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Gathering the                                                evidence
           Monitoring the effectiveness of a homeopathic practice
           through an outcomes-based data collection system


                                               by Barbara J Braun BSc(Hons) DO Dip Ac DHoM MIRCH
                                               and Ruth M Odendaal LCPH

                                                                                                         large-scale funding for the project,
                                               It is common knowledge that homeopathy as                 and also to develop some means
                                               a therapy is currently undergoing a difficult period,     of monitoring other factors in the
                                               and there is a need to provide good and unbiased          day-to-day running of a large-scale
                                               evidence to demonstrate exactly how effective it is.      homeopathy programme. These
                                                  It was in this context that the Swaziland Homeo-       factors include: remedy use for
                                               pathy Project, a charity registered in the southern       keeping track of the pharmacy;
                                               African country of Swaziland, decided to set up           details of individual clinics; fre-
Barbara Braun was      Ruth Odendaal was
                                               a system for gathering evidence of patient outcomes       quency of symptoms; and statistics
born in Swaziland,     born in Zimbabwe
                                               as a result of homeopathic treatment. Initiated           on general patient population
and completed          and trained at the
                                               in June 2008, the Swaziland Homeopathy Project            demographics.
a BSc (Hons) in        College of Practical
Zoology at Reading     Homeopathy, grad-
                                               (SHP) currently conducts on average 19 clinics
University in the      uating in 2004.         per month. Most of these are free, mobile outreach        Collecting the information
UK. She then           She has been            clinics into the impoverished rural areas of northern     Since the majority of the project’s
qualified as an        a director and          Swaziland.                                                clinics are held outdoors in rural
osteopath in the UK    practising homeo-                                                                 areas, often in awkward condi-
and later also as      path for the Swazi-                                                               tions, cases are written, not com-
an acupuncturist       land Homeopathy                           In the process of justifying the need   puterised; and so a cover sheet
and homeopath.         Project for the past                      for further homeopathy clinics,         was devised to include all the
She has been in        three years; prior                        some of the questions that needed       details on each patient that need
private practice       to that she prac-                         to be addressed were:                   to be entered on the database. The
in Swaziland since     tised at an HIV clin-
                                                                 •   Is homeopathy actually working?     cover sheet has been designed in
1986. In 2008 she
co-founded the
                       ic in Kings Cross,
                       London and at                             •   Are the patients actually show-
                                                                     ing improvement?
                                                                                                         a user-friendly way so that the
                                                                                                         information is easily transferred.
Swaziland Homeo-
pathy Project
                       Neals Yard Reme-
                       dies. She was also                        •   Are the improvements noted
                                                                     just a result of taking the case
                                                                                                         However, in a different clinical
                                                                                                         setting, data could be captured
with two British       a manager for the
                                                                     and having someone listen?          directly as the case is taken.
homeopaths,            Richmond Shop
Julie Hodgson          and Therapy                               •   Are enough of the patients
                                                                     reporting improvement?
                                                                                                            For each patient, the following
                                                                                                         overall details are recorded: name,
and Shirley Reece.     rooms. She prac-
The methodology        tises a number of                         •   Which remedies are being pre-
                                                                     scribed most frequently?
                                                                                                         age, sex, HIV status and clinic
                                                                                                         location. Then for each individual
was based on the       healing modalities
Maun Homeopathy        such as Pleiadian                         •   How many of the patients are
                                                                     testing HIV positive?
                                                                                                         consultation, the following are
                                                                                                         noted: the date, the prescription,
Project initiated by   light work,
Hilary Fairclough
in Botswana.
                       Magnified healing
                       and Sekhem.
                                                                 •   Can the individual symptoms
                                                                     be tracked to see if they have
                                                                                                         the remedy justification (symptoms
                                                                                                         or rubrics for the remedy), a symp-
                                                                     improved, changed or aggravated?    tom score (VAS – see info box
                                                                 •   Is it worth all the effort?
                                                                 A straightforward data collecting
                                                                                                         on page 32), an evaluation of the
                                                                                                         treatment, and finally a patient and
                                                                 system was set up to try to provide     practitioner overall health score
                                                                 clear answers to some of these          out of 10 (based on the Karnofsky
                                                                 questions. The motivation for this      scale in which 10 = completely
                                                                 was principally to see whether          healthy – see info box on page 38).
                                                                 it would be worth applying for          These two scoring systems are the

30                                                                                                        Homeopathy in practice Autumn 2011
                                                                                                                          FEATURE




basis for the analysis, provid-
ing both subjective and objective
observations.
   The details of each consultation
are then entered on a weekly basis,
and the patients can then be con-
stantly and easily monitored and
evaluated.
   When deciding the evaluation
scores, it was thought best to stay
with existing scientific systems.
The VAS Symptom score is on
a scale of 0-5, where 5 = highest
severity, 0 = symptom is cleared.
This is evaluated by the practi-
tioner, although it would also be
possible to have both patient and
practitioner score this.

