Homeopathy in the public health system: a seven-year observational study at Lucca Hospital (Italy)By; Elio Rossi1, , , , Cristina Endrizzi1, Maria Alessandra Panozzo1, Alba Bianchi1, Monica Da Frè2

Introduction

Homeopathy is the most widely-used non-conventional medicine in Italy, as confirmed by an epidemiological research project conducted on behalf of the Italian Ministry of Health (coordinated by the Higher Institute of Health).1 During the period 1997–1999, 15.6% of the Italian population used non-conventional therapies, especially homeopathy (8.2% of the population).

Data was recently published in a multipurpose survey of the diffusion of non-conventional medicine in 20052 conducted on a wider sample of families than in the previous survey of 2000 (60,000 compared to 25,000); the study confirmed that 13.6% of Italians (7,900,000) had used at least one form of non-conventional therapy in the last 3 years. The most widespread form of non-conventional medicine is homeopathy, used by 7.0% of the population; manual treatment was chosen by 6.4%; phytotherapy and acupuncture by 3.7% and 1.8% respectively; other types of non-conventional therapies accounted for 0.4%. An in-depth analysis of the data of the multipurpose ISTAT survey of 2005 for the Region of Tuscany showed that 15.5% of the Tuscan population during the three-year period prior to the survey used at least one non-conventional therapy, and homeopathy was the most widely used of the unconventional therapies (7.5%), higher than manual therapies (7.4%).

Considering also this data, in 1998 the Homeopathic Clinic in Lucca was initially established and funded by the Tuscany Region as part of a pilot project aimed at assessing the possibilities of integration of complementary medicine in the public health sector. Through successive health programming legislation, the Region financed study projects on non-conventional medicine and created a Regional Reference Centre for non-conventional therapies.

The 2005–2007 Regional Health Plan3 guarantees complete integration within the regional health system for non-conventional medical treatment, defined as complementary medicine (specifically, acupuncture, phytotherapy, homeopathy and manual medicine), whose therapies have been evaluated as demonstrating an adequate level of efficacy.

The Homeopathic Clinic of ASL 2, Lucca (the Regional Reference Centre for Homeopathy) consists of one homeopathic doctor with clinical activity and responsible for directing and coordinating the service; one homeopathic specialist doctor in obstetrics and gynaecology, to meet the specific needs of the female population; one homeopathic doctor whose role is research and production of data for verifying clinical activity and research projects in response to requirements and in collaborations with other hospital services; one pharmacist, and administrative staff. Furthermore, the clinic is also visited by doctors following courses on homeopathy in clinical practice.

Since September 2006 homeopathic doctors have been equated to specialist clinic doctors in accordance with the Tuscan Regional Integrative Agreement of the National Integrative Agreement for Specialist Clinics.4

The object of this study is to assess the response to homeopathic treatment and analyze homeopathic clinical practice in the public health sector. Materials and methods

A longitudinal observational study was conducted on all patients attending the Homeopathic Clinic at the Campo di Marte Provincial Hospital – ASL 2 Lucca from its establishment in September 1998 until December 2005. Data were collected concerning homeopathic consultations from September 1998 to December 2005 for all patients who returned for at least one follow-up appointment.

Patients who attend the clinic currently pay a public health service charge of €18.59, the amount payable for all other specialist visits. Homeopathic visits last half an hour and are booked by telephone to the Central Booking Centre of the Campo di Marte Hospital. In many cases patients are referred by their GP or by the specialist who has generally already made a clinical diagnosis.

The homeopathic prescription strategy is to administer a single remedy and involves the initial use of the remedy in Quintamillesimal dilutions (LM, Q)5 beginning with 6LM/Q and on a progressive scale of dilutions. If there is a subsequent phase, the prescription then proceeds with a single centesimal dose (CH). Treatment of acute cases generally involves the use of remedies in centesimal dilutions from 6 to 30CH.

Quality control for homeopathic prescriptions is carried in collaboration with the Associazione Lycopodium – Homeopathia Europea of Florence, which has been active since 1978 and operates independently of the clinic.

Patient data (demographic data; clinical diagnoses according to ICD 10; remedy prescribed; potency and dosage; prescription strategy, identification of the case as acute-chronic-recurrent) were collected on paper and by WinCHIP (Computerized Homeopathic Investigation Program).6 Each patient was assigned a numerical identification code for the anonymous treatment of data, and signed a privacy disclaimer.

