Keywords
Systematic review - Prevalence - Homeopathy - Treatment by homeopaths - Homeopathic
medicines - Over-the-counter medicines - Worldwide
Introduction
The therapeutic system of homeopathy was formulated 200 years ago by the German pharmacist
and Samuel Hahnemann.[
1
] Hahnemann argued that medicine should follow the principle of similitude (like cures
like). Hahnemann developed homeopathy by giving medicinal substances to healthy volunteers
and studying the symptoms which they suffered (a process known as a ‘proving’ or a
Homeopathic Pathogenetic Trial). Hahnemann then applied the medicinal substances in
cases of illness which had similar symptoms. Homeopathic medicines are created from
a wide variety of substances (e.g. plants, animals, minerals or chemicals). In order
to diminish toxicity, the medicinal substances are diluted successively and shaken
vigorously between each dilution step.
There is controversy regarding the provision of homeopathy in state funded healthcare
systems, as many claim that the principles on which homeopathy are based are ‘scientifically
implausible’.[
2
] Despite this, treatment by homeopaths and the provision of homeopathic medicines
remain popular, and it is provided and/or subsidized and/or endorsed by a number of
governments worldwide, including its provision in a number of publicly funded healthcare
systems e.g. India which has an estimated 300,000 practitioners of homeopathy[
3
] with homeopathy part of the Indian Ministry of Health,[
4
] France where 43.5% of the overall population of healthcare providers prescribe homeopathic
medicines (mostly co-prescribed with allopathic medicines) and the UK where homeopathy
has been provided by the NHS since its inception in 1948.
This study systematically reviews the data on the prevalence of homeopathy use by
the general public worldwide. Our review summarises prevalence data for both treatment
by a homeopath and all homeopathy use including purchases of over-the-counter (OTC)
homeopathic medicines.
Methods
Search strategy
The systematic review followed the recommendations in the PRISMA statement.[
5
] The following databases were searched in October 2015: MEDLINE via Ovid, Pubmed,
Cochrane Database of Systematic Reviews, Allied and Complementary Medicine Database
(AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Health
Management Information Consortium (HMIC). The search strategy combined terms for:
i) complementary and alternative medicines, ii) prevalence, surveys or patterns of
use, and iii) population-level or national-level data. The full search strategy is
provided in our previous reviews on prevalence of use of any Complementary and Alternative
Medicine (CAM).[
6
],[
7
] The database search was restricted to studies published from 1998 onwards. Studies
published prior to 1998 were identified from previous systematic reviews of CAM prevalence.[
8
],[
9
] Bibliographies of included papers were checked for further relevant studies and
experts in the field contacted.
Inclusion and exclusion criteria
Studies were included if they reported 12-month prevalence of treatment by a homeopath
and/or OTC use of homeopathy, in addition to the prevalence of overall CAM use and/or
visits to CAM practitioners (the latter were inclusion criteria for the broader review[
6
]). Prevalence had to be reported over a 12-month retrospective period within a random
or representative general population sample of a nation or a defined geographical
area. Surveys of clearly-defined age groups (such as adults, children or older adults)
were included. Studies were excluded if they were not based on representative samples
of the general population; for example, surveys of sub-populations with specific clinical
conditions or socio-demographic characteristics (other than age). Included studies
used survey methods such as structured interviews or self-complete questionnaires.
Studies were excluded if they did not report 12-month prevalence or were not written
in English. Studies were also excluded if the prevalence of CAM use was not expressed
as a percentage of the target population (or with data making calculations of percentage
possible).
Study selection and data extraction
Studies identified by the searches were assessed for inclusion by two reviewers. Any
ambiguity was discussed between the reviewers. Data were extracted by one reviewer
and checked by another. Again, any ambiguity was discussed between reviewers (for
example, to discern within each article whether the term ‘homeopathy’ referred to
the homeopathic medicines or to visits/consultations with a homeopath).
Definitions of homeopathy
One challenge in data extraction was understanding what was meant by the term ‘homeopathy’[
10
] when surveys asked ‘do you use homeopathy?’. The term ‘homeopathy’ has multiple
possible meanings: the therapeutic system of homeopathy, the principles of the therapeutic
system of homeopathy, homeopathic medicines (also known as homeopathic remedies),
or treatment by a homeopath. We addressed this by reporting estimates of ‘homeopathy
use’ in three ways:
-
Treatment by a homeopath: includes survey estimates of one or more ‘visits to’ or ‘consultations with’ a homeopath.
-
All homeopathy use (OTC and treatment by homeopath): includes survey estimates of use of homeopathic medicines purchased OTC and treatment
by a homeopath.
-
Homeopathy use (not defined): survey does not define whether estimate refers to treatment by a homeopath or OTC
use or both.
Quality assessment
There is no agreed set of criteria for assessing the quality of health-related surveys.
