Homeopathic Medicine “Like Cures Like” Dr. Ujjaval J Pathak, Pharm D, Temple University School of Pharmacy

Objectives Understand the evolution and major principles of homeopathic medicine Differentiate homeopathic medications from conventional (allopathic) medications as well as dietary supplements Discuss regulations and current issues involving the practice of homeopathic medicine Recognize roles of healthcare professionals in homeopathic management Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

What is Homeopathy? 200 years old system of medicine Introduced by German doctor Samuel Hahnemann opposing the state of medicine in 1800s Dr. Hahnemann self-applied cinchona bark extract to induce malaria like symptoms “like cures like” Homeopathic medicines are made from plants, chemicals, minerals, or animal sources Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Branches of Medicine HOMEOPATHY ALLOPATHY DIETARY/HERBAL SUPPLEMENTS MECHANISM OF ACTION Acts directly on immune system Acts on the disease Treated as a separate category of supplements for supporting the condition not treating it.   ADVERSE EFFECTS PROFILES Least adverse effects Potentially more adverse effects Potential adverse effects TREATMENT Treats the symptoms that are usually produced by the medication in a healthy individual Treats the disease which produce effects different from those produced by the disease under treatment Helps as a supportive care but does not guarantee symptom or disease control FDA REGULATIONS Not-controlled by FDA though potential for stricter regulation exists Controlled by FDA Not-controlled by FDA LABELING Must have a therapeutic indication for self-diagnosing condition **classified as “drugs” by FDA Must have a therapeutic indication. Can make definitive claims to cure/treat Cannot make claims for the diagnosis, relief, cure, of a given condition/illness Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Homeopathy Utilization Estimated $110 million in sales of homeopathic products in 2014. Estimated 5 million adults and 1 million children used homeopathic medicine in 2011, according to National Center for Complementary and Integrative Health. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Prevalence of Use High prevalence among patients with HIV/AIDS and cancer to fight emotional well being CAM= Complementary and alternative medicine Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Central Principles Law of Similar: Substance causing symptoms in a healthy individual will likely cure the ill presenting with the same symptoms; “like cures like.” Law of Individualization: Characteristics of the chosen medicine should be as similar as possible to the characteristics of the illness in the patient. Law of Minimum Dose: They are manufactured using a process combining serial dilution and vigorous shaking to make the ultra-molecular dilutions. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Dilutions 2 scales used for concentration X scale and C scale refers to 10 and 100 respectively X scale is used in the US 3X = 1 part in 103 parts or 1 in 1000 Scale conversion: 1C = 2X Homeopathic medicine: 24X homeopathic solution: pinch of salt in both the North and South Atlantic Oceans i.e. 24X dilution is 1 part of active drug in 1,000,000,000,000,000,000,000,000 [or 1024] parts of water Allopathic medicine: Tylenol syrup 325mg/15ml i.e. 1 part of active drug in 50 parts of solvent Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Significance of Water as a “Drug” Water memory Extreme dilutions do not leave any original substance in the final product Considered to have pharmacologic effect in absence of the substance from water Contains memory or vibration from the diluted substance. Electromagnetic-treated water Experiment with electromagnetic conditioned water on health of soybean Suggested diverse biological effects on both animal and plant cells Potential for further investigation Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Common Treatments MOST COMMON CONDITIONS TREATED WITH HOMEOPATHY MOST COMMON HOMEOPATHIC MEDICINES USED Mental health conditions, such as depression, stress and anxiety Hypericum (St. John's wort) Ignatia (St. Ignatius bean) Allergies Allium cepa (onion) Arthritis Arnica (mountain daisy) Dermatitis (an allergic skin condition) Rhus tox (poison ivy) Ear infections Pulsatilla (windflower) Digestive disorders Nux vomica (poison nut), General pain (spams, sprain) Magnesia phosphorica (phosphate of magnesia) Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Treatment Approach Get patient case history Collect, evaluate, and characterize patient symptoms Compare and select medications that produces similar symptoms in a healthy individual Select potency, dose, and route of administration for particular medication Counsel patient on diet, regimen, and management Follow up Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Homeopathic Practitioners Homeopaths/Naturopathic physicians (requires board certified license from American Board of Homeotherapeutics) Professionals practice homeopathic medicine under strong code of conduct and ethics with boards license in homeopathy Other practitioners Homeopathic pharmacists (www.aahp.info) Homeopathic nurses (www.nursehomeopaths.org) Homeopathic vets (www.ahvma.org) Homeopathic dentists (www.holisticdental.org) Site of Practice Private practices Hospitals Clinics Community health centers Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Challenges to Homeopathy The result of clinical research into the homeopathic medicine is not compelling No good-quality evidence that homeopathic medicines are effective as a treatment for any health condition Extensive risk of missing timely diagnosis and effective treatment of serious conditions Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Safety & Effectiveness Controversial safety “Unlike some conventional drugs, homeopathic medicines are non-addictive and have no dangerous side-effects” per British Homeopathic Association. “Homeopathic remedies may contain substances that are not safe, or that interfere with the action of other medicines” per National Health Service. Homeopathic medicines are safe to use for babies, children and pregnant or breastfeeding women, who are under the supervision of a homeopathic doctor. