its nature, but it only expresses one single frequency pattern at any given point in time. All the combined systems of the healthy body fall under its jurisdiction. All of the symptoms of illness result from a single disturbance of the vital force.
Different illness do not reside simultaneously within the same individual at the same time. This theory suggests that if only one disturbance is present, then only one correction, one medicine, is necessary at any corresponding point in time to treat the entire energetic imbalance. For this reason, classically trained homeopaths generally avoid the practice of polypharmacy. They prescribe only one single medicine at a time recognizing that they are treating not just the manifestations of illness, but the disturbance of the vital force, which caused the illness.
For this reason Hahnemann strongly cautioned against using more than one medicine at a time.
“In no case under treatment is it necessary and therefore not permissible to administer to a patient more than one single, simple medicinal substance at one time.”20
This approach of the “single remedy, single dose” is one of the cornerstones of classical homeopathic prescribing. It persists today among the most authoritative homeopathic practitioners in the world.
The Minimum Dose
The law of the minimum or the “infinitesimal” dose was not a fundamental principle of early homeopathic practice, as defined by Hahnemann, but it has ascended to this position over time. A rudimentary form of homeopathy could be effectively practiced without this principle, but its inclusion and application enhances not only the safety but also the scope and versatility of homeopathic treatments.
Hahnemann proved that illnesses can be safely and effectively treated by utilizing small amounts of substances prescribed in accordance with the law of similars. Through further experimentation he also discovered that the dosage of the medicines could be reduced to surprisingly low levels and still produce the same or even better results. He found that by using infinitesimal doses his treatments were better tolerated, more effective, and accomplished a swifter cure than when the medicines were given in cruder form.
Hahnemann used a method of diluting medicines in serial fashion with repetitive shaking or “sucussing” between dilutions. He discovered that as he did so the toxic effects of these substances were reduced and ultimately eliminated. This was a positive outcome as no practitioner wishes to unwittingly poison a patient.
He further discovered that when dealing with non toxic, so-called, “inert” substances, that diluting and sucussing them resulted in the emergence of unexpected and unforeseen medicinal actions. The study of these properties revealed that even otherwise inert substances had unique and characteristic “signatures” and symptom pictures, not apparent in crude form:
“the properties of crude medicinal substances gain …[by repeated succussion or trituration] … such an increase of medicinal power, that when these processes are carried very far, even substances in which for centuries no medicinal power has been observed in their crude state, display under this manipulation a power of acting on the health of man that is quite astonishing.”21
Hahnemann found that as both the toxic and inert substances were serially diluted and succussed their medicinal actions became more pronounced and more “potent” in a manner inversely related to their material concentration. This surprising finding was laboriously and repeatedly tested until it was no longer surprising, but came to be trusted as a reliable fact.
Hahnemann called the process of serial dilution and succussion “potentization” or “dynamization”. The final concentration was termed the “potency” of the medicine. The potency is named based on the number of dilutional steps that had been performed. A 12C potency was one which had been diluted and sucussed twelve times, each dilutional step being at the ratio of 1:99 (centesimal scale). A 30X potency was one which had been diluted and sucussed through 30 different dilutional steps each at a ratio of 1:9 (decimal scale). The result of the dilutional process is known as an “infinitesimal”, “minimal” or ultramolecular dose.
A fascinating detail of this process takes place when “potentization” goes beyond a small number of steps (roughly 12C or 30x, depending on scale): the statistical likelihood of encountering even a single molecule of the original chemical substance is reduced to less than zero.
That these ultramolecular preparations should show any effect at all on the biological activity of the organism is somewhat surprising if one’s point of view is strictly materialistic. This surprising fact was a controversial topic in its day when homeopathy was introduced, and remains so today.
Once Hahnemann carried the dilutional process beyond the point where even a minute trace of the original medicine could be expected to be present in the final medicine, the argument for homeopathy appeared to be absurd to many. Nonetheless, those unbiased physicians who continued to test the practice of homeopathy, learned that the phenomena were indisputably real. They determined that, even though they could find no plausible explanation, the homeopathic medicines reliably worked when used in strict accordance with the law of similars.
The principle of the minimum dose is the most difficult of the homeopathic doctrines to accept on a rational level. Of all the tenets of homeopathy it is the one most frequently ridiculed and parodied. It does not make sense, at the materialistic level of understanding, that smaller quantities of a substance will produce more potent effects than larger quantities. This fact flies against most conventional logic.
Theory and Application
Homeopathy is rooted in the Hippocratic method of medical therapeutics which emphasizes: (1) rational principles of observation, (2) the study of the patient who is sick is rather than the disease, and (3) assisting the natural process of healing by strengthening the individual’s resistance to illness.
Homeopathy is practiced on a foundation of patient- centered evaluation and observation. It includes careful history- taking, direct and objective observation and physical examination. Physical pathology and disease classification are of limited use to the homeopath who prescribes on the basis of observable disturbances of an individual’s health. Homeopathy does not rely on advanced diagnostic testing, radiographic imaging or blood chemistry analysis. Although homeopaths may choose to utilize these diagnostic modalities in certain circumstances, the information from these forms of testing is generally not helpful in determining homeopathic treatment. Homeopathic medicines are prescribed on the basis of the directly observed and subjectively reported symptoms of either the individual patient in an individual case or the collectively pooled symptoms of many patients in epidemics and pandemics.
