Abstract
We used the 2012 National Health Interview Survey to compare homeopathy users with supplement users and those using other forms of complementary and integrative medicine. Among US adults, 2.1% used homeopathy within the past 12 months. Respiratory and otorhinolaryngology complaints were most commonly treated (18.5%). Homeopathy users were more likely to use multiple complementary and integrative medicine therapies and to perceive the therapy as helpful than were supplement users. US homeopathy use remains uncommon; however, users perceive it as helpful.
Homeopathy is a system of complementary and integrative medicine (CIM) with a resurgence of public interest in recent decades.1,2 In the United States, many homeopathic medicines may be purchased over the counter. Although they are often sold next to dietary supplements, the Food and Drug Administration regulates them differently.3 Federal agencies are interested in understanding public use and perceptions of homeopathic products,4,5 but there is little published information on this topic.6 Recent reports suggest potential public health benefits such as reductions in unnecessary antibiotic use,7 reductions in costs to treat certain respiratory diseases,8 improvements in perimenopausal depression,9 improved health outcomes in chronically ill individuals,10 and control of a Leptospirosis epidemic in Cuba.11 We analyzed data from the 2012 National Health Interview Survey (NHIS) for prevalence and patterns of homeopathy use among US adults in relation to other CIM use.
METHODS
NHIS gathers health-related data on the civilian, noninstitutionalized US population and is used to inform health policy. The most recent survey that had questions about CIM use occurred in 2012 and included 34 525 adults, with a conditional response rate of 79.7%.12
We included all adult respondents and divided them into 4 mutually exclusive categories: individuals who used homeopathy within the past 12 months (homeopathy use), individuals who used herbs and dietary supplements without homeopathy within the past 12 months (supplements without homeopathy), individuals who used neither homeopathy nor dietary supplements but used another form of CIM within a 12-month period (other CIM use), and individuals who did not use any form of CIM (no CIM use). For some analyses, we further subdivided the group that used homeopathy into those who did or did not see a practitioner in association with their homeopathy use.
We used survey procedures in SAS version 9.2 (SAS Institute, Cary, NC) and the sampling weights provided12 to account for the survey’s complex sampling design and to obtain statistically accurate estimates for the civilian, noninstitutionalized US population. Additional analytic details are presented as supplementary methods (available as a supplement to the online version of this article at http://www.ajph.org).
RESULTS
The sociodemographic characteristics and health behaviors of survey respondents are presented in Table A, available as a supplement to the online version of this article at http://www.ajph.org. There were significant differences among the 4 groups for all factors examined. When we excluded non-CIM users, there were no significant differences among the 3 groups of CIM users comparing percentage Hispanic ethnicity, family income, alcohol use, and physical activity. Homeopathy users were more likely than were other CIM users to be women, to be in the aged 30 to 44 years bracket, to be White, to live in the west, to be married, to be highly educated, and to have a lower body mass index. Homeopathy users were significantly more likely than were supplement and other CIM users to use nearly every category of CIM assessed on the survey except for chiropractic or osteopathic manipulation (Table 1). Homeopathy users used significantly more total CIM modalities than did supplement users or other CIM users (Figure A, available as a supplement to the online version of this article at http://www.ajph.org).
TABLE 1—
Most Frequent Complementary and Integrative Therapies Used: National Health Interview Survey, United States, 2012
| Other CIM Use (n = 5298) | Supplements Without Homeopathy (n = 5500) | Homeopathy Use (n = 718) | |
| CIM modality | |||
| Homeopathy | NA | NA | 718 (100.0) |
| Herbs and supplementsa | NA | 5500 (100.0) | 474 (66.6) |
| Chiropractic or osteopathic manipulation | 1904 (36.1) | 873 (16.1) | 216 (30.7) |
| Massage | 1678 (31.2) | 1013 (18.4) | 260 (35.0) |
| Mind–body exercise | 1804 (34.6) | 1102 (20.1) | 299 (42.0) |
| Meditation, imagery, or progressive relaxation | 717 (12.7) | 654 (11.7) | 244 (33.2) |
| Naturopathy | 34 (0.4) | 119 (1.8) | 123 (15.9) |
| Acupuncture | 291 (4.8) | 221 (3.6) | 92 (11.1) |
| Energy healing | 75 (1.3) | 112 (1.7) | 85 (10.0) |
| Special diet | 535 (9.9) | 377 (6.4) | 115 (16.7) |
| Movement therapy | 356 (7.3) | 244 (4.3) | 78 (11.1) |
| Hypnosis | 37 (0.7) | 28 (0.5) | 25 (3.1) |
| Craniosacral therapy | 21 (0.4) | 46 (0.9) | 42 (4.1) |
| Ayurveda | 18 (0.3) | 36 (0.6) | 42 (5.0) |
| Traditional healers | 95 (1.4) | 49 (0.8) | 26 (3.9) |
| Biofeedback | 44 (0.9) | 42 (0.7) | 21 (2.6) |
| Condition | |||
| Respiratory or otorhinolaryngological | 57 (0.7) | 89 (1.5) | 94 (18.5) |
| Musculoskeletal | 1850 (26.7) | 649 (13.6) | 57 (12.3) |
| Fatigue, stress, or chronic pain | 287 (3.8) | 165 (2.9) | 42 (7.7) |
| Gastrointestinal | 74 (0.9) | 213 (3.6) | 29 (5.0) |
| Neurological | 196 (2.8) | 64 (0.9) | 20 (3.4) |
| Mental health | 188 (2.6) | 59 (0.9) | 17 (2.1) |
| Cardiac and vascular | 115 (1.6) | 547 (10.9) | b |
| Endocrine and metabolic | 115 (1.7) | 70 (1.3) | b |
Note. CIM = complementary and integrative medicine; NA = not applicable. The weighted percentage estimate of the US population is presented. Prevalence was very low for gynecological, genitourinary, immune, dermatologic, and developmental conditions and cancer and benign tumors.
