Homeopathy

Brief history
Homeopathy was the discovery of a German physician, Samuel Hahnemann, over 200 years ago. Hahnemann observed that there were therapeutic substances (i.e., used in the treatment of disease) which, when given in small doses to a healthy person, produced symptoms similar to the disease itself. As he explored this phenomenon, he developed a theory which is still the foundation of homeopathy today: "Similia Similibus Curentur" or "Like Cures Like," also known as the Law of Similars. Further experimentation and research by Hahnemann seemed to indicate that the smaller the dose, the stronger the effect - a counterintuitive finding which still puzzles physicians and researchers today. (It is thought by some to resemble the immunization process, but there are several other theories being postulated.)

Homeopathy was brought to the United States in the 1820s, and in 1835 the first homeopathic college was founded. Although it was not successful, the spread of homeopathy was dramatic through the rest of the 19th century. Estimates of usage by the end of the century indicate 10% of all American physicians used homeopathy in practice, and there were more than 20 homeopathic medical schools (as well as courses offered in many regular medical schools).

Even as homeopathy reached its historic peak in the U.S. a hundred years ago, developments were already under way which would almost wipe it out by 1950. Chief among these was the successful effort by the American Medical Association to force medical schools into a uniform approach to teaching medicine, and state laws into a relatively uniform (and monopolistic) approach to practice. Schools which did not conform, were unable to survive. Another factor was the appearance of miracle drugs, making huge advances in treatment, in anesthesia and in antisepsis. It seemed for a good many decades in mid-20th century that we were on our way to discovering cures for everything. Many natural medicine alternatives declined (homeopathy, naturopathy, midwifery, herbalism, hydrotherapy and others) and their practitioners were harassed and suppressed.

Slowly but inexorably, the awareness spread through professional and consumer groups alike that heroic interventions such as drugs, surgery and radiation, while immensely valuable, are not panaceas. In addition, voluminous information began to accumulate about the cascade of conditions and illnesses that are side effects of their use. Consumers began to look for gentler, less toxic ways of treating all those ailments from which civilizations still suffer. Thus was born the current renaissance of natural health care; homeopathy has experienced a substantial rebirth in the last 20 years, and continues to grow rapidly today.

Philosophy
Although the "like cures like" philosophy of homeopathy and the inverse relationship between dilution of the remedy and treatment effect are still poorly understood by scientists and practitioners at the theoretical level, there is a growing body of research to demonstrate the philosophy's validity (see our "Conditions" section for more information). In addition to the Law of Similars, there are other important philosophic principles. Homeopathy falls into the vitalist tradition of health care - meaning that practitioners have a belief in the "vis medicatrix naturae," or the healing power of nature. Homeopaths believe that their remedies strengthen and activate the body's own innate healing capacity, which is what finally accomplishes the cure. Homeopaths also believe that prescribing the correct remedy relies on understanding the totality of a person's symptoms - not just those that appear to be directly related to the disease. In other words, this is also a holistic discipline, whose adherents believe that each individual forms a unique, whole being, and that the whole person must be treated to create optimal health. Homeopathy's aim is the cure: "The complete restoration of perfect health," as Dr. Hahnemann said.

Scope of practice
Homeopathy does not have a well-defined legal scope of practice because it is used by practitioners in many different professions, and there are no uniform educational standards. Practitioners are usually able to adapt their clinical approach to the scope of practice permitted by their own discipline and regulatory environment. Homeopathy is also practiced by lay homeopaths, who are often self-taught or minimally trained, and who do not hold a health care license of any kind. Homeopathy does have a core philosophy and established methods (see Philosophy below) which, because they don't closely resemble conventional medicine, can be interpreted to mean it is - or is not - the practice of medicine. Both interpretations have been applied by states, and there are still variations in state laws which refer to homeopathy.

In the United States today, consumers may find lay homeopaths, physicians (medical, osteopathic and naturopathic), nurses, dentists, chiropractors, and many others offering homeopathy. Consumers should understand that there may be a wide range in training and expertise among practitioners, and the burden rests on each consumer to investigate a practitioner's background to his or her satisfaction. If you choose a practitioner who has a health care license, that person will be bound to the scope of practice established by that licensing law.

Homeopathic medicines, which may be produced from plants, animals, minerals and other substances, are classified as drugs by the Food and Drug Administration. Although most are available over the counter, there are a few (those using disease materials or controlled substances) which are available only by prescription. The Homeopathic Pharmacopoeia of the United States was incorporated into federal law in 1938, making the manufacture and sale of homeopathic medicines legal in this country, and prescribing accepted manufacturing standards. Today, there are more than 2000 remedies, and new ones are still being identified.