At the first consultation, the current state of health and the severity and nature of the patient's symptoms were recorded in detail in accordance with the procedures of the homeopathic consultation. For patients seen for follow-up the effect of the therapies in relation to the main pathology (the object of the request for intervention), was assessed. An adaptation of the Glasgow Homeopathic Hospital Outcome Score (GHHOS)7 was used to assess outcome; whereas the degree of symptom intensity as reported by the patient, and the change after treatment (if any) were assessed by means of a numerical rate scale (NRS). The reference values of the GHHOS scale, distributed according to a Likert scale from −1 to +4, define different degrees of improvement as follows: 0 = none, 1 = slight improvement, 2 = moderate improvement, 3 = important improvement, 4 = cured/back to normal, and −1 = slight deterioration.

Patients attending a homeopathic visit who were already using conventional pharmacological therapy reduced and subsequently to discontinued this, where possible.

Coding and data entry were carried out by the staff of the Homeopathic Clinic of the Campo di Marte Hospital, Lucca, while data analysis was performed by staff of the Observatory of Epidemiology of the Regional Health Agency of Tuscany. Statistical analysis was performed using the statistical package Stata SE (Version 9.0). The Chi-square test was used to assess the association in the univariate analysis (Table 1). Multivariate logistic regression analysis was performed to investigate factors associated with successful therapy (significant improvement or resolution – values 3 and 4 of the GHHOS scale, in contrast to GHHOS scale values of ≤2). The Wald test was used to assess the statistical significance of each variable in the model (Table 4).

Table 1.

Characteristics of patients in follow-up by age ≤14 years 15–39 years ≥40 years Total p-Value n (%) n (%) n (%) n (%) Total number of patients 166 (25) 250 (37) 251 (38) 667 (100)

Sex Male 92 (55) 60 (24) 75 (30) 227 (34) <0.001 Female 74 (45) 190 (76) 176 (70) 440 (66)

Occupation Student – 65 (26) 0 65 (13) <0.001 Clerk – 57 (23) 63 (26) 120 (24) Teacher – 19 (8) 28 (11) 47 (10) Medical staff – 14 (6) 26 (11) 40 (8) Entrepreneur, freelancer – 14 (6) 16 (6) 30 (6) Manual worker, artisan, farmer, technician – 38 (15) 24 (10) 62 (13) Trader – 17 (7) 13 (5) 30 (6) Housewife – 17 (7) 29 (12) 46 (9) Unemployed – 7 (3) 1 (0.4) 8 (2) Retired – 0 46 (19) 46 (9)

Have you already used conventional therapies for treatment of the existing pathology at the time of the visit? Yes 125 (75) 161 (64) 182 (73) 468 (70) 0.035

Have you already used homeopathic therapies for treatment of the existing pathology at the time of the visit? Yes 53 (32) 66 (26) 93 (37) 212 (32) 0.035

Existing pathology Respiratory 111 (67) 62 (25) 37 (15) 210 (32) <0.001 Digestive tract 11 (7) 48 (19) 57 (23) 116 (17) Dermatological 22 (13) 41 (16) 29 (12) 92 (14) Psychological 14 (8) 40 (16) 37 (15) 91 (14) Obstetric-gynecologic 1 (0.6) 28 (11) 27 (11) 56 (8) Headache 3 (2) 11 (4) 11 (4) 25 (4) Cardio-circulatory 0 6 (2) 16 (6) 22 (3) Urological 1 (0.6) 8 (3) 10 (4) 19 (3) Osteoarticular 0 3 (1) 13 (5) 16 (2) Neurological 3 (2) 2 (0.8) 6 (2) 11 (2) Other 0 0 7 (3) 7 (1)

Follow-up visits 2 Months 45 (27) 108 (43) 111 (44) 264 (40) 0.012 6 Months 38 (23) 46 (18) 53 (21) 137 (21) 12–18 Months 44 (27) 53 (21) 43 (17) 140 (21) ≥24 Months 39 (23) 43 (17) 44 (18) 126 (19) Table options

Results Demographics

From September 1998 to December 2005, 1514 patients came to the Homeopathic Clinic of the Campo di Marte Provincial Hospital, Lucca, for a total of 3771 consecutive visits. To assess the results of treatment, we analyzed the data of patients returning for at least one check-up visit after the initial consultation (667 patients: 44% of the total) with follow-ups up to 84 months (from a minimum of one to a maximum of 10 visits subsequent to the initial one).

