Vol. 147 No. 4142 (2017)
Beliefs, endorsement and application of homeopathy disclosed: a survey among ambulatory care physicians
- Stefan Markun
- Marc Maeder
- Thomas Rosemann
- Sima Djalali
Explanation models for the effectiveness of homeopathy are not supported by natural sciences and the aggregated evidence from clinical trials is unconvincing. From this standpoint, placebo effects seem the most obvious explanation for the therapeutic effects experienced in homeopathy. Still, many physicians continue to prescribe homeopathic treatments.
Whether physicians who prescribe homeopathic treatments aim to achieve placebo effects or actually believe in specific effects is poorly understood. However, this distinction has important educational and ethical implications. Therefore, we aimed to describe the use of homeopathy among physicians working in outpatient care, factors associated with prescribing homeopathy, and the therapeutic intentions and attitudes involved.
All physicians working in outpatient care in the Swiss Canton of Zurich in the year 2015 (n = 4072) were approached. Outcomes of the study were: association of prescribing homeopathy with medical specialties (odds ratios [OR] and 95% confidence intervals [95% CI] from multivariable logistic regression); intentions behind prescriptions (to induce specific or nonspecific/placebo effects); level of agreement with specific attitudes; and views towards homeopathy including explanatory models, rating of homeopathy’s evidence base, the endorsement of indications, and reimbursement of homeopathic treatment by statutory health insurance providers.
The participation rate was 38%, mean age 54 years, 61% male, and 40% specialised in general internal medicine. Homeopathy was prescribed at least once a year by 23% of the respondents. Medical specialisations associated with prescribing homeopathy were: no medical specialisation (OR 3.9; 95% CI 1.7-9.0), specialisation in paediatrics (OR 3.8 95% CI 1.8-8.0) and gynaecology/obstetrics (OR 3.1 95% CI 1.5-6.7). Among prescribers, only 50% clearly intended to induce specific homeopathic effects, only 27% strongly adhered to homeopathic prescription doctrines, and only 23% thought there was scientific evidence to prove homeopathy’s effectiveness. Seeing homeopathy as a way to induce placebo effects had the strongest endorsement among prescribers and non-prescribers of homeopathy (63% and 74% endorsement respectively). Reimbursement of homeopathic remedies by statutory health insurance was rejected by 61% of all respondents.
Medical specialties use homeopathy with significantly varying frequency and only half of the prescribers clearly intend to achieve specific effects. Moreover, the majority of prescribers acknowledge that effectiveness is unproven and give little importance to traditional principles behind homeopathy. Medical specialties and associated patient demands but also physicians’ openness towards placebo interventions may play a role in homeopathy prescriptions. Education should therefore address not only the evidence base of homeopathy, but also ethical dilemmas with placebo interventions.
- Maddox J, Randi J, Stewart WW. “High-dilution” experiments a delusion. Nature. 1988;334(6180):287–91. doi:.https://doi.org/10.1038/334287a0
- Linde K, Alscher A, Friedrichs C, Wagenpfeil S, Karsch-Völk M, Schneider A. Belief in and use of complementary therapies among family physicians, internists and orthopaedists in Germany - cross-sectional survey. Fam Pract. 2015;32(1):62–8.
- White AR, Resch KL, Ernst E. Complementary medicine: use and attitudes among GPs. Fam Pract. 1997;14(4):302–6. doi:.https://doi.org/10.1093/fampra/14.4.302
- von Ammon K, Frei-Erb M, Cardini F, Daig U, Dragan S, Hegyi G, et al. Complementary and alternative medicine provision in Europe--first results approaching reality in an unclear field of practices. Forsch Komplement Med. 2012;19(s2, Suppl 2):37–43. doi:.https://doi.org/10.1159/000343129
- Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Rep. 2015;(79):1–16.
- Jong MC, van de Vijver L, Busch M, Fritsma J, Seldenrijk R. Integration of complementary and alternative medicine in primary care: what do patients want? Patient Educ Couns. 2012;89(3):417–22. doi:.https://doi.org/10.1016/j.pec.2012.08.013
- Poitevin B. Integrating homoeopathy in health systems. Bull World Health Organ. 1999;77(2):160–6.
- Piolot M, Fagot JP, Rivière S, Fagot-Campagna A, Debeugny G, Couzigou P, et al. Homeopathy in France in 2011-2012 according to reimbursements in the French national health insurance database (SNIIRAM). Fam Pract. 2015;32(4):442–8.
- Brien S, Lachance L, Prescott P, McDermott C, Lewith G. Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology (Oxford). 2011;50(6):1070–82. doi:.https://doi.org/10.1093/rheumatology/keq234
- Busato A, Künzi B. Differences in the quality of interpersonal care in complementary and conventional medicine. BMC Complement Altern Med. 2010;10(1):63. doi:.https://doi.org/10.1186/1472-6882-10-63
- Fent R, Rosemann T, Fässler M, Senn O, Huber CA. The use of pure and impure placebo interventions in primary care - a qualitative approach. BMC Fam Pract. 2011;12(1):11. doi:.https://doi.org/10.1186/1471-2296-12-11
- Hull SC, Colloca L, Avins A, Gordon NP, Somkin CP, Kaptchuk TJ, et al. Patients’ attitudes about the use of placebo treatments: telephone survey. BMJ. 2013;347(jul02 1):f3757. doi:.https://doi.org/10.1136/bmj.f3757
- Linde K, Friedrichs C, Alscher A, Blank WA, Schneider A, Fässler M, et al. Use of placebos and nonspecific and complementary treatments by German physicians--rationale and development of a questionnaire for a nationwide survey. Forsch Komplement Med. 2013;20(5):361–7. doi:.https://doi.org/10.1159/000356230
- Kanton Zürich, Direktion der Justiz und des Innern, Statistisches Amt: Gemeindefinanzporträt Kanton Zürich [Average per capita income in municipalities of the Canton of Zurich, data from 2011 to 2014, Download 06 April 2016]. http://www.statistik.zh.ch/internet/justiz_inneres/statistik/de/daten/finanzportraet.html; Accessed 23 May 2016.
- Interactive query tool based on the full census of Swiss physicians: Statistics of the Canton Zurich [Interaktives Abfragetool zur FMH-Ärztestatistik: Statistik des Kantons Zürich]. http://aerztestatistik.myfmh2.fmh.ch/; Accessed 19 May 2016.
- Hostettler S, Kraft E. FMH-Ärztestatistik 2015: Zuwanderung grundlegend für Versorgungssystem. SÄZ. 2016;97(12–13):448–53.
- Wardle J, Adams J, Sibbritt D. Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia. Homeopathy. 2013;102(3):199–206. doi:.https://doi.org/10.1016/j.homp.2013.03.002
- Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med. 1998;158(21):2303–10. doi:.https://doi.org/10.1001/archinte.158.21.2303
- Verhoef MJ, Sutherland LR. Alternative medicine and general practitioners. Opinions and behaviour. Can Fam Physician. 1995;41:1005–11.
- Salomonsen LJ, Fønnebø V, Norheim AJ, Pederson EJ. Attitudes about acupuncture and homeopathy among doctors in research positions: a survey. J Altern Complement Med. 2005;11(2):229–31. doi:.https://doi.org/10.1089/acm.2005.11.229
- von Studnitz FS, Eulenburg C, Mueck AO, Buhling KJ. The value of complementary and alternative medicine in the treatment of climacteric symptoms: results of a survey among German gynecologists. Complement Ther Med. 2013;21(5):492–5. doi:.https://doi.org/10.1016/j.ctim.2013.07.005