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No smoke without fire
Homeopathy (2017) 106, 67e68 Ó 2017 Published by Elsevier Ltd on behalf of The Faculty of Homeopathy. http://dx.doi.org/10.1016/j.homp.2017.04.002, available online at http://www.sciencedirect.com
EDITORIAL
No smoke without fire This issue of Homeopathy highlights the worldwide distribution and steady spread of homeopathy. Clare Relton and colleagues from the University of Sheffield report their systematic review of the use of homeopathy by the general population.1 They found a total of 36 surveys to which they applied rigorous quality assessment criteria. They divided them according to the type of use of homeopathy, into three categories: treatment by a practitioner, all use of homeopathy and undefined use of homeopathy where it was not clear whether the estimate referred to treatment by a practitioner or over-the-counter purchase. They identified surveys covering 11 different countries. The overall median worldwide annual rate of use of homeopathy purchased over the counter was 3.9% of the population with 1.5% consulting a practitioner per year. The highest use was in Switzerland, where homeopathy is included in mandatory health insurance. Ironically no data was included from two of the highest use countries: India and France. There appears to be no reliable data for India, but high-quality data is available from the French national insurance database. This was excluded from this systematic review for technical reasons, but it showed relatively high use with 10.2% of the general population and 18% of children aged 0e4 years using homeopathy annually. This would make the French the highest users of homeopathy in Europe; the two Swiss surveys estimated use at 6.4% and 8.2%.
American users of homeopathy A recent study of the use of homeopathy in the USA, from the Harvard Division of General Medicine and Primary Care was based on data from the 2012 US National Health Interview Survey.2 It compared homeopathy users with users of supplements and other forms of complementary and integrative medicine. Among US adults, 2.1% had used homeopathy in the past 12 months, a 15% increase from the previous survey of 2007. Homeopathy was most commonly used for upper respiratory and ear problems, its use correlating with female gender, higher level of education and healthier lifestyle. Homeopathy users were more likely to use multiple complementary and integrative medicine therapies and to perceive it as helpful than were supplement users. Homeopathy users also reported treatment by a practitioner to be more beneficial than self-treatment. Interestingly, this correlates with the findings of our senior deputy editor Robert Mathie and colleagues whose recently published meta-analysis of randomised, doubleblind, placebo-controlled trials of non-individualised ho-
meopathic yielded equivocal results,3 in contrast to their earlier meta-analysis of individualised homeopathic treatment, which was clearly positive.4
East Asia Relton et al also report low usage rates in East Asian countries. However a paper, also published in this issue, from Aaron To, Yvonne Fok and colleagues from the Hong Kong Association of Homeopathy and School of Public Health and Primary Care, Chinese University of Hong Kong suggests that this may be changing.5 They report a small retrospective study of adding homeopathic treatment to conventional treatment in type II diabetes mellitus. They prescribed individualised homeopathic treatment to 27 adults attending a private clinic in Hong Kong, for at least six months. There was no comparator group within the study, but they compared their patients to publish data on Hong Kong patients receiving standard clinical treatment and to a large diabetic registry. The patients included in the study were worse affected than the control groups at baseline with poorer glycaemic control, longer duration of disease and higher incidence of complications. They showed great improvement in glycaemic control compared to the comparator groups and this was robust to sensitivity analysis. This study was of small scale and not randomised or blinded so, although there is an association with homeopathic treatment, one cannot conclude that the observed effects were the result of homeopathic medicines. Nevertheless it is the first clinical study of the glycaemic control with individualised homeopathy and should provoke further investigation, as well as being the first clinical paper from Hong Kong published in Homeopathy.
Cross-fertilisation In another remarkable example of cultural crossfertilisation, a Portuguese-Turkish team led by Afonso Miguel Cavaco of Lisbon University, Portugal, working with colleagues from the University of Ankara, Turkey conducted a qualitative study of Portuguese pharmacists who use homeopathy, with a view to informing colleagues in Turkey.6 In Turkey homeopathy is novel but increasing in popularity, and the subject of a new regulatory system. The Portuguese pharmacists who participated reported that they were grateful to be able to work in homeopathy and considered that specialised education was the most important factor for success; also that patients’ attitudes are generally positive.
