Homeopathy And Lactation


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  • Introduce yourself
  • How many of you have heard of homeopathy and/or used it? But why should all of you, and really all health care providers be interested in homeopathy? Outside of the US, in Europe, where homeopathy is an integral part of everyday health care: In 1994, 40% of the French, 34% of the British used homeopathy. In Great Britain where the royal family uses homeopathy, 40% of physicians refer patients to homeopaths. 500 million use it world wide (Ridley ‘06) % of US medical schools teaching it: 11% in 1995 57% in 1998 (13% in required courses) Medical practitioners using it in US - 2500 (AAFP reporter ‘94)
  • Allopathy = other or opposite/ suffering Term for conventional medicine used by Hahnemann Law of Similars Like cures like - Any substance capable of causing certain symptoms in healthy people is also capable of curing similar symptoms in sick people. Allergy shots. (Charles Harrison Blakley a homeopathy at London Homeopathic Hospital in the 1860s was the first to attribute hayfever to pollen allergy.) 1796-Jenner anc cowpox vaccinations. Allium cepa - When you cut an onion, it causes watery eyes and nose and sneezing, etc. So, in homeopathy we use allium cepa made from red onion to treat colds and allergies which have these symptoms. Now you notice that one remedy Allium cepa, can be used to treat two or more different diseases, a cold caused by a virus and an allergy. To pick the remedy, the name of the disease is not as important as the specific symptom picture. Minimum dose - use the minimum amount needed to produce the desired reactiion. Dosages vary from mother tincture, to small to infinitesimal One remedy at a time - avoid polypharmacy Control the experiment One remedy covers the “totality of symptoms” and several diseases at once. “ Combination remedies”-e.g. Headache, PMS formula
  • The law of similars dates back to the time of hippocrates- a Greek physician, but Samuel Hahnemann, the ‘father’ of homeopathy, was the first to develop it in a systematic and scientific way 200 yrs. ago. Hahnemann was a well known German physician who became disenchanted with the medicine of his day. So he turned to medical translation. While translating a materia medica which said that peruvian bark was useful for malaria because it was bitter and astringent , he doubted this explanation . Being an excellent chemist himself, he knew of other more bitter and astringent substances, which weren’t as helpful for malaria. So he did an experiment in which he took some of the bark himself twice daily and he found that each time he took a dose he developed sx like malaria (my feet and fingertips became cold, I grew languid and drowsy; had palpitations, anxiety, trembling, prostration, pulsation in the head). This lead him to test many other medicinal substances on himself and other healthy people and to develop the law of similars and the other basic principles of homeopathy .
  • Thus, most scientists believe that homeopathy is at best a placebo effect Gives fuel to the quackbusters to ridicule and deride homeopathy “ If they can get you asking the wrong questions, they don’t have to worry about answers.” Thomas Pynchon
  • Picture is Zincum metallicum 30C (L) and 200C (R) Tested for the presence of nanoparticles of starting materials in 30C and 200C dilutions Used remedies made from metals because Such metals would not be impurities Or contaminants Aurum met, Cuprum met, Stannum met, Zincum met, Argentum met and Platinum met were used In potencies of 6C, 30C, 200C Market samples from 2 reputable manufacturers SBL, India WSI, Willmar Schwabe India Transmission Electron Microscopy (TEM) by bright- and dark-field imaging to look for nanoparticles Selected Area Electron Diffraction (SAED) to identify any crystals/particles found Estimation of levels of starting metals by 500-fold concentration, followed by Inductively Coupled Plasma-Atomic Emission spectroscopy (ICP-AES) Eg. 6C, 30C and 200c Aurum met from SBL had 60-100pg/ml of gold This is well within the normal serum range of various active hormones Eg Free T3 normal range is 2.3-4.2 pg/ml Estradiol is 13-54 pg/ml These concentrations fall within the range of hormesis (10 -12 to 10 -6 M)
  • Exposure of neuros to glutamate during normal activity results in energetic and oxidative stress; however, excessive activation of glutamate receptors can kill nurons in a process called excitotoxicity. Hormesis is a fundamental concept in evolutionary theory. To avoid extinction organisms have developed complex mechanisms to cope with the environmental hazards. (Involves ion channels, kinases, deacetylases, and transcription factors which regulate the expression of genes that encode cytoprotective proteins = antioxidants such as SOD and glutathione.) In some cases organisms have harnessed the chemical properties of “toxic agents,” incorporating them into cellular signaling or metabolic pathways. Examples include oxygen (respiration), carbon monoxide (signaling molecule for neurons), iron (potentially toxic metalss that are critical for the function of many different enzymes (ie., heme synthesis). Examples of toxic factors expressing a bi-phasic response: many chemicals, temperature, radiation, exercise, energy intake, etc. 10 years ago, low levels of ceramide (structural lipid and regulator of cell differentiation, apoptosis, etc.) protected cultured brain nerve cells from being killed by a high concentration of the excitatory neurotransmitter glutamate; on the other hand, high concentrations of ceramide were toxic to the neurons. Preconditioning ischemia… Regular engagement in intellectual activities is beneficial for the brain. A common observation in studies of hormesis is that exposure to low levels of one type of hormetic agent can protect cells/organisms against more than one type of stress.
