an introduction to homeopathy
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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withdrawn due to intense public lobbying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