Homeopathy

• How It Works

  Although there is some evidence that homeopathy may benefit individuals with chronic conditions, data are limited and more research is needed.

  Homeopathy was developed more than 200 years ago. It is based on the Law of Similars, or “like cures like.” A patient experiencing a certain symptom is given a medicine containing low doses of plant extracts, animal extracts, or minerals that, when taken in normal amounts, usually cause that symptom. Homeopathy continues to be popular in India and many European countries.

  Clinical studies have been conducted to evaluate benefits of homeopathy, but data are limited and results are inconclusive. More research is needed.

• Purported Uses
  • To treat allergies
    Studies have produced conflicting results. Although observational studies suggest benefit, some reviews found data to be of limited quality.
  • To treat anxiety or depression
    Data are limited and results are mixed.
  • To treat inflammatory conditions
    Studies have produced conflicting results. Although observational studies suggest benefit, some reviews found data to be of limited quality.
  • To treat infections
    Data from clinical trials are inconclusive. The Canadian Paediatric Society states that homeopathic treatments have not been proven effective against infectious disease.
  • To treat cancer treatment side effects
    A few studies suggest potential benefit with various add-on homeopathy treatments for quality of life, well-being, fatigue, or dermatitis, but additional studies are needed.
• Patient Warnings
  • An FDA investigation found over 400 reports of adverse events in infants and children associated with homeopathic teething products filed over 6 years, including tremor, fever, shortness of breath, lethargy, sleepiness, constipation, vomiting, agitation, irritability, and even death.
  • In 2016, the US Food & Drug Administration issued a warning that homeopathic teething tablets and gels may pose risks to infants and children and that consumers should not use these products. Some homeopathic teething products tested were found to have elevated levels of belladonna, which is considered a poisonous plant .
• Side Effects
  • Homeopathic aggravations, described as a short-term worsening of symptoms before improvement occurs, are commonly reported in trials.
  • Some newer homeopathic products may actually contain ingredients in higher doses, which has raised concerns about other potential adverse effects or drug interactions.

  Case reports

  • Potential for false positive reading: On PET/CT evaluation of response to chemotherapy, in a 29-year-old woman with Hodgkin’s lymphoma. An inflammatory reaction was attributed to homeopathic mistletoe injections prescribed by a naturopath, but might have been mistaken as new disease if not more carefully assessed. After product discontinuation, repeat scans over 4 months later were clear.
  • Acute hepatitis: In a patient who took Lycopodium Similiaplex, a homeopathic remedy used to treat hepatopathy, to relieve insomnia.
  • Allergic reactions and intoxication: Following the use of some homeopathic products.
  • Blue-green skin discoloration: In a middle-aged man, with the ingestion of homeopathic medicine as the probable cause. Blood copper levels were also high and returned to normal after product discontinuation.
  • Infant seizures and other symptoms: Attributed to homeopathic teething tablets and gels (see Warnings section).
• Special Point
  • Premarket testing for safety or efficacy of OTC or prescription homeopathic medicines is not required in the US.
• Clinical Summary

  Homeopathy is a medical system developed 200 years ago by Dr. Samuel Hahnemann, a German physician. Promoted as a safer and more holistic approach to treating disease, it has remained especially popular in India and some European countries. Homeopathic remedies are highly diluted forms of botanical, animal, or mineral substances which when given in full strength to a healthy volunteer, cause the presenting symptoms of the patient. Opponents argue that the benefits experienced by patients are merely placebo effects ⁽¹⁾, although these are no larger than those observed in conventional medicine ⁽²⁾.

  In a US national survey, homeopathy was most commonly used for respiratory and otorhinolaryngology complaints ⁽²²⁾. Observational studies suggest that certain homeopathic products can provide long-term relief from symptoms such as headache and allergic rhinitis in adults, and atopic dermatitis and recurrent infections in children ⁽³⁾. One study suggests benefit with an add-on homeopathic preparation for recurrent tonsillitis ⁽²³⁾. However, adjuvant homeopathy was not helpful for otitis media with effusion ⁽²⁴⁾, and systematic reviews found data on homeopathy for otitis media or chronic rhinosinusitis to be scant and of limited quality ^(25) (26).

