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Observationalstudiesonhomeopathy

Tohealthcareproviders,patientsandclinicians,whatmattersmostisnotnecessarilyhowwellatreatmentperformsundertheartificiallycontrolledconditionsonarandomisedcontrolledtrial(RCT),buttheresultsseeninclinicalpractice.Evidencefrom‘uncontrolledobservationalstudies’providesinsightintochangesinpatientswhohavereceivedtreatmentprovidedbyhomeopaths.Thesestudiesconsistentlyshowthatpatientsimproveclinicallyfollowinghomeopathictreatment(oftenfromchronic,difficulttotreatconditions);somealsohighlightareasofpotentialeconomicbenefitfortheNHSasawholeintermsofreducedprescribingofconventionaldrugs.

UnitedKingdomFivepublishedstudiescarriedoutfrom1999tothepresentdayhavetrackedtheoutcomeofpatientsbeingtreatedatNHShomeopathichospitals:Liverpool(2001)

AnoutcomesurveycarriedoutattheLiverpooldepartmentofhomeopathicmedicineovera12monthperiodin1999-2000surveyed1,100patients1;76.6%reportedanimprovementintheirconditionsincestartinghomeopathictreatmentand60.3%regardedtheirimprovementasmajor.814patientsweretakingconventionaltreatmentfortheirconditionand424[52%]ofthesewereabletoreduceorstopconventionalmedication.Themainconditionstreatedwereosteoarthritis,eczema,chronicfatiguesyndrome,asthma,anxiety,headaches,inflammatoryarthritisandirritablebowelsyndrome.

RoyalLondonHomeopathicHospital(2003)

A500-patientsurveyattheRLHHshowedthatmanypatientswereabletoreduceorstopconventionalmedicationfollowinghomeopathictreatment.2Theextentofimprovementvariedbetweendiagnosese.g.72%ofpatientswithskincomplaintsreportedbeingabletostoporreducetheirconventionalmedication;forcancerpatientstherewasnoreduction.Thestudyalsoshowedthatmanypatientsseekhomeopathybecauseoftheirconcernsaboutthesafetyofconventionaltreatment.BristolHomeopathicHospital(2005)

AnobservationalstudyatBristolHomeopathicHospitalincludedover6,500consecutivepatientswithover23,000attendancesinasix-yearperiod;370%offollow-uppatientsreportedimprovedhealth,50%majorimprovement.Thelargestimprovementswere

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reportedinchildhoodeczemaorasthma,andininflammatoryboweldisease,irritablebowelsyndrome,menopausalproblemsandmigraine.Bristol,Glasgow,Liverpool,LondonandTunbridgeWells(2008)Inthispilotstudy,datafrom1602follow-uppatientappointmentsatallfiveNHShomeopathichospitalswerecollectedtogetheroveraone-monthperiod.4Attheirsecondhomeopathicappointment,34%offollow-uppatientsoverallreportedanimprovementthataffectedtheirdailyliving.Forpatientsattheirsixthappointment,thecorrespondingimprovementratewas59%.Eczema,chronicfatiguesyndrome,menopausaldisorder,osteoarthritisanddepressionwerethe"topfive"mostreferredconditions.

PatientsreferredtoNHShomeopathichospitalstypicallyhavechronicconditionsforwhichavailableconventionaltreatmentshavenotbeensufficientlyeffective.Intotal,thestudyidentified235separatemedicalcomplaintstreatedatthehospitalsduringonemonth.Manypatientshadmultiplepathologies.Thestudyshowedthatreportedhealthbenefitsmayoccurmorequicklyinsomemedicalconditionsthaninothers.ThepilotfindingsareinformingaprogrammeofstandardsettingfortreatmentoutcomesintheNHShomeopathichospitals.BristolHomeopathicHospital(2016)Confirmingtheresultsofthe2005study,thisrecentauditofjustunder200patientsperformedatBristolHomeopathicHospitaldemonstratedthatpatientswithlong-termconditionswhocomeunderhomeopathiccareexperiencestatisticallysignificantimprovementsintheirpresentingsymptomsandwellbeing.5Atotalof198patientswereassessedover1to5consultationsusingapatient-reportedoutcomemeasure(MYMOP2).Themostcommonconditionsseenwereneoplasms,psychologicalandgenitourinarycomplaintswhilethemostcommonlyreportedsymptomswerepain,mentalsymptomsandtiredness/fatigue.Intention-to-treatanalysisshowedthatameanMYMOP2scorechangeof1.24fromthefirsttolastconsultationwasachieved,withimprovementsbeingstatisticallysignificantforbothcompletersandnon-completers(p<0.001).France'EPI3’Project(2008-2012)

