Characteristics of visitors to practitioners of homeopathy in a large adult Norwegian population (the HUNT 3 study).

OBJECTIVES: The aim was to investigate characteristics of female and male visitors to practitioners of homeopathy in a large adult population in Norway. METHODS: A cross-sectional adult total population health survey from Central Norway (the Nord-Trøndelag Health Study--HUNT 3) conducted in 2008. Variables included demographics, lifestyle, health status and health care use. Multivariate logistic regression models were employed to analyse the data. RESULTS: In total 50,827 participated (54% of the total population). The prevalence of visits to practitioners of homeopathy was 1.3%, a decline from 4.3% 10 years earlier. Both female and male visitors were 4-5 times more likely to experience recent somatic complaints. Further, female visitors were characterised by higher education, non-smoking, more chronic complaints, and visiting a physician or a chiropractor the past year whereas male visitors were characterised by seeking help for psychiatric complaints and visiting a chiropractor. There were no associations of age, marital status, physical activity, perceived global health, respiratory, skin, or musculoskeletal diseases with visiting practitioners of homeopathy. CONCLUSIONS AND PROPOSALS: There has been a marked decline in visits to practitioners of homeopathy. The results indicate a change in reasons to consult from complaints that influences the visitors' global health to less chronic complaints. Further research should compare changes in visits complementary and alternative medicine (CAM) practitioners and the characteristics of visitors to practitioners of homeopathy to characteristics of other CAM visitors.

What is a competent homeopath and what do they need in their education? A qualitative study of educators' views.

INTRODUCTION: The rise of complementary and alternative medicine (CAM) professions has taken place alongside an increase in public use of CAM therapies. Some actions have been taken to establish educational standards, often focusing on educating competent professionals to ensure citizens' freedom to make choices for their own healthcare while at the same time ensuring their safety. However, in professions like homeopathy that are unregulated in most European countries, it is not clear what it means to be a competent homeopath. The aim of this study was to investigate educators' views on what a competent homeopath is and what they require in their education. METHODS: This was a qualitative study based on grounded theory methodology involving telephone interviews with 17 educators from different schools in 10 European countries. It used constant/simultaneous comparison and analysis to develop categories and properties of educational needs and theoretical constructs and to describe behaviour and social processes. The main questions asked of subjects were "What do you think is necessary in order to educate and train a competent homeopath?" and "How would you define a competent homeopath?" RESULTS: The educators defined a competent homeopath as a professional who, through her knowledge and skills together with an awareness of her bounds of competence, is able to help her patients in the best way possible. This is achieved through the processes of study and self-development, and is supported by a set of basic resources. Becoming and being a competent homeopath is underpinned by a set of basic attitudes. These attitudes include course providers and teachers being student-centred, and students and homeopaths being patient-centred. Openness on the part of students is important to learn and develop themselves, on the part of homeopaths when treating patients, and for teachers when working with students. Practitioners have a responsibility towards their patients and themselves, course providers and teachers have responsibility for providing students with effective and appropriate teaching and learning opportunities, and students have responsibility for their own learning and development. DISCUSSION: According to homeopathy educators' understanding, basic resources and processes contribute to the development of a competent homeopath, who possesses certain knowledge and skills, all underpinned by a set of basic attitudes.

Undergraduate homeopathy education in Europe and the influence of accreditation.

CONTEXT: The safety of patients consulting with practitioners of complementary and alternative medicine (CAM) partially depends on practitioners' competence, and thus the standard of undergraduate education. OBJECTIVES: Describe undergraduate homeopathy courses in Europe, student/graduate numbers and whether there were differences between recognised/accredited and non-recognised/non-accredited courses. METHODS: Cross sectional survey of current homeopathy undergraduate education in Europe in 2008. Data from 145 (94.8%) out of 153 identified courses were collected. Eighty-five (55.6%) responded to a questionnaire survey. For others some data was extracted from their websites. Only data from the questionnaire survey is used for the main analysis. FINDINGS: The average course in the questionnaire survey had 47 enrolled students and 142 graduates, and lasted 3.6 years part-time. An estimated 6500 students were enrolled and 21,000 had graduated from 153 identified European undergraduate homeopathy courses. Out of 85 courses most had entry requirements and provided medical education (N = 48) or required students to obtain this competence elsewhere (N = 33). The average number of teaching hours were 992 (95% confidence interval (CI) 814, 1170) overall, with 555 h (95%CI 496, 615) for homeopathy. Four out of five courses were recognised/accredited. Recognised/accredited part-time courses lasted significantly longer than non-recognised/non-accredited courses (difference 0.6 years, 95%CI 0.0-1.2, P = 0.040), and offered significantly larger numbers of teaching hours in homeopathy (difference 167 h, 95%CI 7-327, P = 0.041). CONCLUSIONS: About 6500 currently enrolled students are doing undergraduate homeopathy education in Europe and 21,000 have graduated from such courses over a period of about 30 years. Undergraduate homeopathy education in Europe is heterogeneous. Recognised/accredited courses are more extensive with more teaching hours.