Homeopathic practice is specific to the individual rather than the disease. Individuals with the same “disease diagnosis” invariably have differences in their symptoms of illness (the exception may be in epidemics, as noted above). It is these differences, not the similarities, that help the homeopath determine the most appropriate therapeutic intervention.
“…each case of disease that presents itself must be regarded (and treated) as an individual malady that never before occurred in the same manner and under the same circumstances as in the case before us, and will never again happen precisely in the same way.”22
Homeopathy is based on the recognition that the entire state of an unwell individual is an expression of illness or disease. Symptoms might arise from physical or psychological areas, but only when considered in totality, do they constitute the particular illness or disturbance of an individual.
While research demonstrating the clinical efficacy of homeopathy may be lacking in many areas, clinical experience demonstrates that there are a wide range of conditions in which homeopathy has demonstrated its utility and effectiveness.
Virtually every organ system has associated pain syndromes that range from acute to chronic. Homeopathy can offer safe nonaddicting pain relief, when symptoms and medicine are correctly matched.
Homeopathic pain management can be a time-intensive procedure on the part of the practitioner because it requires individualization of the prescription based upon the unique features of the individual patient. It does not tend to lend itself to simple “cookbook” strategies and algorithms. When properly carried out it offers maximal clinical utility and long-term benefit since it often works beyond simple pain management and positively affects the clinical outcome of many disorders which are the source of the pain.
The use of homeopathy in management of pain syndromes also reduces the need for conventional pharmacological analgesia, thereby reducing the risk of drug interactions, side effects, abuse, dependency and addiction.
The Homeopathic Prescription
The process of selecting a homeopathic medicine begins with the patient interview. Once all the patient’s symptoms are determined, the homeopathic practitioner refers to the text of a homeopathic medical repertory. The repertory is a catalog of symptoms (organized as rubrics) divided, for easy reference, into sections corresponding to each organ system of the body, including the mind. Each rubric provides references to the medicines which have been shown to evoke those same symptoms in clinical drug provings, toxicity studies or experience with prior cured cases.
Cross-referencing the medicines corresponding to the symptoms in the complete symptom picture is the process through which the correct medicine can be selected. In the event of confusion or conflict, special emphasis is placed on those key symptoms which are most central in distinguishing an individual case, and the remedies corresponding to them. The initial result of the cross-referencing process, or repertorization of symptoms, is to narrow the field of potential medicines to a short list. Once this is achieved each of these outstanding potential candidate medicines is carefully studied in a homeopathic textbook called the materia medica.
The materia medica contains a detailed study and compendium of the specifics of each particular medicine and how it affects each organ system in the body. The data is derived from the provings of the substance, records of its toxicity and the collection of those symptoms found to be relevant in the course of clinical experience with cured cases using this substance as a medicine in homeopathic preparation.
The overall purpose of this study, cross-referencing and analysis is to find the closest match between the symptoms of the patient and the symptoms elicited from the medicine. The finding of this match is referred to as determining “the simillimum” or finding the closest matching remedy.
In the system of homeopathy known as Classical Homeopathy, the desired potency (dilution) of the simillimum is administered to the patient, usually as as a single oral dose. In other homeopathic system, the simillimum might be repeated at more frequent intervals or it might be given in combination with other homeopathic medicines.
Common Remedies for Common Problems
Over the past 200 years Homeopathy has been used world-wide in the treatment of nearly every type of medical condition in nearly every branch of human and veterinary medicine. It has been found to be safe and effective in all stages of life from infancy, through childhood, into adolescence, adulthood, and senescence; during pregnancy and lactation, and in the transition to death at the end of life.
Homeopathy is helpful in easing the discomfort due to the changes of pregnancy and childbirth. Complications of these conditions can be handled well with safe, effective but non-pharmacologic, homeopathic means. It is effective in aiding the body recover from a wide range of infectious illnesses and in aiding recovery from injuries. Homeopathy has demonstrated effectiveness in nearly every aspect of human health.
Homeopathy has applications not only as an integrative medical subspecialty, but also as a comprehensive medical discipline in its own right. It can even be effectively integrated into surgical settings.
Homeopathy has also shown utility in agricultural applications when used to support the practices of biodynamic farming (a system of organic farming) and in the care of large and small animals in veterinary homeopathy. It is a safe treatment modality for diseased animals that leaves no harmful toxins or residues behind in the food chain or the environment.
Table 5 contains a listing of several homeopathic medicines and some of their common applications in pain management. A full listing with indications would be voluminous and is beyond the scope of this chapter.
Does Homeopathy Work?
This question continues to challenge the scientific community worldwide. In order to better respond to the question and ascertain the usefulness of homeopathy in a conventional health care system, two questions arise: 1) Is homeopathy superior to placebo ? 2) What is the evidence that homeopathy helps patients with various medical conditions ?
If homeopathy works, what are the mechanisms underlying its beneficial effects ? This question presents a significant challenge given the ultra-high dilutional nature of the homeopathic treatments.