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Safety & Effectiveness Homeopathy effectiveness study by Leone and researchers suggests: No statistically significant different between the homeopathic and placebo for rates of hospitalization due to progression of the disease. “Proving” homeopathic procedure: determine the dose of a drug sufficient to produce symptoms “There is no good quality evidence that homeopathy is an effective treatment for these or any other health conditions” per National Health Service. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Regulatory Affairs Homeopathic medicines generally must meet the standards for strength, quality, and purity set forth in the Homeopathic Pharmacopeia. HPCUS: The Homeopathic Pharmacopoeia Convention of the United States Reviews homeopathic efficacy, toxicology, adverse effects, and clinical use for individual homeopathic ingredients marketed. HPUS: The Homeopathic Pharmacopoeia of the United States Listings of monographs for currently marketed homeopathic products. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Current Issue FDA to rethink their policy for regulating homeopathic medication Surveying general population for their perspective on current regulations for homeopathic remedies FDA to reveal decision sometimes this year (2015) Questions posed by the FDA include: Consumer thought and attitude towards the use of homeopathic remedies over allopathic Whether or not enough information is available for consumers to select certain products Whether or not it is viable to disperse homeopathic remedies along with conventional medications Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Ethical Dilemmas Veterinary use of these medicines suggests that it is not viable to trial these medications even on animals when evidence suggests that they are not effective for treating a disease state. Currently FDA/HPUS “does not establish that it has been shown by appropriate means to be safe, effective, and not misbranded for its intended use.” UK pharmacies are advertising misleading information that does not specify that these products are biologically implausible to use. Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Role of a Pharmacist The pharmacist’s attitude with regard to homeopathy is still a dilemma.  Pharmacists must keep their integrity by acting honestly, ethically, and with conscience, accepting responsibility for his actions and under no circumstances providing false information to the patient Pharmacist counseling points: Do not attempt to self-treat before undergoing a thorough medical evaluation Always keep an updated list of all homeopathic medications that you are taking Special population should never use homeopathic medications without first consulting their primary health care provider Only use products by reputable manufacturers Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Useful Resources RESOURCES FOR INFORMATION ON HOMEOPATHIC TREATMENTS The National Center for Complementary and Alternative Medicine’s Time to Talk campaign: http://nccam.nih.gov/timetotalk The Homoeopathic Pharmacopoeia of the United States: http://HPUS.com The American Association of Homeopathic Pharmacists website: http://www.homeopathicpharmacy.org The National Center for Homeopathy website: http://www.nationalcenterforhomeopathy.org LEADING MANUFACTURERS OF HOMEOPATHIC MEDICATIONS Boiron, USA Hyland’s, Inc Similasan, USA Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Common Homeopathic Products Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Patient Education Important to know when to make changes especially when self-treating without medical supervision Sufficient level of health literacy Be able to recognize symptoms associated with the disease state Counsel a healthcare professional before selecting a homeopathic medication *** Important to educate patients that homeopathy does not replace conventional therapy Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Conclusion Approach to an appropriate diagnosis and treatment Symptoms can be different for each individual Necessary to pick correct medicine as it relates to the symptoms Consideration of safety and effectiveness is crucial Failure to establish a use in disease state as a cure Underdiagnoses and under-treatment Keeping one self up-to-date for new research and new regulations Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved

Conclusion General public acceptance across the nation Non-supporters call it scientific illiteracy and a pseudoscience Supporters think that they are absolutely effective if used appropriately to treat appropriate symptoms. Potential for further research for these products for symptomatic treatment Conventional wisdom of practitioners and patient education for risk and benefits of using proper remedy Copyright © Dr. Ujjaval J Pathak, Pharm D, Rph [2017]. All rights reserved