HomeopathyiswidelyusedinFranceandamajorstudyfollowing8559patientsattendingGPpracticeswasusedtoassesstheeffectivenessofhomeopathictreatment.This’EPI3

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study’6ismanagedbyLA-SERaUK-basedcompanyspecialisedinscientificevidenceformedicineandhealthtechnologies(http://www.la-ser.com/).Theprojectteamincludesindividualsfromhigh-profileinstitutionssuchastheInstitutPasteurinParis,UniversityofBordeauxandMcGillUniversity,Montreal;LucienAbenhaimistheFrenchGeneralDirectorofHealth(SurgeonGeneral).KeyfindingsoftheEPI3project:

• Upperrespiratorytractinfections(URTIs)

PatientstreatedbyGPstrainedinhomeopathydidaswellclinicallyasthosetreatedwithconventionalmedicine,butusedfewerconventionaldrugs.7Thisstudyinvestigatedtheuseofantibioticsandantipyretic/anti-inflammatorydrugsuseforthetreatmentofupperrespiratorytractinfections(URTIs).518adultsandchildrenwithURTIswereincluded.PatientswhoconsultedwithGPscertifiedinhomeopathyshowedsignificantlylowerconsumptionofantibiotics(OR=0.43,CI:0.27–0.68)andantipyretic/anti-inflammatorydrugs(OR=0.54,95%CI:0.38–0.76),withsimilarevolutioninrelatedsymptoms.

• Musculoskeletaldisorders(MSDs)

Patientstreatedwithhomeopathydidaswellclinicallyasthosetreatedwithconventionalmedicine,butusedonlyhalftheamountofnon-steroidalanti-inflammatorydrugs(NSAIDs)andhadfewerNSAID-relatedsideeffects.8

1153patientswithwhoconsultedGPscertifiedinhomeopathywerefollowed,comparinggroupswhoreceivedhomeopathyorconventionalmedicine(CM),oramixedapproachinvolvingbothapproaches.PatientsdidnotdifferbetweengroupsexceptforchronicityofMSDs,whichwashigherinthehomeopathygroup(62.1%)thaninboththeCM(48.6%)andmixed(50.3%)groups.Thetwelve-monthdevelopmentofspecificfunctionalscoreswasidenticalforallgroups(p > 0.05).Afteradjustingforpropensityscores,NSAIDuseover12monthswasalmosthalfinthehomeopathygroup(OR,0.54;95%CI,0.38-0.78)ascomparedtotheCMgroup;nostatisticallysignificantdifferencewasfoundinthemixedgroup(OR,0.81;95%CI:0.59-1.15).MSDpatientsseenbyhomeopathicphysiciansshowedasimilarclinicalprogressionwhenlessexposedtoNSAIDincomparisontopatientsseeninCMpractice,withfewerNSAID-relatedadverseeventsandnolossoftherapeuticopportunity.

• Sleep,anxietyanddepressivedisorders(SADD)

Patientstreatedbycertifiedhomeopathicphysicianswerelesslikelytobeprescribedpsychotropicdrugs.9TheEPI3study‘SADD’studyinvolved1572patientsdiagnosedwithsleep,anxietyanddepressivedisordersseekingtreatmentfromphysiciansingeneralpractice(GPs),withthreedifferentpracticepreferences:strictlyconventionalmedicine

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(GP-CM),mixedcomplementaryandconventionalmedicine(GP-Mx)andcertifiedhomeopathicphysicians(GP-Ho).PsychotropicdrugsweremorelikelytobeprescribedbyGP-CM(64%)thanGP-Mx(55.4%)andGP-Ho(31.2%).ThethreegroupsofpatientssharedsimilarSADDseverityintermsofcomorbiditiesandqualityoflife.

GermanyComparinghomeopathyandconventionalcare(2005)

AstudycommissionedbyaGermanhealthinsurancecompanytodeterminewhethertocontinuecoveringhomeopathictreatmentassessedthevalueofhomeopathyintreatingchronicconditionscommonlyseeningeneralpractice.10493patients(315adults,178children)treatedbygeneralpractitionersreceivedeitherconventionalmedicineorhomeopathy.Patientsinthehomeopathygroupreportedgreaterimprovementthantheconventionalmedicinegroup(p=0.002)withnosignificantdifferenceincost.

