Journal of Preventive Medicine

Keywords

Current trends; Homeopathic medicine; Population based study

Introduction

Homeopathic medicine is a medical philosophy and practice based on the idea that the body has the ability to heal itself[1]. Homeopathy was founded in the late 1700s in Germany and has been widely practiced throughout Europe and south Asia. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licenses or degrees in conventional medicine from accredited universities are required. In the US the percentage of patient gaining homeopathic treatment has increased four times from 1991 to 1997[2]. In the UK, it was estimated that around 10% of total population had opted homeopathic medication for any illness according to a study conducted in 2004[3]. Another study carried out in the same year in Germany, the country in which homeopathy was invented; proved that nearly 10% of men and 20% of women in the overall population had taken homeopathic treatment in some form[4]. Homeopathy is even more popular in Scandinavian countries; a study done in 2004 demonstrated that 34% and 45% of the general population ever used homeopathic remedy in Norway and Denmark respectively[5]. The overall trend in Pakistan shows that 51.7% chose alternative medication according to a population based survey conducted between 2002 and 2004[6]. There are two main theoretical views: The principle of “similar” and the use of dilutions called “potencies”[7]. The principle of similar states that patients with specific signs and symptoms can be cured if given a drug that harvests the same signs and symptoms in a healthy subject. The second principle is that remedies retain biological action if they are continually diluted and shaken between each dilution. These dilutions are claimed to be efficacious even when diluted beyond Avogadro’s number in which no original molecules of the active principle remain. How the solution “remembers” information from the original substance is speculative. Homeopathy was officially recognized by the government of Pakistan in 1965 and the board of homeopathic system of medicine was established under the unani ayurvedic and homeopathic practitioners' act. Although having very few or no side effects[8], homeopathy has many setbacks that make it usually the secondary line of treatment after allopathy in the modern world. It is a popular main text belief among allopathic practitioners that the absence of side-effects made homeopathy as popular as it is today[9]. According to the International Society for Complementary Medicine Research (ISCMR), there are some convincing factors promoting the popularity of homeopathy which include very low incidence of adverse or side effects, fear of surgery in the general public and cost effectiveness[10]. Literature shows that the use of homeopathy in Pakistan has increased significantly and is further spreading although there is little work done in collecting accurate data[11-14]. Our objective of this study is to assess the satisfaction to homeopathic medication in our population and evaluate the fears regarding allopathic medication in Pakistan.

Materials and Methods

We conducted a cross-sectional survey in all the 6 districts of Karachi; south, east, west, central, Malir and Korangi. Duration of study was 6 months starting from February 2016 to July 2016. The data was obtained by means of self-designed pilot tested questionnaire filled by the researchers by face to face interview with the patients. Participation in the study was voluntary and informed consent was taken. The inclusion criterion was to enroll patients currently undergoing homeopathic treatment for any illness, irrespective of the age, gender, racial, ethnic and cultural differences. Patients reporting any previous homeopathic treatment were excluded to avoid recall bias. Patients attending homeopathic clinic for the first time were also excluded. The sample size was calculated based on the expectation that the prevalence of the use of homeopathy would be 30% in our population. This figure was obtained with respect to other countries, where the rate of use ranged from 3.4%[2] to 56%[12] as there are no systematic population-based studies to assess the prevalence of homeopathy in Pakistan. Confidence interval was kept at 95%.

Simple random sampling technique was used. All patients attending designated homeopathic clinics from 3:00 pm PST to 9:00 pm PST were included in the study. 2794 patients participated in the study, 278 were excluded based on exclusion criteria and 2516 were included with approximate uniform distribution from each district. Trained health care professionals who were licensed doctors from Pakistan medical and dental council were employed to fill the questionnaires. They were given training in a three session program which included understanding and procedure of filling the questionnaire. Over an initial two week period, pilot interviews were conducted and the questionnaires were subsequently reviewed by the field coordinator.

The questionnaire was designed to assess the demographic characteristics; details of the illness; homeopathic treatment record; possible reasons for choosing homeopathy and anticipated fears regarding allopathic medication. Patients healing response was assessed using visual analogue scale and patients own satisfaction regarding the homeopathic treatment. For the statistical analysis, the data was recorded and analyzed using the Statistical Package for the Social Sciences (SPSS)

Software 21.0. Data stratification was performed. Pearson chi square test and student’s t-test was used for comparisons between proportions. P<0.05 were considered significant. The study was approved by the ethical review committee of Jinnah medical and dental college, Karachi, Pakistan.

