MPharm Programme. Homeopathy

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1 MPharm Programme Homeopathy Complementary medicine Slide 1 of 47 MPHM13 Homeopathy

2 Objectives To describe the history and basic principles of homeopathy To be familiar with a number of popular homeopathic remedies To be able to respond to customer queries on homeopathic remedies Slide 2 of 47 MPHM13 Homeopathy

3 Homeopathy Homeopathy complements other medicine. It does not necessarily replace conventional medicine. People want to take responsibility for their own health. Increased demand for other methods of healing. Slide 3 of 47 MPHM13 Homeopathy

4 Homeopathy Principles Like cures Like Use minute amounts of medicine which in much greater concentration actually causes the symptoms being treated. Use one remedy wherever possible. Slide 4 of 47 MPHM13 Homeopathy

5 Homeopathy History Hippocrates (4 th century BC) father of medicine Recommended treating vomiting with emetics. Paracelsus (16 th century AD) Noted that if given in small doses what makes a man ill also cures him Samuel Hahnemann ( ) Founder of modern day homeopathy. Born in Meissen, Germany. Degree in medicine 1779 Became discouraged with contemporary medicine. Slide 5 of 47 MPHM13 Homeopathy

6 Homeopathy Samuel Hahnemann Temporarily left the medical profession. As he was fluent in 8 languages he turned to translating scientific literature. While translating he came across work on Peruvian bark known as cinchona (quinine). He investigated that it could be used to treat malaria by administering it to himself. By taking a dose he presented symptoms of malaria. He claimed this would be the same in any healthy person. Slide 6 of 47 MPHM13 Homeopathy

Homeopathy Samuel Hahnemann Therefore a substance that causes symptoms in a healthy person can be used to treat a person with similar symptoms. I.E.

7 Homeopathy Samuel Hahnemann Therefore a substance that causes symptoms in a healthy person can be used to treat a person with similar symptoms. I.E. Like cures like Produced a Materia Medica Pura different remedies included. Examples include: Arnica Belladonna Cannabis Ipecacuanha Slide 7 of 47 MPHM13 Homeopathy

8 Homeopathy proving Process of matching remedy to symptoms. Hahnemann tested many remedies on healthy volunteers and recorded their effects. This is how he built up his Materia Medica Pura E.g. Belladonna produces symptoms resembling those of scarlet fever. Slide 8 of 47 MPHM13 Homeopathy

9 Homeopathy materia medica All remedies have a drug picture. Drug pictures are collated to make up a materia medica (or formulary). Consult this when an appropriate remedy is being chosen to treat a particular patient. Only use one remedy at a time. Slide 9 of 47 MPHM13 Homeopathy

10 Homeopathy preparation Originally Hahnemann gave normal doses to patients. They sometimes caused substantial if not dangerous reactions. He started diluting the remedies to avoid the reactions. Each dilution was submitted to a series of vigorous shakes (Succussions) Slide 10 of 47 MPHM13 Homeopathy

11 Homeopathy Preparation Mother tincture (ø or MT) Produced by macerating raw materials in a mixture of ethanol/water for a number of days. The resulting solution is filtered off. Contains approximately %v/v of active ingredients in 30% to 90% ethanol. Slide 11 of 47 MPHM13 Homeopathy

12 Homeopathy preparation Dilution process The mother tincture is diluted serially. Diluted by a factor of 1 in 100 (centesimal dilution) Denoted by C E.g. 6c or 30c Diluted by a factor of 1 in 10 (decimal dilution) Denoted by the suffix X E.g. 6x or 30x or the prefix D E.g. D6 (less commonly used). The more dilutions the more potent the remedy becomes. Slide 12 of 47 MPHM13 Homeopathy

13 Homeopathy centesimal dilutions Slide 13 of 47 MPHM13 Homeopathy

14 Homeopathy Preparation Sources Plant material 65% of all remedies. Can be the whole plant or part of it. Animal and insect material samples must be taken from healthy specimens. Spider venom (lachesis)= Bites and stings; menopause PMT. Bees and their stings (apis)= infected stings. Juice of cuttlefish (sepia)= Menopause PMT. Insect remedies are fast acting and often used in an acute inflammatory response. Slide 14 of 47 MPHM13 Homeopathy

