A cross-sectional workforce survey of three traditional and complementary medicine professions in Ontario, Canada.

BACKGROUND: Workforce studies about traditional and complementary medicine (T&CM) occupations in industrialized countries are scant; and, these occupations' position within the broader occupational workforce remains unclear. This study aims to address these gaps using a comparative approach. METHODS: Naturopaths, traditional Chinese medicine (TCM) / acupuncture practitioners, and homeopaths in Ontario, Canada were surveyed regarding their demographics, practice characteristics and self-reported income. Results were compared with parallel data from within and outside of Ontario. RESULTS: Study response rate: 23.3% (n = 1205). While predominantly female (57.9%), Ontario's TCM/acupuncture profession was less feminized than the naturopathic (77.1%) and homeopathic (78.3%) groups. Naturopaths were significantly younger than, and reported fewer years of clinical experience than, the other two groups. About half of TCM/acupuncture practitioners, and almost one-third of homeopaths had trained outside of Canada, predominantly in East and South Asia, respectively. More TCM/acupuncture practitioners (58.9%) and homeopaths (57.6%) had multilingual clinical practices than naturopaths (19.1%). Homeopaths worked fewer hours and saw fewer patients per week than the other occupations. Self-reported mean incomes varied across groups, with naturopaths earning more on average ($63,834, SD $57,101) than did TCM/acupuncture practitioners ($45,624, SD $44,081) or homeopaths ($29,230, SD $41,645). Holding other variables constant, internationally-trained practitioners reported earning one-third less than their Canadian-trained counterparts. DISCUSSION & CONCLUSIONS: Study findings echo occupationally-specific data from other industrialized jurisdictions; and, affirm that different T&CM occupations have distinctive demographic and practice characteristics. The demographic makeup of Ontario's TCM/acupuncture and homeopathy occupations suggests a role for these groups in delivering culturally-responsive care within Asian ethnic communities. T&CM practitioner incomes, in particular for internationally-trained practitioners, fell below the provincial population income median, and in many cases below the poverty line. T&CM occupations' relative socio-political marginality may be impacting clinicians' ability to earn a viable living.

Integration of Homeopathy and Complementary Medicine in the Tuscan Public Health System and the Experience of the Homeopathic Clinic of the Lucca Hospital.

INTRODUCTION: The healthcare programs of the Region of Tuscany (Italy) have started the process of integration of some types of complementary medicine (CM), including homeopathy, which began in 1996. The Homeopathic Clinic of Lucca was opened in 1998, followed by the Homeopathic Clinic for Women in 2003, and the Clinic for CM and Diet in Oncology in 2013. METHODS: Observational longitudinal studies conducted on 5,877 patients (3,937 in the general clinic, 1,606 in the women's clinic and 334 in oncology) were consecutively examined from 2003 to 2016. The Outcome in Relation to Impact on Daily Living (ORIDL) was generally used to assess outcomes. RESULTS: Comparing the clinical conditions before and after homeopathic treatment, improvement was observed in 88.8% of general medicine patients with follow-up (45.1%); in particular, 68.1% of the patients had a major improvement in or resolution (ORIDL +2, +3, +4) of their condition. In women, an improvement was obtained in 74.1% cases and a major improvement in 61.2%. In cancer patients with homeopathic and integrative treatment, a significant improvement was observed for all the symptoms during anti-cancer therapy, particularly for hot flashes, nausea, depression, asthenia, and anxiety. CONCLUSIONS: These results suggest that homeopathy can effectively be integrated with allopathic medicine and that the Tuscan experience could provide a useful reference for developing national and European regulations on the use of CM and homeopathy in public healthcare.

Cutting Edge Research in Homeopathy: HRI's second international research conference in Rome.

Rome, 3rd-5th June 2015, was the setting for the Homeopathy Research Institute's (HRI) second conference with the theme 'Cutting Edge Research in Homeopathy'. Attended by over 250 delegates from 39 countries, this event provided an intense two and a half day programme of presentations and a forum for the sharing of ideas and the creation of international scientific collaborations. With 35 oral presentations from leaders in the field, the scientific calibre of the programme was high and the content diverse. This report summarises the key themes underpinning the cutting edge data presented by the speakers, including six key-note presentations, covering advancements in both basic and clinical research. Given the clear commitment of the global homeopathic community to high quality research, the resounding success of both Barcelona 2013 and Rome 2015 HRI conferences, and the dedicated support of colleagues, the HRI moves confidently forward towards the next biennial conference.