  Only a few clinical trials have been conducted in psychological symptoms. In a trial of individualized homeopathic treatment for climacteric women with major depression, both homeopathy and fluoxetine arms had improved response but not remission ⁽²⁷⁾. Another study on homeopathy for depression was terminated early due to recruitment difficulties ⁽²⁸⁾. An epidemiological study found marginal improvement for anxiety and depression among those who consulted practitioners prescribing homeopathy versus conventional care ⁽²⁹⁾. A meta-analysis on interventions for ADHD symptoms determined that homeopathy was not more effective than placebo ⁽³⁰⁾, and The European Sleep Research Society does not recommend homeopathy for insomnia ⁽³¹⁾. In both papers, low-quality evidence was cited.

  Studies of homeopathy in cancer patients are limited. Various homeopathic care regimens adjunctive to cancer therapy appeared to improve global health status and wellbeing ⁽³²⁾, fatigue and quality of life ⁽¹⁰⁾, and acute radiodermatitis ⁽⁷⁾, but not chemotherapy-induced emesis ⁽⁹⁾ or endocrine therapy-related hot flushes ⁽³³⁾. Other case reports suggest homeopathic remedies may be helpful for advanced cancer ⁽¹¹⁾ or post-treatment breast cancer pain ⁽⁸⁾, and a few in vitro studies suggest some homeopathic ingredients may have anticancer effects ^{(4) (5) (6)}. However, these observations have not been evaluated in clinical trials and cancer patients should be aware that homeopathy is not a substitute for mainstream care.

  Unlike remedies used in classical homeopathy, some contemporary homeopathic products may actually contain ingredients in allopathic doses, which has raised concerns about potential adverse effects or drug interactions ⁽³⁴⁾. In a meta-analysis, the rate of adverse effects from homeopathy compared with studies that randomized patients to placebo and conventional medicine ⁽³⁵⁾.

  The Canadian Paediatric Society states that particular homeopathic treatments called nosodes have not been proven effective against infectious disease and are not alternatives to vaccinations ⁽³⁶⁾. In addition, homeopathic teething products have been associated with harm in infants, and some researchers recommend against homeopathic remedies in general to treat pediatric conditions ⁽³⁷⁾.

• Purported Uses
  • Allergies
  • Infection
  • Inflammation
  • Anxiety
  • Depression
  • Cancer treatment side effects
• Mechanism of Action

  The practice of homeopathy is governed by the Law of Similars, similia similibus curanturor “like cures like.” Hahnemann and his followers observed that while certain plants, animals or minerals could cause specific symptoms when ingested by healthy individuals, the highly diluted form of the same substance could relieve similar symptoms in ailing patients. Other principles include tailored treatment, so that different people with the same condition may receive different treatments; and the “law of minimum dose”—the idea that a lower dose translates to greater effectiveness ⁽³⁸⁾.

  An in vitro study showed that an antidiabetic product commonly used in homeopathy demonstrated anticancer effects by inducing nuclear DNA fragmentation and increasing the level of mRNA expression of apoptotic signal related genes cytochrome c and caspase 3, and by reducing the expression level of anti-apoptotic gene Bcl2 ⁽⁵⁾. Another product, Phytolacca decandra, exerted anticancer properties in melanoma cells via activation of caspase-mediated signaling and by generating reactive oxygen species (ROS) ⁽⁶⁾. However, it is not known if these products will have the same effects when diluted according to homeopathic principles.

  Several challenges endure with evaluating the efficacy of homeopathy, including obtaining adequate documentation from traditional practitioners ⁽³⁸⁾, and its plausibility against known pharmacology principles ⁽³⁹⁾.

• Warnings
  • Premarket testing for safety or efficacy of OTC or prescription homeopathic medicines is not required in the US ⁽³⁹⁾.
  • In 2016, the US Food & Drug Administration issued a warning that homeopathic teething tablets and gels may pose risks to infants and children and that consumers should not use these products ⁽⁴⁰⁾. Some homeopathic teething products tested were found to have elevated levels of belladonna, which is considered a poisonous plant ⁽⁴¹⁾. In addition, there have been over 400 reports of adverse events in infants and children associated with homeopathic teething products filed over 6 years, including tremor, fever, shortness of breath, lethargy, sleepiness, constipation, vomiting, agitation, irritability, and even death.
• Adverse Reactions

  Homeopathic aggravations, described as a worsening of symptoms before improvement occurs, are commonly reported in trials ⁽³⁵⁾. In a meta-analysis, the rate of adverse effects from homeopathy were thought to compare with those from studies where patients are randomized to placebo and conventional medicine ⁽³⁵⁾.

