RH Robert Mathie.

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REAP HEAPS

RESEARCH DEVELOPMENT
IN HOMEOPATHY Robert Mathie

percentages of follow-up patients

o help substantiate our
fession. The key aim of work like this
who reported positive, negative or
unchanged symptoms (the owners
spoke on behalf of their pets!). The
table below shows the high, or very
high, proportions of patients
who felt they had benefitted from
homeopathy:
Finally, we looked at the percent-
age outcomes for each of the most

T claims for homeopathy,

there is a real need first-
ly to identify the symp-
toms or medical conditions that
homeopathic practitioners treat in
routine clinical practice – medical,
dental and veterinary – and the suc-
cess rates that they achieve.
Systematic data collection also helps
to inform practitioners themselves
about their clinical practice of home-
opathy, and it makes an important
contribution to knowledge in home-
opathy more generally.
PILOT DATA COLLECTION
STUDIES
During 2005 the British Homeopathic
Association joined forces with the
Faculty of Homeopathy (its sister
organisation) to run three pilot data
collection projects in Britain. Doctors
and dentists and vets took part in the
studies, each of which lasted for 6
months. The aim of each project was to
pilot the use of a suitable spreadsheet,
and thus inform our approach to more
definitive data collection in each pro-
is to gain insight into the medical com-
plaints that practitioners in Primary
Care treat most commonly using
homeopathy, and to identify any spe-
cific patterns of clinical responses that
commonly treated medical complaints.
Positive outcomes were achieved most
clearly in the following:
Few of these disorders overall –
and none of those in the dental and
would help target future research veterinary lists – have been the sub-
projects more effectively. ject of controlled clinical trials. Our
14 doctors, 14 dentists and 8 vets pilot work has therefore begun to
took part enthusiastically in the three point towards areas where further
pilot studies. The spreadsheets suc- research might best be directed.
cessfully enabled practitioners to
record data from patients at their DEFINITIVE DATA
appointments. The most commonly COLLECTION PROJECTS
treated medical problems in each
study were: We have extended our medical data
We then analysed the overall collection project, in the first
Medical1 Dental2 Veterinary3
Depression Apical abscess Arthritis (dogs)
Anxiety Tooth extraction Atopic dermatitis (dogs, cats)
Cough Anxiety Lameness (dogs, horses)
Menopausal flush Sensitive cementum Epilepsy (dogs)
Chronic fatigue syndrome Periodontal abscess Diarrhoea (dogs, cats)
Catarrh Post-surgery pain Aggression (dogs, cats)
Osteoarthritis Gum swelling Fear (dogs)
Irritable bowel syndrome Reversible pulpitis Pruritus (dogs)
Hay fever Toothache with decay Hyperthyroid (cats)
Upper respiratory tract Pericoronitis Kidney failure (dogs, cats)
Infection