  • Although the exact site and mechanism of analgesic action is not clearly defined, acetaminophen appears to produce analgesia by elevation of the pain threshold.2-4 The potential mechanism may involve inhibition of the nitric oxide pathway mediated by a variety of neurotransmitter receptors including N-methyl-D-aspartate and substance P.5 Investigations indicate that endogenous pyrogens produced by leukocytes cause an elevation of prostaglandin E (PGE) in the cerebrospinal fluid. Fever results when the elevated PGE acts on the preoptic area of the anterior hypothalamus to decrease heat loss and increase heat gain. Acetaminophen has been shown to inhibit the action of endogenous pyrogens on the heat-regulating centers in the brain by blocking the formation and release of prostaglandins in the central nervous system.
  • Homeopathy And Lactation

    1. 1. HOMEOPATHY: Implications for Issues Surrounding Lactation and Pediatrics *Steven Moore, DC ND Center for Integral Health 400 E. 22nd St., Suite F Lombard, IL 60137
    2. 2. <ul><li>“ All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” </li></ul><ul><li>--Paracelsus (16th century) </li></ul>
    3. 3. <ul><li>‘ Patients who seek homeopathic treatment are likely to improve considerably. These effects persist for as long as 8 years.’ </li></ul><ul><ul><li>BMC Public Health 2008, 8:413. </li></ul></ul>
    4. 4. As of 2011 <ul><li>http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp </li></ul>
    6. 6. Why? <ul><li>A 2002 US National Health Interview Survey conducted by the CDC and NCHS found that 62% of US adults has used some form of CAM in the past 12 months </li></ul><ul><li>Total annual out-of-pocket spending, in the US, was estimated at $27 billion </li></ul><ul><li>CAM natural health products have evidence of cost effectiveness in certain areas (Kennedy, DA et al 2007) </li></ul>
    7. 7. BACKGROUND <ul><li>Recent study identified demographic as younger, higher level of education, employed, and longer disease histories. </li></ul><ul><li>Used by patients for symptom relief, supportive care, as well as for adverse effects of treatments. </li></ul>
    8. 8. BACKGROUND <ul><li>Homeopathy - ‘ omeos ’ meaning ‘similar’; and, ‘ pathos ’ meaning ‘suffering’ </li></ul><ul><li>System of medicine that uses highly diluted, potentized substances to induce the body’s self-healing mechanisms to bring about symptom or disease resolution (Jonas & Jacobs, 1996) </li></ul>
    9. 9. BACKGROUND <ul><li>Samuel C. Hahnemann </li></ul><ul><ul><li>1755 to 1843 </li></ul></ul><ul><ul><li>Chemist </li></ul></ul><ul><ul><li>Medical Doctor </li></ul></ul><ul><ul><li>Fluent in many languages </li></ul></ul><ul><ul><li>Influenced by many leading thinkers of his time: Goethe, Kant, etc. </li></ul></ul><ul><ul><li>Major developer of Homeopathic Medicine </li></ul></ul><ul><ul><li>Decades writing Organon </li></ul></ul><ul><ul><ul><li>1st edition 1810, 6th edition 1921 </li></ul></ul></ul>
    10. 10. BACKGROUND <ul><li>Who is the only physician to have a monument dedicated to them in Washington DC? </li></ul>
    11. 11. BACKGROUND <ul><li>Clinical Homeopathy - (nonclassical, complex) one or more remedies suggested after brief examination; analogous to conventional medicine </li></ul><ul><li>Classical Homeopathy - single remedy suggested after holistic examination with regard to emotions and symptoms; considered to be ‘pure’ form </li></ul><ul><li>Dilution - the process of diluting a substance </li></ul><ul><li>Potency - the strength of a homeopathic remedy, often represented as a number attached to the remedy label </li></ul><ul><li>Potentization - the process of preparing a homeopathic remedy by repeated dilution with succussion </li></ul><ul><li>Succussion - the process in which a vial containing a dilution is shaken up and down and struck against something </li></ul><ul><li>Trituration - Process by which insoluble substances can become soluble. </li></ul>