15 Homeopathy Preparation Sources Biological material Sarcode remedy: from healthy animal or vegetable secretions. From bacterial cultures. Nosode remedy: From diseased tissue. Slide 15 of 47 MPHM13 Homeopathy

16 Homeopathy preparation Sources Chemical material 30% of all source material is chemical. Naturally occurring chemicals with their trace impurities. Miscellaneous Allergens Allopathic drugs Industrial chemicals Lunar rays Chocolate Ice Slide 16 of 47 MPHM13 Homeopathy

17 Homeopathy Pharmaceutical form Powders Lactose impregnated with liquid potency. Liquids Prepared from mother tincture by serial dilution. Topical products Ointments; creams; lotions; oils; liniments. Mother tinctures Can be applied neat Slide 17 of 47 MPHM13 Homeopathy

18 Homeopathy pharmaceutical form Tablets; pills; granules; crystals. Blank lactose tablets or granules. Blank sucrose pills and crystals. Small scale manufacture: Surface inoculated in a glass vial. Drops of liquid potency are placed on the surface and the container is agitated to disperse the remedy. Large scale manufacture: Surface inoculated by spraying on the liquid potency in an alcoholic tincture onto the tablets in a revolving pan. Slide 18 of 47 MPHM13 Homeopathy

19 Homeopathy Supply OTC Nelsons Welleda Seven Seas New Era Specials manufacturers Freemans in Glasgow Ainsworths in London Slide 19 of 47 MPHM13 Homeopathy

20 Homeopathy Dispensing All homeopathic remedies are currently allowed to be prescribed on an FP10 (NHS cost of 100k per year) Must be labelled in the normal way. If difficult to put label on original container put in a white carton. Ensure you know the potency and the scale being used. Identify the vehicle e.g. Tablets Know the quantity Solid forms in grams (including container E.g. 14g) Liquid potency in mls Supply original containers to avoid contamination. Slide 20 of 47 MPHM13 Homeopathy

21 Homeopathy counter prescribing Still use WWHAM. Must look at the whole picture. The customer may know exactly what is required. Or may have no idea what remedy is suitable. Physical symptoms form only part of the symptom picture. Emotional Behavioural Slide 21 of 47 MPHM13 Homeopathy

22 Homeopathy counter prescribing Commonly asked questions How does homeopathy work? Is it safe? Will it interfere with my prescription medication? Can I use it when I am pregnant? Which one is suitable for me? (see materia medica) How do I take them and how often? Slide 22 of 47 MPHM13 Homeopathy

23 Homeopathy counter prescribing Polychrests Most of the common OTC remedies are polychrests. Remedies have drug pictures with very wide spectrums of activity. They have a lot of applications. They affect many different body tissues and are effective in a wide range of illnesses in everyone. Slide 23 of 47 MPHM13 Homeopathy

24 Homeopathy counter prescribing 10 most used OTC remedies 1. Aconite* 2. Arnica* 3. Gelmesium* 4. Hypericum* 5. Nat mur* 6. Nux vom* 7. Pulsatilla* 8. Rhus tox* 9. Sepia 10. Sulphur Polychrest* Other common OTC remedies Apis mel Ignatia* Argent nit* Ipecac* Arsen alb* Kali birch Belladonna* Kali phos Byronia* lycopodium Calc carb* Merc sol Calc flour Ruta grav* Carbo veg* Silicea Euphrasia* Thuja Graphites Hepar sulph Slide 24 of 47 MPHM13 Homeopathy

25 Homeopathy counter prescribing Keynote prescribing: Match the strong symptoms (keynotes) of the patient with those of the remedy. This is a simplified approach to homeopathy. Extremely useful for OTC prescribing. Match the patients symptom picture with the remedies drug picture. If you get a close match you can go ahead with treatment. Slide 25 of 47 MPHM13 Homeopathy

26 Homeopathy counter prescribing Dosage: Potency of the remedy Most common OTC are 6c and 30c. 6c chronic problems 30c acute problems More important to chose the correct remedy than the potency. Slide 26 of 47 MPHM13 Homeopathy