Thephysicians’assessmentsshowedthatchildrenwhoreceivedhomeopathyhadabetterclinicalresponsethanthosewhoreceivedconventionalmedicine(p<0.001).Conditionstreatedincludedheadache,lowbackpain,depression,insomniaandsinusitisinadults,andatopicdermatitis,allergicrhinitisandasthmainchildren.Followingthisstudy,InnungskrankenkasseHamburgdecidedtocontinuetocoverhomeopathictreatment.Eight-yearfollowupofchronicallyillpatientstreatedwithhomeopathy(2008)

Thisstudywhichfollowedover3500adultsandchildrenreceivingroutinehomeopathiccarefromGPs,11foundthat"patientswhoseekhomeopathictreatmentarelikelytoimproveconsiderably".Atthestart,97%ofparticipantswerediagnosedwithachroniccomplaint,with95%declaringpriorconventionaltreatmentfortheircondition.Diseaseseveritydecreasedsignificantly(p<0.001)betweenthestartofthestudy,after2yearsandafter8yearsofhomeopathictreatment.Notably,after8years,figureswerealmostidenticalto2-yearfollow-up,indicatingsteadylong-termhealthbenefits.

Thismulti-centre8-yearlongitudinalcohortstudyconcentratedonpatientsinroutinecaretreatedbyGPswithadditionalqualificationsinhomeopathy.Thestudyincluded3,709patients,73%ofwhichcontributeddatatothe8-yearfollow-upi.e.2,722adults(72.8%female,ageatbaseline41.0±12.3)and819children(48.4%female,age6.5±4.0).Themostfrequentdiagnoseswereallergicrhinitisandheadacheinadults,andatopicdermatitisandmultiplerecurrentinfectionsinchildren.

Mainoutcomemeasures,utilisingconventionalmedicalresearchinstruments,includedqualityoflife(QoL)andnumericalseverityscaleassessments.Oneintwopatientsexperiencedreductionsof50%insymptomseverityafter8years,withcorresponding

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changesinQoLmeasures.Ofadults,almost50%ofresponders(67.4%totalstudypopulation)experienced"clinicallyrelevanttreatmentsuccess"(complaintseverityreduced2pointsormoreona10-pointscale);inchildrenthefigurewas80%.Youngerage,femalegenderandmoreseverediseaseatbaselinewerefactorspredictiveofbettertherapeuticsuccess.References1. RichardsonWR.Patientbenefitsurvey:LiverpoolRegionalDepartmentofHomoeopathic Medicine.BrHomeopathJ,2001;90:158-162.2. SharplesF,vanHaselenR,FisherP.NHSpatients'perspectiveoncomplementarymedicine. ComplementTherMed,2003;11:243-248.3. SpenceD,ThompsonEA,BarronSJ.Homeopathictreatmentforchronicdisease:a6-year university-hospitaloutpatientobservationalstudy.JAlternComplementMed,2005;5:793-798.4. ThompsonEA,MathieRT,BaitsonES,BarronSJ,BerkovitzSR,BrandsM,FisherP,KirbyTM, LeckridgeRW,MercerSW,NielsenHJ,RatseyDHK,ReillyD,RonigerH,WhitmarshTE. Towardsstandardsettingforpatient-reportedoutcomesintheNHShomeopathichospitals. Homeopathy,2008;97:114-121.5. ThompsonE,ViksveenP,BarronS.Apatientreportedoutcomemeasureinhomeopathicclinicalpracticeforlongtermconditions.Homeopathy,2016;105(4):309-3176. Grimaldi-Bensouda,L.etal.Benchmarkingtheburdenof100diseases:resultsofanationwide representativesurveywithingeneralpractices.BMJOpen,2011;1:e000215.7. Grimaldi-Bensouda,L.etal.Managementofupperrespiratorytractinfectionsbydifferent medicalpractices,includinghomeopathy,andconsumptionofantibioticsinprimarycare:the EPI3cohortstudyinFrance2007-2008.PloSOne,2014;9,e89990.8. Rossignol,M.etal.Impactofphysicianpreferencesforhomeopathicorconventionalmedicines onpatientswithmusculoskeletaldisorders:resultsfromtheEPI3-MSDcohort. Pharmacoepidemiol.DrugSaf.2012;21:1093–1101.9. Grimaldi-Bensouda,L.etal.Whoseeksprimarycareforsleep,anxietyanddepressivedisorders fromphysiciansprescribinghomeopathicandothercomplementarymedicine?Resultsfromthe EPI3populationsurvey.BMJOpen2012;2.10. WittC,KeilT,SelimD,etal.Outcomeandcostsofhomeopathicandconventional treatmentstrategies:acomparativecohortstudyinpatientswithchronicdisorders. ComplementTherMed,2005;13:79-86.11. Witt,C.M.,Lüdtke,R.,Mengler,N.&Willich,S.N.Howhealthyarechronicallyillpatientsafter eightyearsofhomeopathictreatment?--Resultsfromalongtermobservationalstudy.BMC PublicHealth,2008;8,413.