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An introduction to homeopathy

An introduction to homeopathy. Why learn about homeopathy?. Your patients are using it Your colleagues are using it There is a clinical need for it It’s rewarding. Patient demand. OTC sales of homeopathic remedies: £38 million in 2007 and predicted to reach £46 million by 2012

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An introduction to homeopathy

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  1. An introduction to homeopathy

  2. Why learn about homeopathy? • Your patients are using it • Your colleagues are using it • There is a clinical need for it • It’s rewarding

  3. Patient demand • OTC sales of homeopathic remedies: £38 million in 2007 and predicted to reach £46 million by 2012 • Pharmacies and supermarkets selling homeopathic medicines: Tesco, Sainsbury’s, Boots and many others • British Homeopathic Association website receives around 80,000 visits from the general public a year

  4. Patient demand ROYAL LONDON HOMEOPATHIC HOSPITAL - in the year 2004 : • 3,300 new out-patients • 25,000 follow-up appointments

  5. Patient demand GLASGOW HOMEOPATHIC HOSPITAL - in the year 2004 : • 1,528 new out-patient consultations • 7,400 follow-up appointments • 515 new in-patients • Threat to close the in-patient service a few years ago withdrawn due to intense public lobbying

  6. Patient demand BRISTOL HOMEOPATHIC HOSPITAL - 2004 • 1,100 new out-patient consultations • 3,500 follow-up appointments LIVERPOOL HOMEOPATHIC HOSPITAL - 2004 • 684 new out-patient consultations • 6,468 follow-up appointments

  7. Patient demand • 15% of the UK population trust homeopathy (TGI Global barometer, January 2008) • A poll of 3,373 people found that 79% would like to be able to access complementary medicine alongside conventional treatment in the NHS (One Poll, January 2009)

  8. Why learn about homeopathy? • Your patients are using it • Your colleagues are using it • There is a clinical need for it • It’s rewarding

  9. Professional demand • Professional demand for training • 20-25% of Scottish GPs have had some homeopathic training • There are 54,000 homeopathic medical doctors and other healthcare professionals in Europe. Between 25% and 40% of European healthcare practitioners prescribe homeopathy occasionally, 7% on a regular basis

  10. Lothian GP Survey • 305 of 540 Lothian GPs replied • 90% of respondents had recommended or referred patients for a complementary therapy • 109 GPs said they wished training in a complementary therapy • most of these stated homeopathy as the therapy of choice • 95% said they were willing to refer patients for homeopathic treatment • 64% wanted such a provision in a hospital out-patient setting

  11. B.M.A. “Complementary Medicine, New Approaches ....” • “One of the main reasons for the current upsurge of ‘official’ interest in non-conventional medicine is the rapidly increasing number of patients who are seeking help from such practitioners. This has prompted the Council of Europe to state : ‘It is not possible to consider this phenomenon as a medical side-issue. It must reflect a genuine public need which is in urgent need of definition and analysis.’ ”

  12. Why learn about homeopathy? • Your patients are using it • Your colleagues are using it • There is a clinical need for it • It’s rewarding

  13. The clinical place of homeopathy • Where there is no effective conventional alternative • Where conventional medicine is unsafe • Where conventional medicine has unacceptable side-effects • To minimize the use of conventional medicine

  14. No effective conventional treatment • Allergies • Anal fissures • Anger • Bruises • Chilblains • Colic • Fear/phobias • Glandular fever • Grief • Impotence

  15. No effective conventional treatment • Intermittent claudication • Mastalgia • M.E. / CFS / PVS • Nightmares / night terrors • Premenstrual Syndrome • Teething • Urethral syndrome

  16. Unsafe situation for conventional medicine • Pregnant women • Young children • The elderly • Anticipatory anxiety

  17. Unacceptable side-effect profile • Anxiety • Depression • Cramps • Osteoarthritis

  18. Reduction in long-term conventional treatment • Asthma • Constipation • Convulsions • Dysmenorrhoea • Eczema • Migraine • Neuralgias • Otitis media ( recurrent ) • Psoriasis

  19. Why learn about homeopathy? • Your patients are using it • Your colleagues are using it • There is a clinical need for it • It’s rewarding

  20. The rewards of homeopathy • Making a difference • Patient satisfaction • Effects on consultation technique • Intellectual achievement • The joy of detective work • Making sense of patterns of disease • Making sense of progress of disease • Understanding aetiology

  21. What is homeopathy? • Like cures like • Minimum effective dose

  22. How are remedies prepared? • Original sources • Plant • Mineral • Animal • Disease • Serial dilutions • Succussion

  23. Is there a phenomenon here? • Clinical research • Clinical experience • Consistency of theory

  24. Professional attitudes • British Journal of Pharmacology, 2006 – a study by University of Aberdeen of Scottish general practices found that 49% had prescribed homeopathy (323 practices in total) • The doctor’s mag Pulse reported on a survey of 200 GPs in 2007 - 56% had either provided or recommended complementary medicine to patients

  25. RCTs - the meta-analyses • Kleijnen J, Knipschild P, Ter Riet G. Clinical trials of homeopathy. British Medical Journal 1991; 302: 316-323 • Linde K, Clausius N, Ramirez G, etal. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-843

  26. Linde’s conclusion • Linde's conclusion is: "The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo” • A reading of the study shows a clearly positive result for homeopathy • 49% of the trials were clearly positive and a further 35% showed a positive trend

  27. Kleijnen’s conclusions • They found that of 105 trials with interpretable results, 81 were positive • They then looked at a sub-group of the most rigorous trials and discovered that 15 out of 22 found homeopathy to be superior to placebo • One of Kleijnen's conclusions was that the evidence found: 'would probably be sufficient for establishing homeopathy as a regular treatment for certain conditions'

  28. The Lancet – August 2005 • 110 homeopathy trials were compared with 110 allopathy trials • Overall positive treatment effect found in both groups • Final analysis limited to “best” 8 homeopathy and 6 allopathy trials – significant effect of homeopathy disappeared • Conclusion: “The clinical effects of homeopathy are those of placebo” • Lancet editorial: “The end of homeopathy”!

