There are active public campaigns both for and against homeopathy, and its continuing availability in the NHS is debated in the medical, scientific and popular press. However, there is a lack of clarity in key terms used in the debate, and in how the evidence base of homeopathy is described and interpreted. The term 'homeopathy' is used with several different meanings including: the therapeutic system, homeopathic medicine, treatment by a homeopath, and the principles of 'homeopathy'. Conclusions drawn from one of these aspects are often inappropriately applied to another aspect. In interpreting the homeopathy evidence it is important to understand that the existing clinical experimental (randomised controlled trial) evidence base provides evidence as to the efficacy of homeopathic medicines, but not the effectiveness of treatment by a homeopath. The observational evidence base provides evidence as to the effectiveness of treatment by a homeopath. We make four recommendations to promote clarity in the reporting, design and interpretation of homeopathy research.

Relton C, O'Cathain A, Thomas KJ. University of Sheffield, Medical Care Research Unit, School of Health & Related Research, Regent Court, Regent Street, Sheffield S1 4DA, UK. c.relton@sheffield.ac.uk Homeopathy . 2008 Jul;97(3):152-5.

by Manohar Santwani, M.S., MHM, CCH, RSHom(NA), CCH(US)

In a recent international seminar – Homeopathy: a Hoax or the Medicine for the Twenty-first Century - organized by the Connecticut University, several interesting and new facts about homeopathy were brought out by a couple of Homeopathic scientists which brought out the efficacy and superiority of this holistic system of medicine. The data presented revealed that during the eighteenth and nineteenth century epidemics, Homeopathy had the most effective cures of the diseases without any side effects, had the least mortality rate, and the recovery period was more prompt than the other systems of medicine. It was an eye-opening session that was televised.

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The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

Spine J. 2008 Jan-Feb;8(1):70-9. Gagnier JJ. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. j.gagnier@utoronto.ca

Could theoretical links exist between homeopathy and conventional medicine? In homeopathy, disturbance of the self-regulating Vital Force (Vf) results in dis-ease as multileveled symptom expression. Treatment aids the Vf as it attempts to restore holistic balance. Conventional medicine (allopathy) deterministically considers external agents (viruses, bacteria, etc.) or internal biochemical imbalances as disease causes. Treatment is geared to eradicating causative factors, sometimes at the expense of the homeostatic immune system. Method: A previous mathematical model described the Vf as a quantized gyroscopic "wave function," equating strength of symptom expression to degree of Vf gyroscopic "precession." Diseases and homeopathic remedies were interpreted respectively as braking and accelerating "torques" on Vf "angular momentum." In this paper, approximations applied to the Vf "wave function" could provide insights into why conventional medicine dismisses the action of highly potentized homeopathic remedies. In addition, a simple geometric force diagram provides another mathematical model for allopathic drug action and immune system reaction. Results: The 2 models converge on the same result, delivering conventional biomedicine's conclusion: potentized homeopathic remedies should exert no clinically observable effects. Conclusions: Following the logic of these models, conventional medicine could be seen as a special case of a broader therapeutic paradigm also containing homeopathy.

J Altern Complement Med. 2007 Sep;13(7):759-70. Milgrom LR. Department of Chemistry, Imperial College London, South Kensington, United Kingdom.