Is homeopathy superior to placebo ?
A majority of conventional health care providers and various scientific communities attribute most observed health benefits of homeopathy to placebo effects. However, there are many health care practitioners and researchers who refute this argument. They cite many controlled studies and positive clinical outcome data in supporting homeopathy’s proven benefit. In these circumstances the question ‘Is homeopathy a placebo response? requires a closer examination.
The initial observations made by Dr David Reilly, a world renowned physician homeopath and researcher, documenting the benefits of homeopathy in the treatment of hay fever received world wide attention.23 In three separate randomized controlled trial studies involving the use of homeopathy immunotherapy in the treatment of asthma and hay fever, researchers determined that homeopathy was not a placebo response.24 Subsequently, a meta-analysis of the three trials published in the Lancet “strengthened the evidence that homeopathy does more than placebo (p= 0.0004)”. The authors concluded that “homeopathy differs from placebo in an inexplicable but reproducible way”.25 Reilly’s extensive research of two decades, four double blind controlled trials and pooled analysis of the data from the four studies refutes the notion that homeopathy’s clinical benefits are due only to its placebo effects. 26
Several independent reviews or meta-analyses of randomized controlled trials have shown that the positive results of homeopathy are over and above those placebo effects. (See Table 1). The quality of homeopathy research, in these reviews, has been found to be rather low by many researchers. However, when only high quality studies have been subjected to analysis, interestingly some show positive results. A review of 17 trials by Cucherat27 and colleagues demonstrated a low level of positive evidence for homeopathy. But the authors also reported that studies of high quality are likely to be negative. Linde and Melchart in their review of 32 trials, included 19 studies in their meta-anylsis. They suggested that individualized homeopathy was more effective than placebo.28 However, they noted there were methodological problems with several studies. The systematic review by Linde et al, involving a total of 89 trials, determined that their findings are “not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo”.29
There are some reviews which have failed to demonstrate the superiority of homeopathy to placebo interventions.30 In a recent comparative study31 of controlled trials of homeopathy and allaopathy, Shang and team concluded that that their finding is “compatible with the notion that the clinical effects of homeopathy are placebo effects”. It should be mentioned that the authors restricted their main analysis to just 8 homeopathy trials, and give the impression that their findings are indicative of the entire field of homeopathy, which it is not. Despite these and other findings that support the placebo hypothesis of homeopathy, and the skepticism surrounding its reported beneficial effects, there is some evidence that homeopathy offers more than placebo.32,33 ,34
Evidence for pain, neurological and other conditions
Many randomized trials have documented the usefulness of homeopathy in the treatment of influenza, allergic conditions, childhood diarrhea, post operative ileus and rheumatoid arthritis (Table 2).
The number of randomized trials reported in the literature concerning the role of homeopathy in the treatment of pain producing conditions is very small. In a detailed comprehensive review, Kleijen and colleagues examined the role of homeopathy in the treatment of various conditions. Their review included 107 controlled trials involving a wide range of problems including diseases of respiratory, cardiovascular, nervous, and musculoskeletal systems. For rheumatological conditions such as rheumatoid arthritis and myalgia the evidence appears positive. The results for other problems are mixed.(Table 3). Overall, the evidence of the trials is positive but “not sufficient to draw definitive conclusions”.35 The authors recommend that this is a case “for further evaluation of homeopathy, but only by means of well performed trials.”
In a recent review which examined the cumulative research from various randomized trials, Mathie concluded that homeopathy has positive effects in the treatment of conditions such as fibrositis, pain (miscellaneous), sprains, upper respiratory conditions, hay fever and side effects of radio- or chemotherapy. 36 They also report that homeopathy is unlikely to be effective for conditions such as headache and stroke.
Jonas et al, in their overview, determined that homeopathy “may be effective for the treatment of influenza, allergies, post–operative ileus and childhood diarrhea”, but added that it may not be effective for muscle soreness and migraine.
The evidence for homeopathy in the treatment of neurological and pain conditions such as rheumatoid arthritis and fibrositis appears encouraging, but not conclusive. The effectiveness of homeopathy in the treatment of various neurological and pain syndromes/conditions has not been confirmed. At the same time its benefits cannot be ruled out either. Additional research studies are warranted to better understand its role in neurology and musculoskeletal medicine.
Biological plausible mechanisms of homeopathy
To better understand the mechanisms that underlie the effects of homeopathy from a biomedical standpoint, one must explore several theories. The two main principles behind homeopathy (mentioned above) are the Law of Similars, or ‘Let Likes be Cured by Likes’ (Similia Similibus Curentur), and the Principle of Infinitesimal Dose, according to which homeopaths prescribe medicines in extremely high dilutions at which not a single molecule of the original starting substance is present.
