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 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 demand ROYAL LONDON HOMEOPATHIC HOSPITAL - in the year 2004 : 3,300 new out-patients 25,000 follow-up appointments

Patient demand GLASGOW HOMEOPATHIC HOSPITAL - in the year 2004 : 1,528 new out-patient consultations 7,400 follow-up appointments 515 new in-patients Threat to close the in-patient service a few years ago withdrawn due to intense public lobbying

Patient demand BRISTOL HOMEOPATHIC HOSPITAL ,100 new out-patient consultations 3,500 follow-up appointments LIVERPOOL HOMEOPATHIC HOSPITAL new out-patient consultations 6,468 follow-up appointments

Patient demand 15% 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 demand Professional 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 Survey 305 of 540 Lothian GPs replied 90% of respondents had recommended or referred patients for a complementary therapy 109 GPs said they wished training in a complementary therapy most of these stated homeopathy as the therapy of choice 95% said they were willing to refer patients for homeopathic treatment 64% 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 alternative Where conventional medicine is unsafe Where conventional medicine has unacceptable side- effects To minimize the use of conventional medicine

No effective conventional treatment Allergies Anal fissures Anger Bruises Chilblains Colic Fear/phobias Glandular fever Grief Impotence

No effective conventional treatment Intermittent claudication Mastalgia M.E. / CFS / PVS Nightmares / night terrors Premenstrual Syndrome Teething Urethral syndrome

Unsafe situation for conventional medicine Pregnant women Young children The elderly Anticipatory anxiety

Unacceptable side-effect profile Anxiety Depression Cramps Osteoarthritis

Reduction in long-term conventional treatment Asthma Constipation Convulsions Dysmenorrhoea Eczema Migraine Neuralgias Otitis 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 homeopathy Making a difference Patient satisfaction Effects on consultation technique Intellectual achievement The joy of detective work Making sense of patterns of disease Making sense of progress of disease Understanding aetiology

What is homeopathy? Like cures like Minimum effective dose

How are remedies prepared? Original sources Plant Mineral Animal Disease Serial dilutions Succussion

Is there a phenomenon here? Clinical research Clinical experience Consistency of theory

Professional attitudes British 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 % 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: 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:

Linde’s conclusion Linde'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 conclusions They 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 homeopathy trials were compared with 110 allopathy trials Overall positive treatment effect found in both groups Final analysis limited to “best” 8 homeopathy and 6 allopathy trials – significant effect of homeopathy disappeared Conclusion: “The clinical effects of homeopathy are those of placebo” Lancet editorial: “The end of homeopathy”!

Lancet 2005 – the flaws Standard assessment criteria are insufficient to gauge “high quality” in homeopathy trials Authors did not state which 8+6 trials were analysed in details so their relevance or value was unknown 8 trials of homeopathy cannot fairly represent the entire research literature! Authors ignore homeopathy’s significant effects in RTIs Some key papers are omitted, others wrongly included The rigour and validity of the paper’s conclusions were rebutted in later articles (Rutten and others, 2008)

Categories of research evidence The 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 areas Allergies and upper respiratory tract infections Childhood 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 diarrhoea Fibromyalgia 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 history Presenting complaints Systems review PMH FH SH Allergies Generals Mentals

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

Potency Series of Dilutions and Succussions Two common Scales in UK x or Decimal scale - serial 1:9 dilutions c 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

Most important organs to least important Inwards to outwards Top to bottom Reverse order of appearance of symptoms

Prescribing a Remedy NHS or private Pharmaceutical supply Local chemist Specialist homeopathic pharmacies such as Ainsworths, Freemans, Helios, Nelsons or Weleda Stock order Cost

Obtaining homeopathic treatment NHS GP Homeopathic hospital (Bristol, Glasgow, Liverpool, London) In-patient (Glasgow only) Out-patient Homeopathic clinics around the country Private practitioners Medically qualified Non-medically qualified

First prescriptions Infant Colic Colocynthis Night Cramps Cuprum 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? Acupuncture Alexander technique Aromatherapy Bach Flower Remedies Chiropractic Crystal therapy Healing Herbalism Homeopathy

What is complementary medicine? Hypnotherapy Iridology Kinesiology Massage Osteopathy Radionics Reflexology Shiatsu

Hospital-based complementary medicine Outpatient care Inpatient care Teaching

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