OBJECTIVE: To set a standard of routine goal setting with patients within their package of care at the Bristol Homeopathic Hospital. We hope goal setting will improve communication with our patients and health professional colleagues, focus outcome and improve targeting of problems. We therefore explored motivation for and expectation of hospital attendance from a patient perspective. MATERIALS AND METHODS: Questionnaire based pre-audit survey. The questionnaire was administered to 110 consecutive patients attending outpatients and 20 parents of children attending with asthma and eczema to gain understanding of motivation and expectation and more specific information for two of the commonest conditions. RESULTS: Seventy percent of patients had used some form of complementary and alternative medicine (CAM), 35% had used homeopathy and only 10% had specialist homeopathic care, the majority of use being over the counter. The majority of patients had been encouraged by their General Practitioners, themselves and by word of mouth with family and friends. Few patients cited the media as a major influence. "Pull" factors such as "treating the whole person" were given greater emphasis except for parents of children with asthma and eczema for whom "push" factors such as fear of steroid side effects predominated. In the main patient expectations were reasonable with the majority hoping to see improvements in their conditions. A fifth of patients hoped to reduce conventional medications. CONCLUSIONS: Patients had used CAM in general but not homeopathy in particular. Encouragement from doctors, self motivation and word of mouth most motivated patients to come and might suggest more direct communication with General Practitioners would be worthwhile. Being treated as a whole person was the most significant motivating factor, with a significant number of patients wishing to reduce medication. Goal setting and direct communication with other healthcare professionals is essential for safety, to focus outcome, and to value the role of homeopathy in a patient's healthcare. As a result we have set a standard whereby treatment goals are agreed with patients and communicated to referring health care professionals at each outpatient visit. This could be audited.

Homeopathy. 2007 Oct;96(4):243-6. Thompson E, Dahr J, Susan M, Barron S. Bristol Homeopathic Hospital, Cotham Hill, Bristol, UK.

The HomBRex database indexes basic research on homeopathy (www.carstens-stiftung.de/hombrex). It includes research on effects of homeopathic preparations in bioassays and physico-chemical effects of the homeopathic preparation process (potentization). At the end of 2006 it contained more than 1100 experiments in more than 900 original articles, including 1014 biological studies. The types of organisms used as laboratory "model" organisms in fundamental homeopathic research include animal, human, plant, fungi and microbial organisms. Most animal studies (607) were with rats (209) or mice (171). Most plant studies (171) were with wheat (52). The database catalogues whether the experiment was performed on intact organisms or in organs or cells, isolated and analyzed for changes in structure, function and subcellular composition. The database might be especially useful to facilitate a search for experimental models that have been used in the study of both proving and therapeutic experiments-ultimately in the research on the homeopathic similia principle.

Homeopathy. 2007 Oct;96(4):247-51. Van Wijk R, Albrecht H. Faculty of Biology, Utrecht University, Padualaan 8, 3584CH Utrecht, The Netherlands.

Within the last decade there has been a dramatic increase in the sale and use of herbal supplements and food supplements by Western populations and within the UK. This increased usage has coincided with a resurgence of interest in nutritional therapy and complementary and alternative medicine (CAM) therapies, such as herbal medicine, naturopathy and homeopathy, in which therapists may provide dietary advice and advocate the use of food or herbal supplements. The rise in the use of CAM therapies by the UK population can be attributed to several factors, including: promotion via health programmes and the media; a change in public attitudes; training of more nutritional and CAM therapists as a result of the increased availability of courses; a greater use of CAM and food and herbal supplements, particularly by patients with cancer. The aim of the present paper is to identify the pattern of usage of food and herbal supplements in the UK.

Proc Nutr Soc. 2007 Nov;66(4):479-82. Ritchie MR. The Herbal Medicine Research Unit, School of Life Sciences, Napier University, Edinburgh EH9 2TB, UK.

Complementary and alternative medicine (CAM) is used by large numbers of the general public and is increasingly becoming integrated into the mainstream. An understanding of why people use CAM in general has been developed in the literature, but relatively little is known specifically about adherence to CAM. We tested hypotheses (derived from a dynamic extended version of Leventhal's common-sense model) that patients' beliefs about treatment, perceptions of illness, and treatment appraisals would predict adherence to CAM.DesignA prospective self-report questionnaire study was carried out with a 3-month follow-up period.MethodsA total of 240 patients from five CAM clinics completed self-report questionnaire measures of treatment beliefs, illness perceptions, and treatment appraisals at baseline. Three months later, they completed self-report measures of adherence to therapists' recommendations concerning attendance, remedy use, and life-style changes.ResultsLogistic regression analyses showed that positive perceptions of one's therapist and belief that mental factors do not cause illness independently predicted adherence to appointments. Positive beliefs in holistic health and finding it difficult to travel to appointments predicted adherence to remedy use. Using homeopathy was the only independent predictor of adherence to life-style changes.ConclusionsTreatment appraisals, treatment beliefs, and illness perceptions explain modest proportions of the variance in adherence to CAM. This study highlights the value of operationalizing the appraisal element of the common-sense model when investigating adherence to treatment.

