An introduction to homeopathy

An introduction to homeopathy

اسلاید 1: www.tabaye.ir

اسلاید 2: An introduction tohomeopathy

اسلاید 3: Why learn about homeopathy?Your patients are using itYour colleagues are using itThere is a clinical need for itIt’s rewarding

اسلاید 4: Patient demandOTC 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

اسلاید 5: Patient demandROYAL LONDON HOMEOPATHIC HOSPITAL- in the year 2004 : 3,300 new out-patients25,000 follow-up appointments

اسلاید 6: Patient demandGLASGOW HOMEOPATHIC HOSPITAL- in the year 2004 : 1,528 new out-patient consultations7,400 follow-up appointments515 new in-patientsThreat to close the in-patient service a few years ago withdrawn due to intense public lobbying

اسلاید 7: Patient demandBRISTOL HOMEOPATHIC HOSPITAL - 20041,100 new out-patient consultations3,500 follow-up appointmentsLIVERPOOL HOMEOPATHIC HOSPITAL - 2004684 new out-patient consultations 6,468 follow-up appointments

اسلاید 8: Patient demand15% 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)

اسلاید 9: Why learn about homeopathy?Your patients are using itYour colleagues are using itThere is a clinical need for itIt’s rewarding

اسلاید 10: Professional demandProfessional demand for training20-25% of Scottish GPs have had some homeopathic trainingThere 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

اسلاید 11: Lothian GP Survey305 of 540 Lothian GPs replied90% of respondents had recommended or referred patients for a complementary therapy109 GPs said they wished training in a complementary therapymost of these stated homeopathy as the therapy of choice95% said they were willing to refer patients for homeopathic treatment64% wanted such a provision in a hospital out-patient setting

اسلاید 12: 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.’ ”

اسلاید 13: Why learn about homeopathy?Your patients are using itYour colleagues are using itThere is a clinical need for itIt’s rewarding

اسلاید 14: The clinical place of homeopathyWhere there is no effective conventional alternativeWhere conventional medicine is unsafeWhere conventional medicine has unacceptable side-effectsTo minimize the use of conventional medicine

اسلاید 15: No effective conventional treatmentAllergiesAnal fissuresAngerBruisesChilblainsColicFear/phobiasGlandular feverGriefImpotence

اسلاید 16: No effective conventional treatmentIntermittent claudicationMastalgiaM.E. / CFS / PVSNightmares / night terrorsPremenstrual SyndromeTeethingUrethral syndrome

اسلاید 17: Unsafe situation for conventional medicinePregnant womenYoung childrenThe elderlyAnticipatory anxiety

اسلاید 18: Unacceptable side-effect profileAnxietyDepressionCrampsOsteoarthritis

اسلاید 19: Reduction in long-term conventional treatmentAsthmaConstipationConvulsionsDysmenorrhoeaEczemaMigraineNeuralgiasOtitis media ( recurrent )Psoriasis

اسلاید 20: Why learn about homeopathy?Your patients are using itYour colleagues are using itThere is a clinical need for itIt’s rewarding

اسلاید 21: The rewards of homeopathyMaking a differencePatient satisfactionEffects on consultation techniqueIntellectual achievementThe joy of detective workMaking sense of patterns of diseaseMaking sense of progress of diseaseUnderstanding aetiology

اسلاید 22: What is homeopathy?Like cures like Minimum effective dose

اسلاید 23: How are remedies prepared?Original sourcesPlant MineralAnimalDisease Serial dilutions Succussion

اسلاید 24: Is there a phenomenon here?Clinical research Clinical experience Consistency of theory

اسلاید 25: Professional attitudesBritish 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 2007 - 56% had either provided or recommended complementary medicine to patients

اسلاید 26: RCTs - the meta-analysesKleijnen J, Knipschild P, Ter Riet G. Clinical trials of homeopathy. British Medical Journal 1991; 302: 316-323Linde 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: 834-843

اسلاید 27: Linde’s conclusionLindes 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 homeopathy49% of the trials were clearly positive and a further 35% showed a positive trend

اسلاید 28: Kleijnen’s conclusionsThey found that of 105 trials with interpretable results, 81 were positiveThey then looked at a sub-group of the most rigorous trials and discovered that 15 out of 22 found homeopathy to be superior to placeboOne of Kleijnens conclusions was that the evidence found: would probably be sufficient for establishing homeopathy as a regular treatment for certain conditions

اسلاید 29: The Lancet – August 2005110 homeopathy trials were compared with 110 allopathy trialsOverall positive treatment effect found in both groupsFinal analysis limited to “best” 8 homeopathy and 6 allopathy trials – significant effect of homeopathy disappearedConclusion: “The clinical effects of homeopathy are those of placebo”Lancet editorial: “The end of homeopathy”!