As part of our wider systematic review on prevalence of overall CAM use, we devised
a six-item, literature-based quality assessment tool comprising important and assessable
criteria of methodological quality.[
6
] A revised version of this was applied to each of the included studies.
The criteria covered by the quality assessment tool include: 1) whether homeopathy
use was clearly defined as referring to treatment by a homeopath or OTC use or both;
2) whether the survey was piloted (piloting was assumed for government sponsored health
surveys); 3) whether the sample size was ≥1000 and/or a sample size calculation was
reported; 4) whether the reported response rate was ≥60%; 5) whether data were weighted
to population characteristics to reduce non-response bias; and 6) whether a 95% confidence
interval and/or standard error were reported for the main prevalence estimates.
Results
Number of surveys included
The search for surveys on CAM use identified 3147 unique citations. Of these, 3035
were excluded at the title and abstract stage, while the full texts of 112 references
were examined. A total of 41 references were included in this review, reporting data
from 36 independent surveys conducted in eleven countries (USA, UK, Australia, Israel,
Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). There were
33 surveys reporting data on adults, 4 reporting data for children and adolescents,
and 5 reporting data for older adults. A PRISMA flow-chart for study selection is
provided in [Figure 1].
Figure 1 PRISMA 2009 Flow Diagram e 3147 unique citations. Of these, 3035 were excluded at the title and abstract stage,
while the full texts of 112 references were examined.
Table 1
Characteristics and quality assessment of survey reports of homeopathy use
|
Survey characteristics
|
Quality criteria
|
Meets ≥4 quality criteria
|
|
Country
|
Survey type
|
Year of survey
|
Name of survey
|
Reference(s)
|
1. Homeopathy use defined[*]
|
2. Piloting of survey reported[†]
|
3. Sample size ≥1000 and/or calculation reported (SSC)
|
4. Reported response rate ≥60% (adj/unadj/NR)
|
5. Data weighted to population
|
6.95% CI and/or SE reported
|
|
Adults
|
|
USA
|
Govt. national
|
2012
|
NHIS
|
Clarke (2015)[
11
]
|
Yes
|
Yes (govt. survey)
|
Yes (34,525)
|
Yes 61.2% (NR)
|
Yes
|
Yes (SE)
|
Yes
|
|
USA
|
Govt. national
|
2007
|
NHIS
|
Barnes (2008)[
12
]
|
No
|
Yes (govt. survey)
|
Yes
|
Yes
|
Yes
|
Yes (SE)
|
Yes
|
|
|
|
|
|
|
|
18+: 23,393
|
18+: 67.8% (NR)
|
|
|
|
|
|
|
|
|
|
|
0–17: 9417
|
0–17: 76.5% (NR)
|
|
|
|
|
USA
|
Govt. national
|
202
|
NHIS
|
Barnes (2004)[
13
]
|
No
|
Yes (govt. survey)
|
Yes (31,044)
|
Yes 74.3% (adj)
|
Yes
|
Yes (SE)
|
Yes
|
|
USA
|
Govt. national
|
1999
|
NHIS
|
Ni (2002)[
14
]
|
No
|
Yes (govt. survey)
|
Yes (30,801)
|
Yes 70% (NR)
|
Yes
|
Yes (CI)
|
Yes
|
|
USA
|
Govt. national
|
1996
|
MEPS
|
Druss (1999)[
15
]
|
Yes
|
Yes (govt. survey)
|
Yes (Age 18 + 16,068)
|
Yes 77.7% (NR)
|
Yes
|
No (NR)
|
Yes
|
|
USA
|
Govt. national
|
1995–6
|
MIDUS
|
Honda (2005)[
16
]
|
No
|
Yes (govt. survey)
|
Yes (4,242)
|
Yes 60.8% (NR)
|
Yes
|
No (NR)
|
Yes
|
|
USA
|
Other national
|
1997
|
|
Eisenburg (1998)[
17
]
|
Yes
|
Yes (piloted)
|
Yes (2055; SSC)
|
Yes 60% (adj); 49% (unadj)
|
Yes
|
Yes (SE)
|
Yes
|
|
USA
|
Other national
|
1997
|
|
Landmark Healthcare (1998)[
18
]
|
No
|
No (NR)
|
Yes (1500)
|
NR
|
NR
|
Yes (CI)
|
No
|
|
USA
|
Other national
|
1990
|
|
Eisenberg (1993)[
19
]
|
Yes
|
Yes (piloted)
|
Yes (1539; SSC)
|
Yes 67% (unadj)
|
Yes
|
Yes (CI)
|
Yes
|
|
USA
|
Other sub-nat.