Some case examples
The following cases illustrate how
the patient scores change over
time and indicate improvement or
otherwise. Swaziland Homeopathy
Project adopts the Layers method
(Eizayaga model) for prescriptions
considering miasmatic, constitu-
tional, fundamental and lesion lay-
ers. This is because many of our
cases are of advanced pathology
and often complicated with drugs
and are complex with multiple
aetiologies.                           yellow phlegm. She has financial       Barbara with      Nat mur 200: thrice weekly: cough.
   This involves giving different      stresses as husband not working.       a patient at an   Patient score: 5/10.
remedies in sequence over a period        Burning itching eyes. Can’t focus   outreach clinic
of a week. The remedies are given      her vision. Has a stye in her right                      NB: Patient didn’t return until ten
to last for one month. We aim to       eye. Deaf in right ear. Heartburn in                     months later. Says all cough etc
see patients on a monthly basis        stomach when eating bitter things.                       was cleared.
and they will follow up until they     She is breastfeeding, therefore no                       Patient score: 8/10 on original
feel well.                             menstruation. Itching skin with                          symptoms.
                                       sores on the thighs and buttocks.
Case 1: Female, 27yrs, HIV negative    Watery discharge, worse in rainy                         Follow-up 9.3.10
                                       weather.                                                 Now HIV positive. Waiting to
1st consultation 24.2.09                                                                        start on ART (Anti-retroviral
Presenting complaint: Backache,        Prescription                                             therapy). CD4: 253 (see CD4
headache, dizziness, cough. Has        Tuberculinum bovinum 200: twice                          Count info box on page 39)
a history of TB. December 08:          weekly: history of TB with recur-                        Presenting new symptoms: cough
Completed TB treatment with local      rent symptoms of cough, dizziness,                       has developed. Chest pain with
hospital. Has four children. Sole      headache, sweating.                                      cough burning ‘like a sore inside’,
wage earner, weaving baskets for       Natrum muriaticum 30: thrice                             yellow sputum. Loss of appetite.
Tintsaba crafts. Breastfeeding. Has    weekly: dizziness with dry cough.                        ++ thirsty, worse with cloudy
a throbbing pain in backbone from      Itching skin with watery blisters.                       weather. Has had this for one
top of spine to bottom which is        Chronic headaches throbbing from                         week now. Headache with cough
worse at night. Suffers from sleep-    morning till evening. Itching, burn-                     in forehead and occiput, worse in
lessness due to this. Has headaches    ing eyes.                                                heat and light.
all the time which make her cry. It    Patient score: 3/10.                                        Has new mental stresses; husband
is a throbbing pain, mostly in fore-                                                            is in love with another woman. He
head, morning till evening. Has        Follow-up 12.5.09                                        now has a job but is supporting his
had this for the past year. These      Dizziness has now gone. Cough                            lover and her three children, not
headaches started with a cough         now expectorating, whitish watery.                       her. She has four children to sup-
accompanied by dizziness, heat,        No smell. Pain on right side with                        port. He has abandoned his family
sweating and palpitations. The         cough.                                                   with no support. Feels very sad
cough is a dry cough worse in cold                                                              about this. Cries by herself, feels
weather with a pricking or sharp       Prescription: repeat remedies in                         better for it. Is still breastfeeding.
pain. No sputum.                       higher potencies.
   Her child is ill and this worries   Tub bov 1M: twice weekly:                                Prescription
her. He has a constant cough with      history TB.                                              Arsenicum album 200: thrice

