Homeopathy originated in the late 18th century when bloodletting was used as a treatment for infections and ocular injection of cobra venom was the standard treatment for macular degeneration. Needless to say, during this time period, Dr. Christian Friedrich Samuel Hahnemann’s proposition of using highly diluted substances to treat medical conditions was a much gentler approach to medicine. As the founder of homeopathy, his “new” approach was based on a few basic principles:
• The “law of similars.” A recommendation to use substances that cause the condition in a healthy person as the treatment for the patient.
• The minimum-dose principle. This suggests that the therapeutic potency of a substance increases with decreasing concentration strength.
• Holism. The belief that one remedy should address symptoms throughout the spectrum of the patient’s physical and mental states.1
When the scientific basis of medicine began to increase, homeopathy was largely disregarded as “quackery,” but recent decades have experienced a resurgence in its popularity. Categorized by regulatory agencies under the umbrella of complementary and alternative medicine (CAM), the regulation of homeopathic remedies differs significantly from the FDA mandates required for “mainstream” therapeutic agents.
For homeopathic therapies, proof of clinical efficacy is not required by the FDA prior to marketing, because of the ultra-high dilution of any ingredients (often beyond Avogadro’s number). The FDA relies on the Homeopathic Pharmacopoeia Convention of the United States (HPCUS) to organize such ingredients and products. In fact, if a substance has either “homeopathic provings” or is known to induce symptoms that mimic the condition that it is intended to treat, and is manufactured according to HPCUS standards, it is accepted by HPCUS. Also, it evades the clinical safety and efficacy requirements of allopathic medicine. The labeling on OTC homeopathic remedies indicated for self-limiting conditions must simply include a list of ingredients, the level of dilution, instructions for safe use, and the indication. For remedies claiming to treat more serious, non-self-limiting diseases, such as cancer, the packaging also must include a warning of the prescription status and recommended dosage.2
Common ocular applications of homeopathic remedies include treatments for both allergic conjunctivitis and cataracts. Cataract Care (Similasan Corporation), a homeopathic remedy for cataracts, claims to temporarily “relieve symptoms of diagnosed cataract and aging eyes,” and the packaging states that there are no known side effects or drug interactions. Its active ingredients include Cineraria maritima 6X, Conium maculatum 6X and phosphorus 12X. The “X” denotes dilution in a 1:10 ratio and the preceding digit represents the number of times the substance was diluted in this ratio (e.g., Cineraria maritima has been through six 1:10 dilutions).
Is it Safe?
Despite sweeping scientific critique, homeopathy has a strong draw––33% of Americans are estimated to receive some form of CAM annually.3 One of the most prominent factors that drives patients toward homeopathic therapy seems to be its perceived safety. Because the packaging does not list any side effects, these alternative remedies may appear safer than conventional pharmaceuticals. But, just because homeopathic medicine labels do not include side effects does not mean they are completely safe or effective treatment options. Remember, “clinically proven” claims on homeopathic medicine containers can be misleading, because some studies evaluate the agent’s efficacy against a particular condition versus a placebo, rather than against a proven pharmaceutical treatment.
When it comes to homeopathic therapy, patient awareness and education are key to successful outcomes. Open-mindedness to “folk medicine” is important for any clinician, but you also have a responsibility to explain its limitations to your patients. Perhaps one day, homeopathic remedies will establish clinical proof of efficacy and safety to the same standards of modern medicine. But, until then, let’s make sure our patients are equipped to make their own informed treatment decisions.
1. Jonas WB, Kaptchuck TJ, Linde K. A critical overview of homeopathy. Ann Intern Med. 2003 Mar 4;138(5):393-9.
2. Bell I, Ernst E, Mansky P, Khalsa P (eds). Homeopathy: An introduction. National Institutes of Health: National Center for Complementary and Alternative Medicine. Available at: http://nccam.nih.gov/health/homeopathy/ (Accessed May 10, 2010).
3. Kushner BJ. There is no evidence that… Arch Ophthalmol. 2009 Jan;127(1):94-6.