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RH Robert Mathie.qxd 11/26/2008 3:35 PM
Total no. No. of Improvement
of patients follow-ups
Medical 1783 961 76%
Dental 726 496 90%
Veterinar 767# 539 80%
Medical Dental
Depression Apical abscess
Anxiety Sensitive cementum
Cough Periodontal abscess
Osteoarthritis Reversible pulpitis
Irritable bowel syndrome Pericoronitis
instance, to doctors treating patients
in the five homeopathic hospitals
based within Britain’s National
Health Service. Our main project in
dental homeopathy is currently
exploring periodontal problems, an
area where actual dental surgery is
not typically carried out. And our
definitive veterinary data collection
includes participation by 21 Faculty
vets using homeopathy for the treat-
ment of dogs or cats or horses.
The key results of work from the
homeopathic hospitals are presented
below:
Towards Standard Setting in the
Homeopathic Hospitals
Each of the five hospitals has previ-
ously reported clinical outcomes data
from a wide range of medical com-
plaints. In each hospital, positive out-
come has been reported by about 70%
of follow-up patients overall. From
the perspective of quality assurance
and improvement, on the other hand,
these patient surveys have each been
carried out without an aim of identi-
fying what standard of clinical out-
come might reasonably be expected
in subjects with a given type and
complexity of medical complaint.
Moreover, these earlier studies have
each used different methods and out-
come scoring techniques, without
any attempt to consider unifying
approaches to clinical data collection
across all the hospitals.
We have therefore taken a first
Page 17
Unchanged Deterioration No data
15% 4% 5%
8% 2% 0%
12% 6% 2%
Veterinary
Arthritis (dogs)
Atopic dermatitis (dogs, cats)
Lameness (dogs, horses)
Epilepsy (dogs)
Hyperthyroid (cats)
step in a programme of quality assur-
ance and development across all five
homeopathic hospitals, working
together for the first time. Results
from the first phase of the pro-
gramme were published in the July
2008 issue of the Faculty’s research
journal Homeopathy.4 The findings
are summarised below:
A total of 51 homeopathic doc-
tors took part in data collection over
a 4-week period in March 2007.
Consecutive patient appointments
were recorded by doctors on a
spreadsheet or database under the
headings:
1. Date of first appointment in the
current series;
2. Appointment number;
3. Age of patient;
4. Sex of patient;
5. Main medical complaint being
treated;
6 Whether other main medical
complaint(s);
7 Patient-reported change in
health, using ORIDL (Outcome
Related to Impact on Daily
Living; range –4 to +4, where a
score of +2 or more, or –2 or less,
indicates an effect on the quality
of a patient’s daily life);
8 Patient’s use of other comple-
mentary medicine for main med-
ical complaint.
Patients’ age distribution showed
a main peak at 49 years. A secondary
peak at 6 years clearly reflects the
large number of young children
REAP HEAPS
referred to homeopathy. The male to
female ratio overall was 1 to 3.5.
Data were recorded on a total of
1,797 individual patients: 195 first
appointments and 1,602 follow-ups.
A total of 235 different medical com-
plaints were reported. The 20 most
commonly treated were (in decreas-
ing order of frequency):
1. Eczema;
2. Chronic fatigue syndrome;
3. Menopausal disorder;
4. Osteoarthritis;
5. Depression;
6. Breast cancer;
7. Rheumatoid arthritis;
8. Asthma;
9. Anxiety;
10. Irritable bowel syndrome;
11. Multiple sclerosis;
12. Psoriasis;
13. Allergy;
14. Fibromyalgia;
15. Migraine;
16. Premenstrual syndrome;
17. Chronic rhinitis;
18. Headache;
19. Vitiligo;
20. Seasonal allergic rhinitis
It is interesting to see the differ-
ences and the similarities between
this list and the one obtained via
Primary Care doctors (see above).
The management of serious chronic
conditions, such as multiple sclerosis
and breast cancer, is clearly a feature
specifically of Homeopathic Hospital
rather than Primary Care treatment.
The inclusion of breast cancer repre-
sents the homeopathic management
of difficult symptoms such as hot
flushes and the side-effects of
chemotherapy. The medical prob-
lems treated in the hospitals often
reflect areas of clinical practice where
available conventional treatments are
not fully effective – termed “effec-
tiveness gaps”.
Among those patients seen after
a sixth appointment, 56% had
important other medical problems.
For those patients seen up to and
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REAP HEAPS
including that appointment, the
equivalent figure was only 40%.
This shows that a high proportion of
homeopathic hospital outpatients
have multiple medical complaints,
and that the most complex cases
tend to remain in the healthcare sys-
tem longer than those who have a
single main problem.
The proportion of follow-up
patients who reported an improve-
ment affecting their daily lives
increased overall with appointment
number. Of those at their second
appointment, one-third of
patients reported that important
extent of benefit, whereas by the
sixth appointment three-fifths
did so. We also found evidence
that chronic fatigue syndrome
responds more slowly to treat-
ment than menopausal disorder,
for example, reflecting practi-
tioners’ clinical experience in the
homeopathic treatment of these
particular problems.
The information we have
obtained is now being used to
explore further the opportuni-
ty of standard setting in the
hospital outpatient setting.
Identifying the appointment by
which ORIDL scores typically
achieve at least +2, for instance,
would allow us to set meaning-
ful standards of outcome for a
given medical complaint. It would
assist physicians in their judgment
of when they might expect clinical
improvement affecting a patient’s
quality of daily living. This in turn
would enable practitioners to focus
potential outcome with patients and
communicate that also to referring
doctors.
OPPORTUNITIES
IN INDIA
What about the Indian healthcare
context? Why not get together and
undertake your own pilot data col-
lection studies in your country! For
18 HOMEOBUZZ December 2008
Page 18
those of you who are (or become)
Faculty members, several practition-
ers could get together to form even a
small team to start some data collec-
tion work.
Notes: The British Homeopathic
Association works to promote
patient access to homeopathy. Its
research committee is responsible for
taking forward a number of projects
such as those outlined above.
Members of the Faculty of
Homeopathy is statutorily regulated
What about the Indian
healthcare context?
Why not get together
and undertake your
own pilot data collec-
tion studies in your
country! Get together
to form even a small
team to start some
data collection work.
health professionals who integrate
homeopathy into their practice. They
have conventional qualifications in
medicine etc. and additional post-
graduate training in homeopathy.
They are required to have current
registration with their statutory body
– in the case of doctors in Britain,
with the General Medical Council.
In India currently, there are 132
doctors who are members of the
Faculty of Homeopathy. Sadly, the
present membership includes no
dentists and no vets.
References
1. Mathie RT, Robinson TW.
Outcomes from homeopathic
prescribing in medical practice:
a prospective, research-targeted,
pilot study. Homeopathy 2006;
95: 199–205.
2. Mathie RT, Farrer S.
Outcomes from homeopathic
prescribing in dental practice: a
prospective, research-targeted,
pilot study. Homeopathy 2007;
96: 74–81.
3. Mathie RT, Hansen L, Elliott
MF, Hoare J. Outcomes from
homeopathic prescribing in vet-
erinary practice: a prospective,
research-targeted, pilot study.
Homeopathy 2007; 96: 27–34.
4. Thompson EA, Mathie RT,
Baitson ES, Barron SJ, et al.
Towards standard setting for
patient-reported outcomes in the
NHS homeopathic hospitals.
Homeopathy 2008; 97: 114–121.
About the Author
Robert Mathie PhD outlines news of
clinical data collection projects being run
by the British Homeopathic Association,
UK. He is a Research Development
Adviser, British Homeopathic
Association and Faculty of Homeopathy,
Hahnemann House, UK.