Health CommitteeWritten evidence from The Society of Homeopaths (LTC 65)

1. Summary

The Society of Homeopaths (hereafter “the Society”) is composed of approximately 1,300 practicing homeopaths and represents the majority of professional homeopaths practicing in the UK. There is a significant trend for homeopaths working privately and in NHS settings to see many patients suffering from long-term conditions that have failed to respond to conventional medicine. This document will therefore outline:

How homeopathic treatment is well placed to support patients with long-term conditions.

Evidence that homeopathy is valued by the patients who seek it out.

Evidence of clinical effectiveness in specific long-term conditions.

Evidence supporting the cost-effectiveness of homeopathic treatment.

This document will also highlight the potential for homeopathy as a medical system, treatment option and philosophy to address the following issues of interest to the Health Committee:

Treating multi-morbidities by emphasising the patient as a person rather than focusing on individual conditions.

The interaction between mental health and physical health conditions.

The extent to which patients are being offered personalised services (including evidence of their contribution to better outcomes).

Current examples of effective integration of services which treat and manage long-term conditions.

2. The Homeopathic Approach

Homeopaths often see patients after they have received a medical diagnosis from their doctor and many of these patients have long-term health problems that fail to respond to conventional medicine. Some individuals seek a homeopath because they are experiencing side effects from conventional drugs and others because conventional tests have failed to find the cause of their problem. As a system of medicine, homeopathy aims to treat patients as whole people, rather than focusing on a course of action for each disease diagnosis, thus offering a different approach. As such, homeopathic treatment can be considered as a supportive option in almost any condition where tissue has not been irrevocably damaged. Homeopaths working according to the Society’s code of ethics encourage their patients to keep their appropriate medical practitioners informed when they seek homeopathic treatment and as treatment progresses. When necessary homeopathic and conventional approaches can be used alongside one another to give the most appropriate care to each individual patient, thus integrating all medical approaches and adjunctive advice the patient has been given to manage their health.

3. What is Homeopathy?

The MeSH1 definition of homeopathy is:

“A system of therapeutics founded by Samuel Hahnemann (1755–1843), based on the Law of Similars where ‘like cures like’. Diseases are treated by highly diluted substances that cause, in healthy persons, symptoms like those to be treated. The dilutions are repeated so many times that there is less than one molecule per dose and it is suggested that benefit is from the energetic life force of the original substance”.

Homeopathy can therefore be seen as a “holistic” therapy, such that homeopathic care takes into account all aspects of the patient as an individual assessing their symptoms on mental, emotional, physical and general levels.

During a consultation the professional homeopath will focus on building up a complete picture of an individual’s unique make up considering all aspects of the patient’s health including diet, medical history, life events, lifestyle and personality. Homeopathic prescriptions are based on the process of matching this unique collection of symptoms as closely as possible with those of an appropriate homeopathic medicine (called a “remedy”), rather than automatically prescribing the same medicine for a named condition. This approach to understanding patients’ cases makes homeopathy well placed to treat those people with a diversity of complaints that would conventionally be given a different medication for each condition. For example, a person with asthma, allergies and constipation would typically require three different medications, but would be most likely to require only one homeopathic remedy that covers the totality of their case.

4. Homeopathic Philosophy

The philosophy that underpins the homeopathic medical system considers that physical ill health (in the absence of inherited disorders, accidents or physical trauma) can reflect unresolved life events, leading to prolonged underlying emotional stress. The professional homeopath will always ask a patient what was happening in their lives when the symptoms started or worsened. In this way, homeopathic philosophy places an equal importance on both emotional and physical wellbeing.

For example, a patient who developed hypertension following a significant grief would receive a homeopathic remedy that aimed to support resolution of this grief to first reduce emotional stress, then reducing physiological stress and ultimately reducing the hypertension. This would be done alongside conventional medical care and any other adjunctive treatment required, ensuring that each patient is appropriately supported on all fronts. Patients’ experience of successful homeopathic treatment is often that they first feel better “in themselves” and then that their physical symptoms start to improve, or become more manageable.

5. The Therapeutic Encounter

Patients often find the experience of telling their unique story to a sympathetic and supportive professional to be therapeutic (Eyles et al, 2012). There is some evidence to suggest that this aspect of the encounter with a professional homeopath may explain homeopathy’s therapeutic effectiveness (Jacobs et al, 2005; Brien et al, 2010). Indeed, this can be considered as the most parsimonious explanation for patient responses to homeopathic treatment while we lack a definitive explanation for the mechanism of action of homeopathic remedies. However, there is also evidence of the effectiveness of homeopathic remedies in the absence of the consultation (Frei et al, 2005) suggesting that patient benefit cannot simply be reduced to a therapeutic encounter.

