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 demandOTC 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

Patient demandROYAL LONDON HOMEOPATHIC HOSPITAL

- in the year 2004 : 3,300 new out-patients25,000 follow-up appointments

Patient demandGLASGOW HOMEOPATHIC HOSPITAL

- in the year 2004 : 1,528 new out-patient consultations7,400 follow-up appointments515 new in-patientsThreat to close the in-patient service a few years ago

withdrawn due to intense public lobbying

Patient demandBRISTOL HOMEOPATHIC HOSPITAL - 2004

1,100 new out-patient consultations3,500 follow-up appointments

LIVERPOOL HOMEOPATHIC HOSPITAL - 2004684 new out-patient consultations 6,468 follow-up appointments

Patient demand15% 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)

Why learn about homeopathy?Your patients are using it

Your colleagues are using it

There is a clinical need for it

It’s rewarding

Professional demandProfessional 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

Lothian GP Survey305 of 540 Lothian GPs replied90% of respondents had recommended or referred patients

for a complementary therapy109 GPs said they wished training in a complementary therapy

most of these stated homeopathy as the therapy of choice95% said they were willing to refer patients for homeopathic

treatment64% wanted such a provision in a hospital out-patient setting

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.’ ”

Why learn about homeopathy?Your patients are using it

Your colleagues are using it

There is a clinical need for it

It’s rewarding

The clinical place of homeopathy

Where there is no effective conventional alternativeWhere conventional medicine is unsafeWhere conventional medicine has unacceptable

side-effectsTo minimize the use of conventional medicine

No effective conventional treatmentAllergiesAnal fissuresAngerBruisesChilblainsColicFear/phobiasGlandular feverGriefImpotence

No effective conventional treatmentIntermittent claudicationMastalgiaM.E. / CFS / PVSNightmares / night terrorsPremenstrual SyndromeTeethingUrethral syndrome

Unsafe situation for conventional medicinePregnant womenYoung childrenThe elderlyAnticipatory anxiety

Unacceptable side-effect profileAnxietyDepressionCrampsOsteoarthritis

Reduction in long-term conventional treatmentAsthmaConstipationConvulsionsDysmenorrhoeaEczemaMigraineNeuralgiasOtitis media ( recurrent )Psoriasis

Why learn about homeopathy?Your patients are using it

Your colleagues are using it

There is a clinical need for it

It’s rewarding

The rewards of homeopathyMaking a differencePatient satisfactionEffects on consultation techniqueIntellectual achievementThe joy of detective workMaking sense of patterns of diseaseMaking sense of progress of diseaseUnderstanding aetiology

What is homeopathy?

Like cures like

Minimum effective dose

How are remedies prepared?Original sources

Plant MineralAnimalDisease

Serial dilutions

Succussion

Is there a phenomenon here?Clinical research

Clinical experience

Consistency of theory

Professional attitudesBritish 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

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, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-843

Linde’s conclusionLinde'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

Kleijnen’s conclusionsThey 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'

The Lancet – August 2005110 homeopathy trials were compared with 110 allopathy

trialsOverall positive treatment effect found in both groupsFinal analysis limited to “best” 8 homeopathy and 6 allopathy

trials – significant effect of homeopathy disappearedConclusion: “The clinical effects of homeopathy are those of

placebo”Lancet editorial: “The end of homeopathy”!

Lancet 2005 – the flawsStandard assessment criteria are insufficient to gauge “high

quality” in homeopathy trialsAuthors did not state which 8+6 trials were analysed in details

so their relevance or value was unknown8 trials of homeopathy cannot fairly represent the entire

research literature!Authors ignore homeopathy’s significant effects in RTIsSome key papers are omitted, others wrongly includedThe rigour and validity of the paper’s conclusions were

rebutted in later articles (Rutten and others, 2008)

Categories of research evidenceThe 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…

1. Systematic reviews with focus on specific clinical areasAllergies and upper respiratory tract infectionsChildhood diarrhoea Influenza Post-operative ileus Rheumatic diseases Seasonal allergic rhinitis Upper respiratory tract diseases, including otitis media Vertigo

2. Replicated trials with a majority of positive findings Childhood diarrhoeaFibromyalgia Influenza Osteoarthritis Seasonal allergic rhinitis Sinusitis Vertigo

3. Singleton trials with positive evidence Includes…

Chronic fatigue syndrome Premenstrual syndrome Post-partum bleeding Sepsis Stomatitis

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)

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.

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

Taking a homeopathic historyPresenting complaintsSystems reviewPMHFHSHAllergiesGeneralsMentals

Analysing the data

Significant symptoms

Materia Medica patterns

Repertorising

Basic homeopathic principles

Single remedy, Single dose

Potency

Direction of cure

Basic homeopathic principles

Single remedy, single dose

Potency

Direction of cure

PotencySeries of Dilutions and Succussions

Two common Scales in UKx or Decimal scale - serial 1:9 dilutionsc 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

Basic homeopathic principles

Single remedy, single dose

Potency

Direction of cure

Direction of cure

Most important organs to least important

Inwards to outwards

Top to bottom

Reverse order of appearance of symptoms

Prescribing a RemedyNHS or private

Pharmaceutical supply

Local chemist

Specialist homeopathic pharmacies such as Ainsworths,

Freemans, Helios, Nelsons or Weleda

Stock order

Cost

Obtaining homeopathic treatmentNHSGPHomeopathic hospital (Bristol, Glasgow, Liverpool, London)

In-patient (Glasgow only) Out-patient

Homeopathic clinics around the country

Private practitioners Medically qualified Non-medically qualified

First prescriptionsInfant Colic

Colocynthis

Night CrampsCuprum metallicum

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)

What is complementary medicine?AcupunctureAlexander techniqueAromatherapyBach Flower RemediesChiropracticCrystal therapyHealingHerbalismHomeopathy

What is complementary medicine?HypnotherapyIridology KinesiologyMassageOsteopathyRadionicsReflexologyShiatsu

Hospital-based complementary medicine

Outpatient care

Inpatient care

Teaching

www.facultyofhomeopathy.org

The only body in the UK that promotes the education and training of healthcare professionals in homeopathy

1400 members worldwide in a range of different professions including doctors, nurses, dentists, vets, midwives, pharmacists, podiatrists and osteopaths

Accredited training available in the UK and overseas

Faculty of Homeopathy