Homeopathy in practice Autumn 2011                                                                                                 31
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weekly: burning pains with              Liver drainage support (Carduus
cough. Yellow sputum. ++ thirst.        marianus + Chelidonium +                Visual Analogue Scale (VAS):
Financial worries. Poverty.             Hydrastis) 30x: four times weekly.
Headache with cough. Loss of            ART side effects: burning, numb-        This is commonly used in the medical field, especially
appetite.                               ness, loss of appetite.                 oncology, to assess change in symptomology.
Tub bov 30: twice weekly: repeat        Patient score: 4/10.
history of TB.                                                                  Symptom evaluation:
Patient score: 5/10.                    Case 2: Female, 43yrs, HIV negative     0: Completely better, no symptoms any more
                                                                                1: Noticeable, mild, irritating, occasional, part time,
Follow-up 13.4.10                       1st consultation 24.2.09                   an inconvenience, ‘It hurts a bit.’
Started ART (Anti-retroviral            Presenting complaint: Headaches.        2: Most of the time, can’t easily ignore, bit restric-
therapy); CD4 count 253.                Backache. Ovarian tubes tied two           tive, ‘It bothers me a lot.’
Presenting: Cough still remains.        yrs ago. Terrible headaches with        3: Constant, all of the time, can’t ignore, restricts
Burning pains in chest. Cough           throbbing in the temples for past          activity at times, ‘My pain is …’
now dry. No sputum. Worse in            six months. Itching eyes. With          4: Severe, all the time, intense, strong, incapacitat-
evenings. The cough comes with          lachrymation. Basket weaver for            ing, overwhelming, ‘I’m in pain.’
a stomach ache with a desire            Tintsaba crafts. The weaving            5: Critical, intense, overwhelming, all consuming,
to vomit; she ends up vomiting.         makes it worse. She says the               ‘Help me,’ desperate.
Also a desire to sit up with cough.     headaches and eye problems are          (http://en.wikipedia.org/wiki/Visual_analogue_scale)
Still ++ thirst and loss of appetite.   connected.
Throbbing headache on right side           Lower backache started two                              backache with ‘lightning pains’.
with cough. Worse in evening,           months ago. The pain is like a                             Worse with motion.
worse in cold.                          ‘lightning pain’, especially bad                           Patient score: 4/10.
   Still sadness over family prob-      when getting up and with any
lems. Can’t see a change. ‘Hopeless     movement that is quick, also with                          Follow-up 23.6.09
of future.’ Won’t confront her hus-     side-to-side movement. Has an irri-                        Presenting complaint: headaches
band about the financial and other      tating cough but no pain.                                  have gone completely >>>. They
problems. She has no food. Is expe-        Has huge financial stress. Five                         had been there for six months.
riencing dizziness and numbness on      children in school. Sole wage earn-                        Cough now has an expectorant
right side of body with the ART.        er. Husband is ill. Feels very angry                       which is yellow in colour. Not
                                        when can’t provide for children.                           painful. Has gone in two-week
Prescription: NB: case compro-          Her head hurts with this.                                  cycles since Oct last year. It started
mised by ART.                              Has a slight cough with clear                           when caring for sick mother in
Phosphorus 200: thrice weekly:          phlegm. No pain. Nothing serious.                          hospital; she had a cough (pneu-
HIV. Cough with vomiting.               Can’t sleep due to her problems of                         monia / TB). Had to sleep outside.
Burning pains in chest with cough.      finances. Thinks a lot at night.                           It was cold. All else OK.
Grief. ++ thirst. Worse when cold.
Carcinosin 30: twice weekly: HIV.       Prescription                                               Prescription
Immune deficiency. Grief. Over-         Sulphur 30: twice weekly: terrible                         Hepar sulph 200: thrice weekly:
responsibility. Drug suppression.       headaches with throbbing in tem-                           constant cough with yellow spu-
Tissue salts 6x (all tissue salts in    ples and itching eyes. Fear of                             tum. Worse with cold.
combination): four times weekly:        poverty. Constitutional.                                   Tub 200: twice weekly: consistent
immune boost.                           Hypericum 1M: twice weekly:            Mpofu clinic        cough. Past eight months. Family
                                                                                                   history cough.
                                                                                                   Patient score: 8/10.

                                                                                                   Follow-up 22.9.09
                                                                                                   NB: New problem. All previous
                                                                                                   symptoms >>>
                                                                                                   Presenting complaint: Vision is
                                                                                                   bad, gets fogginess in front of eyes.
                                                                                                   They are itching. Worse strain with
                                                                                                   handicraft. All else clear.

                                                                                                   Prescription
                                                                                                   Nat mur 30: thrice weekly: eyes,
                                                                                                   vision, bad, worse from eyestrain.
                                                                                                   Eyes itching in morning.
                                                                                                   Patient score: 8/10.

                                                                                                   Follow-up 26.1.10
                                                                                                   NB: New problem. All previous
                                                                                                   symptoms >>>
                                                                                                   Presenting complaint: right ankle
                                                                                                   pain. Worse after exertion i.e. long
                                                                                                   walking. Worse on further exertion
                                                                                                   i.e. any movement after resting.

32                                                                                                  Homeopathy in practice Autumn 2011
                                                                                                                              FEATURE




Prescription
Rhus toxicodendron 200: thrice
weekly: ankle strain. Worse after
exertion.
Patient score: 8/10.

Follow-up 9.3.10
Symptoms got better, then returned
again after three months.
Presenting complaint: pain under
heel. Throbbing. Worse in cold
water, walking long distance. Now
is starting to extend up the ankle.

Prescription
Rhus tox 30: thrice weekly: old
sprain injury. Painful throbbing in
heels.
Patient score 8/10.

Follow-up 13.4.10
Ankle now all >>>.
Presenting complaint: cough with
headache, i.e. common cold.
Cough is dry with pain ‘like a tear-
ing apart’ in middle of chest. She
has thirst and is worse in evening.
Headache is worse in heat and
heavy work. Also with thinking.
She has financial stress with school
fees. Young daughter also preg-
nant. She has throbbing on side of
the head. Gets angry. Cries a lot
with her troubles in evening, will
then go to bed.

Prescription
Bryonia 200: thrice weekly: dry
cough with sharp pains. Thirst
and financial worries. Common
cold with headache. Throbbing in
temples.
Patient score: 8/10.

