Squaring

1. Complementary medicine in a basic benefit package   Squaring the Circle Homoeopathy as an Example Dr. Neil Gower M.Tech Hom (UJ) HSA National Secretary The BHF Southern African Conference 22-25 July’07 Sun City

2. CAM Professions Squaring the Circle • As regulated through the Allied Health Professions Act, 1982 (Act 63 of 1982): • PBHNP – Homoeopathy, Naturopathy, Phytotherapy • PBCO – Chiropractic, Osteopathy • PBAUC – Ayurveda, Unani Tibb, Chinese Medicine and Acupuncture • PBARM – Therapeutic: Aromatherapy, Reflexology, Massage Therapy The BHF Southern African Conference 22-25 July’07 Sun City

3. Basic Benefit Package Squaring the Circle DEFINE: • What are we trying to achieve? • What needs are we trying to satisfy? • common basic benefit for all South Africans • Bearing in mind right to choose and access to healthcare • Treatment, maintenance AND prevention • Support Health maintenance / chase our tails?  SYSTEMS • Essentially: primary healthcare? • Established patients of homoeopathy use it for this purpose The BHF Southern African Conference 22-25 July’07 Sun City

4. Homoeopathy Squaring the Circle Two definitions: • Homoeopathy: a comprehensive system of treatment based on the principle of likes cure likes. • Homoeopathy in SA: Inclusive of the use of a variety of medicinal options and applications fulfilling a role of primary contact physician The BHF Southern African Conference 22-25 July’07 Sun City

5. Homoeopathic Training Squaring the Circle • South Africa: • M.Tech Hom – only degree permitting registration (since 2000) • 5 year Masters degree • University of Johannesburg and Durban University of Technology • Aimed at preparing a practitioner for a role in primary healthcare as a first contact and fulfilling the prescribed scope of practice The BHF Southern African Conference 22-25 July’07 Sun City

6. Scope of Practice Squaring the Circle • Allied Health Professions Act, 1982 (Act 63 of 1982): • Section 1 (2): (a) a practitioner may- (i) diagnose, and treat or prevent, physical and mental disease, illness or deficiencies in humans; (ii) prescribe or dispense medicine; or (iii) provide or prescribe treatment for such disease, illness or deficiencies in humans; The BHF Southern African Conference 22-25 July’07 Sun City

7. Scope of Practice (Cont…) Squaring the Circle • Allied Health Professions Act, 1982 (Act 63 of 1982): • Reg. 28: Subject to the provisions of the Medicines and Related Substances Control Act, 1965, a practitioner registered as a homeopath may, for the purposes of his or her practice‑ (a) possess or have under his or her control- (b) prescribe for a patient or supply to a patient- (c) formulate, compound, prepare, manipulate or dispense- The BHF Southern African Conference 22-25 July’07 Sun City

8. Scope of Practice (Cont…) Squaring the Circle • Allied Health Professions Act, 1982 (Act 63 of 1982): • Reg. 28: Crude substances Homoeopathic substances (any & all) Vitamins, minerals, supplements Injectable forms thereof The BHF Southern African Conference 22-25 July’07 Sun City

9. Scope of Practice (Cont…) Squaring the Circle • Allied Health Professions Act, 1982 (Act 63 of 1982): • Reg. 47: The following acts are acts specially pertaining to the profession of a homeopath: (a) The physical examination of any person, taking into account the totality of symptoms and the modalities and peculiarities thereof, for the purpose of diagnosing any physical defect, illness or deficiency in such person. (b) The treatment or prevention of any physical defect, illness or deficiency in any person by remedies, dietary advice or dietary supplementation in accordance with and based on homeopathic principles. The BHF Southern African Conference 22-25 July’07 Sun City

10. Homoeopathy? Squaring the Circle • What does it have to offer? • Comprehensive system that requires a comprehensive analysis • Profound understanding of disease prevention, pathology and its progression • Offers a viable “alternative” for: • Acute conditions • Chronic conditions The BHF Southern African Conference 22-25 July’07 Sun City

