43. Homeopathy In Healthcare

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43. Homeopathy In Healthcare

 

 

CATEGORY:Alternative Medicines 300 Courses

COURSE NUMBER: 43

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

CERTIFICATES DELIVERY: In 48 hours

BOOKS/ MANUALS: Pages

Syllabus

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Peter F. Matthiessen, Gudrun Bornhöft
2 Background and objectives of HTA . . . . . . . . . . . . . . . . . . . . . . . 5
Stefanie Maxion-Bergemann, Gudrun Bornhöft
2.1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Introduction to the speciality of homeopathy –
principles and definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Marco Righetti, Klaus v. Ammon, Peter Mattmann, André Thurneysen
3.1 Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
3.2 The principle of similarity or ‘Law of Similars’ . . . . . . . . . . . . . . . . . . . 10
3.3 Homeopathic pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
3.4 The homeopathic examination and remedy selection . . . . . . . . . . . . . 11
3.5 Medicines: their manufacture, application and mode of action . . . . . . . 11
3.6 The concept of disease in homeopathy and conventional medicine . . . . 12
3.7 Indications and limitations of homeopathy . . . . . . . . . . . . . . . . . . . . 13
3.8 Other therapies known as homeopathy . . . . . . . . . . . . . . . . . . . . . . . 13
3.9 Homeopathy research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.10 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 Homeopathy: Research and Research Problems
(preclinical and clinical) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Marco Righetti, Stephan Baumgartner, Klaus v. Ammon
4.1 Introduction and Research Problems . . . . . . . . . . . . . . . . . . . . . . . . 16
4.2 Preclinical Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.2.1 Fundamental physico-chemical research . . . . . . . . . . . . . . . . . . . . . . . 17
4.2.2 Botanical studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4.2.3 Animal studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4.2.4 In vitro studies with human cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.2.5 Conclusion: fundamental preclinical research . . . . . . . . . . . . . . . . . . . . 19
4.3 Clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.3.1 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
4.3.2 An outline of clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4.3.3 Future research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.3.4 Summary clinical studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
5 General problems with clinical trials in research . . . . . . . . . . . . . 27
Peter F. Matthiessen, Gudrun Bornhöft
5.1 The Problems with Randomized Clinical Trials . . . . . . . . . . . . . . . . . . 28
5.2 The Risk of Bias in Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

VI
5.3 Problems with the Formal Evaluation of Clinical Trials in Meta-analyses . 39
5.4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
6 HTA Homeopathy: Methods and Material . . . . . . . . . . . . . . . . . . 47
Stefanie Maxion-Bergemann, Gudrun Bornhöft, Ursula Wolf
6.1 Project Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
6.2 Methods: Systematic Literature Search . . . . . . . . . . . . . . . . . . . . . . . 49
6.2.1 Selection of data sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6.2.2 Data sources used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6.2.3 Systematic literature search: general search strategy and article selection . . . 54
6.2.4 Systematic literature search for individual HTA aspects: search strategy
and article selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.3 Data Extraction and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6.3.1 Extraction and evaluation of data / procedure . . . . . . . . . . . . . . . . . . . . 56
6.3.2 Extraction and evaluation of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
6.3.3 Evaluation categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
6.4 Data Synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.5 Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
6.5.1 Database research ‘Homeopathy’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
6.5.2 Special search: URTI (Upper Respiratory Tract Infection) . . . . . . . . . . . . . . 62
6.5.3 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.5.4 Cost-effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
7 International Utilisation of Complementary Medical Approaches 67
René Gasser, Ursula Wolf, Martin Wolf, Klaus v. Ammon, Gudrun Bornhöft,
Stefanie Maxion-Bergemann
7.1 Introduction and Research Questions . . . . . . . . . . . . . . . . . . . . . . . . 68
7.2 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.3.1 Outline of studies used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.3.2 Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.3.3 CAM definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
7.3.4 Profile of CAM users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
7.3.5 Frequency of CAM use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
7.3.6 Estimation of satisfaction with CAM and CAM effectiveness . . . . . . . . . . . . 83
7.3.7 Reasons for using CAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
7.3.8 Use of CAM compared with conventional medicine . . . . . . . . . . . . . . . . . 86
7.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
7.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
7.6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
8 CAM Conditions and Use in Switzerland . . . . . . . . . . . . . . . . . . . 91
Ursula Wolf, Martin Wolf, Klaus v. Ammon
8.1 Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
8.2 The Use of Complementary Medicine in Switzerland: Prevalence,
Effectiveness, Acceptance and the Views of Patients and Physicians . . . . 94
8.2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Table of Contents