Case 3: Female, 55yrs. Not tested
for HIV

First consultation 27.11.09                She has constipation and burning    Patients at Mgululu   Hormonal balance.
Presenting complaint: fibroids for      and throbbing in her feet. Worse in    clinic                Patient score: 5/10.
the past 20yrs, untreated. Peri-        hot weather. Her arms ache with
menopausal. Headaches with              the handicraft work. She earns a                             Follow-up 12.2.10
menses. Painful knees. She has          living from handicraft. This is how                          Presenting complaint: no more pain
‘lumps in the womb’, experiences        she supports her family. Her knees                           with menses >>>. Can feel the
painful menstruation with heavy         ache from long sitting when doing                            lumps reducing. Feet still burning.
bleeding. Like ‘labour pains’, starts   handicraft. Better after stretching.                         Knees >>>. Tiredness better but not
with a ‘kicking sensation’. Loses                                                                    gone. She has developed an itching
energy a lot with this. She also has    Prescription                                                 rash with whitish spots that darken
a headache with this menstruation.      Medorrhinum 200: twice weekly:                               after scratching.
This has all been since the birth       fibroids, burning feet and rotten
of her last child.                      discharge.                                                   Prescription
   Husband died two yrs ago, after      Sepia 30: thrice weekly: fibroids                            Medorrhinum 30: twice weekly.
the birth of her last child. She wor-   with ‘labour pain’ with bleeding.                            Sepia 30: thrice weekly.
ries a lot about looking after her      NBWS birth of last child. Head-                              Thyroidinum 30x: twice weekly.
children.                               aches with bleeding. Menopause                               Patient score: 7/10.
   She has itching in her vagina        starting.
with yellow discharge which smells      Thyroidinum 30x: thrice weekly:                              Follow-up 12.3.10
rotten.                                 organ support. Fibroid drainage.                             Presenting complaint: can still feel

Homeopathy in practice Autumn 2011                                                                                                      33
FEATURE




fibroid reducing. Menstruation                    treatment may be effectively
flow is much lighter. No pain                     evaluated.                                    Table 3: Example of individual clinic statistics
either. Only has tiredness left in                                                              Swaziland Homeopathy Project – July 2011
shoulders. Has started skipping                   Compiling the information
menses i.e. menopause. Skin has                   Two databases were set up: one for            Summary by location
now cleared >>>.                                  all the clinics and patients overall,         Change between consultations, for first four consultations
                                                  and a separate database for a study           Endzingeni
Prescription                                      of the HIV positive patients as part          Number of patients:      83         HIV status:
Sepia 30: thrice weekly.                          of ongoing research into the effect           Number of patients                  Not tested                17
Medorrhinum 30: twice weekly.                     of an integrated approach in the              with follow-ups:         45         Tested negative           28
Thyroidinum 30x: twice weekly.                    treatment of HIV / AIDS.                                                          Tested positive           21
Patient score: 8/10.                                 Homeopaths are often criticised            Progress at each follow up:         Unknown                   17
                                                  for not doing sufficient research
From these case studies, it can be                and so-called clinical trials. How-           Patient                             Practitioner
seen that a simple score can easily               ever, it is possible to provide solid         Aggravated             12%          Aggravated                9%
demonstrate the changes in the                    information from pragmatic obser-             No change              24%          No change                24%
case, and in this way homeopathic                 vational studies that are conducted           Improved               64%          Improved                 67%

                                                                                                Vusweni
 Table 1: Patient status, gender and age groups                                                 Number of patients       48         HIV status:
                                                                                                Number of patients                  Not tested                 6
 Swaziland Homeopathy Project – July 2011
                                                                                                with follow-ups          30         Tested negative           25
 Total               1799                                                                                                           Tested positive            9
 Gender                                                                                         Progress at each follow up:         Unknown                    8
 Male:                253
                                                                                                Patient                             Practitioner
 Female              1546
                                                                                                Aggravated             16%          Aggravated               15%
 HIV status       Total        Male      Female                Age distribution                 No change:             17%          No change                19%
 Tested positive   320           33         287                Under 10           109           Improved               67%          Improved                 66%
 Tested negative   662           53         609                10 – 19             83
 Not tested        392           68         324                20 – 29            239
 Suspected positive 11            6           5                30 – 39            315
                                                                                                Table 4: Example from HIV database
 Unknown           413           92         321                40 – 49            358
 Patients on ART   155           19         136                50 – 59            292           Swaziland Homeopathy Project – July 2011
                                                               60 – 69            216
                                                               70 – 79            101           Most frequently used remedies
                                                               Over 79             41           (Remedies prescribed at least 10 times)

                                                                                                Remedy                            No. of times
                                                                                                Tuberculinum                                32
 Table 2: Overall changes in evaluations                                                        Carcinosin                                  30
 Swaziland Homeopathy Project – July 2011                                                       Natrum muriaticum                           22
 Change between consultations, for first four consultations                                     Sulphur                                     19
                                                                                                Arsenicum album                             18
 Patient                                           Practitioner                                 Phosphorus                                  15
 All follow-ups:                      1514         All follow-ups:                  1514        Medhorrhinum                                15
 Improved             940    62%                   Improved        962     64%                  Rhus toxicodendron                          13
 No change            373    25%                   No change       368     24%                  Pulsatilla                                  11
 Aggravated *         200    13%                   Aggravated      184     12%                  Bryonia                                     10