That a chemical medicinal substance can have one action (inhibition, toxicity) at a high dose and an opposite action (stimulation, healing) at a low dose has been known to mankind for many years. There are reports, for example, which claim that micro-dilutions of antibiotics and insecticides actually enhance the growth of bacteria and crickets respectively. This mechanism of “paradoxical opposite action of pharmacological substances above and below their threshold concentrations or threshold signal strengths” is called hormesis. 37
Conventional treatments of oral immunotherapy and allergen desensitization are considered to be forms of applied hormesis. Therefore, it is possible that homeopathy, by providing an obnoxious stimulus at a low dose, provokes a kind of a defensive response so as to strengthen the host to fight disease and its symptoms. In this respect, homeopathy has frequently been likened to an ultra high dilutional immunization.
The real resistance to the acceptance of homeopathy comes not just from the Law of Similars, but from its Principle of Infinitesimal Dose. In terms of basic conventional principles of pharmacology, biochemistry and physics, it is impossible to explain that ultra-molecular dilutions of homeopathic medicines can actually have clinical effects, let alone affects that might be more potent than when given in crude form. In fact, the very suggestion that this is true makes homeopathy appear to be an “absurdity and a foolish science”.
If it is not the infinitesimal molecules of medicine in the treatments that cause the clinical effects observed in research studies, perhaps it is something else. Several thoughts have been put forward to solve this question. Do homeopathic medicines possess a special form of energy, or biophysical type of information (which cannot be measured with the available tools of medical technology) that can stimulate the body toward healing activities? Does the use of alcohol, water and other solvents, or the process of rigorous shaking (succussion) required in the preparation of homeopathic medicines generate a biophysically different molecule with encoded biological or energetic information?
David Reilly, a world renowned physician researcher writes: “Physicists seem more at ease with such ideas than pharmacologists, considering the possibilities of isotopic stereodiversity, clathrates, or resonance and coherence within water as possible modes of transmission, while other workers are exploring the idea of electromagnetic changes.” 38
The final answer on how homeopathy works will have to wait until further research is completed.
Adverse effects and safety
Homeopathic medicines are recognized and regulated by the U.S. Food and Drug Administration, are manufactured under strict guidelines, and most can be purchased over the counter from specialty and nutrition stores. Many of the higher potency (greater dilution) preparations and “nosodes” (preparations made from disease and animal sources) are available only by a physicians prescritption in the U.S. Homeopathy is considered to be safe, and lacks the potential for life threatening side effects, even though minor side effects have been reported.
Any reported adverse effects are usually mild and transient in nature. Examples of such side effects include headaches, skin rashes, dizziness, diarrhea and sometimes exacerbation of existing symptoms. The incidence of aggravation of existing symptoms is estimated to occur in 20 % cases. 39,40 It should be mentioned that similar side effects are also observed with placebo interventions. 41 Additional studies are warranted to better understand the direct and indirect risks of homeopathy.
Homeopathy research: problems and difficulties
Lack of funding, lack of research and lack of academic infrastructure are common problems facing research in homeopathy. There are methodological problems as well.
Homeopathy, like many other CAM treatments such as ayurveda and acupuncture are primarily person-specific. Two persons with similar disease patterns could receive two entirely different treatments. Such a treatment approach does not lend itself to a randomized controlled trials (RCT) without significant methodological obstacles. This is because in a RCT all patients in the treatment group must receive the same treatment while those in the control group must receive an indistinguishable placebo. This makes homeopathy incompatible, by definition, with the RCT structure and methodology. This factor has restricted the extent of research in homeopathy and, as a result, most of the information on its efficacy comes from reports of day-to-day practice, and survey reports.
Although there is abundant empirical data from over two centuries of homeopathic practice from around the world supporting the use of homeopathy in the treatment of a wide variety of conditions (See Table 4), there is very little data from controlled studies which evaluate its use objectively. The evidence of homeopathy’s effectiveness in these conditions is anecdotal, however the case reports are voluminous and compelling.
Empirical data from homeopathic texts demonstrate a wide spectrum of uses of homeopathy (See Table 5). What these texts do not offer are scientific explanations of how and why homeopathy works, nor do they offer any insight into statistical analysis of homeopathic treatment when compared with conventional approaches or placebo.
Homeopathy appears to rely on intrinsic, health-restoring functions and self-regulatory responses within the patient. What homeopathy cannot do is to correct a dysfunction that has progressed beyond the healing potential of the body. It will not reverse congenital malformations or birth defects, severe pathological deteriorations, amputations, Type I Diabetes, or deficiency states. The use of homeopathy in serious, life threatening conditions in place of proven conventional treatments is imprudent.
For patients with chronic conditions including chronic pain, arthritis and myalgias who wish to be treated homeopathically, the adjunctive and supportive use of homeopathic treatments is certainly worth exploring.
Examples of situations in which homeopathy could be explored include those in which (a) conventional treatments for the condition being treated do not exist, (b) conventional treatments have produced maximal benefit and (c) when patients are unwilling to accept side effects of the conventional treatments.
It is imperative that physicians utilizing homeopathy fully explain the benefits, limitations and risks associated with it before making any recommendation concerning its use. Homeopathy must be practiced only within the framework of evidence-based medicine and with informed patient consent.
The use of homeopathy is widespread, worldwide and growing. Its use by those with chronic problems such as chronic pain, arthritis, and neurodegenerative diseases is extensive. Its safety profile is outstanding. The practice of homeopathy lends itself to an integrated medical approach so long as the standards of conventional care and the fundamental principles of homeopathy are observed and respected.