The percentage of new patients lost to follow-up was 56%; the proportion was the same in all categories of the following variables: sex, age, occupation and use of conventional therapies for treatment of the existing pathology. However, among those who had previously used homeopathic treatment for the pathology in question, the percentage of patients lost was lower than those who had not used it (51% vs 58%).

The issue of drop-out was formerly investigated in a specific study9 conducted by telephone interview of a sample of patients who had attended at this clinic, but did not return, over a period of 1 year. This revealed that 50.7% of those interviewed were satisfied, stating that homeopathic treatment was effective and that they did not return for a check-up for this reason; 35.6% of patients interviewed reported various reasons for dissatisfaction such as problems of communication with the doctor during the visit, or relating to the use of the remedy, or to higher expectations than the results obtained; 2.7% of those interviewed did not start treatment due to the disappearance of symptoms. In relation to the perception of therapy effectiveness in the sample of patients lost to follow-up, only 11% said they had not returned for check-up visit due to the ineffectiveness of the prescribed treatment. If we consider only patients who had at least commenced treatment, 60% reported that the treatment was effective; of patients who had completed the prescribed therapy 81% stated the treatment to be effective.

Table 1 shows the demographic characteristics of included patients. Twenty-five percentage of patients up to the age of 14; 37% aged between 15 and 39; 38% aged 40 or more. The sample consisted of 34% male patients and 66% female patients. The distribution of sex varied significantly across the age ranges: 70% or more of adult patients were female; there was a prevalence of males (55%) in childhood age. At the time of the first visit, 70% of patients had had prior recourse to conventional therapies for treatment of their pathology, 32% had already used homeopathic therapies for the same purpose. The most frequent pathologies were as follows: respiratory (32%); digestive tract (17%); dermatological (14%) and psychological (14%). A significant difference was observed in the distribution of pathologies by age. In children, two thirds of the patients came to the homeopathic clinic for respiratory pathologies, compared to 25% of patients aged 15–39 and 15% of patients aged 40 or more. Other frequent pathologies in the 15–39 age group were of the digestive tract (19%), dermatological (16%) and psychological problems (16%); while those aged 40 or more had a higher prevalence of problems of the digestive tract (23%).

The duration of follow-up was 1 year or more for 50% of children age, 37% for patients between the ages of 15–39 and 35% for those of 40 or above. Outcomes

Overall 74% of patients reported at least moderate improvement (+2), 91% showed an improvement of at least (+1), and 50% of patients reporting an important improvement or complete resolution (+3 or 4), 9% did not respond, 0.3% deteriorated. Table 2 shows the outcome distribution for each variable.

Table 2.

Outcome by patient characteristics (%) n −1 0 1 2 3 4 Slight worsening (%) No change (%) Slight improvement (%) Good improvement (%) Significant improvement (%) Resolution (%) Total 667 0.3 9 17 24 31 19

Sex Male 227 0 9 15 23 32 21 Female 440 0.4 9 17 24 31 19

Age ≤14 166 0 5 13 19 35 29 15–39 250 0.4 7 17 24 33 18 ≥40 251 0.4 14 19 26 27 14

Have you already used conventional therapies for treatment of the existing pathology at the time of the visit? Yes 468 0.4 7 16 23 35 18 No 199 0 14 19 24 23 22

Have you already used homeopathic therapies for treatment of the existing pathology at the time of the visit? Yes 212 0 8 17 27 32 15 No 454 0.4 9 16 22 31 21

Existing pathology Respiratory 210 0 4 12 20 36 27 Digestive tract 116 0 11 13 33 28 16 Dermatological 92 0 8 22 16 29 25 Psychological 91 2 13 23 29 25 8 Obstetric-gynecologic 56 0 16 12 20 32 20 Headache 25 0 12 24 28 24 12 Cardio-circulatory 22 0 9 27 18 41 5 Urological 19 0 5 16 16 37 26 Osteoarticular 16 0 12 25 19 25 19 Neurological 11 0 9 18 36 27 9 Other 7 0 14 14 29 43 0

Follow-up visits 2 Months 264 0.8 15 27 27 22 8 6 Months 137 0 7 18 26 36 13 12–18 Months 140 0 5 9 28 34 25 ≥24 Months 126 0 3 2 10 41 44 Table options

The proportion of subjects reporting a significant improvement or resolution of the complaint decreased with increasing age. Current or previous use of conventional pharmacological treatment was positively associated with the positive result of homeopathic therapy. Pathologies with a higher outcome score were respiratory complaints (with 36% reporting a significant improvement and 27% a resolution); while psychological complaints were those which responded least well, although there was good improvement for 29% of subjects.