Does not include vitamin and mineral supplements.
Because relative SE > 30%, estimate is unreliable.
Of the 718 homeopathy users surveyed, only 140 (19%) saw a practitioner for homeopathic therapy (data not shown). Two thirds of homeopathy users ranked this modality within their top 3 CIM therapies (69% of those who saw a practitioner; 68% of those who did not). A third of individuals (35% vs 33%, respectively) used this modality to address a specific health-related condition. Similarly, a third of supplement users (32%) used supplements to target health-related conditions. Table 1 summarizes the most common health conditions addressed by each group of CIM users. The single most common condition homeopathy users addressed was head and chest colds.
Homeopathy users who saw a practitioner were significantly more likely to feel that homeopathy was “very important in maintaining health and well-being” and that it helped their health condition “a great deal” than were homeopathy users who did not see a practitioner (Figure B, available as a supplement to the online version of this article at http://www.ajph.org). Homeopathy users who did not see a practitioner were significantly more likely than were supplement users to find the modality they used helpful.
DISCUSSION
The 2002 and 2007 NHIS demonstrated annual prevalence rates of homeopathy use among US adults at 1.7% and 1.8%, respectively.13 We found that, by 2012, use had increased by approximately 15% to 2.1% of US adults, likely a reflection of the general increase in the prevalence of CIM use around the country. Nonetheless, these numbers are lower than are prevalence rates of use from other Western countries, such as Italy (8.2%) and Germany (14.8%).14 Sociodemographic factors previously shown to be associated with CIM use such as gender, education, income, and the presence of medical comorbidities13,14 were significantly associated with CIM use in our analysis as well.
In response to federal queries regarding public use and perceptions of homeopathy, the majority of users do not see a practitioner for homeopathic therapy (81%) and presumably self-prescribe combination or individual products that are widely available over the counter for specific self-limited conditions. The most common conditions treated were respiratory and otorhinolaryngology complaints (cold symptoms were the most common; there is some evidence of efficacy8,15,16) and musculoskeletal complaints such as pain. Data from a small sample of physicians who prescribe homeopathic medicines suggest that treatment of respiratory and otorhinolaryngology conditions and musculoskeletal complaints is common in clinical practice as well.6 In general, homeopathy users perceive these products to be more helpful for their health than supplement users perceive their use of supplements.
The dramatic difference in perceived helpfulness between those who use practitioner-prescribed homeopathy versus those who self-prescribe homeopathy is intriguing. This difference may be the result of an enhanced therapeutic effect stemming from the nature of the patient–provider relationship,17–19 a more individualized and effective homeopathic prescription by the provider,1,20 or intrinsic differences between these 2 types of homeopathy users. The last possibility we could not examine in this study because of the small sample size of homeopathy users who saw practitioners.
Limitations
The major limitations of our study are the potential for misclassification and recall bias, because NHIS data rely on self-report. Nonetheless, the NHIS is a carefully designed face-to-face survey and the best available source for these kinds of health-related data on the US population.
In addition, because of how the survey was designed, we were unable to assess perceived helpfulness of homeopathy use from all homeopathy users. Modification of the survey to acquire data on perceived helpfulness from all CIM users would be informative. Also, the relatively small number of users who see practitioners for homeopathic treatment precluded any further analysis of this population. We did not calculate out-of-pocket expenditures for homeopathic medicines or practitioner visits because of the large amount of missing data and likely unreliability of such estimates.
Public Health Implications
Homeopathy users constitute a segment of high CIM users and report high levels of perceived helpfulness for this modality, particularly when they see a practitioner for therapy. However, most homeopathy users do not see practitioners and they self-prescribe, predominantly for self-limited conditions. Because of potential public health benefits7–11 associated with the use of homeopathy, further research on this modality and targeted studies of users are warranted.
ACKNOWLEDGMENTS
This work was supported by Harvard Catalyst, the Harvard Clinical and Translational Science Center, the National Institutes of Health (NIH; award 1UL1 TR001102-01), and Harvard University and its affiliated academic health care centers. M. L. Dossett was supported by an Institutional National Research Service Award (T32 AT000051) from the National Center for Complementary and Integrative Health (NCCIH) at the NIH and by the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center. T. J. Kaptchuk was supported by the NCCIH (award K24 AT004095).
M. L. Dossett has served as a consultant for TJL Enterprises, which did not provide any support for this study.
Note. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the NIH.
HUMAN PARTICIPANT PROTECTION
The Beth Israel Deaconess Medical Center Committee on Clinical Investigations granted this study exempted status because all data were publicly available and de-identified.
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