    12. 12. BACKGROUND <ul><li>1X - 1:10 dilution </li></ul><ul><li>3X - 1:1,000 </li></ul><ul><li>6X - 1:10 dilution six times </li></ul><ul><li>1C - 1:100 dilution </li></ul><ul><li>3C - 1 molecule of original solution in 10^6 molecules of solvent </li></ul><ul><li>6C - 1:100 dilution six times </li></ul><ul><li>30C - 1:100 dilution thirty times </li></ul><ul><li>200C - 1:100 dilution two-hundred times </li></ul><ul><li>1M, MM, LM, DM, etc. </li></ul>
    13. 13. BACKGROUND <ul><li>Regulated by FDA since 1938. </li></ul><ul><li>More than 2,000 substances are used homeopathically. </li></ul><ul><li>Homeopathy is legal in the US and most preparations are available without a prescription. </li></ul>
    14. 14. BACKGROUND <ul><li>In the mid-1820s, several physicians who studied homeopathy in Europe brought the new practice to the US </li></ul><ul><li>Schools and medical organizations were developed </li></ul><ul><li>Homeopathy gained popularity as 1 in 5 physicians practiced homeopathy and 22 medical colleges taught it (University of Michigan, Hahnemann Med School, UCSF, etc.) </li></ul><ul><li>100 homeopathic medical schools in India </li></ul>
    15. 15. BACKGROUND <ul><li>5 organizations currently offer certification in the US: </li></ul><ul><ul><li>American Board of Homeotherapeutics </li></ul></ul><ul><ul><li>Homeopathic Association of Naturopathic Physicians </li></ul></ul><ul><ul><li>North American Society of Homeopaths </li></ul></ul><ul><ul><li>Council for Homeopathic Certification </li></ul></ul><ul><ul><li>National Board of Homeopathic Examiners </li></ul></ul>
    16. 16. MECHANISMS
    17. 17. MECHANISMS <ul><li>Lack of strong evidence to support any one hypothesis may be considered THE stumbling block toward acceptance and the KEY issue toward its integration within a major medical model. </li></ul><ul><li>Much has been proposed: </li></ul><ul><ul><li>“ Memory of Water” </li></ul></ul><ul><ul><li>Clathrate formation </li></ul></ul><ul><ul><li>Epitaxy </li></ul></ul><ul><ul><li>Nanoparticle hypothesis (Silica hypothesis a part of) </li></ul></ul><ul><ul><li>Gene Regulatory Model </li></ul></ul><ul><ul><li>Hormetic effect </li></ul></ul>
    18. 18. EPITAXY <ul><li>Recognized by the U.S. Dept of Labor, OSHA </li></ul><ul><li>Epitaxy is the first stage in the process of manufacturing the critical components in a wide range of devices from mobile handsets to solar cells and LEDs. </li></ul>www. physics.ubc.ca
    20. 20. HORMESIS <ul><li>A process in which exposure to a low dose of a chemical agent or environmental factor that is damaging at higher doses induces an adaptive beneficial effect on the cell or organism. </li></ul><ul><li>Thousands of published articles include data showing biphasic responses of cells or organisms to chemicals or changing environmental conditions. </li></ul><ul><li>Ageing Res Rev . 2008 January ; 7(1): 1–7. </li></ul>
    21. 21. HORMESIS
    22. 22. GENE REGULATORY MODEL <ul><li>Potentized, dilute medicines carry specific ‘signals’ that can be identified by specific receptor and can act as a trigger to turn ‘on’ or ‘off’ some relevant genes , (Ageing Res Rev. 2011 Jan 31 ) initiating a cascade of gene actions to alter and correct the gene expressions that went wrong to produce the disorder/disease. </li></ul><ul><li>More specifically, based on the research, these medicines could act through cytokine signaling, particularly in view of the fact certain potentized homeopathic medicines modulate signal proteins like NF-kB and IL-4,6 (upregulation/downregulation) </li></ul><ul><li>These medicines may interact with nano-particles that eventually may have some role in tagging onto some proteins, that eventually act as a ligand. </li></ul>
