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Homeopathy. A theoretical framework and clinical application.

The use of homeopathic remedies for the treatment of mastitis is described. The basic principles of homeopathy are discussed, including the simillimum, the minimum dose, the single remedy, the whole person, the vital force, susceptibility, and constitutional treatment. Homeopathic research trials and papers are examined and discussed. The author explains how homeopathy can be incorporated into midwifery practice and applies this to the treatment of mastitis. Specific indications in the application of 19 homeopathic remedies for mastitis, breast abscess, and lactation difficulties (including problems with supply and painful nipples) are cited. Keynote symptoms are presented in an easy access repertory. General guidelines for potency and dosage protocol are given.

Clinical Trials as Topic↗

Homeopathy.

Homeopathy, using the tenet of "like cures like," is one of the most popular of the complementary medicines. In conventional medicine, however, little is known about this modality. This article describes the field of homeopathy and its principles and philosophy. It also summarizes the current state of evidence and offers an outlook on future research options.

Evidence-Based Medicine↗

Homeopathy and rheumatic disease.

Despite a growing interest in uncovering the basic mechanisms of arthritis, medical treatment remains symptomatic. Current medical treatments do not consistently halt the long-term progression of these diseases, and surgery may still be needed to restore mechanical function in large joints. Patients with rheumatic syndromes often seek alternative therapies, with homeopathy being one of the most frequent. Homeopathy is one of the most frequently used complementary therapies worldwide.

Arthritis, Rheumatoid↗

Understanding homeopathy.

Interest in homeopathy is growing because of the costs and impersonality of modern medical care and the increase in infectious diseases that do not respond to allopathic medicine. Extreme dilutions are the main reason many scientists doubt the effectiveness of homeopathic products. Scientists have petitioned the Food and Drug Administration to hold homeopathic products to the same standards as other drugs. While some studies support the efficacy of homeopathy, controlled clinical studies determining effective levels of dilution for these substances are needed.

Attitude of Health Personnel↗

The perceived efficacy of homeopathy and orthodox medicine: a vignette-based study.

OBJECTIVE: This study examined whether people thought neurotics were more likely to 'get better' when using CAM rather than orthodox medicine. DESIGN: A total of 165 participants completed a four part questionnaire, in which they were required to read eight vignettes (each about 70 words long) describing a British male patient who either visits a Homeopath or General Practitioner with a specific and different medical problem. In the vignette the patient gets better after treatment or remains unwell and they are described as either emotionally balanced (stable) or slightly neurotic in character (2 x 2 x 2 design). Participants were required to rate each vignette on criteria such as, did they think the treatment was effective, and did they think the person would remain feeling better. RESULTS: Homeopathy was perceived as more effective for treating patients with unstable psychological characteristics and orthodox medicine was seen as more effective for treating patients with stable psychological characteristics. Homeopathy was perceived as more effective by participants who themselves used complementary medicine. Participants who had visited a complementary therapist felt more strongly that psychological factors were important in illness than participants who had never consulted a complementary practitioner. Non-complementary medicine users perceived orthodox medicine to be more effective than complementary users.

Adult↗

The relationship between homeopathy and the Dr Bach system of flower remedies: a critical appraisal.

The relationship between homeopathy and the Dr Bach system of flower remedies is explored. A historical perspective is given, doctrinal similarities and dissimilarities between both systems are discussed and the relationship between remedies used in homeopathy as well as in Dr Bach's system of flower remedies is explored. It is concluded that although both systems are clearly different, some common ground exists and that both systems may have a complementary role which is perhaps insufficiently recognised.

History, 20th Century↗

Improving the evaluation of homeopathy: economic considerations and impact on health.

OBJECTIVES: The financial crisis of health insurance systems sometimes drives public policy-makers to take precipitate action dominated by economic imperatives. The question addressed here consists in defining homeopathy's scope of intervention, its place in health care strategies, recourse to treatment, and especially economic data appraising homeopathy's impact on expenditures and outlay covered by health insurance in France. METHOD: We used the General Evaluation Model to define the study (to whom is the evaluation made, situations, criteria, measurement of these criteria, quality and precision). RESULTS: The main results are in terms of costs, as follows: * For reimbursable medicines the public sales price of homeopathic products is a quarter of the average. * The total reimbursement for a prescription of allopathic products is three times more than for a prescription of homeopathic products. * Homeopathic physicians incur annual reimbursement outlays which are half those of general practitioners. The differences observed cannot be explained by the patient profile or the diseases treated. Furthermore, a study carried out in France showed that 87% of patients whose physicians had prescribed homeopathic treatment did not see another physician for the same problem. CONCLUSIONS: Once basic analysis has been done, so that the economic and epidemiological impact of a certain health strategy can be determined, it is necessary to proceed further, helping healthcare providers and public authorities to make decisions. Various possibilities exist and should be investigated.

France↗

Blackie Memorial Lecture 2001. Homeopathy: progress and promise, a critical perspective.