 Follow-ups – HIV+                     319         Follow-ups – HIV+                  319
 Improved             195    61%                   Improved        208     65%                                         on an ongoing basis. This would
 No change             75    24%                   No change        68     21%                                         serve as concrete evidence for
 Aggravated            49    15%                   Aggravated       43     13%                                         the efficacy of homeopathy. Indi-
                                                                                                                       vidual cases as well as large groups
 Follow-ups – patients on ART          182         Follow-ups – patients on ART       182                              of patients may be practically
 Improved            111      61%                  Improved        118     65%                                         analysed.
 No change             41     23%                  No change        38     21%
 Aggravated            30     16%                  Aggravated       26     14%                                         Monthly reports and analyses

 Follow-ups – patients not on ARVS     145         Follow-ups – patients not on ARVS 145                               1. Patient statistics and demographics
 Improved              88     61%                  Improved:        94     65%                                         This information is important for
 No change             36     25%                  No change        32     22%                                         general statistical purposes, and
 Aggravated            21     14%                  Aggravated       19     13%                                         gives an idea of the overall status
                                                                                                                       of the patients seen at clinics (see
 * ‘Aggravated’ does not mean a remedy aggravation; it reflects the patient’s current overall                          Table 1). This is very useful data in
 health. It includes new symptoms as well as changes in previously observed symptoms.                                  general. Due to stigma over HIV /
                                                                                                                       AIDS in Swaziland, many people

34                                                                                                                      Homeopathy in practice Autumn 2011
                                                                                                                       FEATURE




                                                                                             are not tested and are unwilling to
Table 5: Example from overall database                                                       do so. The last census conducted
Swaziland Homeopathy Project – July 2011                                                     in this country was in 2007 and
                                                                                             most of the statistics are projec-
Analysis of changes in symptoms severity                                                     tions made on the results of this
                                                                                             census. Any accurate information is
Total symptom follow-ups                                               3419
                                                                                             therefore very useful in this regard.
Improved                           214            63%
No change                          799            23%
                                                                                             2. Overall patient evaluations
Aggravated                         477            14%
                                                                                             This report gives an overview of
Symptom follow-ups –                                                                         all the patients who have returned
HIV+                                                                    837                  for follow-up treatments along with
Improved                           507            61%                                        the patient and practitioner scores
No change                          218            26%                                        (see Table 2). From this, a steady
Aggravated                         112            13%                                        average overall improvement of
                                                                                             60-65% in patient scores can be
Symptom follow-ups –                                                                         observed. This applies to both the
patients on ART                                                         508                  patient and practitioner evaluations.
Improved                           303            60%                                        These scores are for the previous
No change                          133            26%                                        six-month period of follow-ups.
Aggravated                          72            14%

Symptom follow-ups –                                                                         3. Individual clinic statistics
patients not on ART                                                     350                  This report allows each clinic to be
Improved                           215            61%                                        individually tracked and checked
No change                           92            26%                                        to see how many patients are fol-
Aggravated                          43            12%                                        lowing up and how this can be
                                                                                             improved if necessary (see Table 3).
Note: If symptoms have not been scored within a six-month period, they are not included in   This is particularly useful for pre-
this analysis.                                                                               paring feedback to the women’s
                                                                                             handicraft groups that partner the
                                                                                             project. It also enables monitoring
Table 6: Example: HIV database (300 patients)                                                of the success of the individual
                                                                                             clinics. Each of these clinic loca-
Swaziland Homeopathy Project – July 2011                                                     tions is visited once a month.
Comparison of symptom changes by practitioner
                                                                                             4. Analysis of remedy use
Practitioner                   Improved         No change         Aggravated        Total    The remedy / prescription analysis
Practitioner A              206    65%           69 22%             44 14%           319     provides interesting information
Practitioner B              184    63%           75 26%             34 12%           293     regarding the nature of the treatment,
Practitioner C               11    50%            6 27%              5 23%            22     and in the case of the HIV database,
Practitioner D               11    46%           13 54%              0   0%           24     some insight into the ‘genus epidemi-
Practitioner E                3    38%            3 38%              2 25%              8    cus’ of the HIV / AIDS pandemic
Practitioner F                3 100%              0    0%            0   0%             3    in Swaziland (see Table 4).
Practitioner G                3    75%            1 25%              0   0%             4      As can be seen, the most com-
Practitioner H                2 100%              0    0%            0   0%             2    monly used prescriptions are tuber-
Practitioner I                1 100%              0    0%            0   0%             1    cular remedies with the exception
Practitioner J                1    25%            3 75%              0   0%             4    of Rhus tox. The presence of Rhus
                                                                                             tox is probably due to the high
                                                                                             prevalence of herpes zoster in HIV
Swaziland Homeopathy Project – July 2011                                                     positive patients.
Overall database (1,800 patients)
                                                                                             5. Summary of symptom changes
Comparison of symptom changes by practitioner                                                This report gives an overview
                                                                                             of the total symptoms that were
Practitioner                    Improved        No change         Aggravated        Total    scored at the follow-up treatments,
Practitioner A             1033     62%         374 23%            247 15%          1654     and gives an idea of whether the
Practitioner B              824     62%         314 24%            185 14%          1323     symptoms are improving as a result
Practitioner C               97     59%          51 31%             16 10%           164     of treatment within a period of six
Practitioner D               63     64%          22 22%             13 13%            98     months (see Table 5). There is also
Practitioner E               31     84%           6 16%              0   0%           37     an additional symptom report which
Practitioner F               24     62%          11 28%              4 10%            39     scores the frequency of symptoms;
Practitioner G               23     61%           8 21%              7 18%            38     for example, it can be seen from this
Practitioner H               15     88%           2 12%              0   0%           17     report that grief, cough and headache
Practitioner I               12     75%           1    6%            3 19%            16     are the most common symptoms
Practitioner J               11     61%           6 33%              1   6%           18     treated. This ties in with the tuber-
Practitioner K               10     77%           2 15%              1   8%           13     cular nature of the chronic disease
                                                                                             most commonly encountered.