Homeopathic medicines are recognized and regulated by the United States FDA and manufactured under strict guidelines. When practiced according to homeopathic principles, observing the standards of care and rules of informed consent, it is safe, and lacks the potential for life-threatening side effects or addiction. Only mild and transient side affects have been reported. The most dangerous effect of homeopathy might be its use in place of other proven conventional treatments and life-saving measures.
Research indicates that there is conclusively positive evidence for influenza, allergies, post-operative ileus and rheumatic conditions.40 Additionally, for other problems such as fibromyalgia, low back pain, childhood diarrhea, mild traumatic injury and chronic fatigue syndrome, the evidence is quite encouraging.32,40 For many other conditions the evidence is lacking. No scientific explanation for the mechanism of action of homeopathy currently exists. Beneficial effects of homeopathy do not appear to be entirely due to placebo.
Based on the available scientific information, the evidence concerning homeopathy can neither be confirmed nor refuted. It should be re-iterated that the absence of compelling evidence should not be viewed as lack of effectiveness. The absence of evidence should be balanced against over two hundred years of clinical experience, patient satisfaction and its extensive use worldwide.
“Rather than stressing its implausibility and the notion that its practice fits the definition of quackery or represents a cult…. the best way forward is clearly to do rigorous research until the truth is found … we ought to keep an open mind and remember that a treatment might work even if we fail to understand why.” 42
Homeopathy appears to provide a unique and a refreshing approach to disease management and its role in pain management merits further investigation.
Sincere thanks to Andrew D. Whitmont, Ph.D., clinical psychologist, in Yakima, Washington for his keen and insightful editorial assistance.
The following is a list of professional homeopathic organizations currently active in the United States.
The American Institute of Homeopathy, a 501(C)6 trade association whose membership comprises medical and osteopathic physicians, dentists, advanced practice nurses, and physician assistants, has as its purposes the promotion and improvement of homeopathic medicine and the dissemination of medical knowledge pertaining thereto. It strives to elevate and improve the standards of homeopathic medical education while safeguarding the interests of the profession and attaining general recognition and public acceptance of homeopathy.
The National Center for Homeopathy is an open-membership organization whose mission is to promote health through homeopathy. By providing general education to the public about homeopathy, and specific education to homeopaths, we help to make homeopathy available throughout the United States.
Homeopathic Medical Society of the State of New York
6250 Route 9
Rhinebeck, NY 12572
The Homeopathic Medical Society of the State of New York was established in 1862 as a professional organization open to M.D.’s and D.O.’s formed for the advancement of homepathic therapeutics. The society meets twice annually and distributes a newsletter to its members.
American Board of Homeotherapeutics
801 N Fairfax Street, Suite 306
Alexandria, VA 22314
TEL: (703) 548-7790
FAX: (703) 548-7792
Sandra Chase, M.D., D.Ht., President
10418 Whitehead Street
Fairfax, VA 22030
TEL: (703) 273-5250
The ABHt was founded in 1959 and incorporated in 1960 (New York) for the purpose of promoting the science of homeopathy, and demonstrating its effectiveness to the medical profession, and insuring homeopathy’s growth as a viable medical specialty in the U.S. The ABHt grants Diplomate (advanced specialty) status (D.Ht.) to those medical and osteopathic physician applicants who meet the prerequisites and successfully pass a written and an oral examination.
The Council on Homeopathic Education (CHE) was founded in 1982 as an independent agency to assess homeopathic training programs in the United States and Canada. The Council is comprised of representatives of the founding nationally recognized homeopathic organizations, accredited school designees, and homeopathic education professionals.