6. Why Patients Choose Homeopathy: Qualitative Evidence from UK Studies

A pre-audit study exploring the motivation for patients to attend the Bristol Homeopathic Hospital for homeopathic treatment found that patient’s emphasised “treating the whole person” and a “desire to look at illness in a more complex way” (Thompson et al, 2007). Additionally, a qualitative study of patients choosing complementary therapies for asthma (Shaw et al, 2006) found that it “empowered them to take greater personal control over their condition rather than feel dependant on medication” and “enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings”.

Homeopathy offers an approach to understanding illness that patients with long-term conditions appreciate and appear to be paying for in the absence of access to NHS provision (Perry, 2013). A 2013 audit of 100 randomly selected patients at a privately run integrated medicine clinic (www.wellforce.co.uk) found that many patients with chronic fatigue syndrome, fibromyalgia, arthritis and multiple sclerosis were attending: pain, fatigue, anxiety and depression represented their most common symptoms. A survey by Thomas et al (2003), also found that 90% of complementary and alternative medicine (CAM) provision is purchased privately with total expenditure estimated at £450 million for 1998, with 10% of the adult population contacting a CAM practitioner that year.

In addition to the clear demand for CAM healthcare in supporting patients with long-term conditions, a study carried out at the University of Sheffield on behalf of the Department of Health explored patient satisfaction with complementary therapies in the NHS and found them to be “overwhelmingly positive” (Luff and Thomas, 2000). Specific aspects valued by patients included the development of a therapeutic relationship with their practitioner, the caring nature of the practitioner, being involved in the process of care and a significant improvement in the quality of their lives.

7. Where Patients Access Homeopathic Treatment

Patients currently access homeopathic treatment from a variety of sources within the NHS including:

three homeopathic hospitals in the UK (London, Bristol, Glasgow) and one ex hospital now NHS homeopathy clinic (Liverpool);

some GP surgeries, where homeopathy is offered either by GPs also trained in homeopathy or by practice-funded homeopaths (eg Marylebone Health Centre);

as an integrated component of palliative care (eg St Luke’s Hospice, Plymouth);

as a specialist service for hard to treat conditions (eg within the rheumatology department at Barnsley hospital);

as a specialist NHS clinic (eg Sheffield’s National Health Service community menopause clinic); and

as a general NHS clinic (eg Manor clinic, Sheffield).

However, the majority of patients in the UK access homeopathic treatment privately. Less than 10% of GPs report using homeopathy (Perry et al., 2013) and homeopathic prescribing in the NHS appears to have fallen sharply between 2000 and 2010 (Beckford, 2011).

8. How Patients with Chronic Conditions Fare Using Homeopathy

An observational study at the Bristol Homeopathic Hospital monitored treatment of >6,500 patients with chronic disease during a six year period (Spence et al, 2005). The aims of homeopathic treatment were to enhance general health and well-being, to improve symptom control and to reduce the impact of exacerbations in patients’ chronic conditions: just over 50% of patients self-rated their health as “better” or “much better” and over 70% expressed a degree of improvement. These results concur with studies from other homeopathic hospitals: in Tunbridge Wells improvement was seen in 74% of 1372 patients (Clover, 2000); and in Liverpool improvement was seen in 76.6% of 1100 patients (Richardson, 2001).

An eight year longitudinal cohort study of over 3,500 adults and children (97% of whom were diagnosed with a chronic complaint) also found that patients receiving homeopathic treatment improved considerably (Witt, 2008). That is, 67% of adults and 80% of children achieved significant health improvements at two years after baseline, and this improvement was sustained for the following six years of the study.

9. How Children with Chronic Conditions Fare Using Homeopathy

Children with chronic conditions appear to respond particularly well to homeopathic treatment. In addition to the evidence above, 66% of children in the Bristol Homeopathic Hospital study described rating their health as “better” or “much better” and 80% stated a degree of improvement. 68% of the children with eczema reported that it was “better” or “much better” (Spence et al, 2005). Parents appear to be turning to homeopathic treatment for their children: 24% of children with chronic conditions in an outpatient setting in south-west England were found to be using some form of CAM, homeopathy being one of the most common (Simpson and Roman, 2001). The Avon longitudinal study found that children were using homeopathy for chronic conditions such as asthma, eczema, hay fever, epilepsy, and migraine (Thompson et al., 2010).