Editorial P. Fisher
68
The persistence, wide geographical distribution and steady spread of homeopathy to regions where it is unfamiliar, does not have historic roots and with little commercial promotion is not a rigorous scientific argument for its effectiveness. But it is a ‘no smoke without fire’ argument: it is very difficult to account unless patients and consumers worldwide experience it as effective.
Zincum Most of the remainder of this issue is devoted to a taster of our forthcoming virtual special issue on Zincum. Clara Bonafini and colleagues7 demonstrate modest effects of homeopathically zinc in various cell lines. Silvia Waisse and Gheorghe Jurj trace the clinical use of Zincum in homeopathy: they located twenty-three reports of homeopathic pathogenetic trials of Zincum metallicum in the 19th century literature.8
References 1 Relton C, Cooper K, Viksveen P, Fibert P, Thomas K. Prevalence of homeopathy use by the general population worldwide: a systematic review. Homeopathy 2017; 106: 69e78.
Homeopathy
2 Dossett M, Davis RB, Kaptchuk TJ, Yeh GY. Homeopathy use by US adults: results of a national survey. American J Public Health 2016; 106: 743e745. DOI: 10.2105/AJPH.2015.303025. 3 Mathie RT, Ramparsad N, Legg LA, et al. Randomised, doubleblind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2017; 6: 63. DOI: 10.1186/s13643-017-0445-3. 4 Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebocontrolled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2014; 3: 142. DOI: 10.1186/2046-4053-3-142. 5 To KLA, Fok YYY, Chong KCM, Lee YCJ, Yiu LSS. Individualized homeopathic treatment in addition to conventional treatment in type II diabetic patients in Hong Kong d a retrospective cohort study. Homeopathy 2017; 106: 79e86. 6 Cavaco AM, Arslan M, Sevgi S. Informing homeopathic practice for Turkish pharmacists: reviewing Portuguese community pharmacies example. Homeopathy 2017; 106: 93e102. 7 Bonafini C, Marzotto M, Bellavite P. In vitro effects of Zinc in soluble and homeopathic formulations on macrophages and astrocytes. Homeopathy 2017; 106: 114e124. 8 Waisse S, Jurj G. A clinical history of Zincum metallicum: homeopathic pathogenetic trials and case reports. Homeopathy 2017; 106: 125e141.
Peter Fisher Editor-in-Chief E-mail: [email protected]
EDITORIAL
No smoke without fire This issue of Homeopathy highlights the worldwide distribution and steady spread of homeopathy. Clare Relton and colleagues from the University of Sheffield report their systematic review of the use of homeopathy by the general population.1 They found a total of 36 surveys to which they applied rigorous quality assessment criteria. They divided them according to the type of use of homeopathy, into three categories: treatment by a practitioner, all use of homeopathy and undefined use of homeopathy where it was not clear whether the estimate referred to treatment by a practitioner or over-the-counter purchase. They identified surveys covering 11 different countries. The overall median worldwide annual rate of use of homeopathy purchased over the counter was 3.9% of the population with 1.5% consulting a practitioner per year. The highest use was in Switzerland, where homeopathy is included in mandatory health insurance. Ironically no data was included from two of the highest use countries: India and France. There appears to be no reliable data for India, but high-quality data is available from the French national insurance database. This was excluded from this systematic review for technical reasons, but it showed relatively high use with 10.2% of the general population and 18% of children aged 0e4 years using homeopathy annually. This would make the French the highest users of homeopathy in Europe; the two Swiss surveys estimated use at 6.4% and 8.2%.