|
1999
|
|
Arcury (2004)[
20
]
|
Yes
|
No (NR)
|
Yes (1059)
|
Yes 83.8% (NR)
|
Yes
|
Yes (SE)
|
Yes
|
|
UK
|
Govt. national
|
2005
|
HSE
|
Hunt (2010)[
21
]
|
Yes
|
Yes (govt. survey)
|
Yes (7630)
|
Yes 71% (unadj)
|
NR
|
No (NR)
|
Yes
|
|
UK
|
Govt. national
|
2001
|
NOS
|
Thomas (2004)[
22
]
|
Yes
|
Yes (govt. survey)
|
Yes (1794)
|
Yes 65% (unadj)
|
NR
|
Yes (CI)
|
Yes
|
|
UK
|
Other national
|
1999
|
|
Ernst (2000)[
23
]
|
No
|
No (NR)
|
Yes (1204)
|
NR
|
Yes
|
No (NR)
|
No
|
|
UK
|
Other national
|
1998
|
|
Thomas (2001)[
24
]
|
Yes
|
Yes (piloted)
|
Yes (2669; SSC)
|
No 59% (adj)
|
Yes
|
Yes (CI)
|
Yes
|
|
UK
|
Other national
|
1993
|
|
Thomas (1993)[
25
]
|
Yes
|
Yes (piloted)
|
No (676)
|
Yes 78% (adj)
|
Yes
|
Yes (CI)
|
Yes
|
|
UK
|
Govt. sub-nat.
|
1986
|
CHS
|
Yung (1988)[
26
]
|
Yes
|
Yes (govt. survey)
|
Yes (4268)
|
Yes 70% (adj)
|
NR
|
Yes (CI)
|
Yes
|
|
Australia
|
Other national
|
2005
|
|
Xue (2007)[
27
]
|
Yes
|
Yes (piloted)
|
Yes (1067; SSC)
|
NR
|
Yes
|
Yes (CI)
|
Yes
|
|
Australia
|
Govt. sub-nat.
|
2004
|
SAHOS
|
MacLennan (2006)[
28
]
|
Yes
|
Yes (govt. survey)
|
Yes (15+: 3015)
|
Yes 71.7% (unadj)
|
Yes
|
Yes (CI)
|
Yes
|
|
Australia
|
Govt. sub-nat.
|
2000
|
SAHOS
|
MacLennan (2002)[
29
]
|
Yes
|
Yes (govt. survey)
|
Yes (3027)
|
Yes 70.4% (NR)
|
Yes
|
Yes (CI)
|
Yes
|
|
Australia
|
Govt. sub-nat.
|
1993
|
SAHOS
|
MacLennan (1996)[
30
]
|
Yes
|
Yes (govt. survey)
|
Yes (3004)
|
Yes 73.6% (NR)
|
Yes
|
No (NR)
|
Yes
|
|
Australia
|
Other sub-nat.
|
2012
|
|
Thomson (2014)[
31
]
|
Yes
|
Yes (piloted)
|
Yes (1256)
|
No 40.3% (NR)
|
NR
|
No (NR)
|
No
|
|
Israel
|
Govt. national
|
2003–4
|
INHIS
|
Niskar (2007)[
32
]
|
Yes
|
Yes (govt. survey)
|
Yes (2365)
|
No 58.6% (unadj)
|
NR
|
No (NR)
|
No
|
|
Israel
|
Other sub-nat.
|
2000
|
|
Schmueli (2004a)[
33
]
|
Yes
|
No (NR)
|
Yes (2505)
|
NR
|
NR
|
No (NR)
|
No
|
|
Israel
|
Other sub-nat.
|
1993
|
|
Schmueli (2004b)[
33
]
|
Yes
|
No (NR)
|
Yes (2003)
|
NR
|
NR
|
No (NR)
|
No
|
|
Canada
|
Govt. national
|
2001–5
|
CCHS
|
Metcalfe (2010)[
34
]
|
Yes
|
Yes (govt. survey)
|
Yes (400,055)
|
NR
|
Yes
|
Yes (CI)
|
Yes
|
|
Canada
|
Govt. national
|
1994–5
|
NPHS
|
Millar (1997)[
35
]
|
Yes
|
Yes (govt. survey)
|
Yes (17,626)
|
NR
|
Yes
|
No (NR)
|
Yes
|
|
Switzerland
|
Govt. national
|
2012
|
SHS
|
Klein (2015)[
36
]
|
Yes
|
Yes (govt. survey)
|
Yes (18,357)
|
No 45.0% (unadj)
|
Yes
|
Yes (CI)
|
Yes
|
|
Switzerland
|
Govt. national
|
2007
|
SHS
|
Klein (2012)[
37
]
|
Yes
|
Yes (govt. survey)
|
Yes (14,432)
|
No 51.0% (unadj)
|
Yes
|
Yes (CI)
|
Yes
|
|
Norway
|
Other sub-nat.
|
2008
|
HUNT 3
|
Lohre (2012)[
38
]
|
Yes
|
No (NR)
|
Yes (50,827)
|
No 54.0% (unadj)
|
NR
|
No (NR)
|
No
|
|
Norway
|
Other sub-nat.