For psychological problems duration of follow-up significantly influenced the result of therapy: the longer the duration, the higher the outcome score: after 2 years, 44% of patients reported the resolution of the complaint, compared to 8% of patients after 2 months. Table 3 shows the proportion of patients reporting a significant improvement or resolution of the symptoms in relation to the duration of the therapy. The success rate was 51% and was closely correlated to the duration of therapy: after 2 months the percentage was 30%, rising to 85% after 24 months or more of follow-up. This trend persisted even when all demographic and clinical variables are taken into account.

Table 3.

Number and proportion of cases reporting a significant improvement or the resolution of the complaint Total 2 Months 6 Months 12–18 Months ≥24 Months n (%) n (%) n (%) n (%) n (%) Total 337 (51) 80 (30) 68 (50) 82 (59) 107 (85)

Sex Male 120 (53) 27 (33) 28 (49) 31 (65) 34 (87) Female 217 (49) 53 (29) 40 (50) 51 (55) 73 (84)

Age ≤14 106 (64) 17 (38) 23 (61) 30 (68) 36 (92) 15–39 128 (51) 33 (31) 24 (52) 33 (62) 38 (88) ≥40 103 (41) 30 (27) 21 (40) 19 (44) 33 (75)

Have you already used conventional therapies for treatment of the existing pathology at the time of the visit? Yes 249 (53) 58 (31) 53 (54) 61 (66) 77 (84) No 88 (44) 22 (28) 15 (38) 21 (45) 30 (88)

Have you already used homeopathic therapies for treatment of the existing pathology at the time of the visit? Yes 100 (47) 22 (31) 16 (36) 28 (53) 34 (81) No 236 (52) 58 (30) 51 (56) 54 (62) 73 (87)

Existing pathology Respiratory 133 (63) 31 (45) 23 (57) 39 (67) 40 (93) Digestive tract 50 (43) 14 (25) 12 (48) 8 (44) 16 (89) Dermatological 50 (54) 13 (34) 13 (57) 11 (73) 13 (81) Psychological 30 (33) 8 (19) 5 (33) 9 (45) 8 (57) Obstetric-gynecologic 29 (52) 8 (35) 1 (17) 6 (55) 14 (87) Headache 9 (36) 1 (9) 1 (20) 3 (75) 4 (80) Cardio-circulatory 10 (45) 3 (30) 3 (43) 2 (67) 2 (100) Urological 12 (63) 1 (17) 6 (86) 1 (50) 4 (100) Osteoarticular 7 (44) 0 3 (60) 2 (33) 2 (67) Neurological 4 (36) 0 1 (50) 0 3 (75) Other 3 (43) 1 (33) 0 1 (100) 1 (100) Table options

A logistic regression model was fitted for all the variables considered (Table 4). The table confirms that the variables influencing the success probability of homeopathic treatment are as follows: patient age (p = 0.034), the pathology (p = 0.040) and duration of follow-up (p < 0.001). Young patients had the best outcomes, when all other variables are the same. Those with respiratory pathologies, and urological, cardio-circulatory, dermatological and obstetric-gynecological problems also had relatively favourable outcomes. The variable with the greatest influence on the outcome is the duration of follow-up: an adjusted success probability of 30% after 2 months rises to 86% after 2 years or more.

Table 4.

Logistic regression model: adjusted proportions of significant improvement or resolution Adjusted proportions(95% CI) p-Value Sex Male 51.0 (43.3–58.6) 0.785 Female 52.3 (46.8–57.8)

Age 0–14 59.0 (49.3–68.0) 0.034 15–39 55.0 (47.9–61.9) ≥40 44.0 (36.8–51.4)

Have you already used conventional therapies for treatment of the existing pathology at the time of the visit? Yes 53.5 (48.2–58.8) 0.280 No 48.0 (39.7–56.3)

Have you already used homeopathic therapies for treatment of the existing pathology at the time of the visit? Yes 47.8 (40.1–55.5) 0.217 No 53.8 (48.4–59.1)