American users of homeopathy A recent study of the use of homeopathy in the USA, from the Harvard Division of General Medicine and Primary Care was based on data from the 2012 US National Health Interview Survey.2 It compared homeopathy users with users of supplements and other forms of complementary and integrative medicine. Among US adults, 2.1% had used homeopathy in the past 12 months, a 15% increase from the previous survey of 2007. Homeopathy was most commonly used for upper respiratory and ear problems, its use correlating with female gender, higher level of education and healthier lifestyle. Homeopathy users were more likely to use multiple complementary and integrative medicine therapies and to perceive it as helpful than were supplement users. Homeopathy users also reported treatment by a practitioner to be more beneficial than self-treatment. Interestingly, this correlates with the findings of our senior deputy editor Robert Mathie and colleagues whose recently published meta-analysis of randomised, doubleblind, placebo-controlled trials of non-individualised ho-
meopathic yielded equivocal results,3 in contrast to their earlier meta-analysis of individualised homeopathic treatment, which was clearly positive.4
East Asia Relton et al also report low usage rates in East Asian countries. However a paper, also published in this issue, from Aaron To, Yvonne Fok and colleagues from the Hong Kong Association of Homeopathy and School of Public Health and Primary Care, Chinese University of Hong Kong suggests that this may be changing.5 They report a small retrospective study of adding homeopathic treatment to conventional treatment in type II diabetes mellitus. They prescribed individualised homeopathic treatment to 27 adults attending a private clinic in Hong Kong, for at least six months. There was no comparator group within the study, but they compared their patients to publish data on Hong Kong patients receiving standard clinical treatment and to a large diabetic registry. The patients included in the study were worse affected than the control groups at baseline with poorer glycaemic control, longer duration of disease and higher incidence of complications. They showed great improvement in glycaemic control compared to the comparator groups and this was robust to sensitivity analysis. This study was of small scale and not randomised or blinded so, although there is an association with homeopathic treatment, one cannot conclude that the observed effects were the result of homeopathic medicines. Nevertheless it is the first clinical study of the glycaemic control with individualised homeopathy and should provoke further investigation, as well as being the first clinical paper from Hong Kong published in Homeopathy.
Cross-fertilisation In another remarkable example of cultural crossfertilisation, a Portuguese-Turkish team led by Afonso Miguel Cavaco of Lisbon University, Portugal, working with colleagues from the University of Ankara, Turkey conducted a qualitative study of Portuguese pharmacists who use homeopathy, with a view to informing colleagues in Turkey.6 In Turkey homeopathy is novel but increasing in popularity, and the subject of a new regulatory system. The Portuguese pharmacists who participated reported that they were grateful to be able to work in homeopathy and considered that specialised education was the most important factor for success; also that patients’ attitudes are generally positive.
Editorial P. Fisher
68
The persistence, wide geographical distribution and steady spread of homeopathy to regions where it is unfamiliar, does not have historic roots and with little commercial promotion is not a rigorous scientific argument for its effectiveness. But it is a ‘no smoke without fire’ argument: it is very difficult to account unless patients and consumers worldwide experience it as effective.
Zincum Most of the remainder of this issue is devoted to a taster of our forthcoming virtual special issue on Zincum. Clara Bonafini and colleagues7 demonstrate modest effects of homeopathically zinc in various cell lines. Silvia Waisse and Gheorghe Jurj trace the clinical use of Zincum in homeopathy: they located twenty-three reports of homeopathic pathogenetic trials of Zincum metallicum in the 19th century literature.8
References 1 Relton C, Cooper K, Viksveen P, Fibert P, Thomas K. Prevalence of homeopathy use by the general population worldwide: a systematic review. Homeopathy 2017; 106: 69e78.
Homeopathy
2 Dossett M, Davis RB, Kaptchuk TJ, Yeh GY. Homeopathy use by US adults: results of a national survey. American J Public Health 2016; 106: 743e745. DOI: 10.2105/AJPH.2015.303025. 3 Mathie RT, Ramparsad N, Legg LA, et al. Randomised, doubleblind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2017; 6: 63. DOI: 10.1186/s13643-017-0445-3. 4 Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebocontrolled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2014; 3: 142. DOI: 10.1186/2046-4053-3-142. 5 To KLA, Fok YYY, Chong KCM, Lee YCJ, Yiu LSS. Individualized homeopathic treatment in addition to conventional treatment in type II diabetic patients in Hong Kong d a retrospective cohort study. Homeopathy 2017; 106: 79e86. 6 Cavaco AM, Arslan M, Sevgi S. Informing homeopathic practice for Turkish pharmacists: reviewing Portuguese community pharmacies example. Homeopathy 2017; 106: 93e102. 7 Bonafini C, Marzotto M, Bellavite P. In vitro effects of Zinc in soluble and homeopathic formulations on macrophages and astrocytes. Homeopathy 2017; 106: 114e124. 8 Waisse S, Jurj G. A clinical history of Zincum metallicum: homeopathic pathogenetic trials and case reports. Homeopathy 2017; 106: 125e141.
Peter Fisher Editor-in-Chief E-mail: [email protected]