|
1995–7
|
HUNT 2
|
Steinsbekk (2008)[
39
]
|
Yes
|
No (NR)
|
Yes (40,027)
|
No 43.1% (unadj)
|
NR
|
No (NR)
|
No
|
|
Germany
|
Other sub-nat.
|
1997–2001
|
|
Schwarz (2008)[
40
]
|
Yes
|
No (NR)
|
Yes (4291)
|
Yes 68.8% (unadj)
|
NR
|
No (NR)
|
No
|
|
South Korea
|
Other national
|
2006
|
|
Ock (2009)[
41
]
|
No
|
No (NR)
|
Yes (3000)
|
No 49.8% (unadj)
|
Yes
|
No (NR)
|
No
|
|
Japan
|
Other national
|
2001
|
|
Yamashita (2002)[
42
]
|
No
|
Yes (piloted)
|
Yes (1000)
|
NR
|
Yes
|
Yes (CI)
|
Yes
|
|
Children and adolescents
|
|
USA
|
Govt. national
|
2007
|
NHIS
|
Barnes (2008)[
12
]
|
See adults section above
|
|
USA
|
Govt. national
|
1996
|
MEPS
|
Davis (2003), Yussman (2004)[
43
],[
44
]
|
Yes
|
Yes (govt. survey)
|
Yes (age <18: 6262)
|
Yes 77.7% (NR)
|
Yes
|
Yes (CI)
|
Yes
|
|
Norway
|
Other sub-nat.
|
1995–7
|
HUNT 2
|
Steinsbekk (2010)[
45
]
|
Yes
|
No (NR)
|
Yes (7888)
|
Yes 79.4% (unadj)
|
NR
|
No (NR)
|
No
|
|
Australia
|
Govt. sub-nat.
|
2004
|
SAHOS
|
Smith (2006)[
46
]
|
No
|
Yes (govt. survey)
|
No (age <15: 911)
|
Yes 71.7% (unadj)
|
Yes
|
Yes (CI)
|
Yes
|
|
Older adults
|
|
USA
|
Govt. national
|
1995–6
|
MIDUS
|
Honda (2005), McMahan (2004)[
16
],[
47
]
|
See adults section above
|
|
USA
|
Other sub-nat.
|
1997–8
|
|
Astin (2000)[
48
]
|
No
|
No (NR)
|
No (728)
|
No 51% (unadj)
|
NR
|
No (NR)
|
No
|
|
USA
|
Other sub-nat.
|
NR
|
|
Cheung (2007)[
49
]
|
Yes
|
Yes (piloted)
|
Yes (445; SSC)
|
No 37% (unadj)
|
NR
|
No (NR)
|
No
|
|
Singapore
|
Govt. national
|
2003–4
|
NMHSE
|
Feng (2010)[
50
]
|
Yes
|
Yes (govt. survey)
|
Yes (1092)
|
Yes 72.4% (NR)
|
Yes
|
No (NR)
|
Yes
|
|
Australia
|
Other national
|
2005
|
|
Xue (2007), Zhang (2007)[
27
],[
51
]
|
See adults section above
|
* Homeopathy use was considered to be defined if the survey specified that data related
to over-the-counter use, treatment by a homeopath, or both.
† Piloting was assumed for government surveys. Abbreviations: adj = adjusted; CCHS
= Canadian Community Health Survey; CI = confidence interval; HSE = Health Survey
for England; MEPS = Medical Expenditure Panel Survey; MIDUS = Midlife Development
in the US; NHIS = National Health Interview Survey; NMHSE = National Mental Health
Survey of the Elderly; NOS = National Omnibus Survey; NPHS = National Population Health
Survey; NR = not reported; OTC = over-the-counter purchase; SAHOS = South Australian
Health Omnibus Survey; SE = standard error; SHS = Swiss Health Survey; SSC = sample
size calculation; unadj = unadjusted.
Quality of included survey reports
Based on the information reported, we assessed all survey reports using six quality
criteria ([Table 1]). The quality of survey reports is summarized in [Table 2]. Of the 39 survey reports listed in [Table 1], 26 (67%) of all surveys met at least four of six quality criteria; this was 95%
for government sponsored health surveys and 37% for non-government surveys. Around
75% of all surveys defined whether homeopathy use referred to treatment by a homeopath,
OTC use or both. A sample size of ≥1000 was achieved in around 90% of all surveys.
Government sponsored surveys were more likely than non-government sponsored surveys
to report piloting (100% vs. 42%); to achieve a response rate of at least 60% (75%
vs. 32%), to weight the data to population characteristics (80% vs. 47%); and to report
a confidence interval and/or standard error (65% vs. 42%).
Prevalence of use of homeopathy
[Table 3] presents the 12-month prevalence of homeopathy use as reported in the included surveys.
