HomeopathyHomeopathy

Eleanor BatesEleanor Bates

Tinsley Harrison SocietyTinsley Harrison Society

November 8, 2005November 8, 2005

Complementary and Complementary and Alternative MedicineAlternative Medicine

Traditional Alternative Traditional Alternative MedicineMedicine Acupuncture Acupuncture AyurvedaAyurveda HomeopathyHomeopathy NaturopathyNaturopathy Chinese/OrientalChinese/Oriental

Mind-Body InterventionsMind-Body Interventions Cognitive Behavioral TherapyCognitive Behavioral Therapy MeditationMeditation BiofeedbackBiofeedback HypnosisHypnosis PrayerPrayer Art, Music, DanceArt, Music, Dance

Biologically Based Biologically Based TherapiesTherapies Dietary SupplementsDietary Supplements Herbal MedicineHerbal Medicine

Manipulative and Body-Manipulative and Body-Based MethodsBased Methods ChiropracticsChiropractics MassageMassage

Energy TherapiesEnergy Therapies Electromagnetic Electromagnetic

TherapyTherapy

Complementary and Complementary and Alternative MedicineAlternative Medicine

36% of adults are using some form 36% of adults are using some form of CAMof CAM

CAM is used greater by CAM is used greater by WomenWomen People with higher educational levelsPeople with higher educational levels People who have been hospitalized in People who have been hospitalized in

the past yearthe past year Former smokersFormer smokers

RegulationRegulation

The National Center for The National Center for Complementary and Alternative Complementary and Alternative Medicine (NCCAM) is the Federal Medicine (NCCAM) is the Federal Government's lead agency for Government's lead agency for scientific research on CAM.scientific research on CAM.

Homeopathy is regulated by the US Homeopathy is regulated by the US Food and Drug Administration (FDA).Food and Drug Administration (FDA). Required to list indications, ingredients, Required to list indications, ingredients,

dilutions, and instructions for safe usedilutions, and instructions for safe use

History of HomeopathyHistory of Homeopathy

Late 1700’s – developed in Germany Late 1700’s – developed in Germany by Samuel Hahnemannby Samuel Hahnemann 1825 – Introduced in the US by 1825 – Introduced in the US by Hans Burch GramHans Burch Gram 1835 – 11835 – 1stst homeopathic medical college – homeopathic medical college –

Allentown, PennsylvaniaAllentown, Pennsylvania By the turn of the 20th century, 8 % of all By the turn of the 20th century, 8 % of all

American medical practitioners were American medical practitioners were homeopaths, and there were 20 homeopathic homeopaths, and there were 20 homeopathic medical colleges and more than 100 homeopathic medical colleges and more than 100 homeopathic hospitals in the United States.hospitals in the United States.

Negatively affected by medical advances, Negatively affected by medical advances, including recognition of the mechanisms of including recognition of the mechanisms of disease and antiseptic techniquesdisease and antiseptic techniques

Began to revive in the 1960’sBegan to revive in the 1960’s

HomeopathyHomeopathy

HomeoHomeo (similar) and (similar) and pathospathos (suffering) (suffering)

““Principle of Similars”: Any substance that Principle of Similars”: Any substance that can create symptoms in a healthy person can create symptoms in a healthy person can be used to treat similar symptoms in a can be used to treat similar symptoms in a sick person.sick person.

““Principle of Potentization”: Diluting a Principle of Potentization”: Diluting a substance, with vigorous shaking at each substance, with vigorous shaking at each step of dilution, makes the remedy more, step of dilution, makes the remedy more, not less, effective by extracting the vital not less, effective by extracting the vital essence of the substance. essence of the substance.

MechanismMechanism

Water molecules Water molecules are thought to are thought to form clusters that form clusters that may be unique to may be unique to the original the original substance that was substance that was dissolved. dissolved.

Samal and Samal and Geckeler Geckeler discovered an discovered an inverse inverse relationship relationship between the between the aggregate size and aggregate size and concentration of concentration of the solutes.the solutes.

On dilution, spherical On dilution, spherical clusters appeared, clusters appeared, which were seen to which were seen to aggregate in steps aggregate in steps resulting in a size resulting in a size increase with increase with decreasing decreasing concentration.concentration.

