Homeopathy
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This document discusses the history, current issues, and ethical considerations regarding homeopathy. It proposes that homeopathy was developed in 1797 based on the "like cures like" theory and involves highly diluted substances administered in "potencies." Currently, the British NHS no longer funds homeopathy for parts of England due to lack of evidence of effectiveness. There is also debate around regulating ineffective treatments and restricting consumer access to alternative medicines.
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After reading this chapter, you should be able to
1. Explain reasons for the prevalence of medical mistakes.
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funded largely by taxpayer’s money. However, in recent years, its provision has come under
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After reading this chapter, you should be able to
1. Explain reasons for the prevalence of medical mistakes.
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3. Analyze how ethical health care organizations address the vexing problem of medical mistakes.
4. Examine the legal, regulatory, political, and administrative attempts to reduce threats to
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6. Examine the ethical implications of health care organizations’ responses to medical mistakes.
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Homeopathy is a medical system developed in Germany over 200 years ago based on three principles: like cures like, one remedy for all symptoms, and minimal doses. It is used in India's public health system to treat common diseases. Homeopathy treats conditions like allergies, migraines, depression, and irritable bowel syndrome. While research has not proven its effectiveness, some studies show benefits for symptom management, especially for women and breast cancer patients. Homeopathy providers spend more time with patients and discuss lifestyle practices than conventional doctors.
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geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Homeopathy
- 2. A Brief History Proposed in 1797 by Dr. Samuel Hahnemann ”Like Cures Like” Theory The treatment process Different levels of potency (1 part medicine, 99 part dilute) Succussion (shaken) Outcomes http://www.canine-epilepsy.com/images/hahnemann.jpg
- 3. Current Events British National Health Service (NHS) says Brits can no longer receive homeopathy treatments Applies to Northern part of England Still allowed in London and Bristol FDA vs. Hyland: teething remedies “…This warning has created confusion among parents and limited access to the medicines." - Hyland press release Overall issues https://www.riteaid.com/shop/media/catalog/product/cac he/1/image/600x410/17f82f742ffe127f42dca9de82fb58b1/ 3/5/354973312715.jpg
- 4. Ethical Issues Before NHS took action: Is it unethical to continue to fund treatments that are unsupported by evidence? Is it unethical to give someone a treatment that will not make them better? Currently: not only about making someone better, but harming them as well
- 5. My Thoughts Homeopathy treatments should, at the very least, be much more regulated Very dated system Ineffective “Scientifically implausible”
- 6. Questions Should a company face some sort of punishment for misleading consumers? How do you regulate something that is virtually ineffective? To what extent can you force someone who believes in homeopathy treatments to take an alternative form of treatment?
- 7. Sources http://www.businessinsider.com/nhs-funds-homeopathy-bogus-2016-10 “The British National Health Service still prescribes homeopathy — an ‘alternative’ to modern medicine that doesn’t work” http://www.businessinsider.com/one-of-the-most-popular-alternatives-to-modern- medicine-doesnt-work-2015-10?IR=T “One of the most popular alternatives to modern medicine doesn't work” http://www.independent.co.uk/news/world/americas/teething-pills-deaths- homeopathic-children-die-taking-remedies-a7359411.html “10 children die after taking homeopathic teething pills” http://www.acsh.org/news/2016/10/17/homeopathy-lost-one-science-10311 “Homeopathy Lost This One To Science”