Survey data are ordered by country, then survey type (government sponsored national,
other national, or sub-national), then year of survey. Data are grouped by age: adults;
children and adolescents; and older adults. [Table 4] provides a summary of the median and range for prevalence of treatment by homeopaths
and all use of homeopathy for each age group.
Treatment by homeopaths
Adults
Estimates for 12-month prevalence of treatment by a homeopath for adults (24 survey
estimates) ranged from 0.2% to 8.2% and the median was 1.5% ([Table 4]).
Table 2
Summary of quality of survey reports
|
Quality criterion
|
All survey reports (n = 39) N (%)
|
Govt. sponsored survey reports (n = 20) N (%)
|
Other survey reports (n = 19) N (%)
|
|
1. Homeopathy use measurement clearly defined[*]
|
29 (74%)
|
15 (75%)
|
14 (74%)
|
|
2. Piloting of survey reported (assumed for govt. surveys)
|
28 (72%)
|
20 (100%)
|
8 (42%)
|
|
3. Sample size ≥1000 and/or sample size calculation used
|
36 (92%)
|
19 (95%)
|
17 (89%)
|
|
4. Reported survey response rate ≥60%
|
21 (54%)
|
15 (75%)
|
6 (32%)
|
|
5. Data weighted to population characteristics
|
25 (64%)
|
16 (80%)
|
9 (47%)
|
|
6.95% confidence interval and/or standard error reported
|
21 (54%)
|
13 (65%)
|
8 (42%)
|
|
Meets ≥4 quality criteria
|
26 (67%)
|
19 (95%)
|
7 (37%)
|
* Homeopathy use was considered to be defined if the survey specified that data related
to over-the-counter use, treatment by a homeopath, or both.
The highest estimates (6.4% and 8.2%) were reported by surveys in Switzerland[
36
],[
37
] where homeopathy is covered by mandatory health insurance. Estimates from the USA
in 1990–1999 ranged from 0.2 to 0.7 (four surveys).[
15
],[
17
],[
19
],[
20
] Rates for UK surveys were similar: 0.4–1.9% (five surveys in 1986–2005).[
21
],[
22
],[
24
]–[
26
] Rates for Australia were also similar (0.5–2.9%; five surveys in 1993–2012),[
27
]–[
31
] as were rates for Canada (2.02.3%, two surveys in 1994–2005).[
34
],[
35
] In most countries, rates remained stable over the years surveyed.
Children
Estimates of treatment by a homeopath for children and adolescents (2 surveys) were
0.03% in a USA 1996 survey of ages 0–17 years[
43
],[
44
] and 2.6% in a Norway 1995–7 survey of ages 13–19 years.[
45
]
Older adults
There were no estimates of treatment by a homeopath specifically relating to older
adults.
All homeopathy use (treatment by homeopaths and OTC use)
All homeopathy use (treatment by homeopaths and OTC use)
Adults
Estimates for 12-month prevalence of all homeopathy use by adults (treatment by homeopaths
and OTC use) was reported in 10 surveys and ranged from 0.7% to 9.8% with a median
of 3.9%. A further 8 surveys did not specify type of homeopathy use; estimates ranged
from 0.1% to 5.0% (median 2.1%) ([Table 4]).
The highest prevalence (9.8%) was reported by a 1998 survey in England, which was
the only included survey to report separate estimates for treatment by a homeopath
(1.2%) and OTC use (8.6%)[
24
] ([Table 4]). Two further UK surveys reported rates of 3.1% (all homeopathy use)[
JR
] and 3.5% (use not defined)[
23
] ([Table 3]).
Five USA government sponsored health surveys estimated that between 1.7% and 3.1%
of the adult population had used homeopathy in the last 12 months.[
11
]–[
14
],[
16
] Rates were similar over the years surveyed (1995–2012). Although homeopathy use
was not consistently defined in these USA surveys, the most recent report[
11
] specified that estimates covered both treatment by a homeopath and OTC use, so this
can probably be assumed for earlier surveys. Rates for Australian government sponsored
surveys were similar: 4.4% (1993),[
30
] 4.3% (2000)[
29
] and 2.2% (2004).[
28
] Rates were lower in East Asian countries: Japan (0.3% in 2001)[
42
] and South Korea (0.1% in 2006).[
41
]
Older adults
For older adults (3 surveys), estimates of the 12-month prevalence of all homeopathy
use were 0.0% in Singapore,[
50
] 2.5% in the USA[
49
] and 4.6% in Australia[
27
],[
51
] with a median of 2.5%.
Children
Two surveys in children reported estimates of 1.3% (USA)[
12
] and 2.0% (Australia),[
46
] though type of homeopathy use was not defined.