CORE-Hom: a powerful and exhaustive database of clinical trials in homeopathy.

The CORE-Hom database was created to answer the need for a reliable and publicly available source of information in the field of clinical research in homeopathy. As of May 2014 it held 1048 entries of clinical trials, observational studies and surveys in the field of homeopathy, including second publications and re-analyses. 352 of the trials referenced in the database were published in peer reviewed journals, 198 of which were randomised controlled trials. The most often used remedies were Arnica montana (n = 103) and Traumeel(®) (n = 40). The most studied medical conditions were respiratory tract infections (n = 126) and traumatic injuries (n = 110). The aim of this article is to introduce the database to the public, describing and explaining the interface, features and content of the CORE-Hom database.

The Making Cases Count intiative.

Given the challenges faced, how can homeopaths communicate the power and scope of the therapeutic system of homeopathy? Homeopaths need to communicate to patients, the public and media, other healthcare professionals, healthcare researchers, and funders of healthcare (healthcare insurers, those who commission healthcare services either in publicly funded healthcare systems such as the NHS or charities). Effective communication with these stakeholders requires information that is: (a) easily understood, (b) credible, and (c) relevant. The patient's voice is the trusted, indisputable and easily understood common ground in homeopathy. Yet, the experiences of patients are rarely heard outside the profession of homeopathy. Homeopaths are in a unique position to make these voices heard by disseminating the results of their routine practice cases incorporating their patients' voices. The 'Making Cases Count' initiative has been created in order to bring about a culture where easily understood, trusted and salient information is regularly made available to all stakeholders in homeopathy. The Making Cases Count initiative supports, guides and incentives homeopaths to collect routine data with the aim of bringing about a culture where a significant proportion of homeopaths collect routine data from their patients in a format which will then be able to be transformed (i.e. anonymised, summarised and counted). This routine data requires numbers and categories to report the behavior and the perspective of patients receiving homeopathic treatment. This can be strengthened through the use of validated outcome measures in hearing patients' voices. When transformed, this routine data will then be able to inform homeopaths and more importantly other key stakeholders. It is now time to make patient cases count.

[Knowledge of the municipal health managers about the National Policy on Integrative and Complementary Practices and its influence on the provision of homeopathy in the Local Unified Health System]. / O conhecimento de gestores municipais de saúde sobre a Política Nacional de Prática Integrativa e Complementar e sua influência para a oferta de homeopatia no Sistema Único de Saúde local.

The social determinants of the health-disease process and the challenge of comprehensive care have led the World Health Organization to propose Complementary and Alternative Medicines to be included in health policies. In Brazil in 2006 the National Policy on Integrative and Complementary Practices (PNPIC) was published. It is a tool for the institutionalization of homeopathy in the Unified Health System (SUS). This paper analyzes the knowledge of health managers of municipalities of São Paulo on PNPIC, and its influence on homeopathic care. In 2008, the municipalities that performed homeopathic consultations from 2000 to 2007 were identified in DATASUS, managers were interviewed and the results were analyzed quantitatively and qualitatively: of the 645 municipalities, 47 had offered homeopathy and 42 of them were interviewed. Of these, 26% knew about PNPIC, 31% knew little, 41% were unaware of it. It should be stressed that those aware of it stated that they use PNPIC to: instruct the local government about homeopathy; the construction of specific legislation and the increase in homeopathic services. The conclusion is that PNPIC is unknown by health managers and those that know it use it to make known the homeopathic medical rationale and justify its application in the SUS.

Comparison of effectiveness of frequently and infrequently used homeopathic medicines.

RATIONALE: Patients treated with homeopathy may respond to infrequently used or even 'new' medicines. But does the introduction of an unlimited number of (new) medicines improve homeopathy? Do new medicines solve old problems? METHODS: 1. Consensus meetings to evaluate best cases. 2. Patient outcome study in 10 Dutch practices. RESULTS: Good cases are scarce for many medicines, random variance is an important source of uncertainty. 50 Medicines are responsible for 72% of all successful prescriptions. There is no difference in effectiveness of frequently and less frequently used medicines. Confirmation bias is found for a few well-known symptom-medicine combinations. CONCLUSION: 'New' and infrequently medicines are as effective as 'old' frequently used medicines. Improving the use of frequently used medicines is more effective in improving results than seldom used medicines. Large numbers are required and old mistakes should be avoided developing new medicines. A research agenda for improving the use of homeopathic medicines is imperative.