This lecture attempts to analyse the progress made by homeopathy in recent years, by analysing consumer awareness, sales and distribution trends of homeopathic products, and research publications. Sales of homeopathic medicines are growing rapidly, but remain a very small fraction of the total pharmaceutical market. The proportion of combination to single medicines varies widely between countries. The market is concentrated in a relatively small number of the available medicines; many available homeopathic medicines are never used. Regulation of homeopathic practitioners and medicines is problematic, the legal position varies between countries. The volume of research is growing steadily. A series of recommendations is made, including modernisation of the terminology of homeopathy, training of more practitioners, a defined research agenda and integration into the medical system.

Awareness↗

Clinical trials of classical homeopathy: reflections on appropriate research designs.

The growing popularity of complementary medicine has been accompanied by a call for controlled clinical studies to examine the efficacy and validity of its various methods. The difficulties encountered in applying the evaluation methods of conventional medicine to complementary medicine are the result of the different paradigms underlying these two methods of medicine, and the differences in the healing process. This paper attempts to bridge the gap between these two approaches and to suggest a possibility to use conventional research methodology in clinical studies of classical homeopathy. Two methods are described. One is the randomization into a placebo or a treatment group after an individual remedy is chosen for each patient. This method requires an experienced homeopath and is reproducible only by the same homeopath in the same population. On the other hand, the expected success rate will be high. Another method is prescribing and treating according to so-called keynotes, a set of symptoms known to respond to a particular remedy that must be present in a patient in order to elicit a reaction from the remedy. This method is more suitable to a conventional design of a clinical study and is reproducible by anyone. Yet the expected success rate is much lower. Some general design issues that may have a particular impact on clinical trials of classical homeopathy are discussed, including the need for sufficiently powered trials to detect relatively small effects, strategies to deal with patient preference and embracing the use of "active-control" pragmatic trial designs.

Homeopathy↗

Are the therapeutic effects of homeopathy attributed to the consultation, the homeopathic remedy, or both? A protocol for a future exploratory feasibility trial in patients with rheumatoid arthritis.

Systematic reviews suggest that homeopathy has a greater effect than placebo, however, the mechanisms of its action are unknown. The clinical effects of homeopathy could be attributed to the specific effects of the remedy and/or to the contextual effects of the consultation process; these factors have not been critically evaluated. We have developed a model that attempt to separate the consultation effects from the specific effects because of the remedy. We propose to investigate this design in a chronic condition, rheumatoid arthritis, for which previous research has evaluated both classical and complex homeopathic interventions. The following protocol describes the study design. The aims of this exploratory trial are to assess the feasibility of the study design, identify effect sizes of the consultation, the complex treatment, and the individualized remedy, as well as possibly efficacy, for the two types of homeopathic treatment and the homeopathic consultation. Data collection will take place in 2004.

Adolescent↗

Research on homeopathy: state of the art.

In this paper, we review research on homeopathy from four perspectives, focusing on reviews and some landmark studies. These perspectives are laboratory studies, clinical trials, observational studies, and theoretical work. In laboratory models, numerous effects and anomalies have been reported. However, no single model has been sufficiently widely replicated. Instead, researchers have focused on ever-new models and experiments, leaving the picture of scattered anomalies without coherence. Basic research, trying to elucidate a purported difference between homeopathic remedies and control solutions has also produced some encouraging results, but again, series of independent replications are missing. While there are nearly 200 reports on clinical trials, few series have been conducted for single conditions. Some of these series document clinically useful effects and differences against placebo and some series do not. Observational research into uncontrolled homeopathic practice documents consistently strong therapeutic effects and sustained satisfaction in patients. We suggest that this scattered picture has to do with the fourth line of research: lack of a good theory. Some of the extant theoretical models are reviewed, including placebo, water structure, silica contamination, energy models, and entanglement models. It emerges that local models, suggesting some change in structure in the solvent, are far from convincing. The nonlocal models proposed would predict that it is impossible to nail down homeopathic effects with direct experimental testing and this places homeopathy in a scientific dilemma. We close with some suggestions for potentially fruitful research.

Biomedical Research↗

Are randomized controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory.

INTRODUCTION: Randomized controlled trials (RCTs) have yet to deliver unequivocal results demonstrating the efficacy (or otherwise) of homeopathic remedies and individualized homeopathic prescribing. This could be caused by an implicit assumption inherent in RCT methodology that specific effects of a remedy and any nonspecific effects of consultation are independent of each other. Reported here is a theoretical investigation of the consequences arising from this assumption proving to be false. METHODS: A previously developed theoretical model of entanglement in homeopathy between patient, practitioner, and remedy (called PPR entanglement) was used in this investigation. RESULTS: The adherence to RCT methodology could result in such trials completely disrupting the formation or survival of any three-way PPR entangled state. CONCLUSIONS: Assuming the PPR entangled state is a necessary condition for therapeutic interaction, alternatives to RCTs are urgently required that can take into account possible entangled specific and nonspecific effects during trials of homeopathy. That RCTs sometimes deliver positive results for the use of homeopathic remedies may be caused by residual entanglement arising from homeopathic remedy manufacture.

Homeopathy↗

Homeopathy for postoperative ileus? A meta-analysis.

