Edzard Ernst. The Desktop Guide to Complementary and Alternative Medicine, An evidence-based approach. Second Edition. 2006. стр. 326-329.Сообщение от Сергей Хос
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Homeopathy.
Definition.
A therapeutic method, often using highly diluted preparations of substances whose effects when administered to healthy subjects correspond to the manifestations of the disorder (symptoms, clinical signs and pathological states) in the unwell patient.
Related techniques.
Autoisopathy, biochemic medicine, homotoxicology, isopathy, tautopathy.
Background.
Homeopathy was founded by the German physician Samuel Hahnemann (1755-1843) and became popular first in Europe and later in the US during the second half of the 19th century. With the advent of effective drug treatments in the early part of the 20th century, its popularity decreased in most countries. Today, it is again becoming more widely available due to a general trend towards CAM. Many schools of homeopathy exist.
Traditional concepts.
Homeopathy is built on two key principles. The law of similars or ‘like cures like’ principle states that a remedy which causes a certain symptom (e.g. a headache) in healthy volunteers can be used to treat a headache in patients who suffer from it. According to the second principle, homeopathic remedies become stronger rather than weaker when submitted to ‘potentisation’, which describes the stepwise dilution combined with ‘succussion’, i.e. vigorous shaking of the mixture. Thus remedies are believed to be clinically effective even if they are so dilute that they are likely not to contain a single molecule of the original substance.
Scientific rationale.
Examples can be found where the `like cures like’ principle does apply (e.g. digitalis), but it is not a universal principle or natural law. Presently there is no scientific rationale for understanding how remedies devoid of pharmacologically active molecules produce clinical effects. Homeopathic `provings’, which form the basis for therapeutic selection, often yield negative results or lack scientific rigour.
Practitioners.
Homeopathy is practiced by both medically qualified and non-medically qualified practitioners.
Conditions frequently treated.
Homeopaths do not usually use conventional disease categories. Their aim is to match a patient’s individual symptoms with a ‘drug picture’ (i.e. a set of symptoms caused by a remedy in healthy volunteers). Homeopaths often see patients with benign chronic conditions, e.g. ear, nose and throat disorders, headaches, musculoskeletal and digestive problems, respiratory and skin complaints, stress and anxiety [1,2,3].
Typical session.
A first consultation might take 1½ hours or longer. Homeopaths take a thorough history and explore the patient’s problems in much detail, with a view to finding the optimally matching homeopathic drug (‘similimum’). They put less emphasis on physical examination than conventional physicians.
Course of treatment.
Homeopaths believe that the treatment of long-standing problems is necessarily prolonged. Thus they would typically insist on several consultations during which their prescriptions can be altered according to the changes in symptomatology.
Clinical evidence.
A meta-analysis [4] of all homeopathic, placebo-controlled or randomised trials suggested that the risk ratio for clinical improvement with homeopathy was 2.45 times that with placebo. This publication has attracted much criticism and 6 re-analyses of these data failed to demonstrate efficacy [5]. Similarly, 11 independent systematic reviews of homeopathy did not generate convincing evidence of efficacy [5] and one meta-analytical comparison of 110 homoeopathy trials and 110 matched conventional-medicine trials concluded that the clinical effects of homeopathy were unspecific placebo effects [6]. This includes conditions such as postoperative ileus, delayed onset muscle soreness, migraine prophylaxis, chronic asthma, and osteoarthritis [3]. Only in 2 areas were the conclusions positive: influenza [7] and rheumatic conditions [8]. Since the publication of these systematic reviews, the results of RCTs have been mixed. Encouraging findings were reported for fibromyalgia [9], low back pain [10], chronic fatigue syndrome [11], pain of unwanted lactation [12], mild traumatic brain injury [13], childhood diarrhoea [14], and glue ear [15]. Negative results emerged for rheumatoid arthritis [16], ankylosing spondylitis [17], otitis media [18], generalised anxiety disorder [19] and asthma [20]. Many of the primary studies of homeopathy have serious methodological limitations [21].
Risks.
Contraindications.
Life-threatening conditions, pregnancy and lactation (see p 5).
Precautions/warnings
Do not expose remedies to bright light or other radiation and pungent smells. Some homeopaths advise their clients against immunisation of children [23,24].
Adverse effects.
In about one quarter of cases, homeopaths observe an aggravation of symptoms (which is believed to be a positive sign indicating that the correct remedy has been given) [24]. In low dilutions, homeopathic remedies can have adverse effects such as allergic reactions.
Interactions.
Some medicines (e.g. corticosteroids, antibiotics) are believed to block the actions of homeopathic drugs.
Risk–benefit assessment.
Based on the available trial evidence to date, the effectiveness of homeopathic remedies can be neither confirmed nor ruled out. There are few risks associated with homeopathy. Thus the evidence is insufficient for firm recommendations.
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