Samal S and Geckeler KE. Chem Commun 2001; 2224-25.

TreatmentTreatment

Mostly derived from natural substances that Mostly derived from natural substances that come from plants, minerals, or animals come from plants, minerals, or animals

Used to treat acute and chronic illnesses, as Used to treat acute and chronic illnesses, as well as to prevent diseaseswell as to prevent diseases Used most often to treat arthritis, asthma, colds, Used most often to treat arthritis, asthma, colds,

flu, and allergiesflu, and allergies The choice of medicine is based on a The choice of medicine is based on a

person’s total symptom picture.person’s total symptom picture.

Homeopathic Pharmacopoeia of the United Homeopathic Pharmacopoeia of the United States States contains guidelines for homeopathic contains guidelines for homeopathic remedies.remedies.

TreatmentTreatment

Follow-up on problem in 2-6 weeks after Follow-up on problem in 2-6 weeks after start of the treatmentstart of the treatment

Patients may experience homeopathic Patients may experience homeopathic aggravation.aggravation.

Doses are repeated as necessary, and Doses are repeated as necessary, and treatment is discontinued upon resolution treatment is discontinued upon resolution of the problem.of the problem.

Remedies may be changed as the condition Remedies may be changed as the condition and the associated symptoms change.and the associated symptoms change.

Changes to diet and lifestyle are often Changes to diet and lifestyle are often recommended, as well.recommended, as well.

SafetySafety

Endrezzi et al. studied adverse drug Endrezzi et al. studied adverse drug events related to homeopathic encounters events related to homeopathic encounters in 335 follow-up visits in 181 patients. in 335 follow-up visits in 181 patients.

9 (2.68%) adverse reactions were 9 (2.68%) adverse reactions were reported.reported.

No medical therapy was required to treat No medical therapy was required to treat any of the adverse events.any of the adverse events.

Adverse events exist, but are rare and not Adverse events exist, but are rare and not severe.severe.

Endrizzi C et al. Homeopathy 2005; 94: 233-240.

Does it Work?Does it Work?

Results of controlled trials Results of controlled trials have been contradictory.have been contradictory.

Not placeboNot placebo

Patient assessment: Patient assessment: Greater improvement Greater improvement after homeopathic versus after homeopathic versus conventional treatmentconventional treatment

Physician assessment: Physician assessment: More favorable for More favorable for children who had children who had received homeopathic received homeopathic treatmenttreatment

Witt C et al. Comp Ther Med 2005; 13: 79-86.

Witt et al. compared conventional treatment versus Witt et al. compared conventional treatment versus

homeopathy.homeopathy.

Quality of life:Quality of life: Physical component score increased in Physical component score increased in

homeopathically treated patientshomeopathically treated patients Mental component no significant differenceMental component no significant difference

Witt C et al. Comp Ther Med 2005; 13: 79-86.

Not placeboNot placebo 89 studies89 studies

OR 2.45 (2.05-2.93) OR 2.45 (2.05-2.93) in favor of in favor of homeopathyhomeopathy

26 studies of higher 26 studies of higher qualityquality OR 1.66 (1.33-2.08)OR 1.66 (1.33-2.08)

Homeopathy not Homeopathy not completely due to completely due to placeboplacebo

Insufficient Insufficient evidence that any evidence that any single type of single type of homeopathic homeopathic treatment is clearly treatment is clearly effective in any one effective in any one clinical conditionclinical condition

Linde K et al. Lancet 1997; 350: 834-43.

Not placeboNot placebo Linde et al. revisited their initial study Linde et al. revisited their initial study

(1997).(1997). Higher quality studies tended to yield less Higher quality studies tended to yield less

positive results.positive results. All studies: OR 2.45 (2.05-2.93)All studies: OR 2.45 (2.05-2.93) Jadad Jadad >> 3: OR 1.81(1.41-2.32) – 28% decrease 3: OR 1.81(1.41-2.32) – 28% decrease IVS IVS >> 5: OR 1.97 (1.50-2.59) – 22% decrease 5: OR 1.97 (1.50-2.59) – 22% decrease Jadad Jadad >> 3 AND IVS 3 AND IVS >> 5: OR 1.72 – 30% 5: OR 1.72 – 30%

decreasedecrease “…“…likely that our meta-analysis at least likely that our meta-analysis at least

overestimated the effects of homeopathic overestimated the effects of homeopathic treatments.”treatments.”