11. Homoeopathy? (Cont…) Squaring the Circle • Misunderstandings: • “Natural” • Ethereal, mystic • Severely limited: • Sinusitis • Eczema • Allergies • Immune boosting • Safe, easy - picked up from a book Yet at same time “last hope” and “miracle workers” for so many. The BHF Southern African Conference 22-25 July’07 Sun City

12. Homoeopathy? (Cont…) Squaring the Circle • In fact: • Healing mechanism assists natural healing processes  iatrogenic effects and persistent side effects are not present. Homoeopathic aggravations can occur but under professional guidance are part of the “healing crisis” • Comprehensive system and methodology through precise symptomatology and prescribing The BHF Southern African Conference 22-25 July’07 Sun City

13. Homoeopathy? (Cont…) Squaring the Circle • In fact(cont…): • Every condition is treated – limitations are by way of medical logic: surgical need, end-stage disease, “obstacles to cure”: • Infectious diseases, Hormonal imbalances, Pain, Dermatological conditions, Neurological complaints, Cardio-vascular, Respiratory, Arthritis, Blood pressure, Diabetes,, ADHD, Depression, SLE, Hepatitis, Cancer and Aids. • Due to its nature requires continuous education, reading: pathology, diagnosis, medicine, pharmacology, homoeopathy, prescription, compounding, dispensing, other CAMs The BHF Southern African Conference 22-25 July’07 Sun City

14. Evidence Squaring the Circle • American Journal of Pain Management Osteoarthritic Pain: A Comparison of Homeopathy and Acetaminophen The investigators conclude that homeopathic treatments for pain in OA patients appear to be safe and at least as effective as acetaminophen, and are without its potential adverse effects including compromise to both liver and kidney function. Shealy et al.;American Journal of Pain Management; 1998;8:89-91;Osteoarthritic Pain: A Comparison of Homeopathy and Acetaminophen The BHF Southern African Conference 22-25 July’07 Sun City

15. Evidence (Cont…) Squaring the Circle • British Medical Journal Effect of Homoeopathic Treatment on Fibrositis It showed a significant reduction in tender spots, by 25%, when patients were given the homeopathic medicine, as compared to when they were given the placebo. Fisher et al.;British Medical Journal; Effect of Homoeopathic Treatment on Fibrositis; August 5, 1989, 299:365-66. The BHF Southern African Conference 22-25 July’07 Sun City

16. Evidence (Cont…) Squaring the Circle • CHEST Influence of (homoeopathic) potassium dichromate on tracheal secretions in critically ill patients CONCLUSION: These data suggest that potentised (diluted and vigorously shaken) potassium dichromate may help to decrease the amount of stringy tracheal secretions in COPD patients. M. Frass et al. CHEST, March, 2005; Influence of (homoeopathic) potassium dichromate on tracheal secretions in critically ill patients The BHF Southern African Conference 22-25 July’07 Sun City

17. Evidence (Cont…) Squaring the Circle • BMC Complementary & Alternative Med Homeopathic and conventional treatment for acute respiratory and ear complaints: a comparative study on outcome in the primary care setting. CONCLUSION: In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment. [Ed.: faster improvement in first 7 days; no adverse drug reactions for adult group] M. Haidvogl et al. BMC Complement Altern Med. 2007 Mar 2;7:7Homeopathic and conventional treatment for acute respiratory and ear complaints: a comparative study on outcome in the primary care setting. The BHF Southern African Conference 22-25 July’07 Sun City

18. Evidence (Cont…) Squaring the Circle • Explore (NY) Efficacy of a complex homeopathic medication (Sinfrontal) in patients with acute maxillary sinusitis: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial CONCLUSION: This complex homeopathic medication is safe and appears to be an effective treatment for acute maxillary sinusitis. DI Zabolotnyi et al.; Explore (NY) 2007 Mar-Apr;3(2):98-109.; Efficacy of a complex homeopathic medication (Sinfrontal) in patients with acute maxillary sinusitis: a prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial. The BHF Southern African Conference 22-25 July’07 Sun City