Families' visits to practitioners of complementary and alternative medicine in a total population (the HUNT studies).

AIMS: To investigate characteristics of families with adolescent children who have visited practitioners of complementary and alternative medicine (CAM). METHODS: The Nord-Trøndelag Health Studies (HUNT) invited all inhabitants aged 13 years and older to a population-based study. The data of parents and adolescents were merged through the Norwegian family register. A family CAM visitor was a family where either the adolescent or the mother or father had visited a CAM practitioner in the previous year. The data were analyzed using multivariable logistic regression. RESULTS: A total of 7,888 adolescents with mother and/or fathers were included. The prevalence of families visiting CAM practitioners was 19.8%. The odds of a family visiting a CAM practitioner was significantly associated (p < 0.01) with a father with poor self-reported global health (adjusted odds ratio (adjOR) 3.0, 95% confidence interval (95% CI) 1.7-5.3), who exercised (adjOR 1.3, 1.1-1.5) or smoked daily (adjOR 0.7, 0.6-0.8). Family CAM visits were also associated with the mother having a recent health complaint (adjOR 1.4, 1.1-1.7) or having fair global health (adjOR 1.6, 1.2-2.0), or with the adolescent, mother or father having visited a general practitioner during the past year (adolescent adjOR 1.3, 1.2-1.5; mother 1.7, 1.5-2.0; father 1.4, 1.2-1.6). For family visits to a homeopath, the strongest association was the mother having visited a general practitioner (adjOR 1.9, 1.4-2.5). For visits to chiropractors the strongest association was whether the father was currently working (adjOR 2.1, 1.2-3.8). CONCLUSIONS: The factor most strongly associated with families' visits to CAM practitioners was a father who had poor self-reported health.

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.

Homeopathic care for the prevention of upper respiratory tract infections in children: a pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls.

OBJECTIVE: To investigate whether individualised treatment by homeopaths is effective in preventing childhood upper respiratory tract infection (URTI). METHODS: Open, pragmatic, randomised parallel-group trial with waiting-list group as control. One hundred and sixty-nine children below the age of 10 years, recruited by post from children previously diagnosed with URTI, were randomly assigned to receive either pragmatic homeopathic care from one of five homeopaths for 12 weeks or to a waiting-list control using self-selected, conventional health care. RESULT: There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026). The difference in the median number of days with URTI symptoms was statistically significant with 8 days in the homeopathic group and 13 days in the control group (p = 0.006). There was no statistical difference in the use of conventional medication or care between the two groups. CONCLUSION: In this study, there was a clinically relevant effect of individualised homeopathic care in the prevention of URTI in children.

Risk in homeopathy: Classification of adverse events and homeopathic aggravations--A cross sectional study among Norwegian homeopath patients.

UNLABELLED: The registration of adverse events is important to identify treatment that might impose risk to patients. Homeopathic aggravation, a concept unique for homeopathy may impose a particular risk, as it is tolerant towards a worsening of the patients' symptoms. The aim of this study was to explore the classification of patient reported reactions as homeopathic aggravations or adverse drug reactions. DESIGN AND SETTING: In a cross sectional survey, patients were asked to register any reactions they had experienced 14 days after taking homeopathic remedies. Worsening of symptoms was classified as homeopathic aggravation if it was (i) an increase of the patients' existing symptoms (ii) and/or a feeling of well-being that emerged 1-3 days after taking the remedy (iii) and/or headache and/or fatigue accompanying these symptoms. RESULTS: A total of 26% of the participants reported worsening of symptoms. One third was classified as adverse events. Half of these were graded as minor and the other half as moderate according to the Common Terminology Criteria for Adverse Events. Two thirds were classified as homeopathic aggravations. Of these, 73% were classified as minor and 27% as moderate, giving a tendency towards milder severity for those classified as homeopathic aggravations (p=0.065). CONCLUSION: Patients reported a substantial part of the short-term reactions after taking homeopathic remedy as a worsening of symptoms. These reactions were classified as mild and moderate. Hence, the risk connected to homeopathic treatment is minor. More studies are needed to confirm the existence of homeopathic aggravation and how to classify the concept in a clinically meaningful way.

The use of simplified constitutional indications for self-prescription of homeopathic medicine.