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

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

PlaceboPlacebo Shang et al. compared trials of Shang et al. compared trials of

homeopathy with those of conventional homeopathy with those of conventional medicine and estimated treatment effects.medicine and estimated treatment effects.

They found no convincing evidence that They found no convincing evidence that homeopathy was superior to placebo homeopathy was superior to placebo OR 0.88 (0.65-1.19)OR 0.88 (0.65-1.19)

Whereas, for conventional medicine, a Whereas, for conventional medicine, a significant difference was found.significant difference was found. OR 0.58 (0.39-0.85)OR 0.58 (0.39-0.85)

Clinical effects of homeopathy are placebo Clinical effects of homeopathy are placebo effects.effects.

Shang A et al. Lancet 2005; 366: 726-32.

ConclusionsConclusions Although trials of homeopathic treatment Although trials of homeopathic treatment

have not yet provided a definitive answer, have not yet provided a definitive answer, there are many reports of clinical benefit.there are many reports of clinical benefit.

In addition, dismissal of homeopathy by In addition, dismissal of homeopathy by practicing clinicians may increase the practicing clinicians may increase the likelihood that patients will not likelihood that patients will not communicate about integrative remedies. communicate about integrative remedies.

If homeopathy appears to be helpful and If homeopathy appears to be helpful and safe, then scientifically valid explanations safe, then scientifically valid explanations or proofs of this alternative system of or proofs of this alternative system of medicine may not be necessary.medicine may not be necessary.

ResourcesResources http://nccam.nih.gov/http://nccam.nih.gov/ Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy: Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy:

Aggravations, adverse drug events or medication errors? Aggravations, adverse drug events or medication errors? HomeopathyHomeopathy 2005; 94: 233-240.2005; 94: 233-240.

Frye, JC. Herbal and homeopathic medicine: Understanding the Frye, JC. Herbal and homeopathic medicine: Understanding the difference. difference. Seminars in Integrative MedicineSeminars in Integrative Medicine 2003; 1: 158-66. 2003; 1: 158-66.

Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. analysis of placebo-controlled trials. LancetLancet 1997; 350: 834-43. 1997; 350: 834-43.

Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jomas WB. Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jomas WB. Impact of study quality on outcome in placebo-controlled trials of Impact of study quality on outcome in placebo-controlled trials of homeopathy. homeopathy. J Clin EpidemiolJ Clin Epidemiol 1999; 52; 631-36. 1999; 52; 631-36.

Samal S and Geckeler KE. Unexpected solute aggregation in water on Samal S and Geckeler KE. Unexpected solute aggregation in water on dilution. dilution. Chem CommunChem Commun 2001; 2224-25. 2001; 2224-25.

Shang A, Huwiler-MShang A, Huwiler-Műűntener K, Nartey L, Jntener K, Nartey L, Jűűni P, Dni P, Dörig S, Sterne JAC, örig S, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homeopathy placebo Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects? Comparitive study of placebo-controlled trials of homeopathy effects? Comparitive study of placebo-controlled trials of homeopathy and allopathy. and allopathy. LancetLancet 2005; 366: 726-32. 2005; 366: 726-32.

Vickers A and Zollman C. ABC of complementary medicine: Vickers A and Zollman C. ABC of complementary medicine: Homeopathy. BMJ 1999; 319: 1115-18.Homeopathy. BMJ 1999; 319: 1115-18.

Witt C, Keil T, Dagmar S, Roll S, Vance W, Wegscheider K, Willich SN. Witt C, Keil T, Dagmar S, Roll S, Vance W, Wegscheider K, Willich SN. Outcome and costs of homeopathic and conventional treatment Outcome and costs of homeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic strategies: A comparative cohort study in patients with chronic disorders. disorders. Comp Ther MedComp Ther Med 2005; 13: 79-86. 2005; 13: 79-86.