Homeopathy in practice Autumn 2011                                                                                              35
FEATURE




6. Practitioner symptom analysis
When the symptoms are scored,            Table 7: Analysis of patient and practitioner overall evaluations – July 2011
they are linked to the practitioner      Swaziland Homeopathy Project ART Study
who prescribed at that consulta-         No treatment figures based on all first consultation scores i.e. pre-treatment
tion. This enables the database          Treatment    figures based on last consultation for each patient receiving treatment where they have followed up
                                         Comparison of patient and practitioner evaluations for patients receiving homeopathic treatment compared with
to track the number of symptoms          no treatment
improved, aggravated or unchanged
as per prescription. In this way the     Patient scores
effectiveness of the practitioner can    HIV+                             ART
be measured (see Table 6).                                                No. of patients                   Average score                 std dev
                                         No treatment                     146                               5.58                          0.11
   The scores only really start to       Homeopathic treatment             71                               7.28                          0.18
have significance at a higher num-       Difference                                                         1.70                          1.70
ber of symptoms, but it can be seen                                                                         significant at 99.9% confidence levels
that practitioners A and B (in both                                       t*                                                              71.89
                                                                          approx df *                                                     48
tables) have on average a score of                                        highly significant: t for 50 df
about 60-65% improved symptoms                                            0.001 probability = 3.496
on the VAS score analysis. This is                                        99.9% confidence interval                                       1.70
similar to the overall patient and                                        +/-                                                             0.09
                                                                          range from                                                      1.61
practitioner Karnofsky score analy-                                       to                                                              1.80
sis, which is also in this range. So
with these two scores from differ-       Practitioner scores
ent scales one may fairly accurately     HIV+                             ART
                                                                          No. of patients                   Average score                 std dev
say that homeopathy has brought          No treatment                     146                               5.38                          0.10
about a 60-65% improvement in            Homeopathic treatment             71                               7.18                          0.19
the health of this sample of 1,800       Difference                                                         1.80                          1.80
patients. This is evident in both                                                                           significant at 99.9% confidence levels
HIV and overall databases (see                                            t                                                               76.94
                                                                          approx df                                                       45
Table 6).                                                                 highly significant: t for 40 df
   The above reports are compiled                                         0.001 probability = 3.551
on a monthly basis. In addition                                           99.9% confidence interval       1.80
to this, it is possible to carry out                                      +/-                                                             0.09
                                                                          range from                                                      1.71
further statistical analysis of the                                       to                                                              1.90
database results. The patients
on the HIV database were statisti-       Patient scores
cally analysed using the Student’s       HIV+                             No treatment
                                                                          No. of patients                   Average score                 std dev
t-test (see info box on page 39).        ART                              146                               5.58                          0.11
                                         No ART                           154                               6.17                          0.43
ART study background                     Difference                                                         0.59                          0.59
In Swaziland, patients are only eli-                                                                        significant at 99.9% confidence levels
                                                                          t                                                               16.59
gible for free anti-retroviral treat-                                     approx df                                                       88
ment (ART) if their CD4 count                                             highly significant: t for 80 df
is below 350. Many patients are                                           0.001 probability = 3.416
therefore not yet eligible for ART.                                       99.9% confidence interval       0.59
Those that are on ART and suffer-                                         +/-                                                             0.12
                                                                          range from                                                      0.47
ing from side effects such as peri-                                       to                                                              0.71
pheral neuropathy, nausea, vertigo
and headache, can get a great deal       Practitioner scores
of relief from homeopathic               HIV+                             No treatment
                                                                          No. of patients                   Average Score                 std dev
treatment. Homeopathy does not           ART                              146                               5.38                          0.10
interfere with ART and the               No ART                           154                               5.58                          0.12
patients are more able to adhere to      Difference                                                         0.21                          0.17
their treatment regime.                                                                                     significant at 99.9% confidence levels
                                                                          t                                                               16.51
   It should be noted that the project                                    approx df                                                       218
is not claiming to cure HIV / AIDS                                        highly significant: t for 120 df
and recommends that patients                                              0.001 probability = 3.373
test to determine their status. The                                       99.9% confidence interval        0.21
                                                                          +/-                                                             0.04
patients who are not yet on ART                                           range from                                                      0.17
are even more in need of assistance,                                      to                                                              0.25
and homeopathy is able to help
in maintaining the health of these       * t = t distribution df = degrees of freedom
patients by boosting their immunity      All comparisons showed highly significant differences, using the Student's t test for statistical analysis.
as well as facilitating the recovery
from opportunistic infections.           Interpretation: Comparisons between no treatment and treatment showed a significantly better evaluation of health
   From the database information,        irrespective of whether the patients were on ART and whether the scoring was by the patient or the practitioner.
a statistical analysis of practitioner   Based on both patient and practitioner evaluations, prior to homeopathic treatment, patients not on ART scored a
and patient scores shows the             higher overall evaluation of health.
following (see Table 7).