Table 1 Select systematic reviews and meta-analysis comparing homeopathy with placebo and or conventional treatments (39,40)
|Author (Reference)||# Trials||Results||Conclusions|
|Cucherat (3)||16 trials representing 17 randomized comparisons.||Pooled p value < 0.0001 in favor of homeopathy; however, for the “best quality” trials; results not significant.||“There is evidence that homeopathic treatments are more effective than placebo, but the strength of this evidence is low because of poor trial quality”.|
|Linde and Melchart (4)||32 RCTs (19 included in meta-analysis)||Results statistically significant in favor of homeopathy; however, results not significant for better-quality trials.||Some evidence; evidence not convincing for “best quality” studies.|
|Linde et al (5)||89 RCTs||Results statistically significant in favor of homeopathy.||The results “are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo”. Further research needed.|
|Kleijen et al (8)||105 non randomized trials||81 (77 %) trials reported positive results for homeopathy.||Results positive, but not definitive.|
Adapted from Ernst E. A systematic review of systematic reviews of homeopathy. Brit J Clinical Pharmacology 2002; 54: 577-582; and Jonas BJ, Kapchuk TJ, Linde K. A critical overview of homeopathy. Ann Internal Medicine 2003; 138:393-399. RCT- Randomized controlled trial; CI- Confidence Intervals; RR= Relative risk; OR= Odds ratio
Table 2- Reviews of select clinical trials of homeopathy for specific conditions (40)
|Author/ Year||Indication||Studies #||Results|
|Linde and Melchart / 1998||Asthma||3 RCTs||Two trials with positive results; evidence inconclusive.|
|Earnst/ 1999||Headache prophylaxis||4 RCTs||Results are mixed. (Two positive; two negative)|
|Ludke and Wilkens/ 1999||All trauma and post operatively||23 RCTs and 14 non randomized trials||Evidence suggests that Arnica homeopathic medication can be useful.|
|Vickers and Smith/ 2000||Influenza like syndrome||7 RCTs||Oscillococcinum reduces duration of the syndrome|
|Wiesenauer and Lludke/ 1996||Pollinosis||8 RCTs||1 controlled trial Galphia is more effective than placebo|
|Barnes/ 1997||Post-operative ileus||4 RCTs and 4 uncontrolled trials||Evidence weak|
|Taylor/ 2000||Allergic conditions||4 RCTs||Pooled results in favor of homeopathy|
|Jacobs/ 1993||Childhood diahrrea||3 RCTs||Homeopathy reduces duration of diarrhea.|
|Jonas et al (2000)||Rheumatoid arthritis||6 RCTs||Four achieved good scores. Several trials have suggested that homeopathy is ineffective for migraine, and influenza prevention. RCT- randomized controlled trial.|
Adapted from: Jonas BJ, Kapchuk TJ, Linde K. A critical overview of homeopathy. Ann Internal Medicine 2003; 138:393-399. Table 3- Clinical trials of homeopathy for rheumatological, trauma or pain (27)
|Shipley et al/ 1983||Ostoarthritis||Negative|
|Fisher et al/ 1987||Fibromyalgia||Positive|
|Gibson et al /1980||Rheumatoid arthritis||Positive|
|Audrarde et al/ 1988||Rheumatoid arthritis||Negative|
|Hilderbrand and Eltze/1983||Myalgia||Positive|
|Zell et al / 1988||Ankle sprain||Positive|
|Carlins et al/ 1987||Insomnia||Negative|
Adapted from: Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. BMJ 1991; 302: 316-23. The list above is not comprehensive. It gives the reader a flavor of evidence for various conditions.
Table 4: An abbreviated listing of pain conditions where homeopathy has been utilized 42
Cardiovascular- Myocarditis, Pericarditis.
ENT- Otalgia, Sinusitis, Glossodynia.
Gastroenterologic- Anal Fissure, Colic, Gastritis, Hemorrhoids, Pancreatitis, Proctitis.
Neurologic- Migraine Headache, Post Herpetic Neuralgia, Raynaud’s Phenomena, Reflex Sympathetic Dystrophy, Trigeminal Neuralgia.
Opthalmologic- Eye pain.
Orthopedic- Back Pain, Bone and Joint Pain, Plantar Fasciitis, Sciatica, Sprains, Strains.
Rheumatologic- Arthritis, Chronic Fatigue Syndrome, Fibromyalgia.
Surgery- Post Operative Pain Syndromes, Traumatic Injuries.
Urology- Cystitis, Dysuria, Epididymitis, Prostatitis, Renal Colic.
Women’s Health Issues- Dysmenorrhea, Endometriosis, Menopause, PMS, Vulvodynia, Vulvitis.
Table 5 The following is a short list of several homeopathic medicines and some of their indications in certain pain syndromes.
Aconite- Acute, sudden violent pains. Anxiety, fright and shock. Asthma, Bronchitis, Dysmenorrhea, Headache, Muscle Pain, Myelitis, Nephritis, Otitis, Peritonitis, Pleurisy, Toothache.
Arnica montana- Acute and chronic affects of trauma, bruising, and injury. Back pain, Pleurodynia, Gout, Headache, Rheumatism.
Bryonia alba- Pains worse from motion. Apthous Ulcers, Asthma, Bronchitis, Cancer, Constipation, Dyspepsia, Eczema, Hernia, Migraine headache, Nephritis, Pericarditis, Ovarian Cysts, Pleurisy, Pleurodynia, Pyuria.Rheumatism, Toothache.
Calendula officinalis- Abrasions, Corneal Abrasions, Gunshot Wounds, Lacerations, Mastitis, Muscle Tears, Paronychia, Post Operative Pain, Puncture Wounds, Ruptured Tympanic Membrane, Soft Tissue Injuries, Varicose Veins.
Chamomilla matricaria- Intolerable pains, unendurable pains, oversensitive tissue. Asthma, Blepharitis, Dysmenorrhea, Dyspepsia, Gout, Headache, Intestinal Colic, Labor Pains, Neuralgia, Otalgia, Rheumatism, Sciatica, Seizures, Toothache.
Colocynthis- Cutting pains better from hard pressure. Abdominal Pain, Arthritis, Coxalgia, Cramps, Facial Neuralgia, Headache, Peritonitis, Sciatica.
Eupatorium perfoliatum- Violent deep aching pains. Back Pain, Bone Pains, Headache, HSV, Opthalmia, , Rheumatism.
Hepar sulpuris calcareum- Splinter-like pains. Angina Pectoris, Asthma, Blepharitis, Constipation, Corneal Pain, Diaphrapmitis, Eczema, Headache, Hemorrhoids, Hepatitis, Labial Abscess, Otalgia, Laryngitis, Menorrhagia, Pleurisy, Rheumatism, SLE.