International cooperation in support of homeopathy and complementary medicine in developing countries: the Tuscan experience.

Health is a fundamental human right which contributes to reducing poverty, and encourages social development, human safety, and economic growth. International initiatives have fallen far short of their goals. This paper describes collaboration between the region of Tuscany and Cuba, Western Sahara, Senegal and Serbia. These have introduced various forms of Complementary and Alternative Medicine, including homeopathy and Traditional Chinese Medicine into primary healthcare particularly obstetrics, and into veterinary medicine. Complementary and traditional medicine can represent a useful and sustainable resource in various fields of health care. Inclusion in the public health system must go hand in hand with scientific evaluation.

How do parents of child patients compare consultations with homeopaths and physicians? A qualitative study.

OBJECTIVE: How do parents of child patients experience and compare consultations with homeopaths and physicians, and how do they describe an ideal consultation. METHODS: A qualitative study with interviews of parents to 16 children who had consulted both a homeopaths and a physicians. RESULTS: Comparing consultations with physicians and homeopaths, the parents experienced the homeopathic consultations to a greater extent to have a whole person approach, also described as a core factor in an ideal consultation. This approach included exhaustive questioning, longer consultations, more interaction with the child and looking for the underlying cause. CONCLUSION: The parents in this study perceived that the homeopathic consultation had a whole person approach while consultations with most physicians focused on the symptoms. The homeopathic consultation was said to be more in line with what the parents perceived to be an ideal consultation for their children than consultation with physicians. PRACTICE IMPLICATIONS: Treatment philosophy and the aim of the consultation are likely to play a larger part than the technical aspects in determining the form and content of a consultation. Training in communication could benefit from including discussions on how the practitioner's treatment philosophy influences the consultation behavior.

Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals.

INTRODUCTION: We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS). AIMS: (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and complexity of complaints most frequently treated nationally; (3) to present a cross section of outcome scores by appointment number, including that for the most frequently treated medical complaints; (4) to explore approaches to standard setting for homeopathic practice outcome in patients treated at the homeopathic hospitals. METHODS: A total of 51 medical practitioners took part in data collection over a 4-week period. Consecutive patient appointments were recorded 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 Outcome Related to Impact on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, -4 to +4, where a score or=+2 indicates an effect on the quality of a patient's daily life); (8) receipt of other complementary medicine for their main medical complaint. RESULTS: The distribution of patient age was bimodal: main peak, 49 years; secondary peak, 6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service and proportion of patients who attended more than six visits varied between hospitals. A total of 235 different medical complaints were reported. The 30 most commonly treated complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome (CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis; allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis; headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia; ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with important co-morbidity was higher in those seen after visit 6 (56.9%) compared with those seen up to and including that point (40.7%; P<0.001). The proportion of FU patients reporting ORIDL-PS>or=+2 (improvement affecting daily living) increased overall with appointment number: 34.5% of patients at visit 2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently treated complaints, the proportion of patients that reported ORIDL-PS>or=+2 at visit numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder). CONCLUSIONS: We have successfully piloted a process of national clinical data collection using patient-reported outcome in homeopathic hospital outpatients, identifying a wide range and complexity of medical complaints treated in that setting. After a series of homeopathy appointments, a high proportion of patients, often representing "effectiveness gaps" for conventional medical treatment, reported improvement in health affecting their daily living. These pilot findings are informing our developing programme of standard setting for homeopathic care in the hospital outpatient context.

'Homeopathy': untangling the debate.

