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Homeopathy - should we just remove it from RxNorm Extension?

(Eduard Korchmar) #1

There are currently about 7000 standard concepts in RxNorm Extension vocabulary that specify “homeopathic potencies” in drug_strength table. They were built from source vocabularies that don’t distinguish between proper drugs and homeopathy, giving explicit ‘dosage’ for both.

This causes problems as per RxNorm and RxNorm Extension logic all primitive standard concepts like Branded/Clinical Drug Forms are built from such concepts. This could cause drug concepts like 41117395 “Epinephrine 30 C Oral Tablet Box of 1” as well as their mapping targets to be included in concept set for epinephrine-containing drugs, despite not containing a single molecule of the hormone.

We could cut all homeopathy from drug hierarchy and reclassify it as standard Devices.

Is there any non-obvious use case for when homeopathy concepts are useful? Should we keep them?

(JD Liddil) #2

Well as a scientist I’d like to see homeopathy removed. There are no data to support it’s use.

(Christian Reich) #3

Yeah, we should. It’s work to remove it. Since there is no data - nobody has had any desire to spend the time, I guess.

(Julianna Kohler) #4

What about homeopathic remedies that interfere with pharmaceuticals? I don’t know how likely this would be recorded in a patient record, but St. John’s Wort interferes with NNRTIs and Protease Inhibitors for HIV treatment. Would there be somewhere else that SJW would be recorded if that information is available?

(JD Liddil) #5

Can it not be coded using one of the Herbal terms?

(Dmytry Dymshyts) #6

Please don’t mix Homeopathy and Herbal drugs.
We don’t have anything here against St. John’s Wort or Calendula :slight_smile:
I see
St John’s wort causes dangerous reduction in indinavir levels; implications for other HAART drugs too

(Mark Seal) #7

Not all homeopathic formulations are made with herbal ingredients, so no.

(Mark Seal) #8

If one throws out homeopathic formulations, one will be removing a large portion of data that can be collected from locations such as certain regions of India. Be it good or bad, there will be large holes of treatment data from those regions.

(JD Liddil) #9

Right.But for things like St John’s Wort it could work.

(Christian Reich) #10

So, again, friends: Apart from the challenge to your sense of scientific credibility: Is there anything in homeopathics that makes you want them to be taken out? Because if not - leave them alone. It’s more work to take them out than to leave them in.

(Eduard Korchmar) #11

My concern is that homeopathic drugs – that we can definitely qualify as homeopathic because they give dosages in ‘potencies’ or are explicitly classified as such by source vocabularies – get included in the Standard hierarchy and mapped to concepts.

Homeopathic pill with St.John’s wort in 6C potency (meaning that original ingredient was diluted 1:10 in distilled water six hundred times) is not a type of Oral Tablet containing certain amount of St. John’s Wort extract. It is a sucrose (or lactose) oral tablet completely devoid of St. John Wort’s extract. However, in CONCEPT_ANCESTOR table, such concepts currently are direct descendants of Ingredient concept.

By moving source homeopathic remedies to Devices domain we get rid of false positives (inclusions of homeopathic drugs together with Ingredients they don’t actually include) but still keep observation periods intact by not completely eliminating periods when only medical attention a person got was the administration of sugar pills.

It could be implemented gradually as a new rule during routine update of drug vocabularies that support RxNorm Extension.

(Dmytry Dymshyts) #12

@Eduard_Korchmar is saying that it’s not hard work - we can identify them by specific units (C, X, D).

Homeopathics are descendants of real Clinical Drug Forms, so If I want to find all St.John’s wort (in real dosage), I’ll find 1*10^-600 of it as well.
Thanks God, nobody makes homeopathic dilutions of ALK-inhibitors or some other studied drugs :slight_smile: So, we haven’t met the problem described yet.

(Dmytry Dymshyts) #13

Actually, why not an Observation Domain?
It hard to affiliate homeopathy to Device by any semanic meaning Devices have.

(Christian Reich) #14


So, the only reason you gave us is that homeopathic drugs don’t contain the ingredient, and therefore will water down the effect of a estimation gig. Good point. However, the cheaper way to fix that is to write a paragraph into the cook book to watch out for these.

(Dmytry Dymshyts) #15

It is exactly what we wanted for now.
Yep, they might be left non-standard as a part of source vocabulary. even domain = Drug, but not standard. That’s it.

(Alexander Davydov) #16

@Dymshyts What do you mean saying “leave them non-standard”? Do not process them anyhow while working with some new Drug vocabulary just filtering them out by these specific dilution units? And leave existing RxNorm Extension homeopathic drugs being Standard, including valid links to the ingredients?

(Dmytry Dymshyts) #17


Deprecate them. But it might take time.

So, for now, at least not to add new standard Homeopaty

(Anna Ostropolets) #18

I’m not sure that we have a consensus here, gents. I hear devices, non-standard, not to add, remove, do nothing.
What I would say is that it is simply not such a big issue. We don’t really have a problem with homeopathy and I’ve never seen anybody complaining about that. Epinephrine is a rare exclusion.
So, there was an effort in putting them in the vocabulary. Then, there may be an unforeseen use case one day as it happened to blood products.
Then, it’s not really a device. You can’t make it non-standard either as people will come and ask where the standard counterparts for their source codes are.
So, here comes my question: why bother if we have other, more serious issues with drugs?

(Christian Reich) #19

Exactly. We are chasing geese. Let’s drop the subject. @Eduard_Korchmar just asked a question.