Br J Health Psychol. 2007 Oct 24 Bishop FL, Yardley L, Lewith GT.

Seventy-five dogs that showed a fear response to fireworks participated in a double-blinded, placebo-controlled clinical trial to assess the efficacy of a homeopathic remedy for the alleviation of their behavioural signs. Dogs were randomly assigned to one of two treatments; the homeopathic treatment or the placebo treatment. At the baseline assessments the owners identified the behavioural signs of fear that their dogs normally displayed in response to fireworks, rated their frequency and intensity, and assessed the global severity of their dog's responses. These measures were repeated at the final assessment and owners also completed weekly diaries for the length of the trial. There were significant improvements in the owners' rating of 14/15 behavioural signs of fear in the placebo treatment group and all 15 behavioural signs in the homeopathic treatment group. Both treatment groups also showed significant improvement in the owners' rating of the global severity of their dog's responses. However, there was no significant difference in the response seen between the two treatment groups.

Vet J. 2007 Jun 13;

Cracknell NR, Mills DS.

Animal Behaviour, Cognition and Welfare Group, Department of Biological Sciences, University of Lincoln, Riseholme Park, Lincoln LN2 2LG, UK.

BACKGROUND: Many individuals who appear to suffer from incurable chronic skin disease use complementary and alternative medicine (CAM). Homeopathy has recently increased in popularity among patients with skin disease. The effects of homeopathic treatment have yet to be fully investigated in patients for whom conventional dermatological treatment is not sufficiently effective. OBJECTIVES: To describe patient-reported and clinically observed effects of individualized homeopathic treatment of chronic skin disease. PATIENTS AND METHODS: The effectiveness of individualized homeopathic treatment was measured using the patients' own assessments of seven elements (overall impression, improvement of skin condition, reduction of itchiness, reduction of sleep disturbance, satisfaction in daily life, fulfillment at work and satisfaction in human relations) using a nine-point scale similar to the Glasgow Homeopathic Hospital Outcome Scale (GHHOS). Sixty patients with chronic skin disease were included in the study: atopic dermatitis (AD) (n=25), eczema other than AD (n=20), severe acne (n=6), chronic urticaria (n=6), psoriasis vulgaris (n=2) and alopecia universalis (n=1). These patients received individualized homeopathic treatments in addition to conventional dermatological treatments for a period of from 3 months to 2 years 7 months. RESULTS: Six patients reported a score of 4 (complete recovery), 23 patients a score of 3 (75% improvement), 24 patients a score of 2 (50% improvement) and 7 patients a score of 1 (25% improvement). A total of 88.3% of patients reported over 50% improvement. Around one-half the patients with AD and eczema reported greater satisfaction in daily life, greater fulfillment at work and greater satisfaction in human relations. CONCLUSIONS: The psychological, physical and psychosomatic symptoms and effects of chronic skin diseases are inextricable. Individualized homeopathic treatment can provoke a good response in patients with chronic skin disease; therefore, the holistic approach used in homeopathy may be a useful strategy alongside conventional treatment.

Itamura R.

Department of Dermatology, Obitsu Sankei Hospital, 1-4 Namikinishi-machi, Kawagoe-city, Saitama-ken 350-0025, Japan.

Homeopathic preparations of blue cohosh (Caulophyllum thalictroides) and black cohosh (Actaea racemosa [formerly Cimicifuga racemosa]) have been used around the world for induction and augmentation of labor. There are few clinical studies examining these preparations, and the evidence for their safety and efficacy is largely anecdotal. More research needs to be done to determine whether homeopathy is a potentially viable alternative to oxytocin and prostaglandins for labor induction.

J Midwifery Womens Health. 2007 May-Jun;52(3):303-7.

Kistin SJ, Newman AD.

sjk2115@columbia.edu