36                                                                                                                      Homeopathy in practice Autumn 2011
                                                                                                                                    FEATURE




                                                                                                    This study provides
                                                                                                    empirical evidence
No ART
                                                                                                    that as a result of
                                                                                                    homeopathic treatment
No. of patients                    Average score                 std dev
154                                6.17                          0.43
 78                                7.10                          0.20
                                    0.93                         0.93

t
approx df
                                   significant at 99.9% confidence levels
                                                                 22.60
                                                                 444
                                                                                                    there is a significant
                                                                                                    positive measure of
highly significant: t for 120 df
0.001 probability = 0 3.373
99.9% confidence interval                                       0.93
+/-                                                             0.16
range from
to
                                                                0.77
                                                                1.09                                change in overall
No ART
No. of patients                    Average score                 std dev                            health scores
154                                5.58                          0.12
  78                               8.19                          1.15
                                    2.61                         2.61
                                   significant at 99.9% confidence levels
t                                                                19.95
approx df                                                        39
highly significant: t for 40 df
0.001 probability = 3.551                                                                                   What can be inferred from these
99.9% confidence interval                                       2.61                                        statistics?
+/-                                                             0.51                                        It is probable that patients on ART
range from                                                      2.09
to                                                              3.12                                        were experiencing some drug side
                                                                                                            effects and therefore scored lower
                                                                                                            at the start, prior to the homeo-
Treatment                                                                                                   pathic treatment. However, once
No. of patients                    Average Score                 std dev
71                                 7.28                          0.18                                       these patients had received homeo-
78                                 7.10                          0.20                                       pathy, those on ART scored higher
                                   0.18                          0.00                                       overall – higher even than those
                                   significant at 99.9% confidence levels                                   not yet on ART. It may be that
t                                                                5.75
approx df                                                        147
                                                                                                            after the homeopathic treatment,
highly significant: t for 120 df                                                                            the side effects were alleviated and
0.001 probability = 3.373                                                                                   the patients generally felt better.
99.9% confidence interval                                       0.18                                        This analysis was from a sample
+/-                                                             0.08                                        of about 300 patients and gives
range from                                                      0.10
to                                                              0.26                                        a good indication that there is
                                                                                                            a significant difference in patients
                                                                                                            getting homeopathic treatment as
Treatment                                                                                                   well as the standard ART.
 No. of patients                   Average Score                 std dev
 71                                7.18                          0.19                                          This study provides empirical
 78                                8.19                          1.15                                       evidence that as a result of homeo-
                                    1.01                         0.65                                       pathic treatment there is a signifi-
                                   significant at 99.9% confidence levels                                   cant positive measure of change in
t                                                                7.65
approx df                                                        40                                         overall health scores.
highly significant: t for 40 df
0.001 probability = 3.551                                                                                   Conclusions
99.9% confidence interval                                       1.01                                        As a result of maintaining simple
+/-                                                             0.36
range from                                                      0.65
                                                                                                            and consistent records, the data-
to                                                              1.37                                        base can be used to provide
                                                                                                            answers at some level to all the
Comparison between patients on ART and not ART showed an interesting difference between                     original questions that were posed.
patient and practitioner scoring, where the patient scores show that patients on ART evaluated
their health at a higher level than the evaluations by the practitioners, to the extent that they           Is homeopathy actually working?
scored higher than patients not on ART when looking at patient scores in contrast to the                    Yes: 60-65% of patients reported
reverse when looking at practitioner scores.                                                                improved overall health scores.

                                                                                                            Are the patients actually showing
                                                                                                            improvement?

  Homeopathy in practice Autumn 2011                                                                                                         37
FEATURE




 Karnofsky performance status scale score:                           Our modified version, ‘Patient score’ in the cases, is