اسلاید 30: Lancet 2005 – the flawsStandard assessment criteria are insufficient to gauge “high quality” in homeopathy trialsAuthors did not state which 8+6 trials were analysed in details so their relevance or value was unknown8 trials of homeopathy cannot fairly represent the entire research literature!Authors ignore homeopathy’s significant effects in RTIsSome key papers are omitted, others wrongly includedThe rigour and validity of the paper’s conclusions were rebutted in later articles (Rutten and others, 2008)

اسلاید 31: Categories of research evidenceThe 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 homeopathy3. One positive published clinical trial only…

اسلاید 32: 1. Systematic reviews with focus on specific clinical areasAllergies and upper respiratory tract infectionsChildhood diarrhoea Influenza Post-operative ileus Rheumatic diseases Seasonal allergic rhinitis Upper respiratory tract diseases, including otitis media Vertigo

اسلاید 33: 2. Replicated trials with a majority of positive findings Childhood diarrhoeaFibromyalgia Influenza Osteoarthritis Seasonal allergic rhinitis Sinusitis Vertigo

اسلاید 34: 3. Singleton trials with positive evidence Includes…Chronic fatigue syndrome Premenstrual syndrome Post-partum bleeding Sepsis Stomatitis

اسلاید 35: Outcome studies: Bristol Homeopathic HospitalObservational 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)

اسلاید 36: Outcome studies: Royal London Homeopathic HospitalOutcome 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.

اسلاید 37: 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

اسلاید 38: Taking a homeopathic historyPresenting complaintsSystems reviewPMHFHSHAllergiesGeneralsMentals

اسلاید 39: Analysing the dataSignificant symptoms Materia Medica patterns Repertorising

اسلاید 40: Basic homeopathic principlesSingle remedy, Single dosePotencyDirection of cure

اسلاید 41: Basic homeopathic principlesSingle remedy, single dosePotencyDirection of cure

اسلاید 42: PotencySeries of Dilutions and SuccussionsTwo common Scales in UKx or Decimal scale - serial 1:9 dilutionsc or Centesimal scale - serial 1:99 dilutionsEach Potency written as number, then scale symbol:2x, 3x, 6x, 12x, etc.6c, 12c, 30c, 200c, M, 10M, CM, MM

اسلاید 43: Basic homeopathic principlesSingle remedy, single dosePotencyDirection of cure

اسلاید 44: Direction of cureMost important organs to least importantInwards to outwardsTop to bottomReverse order of appearance of symptoms

اسلاید 45: Prescribing a RemedyNHS or privatePharmaceutical supplyLocal chemistSpecialist homeopathic pharmacies such as Ainsworths, Freemans, Helios, Nelsons or WeledaStock orderCost

اسلاید 46: Obtaining homeopathic treatmentNHSGPHomeopathic hospital (Bristol, Glasgow, Liverpool, London)In-patient (Glasgow only)Out-patientHomeopathic clinics around the countryPrivate practitionersMedically qualifiedNon-medically qualified

اسلاید 47: First prescriptionsInfant ColicColocynthis Night CrampsCuprum metallicum

اسلاید 48: 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)

اسلاید 49: What is complementary medicine?AcupunctureAlexander techniqueAromatherapyBach Flower RemediesChiropracticCrystal therapyHealingHerbalismHomeopathy

اسلاید 50: What is complementary medicine?HypnotherapyIridology KinesiologyMassageOsteopathyRadionicsReflexologyShiatsu

اسلاید 51: Hospital-based complementary medicineOutpatient careInpatient careTeaching

اسلاید 52: www.facultyofhomeopathy.orgThe only body in the UK that promotes the education and training of healthcare professionals in homeopathy1400 members worldwide in a range of different professions including doctors, nurses, dentists, vets, midwives, pharmacists, podiatrists and osteopathsAccredited training available in the UK and overseasFaculty of Homeopathy