Homeopathy

1
Homeopathy

• Eleanor Bates
• Tinsley Harrison Society
• November 8, 2005

2
Complementary and Alternative Medicine

• Traditional Alternative Medicine
• Acupuncture
• Ayurveda
• Homeopathy
• Naturopathy
• Chinese/Oriental
• Mind-Body Interventions
• Cognitive Behavioral Therapy
• Meditation
• Biofeedback
• Hypnosis
• Prayer
• Art, Music, Dance

• Biologically Based Therapies
• Dietary Supplements
• Herbal Medicine
• Manipulative and Body-Based Methods
• Chiropractics
• Massage
• Energy Therapies
• Electromagnetic Therapy

3
Complementary and Alternative Medicine

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

4
Regulation

• 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).
• Required to list indications, ingredients,
  dilutions, and instructions for safe use

5
History of Homeopathy

• Late 1700s developed in Germany
• by Samuel Hahnemann
• 1825 Introduced in the US by
• Hans Burch Gram
• 1835 1st homeopathic medical college
• Allentown, Pennsylvania
• 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
• Began to revive in the 1960s

6
Homeopathy

• 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 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.

7
Mechanism

• 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.

• 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
2224-25.
8
Treatment

• 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 most often to treat arthritis, asthma,
  colds, flu, and allergies
• The choice of medicine is based on a persons
  total symptom picture.
• Homeopathic Pharmacopoeia of the United States
  contains guidelines for homeopathic remedies.

9
Treatment

• Follow-up on problem in 2-6 weeks after start of
  the treatment
• Patients may experience homeopathic aggravation.
• 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.
• Changes to diet and lifestyle are often
  recommended, as well.

10
Safety

• 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.
• No medical therapy was required to treat any of
  the adverse events.
• Adverse events exist, but are rare and not severe.

Endrizzi C et al. Homeopathy 2005 94 233-240.
11
Does it Work?

• Results of controlled trials have been
  contradictory.

12
Not placebo

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

• Physician assessment More favorable for children
  who had received homeopathic treatment

• Patient assessment Greater improvement after
  homeopathic versus conventional treatment

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

• Quality of life
• Physical component score increased in
  homeopathically treated patients
• Mental component no significant difference

Witt C et al. Comp Ther Med 2005 13 79-86.
14
Not placebo

• 89 studies
• OR 2.45 (2.05-2.93) in favor of homeopathy
• 26 studies of higher quality
• OR 1.66 (1.33-2.08)
• Homeopathy not completely due to placebo
• Insufficient evidence that any single type of
  homeopathic treatment is clearly effective in any
  one clinical condition

Linde K et al. Lancet 1997 350 834-43.
15
Not placebo

• Linde et al. revisited their initial study
  (1997).
• Higher quality studies tended to yield less
  positive results.
• All studies OR 2.45 (2.05-2.93)
• Jadad gt 3 OR 1.81(1.41-2.32) 28 decrease
• IVS gt 5 OR 1.97 (1.50-2.59) 22 decrease
• Jadad gt 3 AND IVS gt 5 OR 1.72 30 decrease
• likely that our meta-analysis at least
  overestimated the effects of homeopathic
  treatments.

Linde K et al. J Clin Epidemiol 1999 52 631-36.
16
Linde K et al. J Clin Epidemiol 1999 52 631-36.
17
Placebo

• 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
• OR 0.88 (0.65-1.19)
• Whereas, for conventional medicine, a significant
  difference was found.
• OR 0.58 (0.39-0.85)
• Clinical effects of homeopathy are placebo
  effects.

Shang A et al. Lancet 2005 366 726-32.
18
Conclusions

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

19
Resources

• http//nccam.nih.gov/
• Endrizzi C, Rossi E, Crudeli L, Garibaldi D. Harm
  in homeopathy Aggravations, adverse drug events
  or medication errors? Homeopathy 2005 94
  233-240.
• Frye, JC. Herbal and homeopathic medicine
  Understanding the difference. Seminars in
  Integrative Medicine 2003 1 158-66.
• 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
  834-43.
• 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 52 631-36.
• Samal S and Geckeler KE. Unexpected solute
  aggregation in water on dilution. Chem Commun
  2001 2224-25.
• Shang A, Huwiler-Muntener K, Nartey L, Juni 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
  726-32.
• Vickers A and Zollman C. ABC of complementary
  medicine Homeopathy. BMJ 1999 319 1115-18.
• 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 79-86.