  29. Lancet 2005 – the flaws • Standard assessment criteria are insufficient to gauge “high quality” in homeopathy trials • Authors did not state which 8+6 trials were analysed in details so their relevance or value was unknown • 8 trials of homeopathy cannot fairly represent the entire research literature! • Authors ignore homeopathy’s significant effects in RTIs • Some key papers are omitted, others wrongly included • The rigour and validity of the paper’s conclusions were rebutted in later articles (Rutten and others, 2008)

  30. Categories of research evidence • The medical conditions for which the published literature substantiates the clinical value of homeopathic treatment can be ranked in 3 categories: 1. Systematic reviews with positive conclusions in specific clinical areas 2. More than one published clinical trial favouring homeopathy 3. One positive published clinical trial only…

  31. 1. Systematic reviews with focus on specific clinical areas • Allergies and upper respiratory tract infections • Childhood diarrhoea • Influenza • Post-operative ileus • Rheumatic diseases • Seasonal allergic rhinitis • Upper respiratory tract diseases, including otitis media • Vertigo

  32. 2. Replicated trials with a majority of positive findings • Childhood diarrhoea • Fibromyalgia • Influenza • Osteoarthritis • Seasonal allergic rhinitis • Sinusitis • Vertigo

  33. 3. Singleton trials with positive evidence • Includes… • Chronic fatigue syndrome • Premenstrual syndrome • Post-partum bleeding • Sepsis • Stomatitis

  34. Outcome studies:Bristol Homeopathic Hospital • Observational study of 6,544 consecutive follow-up patients over 6 year period in an NHS hospital outpatient unit • Outcomes were based on scores on a 7-point Likert-type scale • 70.7% reported positive health changes, with 50.7% recording their improvement as better (+2) or much better (+3)

  35. Outcome studies:Royal London Homeopathic Hospital • Outcome study of 500 asthma patients • Of 262 who had been taking conventional medicines, 29% were able to stop conventional treatment and 32% reduced their conventional treatment.

  36. BMJ, Nov 2007: • “A principle of evidence based practice is that the evidence should be only one influence on clinical decision making, alongside the expertise and perspectives of both patients and clinicians. However uncomfortable for health system planners, an evidence based service should reflect expressed patient preference.” David Tovey, Editor of BMJ Knowledge

  37. Taking a homeopathic history • Presenting complaints • Systems review • PMH • FH • SH • Allergies • Generals • Mentals

  38. Analysing the data • Significant symptoms • Materia Medica patterns • Repertorising

  39. Basic homeopathic principles • Single remedy, Single dose • Potency • Direction of cure

  40. Basic homeopathic principles • Single remedy, single dose • Potency • Direction of cure

  41. Potency • Series of Dilutions and Succussions • Two common Scales in UK • x or Decimal scale - serial 1:9 dilutions • c or Centesimal scale - serial 1:99 dilutions • Each Potency written as number, then scale symbol: • 2x, 3x, 6x, 12x, etc. • 6c, 12c, 30c, 200c, M, 10M, CM, MM

  42. Basic homeopathic principles • Single remedy, single dose • Potency • Direction of cure

  43. Direction of cure • Most important organs to least important • Inwards to outwards • Top to bottom • Reverse order of appearance of symptoms

  44. Prescribing a Remedy • NHS or private • Pharmaceutical supply • Local chemist • Specialist homeopathic pharmacies such as Ainsworths, Freemans, Helios, Nelsons or Weleda • Stock order • Cost

  45. Obtaining homeopathic treatment NHS • GP • Homeopathic hospital (Bristol, Glasgow, Liverpool, London) • In-patient (Glasgow only) • Out-patient • Homeopathic clinics around the country Private practitioners • Medically qualified • Non-medically qualified

  46. First prescriptions • Infant Colic • Colocynthis • Night Cramps • Cuprum metallicum

  47. What is complementary medicine? • Definitions - • a) “additional to western medicine” or “not taught in medical schools” ( GP survey ) • b) “all forms of health care which usually lie outside the official health sector” ( WHO ) • c) “those forms of treatment which are not widely used by orthodox health-care professions, and the skills of which are not taught as part of the undergraduate curriculum of orthodox medical and paramedical health-care courses” (BMA)

  48. What is complementary medicine? • Acupuncture • Alexander technique • Aromatherapy • Bach Flower Remedies • Chiropractic • Crystal therapy • Healing • Herbalism • Homeopathy

  49. What is complementary medicine? • Hypnotherapy • Iridology • Kinesiology • Massage • Osteopathy • Radionics • Reflexology • Shiatsu

  50. Hospital-based complementary medicine • Outpatient care • Inpatient care • Teaching

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