10. Evidence for Specific Chronic Conditions

It is fair to say that clinical trial evidence for the effectiveness of homeopathic treatment for specific conditions overall is sparse, although trials of homeopathy in chronic conditions such as fibromyalgia, rheumatoid arthritis, hypertension, eczema, asthma, depression, ADHD and chronic fatigue do exist. However, most trials done to date focus on assessing the efficacy of specific homeopathic remedies compared to placebo and these trials provide little useful information about the effectiveness of homeopathic treatment for patients in a real-world context. For example, two of four studies on homeopathic treatment of fibromyalgia focus on the efficacy of specific homeopathic remedies (Fisher, 1986; Fisher, 1989) while two other studies are closer to real-world homeopathic practice in allowing free choice of homeopathic remedies (Bell et al, 2004; Relton, 2009): interestingly, positive results were recorded in both trial types.

11. Adverse Effects

Homeopathy is generally considered to be a safe therapy, relatively free of adverse events when compared to the rate of side effects from conventional medications. The highly-diluted nature of homeopathic medicines means that they are unlikely to lead to toxicity-related adverse drug reactions (Kirby, 2002). Several studies have reviewed the evidence for homeopathic adverse events and together the conclusion is that as long as homeopathy is correctly administered by a professional, qualified, registered homeopath (such as those registered with the Society) it is safe (Bornhöft et al, 2006; Dantas and Rampes 2000; Endrizzi et al, 2005; Monk, 1986; Thompson et al, 2004).

12. Cost Effectiveness

Cost effectiveness studies indicate that the use of homeopathy as a treatment option can reduce financial burden on patients and healthcare providers alike.

In Europe, a Health Technology Assessment of homeopathy commissioned by the Swiss government recently concluded that homeopathy is “clinically effective, cost effective and safe” (Bornhöft et al, 2006). Additionally, a comparison of homeopathic and conventional treatment of 493 patients with chronic conditions in Germany found that homeopathy achieved better outcomes for similar costs (Witt et al, 2005) and a study involving 499 children with recurrent upper respiratory tract infections showed that homeopathic treatment was more clinically effective (fewer episodes of illness) and more cost-effective than antibiotics (Trichard et al, 2005).

Other studies in the UK suggest that homeopathy can save money by reducing the use of conventional drugs, both in a hospital and a GP setting. Specifically, a 500-patient survey at the Royal London Homeopathic Hospital showed that many patients were able to reduce or stop conventional medication following homeopathic treatment (Sharples et al, 2003) and a study examining prescription costs of 22 GPs in the UK found that practices which included a GP using homeopathy prescribed 12% fewer items of medication per patient (including both conventional drugs and homeopathic medicines) compared with other local practices (Swayne, 1992). Since long-term conditions often require long-term medication regimes, homeopathy has the potential to make a significantly positive impact on the NHS drug budget.

13. Summary

As described in this paper there is a compelling argument to be made that homeopathic treatment is a clinically and cost effective option to support patients with long-term conditions. Importantly, patients who receive homeopathic treatment are also overwhelmingly positive about the experience.

Offering homeopathic treatment to patients with long-term health conditions addresses many of the concerns described by the Health Committee as it:

considers the patient as a whole person;

treats individual people not their individual diagnoses;

treats multi co-morbidities and offers a philosophical approach to support this;

provides effective integrated care alongside other treatments;

is appreciated by patients, who particularly value the personalised care they receive;

is comparatively cost effective; and

is available privately throughout the UK as well as part of the NHS in some areas.

The use of homeopathy in healthcare is increasing in other countries (eg India, Brazil and Japan) and from 1985 to 2001 CAM use in the UK also increased (Thomas and Coleman, 2003). However, UK support for homeopathy has recently seen an unfortunate decrease such that NHS-commissioned services, like the Sheffield menopause clinic and the Manor Clinic (http://www.shsc.nhs.uk) and the Liverpool hospital have been closed despite offering award winning services and fulfilling unmet needs. This may be due to NHS budget constraints; minimal education of doctors about CAM; and a decrease in GPs opinions about the effectiveness of homeopathy (48.7–21.9% in the last 10 years (Perry, 2013). A change in GP opinions may be a consequence of the unprecedented attempts by the biomedical community to discredit homeopathy in recent years (Anonymous, 2005; Bewley, 2011).

As outlined, homeopathy has an emerging evidence base of clinical effectiveness for specific named conditions, but it is important to appreciate that this remains in its infancy as most studies have focused on the efficacy of remedies in isolation: remedy efficacy is not relevant to patients with complex long-term health conditions, who need information about what homeopathy as a therapeutic intervention can do for them as individuals. As such, we would argue that there is a disconnection between patient perception and appreciation of homeopathy compared to medical, scientific and commissioner decision making. The NHS is currently not providing adequate homeopathic services that are clearly appreciated and needed by the public, especially those with long-term health conditions. We therefore suggest that the NHS could benefit from supporting the cheap homeopathic treatments already available at private homeopathy clinics across the country as well as commissioning specialist clinics to offer an integrated approach to health and wellbeing in order to benefit the long-term management of hard to treat chronic conditions.

9 May 2013

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