Homeopathic remedies are advocated for the treatment of postoperative ileus, yet data from clinical trials are inconclusive. We therefore performed meta-analyses of existing clinical trials to determine whether homeopathic treatment has any greater effect than placebo administration on the restoration of intestinal peristalsis in patients after abdominal or gynecologic surgery. We conducted systematic literature searches to identify relevant clinical trials. Meta-analyses were conducted using RevMan software. Separate meta-analyses were conducted for any homeopathic treatment versus placebo; homeopathic remedies of < 12C potency versus placebo; homeopathic remedies of > or = 12C potency versus placebo. A "sensitivity analysis" was performed to test the effect of excluding studies of low methodologic quality. Our endpoint was time to first flatus. Meta-analyses indicated a statistically significant (p < 0.05) weighted mean difference (WMD) in favor of homeopathy (compared with placebo) on the time to first flatus. Meta-analyses of the three studies that compared homeopathic remedies > or = 12C versus placebo showed no significant difference (p > 0.05). Meta-analyses of studies comparing homeopathic remedies < 12C with placebo indicated a statistically significant (p < 0.05) WMD in favor of homeopathy on the time to first flatus. Excluding methodologically weak trials did not substantially change any of the results. There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynecologic surgery. However, several caveats preclude a definitive judgment. These results should form the basis of a randomized controlled trial to resolve the issue.

Homeopathy↗

The world according to homeopathy.

The author, a family nurse practitioner, describes how homeopathic medicines and the homeopathic conceptual framework distinguish her practice from a conventional one. An introduction to homeopathic health care includes a brief history of the discovery of homeopathy, the homeopathic view of the healing process, and the origins of disease. Factors that would influence a person's candidacy for homeopathy are discussed. Case studies are included.

Adult↗

Review, critique, and guidelines for the use of herbs and homeopathy.

The number of Americans that use alternative therapies, including herbal products, is increasing by overwhelming proportions. Hundreds of herbal products and homeopathic remedies are available to the consumer, but most of these have not been proved safe or effective. Consumers are now turning to their health care provider for guidance concerning the quality, proper use, adverse effects, and precautions associated with these products. Health care providers must develop a thorough understanding of the available literature concerning herbal products and homeopathy to provide patients with truthful, unbiased information regarding the potential risks and benefits of each herbal product. This article addresses the distinct difference between herbalism and homeopathy, the importance of standardization, and general use precautions concerning herbal products.

Homeopathy↗

Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials.

BACKGROUND: Previous studies have shown a positive treatment effect of individualized homeopathic treatment for acute childhood diarrhea, but sample sizes were small and results were just at or near the level of statistical significance. Because all three studies followed the same basic study design, the combined data from these three studies were analyzed to obtain greater statistical power. METHODS: Three double blind clinical trials of diarrhea in 242 children ages 6 months to 5 years were analyzed as 1 group. Children were randomized to receive either an individualized homeopathic medicine or placebo to be taken as a single dose after each unformed stool for 5 days. Parents recorded daily stools on diary cards, and health workers made home visits daily to monitor children. The duration of diarrhea was defined as the time until there were less than 3 unformed stools per day for 2 consecutive days. A metaanalysis of the effect-size difference of the three studies was also conducted. RESULTS: Combined analysis shows a duration of diarrhea of 3.3 days in the homeopathy group compared with 4.1 in the placebo group (P = 0.008). The metaanalysis shows a consistent effect-size difference of approximately 0.66 day (P = 0.008). CONCLUSIONS: The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.

Child, Preschool↗

Alchemy, homeopathy and the treatment of borderline cases.

Homeopathy is presented as a modality of potential usefulness in the treatment of borderline patients refractory to psychoanalytic work. In these instances a minimally adequate centre of consciousness did not solidify from the identity with the psychoid stratum. In the view of Alchemy, this failure of the mind to separate from the unio naturalis or massa confusa could be remedied by a medicamentum spagyricum, an archtypal essence acting according to the simile principle, which was to be extracted from various substances. Homeopathy is described as a modern, clinically effective modification of the alchemistic method. Two cases example are given for illustration.

Adult↗

Review of the current involvement of homeopathy in veterinary practice and research.

Homeopathy has become the focus of increasing interest and use as a complementary and alternative treatment for both human and animal disease. However, from the point of view of academic medicine, this type of therapy is controversial. The use of highly diluted remedies cannot be reconciled with the scientific theories on which the current understanding of disease and its treatment is based, and clinical research in the field is considered to be neither extensive enough nor of a high enough standard to determine whether homeopathic treatments are clinically effective. Animals have no choice in their treatment and are dependent on the judgements of their owners and their therapists. There is therefore a need for information about the effects and consequences of the use of alternative therapies. This paper discusses the use of homeopathy in the treatment of animal disease from the point of view of academic veterinary medicine, and the various approaches to research in this field, with an emphasis on the randomised clinical trial. It also discusses the role of the placebo response and the natural resolution of disease in the clinical evaluation of homeopathic treatment.

Animal Diseases↗