  Case Reports

  • Nodal involvement mimicry: On PET/CT evaluation of response to chemotherapy, in a 29-year-old woman with Hodgkin’s lymphoma. The inflammatory reaction was attributed to self-administered subcutaneous homeopathic mistletoe prescribed by a naturopath, which cleared upon product discontinuation and repeat scanning 4.5 months later ⁽⁴²⁾.
  • Acute hepatitis: In a patient who took Lycopodium Similiaplex, a homeopathic remedy used to treat hepatopathy, to relieve insomnia ⁽¹³⁾.
  • Allergic reactions and intoxication: Following the use of some homeopathic products ⁽¹²⁾.
  • Blue-green hands, feet, and sweat: In a middle-aged man, with the ingestion of homeopathic medicine as the probable cause. Blood copper levels were also high and returned to normal after product discontinuation ⁽⁴³⁾.
  • Infant status epilepticus and other adverse effects: Attributed to homeopathic teething tablets containing belladonna, which is considered a poisonous plant ⁽³⁹⁾. A subsequent FDA investigation found over 400 reports of adverse events in infants and children associated with homeopathic teething products filed over 6 years, including tremor, fever, shortness of breath, lethargy, sleepiness, constipation, vomiting, agitation, irritability, and even death.
• References

  1. Shang A, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005; 366:726-32.

  2. Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs – a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.

  3. Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?—Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413.

  4. Frenkel M, Mishra BM, Sen S, et al. Cytotoxic effects of ultra-diluted remedies on breast cancer cells. Int J Oncol. 2010 Feb;36(2):395-403.

  5. Chakraborty D, Ghosh S, Bishayee K, et al. Antihyperglycemic Drug Gymnema sylvestre Also Shows Anticancer Potentials in Human Melanoma A375 Cells via Reactive Oxygen Species Generation and Mitochondria-Dependent Caspase Pathway. Integr Cancer Ther. 2013 Sep;12(5):433-41.

  6. Ghosh S, Bishayee K, Paul A, et al. Homeopathic mother tincture of Phytolacca decandra induces apoptosis in skin melanoma cells by activating caspase-mediated signaling via reactive oxygen species elevation. J Integr Med. 2013 Mar;11(2):116-24.

  7. Balzarini A, et al. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial. Br Homeopath J. 2000;89(1):8-12.

  8. Orellana Alvarellos G, Ruiz de Viñaspre Alvear P, Kaszkin-Bettag M. A series of case reports: clinical evaluation of a complex homeopathic injection therapy in the management of pain in patients after breast cancer treatment. Altern Ther Health Med. 2010 Jan-Feb;16(1):54-9.

  9. Pérol D, Provençal J, Hardy-Bessard AC, et al. Can treatment with Cocculine improve the control of chemotherapy-induced emesis in early breast cancer patients? A randomized, multi-centered, double-blind, placebo-controlled Phase III trial. BMC Cancer. 2012 Dec 17;12:603.

  10. Rostock M, Naumann J, Guethlin C, et al. Classical homeopathy in the treatment of cancer patients—a prospective observational study of two independent cohorts. BMC Cancer. 2011 Jan 17;11:19.

  11. Chatterjee A, Biswas J. A homeopathic approach to treat patients with advanced gallbladder, periampullary, and liver carcinomas: a report of 3 cases. J Altern Complement Med. 2012 Feb;18(2):180-6.

  12. Posadzki P, Alotaibi A, Ernst E. Adverse effects of homeopathy: a systematic review of published case reports and case series. Int J Clin Pract. 2012 Dec;66(12):1178-88.

  13. Braschoss A. Lycopodium similiaplex-induced acute hepatitis: a case report. Eur J Gastroenterol Hepatol. 2009 Jun;21(6):718-9.

  14. Jacobs J, et al. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001;20:177-83.

  15. Fisher P, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology (Oxford) 2001;40:1052-5.

  16. Oberbaum M, et al. A randomized, controlled clinical trial of the homeopathic medication TRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem cell transplantation. Cancer 2001;92:684-90.

  17. Vickers AJ, et al. Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial. J Altern Complement Med 2001;7:141-8.

  18. Vickers AJ, et al. Can homeopaths detect homeopathic medicines? A pilot study for a randomised, double-blind, placebo controlled investigation of the proving hypothesis. Br Homeopath J 2001;90:126-30.

  19. Linde K, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997;350:834-43.

  20. Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol 2002;54:577-82.

  21. Brien S, Lewith G, Bryant T. Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C. Br J Clin Pharmacol. 2003;56:562-8.