Regulatory scope
There are only three states which directly regulate homeopathy: Arizona, Connecticut and Nevada; in these states MDs practicing homeopathy must be licensed by the state homeopathic licensing board (and other providers must have it included in their legislated scope of practice). In those jurisdictions where naturopathic physicians are licensed, homeopathy is included in their scope of practice. Other professions and practitioners must determine whether or not homeopathy is permitted within their existing scope of practice; judging by the rapidly growing number of schools and practitioners, it appears that most health care practitioners are finding it possible to add homeopathy to their clinical practice without incurring regulatory problems. Still, it is always wise for the consumer to ask what the regulatory situation is for a given practitioner, and it is imperative that you ask about training, because in the absence of state laws, education and credentialing are important elements in ensuring accountability.

Education and credentialing
Naturopathic physicians are the only practitioners today who undergo formal, medical school training in homeopathy as part of their standard didactic and clinical curriculum; homeopathy has been included in their scope of practice in every state where they are licensed since the early 1900s. Other than this one field with a continuous, well-established standard, it's open season. There is an astonishing array of programs and schools, for lay people, physicians and a whole range of other practitioners, both here in the U.S. and abroad.
The Council on Homeopathic Education (CHE) was formed in 1982 to monitor and approve the quality of courses offered for licensed professionals; the agency is currently preparing itself to apply for federal recognition as an accrediting agency. It publishes a list of schools which are recognized and those which are in the process of obtaining recognition.
There are several certification boards of homeopathic practitioners: Council on Homeopathic Certification (CHC), North American Society of Homeopaths (NASH), American Board of Homeotherapeutics, Homeopathic Academy of Naturopathic Physicians (HANP), and National Board of Homeopathic Examiners. A practitioner who is serious about offering a high level of expertise in homeopathy should have obtained significant advanced training, and probably some form of certification as well.

Typical first office call or visit
If you schedule a first office call with a practitioner who does primarily (or only) homeopathy, be prepared for a lengthy visit. It is the homeopath's job to obtain as much in-depth information about you as possible, in order to evaluate the totality of symptoms and select the remedy which most closely matches the overall picture. Practitioners whose scope of practice includes diagnostic tests may perform a physical examination and/or laboratory work; others may refer out for such tests, or ask that you bring recent records from a primary care provider with you. It is not unusual for an initial homeopathic work-up to take 1-2 hours. Your practitioner may not give you a remedy immediately, as it may be necessary to reflect on all the information and research the appropriate remedy. Even experienced practitioners may sometimes try two or three remedies before finding the best one. (Since there are over 2000 remedies available, some homeopaths will use a computerized repertory to do this research.) Return visits should be no longer than 30-45 minutes, unless an unusual situation has arisen.

When the remedy is selected, it will be administered in the form of tiny sugar pellets, which have been soaked in a very dilute solution of the appropriate therapeutic agent and which dissolve quickly under the tongue. The more dilute the solution, the higher the potency. Over-the-counter homeopathics tend to be low dilutions, which can safely be used for self-care. Prescribing higher potencies should be done by a trained practitioner. You may be given a single dose, or asked to take repeated doses until you start to feel better. It's important to follow your practitioner's advice about how to take (and store) the medicine. You may be asked to avoid ingesting other substances while under homeopathic care, although there is a lot of disagreement about just which things might antidote a homeopathic remedy. Work with your practitioner on this issue.

In homeopathy, the action of the remedy is considered the initial stage of healing; the body's own capacity to heal is activated by the remedy, and can continue working over many weeks or months. Therefore, homeopaths tend to take a long view of the healing process. Nonetheless, patients should feel free to express any concerns they have about whether they are getting better, or how long it is taking. If not satisfied with the pace of healing, consider asking for a return visit sooner than originally planned, or request a referral. Do not let acute or serious chronic symptoms continue unaddressed if no improvement is noted within a reasonable time frame.

Limitations to be aware of
Many practitioners believe that homeopathics may be inactivated (antidoted) by certain pharmaceuticals, dental work involving drilling or anesthesia, acupuncture treatment, chiropractic manipulations, and strongly aromatic substances such as mint and camphor. Some homeopaths recommend against using coffee, alcohol or certain medicinal herbs while under homeopathic care. The evidence on these issues is not strong, and there is disagreement among practitioners. It is best to find out what your homeopath recommends, and why, and then work within those parameters.