Homeopathy

1. Homeopathy Eleanor Bates Tinsley Harrison Society November 8, 2005

2. Traditional Alternative Medicine Acupuncture Ayurveda Homeopathy Naturopathy Chinese/Oriental Mind-Body Interventions Cognitive Behavioral Therapy Meditation Biofeedback Hypnosis Prayer Art, Music, Dance Biologically Based Therapies Dietary Supplements Herbal Medicine Manipulative and Body-Based Methods Chiropractics Massage Energy Therapies Electromagnetic Therapy Complementary and Alternative Medicine

3. Complementary and Alternative Medicine • 36% of adults are using some form of CAM • CAM is used greater by • Women • People with higher educational levels • People who have been hospitalized in the past year • Former smokers

4. Regulation • The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on CAM. • Homeopathy is regulated by the US Food and Drug Administration (FDA). • Required to list indications, ingredients, dilutions, and instructions for safe use

5. History of Homeopathy • Late 1700’s – developed in Germany by Samuel Hahnemann • 1825 – Introduced in the US by Hans Burch Gram • 1835 – 1st homeopathic medical college – Allentown, Pennsylvania • By the turn of the 20th century, 8 % of all American medical practitioners were homeopaths, and there were 20 homeopathic medical colleges and more than 100 homeopathic hospitals in the United States. • Negatively affected by medical advances, including recognition of the mechanisms of disease and antiseptic techniques • Began to revive in the 1960’s

6. Homeopathy • Homeo (similar) and pathos (suffering) • “Principle of Similars”: Any substance that can create symptoms in a healthy person can be used to treat similar symptoms in a sick person. • “Principle of Potentization”: Diluting a substance, with vigorous shaking at each step of dilution, makes the remedy more, not less, effective by extracting the vital essence of the substance.

7. Water molecules are thought to form clusters that may be unique to the original substance that was dissolved. Samal and Geckeler discovered an inverse relationship between the aggregate size and concentration of the solutes. On dilution, spherical clusters appeared, which were seen to aggregate in steps resulting in a size increase with decreasing concentration. Mechanism Samal S and Geckeler KE. Chem Commun 2001; 2224-25.

8. Treatment • Mostly derived from natural substances that come from plants, minerals, or animals • Used to treat acute and chronic illnesses, as well as to prevent diseases • Used most often to treat arthritis, asthma, colds, flu, and allergies • The choice of medicine is based on a person’s total symptom picture. • Homeopathic Pharmacopoeia of the United States contains guidelines for homeopathic remedies.

9. Treatment • Follow-up on problem in 2-6 weeks after start of the treatment • Patients may experience homeopathic aggravation. • Doses are repeated as necessary, and treatment is discontinued upon resolution of the problem. • Remedies may be changed as the condition and the associated symptoms change. • Changes to diet and lifestyle are often recommended, as well.

10. Safety • Endrezzi et al. studied adverse drug events related to homeopathic encounters in 335 follow-up visits in 181 patients. • 9 (2.68%) adverse reactions were reported. • No medical therapy was required to treat any of the adverse events. • Adverse events exist, but are rare and not severe. Endrizzi C et al. Homeopathy 2005; 94: 233-240.

11. Does it Work? Results of controlled trials have been contradictory.

12. Patient assessment: Greater improvement after homeopathic versus conventional treatment Physician assessment: More favorable for children who had received homeopathic treatment Not placebo • Witt et al. compared conventional treatment versus homeopathy. Witt C et al. Comp Ther Med 2005; 13: 79-86.

13. Quality of life: • Physical component score increased in homeopathically treated patients • Mental component no significant difference Witt C et al. Comp Ther Med 2005; 13: 79-86.

14. Not placebo • 89 studies • OR 2.45 (2.05-2.93) in favor of homeopathy • 26 studies of higher quality • OR 1.66 (1.33-2.08) • Homeopathy not completely due to placebo • Insufficient evidence that any single type of homeopathic treatment is clearly effective in any one clinical condition Linde K et al. Lancet 1997; 350: 834-43.

15. Not placebo • Linde et al. revisited their initial study (1997). • Higher quality studies tended to yield less positive results. • All studies: OR 2.45 (2.05-2.93) • Jadad > 3: OR 1.81(1.41-2.32) – 28% decrease • IVS > 5: OR 1.97 (1.50-2.59) – 22% decrease • Jadad > 3 AND IVS > 5: OR 1.72 – 30% decrease • “…likely that our meta-analysis at least overestimated the effects of homeopathic treatments.” Linde K et al. J Clin Epidemiol 1999; 52; 631-36.

16. Linde K et al. J Clin Epidemiol 1999; 52; 631-36.

17. Placebo • Shang et al. compared trials of homeopathy with those of conventional medicine and estimated treatment effects. • They found no convincing evidence that homeopathy was superior to placebo • OR 0.88 (0.65-1.19) • Whereas, for conventional medicine, a significant difference was found. • OR 0.58 (0.39-0.85) • Clinical effects of homeopathy are placebo effects. Shang A et al. Lancet 2005; 366: 726-32.

18. Conclusions • Although trials of homeopathic treatment have not yet provided a definitive answer, there are many reports of clinical benefit. • In addition, dismissal of homeopathy by practicing clinicians may increase the likelihood that patients will not communicate about integrative remedies. • If homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine may not be necessary.

19. Resources • http://nccam.nih.gov/ • Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy: Aggravations, adverse drug events or medication errors? Homeopathy 2005; 94: 233-240. • Frye, JC. Herbal and homeopathic medicine: Understanding the difference. Seminars in Integrative Medicine 2003; 1: 158-66. • Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-43. • Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jomas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999; 52; 631-36. • Samal S and Geckeler KE. Unexpected solute aggregation in water on dilution. Chem Commun 2001; 2224-25. • Shang A, Huwiler-Műntener K, Nartey L, Jűni P, Dörig S, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects? Comparitive study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005; 366: 726-32. • Vickers A and Zollman C. ABC of complementary medicine: Homeopathy. BMJ 1999; 319: 1115-18. • Witt C, Keil T, Dagmar S, Roll S, Vance W, Wegscheider K, Willich SN. Outcome and costs of homeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic disorders. Comp Ther Med 2005; 13: 79-86.