Homeopathy NIDHI DESWAL GROUP 2 1 ST SEMESTER

Complementary and Alternative Medicine Traditional Alternative Medicine Traditional Alternative Medicine Acupuncture Acupuncture Ayurveda Ayurveda Homeopathy Homeopathy Naturopathy Naturopathy Chinese/Oriental Chinese/Oriental Mind-Body Interventions Mind-Body Interventions Cognitive Behavioral Therapy Cognitive Behavioral Therapy Meditation Meditation Biofeedback Biofeedback Hypnosis Hypnosis Prayer Prayer Art, Music, Dance Art, Music, Dance Biologically Based Therapies Dietary Supplements Herbal Medicine Manipulative and Body- Based Methods Chiropractics Massage Energy Therapies Electromagnetic Therapy

Complementary and Alternative Medicine 36% of adults are using some form of CAM 36% of adults are using some form of CAM CAM is used greater by CAM is used greater by Women Women People with higher educational levels People with higher educational levels People who have been hospitalized in the past year People who have been hospitalized in the past year Former smokers Former smokers

Regulation The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on CAM. The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on CAM. Homeopathy is regulated by the US Food and Drug Administration (FDA). Homeopathy is regulated by the US Food and Drug Administration (FDA). Required to list indications, ingredients, dilutions, and instructions for safe use Required to list indications, ingredients, dilutions, and instructions for safe use

History of Homeopathy Late 1700’s – developed in Germany Late 1700’s – developed in Germany by Samuel Hahnemann by Samuel Hahnemann 1825 – Introduced in the US by 1825 – Introduced in the US by Hans Burch Gram Hans Burch Gram 1835 – 1 st homeopathic medical college – 1835 – 1 st homeopathic medical college – Allentown, 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 homeopaths, and there were 20 homeopathic medical colleges and more than 100 homeopathic hospitals in the United States. Negatively affected by medical advances, including recognition of the mechanisms of disease and antiseptic techniques Negatively affected by medical advances, including recognition of the mechanisms of disease and antiseptic techniques Began to revive in the 1960’s Began to revive in the 1960’s

Homeopathy Homeo (similar) and pathos (suffering) Homeo (similar) and pathos (suffering) “Principle of Similars”: Any substance that can create symptoms in a healthy person can be used to treat similar symptoms in a sick person. “Principle of Similars”: Any substance that can create symptoms in a healthy person can be used to treat similar symptoms in a sick person. “Principle of Potentization”: Diluting a substance, with vigorous shaking at each step of dilution, makes the remedy more, not less, effective by extracting the vital essence of the substance. “Principle of Potentization”: Diluting a substance, with vigorous shaking at each step of dilution, makes the remedy more, not less, effective by extracting the vital essence of the substance.

Mechanism Water molecules are thought to form clusters that may be unique to the original substance that was dissolved. Water molecules are thought to form clusters that may be unique to the original substance that was dissolved. Samal and Geckeler discovered an inverse relationship between the aggregate size and concentration of the solutes. Samal and Geckeler discovered an inverse relationship between the aggregate size and concentration of the solutes. On dilution, spherical clusters appeared, which were seen to aggregate in steps resulting in a size increase with decreasing concentration. Samal S and Geckeler KE. Chem Commun 2001;

Treatment Mostly derived from natural substances that come from plants, minerals, or animals Mostly derived from natural substances that come from plants, minerals, or animals Used to treat acute and chronic illnesses, as well as to prevent diseases Used to treat acute and chronic illnesses, as well as to prevent diseases Used most often to treat arthritis, asthma, colds, flu, and allergies Used most often to treat arthritis, asthma, colds, flu, and allergies The choice of medicine is based on a person’s total symptom picture. The choice of medicine is based on a person’s total symptom picture. Homeopathic Pharmacopoeia of the United States contains guidelines for homeopathic remedies. Homeopathic Pharmacopoeia of the United States contains guidelines for homeopathic remedies.

Treatment Follow-up on problem in 2-6 weeks after start of the treatment Follow-up on problem in 2-6 weeks after start of the treatment Patients may experience homeopathic aggravation. Patients may experience homeopathic aggravation. Doses are repeated as necessary, and treatment is discontinued upon resolution of the problem. Doses are repeated as necessary, and treatment is discontinued upon resolution of the problem. Remedies may be changed as the condition and the associated symptoms change. Remedies may be changed as the condition and the associated symptoms change. Changes to diet and lifestyle are often recommended, as well. Changes to diet and lifestyle are often recommended, as well.

Safety Endrezzi et al. studied adverse drug events related to homeopathic encounters in 335 follow-up visits in 181 patients. Endrezzi et al. studied adverse drug events related to homeopathic encounters in 335 follow-up visits in 181 patients. 9 (2.68%) adverse reactions were reported. 9 (2.68%) adverse reactions were reported. No medical therapy was required to treat any of the adverse events. No medical therapy was required to treat any of the adverse events. Adverse events exist, but are rare and not severe. Adverse events exist, but are rare and not severe. Endrizzi C et al. Homeopathy 2005; 94:

Does it Work? Results of controlled trials have been contradictory.