VII

8.2.2 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
8.2.3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
8.2.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
8.2.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
8.2.6 List of study numbers (referred to in the diagrams) . . . . . . . . . . . . . . . . . 98
8.3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
9 Overview of Systematic Reviews on the Clinical Efficacy
of Homeopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Gudrun Bornhöft, Klaus v. Ammon
9.1 Introduction: Systematic Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
9.2 Literature Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
9.3 Presentation of the Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
9.3.1 Reviews on general effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
9.3.2 Reviews on special indications: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
9.3.3 Reviews on special interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
9.3.3 Reviews on special indications with special intervention . . . . . . . . . . . . . . 108
9.4 Evaluation of the Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9.4.1 Research question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9.4.2 Selection of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
9.4.3 Selection and evaluation of data/information . . . . . . . . . . . . . . . . . . . . 113
9.4.4 Data synthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
9.5 Discussion and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
9.6 List of Excluded Studies with Reasons for Exclusion . . . . . . . . . . . . . . . 118
9.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
10 Clinical Studies on the Effectiveness of Homeopathy for URTI/A
(Upper Respiratory Tract Infections and Allergic Reactions) . . . . 127
Stefanie Maxion Bergemann, Gudrun Bornhöft, Denise Bloch, Christina Vogt-Frank,
Marco Righetti, André Thurneysen
10.1 Selection of Indication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
10.2 Outcome of Literature Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
10.3 Summary of Studies: Data Extraction, Internal and External Validity,
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
10.3.1 Population, study design and implementation . . . . . . . . . . . . . . . . . . . . 140
10.3.2 Intervention and control therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
10.3.3 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
10.3.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
10.3.5 Side effects, initial aggravation, adverse effects . . . . . . . . . . . . . . . . . . . 143
10.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.5 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
11 Safety of Homeopathic Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Klaus v. Ammon, André Thurneysen
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
11.2 Responses to Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
11.3 Interaction of Substances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
11.4 Safety of Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Table of Contents

VIII
11.5 Scientific Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
11.6 Safety: Summary and Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
11.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
12 Cost-effectiveness of Homeopathy . . . . . . . . . . . . . . . . . . . . . . . 163
Klaus v. Ammon, René Gasser, Gudrun Bornhöft, Stefanie Maxion-Bergemann
12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
12.2 Methods of Health Economics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
12.3 Use of CAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
12.4 Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
12.5 Cost-effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
12.6 Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
12.7 Data and Studies for Homeopathy . . . . . . . . . . . . . . . . . . . . . . . . . . 169
12.8 Data and Projects from Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . 171
12.8.1 NFP 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
12.8.2 Further data from Switzerland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
12.9 International CAM Studies and Surveys: Patients . . . . . . . . . . . . . . . . 173
12.10 International CAM Studies and Surveys on: Physicians/Providers . . . . . . 174
12.11 Pilot Projects in Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
12.12 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
12.12.1 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
12.12.2 Cost-effectiveness of complementary medical methods . . . . . . . . . . . . . . 177
12.12.3 Homeopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
12.13 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
13 Full discussion of the HTA results . . . . . . . . . . . . . . . . . . . . . . . . 193
Gudrun Bornhöft, Klaus v. Ammon, Marco Righetti, André Thuneysen,
Peter F. Matthiessen
13.1 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
14 Synopsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
14.1 Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
14.2 Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
14.3 Studies on the Indication Upper Respiratory Tract Infection/Allergy (URTI/A) 207
14.4 Appropriateness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
14.4.1 Estimation of Demand/Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
14.4.2 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
14.5 Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
15 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
15.1 Data Extraction Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
15.1.1 Sample questionnaires: systematic reviews and meta-analyses, also for HTA . 212
15.1.2 Sample questionnaires: clinical studies . . . . . . . . . . . . . . . . . . . . . . . . 218
15.1.3 Sample questionnaire: demand/cost-effectiveness . . . . . . . . . . . . . . . . . 224
15.2 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
15.3 Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
15.4 Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

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