  22. Dossett ML, Davis RB, Kaptchuk TJ, et al. Homeopathy Use by US Adults: Results of a National Survey. Am J Public Health. Apr 2016;106(4):743-745.

  23. Palm J, Kishchuk VV, Ulied A, et al. Effectiveness of an add-on treatment with the homeopathic medication SilAtro-5-90 in recurrent tonsillitis: An international, pragmatic, randomized, controlled clinical trial. Complement Ther Clin Pract. Aug 2017;28:181-191.

  24. Pedrero-Escalas MF, Jimenez-Antolin J, Lassaletta L, et al. Hospital clinical trial: Homeopathy (Agraphis nutans 5CH, Thuya occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum 9CH) as adjuvant, in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. Sep 2016;88:217-223.

  25. Marom T, Marchisio P, Tamir SO, et al. Complementary and Alternative Medicine Treatment Options for Otitis Media: A Systematic Review. Medicine (Baltimore). Feb 2016;95(6):e2695.

  26. Jin AJ, Chin CJ. Complementary and Alternative Medicine in Chronic Rhinosinusitis: A Systematic Review and Qualitative Analysis. Am J Rhinol Allergy. Mar 2019;33(2):194-202.

  27. Macias-Cortes Edel C, Llanes-Gonzalez L, Aguilar-Faisal L, et al. Individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP study): a randomized, double-dummy, double-blind, placebo-controlled trial. PLoS One. 2015;10(3):e0118440.

  28. Adler UC, Kruger S, Teut M, et al. Homeopathy for depression: a randomized, partially double-blind, placebo-controlled, four-armed study (DEP-HOM). PLoS One. 2013;8(9):e74537.

  29. Grimaldi-Bensouda L, Abenhaim L, Massol J, et al. Homeopathic medical practice for anxiety and depression in primary care: the EPI3 cohort study. BMC Complement Altern Med. May 4 2016;16:125.

  30. Catala-Lopez F, Hutton B, Nunez-Beltran A, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One. 2017;12(7):e0180355.

  31. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. Dec 2017;26(6):675-700.

  32. Frass M, Friehs H, Thallinger C, et al. Influence of adjunctive classical homeopathy on global health status and subjective wellbeing in cancer patients – A pragmatic randomized controlled trial. Complement Ther Med. Jun 2015;23(3):309-317.

  33. Heudel PE, Van Praagh-Doreau I, Duvert B, et al. Does a homeopathic medicine reduce hot flushes induced by adjuvant endocrine therapy in localized breast cancer patients? A multicenter randomized placebo-controlled phase III trial. Support Care Cancer. May 2019;27(5):1879-1889.

  34. Csupor D, Boros K, Hohmann J. Low potency homeopathic remedies and allopathic herbal medicines: is there an overlap? PLoS One. 2013;8(9):e74181.

  35. Stub T, Musial F, Kristoffersen AA, et al. Adverse effects of homeopathy, what do we know? A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. Jun 2016;26:146-163.

  36. Rieder MJ, Robinson JL. ’Nosodes’ are no substitute for vaccines. Paediatr Child Health. May 2015;20(4):219-222.

  37. Smolinske SC. Dietary Supplements in Children. Pediatr Clin North Am. Dec 2017;64(6):1243-1255.

  38. Olaku O, Zia F, Santana JM, et al. The National Cancer Institute best case series program: a summary of cases of cancer patients treated with unconventional therapies in India. Integr Cancer Ther. Sep 2013;12(5):385-392.

  39. Abbasi J. Amid Reports of Infant Deaths, FTC Cracks Down on Homeopathy While FDA Investigates. JAMA. Feb 28 2017;317(8):793-795.

  40. US Food & Drug Administration. FDA warns against the use of homeopathic teething tablets and gels. 2016; Accessed December 2019.

  41. US Food & Drug Administration. FDA confirms elevated levels of belladonna in certain homeopathic teething products. 2017; Accessed December 2019.

  42. Abreu P, Sanchez R, Mut T, et al. Homeopathic mistletoe adverse reaction mimics nodal involvement in (18)F-FDG PET/CT performed for evaluation of response to chemotherapy in lymphoma. Rev Esp Med Nucl Imagen Mol. Mar – Apr 2017;36(2):110-112.

  43. Ghosh SK, Rudra O, Kar R, et al. A curious case of blue-green discoloration in a middle-aged indian man: Chromhidrosis. Dermatol Online J. Nov 18 2015;21(11).