Results

Of 2516 individuals, 1560 were male and 956 were female. Our study showed that 48.1% (1210) of the patients using homeopathic medication had a monthly income of PKR30,000 to 50,000 reporting highest trend in average income groups (P<0.05). The majority of homeopathic users were found to be housewives (31.8%) (800), followed by non-government employees (23.3%)(586). The most frequently reported reasons for opting homeopathic medication in our population were recommendation by others (74.4%) (1872) and family preferences (55.5%) (1396) (Tables 1 and 2). Homeopathic medication was mainly used for GI (gastro-intestinal) diseases (27.8%) (699), musculoskeletal symptoms (19%) (478), respiratory diseases (16%)(403) and UTIs (Urinary Tract Infections) (10%)(252). Surprisingly even a few patients of neoplastic disease (2.8%) (70) Also reported use of homeopathic medication. The mean duration of illness was found to be longest for neuropsychiatric diseases (75 months); while the mean duration of treatment was longest for cardiovascular diseases (28 months). The mean duration of treatment was calculated to be more prolonged in females (17 months) as compared to males (14 months) (P<0.05). Only 2% of our study participants reported side effects due to their current treatment. Subject reported healing response by the use of homeopathic medication was calculated to be 88.9% (2237) and only 11.1% (279) of the people reported no therapeutic response. This healing response was statistically significant (P<0.05). To further augment the patient reported healing response visual analogue scale was used as a counter assessment measure by the researcher. The VAS scale was designed to cover all aspects of homeopathic treatment (chief complaint, physical wellbeing, mental/spiritual/emotional wellbeing, energy level (body language and alertness) and confidence in medication. It was found that a significant amount of homeopathic users reported a median score of 7/10 indicating a considerable satisfaction among homeopathic users. The main reasons for disapproval of allopathic medication that were reported among our population were associated side effects, multiple adverse effects and no therapeutic benefits, 56.9%, 41.2% and 31.7% respectively (Figures 1-3).

Table 1: Demographic data regarding gender distribution, monthly income and occupation in our population.

Table 2: Reported reasons for choosing homeopathic medication in our population.

Figure 1: Diseases for which homeopathic medication were utilized by the population of Karachi.

Figure 2: showing parallel view of mean duration of illness and duration of treatment regarding various disorders among homeopathic users.

Figure 3: Reasons for the disapproval of allopathic medication among homeopathic users. (Expensive: Not able to/ difficulty in affording the medication; difficulty in consumption: Any difficulty in swallowing the drug due to size, taste, odor, etc.; no therapeutic benefit: No improvement in symptoms after or during the treatment; multiple adverse effects: Effects of the medication which were therapeutically opposite or harmful from the intended effect; anticipated fatigue and weakness: Any weakness or fatigue immediately after taking the medication; disapproval from family: Influence of family in disapproving the medication; Drug phobia: An extreme or irrational fear from taking the medication; fear of addiction: Fear of chronic dependency on the drug; prolong duration of treatment: Course of medication takes long time to relieve the symptoms or cure the illness; associated side effects: Effects of the medication which were secondary to the intended effect).

Discussion

We found that use of homeopathy has an enormous share in the Pakistan health care system.

We believe to have collected a study sample more representative of the overall population of Pakistan than any previous study from this region. The majority of patients visiting homeopathic clinics in this study comprised of men (62%), but most abundant class of study subjects by occupation were housewives (31.8%). These findings are contradictory with previous studies carried out in Karachi from Aga khan (57%) and Hamdard university (53.5%) hospitals reporting more female users of homeopathic medication however the trend among housewives remains in accord with abovementioned studies[12]. The present study also showed that the majority of the people who opted for homeopathic medicine belonged to average monthly income which is different from other recent studies in Karachi and South Asia which demonstrate that mainly people with poor socio-economic background opt for homeopathy[13]. The possible reason behind this paradox can be explained by small sample sizes of previous studies. To the best of our knowledge it is the only study from the South Asian belt assessing use of homeopathic medication at a large scale. This new data also reflects that homeopathic medicine is gaining popularity among people with better socioeconomic backgrounds.