 The Karnofsky score runs from 100 to 0, where 100 is ‘perfect’      Modified Karnofsky:
 health and 0 is death. Although the score generally uses inter-     10 Normal, no complaints or evidence of disease (I am well)
 vals of 10, a practitioner may choose decimals if he or she feels    9 Able to perform normal activity; minor signs and symp-
 a patient’s situation holds somewhere between two marks. It             toms of disease (I feel the problem only a little)
 is named after Dr David A Karnofsky, who described the scale         8 Some signs and symptoms of disease (My problem is still
 with Dr Joseph H Burchenal in 1949.                                     there sometimes but not very bad)
    Karnofsky score is a subjective measure of how well the           7 Able to perform normal activity with effort; signs and
 patient is doing.                                                       symptoms of disease (I can work but my problem is
 100 Normal, no complaints or evidence of disease                        always there)
  90 Able to perform normal activity; minor signs and symptoms        6 Cares for self but difficulty performing normal activity or
      of disease                                                         doing active work (The problem makes it difficult for me
  80 Able to perform normal activity with effort; some signs             to work)
      and symptoms of disease                                         5 Requires occasional assistance but is able to care for
  70 Cares for self, unable to perform normal activity or to do          most of own needs (I can manage but the problem makes
      active work                                                        me weak and prevents me from doing the things I need
  60 Requires occasional assistance but is able to care for most         to do)
      of own needs                                                    4 Partially disabled; able to walk only with assistance (I am
  50 Requires considerable assistance and frequent medical care          weak and need help to walk)
  40 Requires special care and assistance; disabled                   3 Severely disabled although death not imminent (I am
  30 Hospitalisation indicated, although death not imminent;             very, very weak)
      severely disabled                                               2 Hospitalisation necessary; active supportive treatment
  20 Hospitalisation necessary; active supportive treatment              required, very sick (I cannot get up or walk)
      required, very sick                                             1 Fatal processes progressing rapidly; dying state (I am very
  10 Fatal processes progressing rapidly; dying state                    sick and weak, cannot eat or get up)
    0 Dead.                                                           0 Death.
 (http://en.wikipedia.org/wiki/Performance_status)




38                                                                                                  Homeopathy in practice Autumn 2011
                                                                                                                     FEATURE




                                                                                    The project is not
                                                                                    claiming to cure
                                                                                    HIV / AIDS


Yes: 60-65% of symptoms showed              How many of the patients have
improvement.                                tested HIV positive?                             Student’s t test
                                            18% of patients have been tested
Are the improvements noted just             HIV positive; however, 45% of                    The Student’s t test is a standard
a result of taking the case and hav-        patients have not been tested at all.            statistical analysis:
ing someone listen?
This is difficult to determine from         Can the individual symptoms be                   T = t distribution
the data. From the case studies, it         tracked to see if they have im-                  df = degrees of freedom
can be seen that many patients suf-         proved, changed or aggravated?
fer from poverty and social prob-           Yes, the database makes this easy.               A t test is any statistical hypoth-
lems, and have no access to coun-                                                            esis test in which the test statis-
selling or other social services.           Is it worth all the effort?                      tic follows a Student’s t distribu-
Spending time listening to the              The practitioners have found that                tion, if the null hypothesis is
patient is an important part of the         the process of collecting data has               supported. It is most commonly
healing process. For example, in            improved their overall practice,                 applied when the test statistic
one instance, on being asked to             because it provides a clear over-                would follow a normal distribu-
give a score a patient commented:           view of the day-to-day work of                   tion if the value of a scaling
   When I came in I was definitely 5, but   the project.                                     term in the test statistic were
   now that I have told you my story I am                                                    known. When the scaling term
   10 out of 10(!), when the remedies       Barbara Braun can be contacted at                is unknown and is replaced by
   had not even been prescribed yet.        bjb@africaonline.co.sz.                          an estimate based on the data,
However, infants and small children                                                          the test statistic (under certain
who were not directly questioned                                                             conditions) follows a Student’s
showed similar improvements in                                                               t distribution.
symptoms and overall health.
                                                                                             Calculations
Are enough of the patients report-                                                           Explicit expressions that can be
ing improvement?                                                                             used to carry out various t tests
The improvement rates are high                                                               are given below. In each case,
enough to justify the continuation                                                           the formula for a test statistic
of free clinics.                                                                             that either exactly follows or
                                                                                             closely approximates a t distri-
Which remedies are being                                                                     bution under the null hypothesis
prescribed most frequently?                                                                  is given. Also, the appropriate
Mainly tubercular remedies.                                                                  degrees of freedom are given
                                                                                             in each case. Each of these
                                                                                             statistics can be used to carry


 CD4 Count
                                            The improvement                                  out either a one-tailed test or
                                                                                             a two-tailed test.
                                                                                                Once a t value is determined,
 People infected with HIV lose
 helper T lymphocytes (CD4+
                                            rates are high                                   a p value can be found using
                                                                                             a table of values from Student’s
                                                                                             t distribution. If the calculated
 cells) in three phases over
 months or years. A healthy
 person has a CD4+ lymphocyte
                                            enough to                                        p value is below the threshold
                                                                                             chosen for statistical signifi-
                                                                                             cance (usually the 0.10, the
 count of roughly 800 to 1300
 cells per microlitre of blood.             justify the                                      0.05, or 0.01 level), then the
                                                                                             null hypothesis is rejected
                                                                                             in favour of the alternative
 (The Merck Manual of Medical
 Information (1999, Home                    continuation of                                  hypothesis.
                                                                                             (http://en.wikipedia.org/wiki/
 Edition) 187, 1012 – 1013)
                                            free clinics                                     Student’s_t-test)


Homeopathy in practice Autumn 2011                                                                                             39

				
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