27 Homeopathy counter prescribing Dosage: Frequency of administration Less important than the potency The more acute or painful a situation then the more frequent the doses. Can be 2 every 2 hours for the first 6 doses then four times daily for up to 5 days, or until symptoms improve. Slide 27 of 47 MPHM13 Homeopathy

28 Homeopathy counter prescribing Dosage: Quantity of remedy to take Less important than the Frequency Taking more will not increase efficacy. Normally one or two tablets at each dose. Slide 28 of 47 MPHM13 Homeopathy

29 Homeopathy counter prescribing Taking and handling remedies Dissolve under the tongue. Do not swallow with a drink. Take in a clean mouth(i.e. Do not eat, drink, smoke, clean teeth etc for 15mins before or after taking remedy). Do not touch (use cap of container). Do not transfer from one container to another. Throw away empty containers. Keep away from strong smelling products. Keep away from sources of heat or light. Slide 29 of 47 MPHM13 Homeopathy

30 Homeopathy counter prescribing Response to a remedy: Condition improves Withdraw remedy and restart if relapse. Condition unchanged Check for antidoting; compliance; incorrect remedy. Partial improvement Could start a second remedy. Symptoms deteriorate Stop remedy Reaction to remedy aggravation Slide 30 of 47 MPHM13 Homeopathy

31 Homeopathy counter prescribing Response to a remedy: The law of cure Symptoms will disappear: From within Outwards From above From more important organs Downwards To less important I.E. The reverse order of their development. Slide 31 of 47 MPHM13 Homeopathy

32 Homeopathy counter prescribing Response to a remedy: Timescale of the response depends upon: The length of time the condition has been present. i.e. Some acute cases can be resolved in a matter of hours whereas a chronic condition may take years of treatment. Homeopathy treats individuals Therefore the same response may not be seen treating a group with the same remedy. Slide 32 of 47 MPHM13 Homeopathy

33 Homeopathy - Aconite (Wolfsbane) AKA The queen of poisins Complaints of sudden onset, often due to shock, fright or exposures to extremes of weather. Symptom picture Symptoms sudden violent and brief Dry suffocating cough Sore throat following exposure to cold dry wind High temperature/ great thirst Great pain Bereavement Anxiety; restlessness; fear; grief Insomnia Factors making symptoms worse When lying on bad side In warm room In tobacco smoke In cold winds Listening to music Better In the open air With bedclothes thrown off Slide of 47 MPHM13 Homeopathy

34 Homeopathy Arnica (Leopard s bane) First aid remedy for muscular aches and bruises. Symptom picture Use after any injury Bruises Sprains Physical exhaustion following sustained gardening or a long walk Insomnia due to over tiredness Muscles ache all over Cannot bear to be touched Great sensitivity to pain Gout, rheumatism with a fear of being touched Factors making symptoms worse From touch From motion In damp, cold conditions Better When lying down With head low Slide 34 of 47 MPHM13 Homeopathy

35 Homeopathy counter prescribing Choosing a suitable remedy Most pharmacies use the: Nelsons guide. Prescribing homeopathic medicine Uses tables to match symptoms to remedies. Homeopathic Prescribing - Pocket Companion Dr Steven Kayne & Dr Lee Kayne Pharmaceutical Press, 2007 Slide 35 of 47 MPHM13 Homeopathy

36 Homeopathy research Linde et al (1997,1998,1999) reported three reviews of published clinical trials. Concluded that overall the clinical effects were not completely due to a placebo effect. But the published trial data seemed to be biased toward trials with positive findings. Also there were: methodological shortcomings and inconsistencies The trials that were best methodologically showed: No greater effect than that of placebo and overall did not support their efficacy over that of a placebo. There is no sound pharmacological or scientific basis. Slide 36 of 47 MPHM13 Homeopathy

37 Further publications A 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are 'scientifically implausible'. Lack of scientific plausibility is disappointing, but does not necessarily mean that a treatment does not work. What is important is how a treatment performs when tested fairly against a placebo treatment or other treatments. We consider that the best evidence is provided by randomised controlled trials, meta-analyses and systematic reviews of RCTs. Four out of five comprehensive systematic reviews of RCTs in homeopathy have reached the qualified conclusion that homeopathy differs from placebo. Slide 37 of 47 MPHM13 Homeopathy