Existing pathology Respiratory 60.8 (52.4–68.6) 0.040 Digestive tract 49.5 (39.2–59.9) Dermatological 56.9 (45.4–67.6) Psychological 33.9 (23.7–45.7) Obstetric-gynecologic 52.2 (37.0–66.9) Headache 35.2 (17.7–57.7) Cardio-circulatory 57.6 (35.2–77.2) Urological 65.8 (41.2–84.2) Osteoarticular 43.4 (20.9–69.0) Neurological 28.3 (8.6–62.4) Other 52.1 (17.6–84.7)

Follow-up visits 2 Months 30.4 (24.9–36.5) <0.001 6 Months 48.2 (39.6–57.0) 12–18 Months 58.5 (49.7–66.8) ≥24 Months 86.1 (78.8–91.2) Table options

Discussion

The first point concerns the demographic data: this clinic confirms the tendency found in other studies8 of the greater likelihood of women using homeopathic treatment (in our sample 2:1 female–male ratio). In terms of age, 39% of patients are 40 years old or more; 37% between 15 and 39; while 24% are under the age of 15. Sixty-five percentage of patients older than 15 were in employment, the remaining 35% consisting of students, housewives, pensioners and unemployed. Another important aspect is the chronicity and variety of pathologies observed: this makes the type of user comparable to that of a regional general medicine clinic, in contrast to data from epidemiologic sector studies.

The percentage of patients lost to follow was significantly lower among those who were already familiar with homeopathy. This result might explain the difficulties encountered by those who begin an unfamiliar treatment perhaps with high expectations, or hope that homeopathic treatment will accelerate healing times and reduce consumption of conventional drugs.

The study highlights a progressive improvement related to the length of the follow-up period. Perhaps this is determined by the relationship established with the doctor, given that the homeopathic interview seems to be an important investment in the doctor–patient relationship, when the therapeutic alliance with the patient is sought. This finding, which also contributes toward a bias influencing the results of observational studies, would benefit from further investigation with targeted studies.

A period of at least 3 months is necessary, according to Witt et al. 10 to improve chronic illnesses and the result of homeopathic therapy then stabilizes during the subsequent months. It is possible to surmise – particularly with regard to chronic pathologies – the importance of the patient's adherence to a therapeutic program which in our homeopathic clinic generally involves a progression of increasing dilutions of the same remedy, or of complementary remedies, in order to progress to a single dose. This differs from what occurs in conventional pharmacological treatment when a change in symptoms remains linked to continuing taking treatment. In fact, the duration of follow-up in this study does not only correspond to the period of consumption of the remedy since, after the single dose, the patient does not receive any treatment for a certain period of time, although the patient's clinical state is still observed at follow up visits.

One might expect that if the therapeutic program is discontinued before the overall clinical picture at the basis of the prescription has resolved, the probabilities of success will change. If we consider the sample of patients who did not return for follow-up but were interviewed by telephone, the percentages of improvement are reduced when subjects who discontinued treatment are included, even if the discontinuation was due to improvement. In order to confirm the assumption that it is necessary to complete a therapeutic program to reach stable objectives, it would have been useful to examine the type of prescription (remedy strength, whether or not treatment concerned the recurrence of a clinical picture with chronic tendencies, etc.), as well as assessment of the outcome, specifying whether assessment was monitored during or after consumption of the remedy.

Several studies underline the complex typology and chronic evolution of the complaint treated homeopathically, often after the failure of pharmacological or conventional treatment,11 in which homeopathy influenced not only the quality of the symptom but also the subjective perception of a state of general wellbeing.12 and 13

The usefulness of homeopathy has been evidenced for treatment of recurrent infectious episodes, when antibiotic therapy is not effective in reducing the frequency of recurrence.14 In our study, many problems concern worsening of pathologies which tend to relapse (respiratory infections, asthma, allergies). With regard to respiratory pathologies, the change in pharmacological consumption during the course of homeopathic therapy has been monitored15: showing a reduction of approximately 50% in pharmacological expenses, both for specific medicines and for general pharmacological expenses. The reduction in pharmacological expenses was significantly greater in patients who combined homeopathic therapy with conventional pharmacological therapy, compared to the pharmaceutical expenses of patients who took only conventional therapy.

In the sample examined in this study, there was a trend suggesting that homeopathic therapy is more effective when combined with conventional pharmacological treatment, although this is not significant in the multivariate regression model (Table 4). It would have been useful to distinguish between those who were still using conventional therapies while receiving homeopathic treatment and those who had used such therapies but discontinued them with the start of homeopathic treatment. Nevertheless, the data obtained from the study monitoring pharmacological expenses in patients affected with respiratory pathologies suggest an advantage for the patient even when homeopathic and pharmacological therapies are combined. This finding seems to contradict the view widely held in homeopathic circles that conventional treatment previous to, or in association with, homeopathic treatment reduces the probability of success.