GI diseases (28%) along with surgical problems (19%) were found to be more frequently reported in homeopathic clinics as compared to other diseases in this study. This seems to be a new trend compared to other studies done in the past depicting that skin issues and allergies being the major diseases for which homeopathic treatment was sought[14]. This is an indicator of the broadening spectrum of the usage of homeopathic medicine. Nearly three fourth (74.4%) of the respondents sought homeopathic treatment on the advice of others or family (cultural) preferences. Another study done in a tertiary care hospital in Karachi showed that the majority (72%) consulted a homeopathic practitioner due to peer recommendation[12].

An Indian study also highlighted the influence of family and friends as the most common reason for choosing homeopathic treatment[15]. Furthermore, dissatisfaction or less therapeutic benefits of allopathic medications were the main reasons for opting alternative medicine according to a Brazilian study[16]. In this study it was found out that side effects associated with allopathic medication was the main reason (56.9%) for their disapproval. This is in accordance with another study done in India where subjects experienced more side effects (89%) using allopathic medication as compared to alternative medicine. Almost negligible side effects of homeopathic medication are often linked with the repeated dilutions of active ingredients. These repeated dilutions result in a very less potent drug with almost no side or adverse effects making homeopathy a popular choice of treatment for patients. The patients’ satisfaction with regard to homeopathy was found to be very high in the population of Karachi with a significant healing response. Similar studies done in the past also indicated a compelling trust of patients in homeopathy[2] and this research reflects the ever increasing popularity of this type of alternative medicine in the population of Karachi.

Despite the popularity of this art of medicine, many studies have supported the hypothesis that homeopathy is linked with having placebo effects. A systematic review conducted by Ernst in 1998 showed that homeopathic remedies are no more efficacious than placebo for the treatment of DOMS (Delayed Onset Muscle Soreness)[17]. This was followed by another study by Ernst in 1999 which suggests that homeopathy is ineffective in the prophylaxis of migraine or headache beyond a placebo effect[18]. Linde compared the effects of homeopathy with placebo for the treatment of chronic asthma in 2000. This study again demonstrated no clear trend in favor of homeopathy with regard to treatment of asthma. Another randomized clinical trial done in 2001 by long reflected that homeopathic medication had no therapeutic benefit in the treatment of osteoarthritis among 406 subjects[19]. Placebo factors have neurobiological underpinnings and actual effects on the brain and body. Placebo responses also result from less conscious processes, such as classical conditioning in the case of immune, hormonal, and respiratory functions[20]. On the contrary, studies have been performed which up keep the therapeutic benefits of homeopathic school of medicine. A large 6-year study, published in 2005, comprising of 6544 patients was conducted by David et al. to assess the health changes with homeopathic medication for various chronic diseases. The study showed that 70.7% (n=4627) reported positive health changes, with 50.7% (n=3318) recording their improvement as better (+2) or much better (+3) with the use of homeopathic medication[21]. Another study done in 2001 by Jacobs et al among 75 children demonstrated significant decrease in symptoms of acute otitis media at 24 h and 64 h after treatment in favor of homeopathy over placebo drug (P<0.05)[22]. Homeopathic medication has also been documented to be effective in psychiatric issues and may be useful in the treatment of affective and anxiety disorders in patients with mildly to severely symptomatic conditions.

Our study showed a considerably high healing response and satisfaction among the homeopathic users. It is a possibility that such high responses were linked to the ability of homeopathic drugs to produce profoundly assuring placebo effects as there is no high level evidence based data supporting their benefits. If, however, we consider the possibility of therapeutic effects of homeopathic, there is not much literature available that came across the authors to verify the spectrum of diseases treated by homeopathic medicine in Pakistan, therefore, our study demands that, further research should be conducted on homeopathic medicine. We also outlined the factors in the minds of homeopathic users that might drive them away from allopathic medications. To the best of our knowledge, it is the only study reporting this extremely vital information from this region.

Conclusion

The popularity of homeopathy in the population of Karachi is quite astounding. There are strong correlations between the use of homeopathic medication and gross socioeconomic indicators. There is a wide array of diseases being treated by homeopathy in Pakistan. It is, however, unclear regarding the healing responses reported to be called as curative in intent for disease. The homeopathic physicians should perform further research to support the vast utilization of homeopathic drugs. We also advocate the need for education of homeopathic physicians regarding early referral of patients to allopathic physicians for chronic and malignant diseases. Additionally, effective measures should be done to eradicate the concerns about allopathic medication from the minds of general public.

References

1. Fisher P (2012) What is homeopathy? An introduction. Front Biosci 4: 1669-82.

   [Crossref], [Google Scholar], [Indexed]

2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, et al. (1998) Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA 280: 1569-75.