    23. 23. GENE REGULATORY MODEL <ul><li>Modern techniques have convincingly demonstrated the action of several potentized homeopathic medicines in modulating many parameters. Further multiple parameters change in the same time frame, which without a cascade of gene actions is difficult to explain. </li></ul><ul><li>Nanoparticles have been shown to have effects on the physio-chemical property of the homeopathic dilutions, that may indicate some role of the nanoparticles during the potentization process of homeopathic medicines. </li></ul><ul><li>All parameters studied to date are gene controlled. </li></ul><ul><li>In the presence of Actinomycin D, a transcription blocker, a potentized homeopathic medicine failed to act. </li></ul><ul><li>Homeopathic dilutions have demonstrable action on plants which lack any central nervous system. </li></ul>
    24. 24. RESEARCH
    25. 25. What Are We Dealing With? <ul><li>Basic Research on Homeopathy Database </li></ul><ul><ul><li>By the end of 2000, the database included 829 experiments in 782 primary publications </li></ul></ul><ul><ul><li>Animals (52%) </li></ul></ul><ul><ul><li>Humans (22%) </li></ul></ul><ul><ul><li>Plants (12%) </li></ul></ul><ul><ul><li>Other - eg., microbial, fungal (14%) </li></ul></ul>
    26. 26. Genetic and Immune Modulation
    27. 27. Frenkel, M et al. Cytotoxic effects of ultra-diluted remedies on breast cancer cells. Inter J Oncol 2010. 36:395-403. <ul><li>In vitro study to determine if products prescribed by a clinic in India have any effect on breast cancer cell lines. </li></ul><ul><li>Studied Carcinosin , Phytolacca , Conium , Thuja against two human breast adenocarcinoma cell lines. </li></ul><ul><li>There was down regulation of pRb and upregulation of CDK inhibitor p27 (responsible for cell cycle delay/arrest and induction of apoptotic cascade which manifested as activation of caspase 7 and cleavage of PARP) </li></ul><ul><li>Moderately inhibits proliferation of peripheral blood mononuclear cells. </li></ul><ul><li>Carcinosin and Phytolacca appeared similar to the activity of Taxol. </li></ul><ul><li>This study indicates that the activity of the diluted substances are dependent on genetic background </li></ul>
    28. 28. Wälchli, C et al. Effect of Low Doses and High Homeopathic Potencies in Normal and Cancerous Human Lymphocytes: An In Vitro Isopathic Study . J Alt Comp Med 2006. Pp.421-427. <ul><li>High homeopathic potencies exhibit a biologic effect on cell cultures of normal primary lymphocytes, eliciting a “significant stimulatory effect on primary T-lymphocytes.” </li></ul>
    29. 29. Khuda-Bukhsh, AR. Mice as a model for homeopathy research. Homeopathy 2009. 98:267-279. <ul><li>Homeopathic remedies were found to be effective on various parameters of study and on different organisms . </li></ul><ul><li>As all parameters of study tested are under genetic control, it would appear that corrective activities of different regulatory genes initiate the recovery process. </li></ul><ul><li>This would imply that potentized medicines, though devoid of any drug molecule, were still capable of acting in a multidirectional manner, through their regulatory action on master gene(s)/gene expression. </li></ul><ul><li>Cancerous lymphocytes seem to be unresponsive to high homeopathic potencies. </li></ul>
    30. 30. Sato, DYO et al. Histopathological and immunophenotyping studies on normal and sarcoma 180-bearing mice treated with a complex homeopathic medication. Homeopathy 2005. 94:26-32. <ul><li>A delay in the development, and a reduction in size of the tumors, and increased infiltration by lymphoid cells, granulation tissue, and fibrosis surrounding the tumor were observed with active treatment compared to control. </li></ul><ul><li>All animals from the treated group survived. </li></ul><ul><li>30% of control groups died. </li></ul><ul><li>In 30% of treated animals, a total regression of the tumor was confirmed using light microscopy. No regression was found in the control groups. </li></ul><ul><li>Treatment increased total numbers of leukocytes and lymphocytes. Among lymphocytes, TCD4 and B and NK cells increased in treated groups. </li></ul><ul><li>Contains: Aconitum napellus , Bryonia alba , Thuja ocidentalis , Arsenicum album, and Lachesis muta . </li></ul>
