Homeopathy: Assessing Your Patients' Understanding
Proper patient counseling on homeopathy begins with assessing your patients' understanding of this controversial therapy.
Proper patient counseling on homeopathy begins with assessing your patients' understanding of this controversial therapy.
Homeopathy is derived from the Greek words homeos, meaning the same, and pathos, meaning suffering. While popular in Europe, homeopathy has diminished through the years in the United States, but is once again gaining popularity, fueling a multi-billion dollar industry (Sidebar).
Homeopathic medicine takes a holistic approach to disease, focusing on emotional, mental, and physical issues. Illness is regarded as the body’s attempt to correct an imbalance. The goal of treatment is to restore the body to “homeostasis.” The emphasis is on symptoms, and the initial symptom assessment can take up to 2 hours.
Three principles guide treatment:
- Law of Similars or “like cures like” postulates that a disease can be cured by a substance that produces similar symptoms in healthy people. Many vaccines and allergy treatments work on this principle.
- Law of the Infinitesimal Dose maintains that the more diluted a remedy is, the greater its effectiveness.
- Law of the Individual. The third principle postulates that illness is specific to the individual, and so too is the treatment. Treatments are highly individualized, driven by the patient’s total symptom profile. It is not uncommon for different people with the same symptoms to receive different treatments. Treatment involves only 1 remedy at a time, focusing first on the oldest symptoms before treating more recent ailments. Some symptoms worsen before improving. Providers maintain that symptom worsening is a sign that the remedy is working.2 Treatments are safe, inexpensive, and nontoxic, with minimal side effects.
There is some evidence that homeopathy is useful when treating self-limiting symptoms such as colds and sore throats.3 Critics maintain this is merely a placebo effect. Additionally, critics argue that the solutions are ineffective because they contain so little of the active ingredient. In some instances, there is no active ingredient in the final solution.
Conversely, homeopathy supporters maintain that while solutions are highly diluted, the solution contains a “memory” of the substance. The body recognizes the substance and reacts to it. Science has been unable to explain the mechanism of action of highly diluted remedies, although there is some evidence that certain remedies do cause biological effects.4 There is no scientific evidence, however, to support the premise that the “memory” of the active ingredient remains in the solution.5,6 This skepticism has been the major obstacle for the acceptance of homeopathy by mainstream medicine.7
Research
The critical research question is, “Do homeopathy’s benefits differ from placebo or are they due to some other action?” Unfortunately, rigorous research is lacking. While some studies report homeopathic dilutions differ from placebos, several studies report homeopathy fails to generate clinical effects that differ from those of placebo.8 Conducting large-scale clinical trials is difficult. Since homeopathic interventions are highly individualized, 6 different remedies may be used for6 different patients with the same symptoms.2
Regulation of Homeopathic Treatments
The FDA regulates homeopathic treatments, but does not evaluate remedies for safety or effectiveness. The FDA allows homeopathic remedies that meet certain criteria to be marketed without agency pre-approval. The agency requires that the product label, outer container, or accompanying leaflet include at least 1 major indication, a list of ingredients, the number of times an active ingredient has been diluted, and directions for use. Active ingredients must be those found in the Homeopathic Pharmacopeia of the United States. If a homeopathic remedy claims to treat serious diseases, such as cancer, it must be sold by prescription. Products for minor health problems are sold without a prescription (Table 1).9-11
Counseling Guidelines
Pharmacists have an obligation to inform patients that many studies don’t support the clinical benefits of homeopathic remedies. Counseling begins with assessing the patient’s understanding of homeopathy. Some patients, for example, are unaware that solutions are highly diluted. Table 2 presents other counseling guidelines for pharmacists.
Final Thought
Homeopathic medicine is the most controversial treatment among complementary and alternative interventions. Some call it “pure quackery,” while others regard homeopathy as effective treatment.2 Given the lack of rigorous research on homeopathy, the National Institutes of Health’s National Center for Complementary and Alternative Medicine concludes, “There is little evidence to support homeopathy as an effective treatment for any specific condition.”9
Dr. Zanni is a psychologist and health systems consultant based in Alexandria, Virginia.
References
1. Wells K. Homeopathic medicine. In: Longe J, ed. The Gale Encyclopedia of Senior Health: a Guide for Seniors and Their Caregivers. Detroit, MI: Gale; 2009.5 vols, 2009 11.6 vols.
2. Wells K. Homeopathic medicine. In: Fundukian L, ed. The Gale Encyclopedia of Medicine. 4th ed. Detroit, MI: Gale; 2011.6 vols.
3. Caulfield T, DeBow S. A systematic review of how homeopathy is represented in
conventional and CAM peer reviewed journals. BMC Complement Altern Med. 2005;14(5):12.
4. The Society of Homeopaths. What is homeopathy? www.homeopathy-soh.org/about-homeopathy/what-is-homeopathy. Accessed September 23, 2013.
5. Taylor MA, et al. Randomised controlled trial of homeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ. 2000;32:471-476.
6. WebMD. Topic overview: what is homeopathy? www.webmd.com/balance/guide/homeopathy-topic-overview. Accessed September 3, 2013.
7. Samat L, Gold P. Homeopathy explained. www.nationalcenterforhomeopathy.org/learn-about-homeopathy. Accessed September 19, 2013.
8. Ernst E. The truth about homeopathy. Br J Clin Pharmacol. 2008;65(2):163-164.
9. National Center for Complementary and Alternative Medicine. Homeopathy: an introduction. http://nccam.nih.gov/health/homeopathy. Accessed September 23, 2013.
10. National Women’s Health Resource Center. Homeopathy; treatment. September 8, 2008.
11. FDA. CPG Sec. 400.400 conditions under which homeopathic drugs may be marketed. www.fda.gov/iceci/compliancemanuals/compliancepolicyguidancemanual/ucm074360.htm. Accessed September 23, 2013.
