Excerpts From Homeobuzz (4)

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RESEARCH DEVELOPMENT IN HOMEOPATHY Robert Mathie

o help substantiate our claims for homeopathy, there is a real need firstly to identify the symptoms or medical conditions that homeopathic practitioners treat in routine clinical practice – medical, dental and veterinary – and the success rates that they achieve. Systematic data collection also helps to inform practitioners themselves about their clinical practice of homeopathy, and it makes an important contribution to knowledge in homeopathy more generally.

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PILOT DATA COLLECTION STUDIES During 2005 the British Homeopathic Association joined forces with the Faculty of Homeopathy (its sister organisation) to run three pilot data collection projects in Britain. Doctors and dentists and vets took part in the studies, each of which lasted for 6 months. The aim of each project was to pilot the use of a suitable spreadsheet, and thus inform our approach to more definitive data collection in each pro-

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fession. The key aim of work like this is to gain insight into the medical complaints that practitioners in Primary Care treat most commonly using homeopathy, and to identify any specific patterns of clinical responses that would help target future research projects more effectively. 14 doctors, 14 dentists and 8 vets took part enthusiastically in the three pilot studies. The spreadsheets successfully enabled practitioners to record data from patients at their appointments. The most commonly treated medical problems in each study were: We then analysed the overall

percentages of follow-up patients who reported positive, negative or unchanged symptoms (the owners spoke on behalf of their pets!). The table below shows the high, or very high, proportions of patients who felt they had benefitted from homeopathy: Finally, we looked at the percentage outcomes for each of the most commonly treated medical complaints. Positive outcomes were achieved most clearly in the following: Few of these disorders overall – and none of those in the dental and veterinary lists – have been the subject of controlled clinical trials. Our pilot work has therefore begun to point towards areas where further research might best be directed.

DEFINITIVE DATA COLLECTION PROJECTS We have extended our medical data collection project, in the first

Medical1

Dental2

Veterinary3

Depression Anxiety Cough Menopausal flush Chronic fatigue syndrome Catarrh Osteoarthritis Irritable bowel syndrome Hay fever Upper respiratory tract Infection

Apical abscess Tooth extraction Anxiety Sensitive cementum Periodontal abscess Post-surgery pain Gum swelling Reversible pulpitis Toothache with decay Pericoronitis

Arthritis (dogs) Atopic dermatitis (dogs, cats) Lameness (dogs, horses) Epilepsy (dogs) Diarrhoea (dogs, cats) Aggression (dogs, cats) Fear (dogs) Pruritus (dogs) Hyperthyroid (cats) Kidney failure (dogs, cats)

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Medical Dental Veterinar

Total no. of patients

No. of follow-ups

Improvement

Unchanged Deterioration No data

1783 726 767#

961 496 539

76% 90% 80%

15% 8% 12%

4% 2% 6%

5% 0% 2%

Medical

Dental

Veterinary

Depression Anxiety Cough Osteoarthritis Irritable bowel syndrome

Apical abscess Sensitive cementum Periodontal abscess Reversible pulpitis Pericoronitis

Arthritis (dogs) Atopic dermatitis (dogs, cats) Lameness (dogs, horses) Epilepsy (dogs) Hyperthyroid (cats)

instance, to doctors treating patients in the five homeopathic hospitals based within Britain’s National Health Service. Our main project in dental homeopathy is currently exploring periodontal problems, an area where actual dental surgery is not typically carried out. And our definitive veterinary data collection includes participation by 21 Faculty vets using homeopathy for the treatment of dogs or cats or horses. The key results of work from the homeopathic hospitals are presented below:

Towards Standard Setting in the Homeopathic Hospitals Each of the five hospitals has previously reported clinical outcomes data from a wide range of medical complaints. In each hospital, positive outcome has been reported by about 70% of follow-up patients overall. From the perspective of quality assurance and improvement, on the other hand, these patient surveys have each been carried out without an aim of identifying what standard of clinical outcome might reasonably be expected in subjects with a given type and complexity of medical complaint. Moreover, these earlier studies have each used different methods and outcome scoring techniques, without any attempt to consider unifying approaches to clinical data collection across all the hospitals. We have therefore taken a first

step in a programme of quality assurance and development across all five homeopathic hospitals, working together for the first time. Results from the first phase of the programme were published in the July 2008 issue of the Faculty’s research journal Homeopathy.4 The findings are summarised below: A total of 51 homeopathic doctors took part in data collection over a 4-week period in March 2007. Consecutive patient appointments were recorded by doctors on a spreadsheet or database under the headings: 1. Date of first appointment in the current series; 2. Appointment number; 3. Age of patient; 4. Sex of patient; 5. Main medical complaint being treated; 6 Whether other main medical complaint(s); 7 Patient-reported change in health, using ORIDL (Outcome Related to Impact on Daily Living; range –4 to +4, where a score of +2 or more, or –2 or less, indicates an effect on the quality of a patient’s daily life); 8 Patient’s use of other complementary medicine for main medical complaint. Patients’ age distribution showed a main peak at 49 years. A secondary peak at 6 years clearly reflects the large number of young children