The 74% improvement of at least +2 (if we also include “slight” improvement the percentage rises to 91%), is consistent with that observed in previously published studies: (89% Wassenhoven,13 78% Robinson,8 70.7% Spence11); likewise, the data relative to the non-effectiveness of the therapy are also consistent (9% in this study, 8.5% in Wassenhoven). Robinson reports a higher percentage of failures (19%), which these authors related to factors such as incorrect prescriptions, or the inability of the homeopath to obtain useful information for the prescription due to the patient's reticence in talking about him/herself. In that study, 73% of prescriptions were “targeted to the pathology” (modalized symptoms, key notes, and organ affinity) in contrast to 19% of prescriptions “based on the patient” or on the totality of symptoms; in Wassenhoven's study, 68% of prescriptions related to the overall picture (therefore using a strategy based on the patient) and 18% were symptomatic.

These differences can probably also be explained in part by a prescription strategy that was not always uniform, an issue which we attempted to address in our study through a greater standardization of prescription methodology. Our clinical practice follows the classic methodology targeting the totality of symptoms.

The percentage of unresponsive patients reported by Spence (approximately 15% in children and 24–28% in female and male adults) poses the question of the impact of homeopathic therapy different age groups, an issue we have also attempted to assess in this study. Our results showed greater therapeutic effect in young patients. Witt and collaborators, who analyzed pediatric data separately from adult data from questionnaires on the quality of life completed by patients or the parents of children who were treated, have also reached a similar conclusion: young patients and patients with more serious illnesses benefit from homeopathy. This finding seems to be important in the light of some publications in the Italian National Press which reported negative conclusions or even reasons for concern regarding the use of homeopathy, above all in children: in 2001, the National Bioethics Committee16 stated that non-conventional medicine was acceptable “only in marginal and essentially harmless situations”.

The data in this case study reveal an extremely low percentage for the worsening of symptoms (0.3% reported a slight worsening) compared to data already published (3.1% Spence, 3% Robinson, 2.4% van Wassenhoven). In a prospective observational study17 also conducted at this clinic and targeted to assess the incidence and type of adverse effects in homeopathic treatment, nine adverse reactions were reported from 335 consecutive visits in the period of 1 year (2.68%). A study evaluating the different phenomena of homeopathic aggravation is currently in progress.

In our sample examined, respiratory complaints generally seem to respond best to treatment, whatever the other variables considered, followed by urological, dermatological, obstetric-gynecological and cardio-circulatory complaints. We attempted to assess which pathologies responded better to treatment within different age groups. For pathologies of the digestive tract and for dermatological problems, the success rates were better for patients under the age of 15.

Psychological disturbances generally responded less to homeopathic treatment, compared to other pathologies. In our study, this type of pathology is represented above all by anxiety–depressive syndromes (excluding severe depression), which for the most part had not been previously diagnosed, where patients chose homeopathic therapy due to fear of side-effects of psycho-pharmacological therapy.8 A targeted study seems necessary to examine the specificity of homeopathic therapy and its indications compared to other treatment systems.18 Limitations

This is a longitudinal observational study in which we considered all patients who came under our observation. There was no control group. The difficulty of carrying out randomized studies of patients who choose this method of treatment19 has often been noted and this has limited the credibility in the scientific community of the positive data in many observational studies. There is possible bias related to the doctor–patient relationship in the subjective evaluation of the symptoms on the part of the patient. A further limitation is that 70% of patients had already received pharmacological treatment and no distinction was made between previous or continuing pharmacological treatment during homeopathic therapy. Conclusion

Homeopathic therapy is associated with good results in relation to the variation of symptoms of chronic and recurring pathologies. There seem to be some specific characteristics in certain groups of pathologies and age ranges that would benefit from further investigation including, if possible, randomized, controlled studies.

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Correspondence to: Elio Rossi, Ambulatorio di omeopatia, Padiglione B, Ospedale Provinciale Campo di Marte, 55100 Lucca, Italy.

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Homeopathy in the public health system: a seven-year observational study at Lucca Hospital (Italy) Elio Rossi1, , , , Cristina Endrizzi1, Maria Alessandra Panozzo1, Alba Bianchi1, Monica Da Frè2

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