Discussion
This report provides a comprehensive and systematic review of surveys reporting 12-month
prevalence of use of homeopathy. This complements our previous reports which systematically
reviewed prevalence of any CAM use and visits to any CAM practitioners,[
6
] visits to five specific types of CAM practitioner (acupuncturists, homeopaths, chiropractors,
osteopaths and medical herbalists),[
7
] and visits to massage therapists.[
52
] The data reported here includes estimates from 36 surveys across eleven countries.
Our analysis covers both the prevalence of treatment by a homeopath and also the prevalence
of all use of homeopathy (over the counter use or treatment by a homeopath), and all
estimates were in the context of a survey or survey subsection relating to health
and healthcare which also reported prevalence of any complementary and alternative
medicine use. The survey data indicated that the percentage of the adult general population
using homeopathy over the previous 12 months was in the range of 0.7–9.8%, with a
median estimate of 3.9%, and the percentage accessing treatment by a homeopath over
the previous 12 months was in the range of 0.2–8.2%, with a median estimate of 1.5%.
Table 3
Twelve-month prevalence of homeopathy use (treatment by homeopath and all use) by
the general population across eleven countries
|
Survey characteristics
|
Quality summary
|
Estimates for prevalence of homeopathy use (%)
|
Reference(s)
|
|
Country
|
Survey type
|
Year of survey
|
Name of survey
|
Sample size
|
Sample ages (% males)
|
Meets ≥4 quality criteria
|
Defines homeopathy use
|
Treatment by homeopath
|
All homeopathy use (treatment by homeopath + OTC)
|
Homeopathy use (not defined)
|
|
Adults
[*]
|
|
USA
|
Government national
|
2012
|
NHIS
|
34,525
|
18+ (NR)
|
Yes
|
Yes
|
–
|
2.2
|
–
|
Clarke (2015)[
11
]
|
|
2007
|
NHIS
|
23,393
|
18+ (NR)
|
Yes
|
No
|
–
|
–
|
1.8
|
Barnes (2008)[
12
]
|
|
2002
|
NHIS
|
31,044
|
18+ (NR)
|
Yes
|
No
|
–
|
–
|
1.7
|
Barnes (2004)[
13
]
|
|
1999
|
NHIS
|
30,801
|
18+ (NR)
|
Yes
|
No
|
–
|
–
|
3.1
|
Ni (2002)[
14
]
|
|
1996
|
MEPS
|
16,068
|
18+ (47)
|
Yes
|
Yes
|
0.4
|
–
|
–
|
Druss (1999)[
15
]
|
|
1995–6
|
MIDUS
|
4242
|
25–74 (43)
|
Yes
|
No
|
–
|
–
|
2.4
|
Honda (2005)[
16
]
|
|
USA
|
Other national
|
1997
|
|
2055
|
18+ (48)
|
Yes
|
Yes
|
0.6
|
3.4
|
–
|
Eisenburg (1998)[
17
]
|
|
1997
|
1500
|
18+ (NR)
|
No
|
No
|
–
|
–
|
5.0
|
Landmark (1998)[
18
]
|
|
1990
|
1539
|
18+ (52)
|
Yes
|
Yes
|
0.2
|
0.7
|
–
|
Eisenberg (1993, 1998)[
17
],[
19
]
|
|
USA
|
Other sub-national
|
1999
|
|
1059
|
18+ (NR)
|
Yes
|
Yes
|
0.7
|
–
|
–
|
Arcury (2004)[
20
]
|
|
UK
|
Government national
|
2005
|
HSE
|
7630
|
16+ (45)
|
Yes
|
Yes
|
1.7
|
3.1
|
–
|
Hunt (2010)[
21
]
|
|
2001
|
NOS
|
1794
|
16+ (47)
|
Yes
|
Yes
|
1.9
|
–
|
–
|
Thomas (2004)[
22
]
|
|
UK
|
Other national
|
1999
|
|
1204
|
18+ (45)
|
No
|
No
|
–
|
–
|
3.5
|
Ernst (2000)[
23
]
|
|
1998
|
2669
|
18+ (43)
|
Yes
|
Yes
|
1.2
|
9.8
|
–
|
Thomas (2001)[
24
]
|
|
1993
|
676
|
18+ (47)
|
Yes
|
Yes
|
1.7
|
–
|
–
|
Thomas (1993)[
25
]
|
|
UK
|
Government sub-national
|
1986
|
CHS
|
4268
|
18+ (NR)
|
Yes
|
Yes
|
0.4
|
–
|
–
|
Yung (1988)[
26
]
|
|
Australia
|
Other national
|
2005
|
|
1067
|
18+ (49)
|