referred to homeopathy. The male to female ratio overall was 1 to 3.5. Data were recorded on a total of 1,797 individual patients: 195 first appointments and 1,602 follow-ups. A total of 235 different medical complaints were reported. The 20 most commonly treated were (in decreasing order of frequency): 1. Eczema; 2. Chronic fatigue syndrome; 3. Menopausal disorder; 4. Osteoarthritis; 5. Depression; 6. Breast cancer; 7. Rheumatoid arthritis; 8. Asthma; 9. Anxiety; 10. Irritable bowel syndrome; 11. Multiple sclerosis; 12. Psoriasis; 13. Allergy; 14. Fibromyalgia; 15. Migraine; 16. Premenstrual syndrome; 17. Chronic rhinitis; 18. Headache; 19. Vitiligo; 20. Seasonal allergic rhinitis It is interesting to see the differences and the similarities between this list and the one obtained via Primary Care doctors (see above). The management of serious chronic conditions, such as multiple sclerosis and breast cancer, is clearly a feature specifically of Homeopathic Hospital rather than Primary Care treatment. The inclusion of breast cancer represents the homeopathic management of difficult symptoms such as hot flushes and the side-effects of chemotherapy. The medical problems treated in the hospitals often reflect areas of clinical practice where available conventional treatments are not fully effective – termed “effectiveness gaps”. Among those patients seen after a sixth appointment, 56% had important other medical problems. For those patients seen up to and HOMEOBUZZ

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including that appointment, the equivalent figure was only 40%. This shows that a high proportion of homeopathic hospital outpatients have multiple medical complaints, and that the most complex cases tend to remain in the healthcare system longer than those who have a single main problem. The proportion of follow-up patients who reported an improvement affecting their daily lives increased overall with appointment number. Of those at their second appointment, one-third of patients reported that important extent of benefit, whereas by the sixth appointment three-fifths did so. We also found evidence that chronic fatigue syndrome responds more slowly to treatment than menopausal disorder, for example, reflecting practitioners’ clinical experience in the homeopathic treatment of these particular problems. The information we have obtained is now being used to explore further the opportunity of standard setting in the hospital outpatient setting. Identifying the appointment by which ORIDL scores typically achieve at least +2, for instance, would allow us to set meaningful standards of outcome for a given medical complaint. It would assist physicians in their judgment of when they might expect clinical improvement affecting a patient’s quality of daily living. This in turn would enable practitioners to focus potential outcome with patients and communicate that also to referring doctors.

OPPORTUNITIES IN INDIA What about the Indian healthcare context? Why not get together and undertake your own pilot data collection studies in your country! For

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those of you who are (or become) Faculty members, several practitioners could get together to form even a small team to start some data collection work. Notes: The British Homeopathic Association works to promote patient access to homeopathy. Its research committee is responsible for taking forward a number of projects such as those outlined above. Members of the Faculty of Homeopathy is statutorily regulated

health professionals who integrate homeopathy into their practice. They have conventional qualifications in medicine etc. and additional postgraduate training in homeopathy. They are required to have current registration with their statutory body – in the case of doctors in Britain, with the General Medical Council. In India currently, there are 132 doctors who are members of the Faculty of Homeopathy. Sadly, the present membership includes no dentists and no vets. References

What about the Indian healthcare context? Why not get together and undertake your own pilot data collection studies in your country! Get together to form even a small team to start some data collection work.

1. Mathie RT, Robinson TW. Outcomes from homeopathic prescribing in medical practice: a prospective, research-targeted, pilot study. Homeopathy 2006; 95: 199–205. 2. Mathie RT, Farrer S. Outcomes from homeopathic prescribing in dental practice: a prospective, research-targeted, pilot study. Homeopathy 2007; 96: 74–81. 3. Mathie RT, Hansen L, Elliott MF, Hoare J. Outcomes from homeopathic prescribing in veterinary practice: a prospective, research-targeted, pilot study. Homeopathy 2007; 96: 27–34. 4. Thompson EA, Mathie RT, Baitson ES, Barron SJ, et al. Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals. Homeopathy 2008; 97: 114–121.

About the Author Robert Mathie PhD outlines news of clinical data collection projects being run by the British Homeopathic Association, UK. He is a Research Development Adviser, British Homeopathic Association and Faculty of Homeopathy, Hahnemann House, UK.