Hypericum perforatum- Asthma, Brachial Neuralgia, Coccyx Injury, Crush Injuries, Headache, Herpes Zoster, Hemorrhoids, Lacerated Wounds, Neuralgia, Neuritis, Nerve Injury, Painful Scars and Keloids, Post Concussive Syndrome, Reflex Sympathetic Dystrophy, Rheumatism.
Staphisagria- Back Injury and Backaches, Blepharitis, Cystitis, Crural Neuralgia, Dyspareunia, Epididymitis, Gastralgia, Irritable Bladder, Lacerations, Post Operative Pains, Post Traumatic Pains, PID, Rheumatism, Salpingitis, Sciatica, Testicular Pain, Throat Pain.
A. Homeopathic medicines are derived from many sources. Before they are accepted into the Homeopathic Pharmacopoeia of the United States they must be tested (“proven”) on healthy individuals and their characteristic symptoms must be clearly identified. Since almost any substance can be made into a homeopathic medicine, the determining factor that makes a medicine homeopathic is the manner in which is prescribed for use. If this prescription process follows the principles of the Law of Similars then they may be considered homeopathic to the case (regardless of the source of the medicine). If these medicines are selected randomly, by a machine, or on some basis other than the law of similars then they are not, by definition, homeopathic.
B. The dilutional process (termed “potentization”) involves taking one part of the raw medicinal substance and diluting it in either 9 or 99 parts of diluent to produce a 1X or 1C (from the system of roman numerals designating the total number of parts X=10 and C= 100); taking one part of the new concentration (1X or 1C) and adding one part of it to another 9 or 99 more parts of fresh diluent to produce a 2X or 2C dilution. This process is repeated serially as many times as desired to create 3X or 3C; 4X or 4C; 5X or 5C etc., etc., ad infinitum…. This process of dilution, or potentization frequently goes on into the hundreds and even thousands of steps of dilutions!
When this process of dilution is carried out with a specified number of shakes (termed “succussions”) at each level then the vial containing the new mixture is called a “potentized” homeopathic medicine. The potency is assigned a number depending upon the number of steps of dilution used, i.e., thirty steps make 30x or 30c, etc.
1 The evidence base of complementary medicine 2nd Edition, The Royal London Homeopathic Hospital, 1999.
2 Ridley K, ODE, January/February:22-29,2006.
3 Reilly DT. The Puzzle of Homeopathy. J.of Alternative and Complementary Medicine; 2001 7 (2): S 2103-109.
4 D’Epiro NW, CAM Spotlight, A focus on complementary and alternative medicine, based on research and expert commentary, Homeopathy:Can like cure like?, Patient Care:16-27, Dec 15, 1999.
5 Coulter, HL, Divided Legacy, Vol 1, North Atlantic Books, Berkeley, CA.
6 Lyons AS, Petrucelli RJ: Medicine An Illustrated History, New York, 1987, Harry N. Abrams, Inc.
7 Coulter HL, Divided Legacy, Volume III, North Atlantic Books, Berkeley, CA 1973: 22.
8 Haehl R: Samuel Hahnemann: His Life and Work, 1922, Homeopathic Publishing Co.
9 Hahnemann HCF: Materia Medica Pura, Dresden Germany, 1830, Arnoldischen Buchhandlung.
10 Ernst E, Kaptchuk TJ, Homeopathy Revisited, Arch Int Med 156:2162-2164, 1996.
11 Bradford TL, Homeopathic Bibliography, 483-536.
12 Rothstein WG: American Physicians in the 19th Century, Baltimore MD, 1992, The Johns Hopkins University Press.
13 Op Cit, Coulter, page 303.
14 Chase S, Borneman JA, Borneman JP, Legal Status of Homepathy in The United States of America, Am Inst Hom, 01/2003.
15 U.S. Food and Drug Administration, Office of Regulatory Affairs, Compiance Section 400.400 Conditions Under Which Homeopathic Drugs May Be Marketed (CPG 7132.15)
16 Federation of State Medical Boards, Model Guidelines for Physicians Use of Complementary and Alternative Therapies in Medical Practice (available at HYPERLINK “http://www.fsmb.org” www.fsmb.org)
17 Milan F: An overview of complementary and alternative medicine for the primary care provider, Primary Care Rep 7,:17-28, 2001.
18 Boericke, W, Organon of Medicine by Samuel Hahnemann, 6th Ed.,B.Jain Publishers, New Delhi, India, 1988, section 28.
19 Op Cit, Coulter HL, Volume III:31.
20 Op Cit, Organon: section 273.
21 Tyler ML: Homoeopathic Drug Pictures, Saffron Walden, Essex, England, 5th Impression 1982, The C.W. Daniel Company, LTD.
22 Hahnemann, SC, The Lesser Writings of Samuel Hahnemann, Trans by Dudgeon, RE, Radde, NY 1852:441- 442.
23 Reilly DT, Taylor MA, Beatle N, Campbell JH, McSahrry C, Stevenson RD. Is evidence for homeopathy reproducible? Lancet 1994; 344: 1601-06.