OBJECTIVES: To develop simplified constitutional indications for homeopathic medicines so that parents of children with recurrent upper respiratory tract infection (URTI) could choose homeopathic medicines for their children more "accurately", and to subsequently evaluate if these choices match the prescriptions of trained homeopaths. DESIGN AND SETTING: To initially select the most commonly used homeopathic medicines for URTI, data from a survey of 1097 patients visiting 80 different Norwegian homeopaths were used. A simplified constitutional indication was then developed for the three homeopathic medicines most frequently prescribed for recurrent URTI and otitis media. The constitutional indications were developed by a group of five homeopaths and were then sent to 20 homeopaths for further evaluation. To evaluate the parents' choice of homeopathic medicines compared to the prescription by trained homeopaths, a group of 11 randomly selected homeopaths were asked to participate. They recruited parents of 70 child patients. RESULT: By using simplified constitutional indications for the three most commonly prescribed remedies, Calcarea carb, Pulsatilla and Sulphur, parents were able to choose the same homeopathic medicine as homeopaths' prescribed for 55% (95% CI 43-67) of children with URTI. There was excellent agreement between parents' choice and homeopaths' prescription for the three medicines (Kappa of 0.77, p<0.001). CONCLUSION: Simplified constitutional indications can be used to improve the quality of the choice of homeopathic medicines purchased over the counter (OTC) for self-treatment.

Randomized controlled trials on treatment by homeopaths and self-treatment with homeopathic medicines: design and protocol.

BACKGROUND AND OBJECTIVE: This study investigates (1) whether treatment by homeopaths is more efficacious than self-selected conventional health care and (2) whether self-treatment with self-selected homeopathic medicines is more efficacious than placebo in preventing childhood upper respiratory tract infections (URTIs). DESIGN: A four-arm randomized controlled trial involving two independent investigations, one open and pragmatic (evaluating the effect of treatment by homeopaths including homeopathic medicines) and one double-blinded (evaluating the effect of self-treatment with homeopathic medicine). PATIENTS: The planned sample size is 420 children below the age of 10, recruited by a postal invitation to all children diagnosed with URTIs when attending a casualty department in Trondheim, Norway. INTERVENTIONS: The children are randomly assigned to receive either (1) self-selected homeopathic medicine or placebo (270 patients), (2) treatment by one of four different homeopaths who could prescribe any homeopathic medicine (75 patients), or (3) waiting list control using self-selected conventional health care (75 patients). MAIN OUTCOME MEASURE: Total URTI symptom scores from patients' diary over 12 weeks. PLAN: The results of these two studies (available at the end of 2004) have the potential to provide information about the efficacy of treatment by homeopaths independently from the efficacy of homeopathic medicines in children with URTIs.

[Users of homeopathy in Norway]. / Brukere av homøopati i Norge.

BACKGROUND: 37% of the Norwegian population have been to a homeopath. This article describes user complaints and characteristics and compares this with previous users and patients in general practice. MATERIAL AND METHODS: We conducted a survey of 1097 patients visiting 80 Norwegian homeopaths in 1998 and compared them with a similar survey in 1985 (1072 consultations) and a 1989 survey of patients in general practice (90,458 consultations). RESULTS: One in four of patients seeing a homeopath in 1998 were children below ten years of age compared to one in ten in the 1985 study and one in eleven in the general practice study. Children saw homeopaths most often because of respiratory and skin complaints. One half of the 1998 patients had used prescription drugs provided by a medical doctor the last month for the same complaint that they presented to the homeopath. The reasons for seeing a homeopath are similar to those found in medical general practice, expect for circulatory complaints. INTERPRETATION: There has been a substantial increase in the proportion of children among users of homeopaths. Homeopathy is most often used complementary to services given by general practitioners for the same complaints.

The personality of homeopaths: a cross-sectional survey of the personality profiles of homeopaths compared to a norm sample.

OBJECTIVES: The Revised NEO Personality Inventory (NEO-PI-R) was used to describe the personality profiles of homeopaths in Norway. It was hypothesized that the homeopaths would score higher than the norm sample on Openness, Agreeableness, and Conscientiousness. DESIGN: The NEO-PI-R describes personality scores on five traits; Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. A cross-sectional survey of 128 (39%) members of the Norwegian association for homeopaths was compared with the Norwegian population norm sample. RESULTS: Compared to the norm population score with a mean of 50, the homeopaths scored significantly higher on the personality traits Openness (54.7) and Agreeableness (58.0). Significant, but small differences were also observed with a higher score on Conscientiousness (52.3) and a lower score on Extraversion (48.3). There were no significant differences on Neuroticism (49.7). CONCLUSIONS: People who work as homeopaths can be described as open to new and different ideas, and as caring, understanding, and altruistic persons. Therefore, there is reason to believe that these dispositions are central in choosing homeopathy as an occupation. Further research should investigate whether personality traits are associated with important occupational areas such as job satisfaction, occupational stability, or income.

