9783642206375

This volume includes the full Health Technology Assessment (HTA) report on effectiveness, appropriateness, safety and costs of homoeopathy in health care. The report was commissioned by the Swiss health authorities to inform decision-making on the further inclusion of homoeopathy in the list of services covered by statutory health insurance. Other studies carried out as part of the Swiss Complementary Medicine Evaluation Programme (PEK) caused a massive stir due to their schematic and exclusively quantitative (negative-)outcomes for homoeopathy. The present report, in contrast, offers a differentiated evaluation of the practice of homoeopathy in health care. It confirms homoeopathy as a valuable addition to the conventional medical landscape '¬ ; a status it has been holding for a long time in practical health care. Â

Introduction	p. 1
Background and objectives of HTA	p. 5
Background	p. 6
Objectives	p. 7
Introduction to the speciality of homeopathy - principles and definition	p. 9
Preface	p. 10
The principle of similarity or 'Law of Similars'	p. 10
Homeopathic pharmacology	p. 10
The homeopathic examination and remedy selection	p. 11
Medicines: their manufacture, application and mode of action	p. 11
The concept of disease in homeopathy and conventional medicine	p. 12
Indications and limitations of homeopathy	p. 13
Other therapies known as homeopathy	p. 13
Homeopathy research	p. 14
References	p. 14
Homeopathy: Research and Research Problems (preclinical and clinical)	p. 15
Introduction and Research Problems	p. 16
Preclinical Research	p. 17
Fundamental physico-chemical research	p. 17
Botanical studies	p. 18
Animal studies	p. 18
In vitro studies with human cells	p. 19
Conclusion: fundamental preclinical research	p. 19
Clinical trials	p. 19
Classification	p. 19
An outline of clinical trials	p. 20
Future research	p. 21
Summary clinical studies	p. 22
References	p. 22
General problems with clinical trials in research	p. 27
The Problems with Randomized Clinical Trials	p. 28
The Risk of Bias in Clinical Trials	p. 31
Problems with the Formal Evaluation of Clinical Trials in Meta-analyses	p. 39
References	p. 44
HTA Homeopathy: Methods and Material	p. 47
Project Implementation	p. 48
Methods: Systematic Literature Search	p. 49
Selection of data sources	p. 49
Data sources used	p. 49
Systematic literature search: general search strategy and article selection	p. 54
Systematic literature search for individual HTA aspects: search strategy and article selection	p. 55
Data Extraction and Evaluation	p. 56
Extraction and evaluation of data / procedure	p. 56
Extraction and evaluation of data	p. 57
Evaluation categories	p. 58
Data Synthesis	p. 59
Publications	p. 60
Database research 'Homeopathy'	p. 60
Special search: URTI (Upper Respiratory Tract Infection)	p. 62
Safety	p. 63
Cost-effectiveness	p. 63
References	p. 66
International Utilisation of Complementary Medical Approaches	p. 67
Introduction and Research Questions	p. 68
Methodology	p. 68
Results	p. 69
Outline of studies used	p. 69
Study design	p. 69
CAM definitions	p. 76
Profile of CAM users	p. 79
Frequency of CAM use	p. 79
Estimation of satisfaction with CAM and CAM effectiveness	p. 83
Reasons for using CAM	p. 85
Use of CAM compared with conventional medicine	p. 86
Discussion	p. 86
Conclusion	p. 87
References	p. 88
CAM Conditions and Use in Switzerland	p. 91
Conditions	p. 92
The Use of Complementary Medicine in Switzerland: Prevalence, Effectiveness, Acceptance and the Views of Patients and Physicians	p. 94
Introduction	p. 94
Methodology	p. 94
Results	p. 95
Discussion	p. 97
Conclusion	p. 97
List of study numbers (referred to in the diagrams)	p. 98
References	p. 98
Overview of Systematic Reviews on the Clinical Efficacy of Homeopathy	p. 101
Introduction: Systematic Reviews	p. 102
Literature Search	p. 102
Presentation of the Studies	p. 103
Reviews on general effectiveness	p. 103
Reviews on special indications:	p. 106
Reviews on special interventions	p. 107
Reviews on special indications with special intervention	p. 108
Evaluation of the Studies	p. 109
Research question	p. 109
Selection of studies	p. 111
Selection and evaluation of data/information	p. 113
Data synthesis	p. 114
Discussion and Conclusion	p. 117
List of Excluded Studies with Reasons for Exclusion	p. 118
References	p. 124
Clinical Studies on the Effectiveness of Homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions)	p. 127
Selection of Indication	p. 128
Outcome of Literature Search	p. 128
Summary of Studies: Data Extraction, Internal and External Validity, Results	p. 140
Population, study design and implementation	p. 140
Intervention and control therapy	p. 141
Outcome	p. 147
Results	p. 142
Side effects, initial aggravation, adverse effects	p. 143
Discussion	p. 143
References	p. 156
Safety of Homeopathic Use	p. 159
Introduction	p. 160
Responses to Treatment	p. 160
Interaction of Substances	p. 161
Safety of Application	p. 161
Scientific Research	p. 161
Safety: Summary and Conclusion	p. 162
References	p. 162
Cost-effectiveness of Homeopathy	p. 163
Introduction	p. 164
Methods of Health Economics	p. 166
Use of CAM	p. 167
Costs	p. 168
Cost-effectiveness	p. 168
Reimbursement	p. 169
Data and Studies for Homeopathy	p. 169
Data and Projects from Switzerland	p. 171
NFP34	p. 171
Further data from Switzerland	p. 172
International CAM Studies and Surveys: Patients	p. 173
International CAM Studies and Surveys on: Physicians/Providers	p. 174
Pilot Projects in Germany	p. 174
Discussion	p. 177
Methodology	p. 177
Cost-effectiveness of complementary medical methods .	p. 177
Homeopathy	p. 188
References	p. 189
Full discussion of the HTA results	p. 193
References	p. 203
Synopsis	p. 205
Effectiveness	p. 206
Reviews	p. 206
Studies on the Indication Upper Respiratory Tract Infection/Allergy (URTI/A)	p. 207
Appropriateness	p. 208
Estimation of Demand/Use	p. 208
Safety	p. 208
Economy	p. 208
Appendix	p. 211
Data Extraction Forms	p. 212
Sample questionnaires: systematic reviews and meta-analyses, also for HTA	p. 212
Sample questionnaires: clinical studies	p. 218
Sample questionnaire: demand/cost-effectiveness	p. 224
Abbreviations	p. 227
Conflict of interest	p. 230
Authors	p. 230
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Homeopathy in Healthcare

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