24 Reilly DT, Taylor MA, McSahrry C, Aitchison T. Is homeopathy placebo response? Controlled trial of homeopathic potency, with pollen in hay fever as model. Lancet 1986;ii: 881-86.
25 IBID, Reilly.
26 Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C and Aitchison T, Randomized controlled trial of homeopathy versus placebo in perennial allergic rhinitis with overview of four trials series. BMJ 2000; 321: 471-6.
27 Cucerat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. Homeopathic Medicines Research Advisory Group (HMRAG). Eur J. Clinical Pharmacology 2000; 56:27-33.
28 Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state of the art review. J. Alternative Complement Medicine 1998; 4:371-88.
29 Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV. Are the clinical effects of homeopathy placebo effects? A meta- analysis of placebo controlled trials. Lancet 1997; 350: 834-43.
30 Ernst E. A systematic review of systematic reviews of homeopathy. Brit J Clinical Pharmacology 2002; 54: 577-582.
31 Shang A, Huwiler K, Nartey L, Juni P, Dorig S, Sterne JA Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects ? Comparative study of placebo- controlled trials of homeopathy and allopathy. Lancet 2005 August 27, 366 (9487) 726-32.
32 Jonas BJ, Kapchuk TJ, Linde K. A critical overview of homeopathy. Ann Internal Medicine 2003; 138:393-399.
33 Op Cit, Reilly.
34 Op Cit. Linde.
35 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. BMJ 1991; 302: 316-23.
36 Mathie RT . The research evidence base for homeopathy: a fresh assessment of the literature. Homeopathy, 2003, 92, 84-91.
37 Op Cit, Reilly.
38 Op Cit, Reilly.
39 Op Cit, Royal London Homeopathic Hospital.
40 Ernst E, editor: The desktop guide to complementary and alternative mdicine. An evidence based approach, St. Louis, 2006, Mosby Elsevier.
41 Op Cit, Royal London Homeopathic Hospital.
42 Op Cit, Ernst E, Kaptchuk TJ.
42 Eizayaga, FX, Eizayaga’s Repertory, From MacRepertory ™, Kent Homeopathic Associates, San Rafael, CA.
These are 50 Remedy, 200c potency custom kits for use in consultation with Dr. Whitmont. These kits contain the following homeopathic medicines:
Aconite 200c, Allium cepa 200c, Antimonium tartaricum 200c, Apis mellifica 200c, Arnica montana 200c, Arsenicum album 200c, Baptisia tictoria 200c, Baryta carbonicum 200c, Belladonna 200c, Berberis vulgaris 200c, Bryonia alba 200c, Calcarea carbonicum 200c, Calcarea phosphoricum 200c, Cantharis 200c, Carbo vegetabolis 200c, Causticum 200c, Chamomilla 200c, Colocynthis 200c, Drosera 200c, Dulcamara 200c, Eupatorium perfoliatum 200c, Euphrasia 200c, Ferrum phosphoricum 200c, Gelsemium sempivirens 200c, Hepar sulphuris calcareum 200c, Hydrastis canadensis 200c, Hypericum perforatum 200c, Ignatia imara 200c, Ipecacuana 200c, Kali Bichromicum 200c, Kali Sulphuricum 200c, Lachesis muta 200c, Ledum 200c, Lycopodium 200c, Mercurius vivus 200c, Natrum muriaticum 200c, Nux Vomica 200c, Phosphorus 200c, Phytolacca 200c, Pulsatilla 200c, Rhus Toxicodendrons 200c, Ruta graveolens 200c, Sepia 200c, Silica 200c, Sarsaparilla 200c, Spongia tosta 200c, Staphisagria 200c, Sulphur 200c, Symphytum 200c, Veratrum Album. 200c.
With all the recent press devoted to swine flu or the novel H1N1 influenza pandemic, there may be more fear than fact circulating through the newspapers, television, and the Internet.
It is interesting that the Centers for Disease Control and Prevention (CDC) currently reports that deaths from the flu are actually lower this year than in previous years. Numbers are even below what’s known as the “epidemic threshold” for similar time periods in previous, non-pandemic years.
In the 2007–2008 flu season, the CDC reported that the peak death rate (for pneumonia and influenza) was 9 percent. The highest death rate since the novel H1N1 pandemic began in early 2009 has only been 6.0 percent. 
The CDC estimates that most people who contract the virus are expected to recover without medical attention or any significant consequences. Ninety percent of those who suffered complications from H1N1 since early 2009 also had either asthma or a seizure disorder. Those with preexisting or underlying medical conditions (asthma, seizure disorder, diabetes, heart disease, and pregnancy) are at increased risk of suffering complications, which is typical for influenza. 
Epidemiologists have found that not only is the H1N1 virus associated with milder and less-lethal cases of the flu but also is less easily transmitted from person to person than the regular flu strains. Therefore, less of the population is at risk for this flu pandemic, and those that do contract it are less likely to suffer complications leading to hospitalization or death.
IPSICA Provides Nourishment for the Skin
IPSICA Provides Nourishment for the Skin