An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children.

OBJECTIVES: The aim of this study was to explore the contextual effect of homeopathic consultation by investigating the effect of homeopathic care compared to self-treatment with self prescribed homeopathic medicine in the prevention of childhood upper respiratory tract infections (URTI). METHODS: Randomised parallel group trial with 208 children below the age of 10. The children were randomly assigned to receive either homeopathic care (HC: individual homeopathic consultations with any homeopathic medicine in any potency being prescribed) or one of three self-prescribed homeopathic medicines (SPH) in C-30 administered twice weekly, for 12 weeks. RESULTS: There were no significant differences in clinical effects between SPH and HC for primary outcomes. Mean URTI scores over 12 weeks were 39.0 in the HC group and 43.9 in the SPH group (p=0.782, difference -5.0 points (95% C.I.; -20.5 to +10.5)). The mean number of days where the parents rated their child as 'ill with URTI' was 10.0 in the HC group and 13.7 in the SPH group (p=0.394). There was a trend in favour of HC for other outcomes. CONCLUSIONS: In this innovative and exploratory study, there was no evidence for a clinically relevant effect of homeopathic care vs. a homeopathic medicine given by the child's parents and based on a pre-agreed homeopathic treatment protocol.

Why do parents take their children to homeopaths? -- an exploratory qualitative study.

BACKGROUND: There has been a threefold increase in the proportion of children among patients visiting homeopaths in Norway from 1985 to 1998. As no study has investigated the reasons for this increase, the aim of the present study was to explore why parents take their children to homeopaths. PARTICIPANTS AND METHODS: In this qualitative study, parents who had taken their child to a homeopath for the first time during the last 3 months were interviewed in depth using a semi-structured interview guide. The interviews were analysed using thematic analysis based on techniques from grounded theory. RESULTS: 9 parents were interviewed. Parents consulted a medical doctor to clarify how serious their child's health condition was, and sought treatment from a homeopath if the symptoms were not dangerous. Personal recommendations or personal experience of homeopathy were identified as being a main factor that triggered seeking treatment specifically from a homeopath. The reasons they sought an alternative, or rather complement, to conventional medical treatment were: they did not wish to give their child allopathic medication; they wanted to find an alternative treatment to their child's currently prescribed allopathic medication; they had ceased conventional medication due to its side effects; to obtain treatment whilst waiting for a problem to be assessed; or they were not offered any treatment by their medical doctor. CONCLUSION: Parents took their child to a homeopath due to experiences with the medical encounter or treatment and due to recommendations or own personal experience.

Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial.

AIMS: Homeopathic medicines are frequently purchased over the counter (OTC). Respiratory complaints are the most frequent reason for such purchases. Children with upper respiratory tract infection (URTI) are frequent users of homeopathy. This study investigates the effect of self treatment with one of three self selected ultramolecular homeopathic medicines for the prevention of childhood URTI. METHODS: A double-blind randomized parallel group placebo controlled trial was carried out in 251 children below the age of 10 years, recruited by post from those previously diagnosed with URTI when attending a casualty department. The children were randomly assigned to receive either placebo or ultramolecular homeopathic medicines in C-30 potency (diluted 10(-60)) administered twice weekly for 12 weeks. Parents chose the medicine based on simplified constitutional indications for the three medicines most frequently prescribed by Norwegian homeopaths for this group of patients. The main outcome measure relates to the prevention of new episodes of URTI measured with median total symptom score over 12 weeks. RESULTS: There was no difference in the predefined primary outcome between the two groups (P = 0.733). Median URTI scores over 12 weeks in the homeopathic medicine group were 26.0 (95% confidence interval (CI) 16.3, 43.7) and for placebo 25.0 (95% CI 14.2, 38.4). There was no statistical difference between the two groups in median number of days with URTI symptoms or in the use of conventional medication/care. CONCLUSIONS: In this study there was no effect over placebo for self treatment with one of three self selected, ultramolecular homeopathic medicines in preventing childhood URTI. This can be due to the lack of effect of the highly diluted homeopathic medicines or the process of selection and type of medicines.

Minimum dataset for documentation of homoeopathic practice

In order to compare data from different documentation projects of homoeopathic practice, there is a need for standardisation. A group which met at a European Committee of Homoeopathy (ECH) research meeting in London, made a proposal as a basis for discussion. The proposal is on the minimum data set which every study should include and which methods of effect measurement are most appropriate. (AU)