Yes
|
Yes
|
2.9
|
6.0
|
–
|
Xue (2007)[
27
]
|
|
Australia
|
Government sub-national
|
2004
|
SAHOS
|
3015
|
15+ (49)
|
Yes
|
Yes
|
0.5
|
2.2
|
–
|
MacLennan (2006)[
28
]
|
|
2000
|
SAHOS
|
3027
|
15+ (49)
|
Yes
|
Yes
|
1.2
|
4.3
|
–
|
MacLennan (2002)[
29
]
|
|
1993
|
SAHOS
|
3004
|
15+ (49)
|
Yes
|
Yes
|
1.2
|
4.4
|
–
|
MacLennan (1996)[
30
]
|
|
Australia
|
Other sub-national
|
2012
|
|
1256
|
18+ (NR)
|
No
|
Yes
|
2.7
|
4.3
|
–
|
Thomson (2014)[
31
]
|
|
Israel
|
Government national
|
2003–4
|
INHIS
|
2365
|
21+ (44)
|
No
|
Yes
|
1.3
|
–
|
–
|
Niskar (2007)[
32
]
|
|
Israel
|
Other sub-national
|
2000
|
|
2505
|
45–75 (47)
|
No
|
Yes
|
2.8
|
–
|
–
|
Shmueli (2004a)[
33
]
|
|
1993
|
2003
|
45–75 (48)
|
No
|
Yes
|
1.8
|
–
|
–
|
Shmueli (2004b)[
33
]
|
|
Canada
|
Government national
|
2001–5
|
CCHS
|
400,055
|
12+ (49)
|
Yes
|
Yes
|
2.3
|
–
|
–
|
Metcalfe (2010)[
34
]
|
|
1994–5
|
NPHS
|
17,626
|
15+ (NR)
|
Yes
|
Yes
|
2.0
|
–
|
–
|
Millar (1997)[
35
]
|
|
Switzerland
|
Government national
|
2012
|
SHS
|
18,357
|
15+ (48)
|
Yes
|
Yes
|
8.2
|
–
|
–
|
Klein (2015)[
36
]
|
|
2007
|
SHS
|
14,432
|
15+ (NR)
|
Yes
|
Yes
|
6.4
|
–
|
–
|
Klein (2012)[
37
]
|
|
Norway
|
Other sub-national
|
2008
|
HUNT 3
|
50,827
|
20+ (45)
|
No
|
Yes
|
1.3
|
–
|
–
|
Lohre (2012)[
38
]
|
|
1995–7
|
HUNT 2
|
40,027
|
20+ (47)
|
No
|
Yes
|
4.3
|
–
|
–
|
Steinsbekk (2008)[
39
]
|
|
Germany
|
Other sub-national
|
1997–01
|
|
4291
|
20–79 (49)
|
No
|
Yes
|
1.0
|
–
|
–
|
Schwarz (2008)[
40
]
|
|
South Korea
|
Other national
|
2006
|
|
3000
|
30–69 (50)
|
No
|
No
|
–
|
–
|
0.1
|
Ock (2009)[
41
]
|
|
Japan
|
Other national
|
2001
|
|
1000
|
20–79 (49)
|
Yes
|
No
|
–
|
–
|
0.3
|
Yamashita (2002)[
42
]
|
|
Children and adolescents
|
|
USA
|
Government national
|
2007
|
NHIS
|
9417
|
0–17 (NR)
|
Yes
|
No
|
–
|
–
|
1.3
|
Barnes (2008)[
12
]
|
|
1996
|
MEPS
|
6262
|
0–17 (52)
|
Yes
|
Yes
|
0.03
|
–
|
–
|
Davis (2003), Yussman (2004)[
43
],[
44
]
|
|
Norway
|
Other sub-national
|
1995–7
|
HUNT 2
|
7888
|
13–19 (NR)
|
No
|
Yes
|
2.6
|
–
|
–
|
Steinsbekk (2010)[
45
]
|
|
Australia
|
Government sub-national
|
2004
|
SAHOS
|
911
|
0–15 (46)
|
Yes
|
No
|
–
|
–
|
2.0
|
Smith (2006)[
46
]
|
|
Older adults
|
|
USA
|
Government national
|
1995–6
|
MIDUS
|
335
|
65–74 (48)
|
Yes
|
No
|
–
|
–
|
1.5
|
Honda (2005), McMahan (2004)[
16
],[
47
]
|
|
USA
|
Other sub-national
|
1997–8
|
|
728
|
65+ (45)
|
No
|
No
|
–
|
–
|
5.8
|
Astin (2000)[
48
]
|
|
NR
|
445
|
65–94 (45)
|
No
|
Yes
|
–
|
2.5
|
–
|
Cheung (2007)[
49
]
|
|
Singapore
|
Government national
|
2003–4
|
NMHSE
|
1092
|
60+ (44)
|
Yes
|
Yes
|
–
|
0.0
|
–
|
Feng (2010)[
50
]
|
|
Australia
|
Other national
|
2005
|
|
178
|
65+ (43)
|
Yes
|
Yes
|
–
|
4.6
|
–
|
Xue (2007), Zhang (2007)[
27
],[
51
]
|
|
Xue (2007), Zhang (2007)[
27
],[
51
]
|
Abbreviations: CCHS = Canadian Community Health Survey; HSE = Health Survey for England;
MEPS = Medical Expenditure Panel Survey; MIDUS = Midlife Development in the US; NHIS
= National Health Interview Survey; NMHSE = National Mental Health Survey of the Elderly;
NOS = National Omnibus Survey; NPHS = National Population Health Survey; OTC = over-the-counter
purchase; SAHOS = South Australian Health Omnibus Survey; SHS = Swiss Health Survey.