    31. 31. Bhattacharjee, N et al. Homeopathic drugs Natrum sulphuricum and Carcinosin prevent azo dye-induced hepatocarcinogenesis in mice. Indian J Biochem & Biophys 2009. 46:307-318. <ul><li>Used phenobarbital and p -DAB </li></ul><ul><li>Results demonstrated that administration Nat sulph alone, or in combination, reduced liver tumors </li></ul><ul><li>Decreased lipid peroxidation, genotoxic parameters, GGT, LDH, blood glucose, bilirubin, creatinine, and urea. </li></ul><ul><li>Increased GSH, glucose-6-phosphate dehydrogenase, SOD, glutathione reductase, catalase, hemoglobin, cholesterol, and albumin levels. </li></ul><ul><li>Effect on cytotoxicity, hepatotoxicity, and oxidative stress. </li></ul><ul><li>Similar study with Chelidonium (2002) and Carcinosin (2005). </li></ul>
    32. 32. Khuda-Bukhsh, AR et al. Modulation of Signal Proteins: A Plausible Mechanism to Explain How a Potentized Drug Secale Cor 30C Diluted beyond Avogadro’s Limit Combats Skin Papilloma in Mice. eCAM 2009. Pp. 1-12. <ul><li>It could “successfully combat” skin papilloma in mice as evidenced by histological, cytogenetical, immunofluorescence, ELISA, and immunoblot findings. </li></ul><ul><li>AhR, PCNA, Akt, Bcl-2, Bcl-xL, NF-kB (signal proteins) </li></ul><ul><li>Cytochrome c, Bax, Bad, Apaf, caspase-3 and -9 (pro-apoptotic proteins) </li></ul><ul><li>Secale modulated their expression levels </li></ul><ul><li>There was reduction in genotoxic and DNA damages in bone marrow cells </li></ul><ul><li>Supports hypothesis that potentized homeopathic drugs act at gene regulatory level. </li></ul>
    33. 33. Bhattacharjee, N et al. Amelioration of Carcinogen-Induced Toxicity in Mice by Administration of a Potentized Homeopathic Drug, Natrum Sulphuricum 200. eCAM 2009. 6(1):65-75. <ul><li>Administration of Nat Sulph 200 reduced genomic damage, activities of AcP, AlkP, AST, ALT, LPO and increased GSH content. </li></ul>
    34. 34. <ul><li>LACTATION AND </li></ul><ul><li>PEDIATRIC </li></ul><ul><li>COMPLAINTS </li></ul>
    35. 35. Ekins-Daukes S, et al. Paediatric homeoopathy in general practice: where, when, and why? British Journ Clin Pharm . 2004
    36. 36. Rise, MB et al. How do parents of child patients compare consultations with homeopaths and physicians? A qualitative study. Patient Educ Couns . 2009 Jan;74(1):91-6. <ul><li>Comparison of 16 children who consulted with both homeopathic physician and allopathic physician </li></ul><ul><li>Parents experienced the homeopathic consultations to a greater extent to have a whole person approach </li></ul><ul><li>Included exhaustive questioning, longer consultations, more interaction with the child, and looking for the underlying cause. </li></ul>
    37. 37. Haidvog, M et al. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting. BMC Complementary and Alternative Medicine . 2007, 7:7. <ul><li>The aim to assess the effectiveness of homeopathy compared to conventional treatment. </li></ul><ul><li>57 primary care practices involved (Europe and US) = 1,577 patients </li></ul><ul><li>Onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic treatment in children and adults. </li></ul><ul><li>Adverse drug reactions occurred more frequently in adults of the conventional group than in the homeopathic group </li></ul><ul><li>Conclusion = in primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment. </li></ul>
