Patient and physician assessments of disease severity and quality of life consistently demonstrated substantial improvements following homeopathic treatment, which were maintained through 24 months' follow up. Improvements were more pronounced in younger patients and in those with greater disease severity compared to older patients and those with less severe disease at baseline.
To our knowledge, the present study is the first to evaluate systematically the range of diagnoses and therapies in classical homeopathic medical practices in Germany and Switzerland. In addition, the study provided information on the course of illness in patients receiving homeopathic treatment, as assessed by patients and physicians.
The methodological strengths of our study include consecutive enrolment of a large sample size, the participation of approximately 2% of all physicians certified to practice homeopathy in Germany and 28% of all members of the Hahnemann Association (an organisation for physicians practicing only 'classical' homeopathy) and the use of standardised outcome instruments also used in studies on conventional therapy.
One limitation of our study is that the observed effects cannot be categorized with respect to specificity, i.e. we cannot draw conclusions as to the beneficial mechanisms. Furthermore patients were allowed to use conventional therapies during the study period in addition to homeopathic treatment. Thus, the observed improvement cannot be attributed to homeopathic treatment alone. The aim of the investigation, however, was not to test the effectiveness of homeopathic treatment alone, but rather provide systematic and detailed information about the current status of homeopathic medical care in routine practice and its effectiveness. These data may also be helpful in the planning of further research projects on homeopathy.
The effects observed by patient and the physician assessment, as well as those seen with regard to quality of life, deserve additional comments. The average severity of the chronic diseases was reduced by approximately 50% after only 3 months of homeopathic treatment, and remained around this level during the follow-up period. Physician assessments tended to be more positive than patient assessments.
The improvements we observed in our patients cannot be attributed solely to regression-to-the-mean, because the improvements were greater than could be expected even under conservative model assumptions. This is supported by the fact that patients did not visit the study physicians when they were feeling the worst, but rather after a long waiting period.
A strength of this study is that patients with all diagnoses were included. Therefore, no disease-specific measurement instruments could be used. To assess the severity of different medical complaints, there is no other generally accepted measuring instrument available. Instead numerical rating scales [8
] were applied, which would allow for the determination of illness severity in a diagnosis-independent manner.
Compared to the other quality two of life questionnaires used in our study, the KINDL questionnaire for the age group 7 to 16 years was not sensitive to change, as has been shown in other studies [18
]. Other explanations might be that children adapt easier to perceived quality of life and that the dimensions of Quality of life used for adults are not transferable to children. However, there is no other generally accepted measuring instrument available in German-speaking countries.
In the range of baseline diagnoses, chronic illnesses clearly predominated (>95% of diagnoses). Among these, headache and atopic disease (allergic rhinitis, asthma and atopic dermatitis) were the most common diagnoses. As the clinical histories of our patients showed, most of our patients decided to consult a homeopathic physician only after having received conventional treatment. This, together with the extensive initial case taking and the reputation of homeopathy as a "medicine designed to treat the individual as a whole"' causes a selection for chronic illnesses.
We were unable to confirm the common notion that homeopathy is frequently used for trivial complaints or diseases. The duration of disease in study patients was very long and their symptoms were, on average, of moderate severity.
In this study we were not able to evaluate different types of homeopathic strategies. For quality assurance purposes, we avoided selecting a random sample of homeopathic physicians for the study, choosing instead to recruit physicians schooled and certified in 'classical' homeopathy. The results of our study are, therefore, representative only for the classical type of homeopathy that was practised by participating physicians. Compared to conventional medical practices, headache and atopic disease (allergic rhinitis, asthma and atopic dermatitis) were the most common diagnoses in homeopathic practices (as opposed to hypertension, hyperlipidemia and low back pain in 70,000 patients treated conventionally) [9
]. An American study [20
] found asthma, depression, otitis media, and allergic rhinitis to be the most common diagnoses treated in homeopathic practices, compared to hypertension, upper respiratory tract infection, otitis media and diabetes mellitus, which were treated most commonly in conventional practices.
A health insurance company project that included about 900 patients treated with homeopathy in routine care [21
] showed an improvement in quality of life and in physician assessment. In Güthlin's study [21
], however, only physicians certified to work in the public health care system were able participate. Homeopaths working in private practices (i.e. the great majority in Germany) were excluded. The advantage of the present study is that doctors in private practice were also included, thus providing a more detailed and broader basis for describing the current status of homeopathic health care. Another controlled study in cooperation with a German health insurance company [22
], indicated similar overall effectiveness of homeopathically versus conventionally treated patients for selected diagnoses and in some groups, superiority of homeopathic treatment.