Data from our previous systematic reviews and our more recent findings suggests that
the general public (adult or all ages) of the countries surveyed were similarly likely
to consult a homeopath (median 1.5%) as an acupuncturist (median 1.4%), medical herbalist
(median 0.9%) or osteopath (median 1.9%), while massage therapists (median 5.5%) and
chiropractors (median 7.5%) were visited slightly more often than homeopaths.[
7
]
There were various limitations in conducting this literature review. A limitation
is that only studies reported in the English language were included, although we included
English language reports of surveys from any country. In 10 of 39 reports it was unclear
whether a definition of homeopathy was provided to the individuals before participation
in the survey. This may have created discrepancies in the data collected. Data was
only obtained from surveys which also reported overall 12-month prevalence of any
CAM use and/or visits to any CAM practitioner. Therefore, surveys only reporting use
of homeopathy but not reporting overall CAM use or visits were not included in this
review. This is a potential strength of this review, as data from the types of survey
included here (many of which were government sponsored health surveys or large population
surveys) may be expected to be of higher quality, and potentially more representative
of the general population, than data from surveys of a single therapy.
A number of countries include homeopathy in their publicly funded healthcare systems
(UK, France, Italy, Germany, Switzerland, India, Pakistan, Brazil, and Mexico[
53
]), yet our review identified estimates from only two of these countries – Switzerland
(which has the highest estimate of treatment by a homeopath) and the UK (which had
the highest estimate of all homeopathy use). No published English language surveys
were identified in India, where homeopathy is a popular treatment modality[
54
] and considered part of mainstream medicine. We recommend that a further review is
conducted which includes all languages.
Our stringent review methods meant that rigorously conducted single studies which
reported homeopathy prevalence data (without CAM prevalence data) were excluded even
if they would have met our quality criteria. An example of this is a high quality
study of data from the French national health insurance database (SNIIRAM).[
55
] This study reported that 10.2% of the overall French population and 18% of children
aged 0–4 years in France received at least one prescription for a homeopathic medicine
during a 12-month period. Both figures are significantly higher than those found in
the studies included in our review.
This review summarises 12-month prevalence of homeopathy use from studies in eleven
countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South
Korea, Japan and Singapore). Each year a small but significant percentage of these
general populations use homeopathy. This includes visits to homeopaths as well as
purchase of over-the-counter homeopathic medicines.
Table 4
Summary of twelve-month prevalence of homeopathy use
|
Age group
|
Treatment by a homeopath
|
All homeopathy use (treatment by homeopath + OTC)
|
Homeopathy use (not defined)
|
|
N survey estimates
|
Median % (range)
|
N survey estimates
|
Median % (range)
|
N survey estimates
|
Median % (range)
|
|
Adults
|
24
|
1.5 (0.2–8.2)
|
10
|
3.9 (0.7–9.8)
|
8
|
2.1 (0.1–5.0)
|
|
Children + adolescents
|
2
|
1.3 (0.03–2.6)
|
0
|
–
|
2
|
1.7 (1.3–2.0)
|
|
Older adults
|
0
|
–
|
3
|
2.5 (0.0–4.6)
|
2
|
3.7 (1.5–5.8)
|
|
All age groups[*]
|
26
|
1.5 (0.03–8.2)
|
12
|
3.3 (0.0–9.8)
|
11
|
2.0 (0.1–5.8)
|
* All age groups excludes “older adults” data for Honda 2005 and Xue 2007 to avoid
double-counting as these participants are included within estimates for adults.
Author contributions
CR, KT and KC conceived the idea for the review and contributed to the design of the
review. All authors contributed to data extraction and compiling of the data, and
drafting and critical revision of the manuscript.
Review criteria
Studies were identified via database searches to October 2015. All estimates were
in the context of a survey which also reported prevalence of any complementary and
alternative medicine use. Studies were excluded if they did not report 12-month prevalence
or were not written in English.
Message for the clinic
This study systematically reviews what is known about the prevalence of homeopathy
use by the general public worldwide. This review highlights that globally there is
significant and stable use of treatment by a homeopath and over-the-counter purchase
of homeopathic medicines.
Acknowledgements
Thank you to Phil Harris for co-conceiving the idea for the review, to the reviewers
and to University of Sheffield medical students Katherine Beckett and Francesca Onyina
for their contribution to the searches.