    38. 38. Vickers A, et al. WITHDRAWN: Homeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Databases Syst Rev. 2009 Jul 8;(3). <ul><li>Oscillococcinum treatment reduced the length of influenza illness </li></ul><ul><li>Oscillococcinum was associated with patients considering treatment effective </li></ul>
    39. 39. Jefferson T, et al. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev . 2008 Apr 16;(2) <ul><li>Influenza vaccines are efficacious in children older than 2 but little evidence is available for children less than 2. </li></ul><ul><li>More data on safety needed </li></ul><ul><li>More research is needed before recommended as public health policy. </li></ul>
    40. 40. Derasse M, et al. The effects of a complex homeopathic medicine compared with acetaminophen in the symptomatic treatment of acute febrile infections in children: an observational study. Explore (NY) . 2005 Jan;1(1):33-9. <ul><li>Fever, cramps, distress, disturbed sleep, crying, and difficulties with eating/drinking </li></ul><ul><li>Symptoms graded 0 - 3. </li></ul><ul><li>Both groups improved. Homeopathic tx was NONINFERIOR to acetaminophen. </li></ul><ul><li>Body temperature was reduced by 1.7 degrees (1.9 with acetaminophen) </li></ul><ul><li>Severity of infection decreased by 2.0 in homeopathic group (2.2 in acetaminophen group) </li></ul>
    41. 41. Werner, C, et al. Efficacy of homeopathic and antibiotic treatment strategies in cases of mild and moderate bovine clinical mastitis. Journal of Dairy Research . 2010. 77:460-467. <ul><li>136 lactating cows </li></ul><ul><li>In cases of pathogen-positive mastitis, the cure rate after 4 and 8 weeks was similar between the two treatment strategies. </li></ul><ul><li>A large difference was seen between placebo and homeopathic group in the long term. </li></ul>
    42. 42. Muller-Krampe B, et al. Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children. Pediatr Int . 2007 Jun;49(3):328-34. <ul><li>Homeopathic medication compared to hyoscine butylbromide in children less than 12 yoa. </li></ul><ul><li>1 week treatment arm </li></ul><ul><li>Homeopathic medication seems to be an effective and well-tolerated alternative to conventional therapies in children. </li></ul>
    43. 43. Berrebi A, et al. Traitement de la douleur de la montee laiteuse non souhaitee par homeopathie dans le post-partum immediat. J Gynecol Obstet Biol Reprod 2001; 30:353-357. <ul><li>Homeopathic treatment designed for patients unable or not wanting to breastfeed. </li></ul><ul><li>Apis mellifica 9C and Bryonia 9C </li></ul><ul><li>A significant improvement of lactation pain was observed. </li></ul><ul><li>A similar effect was observed for breast tension and spontaneous milk flow. </li></ul>
    44. 44. Homeopathic Consultation An Overview
    45. 45. Consultation - Overview <ul><li>Initial visit usually lasts between 2-3 hours </li></ul><ul><li>Includes the following: </li></ul><ul><ul><li>History </li></ul></ul><ul><ul><ul><li>CC/PI </li></ul></ul></ul><ul><ul><ul><li>Personal Medical History </li></ul></ul></ul><ul><ul><ul><li>Family Medical History </li></ul></ul></ul><ul><ul><ul><li>ROS </li></ul></ul></ul><ul><ul><ul><li>Specifics - time of day, sensations, concomitants, foods, temperatures, sleep, dreams, etc. </li></ul></ul></ul><ul><ul><li>Physical Exam </li></ul></ul><ul><ul><li>Review of findings and informed consent </li></ul></ul><ul><ul><li>Treatment </li></ul></ul>
    46. 46. Materia Medica and Repertory
    47. 47. Companies <ul><li>Boiron </li></ul><ul><li>Washington Homeopathic </li></ul><ul><li>Remedy Makers </li></ul><ul><li>Standard Homeopathic Company (Hyland’s) </li></ul>
    48. 48. RESOURCES <ul><li>Patricia HATHERLY, BA, DipEd, IBCLC, BHSc (Hom) </li></ul><ul><li>Positive review in Journal of Human Lactation </li></ul>
    49. 49. RESOURCES <ul><li>Miranda CASTRO, RSHom </li></ul>
    50. 50. THANK YOU!!