   [Crossref], [Google Scholar], [Indexed]

3. Thomas K, Coleman P (2004) Use of complementary or alternative medicine in a general population in Great Britain. Results from the national omnibus survey. J Public Health 26: 152-7.

   [Crossref], [Google Scholar]

4. Härtel U, Volger E (2004) Use and acceptance of classical natural and alternative medicine in Germany--findings of a representative population-based survey. For schende Komplementarmed klass Naturheilkd 11: 327-34.

   [Crossref], [Google Scholar], [Indexed]

5. Hanssen B, Grimsgaard S, Launsø L, Fønnebø V, Falkenberg T, et al. (2005) Use of complementary and alternative medicine in the Scandinavian countries. Scand J Prim Health Care 23: 57-62.

   [Crossref], [Google Scholar], [Indexed]

6. Shaikh SH, Malik F, James H, Abdul H (2009) Trends in the use of complementary and alternative medicine in Pakistan: A population-based survey. J Altern Complement Med 15: 545-550.

   [Crossref], [Google Scholar], [Indexed]

7. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, et al. (1997) Are the clinical effects of homoeopathy placebo effects?. A meta-analysis of placebo-controlled trials. The Lancet 350: 834-43.

   [Crossref], [Google Scholar], [Indexed]

8. Marian F, Joost K, Saini KD, von Ammon K, Thurneysen A, et al. (2008) Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine. BMC Complement Altern Med 8: 52.

   [Crossref], [Google Scholar], [Indexed]

9. Baum M, Ernst E (2009) Should we maintain an open mind about homeopathy?. The Am J Med 22: 973-4.

   [Crossref], [Google Scholar], [Indexed]

10. Haidvogl M, Riley DS, Heger M, Brien S, Jong M, et al. (2007) Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complement Altern Med 7: 7.

    [Crossref], [Google Scholar], [Indexed]

11. Malik IA, Khan NA, Khan W (2005) Use of unconventional methods of therapy by cancer patients in Pakistan. Eur 16: 155-60.

    [Crossref], [Google Scholar], [Indexed]

12. Fisher P, Ward A (1994) Complementary medicine in Europe. BMJ 309: 107.

    [Crossref], [Google Scholar]

13. Elahee SF, Rahman MM, Rahman MM, Hossain S, Zaki M (2008) Who seek homeopathic treatment?. Bangladesh Med J 37: 37-40.

    [Crossref], [Google Scholar]

14. Jain A (2003) Does homeopathy reduce the cost of conventional drug prescribing?: A study of comparative prescribing costs in general practice. Homeopathy 92: 71-6.

    [Crossref], [Google Scholar]

15. Tandon M, Prabhakar S, Pandhi P (2002) Pattern of use of Complementary/Alternative Medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiol Drug Saf 11: 457-63.

    [Crossref], [Google Scholar], [Indexed]

16. Justo CP, dé Andrea Gomes MH (2008) Conceptions of health, illness and treatment of patients who use homeopathy in Santos, Brazil. Homeopathy 97: 22-7.

    [Crossref], [Google Scholar], [Indexed]

17. Ernst E (1998) Does post-exercise massage treatment reduce delayed onset muscle soreness?. A systematic review. Br J Sports Med 32: 212-4.

    [Crossref], [Google Scholar], [Indexed]

18. Ernst E (1999) Homeopathic prophylaxis of headaches and migraine?. A systematic review. J Pain Symptom Manag 18: 353-7.

    [Crossref], [Google Scholar]

19. Long L, Ernst E (2001) Homeopathic remedies for the treatment of osteoarthritis: A systematic review. Br Hom J 90: 37-43.

    [Crossref], [Google Scholar], [Indexed]

20. Price DD, Finniss DG, Benedetti FA (2008) A Comprehensive review of the placebo effect: Recent advances and current thought. Annu Rev Psychol 59: 565- 90.

    [Crossref], [Google Scholar], [Indexed]

21. Spence DS, Thompson EA, Barron SJ (2005) Homeopathic treatment for chronic disease: A 6-year, university-hospital outpatient observational study. J Altern Complement Med 11: 793-8.

    [Crossref], [Google Scholar], [Indexed]

22. Jacobs J, Springer DA, Crothers D (2001) Homeopathic treatment of acute otitis media in children: A preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 20: 177-83.

    [Crossref], [Google Scholar], [Indexed]