38 More The review which we consider the most comprehensive to date is that by Shang et al. The review compared 110 placebo-controlled trials of homeopathy matched according to disorder and type of outcome to trials of conventional medicine. The study only included trials that were controlled, included randomised assignment to treatment or placebo groups and were accompanied by sufficient data for odds ratio calculations. The authors concluded that "when analyses were restricted to large trials of higher quality there was no convincing evidence that homeopathy was superior to placebo". Slide 38 of 47 MPHM13 Homeopathy

39 NICE recommendations NICE currently does not recommend that homeopathy should be used in the treatment of any health condition Despite this there are several NHS homeopathic hospitals and some GP practices also offer homeopathic treatment usually as complementary therapies!! Homeopathy is usually practised privately and homeopathic remedies are available from pharmacies. The price for an initial consultation with a homeopath can vary from around 20 to 80. Homeopathic tablets or other products usually cost around 4 to 10. Slide 39 of 47 MPHM13 Homeopathy

40 Homeopathy MEP guide With reference to complementary therapies, pharmacists have a professional responsibility. Pharmacists providing homeopathic remedies must: Ensure stocks are obtained from a reputable source. Not recommend any remedy where there is doubt regarding its safety or quality. Only offer advice if they have undertaken training or have specialised knowledge. Slide 40 of 47 MPHM13 Homeopathy

commonly used: Nelsons Teetha Ashton and Parsons teething

41 Homeopathy in Pharmacies Some pharmacies do not stock any homeopathic remedies, however, there are a few which are commonly used: Nelsons Teetha Ashton and Parsons teething powders Arnica cream Calendula Cream Slide 41 of 47 MPHM13 Homeopathy

treat warts/ verrucas / molluscum contagiosum (a common

42 Homeopathy in Pharmacies Thuja occidentalis (Thuja 30c) Prepared from the White Cedar tree (tree of life) Used to treat warts/ verrucas / molluscum contagiosum (a common childhood wart-like illness) Slide 42 of 47 MPHM13 Homeopathy

43 Edzard Ernst Prof of complementary medicine at the university of Exeter Comments on topic Is it Ethical for pharmacists to sell unproven or disproven medicines? There is no scientific case for homeopathy: the debate is over (March 2015) Look in pharmaceutical journal Slide 43 of 47 MPHM13 Homeopathy

44 Homeopathy in the news BBC 13 September 2010 Doctors have condemned the practice of offering homeopathic vaccinations instead of conventional ones, warning it could leave patients vulnerable to potentially fatal diseases. A BBC Scotland investigation has found alternative practitioners who admit to giving patients a homeopathic medicine designed to replace the MMR vaccine. One also claimed she could protect against other diseases including Polio, Tetanus and Diptheria. Slide 44 of 47 MPHM13 Homeopathy

45 Homeopathy in the news Homeopathy effective for 0 out of 68 illnesses, study finds Prof Paul Glasziou of Bond University reviewed evidence of 176 trials Found no discernible convincing effects beyond placebo Suggested even Samuel Hahnemann would be disappointed by the collective failure of homeopathy Slide 45 of 47 MPHM13 Homeopathy

46 Homeopathy a Doctors view Why do pharmacists sell homoeopathic remedies? PERSONAL VIEW Fred Kavalier BMJ 2011;342:d349 Discusses the promotion of homeopathy by pharmacists and others Mentions a patient that ignores the doctors advice and uses homeopathy instead of malaria prophylaxis and goes on to contracts malaria Mentions a GPhC disciplinary case that was dropped in which pharmacists were promoting homeopathic malaria prophylaxis Slide 46 of 47 MPHM13 Homeopathy

47 Summary To describe the history and basic principles of homeopathy To be familiar with a number of popular homeopathic remedies To be able to respond to customer queries on homeopathic remedies Evidence or lack of it!!! u8q0 Slide 47 of 47 MPHM13 Homeopathy

Making Homeopathic Remedies Handout

Making Homeopathic Remedies Handout Basic Homeopathic Categories Basic Homeopathic Remedies Made from substances such as plants, minerals, toxins, other homeopathic pills / liquids, etc. Homeopathic Nosodes