19. Evidence (Cont…) Squaring the Circle • Complementary Therapies in Medicine Homoeopathy in primary care: self-reported change in health status. 1 year after first examination 73.5% of patients reported a marked or moderate improvement in their health status. F. Attena et al. Complement Ther Med. 2000 Mar;8(1):21-5.Homoeopathy in primary care: self-reported change in health status. The BHF Southern African Conference 22-25 July’07 Sun City

20. Evidence (Cont…) Squaring the Circle • Biomedical Therapy Acute Otitis Media in Children: A Comparison of Conventional and Homeopathic Treatment They found that the total recurrences of the homeopathic treated group was .41 per patient, while the antibiotic treatment group was .70 per patient. Of the "homeopathic" children who did have another earache, 29.3% had a maximum of three recurrences, while 43.5% of the "antibiotic" children had a maximum of six recurrences. KH Friese et al.;Biomedical Therapy, 60,4,1997:113-116; Acute Otitis Media in Children: A Comparison of Conventional and Homeopathic Treatment The BHF Southern African Conference 22-25 July’07 Sun City

21. Evidence (Cont…) Squaring the Circle • British Homeopathic Journal Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? Pain control was achieved in 39% of the patients after 6 h, another 33% after 12 h. This resolution rate is 2.4 times faster than in placebo controls. There were no complications observed in the study group, and compared to conventional treatment the approach was 14% cheaper. H. Frei et al.; Br Homeopath J. 2001 Oct;90(4):180-2; Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution? The BHF Southern African Conference 22-25 July’07 Sun City

22. Evidence (Cont…) Squaring the Circle • Homeopathy Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children Homeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis M. Trichard et al.;Homeopathy. 2005 Jan;94(1):3-9; Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children The BHF Southern African Conference 22-25 July’07 Sun City

23. Evidence (Cont…) Squaring the Circle • Homeopathy Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit. On day 180, survival was statistically significantly higher with verum homeopathy (75.8% vs 50.0%, P = 0.043). CONCLUSION: Our data suggest that homeopathic treatment may be a useful additional therapeutic measure with a long-term benefit for severely septic patients admitted to the intensive care unit. M. Frass et al.; Homeopathy. 2005 Apr;94(2):75-80; Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit The BHF Southern African Conference 22-25 July’07 Sun City

24. Evidence (Cont…) Squaring the Circle • European Journal of Pediatric Surgery Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial CONCLUSION: The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder, particularly in the areas of behavioural and cognitive functions. H. Frei et al.; Eur J Pediatr. 2005 Dec 164(12):758-67; Epub 2005 Jul 27; Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial The BHF Southern African Conference 22-25 July’07 Sun City

25. Examples Squaring the Circle • The WHO noted in 19941 that homeopathy had been integrated into the national health care systems of numerous countries, including: • Germany • United Kingdom • India - AYUSH • Pakistan • Sri Lanka • Mexico Poitevin, B. "Integrating Homoeopathy in Health Systems." Bulletin of the World Health Organization. 1999. 77(2):160-6 The BHF Southern African Conference 22-25 July’07 Sun City

26. Examples (cont…) Squaring the Circle • France • Homoeopathic treatment reimbursed by French social security system • United Kingdom* • Homoeopathic treatment reimbursed and part of National Health System • Brazil • Homoeopathy – recognised speciality by medical authorities since 1992 – forms part of public and community health programmes Poitevin, B. "Integrating Homoeopathy in Health Systems." Bulletin of the World Health Organization. 1999. 77(2):160-6 The BHF Southern African Conference 22-25 July’07 Sun City

27. Basic Benefit Package Squaring the Circle • Primary Healthcare: • First contact • Base Referral System with a recognition of limitations (through education) • Comprehensive • Systematic • Trusted • Prevention – HEALTH based, individualised The BHF Southern African Conference 22-25 July’07 Sun City

28. Squaring the Circle Sir William Osler, Father of Modern Medicine (1849 – 1919): “The individual, not the disease, is the entity.” The BHF Southern African Conference 22-25 July’07 Sun City