There are active public campaigns both for and against homeopathy, and its continuing availability in the NHS is debated in the medical, scientific and popular press. However, there is a lack of clarity in key terms used in the debate, and in how the evidence base of homeopathy is described and interpreted. The term 'homeopathy' is used with several different meanings including: the therapeutic system, homeopathic medicine, treatment by a homeopath, and the principles of 'homeopathy'. Conclusions drawn from one of these aspects are often inappropriately applied to another aspect. In interpreting the homeopathy evidence it is important to understand that the existing clinical experimental (randomised controlled trial) evidence base provides evidence as to the efficacy of homeopathic medicines, but not the effectiveness of treatment by a homeopath. The observational evidence base provides evidence as to the effectiveness of treatment by a homeopath. We make four recommendations to promote clarity in the reporting, design and interpretation of homeopathy research.

Prática médica homeopática e a integralidade / Práctica médica homeopática y la integralidad / Homeopathic care and the principle of integrality

O Centro de Saúde Modelo foi a primeira unidade do Sistema Único de Saúde (SUS) a implantar o serviço de atendimento homeopático no Rio Grande do Sul. Este estudo teve por objetivo conhecer a contribuição desse atendimento para o desenvolvimento do princípio da integralidade. Trata-se de estudo de caso utilizando, como categorias norteadoras, o acolhimento, o vínculo e o cuidado, sendo os dados produzidos com base em documentação, observação direta e entrevistas com usuários e trabalhadores. Os resultados indicam que a homeopatia, ao acolher e tratar pessoas em sua singularidade e totalidade, permite uma atenção diferenciada. Entretanto, a integralidade tem sido restrita a alguns de seus aspectos, como o vínculo e o cuidado diretamente associados à relação médico-usuário. A dificuldade de acesso foi o principal problema identificado. Coerente e fortalecedora dos princípios do SUS, a homeopatia deve ser valorizada como opção terapêutica para que possa efetivamente contribuir na integralidade da atenção em saúde.

The "Centro de Saúde Modelo" was the first Basic Health Care Service of the Brazilian Public Health System to introduce homeopathic care in the State of RS. The aim of this study was to understand this health center's contribution to the development of the integrality principle. This is a case study. The categories employed in guidying the study were: welcoming, bond and care. The data was based on documents, direct observation and interviews with professionals and people using the service. The results indicate that homeopathy, by welcoming and caring for each individual in his/her singularity and totality, makes a differentiated kind of assistance possible. However, integrality has been restricted to some aspects directly associated with the physician-patient relation such as bonding and care. The main problem identified was access to care. Homeopathy is coherent with and strengthens the principles of the Brazilian Public Health System and therefore it should be valued and become more widespread as a therapeutic option, thus contributing towards effectively achieving the goal of integral health care.

El Centro de Saúde Modelo ha sido la primera unidad del Sistema Unificado de Saúde brasileño que ha implantado el servicio de atendimiento homeopático en Rio Grande do Sul. Este estudio tuvo por objeto conocer la contribución de dicho atendimiento para el desarrollo del principio de la integralidad. Se trata de estudio de caso, utilizando como categorías norteadoras la acogida, el vínculo y el cuidado, siendo los datos producidos a partir de documentación, observación directa y entrevistas con usuarios y trabajadores. Los resultados indican que la homeopatía, al acoger y tratar a personas en su singularidad y totalidad, permite una atención diferenciada. Sin embrago la integralidad se ha restringido a algunos de sus aspectos como el vínculo y el cuidado directamente asociados a la relación médico-usuario. La dificultad de acceso ha sido el principal problema identificado. Coherente y fortalecedora de los principios del Sistema Unificado de Saúde, la homeopatía ha de ser valorada como opción terapéutica para que pueda efectivamente contribuir en la integralidad de la atención en salud.

Medicine, rhetoric and undermining: managing credibility in homeopathic practice.

This article examines homeopathic practitioners 'real life' accounts, and illustrates the ways in which they negotiate their homeopathic practices as contingently formulated ongoing social events in research interview settings. Interview transcripts were analysed in a qualitative framework using discourse analysis. The findings show that practitioners construct homeopathy and defend their own individual practices either by 'alignment-with-medicine' or by 'boosting-the-credibility-of-homeopathy'. Homeopathy is also negotiated and sustained as an 'alternative' to notions of conventional medicine, which is the accepted yardstick for practice or as a practice that is portrayed as problematic. Overall, managing personal credibility is accomplished through specific ways of accounting that tend to marginalise homeopathy. Developing and establishing homeopathic practice further as a discipline in its own right is offered as a 'nucleus' to reduce continuing marginalisation.