Not placebo Patient assessment: Greater improvement after homeopathic versus conventional treatment Patient assessment: Greater improvement after homeopathic versus conventional treatment Physician assessment: More favorable for children who had received homeopathic treatment Witt C et al. Comp Ther Med 2005; 13: 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 homeopathically treated patients Physical component score increased in homeopathically treated patients Mental component no significant difference Mental component no significant difference Witt C et al. Comp Ther Med 2005; 13:

Not placebo 89 studies 89 studies OR 2.45 ( ) in favor of homeopathy OR 2.45 ( ) in favor of homeopathy 26 studies of higher quality 26 studies of higher quality OR 1.66 ( ) OR 1.66 ( ) Homeopathy not completely due to placebo Homeopathy not completely due to placebo Insufficient evidence that any single type of homeopathic treatment is clearly effective in any one clinical condition Insufficient evidence that any single type of homeopathic treatment is clearly effective in any one clinical condition Linde K et al. Lancet 1997; 350:

Not placebo Linde et al. revisited their initial study (1997). Linde et al. revisited their initial study (1997). Higher quality studies tended to yield less positive results. Higher quality studies tended to yield less positive results. All studies: OR 2.45 ( ) All studies: OR 2.45 ( ) Jadad > 3: OR 1.81( ) – 28% decrease Jadad > 3: OR 1.81( ) – 28% decrease IVS > 5: OR 1.97 ( ) – 22% decrease IVS > 5: OR 1.97 ( ) – 22% decrease Jadad > 3 AND IVS > 5: OR 1.72 – 30% decrease Jadad > 3 AND IVS > 5: OR 1.72 – 30% decrease “…likely that our meta-analysis at least overestimated the effects of homeopathic treatments.” “…likely that our meta-analysis at least overestimated the effects of homeopathic treatments.” Linde K et al. J Clin Epidemiol 1999; 52;

Placebo Shang et al. compared trials of homeopathy with those of conventional medicine and estimated treatment effects. Shang et al. compared trials of homeopathy with those of conventional medicine and estimated treatment effects. They found no convincing evidence that homeopathy was superior to placebo They found no convincing evidence that homeopathy was superior to placebo OR 0.88 ( ) OR 0.88 ( ) Whereas, for conventional medicine, a significant difference was found. Whereas, for conventional medicine, a significant difference was found. OR 0.58 ( ) OR 0.58 ( ) Clinical effects of homeopathy are placebo effects. Clinical effects of homeopathy are placebo effects. Shang A et al. Lancet 2005; 366:

Conclusions Although trials of homeopathic treatment have not yet provided a definitive answer, there are many reports of clinical benefit. Although trials of homeopathic treatment have not yet provided a definitive answer, there are many reports of clinical benefit. In addition, dismissal of homeopathy by practicing clinicians may increase the likelihood that patients will not communicate about integrative remedies. In addition, dismissal of homeopathy by practicing clinicians may increase the likelihood that patients will not communicate about integrative remedies. If homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine may not be necessary. If homeopathy appears to be helpful and safe, then scientifically valid explanations or proofs of this alternative system of medicine may not be necessary.

Resources Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy: Aggravations, adverse drug events or medication errors? Homeopathy 2005; 94: Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm in homeopathy: Aggravations, adverse drug events or medication errors? Homeopathy 2005; 94: Frye, JC. Herbal and homeopathic medicine: Understanding the difference. Seminars in Integrative Medicine 2003; 1: Frye, JC. Herbal and homeopathic medicine: Understanding the difference. Seminars in Integrative Medicine 2003; 1: Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jomas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999; 52; Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jomas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol 1999; 52; Samal S and Geckeler KE. Unexpected solute aggregation in water on dilution. Chem Commun 2001; Samal S and Geckeler KE. Unexpected solute aggregation in water on dilution. Chem Commun 2001; Shang A, Huwiler-Műntener K, Nartey L, Jűni P, Dörig S, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects? Comparitive study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005; 366: Shang A, Huwiler-Műntener K, Nartey L, Jűni P, Dörig S, Sterne JAC, Pewsner D, Egger M. Are the clinical effects of homeopathy placebo effects? Comparitive study of placebo-controlled trials of homeopathy and allopathy. Lancet 2005; 366: Vickers A and Zollman C. ABC of complementary medicine: Homeopathy. BMJ 1999; 319: Vickers A and Zollman C. ABC of complementary medicine: Homeopathy. BMJ 1999; 319: Witt C, Keil T, Dagmar S, Roll S, Vance W, Wegscheider K, Willich SN. Outcome and costs of homeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic disorders. Comp Ther Med 2005; 13: Witt C, Keil T, Dagmar S, Roll S, Vance W, Wegscheider K, Willich SN. Outcome and costs of homeopathic and conventional treatment strategies: A comparative cohort study in patients with chronic disorders. Comp Ther Med 2005; 13: