classical homeopathy

184

Upload: spyderix

Post on 14-Apr-2015

519 views

Category:

Documents


13 download

TRANSCRIPT

Page 1: Classical Homeopathy
Page 2: Classical Homeopathy

An Imprint of Elsevier Science

The Curtis Center Independence Square West Philadelphia, Pennsylvania 19106

CLASSICAL HOMEOPATHY ISBN 0-443-06565-9 Copyright © 2003, Elsevier Science (USA). All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, elec-tronic or mechanical, including photocopy, recording, or any information storage and retrievalsystem, without permission in writing from the publisher.

Churchill Livingstone and the sailboat design are registered trademarks.

Library of Congress Cataloging in Publication DataClassical homeopathy / [edited by] Michael Carlston

p.; cm. – (Medical guides to complementary & alternative medicine) Includes bibliographical references and index. ISBN 0-443-06565-9 1. Homeopathy. I. Carlston, Michael. II. Medical guides to complementary and alternative

medicine. [DNLM: 1. Homeopathy. WB 930 C614 2003]

RX71 .C534 2003 615.5′32—dc21

2002073670

Publishing Director: Linda Duncan Publishing Manager: Inta Ozols Associate Developmental Editor: Melissa Kuster Deutsch Project Manager: Linda McKinley Designer: Julia Dummitt

KI-MVY

Printed in the United States

Last digit is the print number: 9 8 7 6 5 4 3 2 1

NOTICE

Complementary and alternative medicine is an ever-changing field. Standard safety precau-tions must be followed, but as new research and clinical experience broaden our knowledge,changes in treatment and drug therapy may become necessary or appropriate. Readers areadvised to check the most current product information provided by the manufacturer ofeach drug to be administered to verify the recommended dose, the method and duration ofadministration, and contraindications. It is the responsibility of the licensed prescriber, rely-ing on experience and knowledge of the patient, to determine dosages and the best treatmentfor each individual patient. Neither the publisher nor the editors assume any liability for anyinjury and/or damage to persons or property arising from this publication.

Page 3: Classical Homeopathy

DEBORAH GORDON, MDAssociate FacultyHahnemann College of HomeopathyPoint Richmond, California

STEVEN KAYNE, PhD, MBA, LLM, FRPharmS, FCPP,FFHom (Hon)Hon Consultant Pharmacist Glasgow Homeopathic Hospital Visiting Lecturer in Complementary Medicine University of Strathclyde Glasgow, Scotland

RICHARD PITT, RSHom (NA), CCHDirectorPacific Academy of HomeopathySan Francisco, California

MICHAEL QUINN, RPhFounder and Chief PharmacistHahnemann PharmacyPresidentHahnemann Laboratories, Inc.

JULIAN WINSTON, B.IDDirector Emeritus National Center for Homeopathy Alexandria, Virginia

v

Contributors

Page 4: Classical Homeopathy

This book is dedicated to those who are unafraid to ask questions in their desire to learn

Page 5: Classical Homeopathy

As complementary and alternative medicine(CAM) becomes an increasingly prominentpart of our health care system, more knowl-

edge about these practices is needed. Homeopathy isa CAM system that few professionals know about andfewer still understand. Often it is confused withherbalism, thought to be simply the use of smallamounts of drugs, and approached as if it were sim-ply an alternative to disease treatment by conven-tional medicine. It is none of these. Controversy andbias around homeopathy is often heated and rarelybased on factual data. Thus there are gaps betweenpublic and professional interest, skeptic and advocateopinion, and conventional and complementary prac-titioner knowledge. This book can fill those gaps.

Homeopathy was extensively practiced in theUnited States and Europe at the turn of the last cen-tury and is still widely used in many places of theworld today. Many American medical schools werebegun as homeopathic but closed after the Flexnerreport in 1916 and the advent of laboratory-basedmedicine. Homeopathy was vigorously suppressed inthe United States and almost died out. Ironically, asits popularity waned in the United States, homeopa-thy spread widely in South America and India, whereit is extensively used today for serious conditions.Interest in and use of homeopathy in the UnitedStates and Europe is now on the rise again as thepublic seeks nontoxic and holistic approaches tohealth care. This book is the first comprehensiveintroduction for nonhomeopathic professionalsabout homeopathy—and its history, regulation, prac-tice, and research—to originate from America sincethe rise in interest in CAM.

The book begins with a rationale for why healthcare practitioners should study and learn this systemof medicine. It gives a succinct overview of the prin-ciples and history of homeopathy and its develop-ment. It addresses why patients seek it, how it ispracticed, what it does and does not work for, andsummarizes the current state of the science in a bal-anced and evidence-based manner. It gives the readerinformation about training, licensure and liability,drug production and regulation, self-case use, andcosts. In short, this book has everything the practi-tioner needs to know to understand issues of homeo-pathic practice and where to get more information ortraining.

Homeopathy will, like other areas of CAM, even-tually find its proper place in medicine. This bookwill go a long way in helping that process along. Dr.Carlston is to be commended for taking a clinicalapproach, balanced with evidence, to homeopathy.Although research is important, and more is needed,medicine ultimately begins and ends in the clinic.The strength of homeopathy comes from its gentlenature and holistic view, its foundation in thedynamics of clinical practice, and its vision of thehealing capacity of the person. It has a lot to teach usabout the process of healing, and this book is one ofour best guides.

WAYNE B. JONAS, MD Director

Samueli Institute for Information Biology Director (1995–1999)

Office of Alternative Medicine, National Institutesof Health

Foreword

ix

Page 6: Classical Homeopathy

The aim of this series is to provide clear andrational guides for health care professionalsand students so they have current knowledge

about the following: ● Therapeutic medical systems currently labeled as

complementary medicine● Complementary approaches to specific medical

conditions ● Integration of complementary therapy into main-

stream medical practice Each text is written specifically with the needs

and questions of a health care audience in mind.Where possible, basic applications in clinical practiceare explored.

Complementary medicine is being rapidly inte-grated into mainstream health care, largely inresponse to consumer demand and in recognition ofnew scientific findings that are expanding our view ofhealth and healing—pushing against the limits of thecurrent biomedical paradigm.

Health care professionals need to know what theirpatients are doing and what they believe about comple-mentary and alternative medicine. In addition, a basicworking knowledge of complementary medical thera-pies is increasingly important for practitioners in pri-mary care, some biomedical specialties, and the alliedhealth professions. Complementary therapies expandour view of the art and science of medicine and makeimportant contributions to the intellectual formationof students in health professions.

This series provides a survey of the fundamentalsand foundations of complementary medical systems

practiced in North America and Europe. Each topic ispresented in ways that are understandable and thatprovide an important understanding of the intellectualfoundations of each system—with translationbetween the complementary and conventional med-ical systems where possible. These explanations drawappropriately on the social and scientific founda-tions of each system of care.

Rapidly growing contemporary research resultsare also included where possible. In addition to pro-viding evidence regarding the conditions for whichcomplementary medicines may be of therapeuticbenefit, guidance is also provided about when com-plementary therapies should not be used.

This field of health is rapidly moving from beingconsidered alternative (implying exclusive use of onemedical system or another) to complementary (used asan adjunct to mainstream medical care) to integrativemedicine (implying an active, conscious effort bymainstream medicine to incorporate alternatives onthe basis of rational clinical and scientific informa-tion and judgment).

Likewise, health care professionals and studentsmust move rapidly to learn the fundamentals of com-plementary medical systems in order to better servetheir patients’ needs, protect the public health, andexpand their scientific horizons and understandingsof health and healing.

MARC S. MICOZZI, MD, PhD Philadelphia, Pennsylvania

1997

SeriesIntroduction

xi

Page 7: Classical Homeopathy

Extraordinary claims require extraordinary results.The history of homeopathy, its purported mech-anism of action, and recent research results all

appear extraordinary when seen through the lens of thecontemporary biomedical paradigm. As biomedicineincreasingly turns its attention to investigation of“alternative” and complementary therapies, encour-aged by popular interest and use, research studies areincreasingly yielding positive results with alternativemodalities that were only recently thought not to workbecause they could not work, as was once famously statedfor homeopathy itself. The goal of this book series,Medical Guides to Complementary and Alternative Medicine,is to present information on the historical and scientificbasis of healing traditions outside biomedicine with thehope of expanding the biomedical paradigm to be moreinclusive of all observed healing phenomena.

Many contemporary medical researchers andpractitioners assume that once empiric observationsprove that alternative modalities work, then a prioritheir mechanisms of action must lie easily within therealm of explanations offered by the contemporarymedical paradigm. Problematically, when researchdesigns are created to test alternative therapies, con-trols are created for presumed mechanisms of actionwithin the biomedical paradigm without regard tothe actual mechanisms proposed by alternative prac-tice traditions themselves.

Empiricism has been well established as the basis ofscientific observation and of rational medical practicesince the time of Sir Francis Bacon. On the other hand,positing mechanisms to explain empiric observations isalways bounded by the prevailing paradigm of the time.The medical paradigm has evolved through time andwill not likely remain frozen much longer in its twenti-eth-century reductionist, materialist version.

In perhaps no area of alternative medicine arethese issues as delineated as in homeopathy. If allexplanations of health are to be materialist explana-tions, as in the biomedical paradigm, homeopathyfalls far short. If we are to recognize that there is anonmaterial, “energetic” aspect to healing (as pro-posed by Ayurveda, Chinese medicine, many manualtherapies, and of course, “energy healing,” amongother modalities), then homeopathy may manifestitself in an entirely nonmaterial mechanism.

In the United States, homeopathy and so-calledallopathic medicine (a name conferred on regular medi-cine by homeopaths in mid-nineteenth century) havedefined their practices at least partially in distinctionand opposition to each other through the years. Asstated by the great nineteenth-century physician OliverWendell Holmes, “I care little for homeopathy, and evenless for so-called alleopathy.” In this, he was settingaside debates about mechanism in favor of empiricism.The only rational basis for medical practice is whethertreatment alleviates human suffering and prolongs orimproves human life.

When the prevailing system of healing is unableto cope with the disease burden of a suffering popu-lation, which is increasingly afflicted with stress-related conditions of all types, it is useful to consideralternatives that have “survived” over time (as Dr.Carlston aptly puts in his volume) the standardiza-tion of medical practice into one relatively narrowrealm. The survival of alternative practice such ashomeopathy may ultimately contribute to our ownsurvival as a healthy civilization.

MARC S. MICOZZI, MD, PhD Bethesda, MD

November 2001

Series Editor ’sPreface

xiii

Page 8: Classical Homeopathy

“The physician’s highest calling, his only calling, is tomake sick people healthy—to heal, as it is termed.”

SAMUEL HAHNEMANN, Organon of Medicine1

In the opening sentence of homeopathy’s foundingdocument, Samuel Hahnemann declares his convic-tion that the patient’s well-being is the only vital con-sideration in medicine. Debates about medicaltheories and the economics of health care have mean-ing only when considered in light of the patient’shealth; if it doesn’t help the patient in some way, itdoesn’t matter. Conversely, if it does help the patient,it must not be withheld. Like many of the best ideas,this one is obvious. Unfortunately, sometimes we for-get even obvious truths.

In February of 1994, my father-in-law was seri-ously ill. He spent 1 week in an intensive care unit(ICU) at Stanford Hospital. The families of each ofthe ICU patients sat together in a room waiting forthe brief periods when two families members couldgo in to hold the hand, stroke the hair or talk to ourusually unconscious loved one. Each family sup-ported the other ones with amazing compassion andsensitivity. In many ways we formed an extended fam-ily in the ICU waiting room. The emotions of thisnewer, larger family rose and fell with the conditionof each of the patients, our missing family shelteredin the ICU.

While waiting for my turn to visit, I read a briefnews item about Columbia University opening analternative medicine center. At the same time, I over-heard a conversation between two women whose hus-bands had been in the ICU for many weeks. Withtheir waning hope they lagged behind the other fam-ilies who had just rushed in for their 10-minute visit.One woman said to the other, “You are Chinese,

aren’t you? The doctors say that my husband’s kid-neys are failing and there isn’t much they can do. Afriend of mine had a problem that an acupuncturistcured, so it makes me wonder. Is there anything inChinese medicine that can help the kidneys?” TheChinese-American woman responded by saying thatshe had heard of some treatments that might help.Their initial optimism quickly faded after one of thewomen raised the concern that the doctors werelikely to refuse to allow such treatments or would, atthe least, be upset by their wish to try. The womendecided it was best not to upset the physicians tryingso hard to save their husbands’ lives.

I wonder how often a tragic scene like this passeswithout an interested eavesdropper to later recountthe tale. There is simply no ethical rationale for deny-ing any safe and potentially effective treatment to anypatient. As a physician, I am embarrassed and disap-pointed by our patients’ opinions of us. I am upsetthat patients are afraid to discuss complementarytherapies with their physicians. As it did in this inci-dent, this fear seems to arise from patients’ convic-tions that their physicians are hostile to thesetherapies.

There has been a barrier between medical ortho-doxy and other forms of health care. Somehow, thehealth care used by 80% of the world’s population hascome to be labeled alternative medicine.2 As we form anincreasingly global society, conventional physiciansand other Western health professionals are beginningto accept that human beings have been using thesemethods because they are effective, although to anunknown degree. With this newfound respect, thereis much that can be learned from the “other” formsof medicine in use today. Although few people withwhom I discussed this issue several years ago believed

Preface

xv

Page 9: Classical Homeopathy

a medical détente could occur in our lifetimes, theinjustice of the schism made me optimistic it wouldeventually be bridged. However, I must confess sur-prise at the speed with which this philosophic heal-ing is taking place. The ill-founded barrier iscrumbling rapidly. Writing this book is an attempt tofurther the process.

OVERVIEW

The goal of this book is to familiarize the reader withhomeopathic medicine in its classic form. We willattempt to convey an understanding of homeopathy’sunique view of health and disease, its place (currentand ideal) within the health care system, and a taste ofhomeopathic clinical practice. My perspective, and theperspective of this book, is that patient well-being isparamount and homeopathic medicine is an effectivemeans of achieving that aim. In fact, as a doctor prac-ticing both conventional and homeopathic medicine,my experience has been that homeopathy often worksbetter than conventional medicine for many commonchronic health problems.

This book should be especially interesting to stu-dents of the health professions, practicing health careproviders with a limited understanding of homeo-pathic medicine, and academicians desiring a funda-mental understanding of homeopathic medicine. Webegin with a discussion of the philosophic principlesof homeopathic medicine. This is followed by consid-eration of where homeopathy has been and where itis currently, in a cultural, historical, and scientificcontext. Later sections of the book delve into the clin-ical practice of homeopathy, including discussions ofthe types of health problems particularly suited tohomeopathic treatment. Hahnemann’s motto forhomeopathy, which is translated as “to taste andunderstand,” seems a good idea. Thus I have incor-porated an appendix with specific treatment sugges-tions for some common medical problems, so thatthe reader can test homeopathy in a small way.Homeopathic medicine can be a powerful medicaltool that demands careful application to achieve suc-cess. Therefore, this book is not a substitute forproper homeopathic or conventional medical train-ing. Both require a great deal more information andexperience than can be contained in one book.

Another limitation of this book is in the restric-tion of the homeopathic philosophy discussed.

Recently some clinicians have begun using homeo-pathic remedies in many new and controversial ways.Because these approaches and controversies are intheir infancy and will require many more years to befairly evaluated, they are not the subjects of this texton the classical application of homeopathy in medi-cine.

This book is the outgrowth of a homeopathicelective that I have taught since 1993 in the School ofMedicine of the University of California, SanFrancisco (UCSF). The course has been popular, aver-aging well over 100 health-sciences students per class.My side of that learning experience was critical to theevolution of this text.

I am sympathetic to the point of view that criti-cizes the common use of what would appear to beplacebo dilutions in homeopathy. Despite many yearsof witnessing the beneficial effects of all levels ofhomeopathic dilutions in clinical practice, I am stillpuzzled. How could homeopathy be more thanplacebo? Placebo should not consistently produce theeffects I have seen in patients with all varieties andseverity of complaints. Very good clinical, animal,and basic science research has often documented sig-nificant differences between placebo and homeo-pathic dilutions. I know that, using homeopathy, Ican routinely help patients with problems for whichmy regular medical training offered next to nothing.However, how can dilutions past Avogadro’s numberretain biological activity? In all honesty, I am stillamazed that homeopathy works as often as it does.

In the final analysis, this mystery is fascinating.Scientists need mysteries. Without the unknown toexplore, there is no need of science. As a scientist, I seehomeopathy as the most intriguing form of healingin the world. This book is an exploration of the fasci-nating science of homeopathy. I hope that reading itwill challenge your thinking about homeopathy andabout the practice of medicine, regardless of yourpreconceptions. My greatest hope is that it will, insome way, positively affect your treatment of yourpatients.

References 1. Hahnemann S: Organon of Medicine, ed 6 (original 1842)

(trans Kunzli J, Naude A, Pendelton P), Los Angeles,1982, JP Tarcher.

2. Farnsworth N et al: Medicinal plants in therapy, BullWorld Health Organ 63:965–981, 1985.

xvi C L A S S I C A L H O M E O P A T H Y

Page 10: Classical Homeopathy

Iwould like to acknowledge the assistance ofseveral people. First, the medical students atUCSF and the family practice residents at

Sutter Hospital Santa Rosa for their questions thatilluminated the essential components of this text. Forthe wisdom of their medical perspectives, WayneJonas, Marc Micozzi, Paul Erickson, Kristin Dillon,and Marisha Chilcott. For early editorial assistance,Meg Stemper. For all of the work from the publishingstaff at Elsevier Science, particularly Inta Ozols,Jennifer Watrous, Kellie White, and Melissa Kuster.

Mike McConnell at Graphic World PublishingServices for ironing out the wirnkles. For immenseresearch assistance over many years, the newly retiredmedical librarian Joan Chilton. For their hard workand perseverance, Stephen Kayne, Julian Winston,Deborah Gordon, Richard Pitt, and Michael Quinn.For their patience, Morgan, Rachel, and MarissaCarlston. Most importantly, for her support, my “inhouse” editor and spouse, Melanie Carlston. I hopethe result is worthy of the considerable efforts of thisremarkable group.

Acknowledgments

xvii

Page 11: Classical Homeopathy

WHY LEARN ABOUTHOMEOPATHY?

There are several reasons why a physician or any othermedical professional ought to learn about homeo-pathic medicine. In addition to the health benefit ifhomeopathy works, study of homeopathy can impartknowledge and unique homeopathic perspectivesthat will benefit even a skeptical student and his orher patients.

The most important reason to study any medicaltherapy is for the benefit the therapy can offer topatients. Although homeopathy has not been studiedas extensively as almost anyone would like, homeo-paths have accumulated two centuries worth of doc-umented clinical evidence of homeopathy’s efficacy ina very broad range of illnesses. Recent research tends tosupport this experiential evidence. Homeopathy first

became famous as a means of successfully treating thehorrible epidemics of the nineteenth century. Becausewe are now threatened by the rise of new microbial dis-eases and the waning effectiveness of antibiotics,other options are urgently needed. Homeopathy canoften provide an effective alternative to antibiotics.Homeopathy’s most unique capability is to alleviatechronic illness; because treatment of chronic illness isconventional medicine’s greatest weakness, homeop-athy may be the ideal form of complementary medicine.

Another reason to study homeopathy is its popu-larity. Regardless of a physician’s own interest inhomeopathy, some of his or her patients are verylikely to be using it. At a minimum, physicians mustlearn about the uses and misuses of homeopathicmedicine for their patients’ safety.

Eisenberg and others conducted a landmark studyof “unconventional medicine” that determined that

1Introduction

M I C H A E L C A R L S T O N

1

Page 12: Classical Homeopathy

roughly 600,000 American adults saw homeopathicpractitioners in 1990, and another 1.2 million usedhomeopathy for self-care.1 Over the past decade, fig-ures show that sales of homeopathic medicine havebeen rising at an annual rate of approximately 20%.2

A 1997 survey by Landmark Healthcare foundthat 5% of the American adult population, approx-imately 9 million people, reported use of homeo-pathic products in the prior year; 73% of that use wasfor self-treatment.3

David Eisenberg and colleagues followed up ontheir 1990 data with another national survey in 1997.They found that the use of homeopathy increasedfivefold to 6.7 million adults—3.4% of the adultpopulation. They also found that self-care useincreased to more than 82%, meaning that 5.5 mil-lion American adults were using homeopathy inde-pendent of any professional supervision.4

A linear projection of these data suggests that thenumber of adult Americans using homeopathy by2002 has risen to 12 to 13 million, with 8 to 10 mil-lion using it on their own. Although many of themost popular homeopathic products sold in theUnited States are specifically intended for use by chil-dren, we have no national data regarding the extentof pediatric use.

Self-treatment predominates the homeopathiclandscape and its repercussions must highlight anyconsideration of homeopathy by American healthcare providers. In their first survey, Eisenberg and col-leagues found that more than 60% of those usingunconventional therapies did not tell their conven-tional physicians. This was disturbing proof ofpatients’ mistrust of their conventional physicians’attitudes. Unfortunately, the second survey did notfind any improvement in the following years. Patientshave simply been unwilling to speak to their conven-tional physicians about their use of alternative thera-pies. Assuming this figure is applicable tohomeopathy, approximately 6 to 8 million Americansuse homeopathic medicines every year without theknowledge of their conventional physician or thesupervision of a professional homeopath. Their con-ventional physicians therefore do not know whetherthe effects, beneficial or adverse, their patients areexperiencing are from the covert use of homeopathyor from conventional treatment.

Assuming this pattern of nondisclosure holdstrue for homeopathic patients (we have no data tosupport or confirm this supposition), that minority

who do inform their physicians are likely to be moreknowledgeable about the subject than their physi-cians. Only rarely do patients tell me they discussedtheir use of homeopathy with their “other” doctors.When a patient reports that a conventional physicianhas even the most meager knowledge of homeopathy,it is a rare event. This ignorance can be harmful to thepatient and embarrassing to the physician.

Homeopathic medicine’s philosophy of healingand understanding of illness adds tremendously tothe practice of medicine. Hering’s Laws of Cure, forexample, helps the physician determine whether apatient’s response to any therapy is curative orsuppressive (Box 1-1). This method of analysis isapplicable whether the treatment is homeopathy,acupuncture, conventional medication, or surgery.The family practice residents and medical students inmy classes have been excited about the philosophicunderstanding of health they have gained fromstudying homeopathy. They have a hunger to makesense of their growing experience of clinical medi-cine. Homeopathic philosophy can help them achievean understanding beyond what they learn in theirconventional training.

One of the most striking differences between con-ventional medicine and homeopathic clinical practiceis the patient interview. The homeopath needs atremendous amount of precisely detailed informa-tion to select, from the large number of potential

2 C L A S S I C A L H O M E O P A T H Y

Dr. Constantine Hering, the father of Americanhomeopathy, taught that the healing process pro-gresses as follows:

1. Symptoms are resolved in reverse order; that is,healing progresses from the most recent condi-tion to the oldest

2. The recession of the symptoms progresses fromthe upper body parts downward to the lowerbody parts

3. The symptoms that are resolved first are thosethat affect the deeper organs and tissues,whereas those that are resolved later are moresuperficial

4. Improvement occurs with the more importantorgans and systems first, then moves on to theless important ones

B O X 1 - 1

Hering’s Laws of Cure5

Page 13: Classical Homeopathy

homeopathic medicines, the appropriate medicine foreach patient. The patient interview and physicalexamination is the sole means of acquiring this infor-mation. Laboratory testing and other modern diag-nostic methods have yet to be correlated withhomeopathic prescribing. The homeopath mustdevelop interviewing skills to a very high degree toobtain the necessary information. On several occa-sions, nonhomeopathic medical school faculty mem-bers have suggested to me that medical studentsshould receive their training in proper interviewingskills from homeopaths because of the care withwhich homeopaths interview patients.

HOMEOPATHY ANDCONTROVERSY

Homeopathy is a soup made from the shadow of a pigeonthat starved to death.

ABRAHAM LINCOLN

When Abraham Lincoln was assassinated, WilliamSeward, the Secretary of State, was also wounded byBooth’s gunfire. Like many of America’s mid-nineteenth century elite, Seward’s physician, Dr.Tullio Verdi, was a homeopath. The SurgeonGeneral, Joseph K. Barnes, was first on the scene, andhe cared for both men until Dr. Verdi arrived. Barnesthen reported to Verdi the care he had provided toSeward.

The Surgeon General’s actions provoked contro-versy within the fledgling American Medical As-sociation (AMA). The controversy involved whatofficially constituted unethical behavior on the partof Lincoln’s physician, and led to his censure by theWashington Medical Society. The Surgeon Generalhad violated the AMA’s “Consultation Clause,” whichbanned its members from consulting with homeo-paths or even providing treatment to a patient whohad seen a homeopath until that patient formallydischarged the homeopath.

Fortunately this degree of hostility has been rele-gated to the history books. Research evidence thatthis unorthodox therapy might actually be effectivehas helped open serious consideration of homeop-athy. However, homeopathy has often been controver-sial. Although its history does not lack for colorfuland dramatic personalities, the controversial aspectof homeopathy is primarily a result of its fundamen-

tal philosophic opposition to the world-view of con-ventional medicine.

The name for conventional medicine’s thera-peutic philosophy is allopathy, meaning against suffer-ing, whereas homeopathy’s philosophy is based onthe concept of similar to suffering. Although homeop-athy is almost purely homeopathic, allopathic medicineis far from truly allopathic. Allopathic medicineincludes a philosophic hodgepodge of methods,including some that could even be called homeo-pathic. Uncomfortably, it was Samuel Hahnemann,the founder of homeopathy, who named allopathicmedicine. In many ways homeopathic medicine hashelped allopathic medicine define itself over the pasttwo centuries by providing a clear-cut and consistentmodel of what allopathic medicine is not.

Homeopathy’s “similar to suffering” theory refersto the therapeutic use of substances that, wheningested, create symptoms identical to those thepatient is experiencing. This defining principle is dia-metrically opposed to the therapeutic approach oforthodox medicine, whose aim is to prescribe pharma-cologic substances that will oppose the patient’ssymptoms. Homeopathy and conventional medicinealso have opposing interpretations of the nature ofthose symptoms. The homeopath believes the symp-toms result from the organism’s effort to heal itself,whereas the allopath tends to view the symptoms asequal to the problem. If you look at the index of thePhysicians’ Desk Reference, you will find that it islargely made up of “anti” medication; antacids,antiarthritics, antibiotics, anticoagulants, anticon-vulsants, antidepressants, antiemetics, antihista-mines, and antiinf lammatories, for example.Whereas the homeopath gives a remedy to act in con-cert with the patient’s symptoms, the allopath pre-scribes to obstruct those symptoms.

This fundamental principle of homeopathy makesmore sense as our scientific understanding of humanphysiology advances. When my medical school micro-biology professor lectured to our class about evidencethat the symptoms we experience in acute infectiousdiseases are the result of the immune system’s mobili-zation to combat the disease and are not the directeffect of the microorganism, I recognized the “home-opathy” in the physiology. It makes sense, then, that asubstance that accentuates the symptoms already pro-duced by the body could assist the healing process byaugmenting the already operating source of thosesymptoms—the immune response.

C H A P T E R 1 Introduction 3

Page 14: Classical Homeopathy

The most fervent, almost rabid, opposition tohomeopathy arises from the common use of homeo-pathically diluted medications that do not containany scientifically measurable amount of the medi-cinal substance. Homeopathic medicines are com-monly diluted beyond the point where Avogadro’shypothesis suggests that not even one moleculeshould remain of the original substance. BecauseAvogadro’s number is one of the fundamental con-stants in chemistry, this is a formidable intellectualbarrier. Although there are scientific theories thatmight explain away the problem, all of them are con-troversial. Critics therefore believe homeopathictreatment is solely placebo, and forget that this dilu-tion process is secondary to the primary principle of“like cures like.” Homeopaths believe that the effec-tiveness of homeopathic treatment extends wellbeyond the placebo effect, which inevitably benefitsall groups of patients.

The principles of homeopathic medicine can beapplied without using dilutions that appear to chal-lenge Avogadro’s hypothesis. Since Avogadro’s con-stant was discovered, many homeopaths haverefused, on intellectual grounds, to use medicinesdiluted past this point. Today this attitude is mostcommon in France. What really is most essential tohomeopathy is the primary hypothesis of like cureslike.

In some quarters, entrenched bias against home-opathy has been so unyielding that positive evidencefrom clinical trials, even well-conducted, randomized,and controlled ones, has been ignored. An interestingexample of perceived bias against homeopathy in aca-demic medicine occurred in 1989. It followed thepublication of a clinical trial demonstrating home-opathy’s effectiveness. An editorial in Lancet, entitled“Quadruple-blind,” commented on this double-blind, randomized clinical trial of homeopathic treat-ment for influenza.6 The trial demonstrated a verypositive result in favor of the homeopathic treatment.Expresssing instinctive reservations, the editorialistmused about the number of levels of blinding thatwould be required for a favorable homeopathic trial tobe accepted as a true result. He humorously com-mented that antihomeopathic bias was so entrenchedthat it might be necessary to blind the journal reader tothe fact that the tested substance was homeopathic.

Ideally, a large number of clinical trials wouldhave been performed to document the effectivenessof homeopathy for a large range of medical diag-

noses. Unfortunately, this is not the case. Those whobelieve that homeopathy is effective must continue toproduce high-quality research.

However, the limited proof available in the pub-lished literature does not justify delaying the use ofhomeopathy until more proof is accumulated. In thepast decade, a number of homeopathic clinical trialshave been published in many of the best medicaljournals. Although inconclusive, the balance of thisliterature is favorable to homeopathy.7,8 Few alterna-tive therapies are represented as well as homeopathyin the conventional medical literature.

This is the age of evidence-based medicine, basedon the concept that rigorous clinical trials can helpdelineate the ideal way to practice medicine.Although I believe that this careful, objective consid-eration will undoubtedly improve the quality ofhealth care we provide to our patients, it is impos-sible, at least for the foreseeable future, to base alltreatment on the results of clinical trials.

The biggest impediment to the realization ofevidence-based medicine is the paucity of clinical tri-als. Although it is estimated that more than one mil-lion clinical trials have been conducted, additionalestimates are that these mountains of data provideevidence of effectiveness for only 5% to 15% of ortho-dox medical interventions.9 Medicine, in all its thera-peutic diversity, clearly needs more clinical research.Unfortunately, patients are unable to delay their ill-nesses until the ideal treatment has been determined.Usually, treatment recommendations must be madein relative ignorance.

Most of the remaining problems of applyingresearch findings to clinical practice involve issuesthat were summarized by the famous nineteenth cen-tury social scientist and homeopathic advocate, MarkTwain, who (borrowing from Benjamin Disraeli)wrote, “There are three kinds of lies—lies, damned liesand statistics.” The goal of medical research is to uselessons learned to improve the clinical practice ofmedicine. However, the precise conditions of a clin-ical trial are seldom encountered amidst the complex-ities of “real world” medicine. Generalizing from eventhe best clinical trials and then implementing thefindings into patient care is a difficult and some-times treacherously misleading process. In the finalanalysis, clinicians, and our patients, must unavoid-ably rely largely on our clinical judgments.

More than a decade ago Prince Charles called formembers of the British Medical Association to

4 C L A S S I C A L H O M E O P A T H Y

Page 15: Classical Homeopathy

seriously consider the potential of complementarymedicine. Faced with a royal admonition, theAssociation issued a report on the nature and poten-tial efficacy of various forms of complementary med-icine. The rather insubstantial and brief statement onhomeopathy could be summarized as, “Homeopathydoesn’t work because it couldn’t work.” Althoughmany British physicians now refer patients to home-opaths, and 20% of all Scottish general practitionershave been trained in homeopathy, other physiciansmaintain a stubbornly unscientific attitude andrefuse to objectively consider research evidence.10-12

They base their arguments upon the absence of aproven mechanism for the action of the most highlydiluted homeopathic medicines.

Homeopaths believe that this posture is akin todisavowing the existence of gravity because of aninability to prove how it works. Similarly, most scien-tists believe that unexpected results need to be lookedat critically; however, when results are confirmed,theories must be revised to encompass the new infor-mation. The apparent contradiction becomes a valu-able means of enlarging our understanding of theworld.

The homeopathic sentiment is best expressed bythe quotation from Hahnemann at the beginning ofthe preface. The physician’s highest calling, his only calling,is to make sick people healthy—to heal, as it is termed. Thehomeopath’s mission is to heal the sick. It is import-ant to try to understand the tools we use for thepatient’s benefit. However, as an empiricist, thehomeopath is quite happy to use a tool that is notfully understood, provided it helps the patient.Patients benefit by receiving care from a physicianwho is knowledgeable about homeopathic medicine.Many medical problems, for which no effective con-ventional treatments are available, respond well tohomeopathic treatment. Some of these homeopathictreatments are quite simple and can be learned bystudying this book. Others are more complicated andrequire consultation with a homeopathic specialist.

Fortunately, medical students are beginning tolearn about homeopathic medicine in medicalschools. A 1995 survey found that 11% of Americanmedical schools taught something about homeo-pathic medicine.13 By 1998 this figure had risen to57%, and more than 15% of medical schools requiredsome instruction in homeopathy.14

There remains a great deal of ignorance abouthomeopathy within the conventional medical com-munity. Misconceptions are the norm. Homeopathicpractitioners readily admit our own ignorance of themechanism of its action as well as uncertainty aboutits limitations and ideal clinical methodology. Asmore students are educated about homeopathy, someof them will conduct clinical trials and basic sciencesresearch that will give us the answers we seek and,perhaps, settle some or all of the controversy sur-rounding homeopathic medicine.

References1. Eisenberg D et al: Unconventional medicine in the

United States, N Engl J Med 328:246-252, 1993.2. Herbal and homeopathic remedies: finally starting to

reach middle America? OTC News and Market Report223-238, July 1991.

3. Landmark Healthcare, Inc.: The Landmark report on pub-lic perceptions of alternative health care, Sacramento, 1998,Landmark Healthcare.

4. Eisenberg D et al: Trends in alternative medicine use inthe United States, 1990-1997: results of a follow-upnational survey, JAMA 280:1569-1575, 1998.

5. Swayne, J: Homeopathic method, London, 1998, ChurchillLivingstone.

6. Quadruple-blind, Lancet 1(8643):914, 1989.7. Kleijnen J, Knipschild P, ter Riet G: Clinical trials of

homoeopathy [published erratum appears in BMJ Apr6;302(6780):818, 1991] [see comments]. BMJ 302(6772):316-323, 1991.

8. Linde K, Clausius N, Ramirez G et al: Are the clinicaleffects of homeopathy placebo effects? A meta-analysisof placebo-controlled trials [see comments] [publishederratum appears in Lancet Jan 17;351(9097):220, 1998].Lancet 350(9081):834-843, 1997.

9. Bero L, Drummond R: The Cochrane collaboration,JAMA 274:1935-1938, 1995.

10. Reilly D: A certificate of primary care homeopathy, BrHomeopath J 83:57-58, 1994.

11. Swayne, J: Survey of the use of homeopathic medicinein the UK health system, J R Coll Gen Prac 39:503-506,1989.

12. Fisher P, Ward A: Complementary medicine in Europe,BMJ 309:107-111, 1994.

13. Carlston M et al: Alternative medicine education in USmedical schools and family practice residency pro-grams, Fam Med 29:559-662, 1997.

14. Barzansky B et al: Educational programs in US medicalschools, 1998-1999, JAMA 282:840-846, 1999.

C H A P T E R 1 Introduction 5

Page 16: Classical Homeopathy

Many physicians and lay people are veryconfused about what homeopathy reallyis. Although many tenets of homeopathic

philosophy are open to debate, antagonism towardhomeopathy is surprisingly ill informed. Ironically,conventional medicine’s summary judgment againsthomeopathy derives from a misunderstanding ofhomeopathic principles. Thoughtful considerationof a system of healing requires a sound understand-ing of the method, including its principles and clin-ical practice. The system of homeopathy is socomplex and different from conventional medicinethat it requires careful thought to intelligentlyaccept or reject its principles.

The most common misconception has been thathomeopathic medicine is synonymous with natural medi-cine. Although this sounds nice, it is inaccurate. Evenif true, this definition would not shed much light,because what exactly is natural medicine? Natu-ropaths, the most established group of health profes-sionals specializing in natural medicine, usually learnabout homeopathy as only one of many therapiesduring their training. Although homeopathic medi-cines, or remedies, as they are often called, are oftenmanufactured from naturally occurring materials, thisis not a requirement of the homeopathic pharma-copoeia. Homeopathic theory advocates using reme-dies to heal the patient by stimulating his own

2What Is Homeopathy?

M I C H A E L C A R L S T O N

Aude sapere (“Dare to taste and understand”)HAHNEMANN’S motto for homeopathy

7

Page 17: Classical Homeopathy

healing powers. Although this theory, if proven true,would effect what might be called a natural healing, it isunclear what such healing would mean compared withother forms of natural medicine. Such imprecisionseems to make the identification of homeopathy as“natural” more misleading than helpful.

An American medical student’s first exposure tohomeopathy traditionally occurs when the phrase“homeopathic dosage” is used to castigate a physi-cian who prescribed a subtherapeutic dosage of aconventional medicine. The assumption is thathomeopathy has something to do with using insuffi-cient quantities of medicine. Without investigatingfurther, the student would not learn that homeo-pathic manufacturing involves a process of serialdilution of the medicinal agent, sometimes to animprobable extreme. Further investigation is unlikelygiven the perceived certainty that this pharmacologicnihilism must be a therapeutic blind alley.

In truth, the controversial process of dilution doesnot define homeopathy. Herein lies the irony: conven-tional medicine’s rejection of homeopathy has beenbased upon the issue of ephemeral dosages, althoughsuch dilutions are not essential to homeopathy. Ifhomeopathy cannot be defined simply as the use offantastical dilutions, how then should it be defined?

DEFINITIONS

The National Institutes of Health opened the Officeof Alternative Medicine (OAM) in 1992 (sinceupgraded to center status as the National Centerfor Complementary and Alternative Medicine[NCCAM]). One of the OAM’s early efforts to bringsome order to the amazingly diverse realm of com-plementary and alternative medicine was a classifica-tion schema.1 Among the alternative fields ofpractice identified by NIH–OAM (Box 2-1), homeop-athy was listed under “Alternative Systems of MedicalPractice,” along with Traditional Oriental Medicine,African Traditional Medicine, Naturopathic Medi-cine, and Native American Health Care Practice,among others (Box 2-2). Although this framework isuseful, its ability to define homeopathy and otherforms of alternative medicine is clearly limited bythe tremendous differences within its broad cate-gories. Practitioners of these traditions usually findlittle that is familiar in the methods of the othertraditions.

The attempt to define homeopathy correctly beginssimply with its name. Homeopathy means “similar todisease” or “similar to suffering.” The clinical applica-tion of this principle defines homeopathic medicine.

Use of this essential homeopathic principlestretches far beyond the confines of the two cen-turies–old homeopathic medical tradition. Theaspect of homeopathy defined by the homeopathicmedical tradition and the broader usage of the simi-larity principle will be discussed in greater detail inChapter 3. Homeopathy as a system of medicine orig-inated in Germany with the experiments of SamuelHahnemann. Reviewing Hahnemann’s life story is agood place to begin our investigation.

8 C L A S S I C A L H O M E O P A T H Y

Mind-body interventionsBioelectomagnetic applications in medicineAlternative systems of medical practiceManual healing methodsPharmacological and biological treatmentsHerbal medicineDiet and nutritional therapy

B O X 2 - 1

Alternative Medicine Classification by NIH–OAM

NIH–OAM, National Institutes of Health-Office of AlternativeMedicine.

B O X 2 - 2

Alternative Systems of Medical Practice byNIH–OAM

NIH–OAM, National Institutes of Health–Office of AlternativeMedicine.

● African traditional medicine● Alcoholics Anonymous● Anthroposophically extended medicine● Ayurvedic medicine● Curanderismo● Environmental medicine● Herbal medicine● Homeopathic medicine● Native American Indian health care practices● Naturopathic medicine● Santeria● Shamanism● Traditional Oriental medicine

Page 18: Classical Homeopathy

HAHNEMANN’S STORY

As a conventionally trained physician, Hahnemannused the methods of his time, the late eighteenth cen-tury. These methods included a variety of practicesthat had changed very little in centuries. Patientswere bled to reduce lung congestion, whether causedby pneumonia or heart failure. Various agents wereapplied to the skin to create blisters, in the belief thatthey would purify the body by causing it to excretetoxins. Chemicals such as mercury and arsenic weregiven to patients in poisonous doses. History recordsthe deaths of many people, including heads of state,hastened, if not directly caused, by the medical carethey received during this time in the history of con-ventional medicine.

When Hahnemann observed the clinicalresponse of his patients to these treatments, he wasunderstandably disturbed. Often, the only apparenteffects of these treatments were adverse ones.Pressed by the economic necessity of providing forhis young and growing family, he was caught in amoral dilemma. His practice of medicine was nodifferent from that of the rest of his medical com-munity, but he perceived that this standard carewas harmful to his patients. If he acted in accor-dance with his beliefs and the Hippocratic dictum—First do no harm—he would have to eliminate muchof his medical practice. On the other hand, heneeded to support his family. Why should he suffereconomically when his colleagues harmed theirpatients, made a living, and won praise for theirinjurious methods?Hahnemann wrote the following of his decision:

To become in this way a murderer, or aggravator of thesufferings of my brethren of mankind, was to me a fear-ful thought, — so fearful and distressing was it, thatshortly after my marriage I completely abandoned prac-tice and scarcely treated anyone for fear of doing himharm, and—as you know—occupied myself solely withchemistry and literary labors.2

Hahnemann possessed an easy facility with lan-guages. He put this gift to use when he decided toabandon his clinical practice and earn his livelihoodtranslating medical texts into German from French,Latin, Italian, and English. His work as a translatorprovided his family with adequate means for theirsurvival, and simultaneously allowed him to remaintrue to his convictions.

Hahnemann gained more than economic subsis-tence from this work. The translations brought himinto close contact with the ideas of the most prom-inent physicians of his time and the masters of antiq-uity. These ideas influenced his subsequent medicalpractice. His clinical practice changed, and Hahne-mann acquired a reputation for unorthodoxy.

Hahnemann vigorously espoused unpopularopinions criticizing conventional medicine. Theseforceful declarations alienated the medical commu-nity. When he lectured in the University of Leipzig hewas described as a “raging hurricane.” Hahnemann’sfury and his apparently foolish ideas made him alightning rod for ridicule. Ironically, much of theridicule was for ideas we now accept as conventionalmedical wisdom.

One of his unorthodox opinions was the beliefthat the life circumstances of his patients couldseverely affect their health. Consequently, he insistedthat his patients change harmful circumstanceswhenever possible.

For example, the prevailing medical opinion wasthat exercise was unhealthful. Hahnemann arguedotherwise. To his detractors, one of the proofs ofHahnemann’s ignorance was his family’s practice ofgoing on long walks for health. Hahnemann empha-sized the important contribution of lifestyle tohealth.

Disease engendered by prolonged exposure to avoidablenoxious influences should not be called chronic. Theyinclude diseases brought about by:

the habitual indulgence in harmful food or drink;all kinds of excesses that undermine health;prolonged deprivation of things necessary to life;unhealthy places, especially swampy regions;dwelling only in cellars, damp workplaces, or other closed

quarters;lack of exercise or fresh air;physical or mental overexertion;continuing emotional stress;etc.

These self-inf licted disturbances go away on theirown with improved living conditions if no chronicmiasm is present, and they cannot be called chronic dis-eases.3

Hahnemann’s belief in the prime importance of ahealthful lifestyle persisted throughout his lengthymedical career. In his seminal work, Organon ofMedicine, he wrote:

C H A P T E R 2 What is Homeopathy? 9

Page 19: Classical Homeopathy

If someone complains of one or more trifling symptomsthat he has noticed only recently, the physician shouldnot consider this a full-fledged disease requiring seriousmedical attention. A slight adjustment in the mode of liv-ing usually suffices to remove this indisposition.3

Today’s homeopathic practitioners are trulyHahnemann’s descendants in their staunch advocacyof lifestyle modification over the use of prescriptionmedication. As demonstrated by Goldstein,4 not onlydo homeopaths advocate lifestyle change, but theyare extraordinarily successful at helping theirpatients implement these health habits.

In 1792, Hahnemann was placed in charge of anasylum for the insane. Perhaps as a consequence ofthis experience, Hahnemann was among the firstEuropean or American physicians to speak outagainst the violent treatment directed againstpatients with mental illness.5,6

It is impossible not to marvel at the hard-heartedness andindiscretion of the medical men in many establishmentsfor [the insane], who . . . content themselves with tortur-ing these most pitiable of all human beings with the mostviolent blows and other painful torments. By this uncon-scientious and revolting procedure they debase them-selves beneath the level of the turnkeys in a house ofcorrection, for the latter inflict such chastisements as theduty devolving on their office, and on criminals only.2

Many of Hahnemann’s controversial opinions arenow widely accepted by physicians. Nearly any mod-ern physician who awoke to find his or her colleaguespoisoning their patients with arsenic, using bloodlet-ting, inducing vomiting and diarrhea, torturing thementally ill, and urging their patients to avoid exer-cise at all cost would be as outraged as Hahnemannwas 200 years ago.

Hahnemann’s Experiments withQuinine

Perhaps Hahnemann would have faded entirely frommedical history were it not for an incidental discoveryhe made regarding the clinical effects of quinine.Malaria was a widespread health problem in Europeduring Hahnemann’s lifetime, and quinine was themainstay of conventional treatment. In 1790, whiletranslating one of the most highly regarded medicaltexts of the time, Cullen’s Materia Medica, Hahne-mann was upset by Cullen’s claim that quinine was

an effective treatment for malaria because it was bit-ter and astringent. Cullen’s belief was coherent withthe precepts of Galenic Greek medicine, which,although nearly two millennia old, were still generallyaccepted as correct. Hahnemann rejected Cullen’sclaim on the basis of his experience that many othersubstances that were even more bitter and astringenthad no effect at all on malaria.

Ever the inquisitive scientist, Hahnemann, appar-ently in a fit of pique, ingested a dose of quinine todetermine its actions. He was surprised to discoverthat he developed a headache, fever, diarrhea, andchills. The surprise arose from his recognition of aparadox—that the symptoms created by quinine werethe characteristic symptoms of malaria, the very dis-ease quinine treated so effectively.

Hahnemann reflected upon this experience andsearched the classical medical literature for similarinformation about parallels between toxic and bene-ficial effects of medicines. He also recognized theclinical application of this like cures like principle inthe conventional treatment of tertiary syphilis by hiscontemporaries. Although syphilis was well knownfor causing bone destruction, gingivitis, and copioussalivation, standard conventional treatment was mer-cury, which induced the same physiologic response.Physicians used the patient’s copious salivation as anindication that an adequate dose of mercuryhad been administered. Not only was this anotherexample of the effectiveness of the like-cures-likeapproach, this treatment appeared to deliberately uti-lize the approach.

The implications of this principle graduallybecame apparent to Hahnemann. Over the next sev-eral years Hahnemann slowly transformed his clinicalpractice, refocused his writings on his newly develop-ing theories (most notably his “Essay on a NewPrinciple for Ascertaining the Curative Power ofDrugs, with a Few Glances at Those HithertoEmployed”) and founded the medical system calledhomeopathy.

HOMEOPATHIC PRINCIPLES

Homeopathic medicine is so different from conven-tional medicine that the two could seldom be con-fused. However, arguments over which features areessential to a homeopathic definition have raged fornearly 200 years. This text is focused on the classic

10 C L A S S I C A L H O M E O P A T H Y

Page 20: Classical Homeopathy

foundations, the core of homeopathy as espousedand practiced by Hahnemann. That perspective willguide this discussion.

Hahnemann knew nothing of injecting dilutedsubstance into acupuncture points, using electronicdevices to guide remedy selection, or mixing a collec-tion of homeopathic remedies together and labelingthem for one specific illness. All of these are commonpractices today. Hahnemann, like many modern clas-sical homeopaths, would likely wonder what thesemethods have to do with homeopathy. This specula-tion is not based upon a judgment of merit or effi-cacy. Simply, these approaches, good or ill, are at bestvery distant relations or offshoots of homeopathicmedicine.

Homeopathy in its classical form is founded onthe following four principles: (1) like cures like, (2)provings, (3) single medicine, and (4) minimal dose.Each of these tenets warrants detailed considera-tion.

LIKE CURES LIKE

Considering the paradoxic therapeutic action ofquinine and mercury, Hahnemann recalled the admo-nition to let like cure like from writings attributed toHippocrates, as well as Paracelsus’ correlate, the“Doctrine of Signatures.” Hahnemann’s experience,coupled with the words of these great masters,encouraged him to develop this approach for use inclinical practice. This method of using a substancethat creates certain symptoms to treat a patient suf-fering the same symptoms is the defining principle ofhomeopathic medicine. It is the cornerstone of home-opathy. This importance is reflected in the system’sname: homeo-pathy is literally “similar to suffering.”

Hahnemann did not invent the use of like cureslike, and this approach is not unique to homeopathy(see Chapter 3). On the other hand, homeopathicmedicine is unique in the unwavering application ofthe homeopathic principle to every patient in everyclinical encounter.

A certain measure of debate centers on the ques-tion of what exactly does like mean? What elements ofthe patient’s makeup are open to selection as homeo-pathic characteristics and how alike must like be?

Some health care practitioners connect theirpatients to various electrical devices to determinewhich homeopathic medicine they need. Anthro-

posophists use diluted medicinal agents and pre-scribe them to patients based upon general charac-teristics of each patient’s personality. Nearly 500years ago, Paracelsus wrote that a plant that wasgrowing in the moist darkness hidden among otherplants was a source of medicine for a person whowas shy and withdrawn. Although classical home-opaths do not view any of these approaches aspurely homeopathic, Paracelsus’ intuitive percep-tion of similarity is one with which they feel a greatdeal of sympathy.

Hahnemann made a pivotal recognition of thesimilia principle in the action of quinine, and twocenturies later his homeopathic explanation of quin-ine’s antimalarial effects is as good as any other wehave.7,8 Quinine’s direct actions on the malarialorganism are controversial. It is also intriguing thatoverdoses of quinine led to a disease called blackwater fever, which is characterized by hemorrhagicfever, often fatal and very similar to malaria.9

PROVINGS

Hahnemann’s intention to use a homeopathicapproach was initially stymied by medicine’s relativeignorance of the effects of medicinal substances on thehuman organism. He needed considerably more infor-mation; specifically, he needed to identify detailed indi-cations as to when to give a certain medicine to acertain patient. Obviously, it is impossible to recognizesimilarity between patient and treatment withoutbeing familiar with both sides of the like-cures-likeequation. Carefully taking the patient’s history is cru-cially important, but at best can provide only half of theneeded information. What does the drug do to thehuman organism? What are the symptoms created bythe drug? The practitioner needs fully developed infor-mation on the drug side of the equation as well.

To develop this requisite knowledge base,Hahnemann began testing the commonly used medi-cines of the time and other promising substances inhopes of using their homeopathic characteristics totreat patients. Hahnemann recruited his family,friends, and colleagues to ingest the test substancesand record the symptoms they experienced. Thesesymptoms were compiled and became the initial poolof homeopathic pharmacologic knowledge.

In German, these experiments were calledPruefung (literally, “test”).10 Now the term used is

C H A P T E R 2 What is Homeopathy? 11

Page 21: Classical Homeopathy

proving. This testing process is quite similar to PhaseI drug trials in today’s conventional medicine. Theintention of a Phase I trial is to discover the damag-ing adverse effects of a medication. In a way, homeo-paths are seeking those adverse effects, hoping to usethem to heal their patients. Although Galen, one ofWestern medicine’s great progenitors, had suggestedtesting medicines on healthy people, Hahnemannappears to have been the first to systematicallyemploy this method. As a result, some recognize thistesting process as the beginning of clinical pharma-cologic research.11

This systematic, experimental approach to medi-cine was extremely important to Hahnemann and theestablishment of homeopathy in patient care.Homeopaths claimed the superiority of their meth-ods in part because of this carefully analytic approachto clinical medicine that was lacking in the conven-tional medical practices of their time. In the prefaceto his Materia Medica Pura, Hahnemann wrote:I am not going to write a criticism of the ordinaryMateria Medica, else I would lay before the reader adetailed account of the futile endeavors hitherto made todetermine the powers of medicines from their color, tasteand smell.12

Hahnemann believed that careful scientific exper-imentation was most important, and that theoreticspeculations (such as the conventional practice ofdivining the action of a drug by its color, taste, andsmell) were second-rate in comparison.

The day of the true knowledge of medicines and of thetrue healing art will dawn when men cease to act sounnaturally as to give drugs to which some purely imagi-nary virtues have been ascribed, or which have beenvaguely recommended, and of whose real qualities theyare utterly ignorant; and which they give mixed uptogether in all sorts of combinations. . . . By this methodno experience whatever can be gained of the helpful orhurtful qualities of each medicinal ingredient of the mix-ture, nor can any knowledge be obtained of the curativeproperties of each individual drug.12

Hahnemann’s guidelines for homeopathic prov-ings were quite specific and carefully considered.

As regards my own experiments and those of my disciplesevery possible care was taken to insure their purity, in orderthat the true powers of each medicinal substance might beclearly expressed in the observed effects. They were per-formed on persons as healthy as possible and under regu-lated external conditions as nearly as possible alike.12

If the subjects intentionally or accidentally steppedout of these disciplined experimental conditions(e.g., through injury, overindulgence, vexation,fright), no further symptoms were recorded to avoidcontaminating the data. If some lesser insult sug-gested the possibility of interference, the subsequentsymptoms were marked as being of potentially ques-tionable origination.

Hahnemann and his students discovered thateach medicine or remedy created a large number ofreactions, many of which are familiar to conventionalphysicians as commonly recognized disease charac-teristics such as cough, headache, or back pain.Because each person proving a remedy wouldrespond somewhat differently from the others, pre-cise information was important. Equally importantwas comparing the responses of the provers to ascer-tain the most fundamental and characteristic healingqualities of each substance.

Hahnemann soon learned that, just as there areprecise symptomatic distinctions between remedies,people respond in their own unique manners to everydisease. Although the general pathologic changeswere the same (a pneumonia is a pneumonia), carefulobservation revealed distinct differences amongpatients. Some patients with pneumonia had painfulcoughs, some had coughs that paradoxicallyimproved when they lay down, and some were chillywhile others felt hot during the illness. Many patientsexperienced a tremendous variety of associated symp-toms, irrelevant to conventional diagnosis butimportant to the homeopath precisely because theywere unusual.

These individual peculiarities lead the homeo-path to use different remedies for differentpatients with the same conventional diagnosis. Theindividual variability among patients and remedieshas far-reaching consequences in the clinical prac-tice of homeopathy and for researchers investigat-ing its effectiveness. Fortunately for patients, butunfortunately for homeopaths, each patient pro-duces only a fraction of the fully developed com-plex of the homeopathic symptoms engendered bythe remedy that will help. Some of the symptomsdeveloped by the proving subjects are rarely, if ever,seen in clinical practice. The art of homeopathicclinical practice lies in eliciting the symptoms fromthe patient and then recognizing the same patternamongst the palette of more than 1500 homeo-pathic remedies.

12 C L A S S I C A L H O M E O P A T H Y

Page 22: Classical Homeopathy

In addition to provings, there are other sources ofindications for homeopathic remedies. For example,the recorded symptoms of poisonings can suggestclinical applications of diluted poisons to the homeo-path. Undoubtedly, the most important source ofadditional information about homeopathic remediescomes from records of symptoms cured in the clinicaluse of the remedy. Some argue that this informationis even more reliable and more important than symp-toms learned from provings.

SINGLE MEDICINE

Today it is difficult to find a health food store in theUnited States that does not sell homeopathic medi-cines, and almost all of them sell homeopathic com-bination remedies. The number that sell individualremedies is much smaller. These combinations aremixtures of several different homeopathic medicines.Because these combinations are rarely tested by tradi-tional provings, they are the focus of controversywithin the professional homeopathic community.

Hahnemann reviled the customary practice ofmixing several medicinal agents because of the uncer-tain effects and potential danger to the patient. It isironic that so much of homeopathic medicine is nowthis type of polypharmacy. Modern homeopathspracticing in the classical homeopathic traditioncriticize this mixed approach for essentially the samereasons given by Hahnemann. Although it is difficultor impossible to assess self-care practices that wereused two centuries ago, too many lay people usinghomeopathy today seem to operate by the antiho-meopathic belief, “If a little bit is good, more must bebetter,” and so run the risk of overmedicating them-selves with homeopathic remedies. Although in myown clinical experience adverse effects of thisapproach are uncommon, they do seem to occur, so amore cautious approach appears warranted.

MINIMAL DOSE

Homeopathic use of microdoses is not only contro-versial; its historical development is shrouded in mys-tery. Homeopathic remedies are made from anincredible variety of substances. Plants, minerals, andanimal poisons make up the largest groups of rem-edies. Because these substances are then diluted and

shaken (succussed) serially, many homeopathic rem-edies are postavogadran dilutions (Box 2-3). Thismeans that it is unlikely that there is even one mole-cule of the original substance remaining in many ofthe tubes of homeopathic remedies sold in theUnited States.

Hahnemann initially administered his medicinesin the dosages used by conventional physicians. Therewere problems with this approach. Clinical experi-ence taught Hahnemann that conventional dosagesof homeopathic remedies often temporarily intensi-fied patients’ symptoms. In addition, patients wouldtransiently develop symptoms of the remedy fromwhich they did not previously suffer. To circumventthis undesirable tendency toward adverse effects,Hahnemann began diluting the medicines he used.

In the preamble to Materia Medica Pura,Hahnemann recounts a case of a cleaning woman dis-abled by a collection of symptoms, including abdom-inal pain, irritability, and insomnia:

I gave her one of the strongest homeopathic doses, a fulldrop of the undiluted juice of bryonia root,* to be takenimmediately, and bade her come to me again in 48hours.12

His footnote (*) refers to a more recent change in dos-ing of homeopathic remedies:

According to the most recent development of our newsystem the ingestion of a single, minutest globule, mois-tened with the decillionth (x) development of power

C H A P T E R 2 What is Homeopathy? 13

1X = 1 part in 103X = 1 part in 1,0006X = 1 part in 1,000,00012X (or 6C) = 1 part in 1,000,000,000,000Avogadran limit here12C = 1 part in 1,000,000,000,000,000,000,000,

00030X = 1,000,000,000,000,000,000,000,000,000,

00030C = 1,000,000,000,000,000,000,000,000,000,

000,000,000,000,000,000,000,000,000,000,000

B O X 2 - 3

Commonly Sold Homeopathic DilutionsRelative to Avogadro’s Number

Professional homeopaths often use 200C (i.e., 1 followed by 400zeros), 1M (i.e., 1 followed by 2,000 zeros), or “higher” potencies.

Page 23: Classical Homeopathy

would have been quite adequate to effect an equally rapidand complete recovery; indeed, equally certain wouldhave been the mere olfaction of a globule the size of amustard seed moistened with the same dynamization, sothat the drop of crude juice given by me in the above caseto a robust person, should not be imitated.12

To allay the reader’s concern, it should be knownthat the patient recovered and, like many a modernpatient, did not return for the follow-up appoint-ment. When a skeptical colleague tracked the patientto her village, she reportedly told him this:What was the use of my going back? The very next day Iwas quite well, and could again go to my washing, and theday following I was as well as I am still. I am extremelyobliged to the doctor, but the like of us have no time toleave off our work; and for three weeks previously my ill-ness prevented me from earning anything.12

The homeopathic process of dilution and succus-sion is carried to such a remarkable degree that manycannot think clearly about the system of homeopathybeyond this issue. They ignore the other principles,most notably the similia doctrine, and erroneouslyview the entire system as a simple matter of dilutingmedicinal substances beyond the possibility ofpharmacologic action. Nor is this misconceptionheld only by detractors. Some health care practitionersnow inject acupuncture points with diluted sub-stances of all sorts and call it homeopathy, eventhough they ignore the fundamental doctrine of likecures like in this process.

Although Hahnemann routinely recorded hisexperiments and clinical treatments in the samedetail as the case of the washerwoman above (recallmy abbreviated retelling of one of his cases), no onehas found any record explaining the rationale behindthe mechanics of Hahnemann’s very specific processof dilution and succussion. Many have theorized thatHahnemann’s Masonic affiliation led him to know-ledge of alchemic principles and then to this alchemy-like process. However, there is no direct evidence tosupport this claim. We do know that Hahnemann’smotivation for dilution was to minimize adverseeffects by administering the minimal dose. Theprocess of succussion is more mysterious, as is therationale for the specific proportions he chose for hisdilutions. Late in his life Hahnemann altered his dilu-tion procedure and thereby generated controversyabout the relative merits of this later protocol, a con-troversy that lasts to this day. In view of the great dealof information we possess regarding Hahnemann’s

thinking and his patient records, our ignorance onthis seemingly important matter is notable. Thisuncharacteristic vacuum suggests that Hahnemannmight have intended secrecy, perhaps lending cre-dence to the theory of Masonic influence. Somethink that Hahnemann simply did not believe his rea-soning was important enough to write down. He wasmerely attempting to create a uniform dilution.

HOMEOPATHIC VIEW OFHEALTH AND DISEASE

Homeopaths since Hahnemann have always viewedsymptoms of illness a bit differently from conven-tional physicians. Homeopaths emphasize the import-ance of the precise characteristics of each patient’ssymptoms, because they are the means the hom-eopath uses to ascertain the pattern of each individ-ual’s unique response to his illness. The specificdistinguishing features help the homeopath sort outthe patient in front of him from all others with thesame disease condition.

Homeopaths also view symptoms as signpostsindicating the manner in which the organism isworking to restore itself to health. In other words,symptoms are not bad in themselves, nor are they thedisease. Symptoms are a consequence of the body’swork to regain health. Treatment should thus bedirected at improving healthy response and correct-ing underlying imbalance, which then, secondarily,will relieve the symptoms.

Furthermore, there is a hierarchy of symptoms.Some symptoms are more important than others.Generally speaking, mental and emotional distur-bances are more important than dermatologic com-plaints and even rarely some serious physicalconditions. For example, a patient who is emotionallydisturbed is sicker than a patient with a disfiguringskin rash. Likewise, a lively, energetic, and sociallyinvolved paraplegic is healthier than an able-bodiedperson who is crippled by anxiety or depression. Apositive response to treatment is reflected in themovement of the disorder from deeper (more import-ant) to more superficial symptoms. Interpreting thepattern of symptoms following treatment tells thehomeopath whether the treatment was beneficial orharmful. The homeopath must use the analysisframework provided by homeopathic theory to cor-

14 C L A S S I C A L H O M E O P A T H Y

Page 24: Classical Homeopathy

rectly evaluate clinical information and determinethe subsequent course of treatment. The answer tothe question “Was my treatment effective?” mustmeet very specific criteria recognized throughout theworld’s homeopathic community. As a result, twohomeopaths will rarely disagree in their assessmentof the changes in a patient’s health. In many wayshomeopathic principles create a formalized processleading to a determination very much in harmonywith the common sense perspective of laymen.

Disturbances in the deepest aspects of a patient’sbeing are reflected in the patient’s mind and body.This is the nature of disease. Pursuing this line ofthought to its logical conclusion, some homeopaths(including Hahnemann) have identified spiritual dys-function as the primal origin of disease. Few havegone so far as to claim it as the exclusive disease-generating force, generally allowing that external forces(e.g., lifestyle and exposure to health-damaging influ-ences) also play a part. Clearly, philosophical consid-erations are more central in the clinical practice ofhomeopathy than they are in conventional medicine.Because homeopathy is a highly structured approachto healing, compared with the empirical bent of con-ventional medicine, this difference is not surprising.

SURVIVAL OF HOMEOPATHY

One way to answer the question “What is homeop-athy?” is to borrow from modern pop psychology byanswering, “Homeopathy is a survivor.” Given thecontroversy surrounding and even encouraged byHahnemann and his therapy, the fact that this med-ical system survived and even came to flourish in theearly nineteenth century is intriguing. The principalreason for the rise of homeopathy is a familiar andimportant one—effectiveness. Homeopathic treat-ment was at least as successful as conventional med-ical treatment. There is evidence that stronglysuggests that homeopathy was superior to conven-tional therapies in the treatment of epidemic dis-eases. The first big advances in the popularity ofhomeopathy came through the relative successhomeopaths achieved treating the typhoid andcholera epidemics that swept through early nine-teenth-century Europe.

Although the ability to alleviate suffering is themost attractive feature to the largest constituency,philosophy is important as well. The current homeo-

pathic resurgence is fueled in part by interest in itsphilosophy and identity as a “natural” form of heal-ing. The homeopathic view of disease and health dif-fers from that of most orthodox physicians. Whereassome find the philosophic perspectives of homeop-athy controversial, they are quite appealing to others.Many people live their lives aspiring to certain ideals.People who highly value emotional well-being or spir-itual principles often find appealingly familiar echoesof those values and principles in homeopathic medi-cine. Choosing homeopathy gives them a way toincorporate their broadest ideals into their healthcare.

Homeopathy has always been the medical per-spective of a minority. As a dissenting minority,homeopathy and the homeopathic community haveforged a contrarian identity. This alternative perspec-tive attracts individuals who, for a variety of reasons,reject orthodox opinions, medical and otherwise. Inthis sense, the homeopathic community sometimesprovides a comfortable home for people who findthemselves at odds with the larger society. This grouprepresented a larger portion of the homeopathiccommunity in the past than it does today. However,despite this rapprochement, homeopathic principlessimply do not allow this system of medicine to beentirely compatible with conventional medicine.

Homeopathy survives because it provides certainelements missing in conventional medicine. It isanother option, sometimes complementary to con-ventional medicine, sometimes an alternative, andsometimes even hidden within the practice of con-ventional medicine.

SUMMARY

Writing a century ago in his essay “What IsHomeopathy?” James Tyler Kent wrote:

Then to the question, what is homeopathy? I mustanswer, no man knows! God only knows the length andbreadth of the intricate, unfathomable mystery. Theknowable part of this science, if I may use the word, con-sists in observing the sick-making phenomenon of drugsand the phenomena of sickness, gathering and groupingthe similars, selecting with the likeness in view and wait-ing for results.13

Although Kent might have believed the attemptfutile, my fullest answer to “What is homeopathy?” isthe entirety of this book. Many of the ideas presented

C H A P T E R 2 What is Homeopathy? 15

Page 25: Classical Homeopathy

in this chapter are discussed in greater detail later in thechapters that follow. Hopefully you now know enoughto have more (and better) questions than you didbefore. Continued reading should answer many ofthose questions, but it will inevitably lead you to othersthat are currently unanswerable. Although “currentlyunanswerable” may disappoint some readers, the truthis there is a very great deal we do not know about home-opathy, and, in Kent’s view at least, “currently unan-swerable” might be an overly optimistic assessment.

References1. Alternative Medicine: Expanding horizons: A report to the

National Institutes of Health on alternative medical sys-tems and practices in the United States, NIH PublicationNo. 94-066, December 1994. US Government PrintingOffice, Washington, D.C. Prepared under the auspices ofthe Workshop on Alternative Medicine, Chantilly, VA,Sept 14-16, 1992.

2. Dudgeon RE, editor: The lesser writings of SamuelHahnemann. New Delhi, 1999, B. Jain, p 512 (original1851).

3. Hahnemann S: Organon of medicine, ed 6, Los Angeles,1982, JP Tarcher (original 1842).

4. Goldstein MS, Glik D: Use of and satisfaction withhomeopathy in a patient population, Altern Ther HealthMed 4(2):60-65, 1998.

5. Gamwell L, Tomes N: Madness in America: cultural andmedical perceptions on mental illness before 1914,Binghampton, New York, 1995, Cornell University Press.

6. Dudgeon RE: Lectures on the theory and practice of homeop-athy, London, 1854, Leath and Ross.

7. Foley M, Tilley L: Quinoline antimalarials: mechanismsof action and resistance and prospects for new agents,Pharmacol Ther 79(1):55-87, 1998.

8. Slater AF: Chloroquine: mechanism of drug action andresistance in Plasmodium falciparum. Pharmacol Ther 57(2-3):203-235, 1993.

9. Garrett L: The coming plague: newly emerging diseases in aworld out of balance, New York, 1994, Penguin Books, pp447-448.

10. Coulter H: The origins of modern western medicine, J.B. VanHelmont to Claude Bernard. Washington, DC, 1988,Wehawken Book Company, p 311.

11. Kaptchuk TJ: Intentional ignorance: a history of blindassessment and placebo controls in medicine, Bull HistMed 72(3):389-433, 1998.

12. Hahnemann S: Materia medica pura, New Delhi, 1995, B.Jain (originally published in 1811).

13. Gypser KH, editor: Kent’s minor writings on home-opathy, Heidelberg, 1987, Karl F. Haug Publishers,p 147.

Suggested ReadingsBradford TL: The life and letters of Dr. Samuel Hahnemann,

Philadelphia, 1895, Boericke and Tafel.Coulter H: The origins of modern western medicine: J.B. Van

Helmont to Claude Bernard, vol 2, Washington, DC, 1988,Wehawken Book Company.

Dudgeon RE: Lectures on the theory and practice of homeopathy,London, 1854, Leath and Ross.

Haehl R: Samuel Hahnemann, his life and work, 2 vols,Homeopathic Publishing, New Delhi, B. Jain, 1983(translated by M Wheeler, WHR Grundy; edited by FEWheeler, JH Clarke; originally published in 1922).

Hahnemann, S. Organon of medicine, ed 6, Los Angeles, 1982,J. P. Tarcher (original 1842).

Hobhouse RW: Life of Christian Samuel Hahnemann, founder ofhomeopathy, Rosa CW Daniel, New Delhi, B. Jain, 2001(originally published in 1933).

Jutte R et al: Culture, knowledge and healing: historical per-spectives of homeopathic medicine in Europe and NorthAmerica, Sheffield, England, 1998, European Asso-ciation for the History of Medicine and HealthPublications.

Vithoulkas G: Science of homeopathy, New York, 1980, GrovePress.

16 C L A S S I C A L H O M E O P A T H Y

Page 26: Classical Homeopathy

HOMEOPATHY BEFOREHAHNEMANN

“The same substances that cause strangury, cough,vomiting and diarrhea will cure those diseases.”1

HIPPOCRATES

Homeopathy has always been controversial.Hahnemann was compelled to move to anothercountry to escape the political and social pressurebrought to bear on him and his students. In fairnessto his detractors, Hahnemann probably contributedsubstantially to the conflict, because he was not at allgentle in his public criticisms of the methods and

ethics of his opponents. After Austria’s emperor died,he placed an advertisement in a major newspaperblaming the emperor’s orthodox physicians for thedeath.

Although homeopathic history is rich with color-ful and dramatic personalities, the controversy sur-rounding homeopathy has always had more to dowith its fundamental philosophic opposition to theworld-view of conventional medicine than with per-sonalities. This polarity is so deeply ingrained thatorthodox medicine’s most widely used philosophicname, allopathy, was devised by homeopaths. In manyways, homeopathic medicine has helped allopathicmedicine define itself over the past two centuries.

3History of Homeopathic Medicine

M I C H A E L C A R L S T O N

J U L I A N W I N S T O N

17

Page 27: Classical Homeopathy

But how does homeopathy define itself? The ideaof using like to cure like did not spring unique andfully born from Hahnemann’s brain. Hahnemannrecognized this principle, familiar from the writingsof Hippocrates, manifesting in his experience withpatients. He resurrected the phrase similia similibuscurantur (“let likes cure likes”) from Hippocratic liter-ature and did not claim that the fundamental prin-ciple of his method was new. Hahnemann’s specialcontribution along this line was to promote a highlysystematic approach to healing founded on this prin-ciple. His system encompassed a rigorous process oftesting potential therapeutic agents, specific methodsof processing the raw material, and detailed protocolsfor applying the principles to patient care. He namedthis system homeopathy, from the Greek words homoios(“similar”) and pathos (“suffering”).

Hahnemann’s contribution was significant, butto fully understand homeopathy we must considerprinciples that have not necessarily been labeledhomeopathic. A work by Boyd2 from 1936 includesan interesting discussion of Hahnemann’s philo-sophic forebears. Dudgeon’s3 1852–1853 lecturesgiven at London’s Hahnemann Hospital and HarrisCoulter’s4 series on the history of Western medicalthought are other excellent sources of information.Often unwittingly, like has been used to treat likeworldwide throughout medical history, under differ-ing names, to varying degrees, and with differingdetails of application. Other homeopathic principleshave appeared in varying guises over the millennia.

Hippocrates

Many writings have been passed down from theschool of thought identified as Hippocratic. Althoughwe know that Hippocrates was not the author ofmany of these writings, they do represent a relativelyconsistent viewpoint compared to the hodgepodge oftheories expounded six centuries later by Galen,another founding father of Western medicine. Thisancient Hippocratic corpus in many instances advo-cates the use of like to treat like. For example, “Sothat which produces urinary tenesmus in the healthy,cures it in disease.”1 Another passage, translated byJones, makes the point even clearer:

The pains (complaints) will be removed through theopposite of them, each according to its own characteris-

tics. So warm corresponds to the warm constitutionwhich has been made ill by cold; so correspond the oth-ers. Another type is the following: through the similarthe disease develops and through the employment of thesimilar the disease is healed.1

One of the Hippocratic writings records the fol-lowing as the recommended treatment for a patientwith suicidal mania (quoted in Dudgeon): “Give hima draught made from the root of mandrake, in asmaller dose than will induce mania.”3

Compare that clinical recommendation with thisexcerpt from a modern reference discussing the illeffects of mandrake (Mandragora officianarum):

Because of the high content of scopolamine in the drug,poisonings lead at first to somnolence, but then also,after the intake of very high dosages, to central excitation(restlessness, hallucinations, delirium and manicepisodes), followed by exhaustion and sleep.5

The modern description of the mania-inducingeffects of this plant makes its selection as a Hip-pocratic prescription for a mental disorder clearlyharmonious with Hahnemann’s later teaching.

The therapeutic recommendations in theHippocratic corpus were not purely or even predomi-nantly homeopathic. Both allopathic and homeo-pathic approaches were advocated, sometimes in thesame sentence: “If this held in all cases it would beeasy, now according to the nature and cause of thedisease to treat according to the contrarium and nowaccording to the nature and origin of the diseasethrough the similar.”1

Even before Hippocrates, the role for similia in thepractice of medicine was recognized by many tradi-tions. Ayurvedic medicine encompassed the use ofsimilars, enumerating it as one of the possible thera-peutic approaches to the patient. The Egyptian Eberspapyrus from 1,500 BCE advocated using the eyes ofpigs to treat blindness. Also suggesting similars, thisdocument gave instructions on the use of fish headsto treat headaches in human sufferers.

Similar concepts influenced Galen, a Greek physi-cian living in Rome in the second century. His inde-pendent thinking was ref lected at times in hiscontentious self-confidence. Galen’s synthesis of thecompeting trends of empiric and philosophic med-ical traditions made his writings the foundation ofWestern medicine for 1400 years. Although Galenactively opposed the Doctrine of Signatures, variousmedical historians point out that he “carried on” or

18 C L A S S I C A L H O M E O P A T H Y

Page 28: Classical Homeopathy

“paid lip service” to the use of similars. Because theyare so at odds with the mass of the Galenic literature,it appears that his writings advocating the use of simi-lars are either theoretic anomalies or untidy rem-nants in his synthesis of earlier medical thought.6,7

Paracelsus

Another of the recognized fathers of Western medi-cine was Philippus Aureolus Theophrastus Bom-bastus van Hohenheim, more commonly known asParacelsus (b. 1494?, d. 1541). Some observers viewHahnemann’s homeopathy as the child of theDoctrine of Signatures so vigorously advocated byParacelsus. Hahnemann and Paracelsus shared manymore beliefs than just the similia principle. It is tempt-ing to view Paracelsus as Hahnemann’s intellectualforefather. Closer investigation suggests that the lin-eage is contestable, particularly when we considerother antecedent medical philosophies that in someway defended the similia. Although the philosophy andwritings of Paracelsus were very likely to have someinfluence on Hahnemann, the same can be said ofHippocrates and other advocates of the similia principle.

Similia and the Doctrine of Signatures Because through the art of chiromancy, physiognomy andmagic it is possible to recognize in the external appearance,the peculiarities and virtue of every root and herb by itssignature, shape, form and color, and it requires no furthertesting or long experience. Does not the leaf of the thistlestick like needles? Because this sign has been found by magic,there is no better herb for internal sticking than the thistle.

PARACELSUS, Quoted in Boyd2

Because Paracelsus sometimes mentioned the useof a certain plant that was shaped like the diseasedorgan he was treating, some claim that his version ofthe Doctrine of Signatures was based simply uponshape. However, Paracelsus’ use of similia was morecomplex. For example, he valued the herb Hypericumperforatum (St. John’s Wort) even more than present-day American consumers, advocating it for all man-ner of disease: “The Hypericum is almost a universalmedicine.”2 Although he did look at the plant’s visi-ble characteristics, he made a broad intuitive jump,linking Hypericum’s perforated leaves to an ability todrive away spirits, toxins, and parasites that hadinvaded the patient. Similarly, he wrote that the shy,

cowering nature of a plant growing in the under-brush indicated its usefulness for a shy, coweringpatient. Similarity as perceived by Paracelsus was amatch between his perceptions of the patient’s innernature and the healing qualities of the substance.

Boyd argued that these similarities are magical,not physiologic; that they are more intuitive or per-haps capricious than similarities discovered by theprocess of homeopathic testing (proving). He wrote,“In contrast the fundamental implication of themodern simile is: the similarity of a ‘drug’ to a diseaseis determined by a complete study of the real physio-logic actions ascertained by actual experimentationupon a reasonable number of subjects.”2 Boyd triedto distance the modern simile of homeopathy fromthe magic simile of Paracelsus and others. However,throughout homeopathic history there have beenhomeopaths who emphasized the primacy of spiritover physical reality to an extreme degree.

A current example is supplied by Rajan Sankaran,a widely respected Indian homeopathic physician. Dr.Sankaran emphasizes the importance of provingsymptoms developed by people who do not eveningest the homeopathic preparation being tested.

The most characteristic symptoms of the drug were pro-duced in a woman (seminar participant) who had nottaken the proving dose! She developed symptoms thatshe had never experienced before in her life, and theycoincided with those who had taken the dose. A similarphenomenon was observed again at the Spierkeroog (N.Germany) seminar, where bacillinum was proved. Thebest provings were from those who had not taken thedose. This is enough to set the mind thinking for a longtime.8

Boyd would have great difficulty characterizinginformation gathered from Sankaran’s provings asphysiologic.

In other examples of similia, Paracelsus has beenquoted as stating the following: “Contraria contrariescurantur, that is heat dispels cold; that is false andhas never been so with drugs,”9 “The simile, accord-ing to which you should treat, gives understanding tohealing,”2 and “Never a hot illness has been cured bysomething cold, nor a cold one by something hot.But it has happened that like has cured like.”7

Both Paracelsus and Hahnemann applied the sim-ilia principle with great subtlety. Such subtle applica-tion demands that the physician comprehend thequalities that distinguish one patient or medicinefrom every other because of the precise concordance

C H A P T E R 3 History of Homeopathic Medicine 19

Page 29: Classical Homeopathy

between patient and remedy. Individual inconsisten-cies or quirks are not trifles to ignore; rather, they arethe key to unlocking the most difficult cases.Uniquely individual characteristics must be respectedand understood to successfully treat the patient.

The obverse of this philosophic coin is that dis-ease categories are imprecise. One patient’s disease isunlike every other. Although two patients can sufferasthma, the specific qualities of their asthma andmany other characteristics of each patient differ fromthe other. Much of the time, the imprecision of dis-ease categories makes them practically useless. Just aseach patient is unique, so is each patient’s treatmentdifferent.

Paracelsus and Hahnemann held vitalistic med-ical viewpoints, in keeping with the spiritual values oftheir worlds. Paracelsus explained this viewpoint asfollows:

The visible body has its natural forces, and the invisiblebody has its natural forces, and the remedy of all diseasesor injuries that may affect the visible form are containedin the visible body, because the latter is the seat of powerthat infuses life into the former, and without which theformer would be dead and decaying. If we separate thevital force from the physical form, the latter dies andputrefies.9

Hahnemann’s take on the subject was that “with-out the vital force the material organism is unable tofeel, or act, or maintain itself . . . without the vitalforce the body dies; and then, delivered exclusively tothe forces of the outer material world, it decomposes,reverting to its chemical constituents.”10

Accompanying the belief that healing comes fromthe inner, or more spiritual, essence of man was thebelief that illness was a trial, and overcoming it puri-fied the patient. Successfully navigating a diseasepurged and strengthened the patient. This is anotherphilosophic canon of homeopathy that had beenespoused by Hippocrates. Whereas homeopaths callit a healing crisis, others call this principle “coction”—essentially cooking out the impurity. Althoughancient, the idea had fallen out of favor untilParacelsus revived it.

Other Philosophic Similarities Paracelsus insisted upon consideration of the entirety(anatomie) of the patient and of the drug. On thepatient side of the equation, homeopaths call thisthe totality of symptoms. A clear image of each mustbe developed in the mind’s eye of the physician.

Now the anatomie of this external man should be completelydeveloped by the physician and indeed so completely that hecannot find a little hair on the head, nor a pore which he hasnot found ten times before. Because from this out of theanatomie, the physician goes to the prescription, that limb tolimb, arcanum to arcanum, disease will be placed to disease.

PARACELSUS, From Paragranum, 8, 87 (Sudhoff edition)

Because out of the entire man comes health, not out ofcrumbling fragments, and that is never considered in collegesand has at all times merely patched, not warm to cold,constrictive to laxative, that is not a basis for a physicianand never has been.

PARACELSUS, From De caduco matrices 1, 606 (Huser edition)

So now you know what arsenic is, so heal accordingly to thecontent of the anatomie, the arsenic with arsenic, asanatomie teaches you.

PARACELSUS, From Labyrinth. Med., 9, 120 (Sudhoff edition)

Pharmaceutical matters were very important inthe case of Hahnemann and Paracelsus. Not onlywere their thoughts about the materials of medicinedefining and similar to each other, their parallelrelationships with the apothecaries were at beststrained. These shared attitudes and beliefs gener-ated much of the controversy surrounding theirprofessional lives.

Both men believed that medications should beadministered in a manner beyond considerations ofmaterial dosage. Long before the controversy arisingfrom homeopathy’s conflict with Avogadro’s theo-rem, Paracelsus wrote the following:

Because drugs should be administered not with the weightbut beyond the weight. Because who can weigh the beams ofthe sun, who can weigh the air or the spiritum arcanum? Noone. But now in what way should drugs be administered?The drug should work in the body as a fire. . . . Can one findthe weight of fire? No, one cannot weigh fire. Now a spark iswithout weight. Also the same is to be understood of theadministration of drugs.

PARACELSUS, From Vom Ursprung un Herkommen der Franzosen, 7, 300–302 (Sudhoff edition)

Hahnemann and Paracelsus each extolled thevirtues of the inner essence (Paracelsus called itthe arcanum) of the medicine. Paracelsus wrote thefollowing:

20 C L A S S I C A L H O M E O P A T H Y

Page 30: Classical Homeopathy

[one must] understand that the power all lies in a simpleand the same simplicia needs nothing else than alchemy . . .it lies in the extraction and not in the composition.

PARACELSUS, From Paragranum, 8, 84 (Sudhoff edition)

Hahnemann wrote the following in his Organon ofMedicine:

If this mechanical process is properly carried out accord-ing to these instructions, the medicinal substance thatseems to us in its crude state only matter, sometimes evennonmedicinal matter, is at last completely transformedand refined by these progressive dynamizations tobecome a spirit-like medicinal force. This spirit-like medicinal force by itself is no longer perceptibleto the senses, but the medicated globule acts as its car-rier.10

Although Paracelsus claimed that iron miners couldbe cured by the toxin that poisoned them, he alsomaintained that the elemental poison had to be puri-fied by the healer to become curative. He believedthat processing a material could change its medicinalcharacter, just as Hahnemann wrote centuries later:“And thus it is to be understood with regard toothers, that what may be harmful to us through ourhands, the same is also again fashioned by our handsinto a remedy” (quoted in Coulter, p. 384).7

Controversy Like Hahnemann, Paracelsus fought with the apothe-caries. As a group, the apothecaries were powerfuland formidable adversaries. This social reality doesnot appear to have tempered the attacks mounted byParacelsus or Hahnemann. Paracelsus demeaned thepharmacists’ practice of mixing medicinal substancesand vociferously proclaimed their lack of integrity, aswould Hahnemann centuries later.

The battle against the medical establishment wasboundless. Again like Hahnemann, Paracelsus wasnot at all interested in excusing the failings of hisprofessional brethren. He energetically and ven-omously ridiculed other physicians:

Not one of you will survive, even in the most distant cor-ner, where even the dogs will not piss. I shall be monarchand mine will be the monarchy. . . . And I do not take mymedicines from the apothecaries, their shops are just foulsculleries which produce nothing but foul broths. Butyou defend yourselves with belly-crawling and flattery.How long do you think it will last? . . . Let me tell you this,

the stubble on my chin knows more than you and all yourscribes, my shoebuckles are more learned than your Galenand Avicenna, and my beard has more experience than allyour high colleagues.11

All disease, except such as come from mechanical causes,have an invisible origin, and of such sources popularmedicine knows very little. Men who are devoid of thepower of spiritual perception are unable to recognize theexistence of anything that cannot be seen. Popular medi-cine knows therefore next to nothing about any diseasesthat are not caused by mechanical means, and the scienceof curing internal disease. . . . The best of our physiciansare the ones that do the least harm. But unfortunately,some poison their patients with mercury, others purgethem or bleed them to death. There are some who havelearned so much that their learning has driven out alltheir common sense, and there are others who care agreat deal more for their own profit than for the healthof their patients.9

Paracelsus died at age 47 or 48. Supposedly his deathwas the result of a push off a cliff; the rumor was thatthugs hired by the local medical school supplied thepush.

Paracelsus recognized the similia and other ap-proaches to healing, and although there are parallelswith and undoubted influences on Hahnemann andhomeopathic thinking, Paracelsus was not a home-opath.

Swedenborg

Over many centuries physicians, philosophers, andmystics have discussed varying shades of similia.Certain plants or minerals are thought to be “like”certain patients. That similarity could be morpho-logic, physiologic, or perceived as some sort of myst-ical congruence. One of the great champions of thisdoctrine was the Swedish scientist and mysticEmanuel Swedenborg. The core of Swedenborg’smystical belief was in some ways similia writ large overthe entirety of creation, and it held strong appeal tohomeopaths.

Like many members of the Western intel-ligentsia and arts community (e.g., Goethe, Linneaus,Coleridge, William Blake, Balzac, Baudelaire, RalphWaldo Emerson, Elizabeth Barrett Browning,Dostoevsky, Thomas Cole, Frederick Church, Yeats),many of the greatest homeopaths of the nineteenthcentury studied the spiritual philosophy of

C H A P T E R 3 History of Homeopathic Medicine 21

Page 31: Classical Homeopathy

Swedenborg.12 John James Garth Wilkinson, anEnglish homeopathic physician, was particularlyimportant because he introduced homeopathicmedicine to the English upper class and the royalfamily. Wilkinson was introduced to homeopathy byhis Swedenborgian friend, Henry James, Sr., who hadovercome a personal crisis through reading Swed-enborg’s writings.

Swedenborg believed there was a precise correla-tion between the physical world and higher spiritualrealms. Entities in the higher realms would manifestin a cruder manner on lower realms down to thephysical realm where we live. For example, Sweden-borg considered the sun the manifestation of God’sloving energy on the physical plane:

The first step down is the celestial heaven, which in itscelestial love corresponds most closely to the One itself.The spiritual heaven is the next step down, a lesser repre-sentation, corresponding to celestial love, the love of oneperson for another. . . . The natural heaven is the lowestlevel of heaven. The world of spirits is the next level. Heremen are opened to and discover their inner nature. Andthe world of spirits interacts with the inner processes ofmind. Man’s mind itself is a series of levels correspon-ding to all levels of the spiritual world, ranging fromalmost pure feelings to thoughts and ideas, to speech andgestures, to the body itself. Beyond man, animals, plants,and the physical world are further lower-order corre-spondents to the One. This whole series of existences cor-responds to the One God who is thereby everywheremanifest. Not only man is made in the image, but cre-ation itself is a series of images.13

As described by Van Dusen, this view of realitymakes everyday experiences deeply symbolic andrichly meaningful. Some homeopaths believed thataccessing these higher realms through the mediumof homeopathically potentized remedies broughthealing down to the human realm. One of the mostfamous homeopathic physicians was SwedenborgianJames Tyler Kent.14 Kent wrote that a man who didnot believe in God could not become a homeopath.However, another Swedenborgian, ConstantineHering, who was an equally important homeopathicphysician and Hahnemann’s most important pupil,wrote, “While there is good reason why Sweden-borgians might prefer homeopathic treatment,there is none at all that homeopaths be Sweden-borgians.”15

Swedenborg lived a century before Hahnemann.His thought influenced many of Hahnemann’s great-

est contemporaries, including Goethe, who corre-sponded with Hahnemann and may have been treatedby him. Despite the tantalizingly close connections,we have no evidence of a direct influence fromSwedenborg to Hahnemann.

Hahnemann’s Teachers

As noted previously, Hahnemann did not claim thathe invented homeopathy out of nothingness. Hecredited his teacher with his achievements as a physi-cian—”All that I am as a physician I owe to Quarin.”2

We also know that Quarin’s teacher, Stoereck, advo-cated testing drugs for their opposite effects: If stramonium makes the healthy mentally sick througha confusion of the mind, why should one not determinewhether it gives mental health in that it disturbs andalters the thoughts and sense in mental disease, and thatif it gives health to those with spasms, to try and see if, onthe other hand, they get spasms.2

These influences are inadequate to account for allthat Hahnemann created. The practices of Hippoc-rates and others contained only portions of thesystem Hahnemann developed. However, the quasi-homeopathic ideas expressed by Hahnemann’simmediate forebears are evidence that the system ofhomeopathy represented an evolutionary develop-ment rather than a revolution in medical thought.

Summary

It can be reasonably argued that similia is still a partof modern conventional medicine. Consider the listin Table 3-1 of conventional treatments used for theirhomeopathic or similia effects.

Importantly, the applications of similia listed inTable 3-1 are unintentional and are easily recogniz-able only to homeopaths. Conventional physiciansare not using “like to cure like” if they do not knowthey are doing so. When a conventional physicianmirrors the practices of a homeopath in this way, it isentirely accidental.

Hahnemann’s system of medicine looks muchless radical when viewed in context. Homeopathy as asystem of medicine grew out of a long-standing,albeit minority, tradition. The most prominent fea-ture of that tradition was the similia doctrine.Modern homeopathy is an expression of several

22 C L A S S I C A L H O M E O P A T H Y

Page 32: Classical Homeopathy

ancient principles of medical thought, including thedoctrine of similars.

HOMEOPATHY IN THEUNITED STATES

Nineteenth Century AmericanProminence

Homeopathy arrived in the United States in 1825,brought by Hans Burch Gram, a doctor of Americanbirth who was trained in Denmark by a pupil ofHahnemann’s. Within a few years of his return toNew York, Dr. Gram converted several “regular” prac-titioners in the New York City area, and these physi-cians became the leaders of homeopathy in the state.This group was responsible for teaching homeopathyto several other physicians who, in turn, spread it toother states—New Jersey, Rhode Island, Massa-chusetts, Connecticut, Indiana, and Illinois.

At the time, almost all states had abandoned thepractice of licensing physicians. There were manypractitioners of botanic medicine, some of whomlearned from Native American herbalists. At a timewhen regular medical training consisted of 4 monthsof lectures and 2 years of preceptorship, the careoffered by herbalists was often better than the bleed-ing, purging, and administration of mercury com-pounds prescribed by the “regulars.” Homeopathistsstood apart from herbal practitioners in that most

homeopaths were converts from conventional medi-cine.

At about the time that Gram settled in New York,William Wesselhoeft and Henry Detwiller, twoGerman physician immigrants living near Bethlehem,Pennsylvania, began studying Hahnemann’s books,Organon of Medicine and Materia Medica Pura, sent tothem by Dr. Stapf, a pupil of Hahnemann. WhenDetwiller cured a patient with a homeopathic dose in1828, the two became homeopaths and introducedthe system to others in their community.15

Constantine Hering, trained in medicine inGermany, had been working as a botanist in Surinam,South America. Introduced to homeopathy while amedical student, he practiced in South Americabefore moving to the United States in 1833. He foundthe practice of homeopathy well underway in theGerman communities around Philadelphia, and hebecame the guiding force that brought the homeo-pathic movement together. In 1835 he founded,together with several other physicians, the first med-ical school in the world to teach homeopathy.Although the Allentown Academy, as it was called,lasted for only a few years, it became the trainingground for some of the finest homeopathic doctors—the teachers of the next generation.

In 1844 Hering, with a group of doctors fromNew York and Boston, founded the AmericanInstitute of Homeopathy (AIH)—the first nationalmedical organization, antedating the AMA by threeyears. The AIH has actively promoted homeopathicmedicine and the dissemination of related medicalknowledge ever since.

In 1847, conventional physicians formed their ownnational association—the American Medical Associ-ation (AMA). The question almost immediately aroseas to what position the AMA would take in relation tohomeopathic physicians. After considerable discus-sion, the AMA adopted the position that those“adhering to an exclusive dogma” (i.e., homeopaths)could not be members of the association and, fur-thermore, no member of the association wasallowed discourse with such practitioners. Nearlytwo decades later, the White House physician wasalmost removed from the Washington MedicalSociety because, in the aftermath of the Lincolnassassination, he had talked to the physician ofSecretary of State Seward, a homeopath. The hos-tility of the AMA toward homeopathy continuedinto the twentieth century.

C H A P T E R 3 History of Homeopathic Medicine 23

GABA, γ-Aminobutyric acid; GI, gastrointestinal.

T A B L E 3 - 1

Conventional Treatments Used for Their Homeopathic or Similia Effects

Treatment Causes and Cures

Methylphenidate hydrochloride (Ritalin) Hyperactivity

Digitalis Rapid heart beats Aspirin Fever and GI bleeding (cancer) Radiation Cancer Chemotherapy Cancer Red pepper Pain

(capsicum)Quinine Symptoms of malaria GABA Narcolepsy

Page 33: Classical Homeopathy

In 1848, in Philadelphia, Hering, joined by Dr.Williamson and Dr. Jeanes, founded the HomeopathicMedical College of Pennsylvania, later to become theHahnemann Medical College. Dr. Hering, oftenreferred to as the father of American homeopathy,was a prover of many remedies, and the author of TheGuiding Symptoms, a 10-volume Materia Medica that isin use to this day.

The practice of homeopathy continued to spread.Its growth was twofold. On one hand, many practi-tioners were graduates from the increasing numberof homeopathic medical colleges that were foundedbetween 1850 and 1880. Colleges were begun in NewYork, Boston, Chicago, St. Louis, Cincinnati, Detroit,Louisville, Detroit, and Des Moines, and by 1880these colleges had placed about 5000 homeopathicphysicians into practice.

The other impetus for growth came from the layusers of homeopathy. In 1835, Constantine Heringwrote The Homeopathic Domestic Physician, a book thatgave instructions for using homeopathic medicinesin domestic situations. Over the next 45 years, otherdomestic manuals were printed, and these books andtheir accompanying kits often became the only med-ical advice available to the far-flung pioneer commu-nities. A doctor at the 1869 meeting of the AIHobserved that “many a woman, armed with her littlestack of remedies, had converted an entire commu-nity to homeopathy.”16

At the Centennial Exposition in Philadelphia in1876, the AIH held its first International Congress,and more than 700 homeopaths from around theworld were in attendance. But the movement wasbeginning to split apart from within. The split hadstarted in 1870 when Carroll Dunham, MD, the AIHpresident, proposed that the organization open itselfto all medical practitioners—even if those joiningwere not committed homeopaths. His hope was thatthe “pure” homeopaths within the organizationwould teach the method to those who had but asmattering of knowledge. This “opening” was decriedby the “pure” homeopaths.

At the same time, homeopathic schools wereteaching less of the method taught by Hahnemannand more of an eclectic blend of therapeutics thatcombined simplified homeopathic therapeutics withconventional allopathic medicine. By the 1876 meet-ing, factions began to form. Dunham, try as hemight, could not pull them together. The AIH gradu-ally fell into the hands of the “half-homeopaths,” and

the “pure” homeopaths established the InternationalHahnemannian Association (IHA) in 1880. Hering,who had been the glue in homeopathy, died in 1880,and the movement began to founder. Although “half-homeopaths” continued to run the AIH and theschools, a new leader arose among the “pure” homeo-paths.

James Tyler Kent, an eclectic trained physician inSt. Louis, was introduced to homeopathy when heconsulted a local homeopath to treat his wife. Kentemerged as one of the prominent homeopathic prac-titioners and educators for the next 30 years. In 1890,Kent moved to Philadelphia and established the PostGraduate School of Homoeopathics. Kent’s Lectureson Homeopathic Philosophy and Lectures on MateriaMedica, still in print, were derived from his lectures atthis school. With the help of his pupils, Kent assem-bled the Repertory of the Homeopathic Materia Medica—the classic reference work still used worldwide. BeforeKent moved to Chicago in 1900, the free clinic at theschool had treated more than 40,000 patients andthe school had trained 30 physician who became theleaders in the homeopathic movement in the nextcentury.17

Twentieth Century Decline andResurgence

While new innovations were being made in the fieldsof transportation, communications, and architec-ture, medicine, too, was experiencing changes.Pasteur’s germ theory had become well established.The German chemical industry developed a numberof synthetic drugs, among them aspirin, and an eagerpublic was beginning to use them. The French physi-ologist Claude Bernard had described the body as amachine that responded to the laws of chemistry andphysics, and medicine began to be driven by “science”and moved into areas of increasing specialization.

Organized homeopathy, already experiencing asplit within its ranks, did not cope well with the riseof “modern medicine.” Beginning in 1900, home-opathy in the United States experienced a suddenand seemingly final decline. Although there were12,000 “homeopathic graduates” in the United Statesat the turn of the century, most were homeopaths inname only. Few of them were really educated in thephilosophy of homeopathy, and most were using bothallopathic and homeopathic medicine according to

24 C L A S S I C A L H O M E O P A T H Y

Page 34: Classical Homeopathy

their whim. Only about 2000 were members of theAIH, and fewer than 150 were members of the IHA,the professional association for the few that practiced“pure” homeopathy.

To understand how homeopathy stayed alive wemust first look at the factors that led to its demise.One factor in homeopathy’s decline was the rise ofallopathic pharmaceutic companies, which earnedsignificant profits during the Civil War and wereinvesting the money in the medical establishment.

These companies slowly moved from traditionalbotanic medical products into the production andsale of “patent” medicines—compounds whose for-mulation was proprietary to the company. As his-torian Harris Coulter says:

The f looding of medical practice with these “propri-etaries” represented the final conquest of the medicalprofession by the patent-medicine industry. . . . it wasthe newest avatar of the profession’s unrelenting desireto simplify medical practice. The compounding of med-icines were centralized, and the physician was sparedthe intellectual effort required to obtain knowledge ofhis principal means of cure. Instead of learning thepowers and properties of medicinal drugs, he had onlyto memorize the names of series of specific compoundsand prescribe them for the disease names of hispatients.18

At about the turn of the twentieth century, theAMA decided to accept advertising for pharmaceuticproducts in its journal. Advertisements could list aproduct’s ingredients—although the actual formulaneed not be printed—and its therapeutic indications.Advertisers flocked to the journal and drug compa-nies became the largest source of income for theAMA.

A second factor in homeopathy’s decline was theopening of the AMA to homeopaths. In 1901, theAMA changed its code of ethics to allow membershipto “every reputable and legally qualified physicianwho is practicing or who will agree to practice non-sectarian medicine.”18,21 In 1903, the AMA rescindedits “consultation clause,” which prohibited AMAmembers from consulting with homeopaths, andinvited homeopaths back into the organization.Saying that it was time to forget sectarian differences,the AMA espoused the development of “modernmedicine” and “scientific medicine.” Local AMA soci-eties began to recruit physicians. It was allowable topractice homeopathy—as long as you did not statepublicly that you were doing so. Wrote one homeo-

path to a homeopathic journal: “I thought therewould be an opportunity to discuss homeopathicprinciples and homeopathic remedies if I joined thecounty and national societies of the old school, andso put some leavening into the lump. I found, how-ever, that I was counting without my host. Such dis-cussions were not permitted, so I am coming back.”19

Dr. J. N. McCormack, the brains behind the drive tobring homeopaths into the AMA, noted in 1911, “Wemust admit that we have never fought the homeo-path on matters of principle; we fought him becausehe came into our community and got the business.”19

“The homeopaths,” says Coulter, “were caught offguard by this onslaught and it produced a crisis inthe new school’s affairs through the whole of thedecade.”19

A third factor in homeopathy’s decline was thepoor quality of instruction in homeopathic schools.Most of the graduates, never having been taughthomeopathic principles, saw little difference betweenhomeopathy and conventional medicine. They weretaught a mish-mash of therapeutics that, when tried,more often than not failed them, and they “slipped”into a regular practice. The AMA, seeing this trendfor homeopaths to resort to everything but home-opathy, saw it not as a lack in their homeopathictraining but as a proof that education in “scientificmedicine” was worthwhile.

There was a sharp drop in the number of gradu-ates of homeopathic schools between 1895 and 1905.By 1910 the schools were already floundering.20

In 1909, the Carnegie Foundation, wishing togive money to medical schools but not having anystandard by which to judge them, commissionededucator Abraham Flexner to conduct a survey ofAmerican medical schools. Flexner visited all med-ical schools in the United States and wrote an 846-page report that was issued by the CarnegieFoundation. Flexner noted the drop in the numberof homeopathic school graduates: “In the year 1900there were twenty-two homeopathic colleges in theUnited States; to-day there are fifteen; the graduat-ing classes have fallen from 418 to 246. As the coun-try is still poorly supplied with homeopathicphysicians, these figures are ominous.”21 AlthoughFlexner commented on the need for continuedhomeopathic education, his report was extremelycritical of the facilities of the 15 homeopathic col-leges still in operation. Many of them had inade-quate facilities in general, and those that had

C H A P T E R 3 History of Homeopathic Medicine 25

Page 35: Classical Homeopathy

adequate facilities had little clinical training for thestudents. Said Flexner:

Logically, no other outcome is possible. The ebbing vital-ity of homeopathic schools is a striking demonstration ofthe incompatibility of science and dogma. One may beginwith science and work through the entire medical cur-riculum consistently, espousing everything to the samesort of test; or one may begin with a dogmatic assertionand resolutely refuse to entertain anything at variancewith it. But one cannot do both. One cannot simultane-ously assert science and dogma; one cannot travel halfthe road under the former banner, in the hope of takingup the latter, too, at the middle of the march.21

The result of the Flexner report was the closing ofmany medical schools, including most of the homeo-pathic schools. Between 1911 and 1926 there was a pre-cipitous drop in the number of homeopathic collegesin operation. By 1922 all but three—Hahnemann inPhiladelphia, New York Homeopathic Medical College,and Hahnemann San Francisco—had closed.22

A fourth factor in homeopathy’s decline was thelack of commitment and the poor quality of homeo-pathic medicine practiced by many of those who calledthemselves homeopaths. This lack of commitment ispersonified by Dr. Royal Copeland, president of theAIH in 1908. Copeland was an 1889 graduate of theHomeopathic department of the University ofMichigan at Ann Arbor. He was professor of MateriaMedica at Ann Arbor, and was elected mayor of AnnArbor in 1901. He was Dean of New York HomeopathicMedical College from 1908 to 1923. He served asHealth Commissioner for the city of New York from1918 to 1923 and was elected Senator from New York in1923, serving until his death in 1938.

As Senator, Copeland introduced the legislationthat would become the Food, Drug, and CosmeticAct of 1938. This Act created the Food and DrugAdministration. The problem for homeopaths wasthat Copeland (and many others) were trained in the“name” homeopathy but not at all in the “practice” ofit. Judging by his 1934 “domestic manual,” which hasnot a mention of homeopathy in it, Copeland hadceased practicing homeopathy by that time.23

In 1919, Dr. Edwin Lightner Nesbit commentedon the decline of homeopathy in the Journal of theAmerican Institute of Homeopathy (JAIH):

When Copeland says, “If homeopathy had strengthenough, and vigor enough and old-time stamina enoughto fight its battles now as it did in the pioneer days, itcould accomplish enough in this generation,” etc. I say,

“Yep, attaboy, and me too,” meaning “amen.” Only fromthis practitioner’s viewpoint I would say, if our homeo-pathic leaders—like Copeland—had their vision enoughten years ago to see the inevitable trend of their trucklingto non-homeopathic “standards” and to stand for“standards” of their own devising alone, the homeo-pathic branch of the medical profession would have hadmore and better colleges of its own today than our pio-neers ever dreamed.24

Kent died in 1916. His pupils, in large part, helped tokeep homeopathy in the United States alive during atime when it was seen as “grandma’s medicine” andnot scientific and modern.

With the 1920s approaching, homeopathy’sfacade was barely standing. Even the homeopathicsuccesses in The Flu Epidemic of 1918 were of littleconsequence. Although the mortality rate forpatients receiving homeopathic treatment wasbetween 1% and 3% (considerably lower than themortality rate of between 25% and 30% for thosereceiving allopathic treatment), the differencescaused not a stir from the conventional medicalestablishment.25-28

A myth lays the demise of homeopathy at the feetof the “fanatical” high-potency prescribers, therebyblaming the very people who were responsible for pre-serving homeopathy in the United States. Althoughpseudohomeopathy failed to work for its practitionersand their patients, those who were using real homeo-pathic care knew its value. Like a persecuted sect thatsurvives through the centuries by passing informa-tion from generation to generation, those who under-stood homeopathy as the methodology outlined byHahnemann managed to keep it alive.

One of the leaders of the next generation wasJulia M. Green. Green was born in 1871 and died in1963. Her life spans the time from the beginning ofthe decline of homeopathy almost through its resur-gence. Trained in medicine at Boston University (ahomeopathic school) she began her medical practicein Washington, DC, in 1900. In 1921, spurred by hervision, 12 homeopathic physicians assembled to starta new organization. One of the first orders of busi-ness was to establish a postgraduate training pro-gram for physicians. The first course, 6 weeks long,ran in 1922. In 1924, the organization was officiallyincorporated as the American Foundation forHomeopathy (AFH). The AFH postgraduate schoolbegan to train a number of physicians who wouldkeep homeopathy alive in the coming years.

26 C L A S S I C A L H O M E O P A T H Y

Page 36: Classical Homeopathy

The collapse of the homeopathic edifice wasclearly seen by Rudolph Rabe, MD, an 1896 graduateof New York Homeopathic Medical College. In anessay in 1926, Rabe clearly saw the demise of homeop-athy and placed the blame squarely on the shouldersof the profession itself and those who curry favorwith the dominant school to the detriment of theirown. Said Rabe:

We invite to our national medical conclaves and ban-quets, men prominent in the professional and office lifeof the old school and then pat ourselves vigorously onthe back, for the glory of our achievement. But do wereally achieve anything worthwhile by these press-agentmethods? Does all this diplomatic tomfoolery bring usanywhere? We doubt it and look in vain for evidence. Hasany Old School college seriously taken up the study andinvestigation of homeopathy? If so, we have not heard ofit. On the contrary, the juggernaut of established medi-cine continues to roll relentlessly on and to flatten out alldoctrinal differences. In keeping with every other depart-ment of American national life, we are undergoing aprocess of standardization, which is killing all individu-ality. We have become ‘good fellows,’ who applaud voci-ferously every compliment thrown at us, but in our eagerrunning after the glittering chariots of the old school, aredivesting ourselves more and more of such shreds ofprinciple as are left to us. The end is easy to foretell.29

Rabe was 44 when he penned this piece, and he livedto see his fears play out. Four years after he wrotethis, his position as instructor of Materia Medica atNew York Homeopathic Medical College was abol-ished.

In 1935, the AMA’s Council on MedicalEducation and Hospitals said it would no longercarry schools of sectarian medicine on its approvedlist. New York Homeopathic Medical College becameNew York Medical College, and other hospitalsremoved the word homeopathic from their names.Although these hospitals assured their homeopathicstaff that they would not be dropping homeopathy, itwas gradually phased out as the hospitals cameunder the control of conventional physicians.29

The Social Security Act, passed by the Rooseveltadministration in 1935, was perceived by the AMA asan imminent threat. The fear of socialized medicinewas very real to conservative medical professionalswho were wary of any incursion into traditionalAmerican freedoms. For all of their differences,homeopathic physicians were as conservative a lot astheir AMA colleagues. Lucy Stone Herzog, MD, an1891 graduate of Cleveland Homeopathic Medical

College, took the lead in attempting to form a unitedfront with the AMA. A national committee wasformed to act as a liaison with the AMA to protectthe interests of the medical profession. In retro-spect, the fears were unfounded. Although nothingmuch came of the joint committee in regard to theSocial Security Act, the perceived acceptance ofthe AMA was important to homeopaths, and desireto forge stronger links between the two schoolsgrew.

Royal E. S. Hayes was a graduate of the New YorkEclectic Medical College in 1898. He was an early mem-ber of the IHA and served as the organization’s presi-dent in 1926. He practiced in Waterbury, Connecticut.In a talk to the Connecticut Homeopathic MedicalSociety in 1951, Hayes recalled what it was like when hejoined the Society in 1904:

Only one member was able to cope with chronic disease,improve constitutions or deal homeopathically withsevere crises. . . . When a homeopathic remedy was usedit was almost certain to be 1X to 6X. The 12th was highand the 30th had no medicine at all. . . . But at that time,not only was straight prescribing and the single remedynot adhered to, such supposed lunacy was tabooed andeven booed. . . . While this was going on, perhaps to thelasting benefit of our art, our institutions were gradually“fading away.” I mean really fading away. As you know,the external cause of this was pharmacal and medicalmonopoly in collusion with bureaucratic prerogatives.But ten times more ominous were the internal causes,that is, lack of understanding, fear of disapprobation,appeasement on the part of some, and the serenity andcontent of the purists. It was almost fatal. Many wentover to the conventional caste and the ones tied to hos-pitals, asylums, clinics and colleges were too few to copewith the external pressure and infiltration. But the lossshocked the remnant into renewed efforts to improvetheir own therapy and homeopathic standing, so thatnow we have proportionately more real homeopathicpractice with a minimal contingent than we had fiftyyears ago with a large one.30

By the late 1940s, Hahnemann Medical College, theonly school ostensibly teaching homeopathy after1940, was in disarray. The trustees, seeing an inad-equate funding base, mandated more students beadmitted. With more students, it became harder toteach at the levels required and scholastic standardsfell. Some graduates were unable to pass their licen-sing exams. In 1945, as soon as the pressure to supplyphysicians for the war eased, the AmericanAssociation of Medical Colleges and the AMA

C H A P T E R 3 History of Homeopathic Medicine 27

Page 37: Classical Homeopathy

Council on Medical Education and Hospitals noti-fied Hahnemann that it was being put on probation.The teaching of homeopathy did not help its pro-bationary standing. In 1947, the faculty and trusteesvoted to make homeopathy an elective. It became asingle course, taught by a single teacher, GarthBoericke. In 1949, the probation was lifted, andHahnemann Medical College divested itself of homeop-athy. Said one student, “Antibiotics came in andhomeopathy went out.”22, 23

All along there were those who thought, some-how, it might be possible to retain whatever vestigeof homeopathy there was at Hahnemann, and bydoing so retain some amount of legitimacy for thepractice. By 1950, it was becoming clear that such avision was indeed a chimera. When Garth Boerickeretired in 1961, homeopathy went with him. An edi-torial in the JAIH in February of 1957 speaks of thetime:

Hahnemann was “put on probation.” The resultantupheaval brought about a complete reorganization of itsteaching program which eventually got Hahnemann “offthe hook,” but resulted disastrously for homeopathy. . . .but homeopathy cannot exist without practitioners. Inessence, homeopathy in this country received its deathblow when Hahnemann “got off the hook.”31

By the late 1940s, homeopathy was in its finaldecline. Many young doctors had served in the armedforces during World War II and had learned the use ofantibiotics and pain killers in the emergency workthey did. When they returned, many of them wereready to apply this newfound knowledge to the non-emergency practices of the general practitioner. Inthe view of a 1948 graduate of Hahnemann, the mostsignificant factor driving physicians into the use ofantibiotics and injections was this—they already knewhow to do it. And the public was willing and ready toaccept the new and modern medicine. Said RudolphRabe in 1948:

Families which years ago employed loyal homeopathicdoctors are now in the hands of the Old School. Theyhave gone over to the Old School because they under-stand that school to be “scientific and modern.” Theywant “streamlined” medicine, even though many of themultimately pay a high price for their folly. Unfortunately,they do not always associate the disasters with theirabandonment of homeopathy.29

Meanwhile, AFH postgraduate instruction continuedunder the leadership of a group of doctors who

would teach the 6-week course even if only one per-son enrolled.

Anthony Shupis was a graduate of HahnemannMedical College in 1938, and was one of the first totake the AFH postgraduate course after World War II.He was president of the Connecticut HomeopathicMedical Society, and spoke these words at the 1948meeting:

The precipitous drop in the popularity of homeopathy incontrast to its meteoric rise to the present are a frightfulphenomenon to behold. What has happened since theturn of this century to cause its undoing? Has timefinally erased its utility? Has homeopathy finally provento be just another passing fad to be regarded as just an“historical curiosity” or will Hahnemann still refuse to liequiet in some dusty corner of medical history like other“centenarians”?

Everywhere about us we see our numbers diminish-ing. Our undergraduate schools are no longer ours, oldschool physicians have been substituted on the teach-ing staffs and the control of our hospitals usurped bythe surgical and mass drug clique of the dominantschool.

Although this is all too true, we are prone to accusethe old school of political skullduggery while whitewash-ing ourselves. Perhaps it would be better for us to turnabout and view our collective selves as we are. In short,perhaps we have been too easily raped.

Let us question ourselves. Are we homeopaths, or bet-ter still, are we “fightin” homeopaths? Do we follow theteachings of Hahnemann or are we just graduates fromwhere once homeopathy was only apologetically men-tioned? How convincing were our teaching fathers? Havewe pursued the study of homeopathy beyond our schoolborders? If so, how many have done so a whole week?These are but a few of the many questions we must askourselves.

How many of us have ever studied The Organon, to saynothing of Hahnemann’s Chronic Diseases, Lesser Writings,Materia Medica Pura, etc., etc.? Have we followed the studyof these original teachings with the writings of subse-quent workers? Can we honestly say we are really homeo-paths? Have we in the treatment of our cases exhaustedthe possibilities in our search for curative remedies? Havewe satisfied Hahnemann’s definition of the highest andonly calling of a physician? Is it not high time we stoppedblaming our “regular” school colleagues? Are not we,ourselves, to blame? Is not our blame the triple chronicstate of ignorance, indolence and fear upon which breedthe secondary factors to the detriment of our society andcause? It is time we followed Hahnemann’s recognition ofthe outward manifestations alleviating internal ills andceased suppressing our homeopathic feelings. If we can

28 C L A S S I C A L H O M E O P A T H Y

Page 38: Classical Homeopathy

no longer recruit in our ranks the almost extinct home-opathically-minded graduates, then it falls upon us, asnecessary, to attempt to educate our less fortunate reg-ular school graduates. I am certain that there areamong them many enlightened open-minded individu-als who, given the opportunity, would avail themselvesof it if it were offered. If we should attract only one, ourpurpose would be rewarded and our obligation ful-filled.30

The decline of homeopathy through the 1940swas gradual. The 1941 Directory of HomeopathicPhysicians in the United States listed more than 6600names. A number of the people listed had been inpractice for more than 50 years—some graduating asfar back in 1878. But few new graduates were cominginto the marketplace while the old guard was rapidlydying off.

Yet the literature of the IHA at the time is full ofvitality. It was as if the essence of homeopathy—thereal heart of it—drew in tighter to protect itself fromthe outside assault. And those who were holding ittogether should certainly not be forgotten. They heldit together by example; they did real homeopathywith their patients, and their patients, in turn, recog-nized the special nature of the treatment and workedto keep the flame of homeopathy alive.

When homeopaths pulled together with the AMAover the issue of socialized medicine, several homeo-paths came to the conclusion that the “regulars”were ready to accept homeopathy—at least as a spe-cialty in therapeutics rather than as an independentmedical practice. In 1950, a committee was estab-lished by the AIH to investigate the possibility of aspecialty board. There was considerable debate. LewisP. Crutcher, MD, wrote a scathing article in theJanuary 1951 JAIH32 in which he called the attempt togain recognition by the AMA “cowardly” and saidthat there are but two schools of medicine: “homeo-pathic and hypodermic.” The drive, he said, was like“asking Protestantism to become a ‘specialty’ underthe control of the Roman Catholic Church.” Butothers within the AIH were urging that links be forgedwith conventional medicine. In January 1960, AIHPresident Elizabeth Wright Hubbard announced thatthe American Board of Homeotherapeutics (ABHT)had been legally incorporated, and they were accept-ing applications for the specialty designation DHt—Diplomate of Homeotherapeutics. It was understoodthat the AMA would accept homeopathy as a spe-cialty if 100 people registered with the ABHT. When

100 members were finally granted Diplomate status,the AMA questioned the education of a few of thoseapplying, and would not accept them. When otherswere granted the diplomate—raising the number to100 again—there were more questions. The AMAnever granted the ABHT the status it requested.Although the ABHT is still with us, the AMA has stillnot recognized homeopathy as a specialty.

In the early 1950s, the leadership of the AIHbegan to talk about bringing the IHA under its direc-tion. In an editorial in the October 1955 issue of theJAIH,33 Donald Gladish, MD, said it clearly: “As thenumbers of the Institute members have fallen, theirdegree of homeopathicity is increased, partly becausenearly all the members of the IHA are also membersof the Institute.”

Ever since the late 1940s, the annual meetings ofboth the AIH and the IHA had been held at the sameplace and time. With membership falling, it was onlynatural for the two organizations to merge. InDecember 1959, the Homeopathic Recorder ceased pub-lication and was absorbed into the JAIH. At the jointmeeting in 1960, the IHA disbanded. The AIH, for thefirst time since 1870, was in the hands ofHahnemannian homeopaths.

The 1950s were dark times. The United Statesexperienced a regressive turn under the influence ofSenator Joseph McCarthy. Political and social sup-pression was rampant. All unconventional ideas werelooked upon with suspicion, and many alternativehealers were prosecuted.

The stalwarts who kept homeopathy alive duringthese dark times were few and far between. In 1971, inhis book, Homeopathy: The Rise and Fall of a MedicalHeresy, Martin Kaufman wrote a grim summary: “By1960, with few notable exceptions, the average homeo-path was well over sixty years old. Every year, deathfurther depletes the ranks. With only a few converts,the future looks grim, indeed. Unless this trend canbe reversed, homeopathy will not survive for morethan two or three decades.”34

What Kaufman could not foresee was the rise ofconsciousness that happened in the 1960s and1970s. While the Vietnam war raged, young peopleon our home shores f locked to a never-endingstream of Indian gurus and to Timothy Leary’s callto “turn on, tune in, and drop out.” Some of thoseheeding this call were medical students who werelooking for better ways, and some of them foundhomeopathy.

C H A P T E R 3 History of Homeopathic Medicine 29

Page 39: Classical Homeopathy

One of these young doctors, Richard Moskowitz,summed it up beautifully when he described comingto the postgraduate course at Millersville in 1974(quoted in Winston):

At first glance, neither the sleepy state college campuswhere the course was given nor the rumpled clothes andadvanced age of the homeopaths who taught it auguredwell for the future of the profession. Most of the facultywere quite old and semi-retired, and very few were activelyearning their living from practicing the method theywere teaching us. It was as if a whole generation of themost active, successful experienced practitioners whoshould have carried the main teaching load were miss-ing.35 (p 340)

In 1969, Dr. Maesimund B. Panos, who had takenover Julia M. Green’s practice in Washington, DC, atten-ded the meeting of the International HomeopathicMedical League (LHMI) in Athens, Greece. Oneevening, while walking with a group of other atten-dees to view the sunset over the sea, she fell in besidea young homeopath and struck up a conversation. Itwas a chance meeting that would change the face ofhomeopathy in the United States and throughout theworld. The young man “with the engaging personal-ity” was George Vithoulkas, a self-taught homeopathwho seemed to “understand” homeopathy in greaterdepth than many of the teachers at the time. In 1974,Dr. Panos brought Vithoulkas to the United States forthe joint AFH and LHMI meeting in Washington, DC,introducing him to a whole new generation of homeo-paths. The rest is the Rest of the history—this intro-duction helped fuel homeopathy’s resurgence under agroup of young physicians like Bill Gray, DaveWember, Nick Nossaman, Richard Moskowitz, KarlRobinson, Roger Morrison, and Sandra M. Chase—allwho went to study with Vithoulkas in Greece, andbrought his ideas back to their practices in the UnitedStates. It was this group that became the “core” of theteachers for the next generation. Concurrent withthese events was the rise of two colleges of naturo-pathic medicine in the Northwest. John Bastyr, anaturopathic physician who was deeply into homeop-athy, helped to found the National College ofNaturopathic Medicine in Portland, Oregon. Within afew years, another group of naturopaths founded theJohn Bastyr College of Naturopathic Medicine (nowBastyr University) in Seattle. These two schools grad-uated a number of practitioners who became leadersin the homeopathic community through the 1980sand 1990s.

The 1980s and 1990s saw a number of homeo-paths from around the world (where homeopathyhad continued to flourish), come to the UnitedStates to teach seminars and share their knowledge.Through the “dark ages,” it was a few homeopathsand their patients who kept homeopathy alive. TheAFH set up “layman’s leagues,” usually under theleadership of a doctor, to educate lay people abouthomeopathy (but not in the practice of it). The waylay people kept homeopathy alive in the UnitedStates was very different from the way they con-tributed to the effort in Great Britain. There, becauseof the legal system, the lay person was allowed topractice openly. And because so few physicians wereinterested in learning homeopathy, physicians likeJohn Henry Clarke, frustrated with his efforts tointerest doctors, began teaching lay people the prin-ciples of homeopathy. This was not the direction inthe United States. Although there were lay persons’leagues in the United States, their purpose was to cre-ate an interest in homeopathy and generate patientsfor homeopathic physicians.

In 1946, when Julia M. Green wrote the 40-page“Qualifying Course for Laymen,” the thrust was sim-ply to educate people in enough philosophy that theymight become good patients.36 The official role of thelay person was to demand good homeopathy fromtheir physicians. What they would do when homeo-pathic physicians no long practiced was never dis-cussed.

The first lay course was held by the AFH in 1966.Dean William Boyson assured the Board of Trusteesthat “the laymen were not being taught remedies northerapeutics—just philosophy.” With the resurgenceof homeopathy in the 1970s came an interest inlearning more by the lay public. Looking across thesea, they saw the rise of the professional, nonmedicalhomeopath in the United Kingdom and tried to emu-late it at home. The 1980s and 1990s saw the rise ofseveral part-time educational programs (similar tothose in the United Kingdom) that were trainingnonmedical practitioners. The question of the legal-ity of such practice is an issue that concerns thehomeopathic community today.

In 1833, when Dr. Quin, the first homeopath inEngland, came before the Royal College of Physicians,one of the censors advised to leave him alone because(so went the reasoning) homeopathy could not lastvery long. Two years later, when Hahnemann arrivedin Paris, he applied for permission to practice. Several

30 C L A S S I C A L H O M E O P A T H Y

Page 40: Classical Homeopathy

members of the Academy wrote to the Minister ofEducation and Public Health, protesting Hahne-mann’s practice and method. Guizot, the Minister,replied, “Hahnemann is a scholar of considerablemerit. Science must be free for all. If homeopathy is achimera or a system without inward application, itwill fall of itself.”37 In 1989, when Martin Kaufman,the author of Homeopathy: The Rise and Fall of a MedicalHeresy, was asked to write a chapter on homeopathyfor the book Other Healers, he titled it “The Rise andFall and Persistence of a Medical Heresy.”

Early in the first decade of the twenty-first cen-tury, homeopathy has shown itself to be not achimera, and it has certainly persisted. As we pass thetwo-hundredth anniversary of Hahnemann’s firstessay about a “new principle for ascertaining the cur-ative power of drugs,” we find that homeopathy isalive and well in the United States and worldwide.

References 1. Jones WHS (translator): Hippocrates, Cambridge, Mass.,

1923, Harvard University Press. 2. Boyd LJ: A study of the simile in medicine, Philadelphia,

1936, Boericke and Tafel. 3. Dudgeon RE: Lectures on the theory and practice of hom-

eopathy, London, 1854, Leath and Ross. 4. Coulter H: Divided legacy: a history of the schism in medical

thought, Washington, DC, 1973, McGrath. 5. PDR for Herbal Medicines, ed 2, Montvale, NJ, 2000,

Medical Economics Company, Inc., 2000. 6. Richardson-Boedler C: The doctrine of signatures: a

historical, philosophical and scientific view (I), BrHomeopath J 88(4):172-177, 1999.

7. Coulter H: Divided legacy: the patterns emerge: Hippocratesto Paracelsus, Washington, DC, 1975, Wehawken BookCompany.

8. Sankaran R: The substance of homeopathy, Bombay, 1994,Homeopathic Medical.

9. Hartmann F: The life and doctrines of PhillippusTheophrastus, bombast of Hohenheim known by the name ofParacelsus, ed 4, New York, 1932, Macoy Publishing andMasonic Supply.

10. Hahnemann S: Organon of medicine, ed 6, Los Angeles,1982, JP Tarcher.

11. Goodrick-Clarke N: Paracelsus: essential readings,Berkeley, Calif., 1999, North Atlantic Books.

12. Larsen R editor: Emanuel Swedenborg: a continuing vision,New York, 1988, Swedenborg Foundation.

13. Van Dusen W: The presence of other worlds, New York,1974, Swedenborg Foundation.

14. Carlston M: Swedenborgian influences in Kent’s home-opathy, American Homeopath 2:24-26, 1995.

15. Bradford TL: Homeopathic bibliography, Philadelphia,1892, Boericke and Tafel.

16. Bradford TL: The pioneers of homeopathy, Philadelphia,1897, Boericke and Tafel.

17. Bradford TL: Biographies of homeopathic physicians,Philadelphia, 1916, Hahnemann Collection, AlleghenyUniversity of Health Sciences. [Bradford’s Scrapbooks(35 vols)].

18. Coulter HL: Divided legacy, science and ethics in Americanmedicine 1800–1914, vol 3, Washington, DC, 1973,McGrath Publishing.

19. Coulter HL: Divided legacy, the bacteriological era: a historyof the schism in medical thought, vol 4, Berkeley, Calif.,1994, North Atlantic Books.

20. Kaufman M: Homeopathy: the rise and fall of a medicalheresy, Baltimore, 1971, Johns Hopkins.

21. Flexner A: Medical education in the United States andCanada, New York, 1910, The Carnegie Foundation.

22. Rogers N: Hahnemann closing: an alternative path: the mak-ing and remaking of Hahnemann Medical College andHospital, New Brunswick, 1998, Rutgers University.

23. King WH: The history of homeopathy and its institutions inAmerica, 4 vols, New York, 1905, Lewis.

24. Nesbit, EL: A Research Institute (letter to the editor),JAIH XII(2):149-152, 1919.

25. Dewey WA: Homeopathy in influenza: a chorus of fiftyin harmony, JAIH XIII(11):1038-1043, 1921.

26. Pearson WA: Epidemic influenza treated by homeo-pathic physicians, Homeopathic Recorder 34:345-348,1919.

27. Transactions of the International Hahnemannian Association,1880–1946. (Division under Dunham of AIH) Transac-tions of the American Institute of Homeopathy, 1870, pp570–589; 1879, p 1180; 1880, pp 144–163.

28. Cook D, Naude A: Myth and fact, JAIH 89(3):125-141,1996.

29. Rabe R: Can the school of homeopathy survive? JAIH42(1):1-4, 1949.

30. Shupis A: Presidential address: the AIH during the1940–60 period, Homeopathic Recorder LXIV(5):123, 1948.

31. Sutherland AD: Homeopathic examining boards (edi-torial), JAIH 50(2):55–58, 1957.

32. Crutcher L: Retrospect and prospect, JAIH 44(1):11-15,1951.

33. Gladish D: A time for decisions, JAIH 48(10):314, 1955. 34. Kaufman M: Homeopathy: The rise and fall of a medical

heresy, Baltimore, 1971, Johns Hopkins University Press.35. Winston J: The faces of homeopathy: an illustrated history of the

first 200 years, Tawa, New Zealand, 1999, Great Auk. 36. The qualifying course for layman, Washington, DC, 1946,

American Foundation for Homeopathy.

C H A P T E R 3 History of Homeopathic Medicine 31

Page 41: Classical Homeopathy

37. Haehl R: Samuel Hahnemann, his life and work, 2 vols(translated by ML Wheeler, WHR Grundy), London,1922, Homeopathic Publishing.

Suggested Readings Boyd LJ: A study of the simile in medicine, Philadelphia, 1936,

Boericke and Tafel. Coulter H: Science and ethics in American medicine: 1800-1914,

Volume III, Washington, DC, 1973, McGrath.Dudgeon RE: Lectures on the theory and practice of homeopathy,

London, 1854, Leath and Ross. Goodrick-Clarke N: Paracelsus: Essential readings, Berkeley,

Calif, 1999, North Atlantic Books.

Hartmann F: The life and doctrines of Phillipus Theophrastus,bombast of Hohenheim known by the name of Paracelsus (ed4), New York, 1932, Macoy Publishing and MasonicSupply.

Hippocrates: Hippocrates, Volume I, Cambridge, Mass, 1972,Harvard University Press.

Kaufman M: Homeopathy in America: The rise and fall of a med-ical heresy, Baltimore, 1971, Johns Hopkins UniversityPress.

Larsen R, editor: Emanuel Swedenborg: A continuing vision,New York, 1988, Swedenborg Foundation, Inc.

Van Dusen W: The presence of other worlds, New York, 1974,Swedenborg Foundation, Inc.

Winston J: The faces of homeopathy: An illustrated history of thefirst 200 years, Tawa, New Zealand, 1999, Great Auk.

32 C L A S S I C A L H O M E O P A T H Y

Page 42: Classical Homeopathy

INTRODUCTION

The world has changed profoundly since Hahne-mann’s day. His followers have spread homeopathyover much of the world. Simultaneously, they havecarried homeopathy, begrudgingly at times, into themodern world. Today the production of homeo-pathic medicines takes place in gleaming industrialfacilities, and even classical homeopaths often usecomputers to help them select the correct homeo-pathic remedy.

Although many observers note the historicalimportance of its early nineteenth-century Americangolden age, much of homeopathy’s worldwide popu-

larity can be attributed to the influence of the BritishEmpire. In the same way that homeopathy came toAmerica in the medical bags of immigrating Germanhomeopathic physicians, it experienced a secondwave of expansion via emigration when it was spreadthroughout the British Empire by British physiciansin the mid-to-late nineteenth century. The practice ofhomeopathy has very deep roots in many of the mostfar-flung corners of the globe. International gather-ings of homeopathic physicians have been the normfor generations.

Although there are considerable differences inhomeopathic practice from country to country,they are outweighed by the commonalties among

4Homeopathy Today

M I C H A E L C A R L S T O N

33

Page 43: Classical Homeopathy

homeopathic patients and practitioners. Worldwide,homeopathic practitioners and patients are tiedtogether by the twin beliefs that healing should be asclosely allied to natural processes as possible and thathomeopathy works in precisely this manner. Becausehomeopathic thinking differs qualitatively from con-ventional medicine, a homeopathic understanding ofa patient is available to anyone who studies a fewreadily available texts. A consequence of this accessi-bility is that patients are empowered to treat them-selves, their families, and their friends. Lay practiceand self-care are prominent features of the homeo-pathic landscape, essential facts for all health carepractitioners.

HOMEOPATHY IN THEUNITED STATES

Who uses homeopathy? Who chooses a medical sys-tem notorious for its controversial principles, andwhy do they do so? Despite homeopathy’s worldwidepopularity, we have relatively little information abouthomeopathic patients as a group to help us answerthese questions. A disproportionate amount of theavailable data are from studies of what we have cometo call complementary and alternative medicine (CAM) inthe United States. Homeopathy is but a small portionof CAM, and Americans represent a relatively smallfraction of worldwide users of homeopathy. It istherefore difficult to answer broad questions abouthomeopathic patients worldwide. Despite the relativemystery, however, the data are sufficient to concludethat modern homeopathic patients, at least in theWestern world, are different from patients whochoose only conventional treatment.

Who Uses Homeopathy?

Homeopathy Is Growing Rapidly One of the signal events in the rising awareness ofcomplementary medicine in the United States was a1993 article by David Eisenberg and associates inNew England Journal of Medicine.1 This study repre-sented the first national measuring stick for“unconventional medicine,” as Eisenberg thenlabeled CAM. The popularity of CAM surprisedmany and led to a swelling tide of investigation andeven greater popularity.

Eisenberg’s survey found only modest use ofhomeopathic medicine in his study population. In1990, approximately 600,000 American adults sawhomeopathic practitioners, a very small fragment ofusers of CAM at the time. However, the survey madea particularly interesting finding about homeopathy.In addition to the 600,000 adult homeopathicpatients, another 1.2 million American adults usedhomeopathy for self-care.1 In other words, approxi-mately two thirds of patients using homeopathy didso without professional supervision.

Although the 1990 popularity of homeopathy wassmall, it had already been growing rapidly. In the 1980s,sales of homeopathic medicine rose at an annual rate ofapproximately 20%.2 Evidence is accumulating thatthis rising interest has not abated, but that the pace ofhomeopathic expansion has actually accelerated.

In 1997, a survey by Landmark Healthcare3 foundthat 5% of the American adult population (approxi-mately 9 million people) reported use of homeo-pathic products in the prior year. Self-treatmentaccounted for 73% of that use. In addition, 61% ofthose who had heard of homeopathy reported theywere either very likely or somewhat likely to turn tohomeopathy if the need arose.

Eisenberg and his associates at Harvard conductedanother national survey in 1997,4 following up on their1990 data. This time they found that the use of home-opathy increased fivefold to 6.7 million adults—3.4% ofthe adult population. They also found that the previ-ous dominance of homeopathic self-treatment overprofessional care increased to more than 82%. Thismeant that 5.5 million American adults were usinghomeopathy without professional supervision.

Assuming that the popularity of homeopathy hascontinued to grow at the same pace, the number ofadult Americans using homeopathy in 2002 wouldhave risen to 12 to 13 million, with 8 to 10 millionusing it on their own.

Although these projections are impressive, a 1999survey suggests they might significantly underesti-mate the popularity of homeopathy.5 Roper StarchWorldwide conducted telephone interviews with1000 Americans who identified themselves as the pri-mary grocery shopper for their families; 17% reportedusing homeopathic remedies to maintain health.

Homeopathy in Children As with CAM use in general, the use of homeopathyin children is disappointingly mysterious. Many of

34 C L A S S I C A L H O M E O P A T H Y

Page 44: Classical Homeopathy

the most popular homeopathic products in theUnited States are specifically intended for pediatricuse, and a number of studies have been publishedregarding the use of homeopathy in a variety of pedi-atric conditions.6-9 However, we have only limitednational data regarding the extent and nature ofpediatric use.10 Studies in other countries suggestthat although the use of CAM is less common inpediatric populations than among adults, homeop-athy represents a relatively larger portion of thatpediatric use.11-14

Many who are concerned with pediatric use ofCAM therapies are concerned about the children,whose use of CAM therapies is not self-determined. Itis possible that children may suffer adverse effectsfrom CAM treatment or from neglect of beneficialconventional treatment. A recent regional studyraised this issue in the homeopathic community.

As a part of a survey of professional homeopathsand naturopaths in the Boston area, investigatorsasked how they would manage a febrile newborninfant.15 Half of the nonphysician homeopathsreported that they would not immediately refer afebrile newborn to a conventional physician (slightlybetter than the 60% nonreferral rate among thenaturopaths). Although the high incidence of thisquestionable response creates anxiety about the qual-ity of nonphysician homeopathic care, it is only onesmall bit of data from a small survey considering onevery specific clinical scenario. This finding was sur-prising because all major homeopathic training pro-grams in the United States include instruction aboutappropriate medical referrals. Clearly, we need moredata about the use of homeopathy among pediatricpopulations, and homeopathic educational institu-tions must be certain that graduating students rec-ognize their limitations and the need to cooperatewith conventional physicians.

Much of Homeopathy is Self-care One of the most important facts for conventionalhealth care providers to grasp about homeopathy isthe predominance of self-care. This pattern is import-ant, because most of those who use homeopathy arenot doing so under the supervision of professionallytrained homeopathic practitioners. Thus most ho-meopathy users are quite likely to receive their medicalcare from conventional health care providers.Because of the increased time they spend with eachpatient, classical homeopaths tend to see many fewer

patients in a day than do physicians. As a result, insome areas of the United States the average busy pri-mary care physician might see more patients who usehomeopathy than does the homeopathic practitionerdown the street.

Unfortunately, considerable evidence supportsthe belief that most patients who use CAM do nottell their physicians.1,4,16-18 So, not only do many con-ventional primary care physicians care for a largenumber of patients who use homeopathic remedies,they are unaware of this usage. For the patient tomaximize the benefit from treatment while minimiz-ing adverse effects, the physician must be aware of allelements of that treatment. Homeopathy is especiallychallenging in this way because of its popularity as aself-care modality.

Patient use of homeopathy unfettered by profes-sional supervision is not a new phenomenon, butrather a long-standing tradition. Since the middle ofthe nineteenth century, homeopathy’s greatest popu-larity has been among laypeople treating themselvesor family members, particularly mothers treatingtheir families. For more than 150 years, until the late1980s, the largest-selling book on homeopathy wasConstantine Hering’s Domestic Physician. Written ini-tially as a self-treatment manual for Moravian mis-sionaries, the author describes his book in theintroduction: “It is intended to be an advisor in manycases of indisposition, when one will not or cannotconsult a physician.”19 It was most widely used by“Dr. Moms” throughout North America. Profes-sionally administered homeopathy has always beenthe exception rather than the rule.

CAM Demographics More specific information, although still quite lim-ited, is just now becoming available about usersof homeopathic medicine. Again, because the bulk ofdata we have pertains to the larger population ofCAM users, let us first consider that information andthen use the meager homeopathy-specific data to dif-ferentiate the homeopathic subpopulation. The bestquality data come from Eisenberg’s most recent U.S.survey.4

CAM users had more education and higherincomes than Americans who did not use CAM. CAMuse was most common among females, adults in the 35-to 49-year-old age-group, and Americans living in theWestern states. All ethnic groups used CAM, althoughit was least common among African-Americans (33.1%).

C H A P T E R 4 Homeopathy Today 35

Page 45: Classical Homeopathy

These distinctions are only a matter of degree. CAMpractices are so common that essentially all popula-tions in all parts of the United States use them often.

Homeopathy Demographics Demographic information about homeopathicpatients is largely confined to data from two studies,Goldstein and Glik’s survey of patients seeking pro-fessional homeopathic care in the Los Angeles area20

and a national sample of physicians practicing home-opathy conducted by Jennifer Jacobs and associates.10

Both studies surveyed the subset of professionalAmerican homeopathy rather than the more preva-lent self-care. Although both surveys are limited inscope, the data appear meaningful and useful in ourattempts to understand professional homeopathicpractice.

Goldstein’s regional study found a pattern ofdemographic characteristics that was much the sameas the one seen in general surveys of CAM users.Homeopathic patients had above-average incomesand were highly educated, even more so than averageCAM users. More than two thirds of the patients sur-veyed had completed a college degree, and 95% hadattended college.

Jacob’s survey, like Eisenberg’s, found significantdifferences in the financial aspects of the homeo-pathic encounter compared with conventional medi-cine. Jacob’s survey was conducted in 1992, whichmay alter interpretation of some of the data.Although both Eisenberg surveys found that wellmore than half of the expenses for professional CAMtreatments were not reimbursed by health insurance,Jacobs found that less than 20% of homeopathic vis-its were not reimbursable by insurance. Given therecent growth in insurance plans that restrict thepanel of providers and the rarity of homeopaths prac-ticing within such restrictions, a new survey is likelyto reveal significantly different insurance figures.Homeopathic practitioners commonly report thatmany of their patients with health insurance pay out-of-pocket for homeopathic services because theirinsurance does not cover visits to a homeopath.

Jacobs learned that the ages of patients seekinghomeopathic treatment diverged significantly fromthose seeing conventional physicians. The portion ofconventional patients who were elderly was twice thatof homeopathic patients. Similar differences wereseen in the 15- to 24-year-old age-group (5.2% ofhomeopathic patients versus 11.6% of conventional

patients). Patients aged 25 to 64 represent a some-what larger percentage of homeopathic practitioners’patients.

Finally, given our limited data about CAM use inchildren, the data in this study add significantly toour understanding. Jacobs found that 23.9% ofhomeopathic patients in the sample were 14 years oryounger compared to only 16.6% of conventionalpatients. Two of the three conditions most com-monly treated by homeopaths (asthma and otitismedia) are quite common in the pediatric popula-tion. Jacob’s data and the popularity of homeopathicover-the-counter (OTC) products specificallyintended for use in children suggest that the strengthof the homeopathic presence in pediatrics may dis-tinguish it from other CAM therapies.

Homeopathic Regular Age Physicians (%) Physicians (%) >64 10.5 20.5 45-64 27.8 22.8 25-44 32.6 28.5 15-24 5.2 11.6 <15 23.9 16.6

Homeopathic Practice Patterns Jacob’s survey disclosed other highly important dif-ferences in the practice patterns of homeopaths com-pared with conventional physicians. Visit length,number of medications prescribed, and use of labora-tory testing all contrasted markedly. These differ-ences could certainly account for some of the appealof homeopathy to patients who are concerned aboutoveruse of prescription medication and frustrated bythe increasingly limited time they have to discusstheir concerns with their physician.

Homeopaths spent more time with their patients.Nearly 75% of homeopathic visits were more than 15minutes in length, compared with 23.2% of conven-tional visits. Similarly, the mean duration of a homeo-pathic visit was 30 minutes, but only 12.5 minutes fora conventional practitioner. Given the great amountof clinical information required for classical homeo-pathic diagnosis and treatment, this dissimilarity iseasy to understand.

Another distinction, which is obvious given the his-torical roots and philosophic impulses of homeopathy,is that homeopathic physicians prescribed much lessconventional medication. Conventional physicians pre-scribed pharmaceutic medications in 68.7% of visits,whereas homeopaths did so only 27.5% of the time.

36 C L A S S I C A L H O M E O P A T H Y

Page 46: Classical Homeopathy

A final variation, which could prove interesting inthis climate of economic restraint in medical prac-tice, was that homeopathic physicians used much lessdiagnostic testing (39.9% versus 68.3% for conven-tional physicians). This finding may reflect nothingmore than the high frequency with which homeo-pathic patients had already sought conventionaltreatment and already received diagnostic tests. Thispossibility was not investigated in Jacob’s survey, andfurther study is necessary to determine the realmeaning of this finding.

Why Homeopathy?

Why Do Patients Turn to CAM? Astin21 confirmed many of Eisenberg’s demographicfindings and also found that CAM users reportedpoorer health and viewed health holistically, encom-passing body, mind, and spirit. They sought care-givers sharing this attitude. People who viewedthemselves as culturally creative (i.e., culturallyunorthodox), a term coined by sociologist PaulRay,22,23 and those who had an experience that trans-formed their view of the world were even more likelyto use CAM. A significant percentage of CAM usersbecome so because they find the philosophy of CAMtherapies more congruent with their own values andworld-view.

Although these attitudinal differences were sig-nificant, safe and effective results were still thepatients’ primary concern. While Astin found thatmany CAM users valued the health-promoting effectsof such therapies, they rated the superior effective-ness of CAM therapies as more important reasons fortheir choosing them. The desire to avoid the adverseeffects of conventional medicine and the belief thatCAM therapies offer an ideal balance of effectivenessand health promotion was an attractive feature forpeople seeking CAM services.

A London survey24 of CAM patients reached sim-ilar conclusions. These patients sought CAM treat-ment primarily because conventional medicine hadbeen ineffective or produced adverse effects. In addi-tion, communication issues and philosophic consid-erations came into play. Many patients chose CAMbecause of perceived communication difficulties withtheir conventional physicians. CAM users in thisLondon survey, like those in Astin’s survey, attachedgreat importance to psychological factors in disease

and sought out practitioners who shared this per-spective.

Rather than set us adrift, Astin’s survey andothers throw a lifeline to those of us who have investedyears of our lives in conventional medical training.That is, patients seldom choose CAM therapies insteadof conventional medicine, but rather choose CAM inaddition to conventional medicine. Complementary medi-cine, or even the recently vogue term integrative medicine,more accurately describes patient use patterns thandoes the term alternative medicine. It appears thatpatients recognize roles for a variety of healingapproaches, and want to use each of them as seemsmost appropriate to their health concerns.

Why Do Patients Turn to Homeopathy? As with the general population of CAM users, mosthomeopathic patients use homeopathy in addition toconventional medicine. Goldstein20 found thatnearly 80% of homeopathic patients tried conven-tional medicine before turning to homeopathy, andmore than 91% tried some other treatment beforehomeopathy. These figures echo those of Vincent andFurnham’s London study,24 which found that 80% ofhomeopathic patients had previously accepted con-ventional treatment for their disease and 96.5% hadalready seen a physician for the problem.

Goldstein’s subjects sought homeopathic treat-ment primarily to cure a problem that conventionalmedicine had not. However, nearly one quarter ofpatients sought homeopathic treatment for generalwellness, and others wanted relief that would allowthem to avoid toxic medications.25 This desire toavoid toxic medication echoes Astin’s findings21

regarding the motivations of patients seeking CAMtherapies.

Vincent’s study24 gives us additional informationon the motivations of homeopathic patients. Thoseseeking homeopathic treatment were, generally speak-ing, much like those seeking the two other forms ofCAM studied (acupuncture and osteopathy). Oneexception was that homeopathic patients were morelikely to believe that complementary treatment wasmore natural than conventional medicine. Anotherstriking difference was that homeopathic patientsexpressed more desperation and a willingness to tryanything to get better, which is probably connected tothe finding that conventional medicine had beenuniquely ineffective for the homeopathic patients.The remaining difference was that homeopathic

C H A P T E R 4 Homeopathy Today 37

Page 47: Classical Homeopathy

patients were drawn by the belief that complementarymedicine allowed them to take a more active role intheir health care. Given the preponderance of homeo-pathic self-care evident in the United States, this find-ing is not at all surprising.

Although homeopathic patients tend to have dif-ferent values from those of conventional patients,they do not reject conventional medicine. They areattracted to homeopathy’s philosophy and patientempowerment, and their enthusiasm for conven-tional medicine has been cooled by their personalexperience of its ineffectiveness or by adverse effectsthat came with its success.

For What Problems Do PatientsSeek Homeopathic Treatment?

To analyze patient use of homeopathy, we must con-sider two categories: professional care and self-treatment. On the professional side, our data comefrom Goldstein’s 1994-1995 Los Angeles area survey20

and Jacob and associate’s 1992 national survey.10

Goldstein’s subjects sought homeopathic treat-ment for chronic complaints, with more than 75% hav-ing the primary complaint for more than 6 months.Although the problems (patient-defined) were under-standably diverse, the most common were chronicpain, anxiety, back problems, chronic fatigue syn-drome, addictions, headaches, and arthritis. Astin, too,found that use of homeopathy was common amongpatients with arthritis and rheumatism, rankingbehind only exercise and chiropractic treatment.21

Jacob’s data on the diagnoses of homeopathicpatients are the most extensive we possess. Table 4-1provides frequency data for diagnosis categoriesdefined by the medical professionals surveyed in the1990 National Ambulatory Medical Care Survey con-ducted by the National Center for Health Statisticsand the U.S. Bureau of the Census26 and in Jacob’ssurvey.

Swayne reported similar data in a 1987 survey ofhomeopathic medical doctors in the UnitedKingdom.27 Although the paper contains less specificdiagnostic data in its comparison of homeopathicphysicians with conventional physicians, similar pat-terns are evident. Most notable is that homeopathsdiagnose twice as many of their patients with mentaldisorders than do conventional physicians.

The data gathered from these studies are congru-ent with information gleaned from discussionsamong homeopathic physicians. It appears thatpatients seek professional homeopathic treatmentprimarily for chronic health problems, possibly influ-enced by the limited number of homeopathic profes-sionals or perhaps because many patients elect toself-treat acute conditions. In addition, many of theprofessional homeopaths practicing without a med-ical license refuse patients with acute conditions andtreat only patients with chronic diseases.

Information about self-treatment is understand-ably difficult to come by. Perhaps the best data are salesinformation from manufacturers of homeopathicpharmaceutics. As of late 1999, 94% of U.S. health foodstores, 72% of chain pharmacies, and 30% of independ-ent pharmacies carried homeopathic medicines.27a

38 C L A S S I C A L H O M E O P A T H Y

T A B L E 4 - 1

Ten Most Common Principal Diagnoses of Patients Seeking Care from Physicians Using Homeopathic Medicine Compared with Physicians Using Conventional Medicine10,26

Homeopathic Medicine (n = 1177) Cases (%) Conventional Medicine (n = 11,614) Cases (%)

Asthma 4.9% Hypertension 6.4% Depression 3.5% Upper respiratory infection 3.9% Otitis media 3.5% Otitis media 3.1% Allergic rhinitis 3.4% Diabetes mellitus 2.9% Headache/migraine 3.2% Acute pharyngitis 2.6% Neurotic disorders 2.9% Chronic sinusitis 2.6% Allergy (nonspecific) 2.8% Bronchitis 2.6% Dermatitis, eczema 2.6% Sprains/strains 1.7% Arthritis 2.5% Back disorders 1.4% Hypertension 2.4% Allergic rhinitis 1.4%

Page 48: Classical Homeopathy

Traditionally, homeopathic remedies used by pro-fessionals consisted of a single homeopathicallyprocessed chemical or biological component. Manyproducts now used by laypeople, however, are combi-nations of several individual homeopathic remediesdeemed helpful for a specified condition. They arelabeled appealingly by indication, thus simplifyingthe selection process for the consumer. The productCalms Forte is currently the fifth-largest-selling OTCsleep aid in the United States. Hyland’s TeethingTablets are currently the third-largest-selling OTCproduct for mouth pain (primarily teething) in theUnited States.28 In 1998, the number of Americanswho chose the homeopathic f lu preparationOscillococcinum to treat their illness equaled the totalof all prescriptions for conventional influenza med-ications.27a

These snippets suggest a few conclusions.Combination homeopathic products are highly popu-lar. They appear to outstrip sales of classically pre-pared individual homeopathic remedies. Theirpopularity extends to a variety of conditions, some ofwhich are pediatric in nature. Specific productsappear to have established a therapeutic identity,which might have little to do with their homeopathiccomposition. We don’t know how many Americanswho purchase homeopathic remedies know anythingabout homeopathic principles or even realize thattheir purchase is a homeopathic product. For exam-ple, a recent British study found that less than 5% ofpeople in a random sample mentioned the idea ofusing like to treat like when defining homeopathy,although 30% reported they had received homeo-pathic treatment.29

People tend to use homeopathic self-treatmentfor minor acute complaints. Food and DrugAdministration (FDA) regulation of OTC productlabeling, including homeopathic remedies, generallydiscourages self-treatment of chronic conditions.Homeopathic tradition and principles also discour-age self-care for chronic or serious conditionsbecause of the complexity of collecting the detailedinformation needed for these conditions. The self-assessment required is at best extremely difficult. Onthe other hand, homeopathic tradition strongly sup-ports self-treatment for minor acute conditions andFDA regulations do not discourage this tradition.

It seems fair to conclude there are two distinctivepatterns in the clinical application of homeopathy.Most widespread is patient use of homeopathy to

treat minor acute conditions independent of profes-sional advice. It appears that this application ofhomeopathy is not founded on any significantamount of homeopathic expertise among the users.The other pattern, entirely different in character, ispatients seeking out highly trained homeopathic pro-fessionals for treatment of long-standing health com-plaints that are unrelieved by other therapies. Thesepatient-professional interactions involve lengthy,detailed consideration of the patient’s complaints.

Although these generalizations appear to accu-rately describe the American homeopathic landscape,worldwide the picture is inevitably more complex. InFrance, homeopathy might be more popular thananywhere else, with more than 36% of the populationusing homeopathy in 1992. Quite unlike Americanusage patterns, 80% of homeopathic medicine usedin France is dispensed by prescription.30-32

The Medical Profession andHomeopathy

Ever since its founding by Hahnemann, homeopathyhas usually been in conflict with orthodox medicine.Considering the fevered intensity of many past bat-tles, the present relationship is positively affectionateby comparison. Today, conflict more often takes theform of collegial debate, as exemplified by the gentle-manly correspondence published in the BritishMedical Journal, than the pitched battle of the nine-teenth century.33 Conventional medicine by nomeans accepts the legitimacy of homeopathic princi-ples, but the homeopathic community has gainedrespect for its attempts to produce rigorous experi-mental investigations of the method.

The oppositional attitude historically so commonbetween conventional and homeopathic physiciansappears to derive largely from the conventional beliefthat homeopathy is “obviously” ineffective. This con-clusion, which logically proceeds from rejection ofthe homeopathic principle of dilution, is seeminglyobvious, because how could anyone believe that noth-ing (a postavogadran dilution) can exert any physio-logic effect whatever? The erosive inf luence ofpositive findings (in homeopathic clinical trials) onthis theoretic objection to homeopathic principlesshould not be underestimated. In view of the seemingimpossibility of physiologic effects, positive findingsare surprising and make the “obvious” conclusion

C H A P T E R 4 Homeopathy Today 39

Page 49: Classical Homeopathy

less so. The positive trials published in major medicaljournals have attracted a great deal of attention, andeach study opens the door between conventional andhomeopathic medicine just a little bit wider.Although these trials have not convinced large num-bers of physicians that homeopathy is efficacious,they have made it increasingly difficult for conven-tional physicians to simply reject homeopathy out ofhand.

In addition (and somewhat ironically, given thenature of the previous criticism), some believe home-opathy is dangerous because many homeopathic med-icines are made from toxic substances. The process ofmanufacturing homeopathic medicines is largely oneof diluting the source material. Because the dosagesmost commonly used meet or exceed Avogadro’snumber, toxicity should not be an issue. However, ifundiluted doses of raw source material were used,toxicity could become a concern. Fortunately, home-opathic regulatory agencies, in concert with the FDA,have been working for many years to eliminate thispossibility.

Another factor that sometimes contributes toconventional medical hostility toward homeopathy isthe tendency to confuse homeopathy with otherforms of complementary medicine. For example,occasionally publications in the medical literaturerefer to toxic effects from homeopathic medicines.Further investigation reveals that the suspect treat-ment was in fact an herbal preparation or someother treatment that was misidentified as homeo-pathic.34,35 Hopefully, as editors and reviewers formedical journals learn more about homeopathy,these errors will disappear and we will get more reli-able information about adverse reactions to homeo-pathic remedies.

A survey of Dutch rheumatologists, theirpatients, and complementary medicine, includinghomeopathy, found that rheumatologists whoreported a dislike of alternative medicine scoredlower in all measures of patient satisfaction than didrheumatologists with a positive attitude toward alter-native medicine.36 This was despite patients’ inabilityto recognize their rheumatologist’s favorable or un-favorable bias. Rather than simply putting black hatson those “bad guy” rheumatologists, perhaps thisinstead reflects a tendency for CAM-inclined physi-cians to be more people-oriented. This hypothesismakes sense given the relationship-intensive qualityof many forms of CAM, particularly homeopathy.

Physicians with better interpersonal skills are simplybetter liked by patients. Physician antagonism towardCAM could therefore be fueled, to an uncertaindegree, by competitive jealousy.

Although a minority of physicians currentlybelieve that homeopathy is a useful or legitimatemedical practice, this minority represents a signifi-cant percentage of physicians. Regard for homeopa-thy varies significantly by locale. In the Netherlands,for example, 45% of physicians who do not them-selves use homeopathy believe it is effective in thetreatment of upper respiratory infections and hay-fever, and 30% believe homeopathy is effective forchronic joint problems.37

In 1997, Astin and associates reviewed the surveys,published anywhere in the world from 1982-1995, ofphysicians’ use of and attitudes toward CAM.38 At25%, homeopathy was in the middle of the range ofeffectiveness ratings assigned to CAM therapies(range 1% to 53%). Although many of these surveysreflected the greater enthusiasm for CAM and home-opathy typical of non-American physicians, it is inter-esting to contrast the much lower acceptance of theworld’s most common CAM practice, herbal medi-cine, at 13%. Most studies reviewed showed the samerelative hierarchy of popularity among CAM meth-ods, with chiropractic rated more highly thanacupuncture, which is rated more highly than home-opathy.

Also in 1997, Berman and associates39 surveyedU.S. primary care physicians regarding their CAMtraining, attitudes, and practice patterns. They foundthat 18.4% of physicians surveyed believed that home-opathy was a legitimate medical practice, signifi-cantly less than the 27% who believed homeopathywas efficacious in Berman and associate’s earlierregional survey40 of physicians in the Chesapeake BayArea. When Sikand and Laken41 surveyed Michiganpediatricians about their CAM use and attitudes, 21%felt that homeopathy might be effective, 12.1%believed that homeopathy is safe, and a slightly largergroup (13.5%) stated that they believe homeopathymight be harmful. This modest belief in homeopa-thy’s effectiveness is congruent with the modest usefigures discussed later. If more physicians believedhomeopathy effective, more physicians would use it.

Attitudes toward homeopathy are changinginside medicine and among the general populace. Insome ways they go hand in hand. This warminginfluence in relations arises from the nature of

40 C L A S S I C A L H O M E O P A T H Y

Page 50: Classical Homeopathy

evidence in medicine. Although medicine prides itselfas a scientific discipline, physician beliefs appearmore readily influenced by anecdotal evidence andpersonal experience than by research. For example, asurvey42 of the attitudes of 145 British general prac-titioners in the mid-1980s found that their viewsabout CAM were most inf luenced by observedpatient benefit (41%) and personal or family experi-ence (38%).

The immense variability of clinical medicine makesconclusive research evidence of the “right way” to man-age every single patient nearly impossible. Perhaps thisreal-world uncertainty generates physician mistrust ofresults from the idealized world of clinical trials.Whatever the reasons for physicians favoring experi-ence over research, the repercussions are clear. Withmore patients turning to complementary medicine,including homeopathy, more physicians inevitably hearof a patient’s or family member’s experience withhomeopathy. If these stories are predominantly posi-tive—telling how homeopathy helped with a medicalproblem—the weight of these favorable impressionscreates a favorable disposition toward homeopathy.Astin and colleagues’ meta-analysis38 supported thistheory, finding a direct correlation between physicians’interest in and favorable attitude toward a therapy andthe popularity of the therapy.

All studies we are aware of show that youngerphysicians are most favorably inclined toward CAMgenerally and homeopathy specifically. This suggeststhat even the passage of time alone is likely toimprove acceptance of homeopathic medicine withinthe medical community.

Although there are dissenters, the net result ofthese shifting attitudes is that some parts of alterna-tive medicine gradually become conventional.43

Unorthodox practices become the new orthodoxy, asoccurred with relaxation therapies and biofeedback.Various forms of dietary supplementation have gonethrough this process in recent years, including B vita-min supplementation to prevent neural tube defectsand cardiovascular disease and raising recommendedvitamin C consumption levels above those neededmerely to prevent disease. Perhaps the best CAMexample is the newly orthodox application ofacupuncture for the treatment of acute and chronicpain.44

Can we expect homeopathy to become orthodox?Even asking this question seems startling, consideringthe prevailing attitudes of the recent past. Given the

pace of recent changes, anything, perhaps even home-opathy becoming conventional in certain circum-stances, seems imaginable.

Referral. Once a physician accepts the validity of atreatment such as homeopathy, it is a matter of timebefore he or she begins to refer patients for the treat-ment. For the practicing physician, referral is themiddle ground; it falls short of committing the timeand energy needed to learn to apply the therapy, butit is nonetheless an acknowledgment that the therapyhas a legitimate role to play in health care. Also inher-ent in the referral is recognition of the limitations ofthe health care the physician is able to provide to thepatient. Or, as one local endocrinologist humorouslysaid to me when he referred a patient, “I wonderedwhether the voodoo you do would work any betterthan the voodoo I do.”

Data from throughout the world show that con-ventional physicians are often comfortable referringpatients for alternative medical treatments. In a 1987survey45 of 360 Dutch physicians, 90% referredpatients for complementary therapies of one type oranother. Referral rates vary by country and specifictherapy.

Conventional physicians refer patients for homeo-pathic treatment at wildly variable rates, dependingon their geographic location and the patient’s diag-nosis. Astin’s 1997 review of the literature38 foundthat medical referral rates for homeopathy rangedfrom 3% to 42%, with the higher rates occurring inEurope. The mean rate for homeopathy was 15%,compared with 43% for acupuncture, 40% for chiro-practic, and 4% for herbal medicine.

Wharton and Lewith’s 1985 survey42 of Britishgeneral practitioners found that 42% had referred tohomeopathically trained physicians in the previousyear. A study of Dutch physicians46 shows referralrates up to 42% for certain diseases, particularlyarthritic conditions.

In American studies,47,48 referral rates for home-opathy consistently fall below 10%. For example,Berman’s Chesapeake Bay Area survey40 found that5% of physicians reported some use of homeopathy,and only 6% referred patients for homeopathic treat-ment. A sample of Michigan pediatricians found thatalthough 50.3% would refer for some form of CAM,only 4% would refer patients for homeopathic treat-ment.41

Use. In these days of growing acceptance of com-plementary medicine, many conventionally trained

C H A P T E R 4 Homeopathy Today 41

Page 51: Classical Homeopathy

physicians offer some sort of complementary ther-apies to their patients. The old “us against them” atti-tude fades as dividing lines erode. Medical insurersand many large medical groups are beginning to seeknowledge of complementary medicine as a desirablequality in new physicians.

Despite the growing appreciation of complemen-tary medicine in conventional medical practice, a rela-tively small group of conventionally trained Americanphysicians provides homeopathic care to their patients.The American Institute of Homeopathy (AIH), thehomeopathic counterpart to the American MedicalAssociation (AMA), has fewer than 500 members. Thisnumber is misleading because AIH membership ismuch rarer than is the use of homeopathy amongAmerican physicians. Sikand and Laken’s Michigansurvey of pediatricians41 found that although 37% usedsome form of CAM in their personal lives, only 5.5%reported that they or their family used homeopathy,and only 1.1% used homeopathy professionally.Although 10.3% used some form of CAM with patients,only 1.1% used homeopathy in a professional capacity.Berman’s survey40 of Chesapeake Bay physicians foundthat 5% had used homeopathy. His later national sur-vey39 asked physicians if they “had used” or “woulduse” complementary therapies. Regarding homeop-athy, 5.9% reported they had used homeopathy andanother 27.9% reported they would use homeopathy (atotal of 33.8%). Total figures by specialty were 26.3% forpediatrics, 29.4% for internal medicine, and 41.2% forfamily and general practice.

Astin’s international review38 of studies pub-lished between 1982 and 1995 found 9% of conven-tional physicians using homeopathy with patients.The range was enormous. Although many countrieshad use rates in the single digits, at the other extreme45% of German physicians reported using homeopa-thy, along with 40% of Dutch and 37% of British gen-eral practitioners. Given the high level of use inFrance and the required homeopathic training inFrench medical education, the paucity of data fromthat country is disappointing.

Although growing rapidly, the use of complemen-tary medicine generally remains a minority practiceamong conventionally trained physicians in America.Homeopathy is an even rarer tool, seldom found inthe medical bag of American physicians. The rarity ofAmerican medical homeopathy does not accuratelyreflect the presence of homeopathy in the world’smedical community.

Education. Most studies show that physiciansbelieve they know little about homeopathy. ACanadian study by Verhoef and Sutherland49 foundthat 7% of general practitioners claimed they knew alot about homeopathy compared with 24% foracupuncture. In Wharton and Lewith’s English sur-vey,42 79% of physicians rated their knowledgeof homeopathy as “poor” or “very poor.” Under-standably then, physician desire for education abouthomeopathy is disproportionately high. In fact, withphysicians’ self-perceived lack of knowledge abouthomeopathy, it is surprising that physicians are aswilling as they are to refer patients to homeopaths.

Institutions of medical education set the tone foreach new generation of physicians by means of theirinstructional content and the attitudes expressed byinstructors. Although medical education supportsestablished ways of thinking about and practicingmedicine, it can also provide the impetus for change.Throughout their careers, physicians experiencesome evolution in the way they practice medicine, butthese changes tend to be incremental. Because mostforms of CAM, and certainly homeopathy, are sub-stantially different from conventional medicine,expanding the clinical practice of medicine to includethem is not an incremental change.

The opinions of academic medicine are the defin-ing truths of the larger medical community. Highlycritical thinking is the foundation of academic medi-cine. In a climate of skepticism, unfamiliar theoriesare often subject to derision until they have beenintently scrutinized. Academic medicine, which isnotorious for criticizing even the most commonplaceclinical practices for their lack of scientific rigor, isexceptionally dubious of CAM practices. The pene-tration of CAM into these truth-defining academicinstitutions is thus a highly significant trend.

Berman’s 1997 survey39 of U.S. primary physi-cians clearly demonstrated that familiarity with CAMtranslates directly into acceptance: “Our finding [is]that knowledge of a therapy best predicts its accep-tance and usage. . . . suggesting once again that famil-iarity with, not necessarily scientific acceptance of, atherapy plays a major role in its acceptance.” Animportant component of this process of acquiringfamiliarity is the student’s conventional training. Inthe same way that (according to P.T. Barnum, at least)there is no such thing as bad publicity, there is no evi-dence that increased awareness of any form of CAMdiscourages physician acceptance. Teaching medical,

42 C L A S S I C A L H O M E O P A T H Y

Page 52: Classical Homeopathy

osteopathic, and other health sciences studentsabout CAM increases familiarity and therefore leadsto further acceptance.

A recent Canadian survey of health science stu-dents’ attitudes toward CAM disclosed several inter-esting findings.50 Echoing Berman’s findings, thissurvey found that, compared with other health sci-ences students, medical students knew least aboutCAM and were least favorably inclined toward CAMtherapies, including homeopathy. Only 18% believedthat they knew “a lot” about homeopathy (comparedwith 39.3% for massage, 37.7% for chiropractic, 32.8%for herbal medicine, and 18% for acupuncture).Despite their relative conservatism compared withother health sciences students, more than 57% ofmedical students believed CAM therapies were a use-ful supplement to regular medicine, and 88.5%believed that physicians should have some knowledgeabout the most common CAM therapies. Nearly half(42%) of medical students wanted training to learnhow to practice some CAM therapy with patients.

In the spring of 1995, the Alternative MedicineInterest Group of the Society of Teachers of FamilyMedicine surveyed51 all U.S. medical school depart-ments of family medicine and all family practice resi-dency programs to assess instruction in alternativemedicine. This survey was the first nationwide surveyof CAM instruction within conventional medicalinstitutions. The survey found that CAM was widelytaught in U.S. medical schools (34.0%) and familypractice residency programs (28.1%). Some interest-ing information about the characteristics of theinstruction also came to light from the survey.Instruction in CAM therapies was primarily elective(72.2%) and varied markedly in both content and for-mat. In addition, marked geographic variation wasfound, with CAM instruction most prevalent in theNortheast (65.4% of medical schools) and RockyMountain states (50.0% of medical schools), but rarein the South Central area (7.1% of medical schools).Of those medical schools teaching some CAM, only aminority (18%) included instruction in homeopathy.

Furthermore, some of the data gave evidence ofthe growing trend toward CAM instruction in con-ventional medical education. While 34.0% of medicalschools were offering instruction, another 5.2% werestarting up courses and an additional 7.2% were con-sidering offering CAM instruction. Roughly onethird of those institutions starting or considering

additional CAM education were planning expansioninto homeopathy.

More recent data confirm the growing presenceof CAM as part of conventional medical educa-tion.52-54 The most recent data from the Associationof American Medical Colleges showed that 82.8%offered some CAM instruction to medical students.Most medical schools included CAM instruction aspart of required coursework.

Our 1995 survey51 found that only eightAmerican medical schools offered instruction abouthomeopathy. The incidence of homeopathic instruc-tion has grown even more rapidly than the impressivefigures for CAM generally. A 1997-1998 AMA sur-vey55 found that 71 medical schools (56.8%) taughtmedical students about homeopathy. Sixteen ofthose (12.8% of all U.S. medical schools) includedinstruction about homeopathy within requiredcoursework.

European medical education about homeopathydefies generalization. Germany and France requiretraining about homeopathy as a part of every medicalstudent’s education. On the other hand, a survey56 ofall British medical schools published in 1997 foundthat only 12.5% were offering some form of CAMinstruction, and only two schools (8.3%) made thatinstruction part of the core curriculum by requiringinstruction in homeopathy. Homeopathy is taught,albeit to an unknown degree, in medical schools inAustria, Hungary, Spain, India, and Mexico.57 We areunaware of any other published or formally presenteddata regarding homeopathic instruction in conven-tional medical institutions in other parts of theworld.

We know little about the content of homeo-pathic education in conventional medical schools.As with many forms of CAM, homeopathy requires asignificant amount of training to understand its dis-tinctly different principles and their clinical applica-tion. It is quite unlikely that any significant numberof conventional institutions of medical educationoffer enough instruction to really train homeopathicclinicians. The Society of Teachers of FamilyMedicine’s Group on Alternative Medicine producedcurriculum guidelines for medical schools and fam-ily practice residency programs in an effort to ensureproper instruction in the essential concepts of themost common forms of CAM (including homeop-athy).58

C H A P T E R 4 Homeopathy Today 43

Page 53: Classical Homeopathy

SUMMARY

Although many of the deepest roots of homeopathyare American, it had nearly withered away here untilthe social reassessments of the 1970s gave homeop-athy new life. Since then, homeopathy has been grow-ing at an ever-increasing pace. It is now one of themany health choices routinely available to con-sumers, although much more commonly as a self-treatment option than as professional care.Homeopathy appears to be one of the most wide-spread forms of CAM used in the pediatric popula-tion. Homeopathic patients are well educated,concerned about overuse of medication, seeking helpfor chronic health problems unresponsive to conven-tional treatment, and impressively compliant toinstructions from the physician homeopath. Over thepast several years, homeopathy has established a pres-ence in American medical schools.

References 1. Eisenberg D, Kessler RC, Foster C et al: Unconventional

medicine in the United States, N Engl J Med 328:246-252, 1993.

2. Herbal and homeopathic remedies: finally starting toreach middle America? OTC News and Market Report223-238, July 1991.

3. The Landmark report on public perceptions of alternative healthcare, Sacramento, Calif., 1998, Landmark Healthcare.

4. Eisenberg D, Davis RB, Ettner SL et al: Trends in alter-native medicine use in the United States, 1990-1997:results of a follow-up national survey, JAMA 280:1569-1575, 1998.

5. Roper Starch Worldwide: The growing self-care movement,Washington, DC, 1999, Food Marketing Institute.

6. de Lange de Klerk ES, Blommers J, Kuik DJ et al: Effectof homeopathic medicines on daily burden of symp-toms in children with recurrent upper respiratory tractinfections, BMJ 309:1329-1332, 1994.

7. Jacobs J, Jimenez LM, Gloyd SS et al: Treatment ofacute childhood diarrhea with homeopathic medicine:a randomized clinical trial in Nicaragua, Pediatrics93:719-725, 1994.

8. Kainz JT, Kozel G, Haidvogl M et al: Homeopathic ver-sus placebo therapy of children with warts on thehands: a randomized, double-blind clinical trial,Dermatology 193:318-320, 1996.

9. Friese KH, Kruse S, Ludtke R et al: The homeopathictreatment of otitis media in children: comparisons withconventional therapy, Int J Clin Pharmacol Ther 35:296-301, 1997.

10. Jacobs J, Chapman EH, Crothers D: Patient characteris-tics and practice patterns of physicians using homeop-athy, Arch Fam Med 7:537-540, 1998.

11. Spigelblatt L, Laine-Ammara G, Pless B et al: The use ofalternative medicine by children, Pediatrics 94:811-814,1994.

12. Paterson C: Complementary practitioners as part ofthe primary health care team: consulting patterns,patient characteristics and patient outcomes, Fam Pract14:347-354, 1997.

13. Witt C, Ludtke R, Weber K, Willich SN: Who is seekinghomeopathic care: the spectrum of diagnoses, Alter-native Therapies 7:S37, 2001.

14. Menniti-Ippolito F, Gargiulo L, Bologna E et al:Prevalence of use of alternative medicine in Italy: a sur-vey of 60,000 families, Alternative Therapies 7:S24, 2001.

15. Lee AC, Kemper KJ: Homeopathy and naturopathy:practice characteristics and pediatric care, Arch PediatrAdolesc Med 154:75-80, 2000.

16. Perlman AI, Eisenberg DM, Panush RS: Talkingwith patients about alternative and complementarymedicine. Rheum Dis Clin North Am 25(4):815-822, 1999.

17. Anderson W, O’Connor B, MacGregor RR et al: Patientuse and assessment of conventional and alternative ther-apies for HIV infection and AIDS. AIDS 7:561-566, 1993.

18. Elder NC, Gillcrist A, Minz R: Use of alternative healthcare by family practice patients. Arch Fam Med 6(2):181-184, 1997.

19. Hering C: The homeopathic domestic physician, ed 14, NewDehli, 1984, Jain.

20. Goldstein M, Glik D: Use of and satisfaction withhomeopathy in a patient population, Altern Ther HealthMed 4:60-65, 1998.

21. Astin J: Why patients use alternative medicine: resultsof a national survey, JAMA 279:1548-1553, 1998.

22. Ray PH, Anderson SR: The cultural creatives: how 50 mil-lion people are changing the world, New York, 2001, ThreeRivers Press.

23. Ray PH: The emerging culture, American DemographicsFebruary 1997. Available at www.demographics.com;accessed April 10, 1998.

24. Vincent C, Furnham A: Why do patients turn to com-plementary medicine?: an empirical study, Br J ClinPsychol 35:37-48, 1996.

25. Goldstein M: Unpublished additional data presented atthe Third Homeopathic Research Network Sym-posium, San Francisco, 1996.

26. Schappert SM: National ambulatory medical care survey:1990 summary, Advance data from Vital and HealthStatistics, No. 213. Hyattsville, Md, 1992, NationalCenter for Health Statistics.

27. Swayne J: Survey of the use of homeopathic medicinein the UK health system, J R Coll Gen Pract 39:503-506,1989.

44 C L A S S I C A L H O M E O P A T H Y

Page 54: Classical Homeopathy

27a. Personal communication with Thierry Boiron,President, Boiron Laboratories, France, November 1999.

28. Personal Communication with Jay Bornemann,Executive Vice president, Standard HomeopathicCompany, Los Angeles, April 2000.

29. Furnham A: Ignorance about homeopathy, J AlternComplement Med 5:475-478, 1999.

30. L’Homeopathie en 1993, Lyons, France, 1993, SyndicatNational de la Pharmacie Homeopathique.

31. Fisher P, Ward A: Complementary medicine in Europe,BMJ 309:107-110, 1994.

32. EEC market for homeopathic remedies, London, 1992,McAlpine, Thorpe and London.

33. Buckman R, Lewith G: What does homeopathy do—and how? BMJ 309:103-106, 1994.

34. Benmeir P, Neuman A, Weinberg A et al: Giantmelanoma of the inner thigh: a homeopathic life-threat-ening negligence, Ann Plast Surg 27:583-585, 1991.

35. Boisset M, Fitzcharles M: Alternative medicine use byrheumatology patients in a universal health care set-ting, J Rheumatol 21:148-152, 1994.

36. Visser G, Peters L, Rasker J: Rheumatologists and theirpatients who seek alternative medicine: an agreementto disagree, Br J Rheumatol 31:485-490, 1992.

37. Knipschild P, Kleijnen J, ter Riet G: Belief in the efficacyof alternative medicine among general practitioners inThe Netherlands, Soc Sci Med 31(5):625-626, 1990.

38. Astin J, Marie A, Pelletier K et al: A review of the incor-poration of complementary and alternative medicineby mainstream physicians, Arch Intern Med 158:2303-2310, 1998.

39. Berman BM, Singh BB, Hartnoll SM et al: Primary carephysicians and complementary-alternative medicine:training, attitudes, and practice patterns, J Am BoardFam Pract 11(4):272-281, 1998.

40. Berman BM, Singh BK, Lao L et al: Physicians’ attitudestoward complementary or alternative medicine: aregional survey, J Am Board Fam Pract 8:361-366, 1995.

41. Sikand A, Laken M: Pediatricians’ experience with andattitudes toward complementary/alternative medicine,Arch Pediatr Adolesc Med 152:1059-1064, 1998.

42. Wharton R, Lewith G: Complementary medicine andthe general practitioner, BMJ 292:1498-1500, 1986.

43. Ernst E, Resch KL, White AR: Complementary medi-cine: what physicians think of it: a meta-analysis, ArchIntern Med 155:1405-1408, 1995.

44. Acupuncture, NIH Consensus Statement 15(5):1-34, 1997. 45. Visser GJ, Peters L: Alternative medicine and general

practitioners in the Netherlands: towards acceptanceand integration, Fam Pract 7:227-232, 1990.

46. Anderson E, Anderson P: General practitionersand alternative medicine, J R Coll Gen Pract 37:52-55,1987.

47. Borkan J, Neher JO, Anson O et al: Referrals for alter-native therapies, J Fam Pract 39:545-550, 1994.

48. Goldstein MS, Sutherland C, Jaffe DT et al: Holisticphysicians and family practitioners: similarities, differ-ences and implications for health policy, Soc Sci Med26:853-861, 1988.

49. Verhoef MJ, Sutherland LR: General practitioners’assessment of and interest in alternative medicine inCanada, Soc Sci Med 41:511-515, 1995.

50. Baugniet J, Boon H, Ostbye T: Complementary/alterna-tive medicine: comparing the view of medical studentswith students in other health care professions. Fam Med32(3):178-184, 2000.

51. Carlston M, Stuart MR, Jonas W: Alternative medicineinstruction in medical schools and family practice resi-dency programs, Fam Med 29:559-562, 1997.

52. 1997-1998 curriculum directory, Washington, DC, 1998,Association of American Medical Colleges.

53. Wetzel MS, Eisenberg DM, Kaptchuk TJ: Coursesinvolving complementary and alternative medicine atUS medical schools, JAMA 280(9):784-787, 1998.

54. 1998-1999 curriculum directory, Washington, DC, 1999,Association of American Medical Colleges.

55. Barzansky B, Jonas HS, Etzel SI: Educational programsin US medical schools, 1997-1998. JAMA 280(9):803-808, 827-835, 1998.

56. Rampes H, Sharples F, Maraghs S et al: Introducingcomplementary medicine into the medical curriculum,J R Soc Med 90(1):19-22, 1997.

57. Homeopathy in Europe: developing standards for profes-sional practice of homeopathy in the EuropeanUnion, Brussels, 1994, European Committee forHomeopathy.

58. Kligler B, Gordon A, Stuart M et al: Suggested curricu-lum guidelines on complementary and alternativemedicine: recommendations of the Society of Teachersof Family Medicine Group on Alternative Medicine,Fam Med 32(1):30-33, 2000.

Suggested Readings Cohen M: Complementary and alternative medicine: Legal

boundaries and regulatory perspectives. Baltimore, 1998,Johns Hopkins University Press.

Winston J: The faces of homeopathy: an illustrated historyof the first 200 years, Tawa, New Zealand, 1999, GreatAuk Publishing.

C H A P T E R 4 Homeopathy Today 45

Page 55: Classical Homeopathy

The popularization of what might be calledmodern homeopathy owes much to interna-tional inf luences. Scotland, Germany,

France, and the United States have played major his-torical roles in its development. Not surprisingly,on the continent where it was popularized byHahnemann himself, homeopathy is well organizedin Europe. Much of this chapter relates to homeo-pathic practice in Western European countries. Evenwithin this relatively small geographic area, substan-tial differences occur.

WHY PATIENTS CHOOSEHOMEOPATHY

Homeopathy is one of a large number of nonortho-dox disciplines collectively termed complementary or

alternative medicine. The term complementary is pre-ferred in many countries (including the UnitedKingdom) because it implies that the therapy canbe used to complement other procedures, rather thanto replace them, as inferred by the word alternative.However, there is evidence that consumers do buyhomeopathic remedies over-the-counter instead oforthodox medicines, and the terms are often usedinterchangeably.1 It may be that the preferredNorth American term, complementary and alternativemedicine (CAM), could provide a suitable compro-mise.

The popularity of homeopathy varies in differentparts of the world. The most important factors influ-encing its popularity are public and professionalexpectations of its effectiveness. Typically, peoplehave more than one reason for switching from ortho-dox therapies, reasons that vary with their

5Global Perspectives

S T E V E N K A Y N E

47

Page 56: Classical Homeopathy

background, culture, and the availability of homeop-athy where they live. The balance of this section isdevoted to discussion of these varied reasons.

Perceptions of Drug Risks

Many people consider homeopathy and other comple-mentary therapies attractive because they are perceivedto have acceptable risk/benefit ratios. Although per-ceptions are notoriously fickle and are often basedon misconceptions, they are important to considerbecause they influence supply and demand. Per-ceptions of drug risks have been studied by vonWartburg2 and found likely to influence patients’treatment choices.

The attitudes and perceptions of a representativesample of Swedish adults with respect to a number ofcommon risks have been determined by Slovic andassociates.3 Respondents characterized themselvesas persons who disliked taking risks and who resis-ted taking medicines unless forced to do so. Unfor-tunately, homeopathic remedies were not included inthe study, but the results for herbal medicines show avery low perceived risk, only slightly higher than withvitamin tablets, and a perceived benefit approxi-mately equal to vitamin pills, contraceptives, andaspirin. On the “likelihood of harm” and “serious-ness of harm” scales, herbal medicines were againclose to vitamin pills.

Vincent and Furnham4 examined the perceivedeffectiveness of acupuncture, herbalism, homeopa-thy, hypnosis, and osteopathy in the UnitedKingdom. They showed that conventional medicinewas clearly seen by the majority of respondentsas being more effective in the treatment of most com-plaints. Complementary medicine was seen as beingmost useful in specific conditions, including depres-sion, stress, and stopping smoking (for which hypno-sis was perceived as superior to conventionalmedicine), and in the treatment of common coldsand skin problems. Among people with a strongbelief in complementary medicine, homeopathy andherbalism were seen as valuable in chronic and psy-chologic conditions, as well. Overall, herbalismappeared slightly more popular than homeopathyand acupuncture, but homeopathy was favored in thetreatment of allergies.

Greater Attention to Symptoms

The great advantage of offering treatment with aholistic discipline such as homeopathy is that atten-tion is paid to the totality of symptoms, not just thephysical signs of disease in isolation. This may causedifficulties in countries with socialized medicine. Inthe United Kingdom, for example, general practition-ers conduct their consultations on a 7- to 10-minuteappointment scale; many patients believe this isinsufficient time to deal with their problem ade-quately. It has been suggested that homeopathyappeals to patients who like the feeling that attentionis being paid to more aspects of themselves than justthe symptoms.5

Disenchantment with AllopathicConsultation

People who choose homeopathy may do so be-cause of disenchantment or bad experiences withtraditional medical practitioners, rather than outof a belief that traditional medicine is ineffectiveper se.6

Dissatisfaction with Eff icacy ofAllopathic Medication

In countries where homeopathy is not considered arealistic adjunct to orthodox treatment, patients mayturn to homeopathy out of dissatisfaction with theefficacy of allopathic medicine, according to Avinaand Schneiderman.7 Worries about long-term use ofcertain medicines (e.g., steroids) also cause somepatients to switch.

The “Green” Association

The media often portray homeopathy as “natural,”and this approach appeals to the fads and fash-ions of the “green” lobby in many countries,particularly where the green movement is strong(e.g., Germany). In New Zealand, the fresh greenimage of the country is used to market “natural”remedies.

48 C L A S S I C A L H O M E O P A T H Y

Page 57: Classical Homeopathy

Financial Considerations

In the United Kingdom, most homeopathic remediesretail at about half the cost of an average OTC medicine,making them an attractive buy (in other countries, thecost of remedies is rather more expensive). Also, home-opathic medicines are fully reimbursable under the U.K.National Health Service. The net ingredient cost is, onaverage, substantially below the cost of orthodox medi-cines for a similar course of treatment, although thisfigure does not take into account the longer consulta-tion times and does vary widely. Swain carried out astudy on the prescribing costs of 21 doctors.8 Theresults suggested that physicians practicing homeo-pathic medicine in the United Kingdom issue fewer pre-scriptions, and at a lower cost, than their colleagues.Unfortunately, there were several serious limitations tothe study, not the least being that the sample was toosmall to allow generalizations to be made. Further, noaccount was taken of the extended consultation timesinvolved. However, the survey gained considerableattention in the press. The results were also met withsome interest by the health authorities and prompteddiscussions on widening the availability of homeopathyin the health service. Similar cost advantages have beenidentified among German dental surgeons.9

Even when prescribed, homeopathic remediesoffer an advantage to patients. In nearly all cases, thecost of the remedy will be less than the U.K. prescrip-tion tax (in effect a flat fee contribution toward thecost of the medicine), but pharmacists will generallyinvite patients who are subject to the tax to buy theOTC remedies at the lower price.

Inf luence of Opinion Leaders

Demand for homeopathic remedies in the UnitedKingdom has been encouraged by the interest of theRoyal Family in the discipline, especially the Prince ofWales. This effect has spread to New Zealand and othercountries with historic ties to the United Kingdom.

Media Encouragement

More than ever before, patients are being encouragedto question the suitability of existing treatments. In

her book entitled Controversies in Health Care Policies,the celebrated English rabbi Julia Neuberger statesthat patients should ask their family doctor a seriesof questions, including the following10:

● What is the likely outcome if I do not have thetreatment you are offering?

● What alternative treatments are available? ● What are the most common side effects? ● Would you use this treatment? Newspapers also encourage patients to ask ques-

tions about their treatment and thus make doctorsaccountable.

Cultural Reasons

A final reason for the increased demand for homeo-pathic products is increased mobility across nationalborders of people whose cultural backgroundsdemand the use of holistic medicine. People from theIndian subcontinent, China, and Russia take their cus-toms with them when they emigrate to other coun-tries. Either from an inherent mistrust of Westernmedicine or a misunderstanding of what it canachieve, they look to continue using traditional meth-ods that have proved successful over centuries. Therecent influx of Russian immigrants to Israel hascaused problems for the authorities in standardizingthe remedies being used by their new citizens.

All of these factors have contributed to a signifi-cant and steady increase in the number of requestsfor homeopathic medicines over the past 15 years. Inthe United Kingdom at least, this increase has beenmatched closely by a similar trend with homeopathicveterinary practice for the treatment of domestic andfarm animals.

INTERNATIONAL DEMANDFOR HOMEOPATHY

If the popularity of homeopathy is compared withthree other complementary therapies across severalEuropean countries, we find some interesting idio-syncrasies with respect to individual preferences(Table 5-1). In Belgium and France, homeopathy iswidely used and is the most popular of the therapiesfor which data were collected. In Spain and the

C H A P T E R 5 Global Perspectives 49

Page 58: Classical Homeopathy

United Kingdom, the manipulative therapies appearto be more popular.

Interest in homeopathy does not always translateinto use. A survey carried out in Scotland by the Timesof London in 1989 showed that about 40% of thepopulation in that country considered homeopathyat some time when they were unwell.11 The figure forthe whole of the United Kingdom is likely about 35%.Only about a quarter of the people surveyed, however,actually converted their initial interest into actionand used homeopathy. An interesting topic for fur-ther study is why so many respondents rejected thetherapy. Considerable anecdotal evidence exists thatthe increased exposure enjoyed by complementarymedicine over the past 10 years has helped greatlyreduce the traditional worries about effectiveness.

Following heightened interest in the risk/benefitratios of medicines in the 1960s and 1970s, UnitedKingdom homeopathy enjoyed a spectacular revival.The market value grew steadily from $25 million in1994 to $30 million 2 years later. These figures palein significance compared with those of some otherEuropean countries. Figure 5-1 shows the estimatedvalue of markets in other European countries in 1997.France, for example, with a population close to thatof the United Kingdom, had a market value of about15 times the size.12

The 1998 market estimate for the UnitedKingdom is approximately $36 million.13 This repre-sents a 30% increase over a 4-year period. It compareswith market growth of 43% for herbal medicines (to$78 million) and an impressive 100% increase for aro-matherapy products (to $32 million) over the same

period. Although the homeopathic market is increas-ing, albeit comparatively slowly, the trends in Figure5-2 show that homeopathy’s popularity is fallingbehind that of herbalism and aromatherapy.Experience suggests that this is a result of homeopa-thy’s failure to capture new converts to complemen-tary medicine in an overall growing market, ratherthan as a result of losing loyal followers.

According to Jacky Abecassis12 of the Frenchhomeopathic manufacturer LHF-Boiron, the U.K.market is split nearly evenly between OTC productsand prescribed medications. About half of the OTCmarket (25% of the overall market) is satisfied by phar-macies, the rest by health food stores and other outlets.In the Netherlands, 70% of people taking homeopathicremedies are thought to be self-treating without expertsupervision. In France and Germany, the OTC marketaccounts for a much smaller share—only 20% to 30%and 27% of the total market value, respectively. In theUnited States, the low rate of prescribed homeopathicmedicines has significant implications for the way inwhich the products are promoted.14

The value of the U.K. market for OTC homeo-pathic remedies is small, accounting for less than 1%of the total pharmaceutic market. Despite its limitedvalue, the market is still considered significant for thefollowing reasons:

1. The growing acceptance of complementary treat-ments by health professionals and the public

2. The increasing number of people now usingsuch treatments regularly

3. The effect of complementary treatments onhealth status

50 C L A S S I C A L H O M E O P A T H Y

Data from Fisher P, Ward A: Complementary medicine in Europe: report from complementary research—an international perspective, Cost and RCCMConference, London and Luxembourg, 1994, EU Science, Research, and Development Directorate. —, Information not available.

T A B L E 5 - 1

Comparative Use of Complementary Medicine (Percentage of Population Using Complementary Therapies)

Country Acupuncture Herbal Medicine Homeopathy Osteopathy/Chiropractic

Belgium 19 31 56 19 Denmark 12 — 28 23 France 21 12 32 7 Germany — — — — Netherlands 16 — 31 — Spain 12 — 15 48 UK 16 24 16 36

Page 59: Classical Homeopathy

4. The detrimental effect on clinical trials of par-ticipants being unwilling to admit using suchtreatments for fear of admonishment15

5. The high rate of use by older people, females,and health practitioners

In the Netherlands, the average per capita expen-diture on homeopathy in 1991 was the equivalent ofapproximately $8.13 This compares with an estimated35 to 40 cents in the United Kingdom! The figuresare not entirely compatible for a number of reasons,including the fact that citizens of continentalEuropean countries tend to buy many more OTCproducts across all health sectors than people in theUnited Kingdom. For example, the French andGermans together account for more than half thetotal European OTC market value of about $12 bil-

C H A P T E R 5 Global Perspectives 51

0

50

100

150

200

Neths Germany France Italy Belgium Spain UK Sweden

Country

Mar

ket v

alue

(m

illio

ns $

)

Figure 5-1 Comparative estimated values of homeopathic market in Europe in 1997.

01994 1996 1998 2000

50

100

Year

Mar

ket v

alue

(m

illio

n $)

HomeopathyHerbalismAromatherapy

Figure 5-2 Estimated U.K. market trends in complemen-tary medicine 1994-98.

Page 60: Classical Homeopathy

lion. Even if appropriate adjustments were made,there would still be a large disparity. Homeopathysuffers in most English-speaking countries becauseof its unexplained mode of action; non–English-speaking countries do not seem to share this concern.There are many examples of orthodox or allopathicmedicines whose action is not fully understood; someare not as safe as homeopathic remedies, and theymay be potentially dangerous if misused, yet they arefreely available in supermarkets, corner shops,and even garages in some countries. Acetaminophen(paracetamol) is one such drug. There have been callsfor its restriction in several countries, and recent U.K.regulations reducing the pack sizes that can be soldOTC have gone some way to satisfy these demands.

Buyer Characteristics

In many countries, homeopathic remedies are readilyavailable in pharmacies and health shops, providingconsumers with an attractive option. Kayne and asso-ciates investigated the characteristics of buyers in theBritish homeopathic OTC market.1 In a question-naire-based study of 407 purchasers in 107 pharma-cies, it was found that very few people under age 25bought OTC homeopathic medicines, and only 12%of buyers aged 25 to 35 years were male. Most respon-dents bought the remedy for themselves ratherthan for other members of their family, emphasizingthe specific nature of homeopathic medicines. Themost popular group of products were polychrests(remedies with a wide spectrum of activity, makingthem well suited to the OTC environment) and com-plex remedies (mixtures of remedies, usually withspecific uses). There were a small number of brandedmedicines. The most commonly purchased poly-chrests were Arnica (6.3% of purchases), Pulsatilla(3.0%), and Rhus tox (2.3%). The predominance ofpolychrest homeopathic medicines is understand-able, because buyers can readily equate remedies withailments and buy the medicine most likely to be effec-tive for their particular condition, using explanatoryleaflets or brochures provided by manufacturers.Retailers also benefit by not having to offer what canbe lengthy and complex advice to buyers, given thatcurrent legislation precludes giving uses on the label.

Kayne’s study showed that the ailments for whichOTC homeopathic medicines were bought werevery wide-ranging. Many were acute, self-limiting

ailments, such as coughs, colds, and minor injuries;others included digestive complaints, skin conditions,and anxiety. In most of these categories, with the excep-tion of anxiety, orthodox OTC products were also avail-able. Most respondents (60%) reported that they tookthe homeopathic medicine as sole medication for theirproblem; others (27%) used more than one homeo-pathic medicine at a time; and some (13%) used home-opathic and allopathic medicines simultaneously.

The excessive length of time for which somerespondents took their remedies is a concern. Mosthomeopathic OTC remedies are designed for short-term administration. Long-term chronic conditionsare best treated under the guidance of a practitioner,whose skill should ensure the choice of appropriatetherapy, as well as minimize the possibility of adverseeffects from taking the correct homeopathic remedyfor too long a time. Although taking homeopathicmedicines for long periods should not cause any irre-versible harm, because the medicines are not in them-selves toxic, patients may suffer by not receivingappropriate treatment for their condition.

A similar study by Kayne and Usher in NewZealand produced comparable results.16 The studydocumented a high degree of awareness of homeopa-thy, with 92% of a sample of 503 pharmacy clientsclaiming to have heard of homeopathy and 67% say-ing they had used the therapy.

HOMEOPATHICPRACTITIONERS

In many English-speaking countries, most healthprofessionals have responded reactively to a demandfor homeopathy from clients, rather than encourag-ing its use proactively. With improved access tohomeopathic information and training, however, thisposition is changing.

In the United Kingdom and Ireland, homeopathymay be practiced not only by statutorily registeredqualified health professionals, but also, under com-mon law, by non–medically qualified professionalhomeopaths (NMQPs), who have training in home-opathy but not in conventional medicine, and by layhomeopaths, who have no formal training. NMQPs,and to an increasing extent lay homeopaths, are rec-ognized by the National Health Service in the UnitedKingdom. Common law permits patients freedom ofchoice to choose the health care provisions they

52 C L A S S I C A L H O M E O P A T H Y

Page 61: Classical Homeopathy

believe appropriate, and allows people to practicehomeopathy if they wish. The main drawback of sucha liberal system is that it allows a person to practiceas a homeopath with little or no training. Medicalhomeopathy (together with veterinary homeopathyand other professions allied to medicine) and theNMQPs have separate educational facilities and gov-erning bodies. Despite their substantial training inwell-established colleges of homeopathy (and morerecently at universities), NMQPs were formerlyregarded as second-class practitioners by medicalhomeopaths, an opinion that continued into the1980s. However, amicable discussions are now pro-ceeding in the United Kingdom, Australia, and NewZealand, and the two groups are slowly establishing amore solid working relationship.

The incidence of published material on homeop-athy in mainstream medical journals is increasing.For example, the British Medical Journal has publisheda series of articles on complementary medicine,including homeopathy.17

Professional medical homeopathy in the UnitedKingdom is controlled by the Faculty of Home-opathy, founded in 1950 by Act of Parliament.National Health Service Homeopathic hospitals arelocated in Bristol, Glasgow, London, and TunbridgeWells. Among the health care professions, pharmacyappears to give its undergraduates the best exposureto homeopathy, with 14 of the 16 U.K. schools offer-ing some teaching on the subject. As a result, OTCprescribing is increasing.

The British Association of Homeopathic Vet-erinary Surgeons has approximately 350 active mem-bers and has recently secured specialty recognitionfrom the profession’s governing body. Of all the pro-fessions allied to medicine, veterinarians have beenthe most reticent to embrace complementary practiceat the highest levels.

Germany has two classes of practitioners—doc-tors (95% of whom practice some form of comple-mentary medicine) and heilpraktikurs. The lattergroup, literally translated as “health practitioners,”developed in the years before World War II, when doc-tors did not have a monopoly on the delivery ofhealth care. At present, the ratio of practicing heil-praktikers to physicians is about 1:4. Heilpraktikersare not obliged to undertake formal medical training,but are obliged to take a test administered by thelocal health authority. If a candidate fails, he or shemay retake the test until successful. Heilpraktikers’

activities are comparable to those of British NMQPs,except that they tend to use several different thera-pies concurrently and place more emphasis on diag-nostic procedures.18

In Belgium, France, and Italy, the law states thatonly medical doctors may practice medicine or per-form a medical act. Homeopathy is fully integratedinto the medical system and is widely prescribed.Non–medically qualified practitioners are obliged tokeep their activities low-key, otherwise they are likelyto be taken to court by medical doctors.

In Denmark and the Netherlands, medical andnonmedical homeopaths can practice. In Greece,Portugal, and Spain, although nonmedical homeo-paths are theoretically excluded, they are seldomprosecuted.

APPROACHES TO PRACTICE

In Europe and in other countries where Europeaninfluence is strong, homeopathic remedies are pre-scribed in three ways: one remedy at a time, morethan one remedy at a time, or in mixtures of two ormore remedies at different potencies.

One remedy at a time, in a single or repeated dose,is prescribed by practitioners claiming to be classical,or unicist, homeopaths, and is generally favored byhomeopaths in the United Kingdom. However,Hahnemann changed his ideas several times, espe-cially toward the end of his life, and so the term clas-sical could be applied to several prescription methods.The influence of the great American homeopaths hasalso been significant in shaping current practice.There is no “standard” or “pure” form of homeopa-thy, because the so-called classical homeopathy isreally a rather complex mixture of ideas drawn froma variety of sources, some of which were unconnectedwith homeopathy.19

When more than one remedy at a time is pre-scribed, they may be given in alternation or concur-rently. This practice is called pluralist prescribing andclaims to treat more than one aspect of a patient’scondition. It is common in France, Germany, Italy,and where remedies from these countries are avail-able.

Mixtures of remedies at different potencies,selected for their combined effect on particular dis-ease states, can be combined in one container. Thismethod, known as complex prescribing, is very popular

C H A P T E R 5 Global Perspectives 53

Page 62: Classical Homeopathy

in France and Germany, where it is not uncommon tohave 15 to 20 remedies ranging from very low to highpotencies in the same preparation. Classical homeo-paths claim that this is not true homeopathy, becausethe patient’s symptoms and the drug picture (a com-prehensive review of the symptoms that a specificmedicine produces when given to healthy individu-als) are not individually matched. Further, no prov-ings exist of the mixtures. Interestingly, this complexapproach to prescribing is being adopted in modernorthodox medicine as an element of care plans for thetreatment of various diseases, including diabetes.

HOMEOPATHIC REMEDIES

Three main issues should be considered regardinghomeopathic remedies, all of which are concernedwith obtaining equivalence among international sup-pliers: nomenclature, methods of manufacture, andlicensing requirements to ensure safety and quality.

Nomenclature

When discussing homeopathic remedies with ho-meopaths from other parts of the world, a seriousproblem often arises: Are we all talking about thesame remedy? The current nomenclature of homeo-pathic remedies, and the abbreviation system bywhich remedies are identified, has evolved over 200years and is full of irregularities and mistakes.Plagued by a multitude of synonyms, differentspellings of homeopathic remedy names, and differ-ences in the botanic parts used for the remedy prepa-ration, international confusion is difficult to avoid.Within a particular country, it is unlikely that anyconflict will arise. However, the situation is ratherdifferent internationally. Patients are well advised totake any prescribed medication with them when theytravel.

Difficulties with nomenclature are not confinedto remedy names. A group of Latin American andEuropean authors has pointed out that interna-tional confusion exists as to the exact meaning ofmany words used routinely in homeopathy, and sug-gests that many inaccurate or imprecise termsshould be replaced.20 The idea of seeking a consen-sus view is not new. In 1990, Bernard Poitevin wrote,“Studies and discussions concerning homeopathic

medical concepts are an integral part of homeo-pathic research and are the cornerstone of its evolu-tion.”21

The following examples, which illustrate sourcesof potential confusion, have been highlighted in areport prepared by Dellmour and associates underthe auspices of the European Committee forHomeopathy (ECH).22 Most botanic names used inhomeopathy are similar to the botanic nomenclatureused for the source material. However, some remedieshave synonyms that do not correspond with eitherthe pharmacopoeias or the current botanic names.For example, Belladonna (Atropa belladonna), Cactusgrandif lorus (Cercus grandif lorus), and Chamomilla(Matricaria chamomilla) are commonly used homeo-pathic names that are incorrect. Further, the botanicnomenclature used in homeopathy does not indicatethe part of the plant that has been used. In somecountries the whole plant is used, in other countriesit can be the root, the seeds, the leaves, the flower, orthe fruit. It would help greatly if the parts were clearlydefined and specified in the remedy name.

Most zoologic names used in homeopathy aresimilar to zoologic nomenclature, such as Apis melli-fica (honey bee), Latrodectus mactans (black widow spi-der), and Vespa cabro (wasp). Some, however, are not.For example, Cantharis would be more correctlycalled Lytta vesicatoria, and Coccus cacti, Dactylopius coc-cus. Snake venoms present another problem. Often, athird Latin name denotes the different subgenus(e.g., there are four variants of the copperhead snake,each with its own name). Variants of Cenchris areprobably used from country to country. Similarproblems exist for Naja, Vipera, and Crotalus. In addi-tion, some products of plants and animals, likeAmbra grisea, Calcium carbonicum (Hahnemanni),Opium, Secale cornutum, and Resina laricis, do not rep-resent the whole organism, but are natural productsor artificially obtained substances having their ownparticular identity.

Remedies from chemical sources may presentproblems as well. Compounds with F, Br, IO, or Sions are usually called f luoratums, bromatums, iodatums,or sulphuratums, respectively. Calcium fluoride iscalled Calcarea fluorica in some countries, and Calciumfluoricum in others, which is not consistent (Calciumfluoratum would be more logical).

Many of the nosode names used in homeopathy areinsufficiently specific (e.g., Psorinum, Carcinosinum,Tuberculinum, Medorrhinum). Nosodes from various

54 C L A S S I C A L H O M E O P A T H Y

Page 63: Classical Homeopathy

locales often use different starting materials and arederived through manufacturing methods.

Homeopathy needs a consistent internationalnomenclature system to ensure the accurate identifi-cation of remedies and the logical incorporation ofnew remedies in the future. The ECH has proposedthe development of a more logical system of abbrevi-ations that will ensure international standardization.It seems sensible for the homeopathic community toadopt the International Code of Botanical Nomen-clature, which stipulates that single-word names nolonger be applied. Thus, for example, one would usethe following:

● Aconitum napellus instead of Aconitum to dis-tinguish the remedy from A. cammarum, A.ferox, and A. lycoctonum

● Euphorbium resiniferum instead of Euphorbiumto distinguish the remedy from otherEuphorbium species

● Pulsatilla pratensis to avoid confusion with theother Pulsatilla species

To leave no doubt as to the source of the remedy,the exact plant part should also be specified. Rheumpalmatum (radix) or Cinchona pubescens (cortex) areexamples. I favor the addition of a suffix to indicatewhich pharmacopoeia is being used; this changewould also help identify the source material beingused.

Zoologic material can be identified by using theInternational Code of Zoological Nomenclature.Latin is the accepted language in this reference. TheCommittee’s proposals suggest that the name of zoo-logic species and the source of the material should beused in the same manner as for botanic species; thusLac felinum should be Felix domestica (lac).

The international chemical nomenclature is givenmainly in English, but also in Latin. However, theECH suggests that Latin nomenclature is preferredfor its conformity with the botanic and zoologicnomenclature and acceptance by French, Spanish,and Russian homeopaths.

The generally accepted Latin names of elementsare no different from homeopathy’s current use (e.g.,Aurum, Plumbum), but sometimes there are slight dif-ferences from some old and obsolete English names(e.g., Barium, Calcium, Kalium, Natrium instead ofBaryta, Calcarea, Kali, Natrum). In addition, a fewchanges are new for homeopathy (e.g., Stibium andHydrargyrum for Antimonium and Mercurius, respec-tively). Some special homeopathic preparations, such

as Causticum and Mercurius solubilis, should, after stan-dardizing, take names that refer to the method ofpreparation (e.g., Mercurius Hahnemanni [to distin-guish from the pure Hydrargyrums] and CausticumHahnemanni).

Nosodes constitute a nonhomogenous class ofhomeopathic remedies. Most nosodes, except in vitrocultures and vaccines, are derived from a diseasedhost, which means that the composition and qualityof the matter used to prepare the nosode depend notonly on the infectious agent, but also on the featuresof the individual host. Such features vary widelyacross international borders. So many variables influ-ence the symptom picture of nosodes that it would beimpossible to arrive at an appropriately comprehen-sive description in the name of the remedy. For exam-ple, Tuberculinurn might be called Mycobacteriumtuberculosis pulmonis macerati (sputi resp.) hominis mortis!There is still work to be carried out in this area toreach some degree of international consensus.

The Manufacture of HomeopathicRemedies

Associated with the nomenclature issue is the prob-lem of differences in method of preparation amongmanufacturers, depending on which pharmacopoeiais being used. Preparation methods differ betweenGerman and French pharmacopoeias, introducing aninternational variable. For example, the German textstates that to make a mother tincture, the sourcematerial must be macerated for at least 10 days at atemperature not exceeding 30°C, whereas the Frenchpublication specifies a period of 3 weeks. Other phar-macopoeias, notably the Indian, are used elsewhere inthe world.

In the absence of a European pharmacopoeia(which has been under preparation for many years),British manufacturers have relied on a selection of for-eign reference works for most of their information, par-ticularly with regard to the analysis of startingmaterials. They used principally the GermanHomeopathic Pharmacopoeia (HAB) with its varioussupplements, together with the French and U.S. phar-macopoeias. The first edition of the British Ho-meopathic Pharmacopoeia (BHomP) was published bythe British Homeopathic Society in 1870, with latereditions in 1876 and 1882 by E Gould and Son ofLondon. It then went out of print for more than a

C H A P T E R 5 Global Perspectives 55

Page 64: Classical Homeopathy

century. Spurred on by the requirements of theEuropean Parliament’s Directive number 92/73/EEC, anew edition of the BHomP was published by the BritishHomeopathic Manufacturers’ Association in 1993, andan updated edition was issued in 1999. In loose-leaf for-mat, the book reflects many of the current practicesdeveloped by British manufacturers in adaptingGerman methods.

Little research has been carried out to quantify thevariance in active ingredients that may occur,although nuclear magnetic resonance (NMR) tech-niques can test source materials.23 The manner inwhich the first potency is made also varies accordingto the pharmacopoeia. This has implications forhigher potencies. In the French Pharmacopoeia, the1C potency is made by adding one part of mother tinc-ture by weight to 99 parts of 60% to 70% alcohol,whereas in the HAB it is made by adding 2 parts byweight to 98 parts of 43% alcohol. The U.S.Homeopathic Pharmacopoeia directs that a 1:10 dilu-tion of a 10% mother tincture be prepared in 88% alco-hol. Such differences mean that remedies may welldiffer from country to country even though the poten-cies appear to be equivalent.

Regulatory Affairs—the Licensingof Remedies

Manufactured homeopathic remedies are subject tocareful scrutiny to ensure that they are of the highestquality and safety. In the United Kingdom, they havebeen treated as medicines since the inception of theNational Health Service in 1948, and are available onmedical prescription just as orthodox medicines are.As a result, they are subject to rules governing theirmanufacture and supply.

During the late 1950s and early 1960s, a numberof babies were born with deformed limbs as a directresult of their mothers taking the drug thalidomideduring pregnancy. Unfortunately, it was not the prac-tice in those days to test new drugs for adverse reac-tions during pregnancy before putting them on themarket. Following these tragic consequences,the Medicines Act of 1968 was implemented in theUnited Kingdom to protect the public. Thereafter,manufacturers wanting to bring a new medicine tothe market were obliged to demonstrate safety, qual-ity, and, in the case of orthodox medicines, efficacy,before their product could be licensed for any given

application. In addition, premises used for manufac-turing medicines became subject to regular inspectionand approval. About 4000 homeopathic medicineswere already on the market before the Medicines Actbecame law, and were granted Product Licences ofRight (PLRs) and allowed to remain on sale.

On September 22, 1992, the European Parliamentadopted Directive number 92/73/EEC, designed toestablish regulations for homeopathic medicinalproducts throughout what was then called theEuropean Economic Community, now known as theEuropean Union (EU). The Directive is divided intofour chapters and eleven articles covering scope, man-ufacture, control and inspection, placing on the mar-ket, and final provisions. It passed into U.K. law onJanuary 1, 1994, and defines homeopathic medicineas any medicinal product prepared from products,substances, or compositions called homeopathicstocks in accordance with procedures described inany recognized pharmacopoeia.

The labeling requirements for homeopathicmedicinal products and the provisions for control-ling the import, export, and manufacture of homeo-pathic medicinal products are specified in theEuropean Directive. In addition, Member States areobliged to share with each other the information nec-essary to guarantee the quality and safety of homeo-pathic medicinal products within the EU.

The Directive acknowledges the difficulty inapplying established scientific methods of demon-strating efficacy to homeopathy by adopting a speciallicensing scheme for homeopathic medicines basedon safety and quality only. The main provisions are asfollows:

1. The remedies must be intended for oral orexternal use only (i.e., not injections).

2. The remedies must be sufficiently dilute toguarantee safety. A minimum dilution of 4X(a homeopathic dilution made by seriallydiluting a mother tincture 1:10 four times) isspecified for most remedies. Mother tincturesare covered by other means.

3. No claims for therapeutic efficacy can bemade. The remedy must be sold without spe-cific indications (e.g., “for back-ache” or“colds and flu”). Despite this requirement,when seeking a license, manufacturers areobliged to submit evidence from authoritativerepertories and textbooks that the remedy hasbeen recommended for a particular use in the

56 C L A S S I C A L H O M E O P A T H Y

Page 65: Classical Homeopathy

past. The customer is obliged to choose thecorrect product, by whatever method he orshe can. Advice from health professionals, themedia, and leaflets in the retail outlet arethe main sources of information.

4. The phrases “Homeopathic medicinal prod-uct without approved therapeutic indica-tions” and “Consult your doctor if symptomspersist” must be on the label.

5. Brand names and names that indicate possi-ble uses (sometimes called fantasy names) areofficially banned, but there appear to be areaswhere the Licensing Authorities will allowsome latitude in the regulations with respectto the naming of homeopathic products con-taining a number of different remedies.Following representations from some manu-facturers regarding safety, some complexremedies containing several ingredients arebeing licensed with names of the type“Remedy X Co” to obviate the necessity ofremembering a long list of ingredients whenrequesting an OTC remedy or writing a pre-scription. There is a potential source of confu-sion here, because some products that were onthe market before the new legislation wasadopted are still allowed to use brand namesand even make limited claims of effectiveness.The Licensing Authorities have not announceda date by which the products licensed underthe old regulations have to be relicensed underthe new EU regulations. Until they do, bothtypes of medicine will be sold, although manymanufacturers are beginning to register theirproducts voluntarily. There is provision forone other national route of registration underthe Directive. Individual Member States canintroduce a set of national rules. Nationalrules allowing limited claims of effectivenessto be made (based on bibliographic evidence)are being developed in several countries.

A multidisciplinary expert committee, the AdvisoryBoard on the Registration of Homeopathic Products,was established in the United Kingdom in 1993 toadvise the Medicines Control Agency, the governmentbody responsible for assessing the safety and quality ofhomeopathic remedies before they are licensed. Thecommittee comprises a number of practicing doctors,pharmacists, veterinarians, and academicians. Similarbodies exist in other European countries.

Directive 92/73/EEC has been implementedacross European Member States to varying degrees.For example, it has been implemented into Dutchlaw as Besluit Homeopathische farmaceutische producten.This law establishes two procedures for acquiringmarketing authorization for homeopathic productsin the Netherlands. First, when the homeopathicmedicinal product is intended for oral or externaluse, no therapeutic indication appears on the label-ing. Second, if there is a sufficient degree of dilu-tion to guarantee the safety of the medicinalproduct (diluted to at least 1:10,000), the registra-tion will be applied for according to Article 4 of theregulations. Homeopathic medicinal products thatdo not comply with the above-mentioned Article 4criteria have to be authorized according to theassessment criteria of Article 6, corresponding tothe implementation of Article 9.2 of CouncilDirective 92/73/EEC.

In the Netherlands, homeopathic medicinal prod-ucts are authorized by the Medicines EvaluationBoard on the basis of quality and safety, much thesame as the U.K. Medicines Control Agency.Authorized homeopathic medicinal products arerecorded in a register that may be inspected on theInternet. For every product to be evaluated, a com-pany must submit a dossier comprising a number ofspecified documents.

It is generally accepted that the United Kingdominterprets Directive 92/73/EEC strictly and this hastraditionally presented a barrier to foreign companieswishing to bring their products to this country. Inparticular, the inclusion of certain nosodes and otherbiologic material, the purity of which is thought dif-ficult to prove, has not been viewed favorably by theAdvisory Board on the Registration of HomeopathicProducts. A few foreign remedies have been licensed,however, and this trend will likely continue in thefuture.

None of the regulations discussed heretofore pre-clude experienced homeopathic practitioners andpharmacists from continuing to recommend andsupply remedies compounded for individual needs.When a professional is involved, the guarantee ofquality and safety is the integrity and skill of theoperator—as it always has been.

In France, remedies for sale and use are restrictedto potencies below 30C. Homeopaths have topurchase higher potencies from abroad, usuallySwitzerland, Germany, or the United Kingdom.

C H A P T E R 5 Global Perspectives 57

Page 66: Classical Homeopathy

In October 1998, the French authorities sus-pended the license of a number of nosodes, includingMedorrhinum, Morbilinum, and Psorinum, and 170remedies of animal origin for safety purposes. Theauthorities were dissatisfied with the dossiers onmicrobial safety submitted by the laboratories pro-ducing these remedies. In Germany, sterilization ofthe starting materials for nosodes has been obliga-tory since 1985, according to HAB monographs. Wedon’t yet know how sterilization may alter the effec-tiveness of the remedy. Recently, French manufactur-ers were asked to submit their dossiers on nosodes forapproval to the registration authorities. If thedossiers are not approved, the market authorizationfor nosodes will be withdrawn.

Some manufacturers are apparently consideringthe use of allopathic vaccines as starting material forcertain nosodes. This action would have substantialimplications for the material media and would neces-sitate new provings.

The German authorities have recently madechanges to the sterilization methods required for thelicensing of remedies of zoologic origin. There wassome concern that the high core temperatures stipu-lated (133 degrees for 20 minutes) might denaturethe remedies.

In countries outside Europe, the licensing regu-lations vary from absolutely nothing to require-ments for the adoption of good manufacturingprocedures.

HOMEOPATHY WORLDWIDE

Homeopathy is found in many countries worldwide,and outside Europe each has its own particular wayof dealing with the therapy. The following is notmeant to be comprehensive, but is offered as a briefsurvey and an indication of how widely homeopathyis practiced.

Africa

The new South Africa provides an environment inwhich homeopathy can make considerable progress.The ongoing war between medically qualified doctorsand dentists and NMQPs has been resolved and thetwo factions are working amicably, each under itsown code. Homeopaths are able to request medical

tests, receive referrals from other health profession-als, hospitalize patients when necessary, and visithospitals. A comprehensive training course is offeredby the Technikons of Natal in Durban and Wit-watersrand in Johannesburg. This course was set upin association with the statutory body with whomhomeopaths must register. Approximately 450 home-opaths are registered in South Africa.

Training for health professionals (physicians,dentists, and pharmacists) has been provided bythe British Faculty of Homeopathy with localassistance. Students have taken both the PrimaryCare Certificate and the more advanced Memberof the Faculty of Homeopathy (MFHom) examina-tions. However, veterinary homeopathy is in itsinfancy.

Homeopathy has been practiced in Nigeria for atleast 40 years. The first formal organization, the AllNigeria Homeopathic Medical Association, wasfounded in 1961, shortly after Nigeria gained inde-pendence from Britain. Dr. Peter Fisher visited thecountry in 1989 and found it difficult to identify thenumber of practicing homeopaths, partly because ofthe problem of defining exactly what constituted ahomeopath.24 There were about 50 to 100 homeo-paths with an acceptable level of training at thattime. Generally speaking, the standards of trainingwere below what would be expected in developedcountries. Dr. Fisher reported that there were a num-ber of homeopaths in and around the federal capital,Lagos, and in the eastern part of the country, partic-ularly in the states of Imo and Anambra. By 1991,some progress had been made, and the acceptance ofthe medical and dental professions had beensecured.25 Further advances have been hampered bypolitical pressures.

Asia

Homeopathy in India is widespread, with an esti-mated 150,000 practitioners. According to JulianWinston, in his fascinating chronicle of the history ofhomeopathy,26 110 institutes teach the subject as abasis for degrees and doctorates in homeopathic sci-ence. A substantial book publishing industry exists,and several manufacturers produce remedies of vary-ing quality.

The influx of Jewish refugees from countriesof the former Soviet Union to Israel has caused a

58 C L A S S I C A L H O M E O P A T H Y

Page 67: Classical Homeopathy

substantial increase in demand for homeopathy. Alarge number of the immigrant practitioners arepreparing their own remedies (as indeed Hahnemannand his followers did), but there are no official stan-dards. Contact with Europe (mainly through visitinglecturers from France, Germany, and the UnitedKingdom) has helped to establish trained practition-ers, and discussions are in progress to regulate home-opathic practice and manufacture.27 The IsraelAssociation of Classical Homeopathy is active in pro-moting homeopathic practice and maintains contactwith the Israeli authorities.

Homeopathy was introduced to Malaysia duringWorld War II by Indian soldiers who were fighting forthe British Army, and influence from the subcontinentis still strong. Teaching began in 1979 under the aus-pices of the Faculty of Homeopathy Malaysia. Therewere four homeopathic medical centers in the countryin 1988.28 Although the government allows comple-mentary medicine, there are no formal registrationprocedures for practitioners. An organization calledthe Registered Malaysian Homeopathic MedicalPractitioners Association was established in 1985 tounite qualified homeopathic practitioners. Withoutstandards, it is uncertain as to exactly what constitutesqualification. The group has about 500 members.

Singapore recognizes homeopathy, but there is nolegislative framework to control its practice. Few ifany practitioners are medically qualified.

Australia

Approximately 150 medical homeopaths practice inAustralia, of whom about 20 may be considered com-mitted to using the discipline. An outpatient clinicoperates in Sydney at the Balmain Hospital. The splitof medical and nonmedical homeopathy seen in theUnited Kingdom is present in Australia as well. Thestate societies for nonmedical homeopaths eventuallymerged to form a national organization known asThe Australian Homeopathic Association. The med-ical homeopaths’ organization, which contains anumber of British-trained practitioners, is known asthe Australian Faculty of Homeopathy. One activeAustralian homeopathic manufacturer is situated inthe Barossa, a renowned wine-producing area ofSouth Australia.

In New Zealand, nonmedical homeopaths out-number medical homeopaths. Physicians appear to

have an open mind, with various surveys showingthat upward of 80% of family doctors do not object totheir patients consulting professional homeopaths.Regulations for the licensing of homeopathic reme-dies are being developed, and most pharmacies stockhomeopathic medicines.

Caribbean

Cuba, a republic of 20 million people, has a well-organized homeopathic presence.29 Some Mexicandoctors helped reintroduce homeopathic practice toCuba in 1992, when it was incorporated into theNational Health Service. A year later, some Brazilianhomeopaths offered the first formal medical train-ing. Other health professions—pharmacy, dentistry,and veterinary surgery—followed shortly after. Thereare now a total of 922 homeopaths in Cuba, includ-ing 320 physicians, 220 veterinary surgeons,161 pharmacists, and 141 dentists. Instruction uses anational homeopathic curriculum and leads tothe award of a diploma after 1 year of study.Unfortunately, further development is being ham-pered by a shortage of literature and remedies, partic-ularly in hospitals.

All the municipalities around Havana and manyelsewhere in the island offer homeopathictreatment through family doctors and clinics.Many pharmacies, including a magnificent newhomeopathic pharmacy in Havana, dispense home-opathic prescriptions. They are state owned. The 48homeopathic dentists in the capital have performed667 extractions collectively with the aid of homeo-pathic anesthesia, achieved with the remedyHypericum 200C given by mouth. Gathering statis-tics about consultations is difficult because home-opathy is officially included with other therapies,under the heading Traditional Medicine, by thehealth authorities, but there is considerable sympa-thy for the discipline at high levels within the gov-ernment. I was privileged to meet with the Ministerof Health, who reiterated a commitment to provid-ing homeopathic facilities. Homeopathy is used bythe medical facilities at Havana InternationalAirport. Almost all the 200 patients who used thisthese facilities last year improved within 20 min-utes of receiving their medicines. Of the 49 differ-ent remedies used, the most popular were Barytacarbonica and Nux vomica.

C H A P T E R 5 Global Perspectives 59

Page 68: Classical Homeopathy

A considerable amount of homeopathic researchis being carried out, particularly with animals. Forexample, homeopathic veterinary surgeons havereported that homeopathy can be used as a growthpromoter for animals in the food chain, especiallycows, pigs, and chickens, and also to treat mastitis. Arecent congress in Cuba received delegates fromJamaica, but the general status of homeopathy inthat country is unknown.

Eastern Europe

Although officially allowed only in Russia in 1992,homeopathy had been widely available unofficially inthe republics of the former Soviet Union, where manypractitioners prepare their own remedies. In Russia,homeopathy is taught in medical schools and minimalstandards have been introduced to try and standardizeremedies, many of which are now being prepared bypharmacies. International congresses are held by theRussian Homeopathic Association on an irregular basis.

Occasional correspondents in Bulgaria, Hungary,Poland, and Romania have indicated that homeopa-thy is available in those countries. Although generallyrestricted to medical doctors, some pharmacists arealso involved. Small, active communities are workinghard to establish its popularity, and with increasedcontact with the West following the fall of commu-nism, progress is being made.

Latin America

Homeopathy is popular in Costa Rica, where morethan half the population uses the therapy regularly.Training is available for both medical doctors andpractitioners who are not medically qualified.

Homeopathy is also practiced in Argentina,Brazil, and Mexico. Of the three, Mexico is the bestorganized.30 Training to become a medical doctorand homeopath is available from two facilities inMexico City. Three other institutions offer postgrad-uate training. In 1996, the National School ofMedicine and Homeopathy (Escuela Nacional deMedicina y Homeopati′a) celebrated its hundredthanniversary.

Homeopathy in Mexico dates back to 1850, whenmigrating physicians from Spain taught local physi-cians.31 One of the first successes was attributed to a

Dr. Carbo, who, in 1854, treated 45 patients during ayellow fever epidemic on the island prison of SanJuan de Ulúa. His success was rewarded by PresidentAntonio López de Santana, who granted Dr. Carbo acertificate to practice medicine in Mexico. In 1867,the first homeopathic pharmacy was founded, fol-lowed by the first homeopathic hospital at SanMiguel de Allende Guanajuato 4 years later.

Many pharmacies now stock remedies, and severalothers manufacture remedies. Although only medicalpractitioners are supposed to practice homeopathy,many active practitioners are not medically qualified.One state in Mexico allows training for such practi-tioners.

In Brazil, homeopathy as a therapeutic optionbecame a politically tenable possibility only in the1980s, in spite of the presence of homeopathic medi-cine in the country since 1840.32 Overcoming resist-ance from academic and clinical sources can bedifficult. Only medical doctors, dental surgeons, andveterinarians are legally able to prescribe homeo-pathic remedies. However, supplies may be purchasedfrom pharmacies and “Drogeries,” whose exact statusis difficult to identify. Drogeries appear to sell mostof the items found in pharmacies, but without aqualified pharmacist on the premises. The small butactive group of homeopaths in Brazil uses a variety ofapproaches to prescribing.

Argentina also has a modest number of homeo-paths (approximately 1500), but little is known aboutthe methods being used to treat patients or the dis-tribution of the services they offer.

SUMMARY

The practice of homeopathy varies throughout theworld. The global distribution of homeopathic prac-tice is encouraging, especially because it appears to bespreading further. The problems associated with thelack of international standards make it rather con-fusing for the traveling practitioner and patient. It isimportant that the potential difficulties are acknowl-edged and appropriate steps taken to minimize thepossibility of untoward outcomes.

References 1. Kayne SB, Beattie N, Reeves A: Buyer characteristics,

Pharm J 263:210-212, 1999.

60 C L A S S I C A L H O M E O P A T H Y

Page 69: Classical Homeopathy

2. Von Wartburg WP: Drugs perception of risks, SwissPharma 6(11a):21-23, 1984.

3. Slovic P, Kraus NN, Lappe H et al: Risk perception ofprescription drugs: report on a survey in Sweden,Pharmaceut Med 4:43-65, 1989.

4. Vincent C, Furnham A: The perceived efficacy of com-plementary and orthodox medicine: preliminary find-ings and development of a questionnaire, ComplementTher Med 2:128-134, 1994.

5. English JM: Homeopathy, The Practitioner 230:1067-1071, 1986.

6. Furnham A, Smith C: Choosing alternative medicine: acomparison of the beliefs of patients visiting a generalpractitioner and a homoeopath, Soc Sci Med 26(7):685-689, 1988.

7. Avina RL, Schneiderman LJ: Why patients choosehomeopathy, West J Med 128:366-369, 1978.

8. Swain J: The cost and effectiveness of homeopathy, BrHomeopath J 81:148-150, 1992.

9. Feldhaus H-W: Cost-effectiveness of homeopathictreatment in a dental practice, Br Homeopath J 82:22-28,1993.

10. Neuberger J: Controversies in health care policies, London,1994, BMJ Books.

11. Anon: Take a little of what ails you, The Times (London),November 13, 1989.

12. Abecassis J: Homeopathic OTC medicines in Europe,Proceedings of International Conference, RoyalLondon Homeopathic Hospital, London, January23-24, 1997.

13. Mintel report on complementary medicine, London, 1999,Mintel International Group Limited.

14. Borneman JP: Executive Vice President, StandardHomeopathic Company, Los Angeles, personal com-munication, April 1997.

15. Vickers A: Use of complementary therapies, BMJ304:1105-1107, 1994.

16. Kayne SB, Usher W: Homeopathy: attitudes and aware-ness amongst pharmacy clients and staff in NewZealand, N Z Pharm 19:32-33, 1999.

17. Vickers A, Zollman C: ABC of complementary medi-cine: homoeopathy, BMJ 319:1115-1118, 1999.

18. Ernst E: Towards quality in complementary health care: isthe German ‘Heilpraktiker’ a model for complementarypractitioners? Intl J Qual Health Care 8:187-190, 1996.

19. Campbell A: The origins of classical homoeopathy?Complement Ther Med 7(2):76-82, 1999.

20. Guajardo G, Bellavite P, Wynn S et al: Homeopathicterminology: a consensus quest, Br Homeopath J 88:135-141, 1999.

21. Poitevin B: Introducion a la homeopatia, (nueva ed),Mexico City, Mexico, 1990, Medico HomeopaticaMexicana.

22. Dellmour F, Jansen, Nicolai T et al: The proposal for arevised international nomenclature system of homeopathicremedies and their abbreviations, Brussels, 1999, EuropeanCommittee for Homeopathy.

23. Kayne SB: Homeopathic pharmacy: an introduction andhandbook, Edinburgh, 1997, Churchill Livingstone.

24. Fisher P: Homeopathy in Nigeria, Br Homeopath J78:171-173, 1989.

25. Okpokpor SO: Homeopathy: Nigerian update,Homeopathy 41:140, 1991.

26. Winston J: The faces of homoeopathy, Tawa, 1999, GreatAuk Publishing.

27. Moschner A: Homeopathic pharmacist, Tel-Aviv, per-sonal communication, October 1999.

28. Nasir N, Zain M: A brief history of homeopathy inMalaysia, J OMHI 1:26, 1988.

29. Kayne SB: Homeopathy today, Br Homeopath J 89:99-100, 2000.

30. Guajardo G: Instituto de Investigaciones en CienciasVeterinarias, University de Baja California, Mexico, per-sonal communication, October 1999.

31. Oceguera JA: Sección de Estudios de Posgrado eInvestigación, Escuela Nacional de Medicina yHomeopatía Mexico DF (translated by GermánGuajardo-Bernal), personal communication, October1999.

32. Luz, MT: The incorporation of homoeopathy into pub-lic health, Br Homeopath J 81:55-58, 1992.

Suggested Readings Kayne SB: Complementary therapies for pharmacists, London,

2002, The Pharmaceutical Press. Mitchell A, Cormack M: The therapeutic relationship in comple-

mentary health care, Edinburgh, 1998, ChurchillLivingstone.

Stone J, Matthews J: Complementary medicine and the law,Oxford, 1996, Oxford University Press.

Vincent V, Furnham A: Complementary medicine. a researchperspective, Chichester, UK, 1998, John Wiley & Sons.

C H A P T E R 5 Global Perspectives 61

Page 70: Classical Homeopathy

INTRODUCTION ANDFUNDAMENTAL ISSUES

“There are three kinds of lies: lies, damned lies, andstatistics.”

BENJAMIN DISRAELI

Medical research and the scientific method havebeen an integral part of homeopathy since its incep-tion. Hahnemann’s experimentalist temperament ledhim to reject conventional wisdom and medical prac-tices because he observed the harm they caused whileproviding little benefit to the patient. As a result ofthis observation, he developed an alternativeapproach and tested it methodically. Ever since, thehomeopathic scientific community has spent muchof its time attempting to prove that he did not goastray.

The customary means of developing that proofhas been through scientific experimentation. As earlyas 1833, clinical trials instigated by homeopaths com-pared conventional and homeopathic treatments.1

Throughout the second half of the nineteenth cen-tury, the American Institute of Homeopathy annuallychallenged the American Medical Association (AMA)to compare treatment effectiveness in a scientificstudy. The AMA ignored the challenge. When homeo-paths were finally accepted into the AMA early in thetwentieth century, the challenge was dropped in thenew, less contentious social climate.

Research is an extremely important tool for eval-uating the merits of any medical therapy. Certainly,we should respect the clinical wisdom of any experi-enced health care provider. However, the complexityand variety of human experience can lead to incorrectconclusions. Experience and common sense can be

6Homeopathic Research

M I C H A E L C A R L S T O N

63

Page 71: Classical Homeopathy

inadequate or even misleading at times when westudy complex living organisms.

One of the classic examples of research disprovinga “common sense” treatment was the famous study ofinternal mammary artery ligation for anginapectoris.2 Because angina is caused by inadequateblood flow to the heart, in the late 1950s surgeonsattempted to divert blood flow to the heart by ligat-ing the internal mammary artery. Many physiciansthought the treatment effective until the publicationof a study that would never be approved by ahuman subjects committee today. In this study, thesurgeon performed either the usual mammary arteryligation procedure or a fake operation. The highlyinvasive placebo proved as effective as the real surgery.

Formalized research, particularly human clinicalresearch, can help bring objectivity to the analysis ofhealing interventions. This ritualized investigationprocess is particularly important when the interven-tion is controversial. Although a double-blind ran-domized placebo-controlled trial (RCT) does notautomatically produce truth, it does lend credibility.

Several types of studies are currently in use, someof them observational and others experimental.Ideally, for the sake of credibility and comparison,experimenters should use conventional researchdesigns. However, as we will discuss in the followingsection, homeopathy, like acupuncture and someother forms of complementary medicine, does notlend itself well to many conventional researchdesigns. Unfortunately, this is particularly true of thedouble-blind RCT design.

Although consensus is difficult to achieve whenthe topic is homeopathy, most of the medical com-munity agrees that research is important. It is wise tokeep Disraeli’s caution in mind, but research supportfor the controversial theories of homeopathy is essen-tial. Homeopathy does have research support.Furthermore, this support has had an importanteffect on increasing physician awareness and accep-tance of homeopathic medicine.

When conventional physicians and the conven-tional medical community are asked to consider anyform of complementary medicine, the first responseis asking to see the research. Questions about patientsafety are also important, but scientific evidence ofefficacy is the foundation for credibility. Thisdemand for research evidence is reasonable and cus-tomary in modern medicine. The worth of a conven-tional medicine is proved by research evidence that it

is superior to placebo or, better still, clinically effec-tive (i.e., the treatment has an effect on the diseasethat is meaningful to the patient) in a rigorous trial.

Achieving such standards can be difficult, expen-sive, and time consuming. Some observers believethat when homeopathic medicine is being studied,the standard must be higher than for conventionalmedicine, because the ability of extreme dilutions, orperhaps the “memory” of the therapeutic agent, togenerate physiologic effects would fly in the face ofcurrent scientific understanding. Supporters ofhomeopathy respond by claiming that the scientificevaluation of a treatment is based on its effectiveness,not on our understanding of the mechanism of itseffect. In this view, the focus is on whether it works,not why it works. Our failure to understand whysomething works is not an indication that it does notwork. Is it hypocritical—or prudent—to demand morethan proof of effectiveness for an intervention whosemechanism of action we do not understand?

The Nature of Proof

I may have taken liberty depicting my fellow physiciansas more scientifically objective than we truly are. Iscredibility synonymous with scientific proof? Studiesof physicians find that we do not customarily rely onresearch findings when we make decisions about com-plementary and alternative medicine (CAM) therapiesor even in our use of conventional medicines.3-16

Noncompliance with formal guidelines for clinicalpractice is common, and its causes are many.17-26

Although the reasons for our ambiguous rela-tionship with scientific evidence are complex andpoorly understood, our recommendations are clearlymore arbitrary than the average patient believes. Toooften it appears that some physicians selectivelyrecognize research evidence supporting their preex-isting opinions and ignore studies that contradictthose opinions. This is as true of physicians who useCAM as of those who use only conventionalmedicine. Such bias is most unfortunate. Althoughwe might prefer to categorize evidence in terms ofsimple dichotomies (e.g., wonderful or worthless), thecomplexity of contradictory or seemingly contradic-tory findings often leads to greater understanding.Reality is seldom so black and white.

Two examples from nutritional medicine mightbe helpful. We have good evidence that high dietary

64 C L A S S I C A L H O M E O P A T H Y

Page 72: Classical Homeopathy

consumption of beta carotene is associated withmany health benefits, including decreased risk oflung cancer. We also have evidence that supplemen-tation with synthetic beta carotene actually increasesthis risk. Why? Also, high levels of urinary calciumare associated with increased risk of kidney stones, sofor many years patients were told to restrict dietarycalcium. The medical literature of those years con-tained articles supporting the efficacy of this inter-vention.27,28 However, we now believe that highcalcium intake does not lead to calcium-contain-ing renal calculi—but rather prevents them.29,30

The instances when common sense conflicts withobserved facts or when research data are inconsistentare precisely when we can learn the most. It is foolishand unscientific to blind ourselves to contradictionsor data that make our world a little less tidy than weformerly believed it to be.

Although an argument could be made that thestatistical methods employed by medical researchersserve only to find falsehood and not truth, the impe-tus for research is the search for proof, proof of effi-cacy and proof that an intervention works. We cancollect survey data or conduct case control studies orclinical trials in our efforts to answer this question.Survey data are seldom convincing because of uncon-trolled confounding factors. To establish credibility,investigations of homeopathy and other forms ofCAM must be of the very highest quality. Is it fair torequire higher standards of CAM therapies thanwould otherwise be necessary? Probably not, butpresent political realities of medicine necessitate thevery highest standards.

The most highly regarded study design is the dou-ble-blind, placebo-controlled RCT. RCTs, whethersingle-blind or double-blind, are costly and laborious.The requirements of a well-designed RCT can makethe results difficult to generalize to less-preciselydefined circumstances (i.e., “the real world”). RCTdesign can be extremely difficult to apply in therapieslike homeopathy or acupuncture, which make blind-ing the patient nearly impossible (discussed later inmore detail). Although these factors limit the practi-cality of RCTs, they remain important because theyare the gold standard of today’s medical research.

Stages of ProofUsually these trials are “ideal-world” studies in thesense that investigators select the problem, practition-ers, and patients to maximize the chances of a positive

finding. If the initial ideal-world scenario showspromise, further research follows. If subsequentresearch, most commonly investigations of otherideal-world circumstances, is similarly positive, themedical community might conclude that the methodworks. Besides being somewhat premature, this con-clusion is also naïve, for reasons discussed later. Proofis relative, and there are different levels or stages ofproof along the path to integrating an unfamiliar sys-tem of therapy into conventional medicine.

The first investigation stage is to considerwhether the entire therapeutic system is faulty. Thisinitial process is extremely dependent on makingoptimal investigative choices. For example, we knowthat surgery is a useful technique under the correctcircumstances. A study of a surgical intervention forappendicitis will show positive outcomes. A singlestudy, or even a series of studies, of surgical treatmentfor viral gastroenteritis would lead investigators tothe conclusion that surgery does not work. If a fanat-ical supporter of surgery with an unlimited budgetpersisted and conducted trials investigating surgicaltreatment of anxiety and hay fever, the cumulativenegative findings would make it difficult to argue thecase that surgery has a legitimate role within modernmedical practice. Similarly, assuming that surgerycan successfully treat any problem based upon a sin-gle positive finding is naïvely optimistic.

The first stage of investigation is much like send-ing out a scouting party for a quick glimpse of theterrain. The information obtained at this level ofinvestigation is quite inadequate and very frustratingfor patients and clinicians, because while a positivefinding can raise hopes, it does not give us the prac-tical information necessary in clinical practice—weneed to know for what it works and when. On theother hand, this stage is a necessary screening hurdlethat a therapy must jump before more energy is ded-icated to the investigation process.

After demonstrating a pattern of apparent effec-tiveness, investigations proceed to the next level. Thisnext stage has two components. The first is buildingan evidence base for the use of a treatment in specificclinical conditions. The second is conducting morereal-world investigations of the treatment as appliedin the average community setting. Real-world studiesare important because they most truly ref lectthe average patient’s clinical experience. Eventuallythe focus of study can move to other matters,such as delineating differences between treatment

C H A P T E R 6 Homeopathic Research 65

Page 73: Classical Homeopathy

approaches and evaluating the therapy’s cost effec-tiveness for example.

The recent National Institutes of Health (NIH)Panel Consensus on Acupuncture is a good exampleof the early stages of this process. After criticallyreviewing MedLine’s indexed studies, the panel con-cluded that there was promising evidence ofacupuncture’s efficacy in certain clinical conditions.They also determined that there was suggestive butinconclusive evidence about a number of other con-ditions. They reached these positive conclusionsdespite an admitted lack of understanding for themechanisms behind acupuncture’s effects.31-34

Outcomes Research

“The patient’s opinion is the ultimate outcome measure.”

IAN CHALMERS

I would be remiss not to include some discussionof outcome measures, because this issue strikes veryclose to the heart of the philosophic differencesbetween many CAM therapies and conventional med-icine. Many conventional medicine practitionerswould argue that this division exists within conven-tional medicine as well.

What do you measure to determine a treatmentresponse? Clearly the most acceptable and perhapsthe most objective way to measure response is viaphysiologic parameters that can be measured by lab-oratory tests. We have a great deal of experience withsuch measures, and precise information about thereliability of the testing procedures themselves. Theseprocedures can be costly, always an issue in clinicaltrials, but more importantly the information may nottell us what we hope it will. Although we use thesetests as surrogate disease markers, very few testsindisputably quantify a patient’s disease state. Mostimportantly, these tests do not tell us whether thepatient feels better and is more fully able to function.A good example of this deficiency is found in clinicalcancer research, which increasingly includes valua-tion of the quality of a patient’s life, as well as the tra-ditional method of simply tracking the length of apatient’s survival.

We are in the infant stages of developing reliablemeasures to answer the very simple question, the onemost crucial to the patient, “How do you feel?” ManyCAM therapies, homeopathy more than most others,

espouse a philosophy of health based on all aspects ofa human being: physical, mental, emotional, and evenspiritual. It is therefore essential to attempt to mea-sure patients’ health just as broadly. Homeopathicprinciples sometimes define even the worsening ofsome physical symptoms as an improvement in apatient’s condition, provided this decline is linkedto improvement in other, more important, facets ofthe patient’s health. Patients often share the home-opathic perspective, recognizing that they feel bet-ter because of their improved mental state, forexample, although their skin condition may haveworsened.

The current state of homeopathic research isambiguous and complicated. We do not have simpleanswers about clinical homeopathic medicine orthe basic science questions its efficacy wouldpose. Homeopathic research is a conundrum—fertileground for questions about homeopathy and theprocess of scientific research. Although it is not easyto use conventional scientific protocols to examinehomeopathy, the attempt teaches researchers a greatdeal about homeopathic principles. A researchermust overcome considerable challenges if he or she isto simultaneously respect homeopathic principlesand conventional research methodology. Designinghomeopathic clinical trials can be more than a littlechallenging; however, with great understanding andeffort, it is possible.

Methodology Issues

“A poorly or improperly designed study involving humansubjects is, by definition, unethical.”

SCIENCE, 11/18/1977

Because a clinical trial must inevitably exposesubjects to some risk of adverse effects, a study thatdoes not lead to an answer needlessly places subjectsin harm’s way. The essential principles of homeopa-thy must be respected for research investigations toproduce meaningful answers.

Mistakes do occur and they are an inevitable partof the learning process. If we do not learn from ourresearch mistakes we only compound them and actirresponsibly.

First, let us consider the most essential homeo-pathic principle, using like to cure like. In practical

66 C L A S S I C A L H O M E O P A T H Y

Page 74: Classical Homeopathy

terms, this principle necessitates highly individual-ized prescriptions for each patient. The intense andusually lengthy homeopathic interview, which is anecessary step toward providing highly individualizedprescriptions, may be an ideal setting to maximizeplacebo effects. The interview also makes blindinguniquely difficult. The practitioner carefully consid-ers the patient’s words and expressions as she drawsconclusions about the nature of the patient and thecorrect homeopathic prescription. The patientbecomes an important party in the decision-makingprocess as questions and answers pass back and forthconfirming or denying the practitioner’s suspicions.Subtle indications of the practitioner’s certaintyabout the prescription are likely to affect the patient’sexpectations about the response to the treatment.Interpersonal perception and interaction is central tothe homeopathic clinical process.

Although these interpersonal elements might becontrolled by a dispassionate third party actuallyadministering the medicine, other issues arise. Mostobvious is the certainty that, in an unknown percent-age of cases, the interaction between practitioner andpatient is the cure. The placebo effect may be evenmore important to the success of homeopathy thanto conventional medicine. Taken to the extreme, ifthe effects of homeopathy were predominantly theresult of placebo, it would not mean that homeo-pathic treatment is worthless, but that the mostimportant element is the interaction, that the personwas more important than the pill.

Several years ago, I had an interesting discussionwith a European homeopathic researcher in which welamented the vanishing opportunity to test thishypothesis by conducting a “homeopathic trial” withAmerican patients whose only treatment would havebeen the homeopathic interview. Americans werestarting to learn enough about homeopathy toexpect more from a homeopath than only an inter-view, no matter how insightful.

Most homeopaths believe that the success ofhomeopathic treatment is almost entirely dependenton the accuracy of the practitioner’s prescription. Atrial of classical homeopathy cannot be credible,therefore, unless it is based on accurate prescriptions.A trial design not meeting this requirement that leadsto a negative finding would generate a loud chorus ofcomplaint from the homeopathic community aboutthe inadequacy of the homeopath who chose thehomeopathic remedy. Negative findings from poorly

designed trials are meaningless, because an informedadvocate or critic would expect that failure was theonly likely outcome.

One means of overcoming this difficulty is for apanel of homeopaths to select the correct homeo-pathic remedy for each patient. This method makes itnecessary for each panelist to independently inter-view every patient, or for the panel as a group toexamine each patient (a circumstance that would verylikely significantly alter patients’ behavior), or for thepanel to watch videotaped cases. A videotaped casedoes not allow for interaction between the patientand the panelists, thus changing the dynamic andeach practitioner’s perception of the patient. Thepractitioners viewing the videotape could not ques-tion the patient, thus limiting the information onwhich they based their prescriptions. On the whole,the process of prescription by committee is very timeconsuming and potentially contentious.

Another research-complicating factor involved inproviding highly individualized prescriptions is thatevery disease must be treated with one of a largenumber of homeopathic remedies. For example, oneof the classic texts in homeopathy, Kent’s Repertory ofthe Homeopathic Materia Medica, lists more than 120different homeopathic medicines for asthma. Noclassical homeopath believes that all of them wouldbe useful for any one patient with asthma. To thecontrary, the classical homeopath believes that thereis one best choice for each patient. Other remediesmay be of limited benefit, but one will be uniquelyhelpful. It is worth emphasizing—the choice of thehomeopathic remedy is crucially important.

Another issue was brought to my attention adecade ago during a research meeting in the De-partment of Family and Community Medicine at theUniversity of California, San Francisco. After Iproposed a trial and explained some of the methodol-ogy issues, one of the two department research special-ists insisted that any homeopathic study must use onlyone homeopathic remedy for proper statistical analysis.She argued that every different remedy was a differenttreatment. The other disagreed. If “correct design” in atrial of classical homeopathy means using only onesingle remedy, homeopathic clinical research would beso impractical it would be essentially impossible.Although we might reach a point where we can com-pare the effectiveness of various homeopathic remediesin certain disease conditions, at this point we have yetto produce incontestable research evidence settling the

C H A P T E R 6 Homeopathic Research 67

Page 75: Classical Homeopathy

more fundamental question of homeopathy’s effective-ness as a system of medicine.

Clinical trials using classical homeopathic princi-ples represent only a small fraction of homeopathicclinical research. Given the foregoing difficulties, it iseasy to sympathize with researchers who choose notto try to pick their way through this Gordianknot complicating homeopathic clinical research.Unfortunately such expediency is unacceptable whenwe must be consistent with homeopathic principlesto get meaningful answers.

Like the many-headed Hydra, a new series ofproblems arise to take the place of each one con-quered by the researcher. Ignoring the demands ofclassical homeopathy simplifies the problems; how-ever, the requirements posed by more simplistic ver-sions of homeopathy are still formidable. Eachchallenge demands careful consideration from a con-scientious researcher. Overlooked, they can easilynegate any conclusions derived from what will surelybe a poorly designed study.

Response Expectations Change with thePassage of Time Patient response varies with time. Once a patienttakes the correct homeopathic remedy, he is expectedto improve after a certain interval (Figure 6-1). Thatinterval is dependent on several factors, among themthe patient’s disease severity, duration of illness, gen-eral health, and age. In addition, homeopaths expecta short-term intensification of a patient’s symptoms(aggravation) before long-term improvement sets in.

Homeopaths expect the correct remedy to makethe patient worse at time B but better at timeC. Choosing the correct time to measure response isone of the arts of combining homeopathic clinicalexperience with research methodology. Some studiescreatively used the homeopathic aggravation as an

outcome measure, identifying a temporary decline inpatients’ condition as a successful intervention.

A correct homeopathic prescription should leadto persistent improvement in the patient’s clinicalcondition. This process should continue long afterthe patient stops taking the homeopathic remedy.Theoretically, the long-term effect of homeopathywould be expected to confound the response of astudy group changing from active treatment toplacebo. This effect makes it very difficult to performcrossover studies.

Provings Make the Patient Worse A patient who takes too much of the correct homeo-pathic remedy for too long a time will get worse.Healthy people test homeopathic remedies by takingthem for a time, hoping to develop a reaction to themedicine (proving) and thereby learn what symptomssuggest its use. In the same manner, patients who takea remedy repeatedly will pass the point of improvementand get worse from taking too much of what wouldotherwise be a beneficial remedy. In addition, patientswho overmedicate often temporarily develop symp-toms of the remedy they did not previously suffer.

Dosage Questions about dosage may be homeopathy’s not-so-secret Achilles’ heel. Although dosage is the mostobvious sticking point, it is separate from and sec-ondary to the principle of using like to treat like.Perhaps like to treat like will prove useful for certainconditions only if certain doses are administered.Homeopaths often argue among themselves, some-times heatedly, about appropriate dosage regimens,whereas conventional critics seldom investigatehomeopathy any further than the dilution contro-versy. There are many different points of view on thisissue, which is a question of interest to all partiesdebating the worth of homeopathic medicine.

REFLECTIONS ON PL ACEBO

Why Talk About Placebo?

The use of placebo controls in research is an importantcomponent of the effort to develop a foundation of evi-dence on which to base the clinical practice of medi-cine. Unfortunately, the term placebo has pejorativeconnotations in clinical medicine.35 Considerations of

68 C L A S S I C A L H O M E O P A T H Y

Time

A

B

C

better

Sym

ptom

Inte

nsity

worse

Figure 6-1. Response to homeopathic treatment. A, Startof treatment; B, homeopathic aggravation; C, long-termimprovement.

Page 76: Classical Homeopathy

alternative forms of medical care, for example,inevitably rouse cries of, “Placebo!” from the mostskeptical corners of the medical community.36-38

Placebo is too often a term of disparagement, not dis-cussion. Given homeopathy’s marked difference fromconventional medicine—its extreme “otherness”—theplacebo issue naturally arises and must be examinedwhen considering homeopathy as a medical science.

Homeopathy as “Other” Homeopathy is nearly archetypal in the numerouschallenges it poses to conventional medical thinking.Metaphors of battle often appear when an author onone side writes about the other side. The differencesbetween the systems are so profound that the use ofsuch metaphors is understandable.

The following passage (in my opinion, one of thefinest in homeopathic literature) is a beautifully cleardepiction of the philosophic battleground fromthe homeopathic side. The author, John James GarthWilkinson, was introduced to homeopathy throughhis friend, Henry James, Sr. Wilkinson is famous inhomeopathic history for spreading the therapyamong the upper class in England, in no small partbecause of his gift for communicating homeopathicideas. One of his friends, Ralph Waldo Emerson,praised his “rhetoric like the armory of the invincibleknights of old.” The following quotation is from aletter to Henry James:

The matter of doses depends upon the fineness of theaim. In everything there is a punctum saliens so small, thatif we could find it out, a pin’s point would cover it as witha sky. What is the meaning of that invisible world whichis especially versed about organization, if there be notforces and substances whose minuteness excludes themfrom our vision? We have not to batter the human bodyto pieces in order to destroy it, but an artistic prick—abare bodkin—under the fifth rib, lets out the life entire.Nay had we greater skill of delineation, a word would doit. The sum of force brought to bear depends upon preci-sion, and a single shot, true to its aim, or at most a suc-cession of a few shots would terminate any battle thatwas ever fought, by picking off the chiefs. If our gunnerybe unscientific, the two armies must pound each other,until chance produces the effects of science, by hittingthe leaders; and in this case a prodigious expenditure ofammunition may be requisite; but when the balls arecharmed, a handful will finish a war. It is not fair tocount weight of metal when science is on the one side,and brute stuff on the other; or to suppose that there isany parallel of well-skilled smallness with ignorance of

the most portentous size. The allopathic school is there-fore wrong in supposing that our “littles are the fractionsof their mickles”; the exactness of the aim in giving theformer a new direction, takes them out of all comparisonwith the unwieldy stones which the orthodox throw fromtheir catapults.

But again there is another consideration. Fact showsthat the attenuation of medicines may go on to such apoint, and yet their curative properties be preserved, nay,heightened, that we are obliged to desert the hypothesisof their material action, and to presume that they takerank as dynamical things. A drop of Aconite may be putinto a glass of spirit, a dreg of this latter into anotherglass of spirit, and so on, to the hundredth or the thou-sandth time, and still the Aconite-property shall be avail-able for cure. Here then we enter another field, and dealwith the spirits of things, which are their potential forms,gradually refining massy drugs, until they are likened tothose sightless agents which we know to be the roots ofnature, and feel as the most powerful in ourselves. Howsuch delicate monitors be looked at from the old point ofview, as assimilated to the violence that is exercised bymaterialist physic? If the latter would stir the man, itdoes by as much main force as it dares to use; whereas theformer moves him by a word, through the affinities andlikings of his organization.39

Although homeopathy has changed from thedays of Wilkinson, a gulf remains between the medicalphilosophies of the average homeopathic physicianand the typical conventional physician. The differencesbetween these understandings of patient health con-tinue to create a great deal of mistrust on both sides.

There are points of contact. A homeopath look-ing at conventional medicine will recognize thathomeopathy’s primary principle, like cures like, hasunwittingly been used to a limited degree in conven-tional medicine and in many forms of traditionalhealing. However, this principle is far from being gen-erally accepted.

Homeopathic and conventional opinions about theeffects of a specific treatment on a specific patient areoften diametrically opposed. These disagreements are adaily event in the practice of clinical medicine. In someinstances, viewing the patient’s clinical response to con-ventional treatment through the lens of Hering’s Lawsof Cure leads to the conclusion that the conventionalmedical treatment harmed the patient. This interpreta-tion is usually at odds with the conventional interpre-tation of the same experience.

The matter of homeopathic dilution is quite dis-turbing to most scientifically trained professionals.

C H A P T E R 6 Homeopathic Research 69

Page 77: Classical Homeopathy

How could any physiologic effect possibly result fromingesting such fantastic dilutions? It is so unsettlingthat some find it impossible to seriously consider thepossibility that there may be something of value inthe other elements of the homeopathic approach topatients.

I recall an incident years ago when I presented aproposal for a homeopathic study to a research groupat the University of California, San Francisco. Afterhearing my proposal and learning I was a homeo-path, a physician with whom I had earlier been hav-ing a very friendly discussion became quite agitatedand refused to consider the proposal in any way.When another faculty member asked him what hewould do if the study were perfectly designed andfound homeopathy effective, he replied, “Designanother study.” The proposal, which was for a trial ofhomeopathic treatment for pediatric diarrheal dis-ease, was very similar to a study later completed byDr. Jennifer Jacobs and associates finding homeo-pathy statistically superior to placebo.40

Another factor heightening the belief that ho-meopathy’s effects could result solely from placebo isthe homeopathic interview. The classical homeo-pathic interview, with its carefully detailed, respectfulinquiry into the patient’s medical and life history,appears ideally suited to maximize the placebo effect.

These many fundamental questions abouthomeopathic medicine demand attention. It isimportant to consider the possibility that homeopathictreatment is synonymous with placebo treatment.

Some within the homeopathic community areoffended when this issue is raised. They are threat-ened by the derogatory implications of the wordplacebo and consider raising the question of placebotantamount to impugning their honesty or intelli-gence. They point out that homeopathy has contin-ued in much the same form for nearly 200 years, witha large cadre of enthusiastic patients. Surely thislengthy track record of satisfied patients must proveefficacy and therefore disprove the supposition thathomeopathy is placebo.

Other homeopaths take a broader view. They arenot frightened by the complicated questionsgrowing out of our ignorance about the nature ofthe placebo effect. They consider discussion of theplacebo issue fascinating and potentially laden withvitally important information about the healingprocess—information from which all health careproviders can learn. Their view is that homeopathy

has survived because it appears to have some degreeof clinical efficacy and therefore considerableimplications for medicine. This is true regardless ofwhether homeopathy is entirely or only partiallyplacebo.

This second group of homeopaths agrees withthe opinion, widely accepted within conventionalmedicine, that alternative forms of medicine must besubjected to scientific examination. Just as conven-tional medical practices need to be critically evalu-ated, this age of evidence-based medicine demandsnothing less of alternative medical treatments. Thegold standard of research in clinical medicine is thedouble-blind placebo-controlled RCT. Because RCTsoften use placebos as controls, understanding theplacebo is essential to the process of understandingmedicine, including alternative medical practicessuch as homeopathy.

Homeopathy is Placebo, But . . . Is homeopathy then placebo? The brief and mislead-ing answer is certainly yes. Every patient encountergenerates placebo effects, whether the treatment ishomeopathy, psychiatry, or surgery (interestingly,surgical procedures appear to create some of themost powerful placebo effects known41).

A better question is this: How much of the bene-fit derived from homeopathic treatment is exclusivelythe result of placebo? The answer to this question ismuch more difficult and likely to change with differ-ing circumstances. Unfortunately, despite the routineuse of placebo in clinical trials, few in the medicalprofession have any clear understanding of thenature of placebo. Because of the limited amount ofresearch and its inconsistent results, even placeboexperts debate the nature or even existence ofplacebo. One of the few points of agreement is ourignorance; we do not understand placebo as well aswe should, given its omnipresence and its apparentpower as a healing force.

What Is Placebo?

“Placebos, in other words, are not only puzzles to be ‘solved,’but—to the extent that they elude ready solutions—they alsoteach us how far we still are from closure on the question ofwhat it will mean to create a science subtle and complexenough to encompass all that is entailed in being human.”42

ANNE HARRINGTON, Harvard University

70 C L A S S I C A L H O M E O P A T H Y

Page 78: Classical Homeopathy

The word placebo, literally translated, means “Ishall please.” Defining placebo is far more difficultthan simply translating the word from Latin. In fact,it is reasonable to argue that there is no satisfactorydefinition of placebo at this time. Nearly everyauthor on the subject has devised a different defini-tion. Each definition is at odds with some part ofwhat we know about placebo. Some academiciansrecommend abandoning the concept entirely becauseof the immense confusion about what placebo is.43,44

One of the most commonly accepted definitionsin clinical research defines placebo as an interventionbelieved to lack a specific effect (there is no empiri-cally supported theory for its action) on the studiedcondition, but which has been demonstrated betterthan no intervention. By this definition, placebo issomething that works when we believe it should not.This is most unsatisfying because it merely highlightsour ignorance—we do not understand it, therefore itis placebo.

In clinical practice the deficiencies of this defini-tion are even more apparent. The definition does notencompass the circumstance that is the crux of theplacebo–alternative therapy question. The followingexample may illustrate this point. A patient receives atreatment from an individual who believes it will helpthe patient. Later, a placebo-controlled trial shows nodifference between the treatment and placebo.Despite the research finding, using the definition inthe previous paragraph, the practitioner’s belief thatthe treatment would have a specific effect on thepatient’s disease would mean the treatment was not aplacebo.

A historical example of this circumstance in con-ventional medicine might be helpful. In the late1970s, Benson and McCallie reviewed various treat-ments for angina, treatments that were later foundineffective.45 They learned that many of these inef-fective therapies showed response rates up to 100% inearly open and double-blind trials (mean response82.4%) involving 1187 patients. Several patients whowere improved by these interventions continued to bewell for more than a year (unfortunately, few patientshad such extended follow-up). Benson’s analysis wasa dramatic demonstration of the effectiveness of“ineffective” treatments. The clinicians did not realizethat their interventions were merely placebo.

Most definitions of placebo require that thephysician believe that the treatment is ineffective. Bythese definitions, placebo is at some level a deceit.46

Traditional treatments acquire the placebo labelwhen the medical community acknowledges thatthey were ineffective. Although the past errors ofconventional medicines are recognized, no oneseems eager to label those misguided practitioners asquacks. Similarly if practitioners of homeopathy andother forms of CAM are making clinical errors, thesemistakes are most likely the result of well-intentionedignorance rather than deliberate deceit. Muddlingthese uses of the term placebo (placebo equals trickery,as opposed to placebo equals error) may contributeto physician mistrust of alternative medicine.

Placebo Theories Many theories have been proposed to explain themechanism of placebo action. The popularity of eachtheory waxes or wanes as new information comes tolight, and the relative importance of each is open todebate. Placebo effects most likely derive from a vari-ety of causes unified only by the patient’s experienceof improved well-being.

The placebo-reactor theory maintained that cer-tain individuals were susceptible to placebo andothers were not. Research in the 1970s proved other-wise.47 No correlation between clinical placebo effectsand suggestibility exists. The sole personality charac-teristic consistently associated with a greater likeli-hood of placebo response is anxiety. We also learnedthat everyone is a placebo-reactor at one time oranother. Placebo reactivity varies more from one timeto another in an individual than it does from personto person. Unfortunately many physicians areunaware of the inaccuracies of the placebo-reactortheory. Sadly, some of these confused physicians viewa placebo reaction as an indication that the patient ishysterical.48

Another theory that has impeded our under-standing of placebo is the misattribution theory.This theory argues that the patient would have got-ten better anyway and wrongly attributed improve-ment to an inactive intervention. Most acute illnessesand minor complaints do tend to go away with thepassage of time, and the symptoms of many majorchronic diseases vary in intensity over time. We knowthat a positive benefit from placebo is more likely inconditions that have a variable natural history. Also,because of the phenomenon of regression toward themean (i.e., extreme states are unusual, and change istherefore likely to be in a beneficial direction),repeated measurements or patient contacts are likely

C H A P T E R 6 Homeopathic Research 71

Page 79: Classical Homeopathy

to show improvement. However, a significant accu-mulated body of research demonstrating repro-ducible physiologic changes following placeboadministration in human being and animal experi-mental models exists. It does appear that something“real” happens from placebo.

Pain appears particularly responsive to placebotreatment.49 The discoveries of endorphin biochem-istry and its importance in the central nervoussystem, stimulation by placebo, and blockage ofplacebo pain relief by naloxone were very excitingto placebo researchers. However, the answers wegained chief ly succeeded in multiplying ourquestions.50 Although placebo-induced endorphinrelease can account for placebo effectiveness in paincontrol, how does placebo induce endorphin release?Even more importantly, what could placebo-inducedendorphin release have to do with non–pain-relatedplacebo effects?

There is much to learn from the conditioningmodel of placebo. Essentially this theory maintainsthat associating an intervention with an outcomeleads to a persistent linkage. Patients then achieve theidentical response even if the active part of the inter-vention is missing. For example, people who believethey are drinking alcohol will develop symptoms ofalcohol intoxication even if the drink is entirely alco-hol-free. Building on Ader’s earlier work (seediscussion of nocebo later in this chapter), Olnessand Ader reported on a patient for whom they wereable to use this linkage of expectation to the patient’sbenefit.51 A child undergoing chemotherapy had dif-ficulty tolerating cyclophosphamide treatment forlupus. The cyclophosphamide was routinely adminis-tered with cod liver oil. The researchers then gave thechild cod liver oil alone for half of the chemotherapysessions, resulting in the same benefit as thecyclophosphamide but without the same degree ofadverse effects.

Placebo theories include societal factors as well.The theory of ritualized healing recognizes thepotency of cultural elements. Shamanic rituals,for example, typically require participation of thepatient’s family and community in the healingprocess. Of course, our own system of clinics, phar-macies, and hospitals can be viewed as an alternativeform of ritualized healing.

The most often repeated example of one placebotheory is of great interest to homeopaths. This theoryis that placebo effects logically follow expectations

about the treatment. Patients respond because theyhave, in some way, been told they should respond.Unlike the conditioning theory, patients need nothave any prior experience with an active agent associ-ated with the treatment. In 1950, Wolf reported thatipecac was a successful means of treating disablingnausea in a pregnant woman.52 He even documentedthe physical effects of the ipecac through gastric pres-sure monitoring. The use of ipecac in conventionalmedicine is limited to its emetic effects—precisely theopposite action sought in this pregnant patient. Ofcourse, when ipecac is used in homeopathy, thepatient is expected to suffer from nausea that theipecac is expected to relieve, giving this classic exam-ple an alternative explanation.

The most appealing placebo theory to many clini-cians is the interpersonal theory. Patients who per-ceive their physician as warm, caring, attentive, andpositive are more likely to enjoy the benefits of theplacebo response than are other patients. Some havesaid that the most powerful placebo is the physician.The idea that healing can happen just by listeningand attending to the patient is a powerful concept,one distinctly at odds with the weaknesses of moderntechnologic medicine. Interesting, isn’t it, that thequalities so valued by patients are also highly valuedby homeopaths?

None of these theories can account for allinstances and aspects of placebo. Each of them pro-vides some information, helping us get a sense of thebounds of our understanding of placebo—much likethe tale of four blind men describing an elephant bythe part each was touching. Perhaps the best way tounderstand placebo is by its effects—what it can doand when it does it.

Characteristics of the PlaceboResponse

“You should treat as many patients as possible with the newdrugs while they still have the power to heal.”

TROUSSEAU

The response of patients to placebo varies. Thepatient’s anxiety, perception of the physician, expec-tations, and prior experience of the treatment affecthis or her response. As Trousseau wrote long ago,enthusiasm for a new or unfamiliar treatment canaccentuate the reaction. Interestingly, patient compli-

72 C L A S S I C A L H O M E O P A T H Y

Page 80: Classical Homeopathy

ance is also associated with a positive placeboresponse. In a study of patients taking a drug to lowercholesterol, those who took their pills regularly had areduced mortality rate in both the active and placebotreatment arms of the trial.53

Most published placebo research suggests thatevery human ill responds to placebo, at least tran-siently. Pain is particularly responsive to placebo,as are diseases that have an erratic clinical course.Human case reports and animal studies indicate thateven serious diseases appear to respond to placebo.Unfortunately, some misguided physicians have erro-neously convinced themselves that a patient’sresponse to placebo is proof that the patient did nothave a “real” medical illness. Few doctors believe suchreasoning has any role in the ethical practice of med-icine.

The placebo response occurs in every clinicalencounter. The evidence suggests that everyclinical interaction has the potential for an entirespectrum of patient response, ranging from wonder-fully beneficial to extremely harmful. Clinicians havea professional obligation to recognize this potential.We must carefully avoid interactions that harm thepatient as we strive to help to the best of our ability.

Some research supports the idea that transience isa characteristic of placebo response. Benson andMcCallie’s angina work45 and a few other studies sug-gest otherwise. To those who prefer a world ruled bycommon sense, proof that placebo effects are transientwould provide a mind-settling confirmation ofplacebo’s ephemeral nature. In addition, a pattern offleeting response could become the key to distinguish-ing placebo effects from the “real” effects of activetreatment. Only time and further research will tell.

Adverse Effects of Placebo Another false belief about placebo, a belief that is par-ticularly relevant to homeopathy, concerns adverseeffects. Some have claimed that one of the proofsthat the effects of homeopathic treatment are notsolely attributable to placebo is that homeopathicremedies can cause adverse effects. Homeopathsaccept that the correctly chosen homeopathic remedyfor a chronic condition is likely to create a transientexacerbation of symptoms. The term aggravation isused to describe this process. The aggravation con-cept is so well accepted that homeopaths sometimesexpress concern that the correct remedy was notgiven if an aggravation does not take place.

However, the ability to produce adverse effectsdoes not prove that homeopathy is more thanplacebo, because placebos can generate adverseeffects. Before discussing adverse effects createdby placebo, it is important to distinguish adverseplacebo effects from nocebo effects. Nocebo, whichmeans “I shall harm,” is the true opposite of placebo.Nocebo effects are those that result from negativeexpectations. In other words, a patient expects somedamaging effect from an inactive treatment and theexpectation leads to the undesired outcome. One ofthe most famous studies in placebo literature is anexample of the power of nocebo. In 1975, Ader andCohen released a study regarding the administrationof cyclophosphamide mixed in saccharin water torats.54 While tracking the rats’ death rate followingingestion of this combination, Adler and Cohen dis-covered that even when cyclophosphamide was nolonger administered, rats receiving saccharin alonecontinued to die as if they were still suffering the illeffects of the cyclophosphamide.

Rats are not alone in their vulnerability toplacebo or nocebo. Conditioned nocebo effects alsooccur in human beings. Various reports, usuallyunsubstantiated, of “voodoo death,” in which a per-son dies after having been the subject of a curseplaced by a powerful member of the community,have been a part of the lore of placebo for genera-tions. There have been a number of recent reports ofmass hysterical-symptom outbreaks following per-ceived (but subsequently disproved) exposures totoxins.

Adverse effects from placebo are unexpected,undesired reactions to treatment. The patient’s highhopes are disappointed or accompanied by additionalunforeseen unpleasant effects.

The previously cited study by Shapiro and associ-ates47 found that more than half of a group ofpatients taking placebo to improve their generalhealth experienced adverse effects of some sort.Interestingly, Shapiro also found that patients whodid not benefit from the placebo also did not experi-ence any adverse effects. In other words, not only doadverse effects occur, but they often appear to be anintegral part of the placebo response.

Another viewpoint considers the issue of placeboirrelevant. The patient’s beneficial response to atreatment is important. The means to that end is not.This view is most commonly that of clinicians and, ofcourse, patients themselves. A recent Lancet editorial

C H A P T E R 6 Homeopathic Research 73

Page 81: Classical Homeopathy

advocated more research into this aspect of theplacebo:

Second, perhaps there should be more investigations intothe role of placebo, not as a confounding factor interfer-ing with study design, but as a method of enhancing theefficacy of and reducing the variable response to anal-gesics and other methods of pain control.55

Carrying the idea of patient benefit as the physi-cian’s primary ethical duty further, some believe thatraising the specter of placebo might have unethicalrepercussions. Discussing the concept of placebocould be harmful to the patient, because acknowl-edging the possibility of placebo treatment alters theinteraction with the patient. The possibility that thetreatment might be placebo can reduce the responseto an effective nonplacebo treatment.56

Placebo effects are not restricted to inactive treat-ments. They also augment effective ones.57 In a study bySkovlund, women who had just given birth were treatedfor postpartum uterine pain.58 In the first phase, fol-lowing an informed consent procedure, they were giveneither paracetamol or placebo. In the second phase, con-ducted immediately afterward, a new group of patientson the same hospital ward were randomly given parac-etamol or naproxen knowing they might receive eithermedication. Interestingly, the effect of the paracetamolin the second trial was markedly enhanced, apparentlyby the patients’ knowledge that they were certain toreceive active treatment (Figure 6-2).

Although complementary medicine is certainly notentirely placebo, placebos appear to be a form of com-plementary medicine, because their effects augmentthe effectiveness of conventional medicine. Conversely,the knowledge that he or she might not be receiving aneffective treatment diminishes a patient’s expectationsand therefore the clinical response. One could arguethat it is the ethical duty of the physician to set asidedoubts about the effectiveness of a treatment andadminister treatment with a full measure of convictionto maximally benefit the patient.

Limitations of Placebo in Research Although these concepts have many repercussions forclinical medicine, the challenges created forresearchers are no less significant.59 Distinguishing atreatment from placebo is the usual objective of clin-ical trials. Although this is a difficult task, it is oftenby itself insufficient to meet the needs of patientsand clinicians.

Because placebo can be effective treatment formany patients, its power must be recognized andrespected. When placebo’s power is respected, com-paring a treatment to placebo becomes a considera-tion of the degree of effect as well as the frequencyand nature of adverse effects.

Statistical superiority over placebo can be mis-leading. Some homeopathic trials have been criticizedon this basis. A difference that is statistically signifi-cant but not clinically meaningful to the patient isirrelevant to that patient and his physician unlessthere is some other compelling advantage, either inthe adverse effect profile or cost of the treatment.

It is clear that an important limitation of RCTs isthe issue of clinical relevance—sometimes the patientis forgotten in clinical research. Researchers who areprimarily interested in measuring quality of life havecome to believe that the patient’s well-being is theultimate outcome measure.60 In addition, there issome evidence that the patient’s opinion might bethe best discriminator between placebo and activetreatment.61 It is essential that the patient never beforgotten in research as well as in clinical medicine.

74 C L A S S I C A L H O M E O P A T H Y

Pai

n in

tens

ity

Time

Paracetamol 2

Naproxen 2

Paracetamol 1

Placebo 1

Paracetamol 2

Paracetamol 1

Naproxen 2

Placebo 1

Time

0

0

0

0

2 Hours

40

30

20

3

4 Hours

38

29

18

2

Figure 6-2. Effect of expectation on pain relief.

Page 82: Classical Homeopathy

Lessons from Placebo andHomeopathy

“Homeopathy may bring benefit, as do so many other formsof alternative medicine, because its practitioners are friendlyand unhurried, taking into account the patient’s values andteaching that illness is a part of life, to be overcome when itcannot be eliminated.”

HOWARD SPIRO, The Power of Hope: A Doctor’s Perspective

There is evidence that homeopaths were the firstto use placebo controls as a consistent part of clinicalresearch; placebos have been used in homeopathicprovings since 1828.62 Hahnemann used placebo rou-tinely in his clinical practice as early as 1819 to estab-lish a symptom wash-out period for new patients andto provide them with otherwise needless daily treat-ment. There is also evidence that placebo controlswere used in attempts to challenge and to prove theefficacy of homeopathy, perhaps as early as 1834 butcertainly by 1846 (despite the rather lengthy investi-gation conducted in the years hence, we still do nothave clear answers).63

Although there is ample reason to believe other-wise, if homeopathy is solely placebo, studying such apopular therapy could help teach us a great dealabout the nature of placebo. Similarly, an exclusivelyplacebo homeopathy could teach us about the defi-ciencies of current medical practice. Why favor a con-ventional treatment that is no more effective than ahomeopathic placebo? If the adverse effects producedby conventional treatment outweigh those producedby a similarly effective placebo, does it follow that theplacebo is the better prescription? The first line ofthe Hippocratic Oath—primum no nocere (“first do noharm”)—leaps to mind and suggests so.

One of the greatest truths to be gained fromplacebo research is that the most powerful placebo isthe physician. Our demeanor has considerable effecton patients’ well-being. A reasonable summary ofplacebo research regarding patient-physician interac-tion is that the effect of physicians can be range fromextremely positive to extremely negative.

Perhaps another of the lessons conventionalphysicians can learn from homeopathy has to dowith the attention a homeopath gives to the patient.The interview must be conducted with careful andrespectful attention to the patient’s complaints and

to the patient as a unique individual. The greathomeopaths have always taught their students aboutthe tremendous importance of the interview process.When properly conducted, the homeopathic inter-view appears ideally suited to maximize placeboeffects. We must approach each clinical encounterthoughtfully if we hope to provide the best possiblecare to our patients.

Modern medical practice has become increasinglytechnological, and many believe we have neglectedthe relationship aspect of the healing process.Bernard Lown, MD, Professor Emeritus at HarvardUniversity, recently wrote:

Medicine’s profound crisis, I believe, is only partiallyrelated to ballooning costs, for the problem is far deeperthan economics. In my view, the basic reason is that med-icine has lost its way, if not its soul. An unwrittencovenant between doctor and patient, hallowed over sev-eral millennia, is being broken.64

The covenant Dr. Lown believes is being brokenis the physician’s respectful commitment to thepatient, unsullied by arrogance, selfishness, orridicule of the patient’s concerns. Homeopathy,through the interview, represents one pathway backtoward a healthier relationship between physicianand patient.

Just as patients are increasingly displeased withthe medical care they receive, physicians are increas-ingly disenchanted with the system of medical carein which we find ourselves immersed. Time con-straints often force the hurried conventional physi-cian to view the patient as a runny nose that must betreated and sent back out the door as quickly as pos-sible. Homeopaths learn that the story of everypatient is in some way interesting. The richness ofthe homeopathic interview enlivens the patient-physician interaction. Perhaps this interaction,which can heal the patient, can also heal the physi-cian in a certain way.

Whenever I find myself struggling with a chal-lenging patient, a bit of advice from one of myfavorite homeopathic teachers comes to mind. Hisadvice was, “Always remember that you must be therewith the patient. Do not worry about which remedythe patient needs while you are taking the case. If youattend to the patient, he will get better and you willfind the remedy.” Sage advice, it seems, for a healer ofany therapeutic persuasion.

C H A P T E R 6 Homeopathic Research 75

Page 83: Classical Homeopathy

PUBLISHED HUMAN TRIAL SOF HOMEOPATHY

Now that we have completed our preparatory consid-eration of methodology issues, let us move on to theresearch itself. The following review will not beexhaustive; far too much work has been completedto give due consideration to the entirety of homeo-pathic research. Although there are earlier bits ofdata about homeopathic effectiveness in various epi-demics and for patients exposed to mustard gas inWorld War I, homeopathic clinical research has reallyblossomed in the past two decades.

For the sake of clarity, we should review a few bitsof statistical terminology used to identify signifi-cance. The “p” value is an indicator of the probabilitythat a difference is due to chance. Customarily a pvalue less than .05 is accepted as meaningful. Thismeans that there is one chance in 20 (1/20 = .05) thatthis finding was an accident. The lower the p valuethe less likely this is a chance finding. Relative risk(RR) provides a ratio of the incidence of a variable(disease, symptom, abnormal laboratory value) fortreated subjects as compared to an untreated popula-tion. In case-control studies the odds ratio (OR) isused and is roughly equivalent to the RR used incohort studies. Confidence intervals (CI) are usuallyexpressed as “95% CI” followed by a numerical range.Using a CI recognizes that the true value cannot bedetermined, but we can determine that it is within acertain range with a specific degree of certainty. A95% CI (range, x-y) means there is a 95% chance thatthe true value is between x and y. In a simplistic way,we can say that the wider the CI, the less reliable theresults of the study. A meaningful result will have aCI that does not include identity between the groups(0 change or 1 when used with RR or OR to differen-tiate between groups). Confidence intervals are alsouseful in that they are readily compatible with meta-analysis techniques and help lead to estimates of thesize of the treatment effect, not only whether oneoccurred.

1980-1984

The first homeopathic study published in a majorclinical journal was a trial of homeopathic treatmentof patients with rheumatoid arthritis.65 Two homeo-pathic physicians examined 46 patients meeting

American Rheumatism Association diagnostic crite-ria for rheumatoid arthritis; the examinations wereconducted at The Centre for Rheumatic Diseases,Royal Infirmary, Glasgow, Scotland. The two examin-ing physician-homeopaths categorized the patientsby the clarity of their homeopathic cases. This is onemeans of controlling for the uncertainty of responseattributable to errors in remedy selection. Thepatients were then divided equally between treatmentand placebo groups by a third physician not other-wise involved in the clinical assessments. Thephysicians then used a matching strategy to assignpatients to placebo and control groups by the con-ventional medications they were taking to treat theirdisease. The investigators also attempted to equallydivide the subjects by disease severity. The 23 patientsin the treatment group received 20 different homeo-pathic medicines. The article contains no informa-tion about the concentration of the homeopathicremedies used in the study. The placebo powderswere indistinguishable in appearance from thehomeopathic remedies, and both were dispensed bydouble-blind protocol. The treatment period was 3months. During that interval the patients were seenfour additional times and the homeopath wasallowed to change the homeopathic prescription ifindicated by the patient’s condition.

Assessment criteria were laboratory data (com-plete blood count, sedimentation rate, serum bio-chemistry, and serology) collected at the beginningand end of the study, a pain rating along a visual ana-log scale (VAS), articular index of joint tenderness,grip strength in both hands, digital joint circumfer-ence, duration of morning stiffness, and functionalindex. An independent assessor who routinely per-formed these tasks for the clinic conducted the clin-ical assessments. Although the results of laboratorytests were unchanged at the conclusion of the studyperiod, all clinical measures excepting digital jointcircumference were statistically favorable to homeo-pathy, with p values less than .005. Improvement wasmost marked in patients with clear homeopathicsymptoms (i.e., those with the most obvious homeo-pathic prescriptions). There were no significant out-come differences between the examining physicians.

This trial would be a powerful landmark findingfor homeopathy if the data were incontestable. Theyare not. The differences in disease severity and ongo-ing medication use were inadequately controlled bythe design. The small sample precluded random sub-

76 C L A S S I C A L H O M E O P A T H Y

Page 84: Classical Homeopathy

group assignment. Variability among outcome meas-ures is found in all subsequent homeopathic trialsand is normal in clinical trials. The lack of variabilityin this study is surprising. These flaws make it diffi-cult to draw meaningful conclusions.

A study by Shipley and associates66 was the nexttrial of note. For this study, 24 adult females and 12adult males with osteoarthritis of the hips or kneesby clinical and x-ray examination were enrolled in adouble blinded RTC published in Lancet in 1983.Previous use of either study medication (fenoprofenand homeopathic Rhus toxicodendron) excludedpatients from the trial. Patients who did not meet themost essential homeopathic characteristics of Rhustoxicodendron (aggravation from initial movementwith improvement from continued motion and exac-erbation of pain from cold and damp) were excludedfrom the trial.

Two sets of patients were recruited. The 15 con-stituents of one group were specifically referred forhomeopathy at the Royal London HomeopathicHospital. The other group of 21 entered the studythrough two conventional hospital departments ofrheumatology.

The trial was a crossover design comparing feno-profen (600 mg tid), Rhus toxicodendron 6X dilution(1:1,000,000 or 1 × 10−6) tid, and placebo. Patientsreceived each treatment for 2 weeks in random order.Visual analog scales (VAS) and a four-point pain scorewere used to measure pain outcomes. Subjects werealso asked which of the three treatments they pre-ferred.

Two of the three patients who dropped out appar-ently did so as a result of the aggravation of symp-toms they experienced (customary while receivinghomeopathic treatment). The other drop outoccurred because a patient rose to the top of the wait-ing list for a hip transplant during the course of thetrial.

On nearly every measurement fenoprofen was sta-tistically superior to Rhus toxicodendron and placebo.The only significant adverse effects experienced bythe subjects occurred during the fenoprofen treat-ment phase. Despite the side effects, patients pre-ferred the fenoprofen over both Rhus toxicodendronand placebo, each by a 4:1 margin. There was no dif-ference in response among patients who had contactwith the study’s homeopaths.

Surprising to no one, homeopathic advocate orcritic, this study found that improperly used home-

opathy did not work for osteoarthritis. Although thisstudy appeared to be well designed to the conven-tional investigators, it was not from a homeopathicperspective and so brought down a rain of protest.Despite the experimenter’s cursory effort to screen forappropriate patients, the idea of using one of 1600homeopathic medicines for a common a problem likeosteoarthritis ignores basic homeopathic reasoning.Similarly, a treatment interval of just 2 weeks is likelyto document only the initial homeopathic aggrava-tion of symptoms common in chronic conditions. Adecline consistent with this expectation was clearlydocumented in five patients. Although the declinecould have resulted from terminating effective treat-ment, it could also have been the short-term homeo-pathic aggravation without sufficient observationtime allotted to document subsequent improvement.Also, the delayed effects of homeopathy make thecrossover design of this trial untenable.

One of the homeopathic investigators wrote thefollowing in response to criticism of the study’smethodology:

One cannot logically extrapolate from this any conclu-sions about other potencies of Rhus tox., other homeo-pathic remedies, or homeopathic medicine in general.The most important lesson that we have learned fromthis study is that a double-blind crossover trial of shortduration using a single potency of a remedy prescribedon local features is unlikely to be a fruitful method ofseriously studying homeopathic medicine.67

1985-1989

There have been a series of small but interesting trialsof the use of a homeopathic preparation made fromthe topical plant Galphimia glauca. The first was pub-lished in 1985.68 In this trial Wiesenauer and Gauscompared a 6X homeopathic preparation (1 × 10−6)with placebo and with a nonhomeopathic 1 × 10−6

simple dilution. Although the study was too small toachieve statistically meaningful results, they foundstrong trends toward efficacy of the homeopathicpreparation and equivalency of the placebo and simpledilution. This study is especially interesting because ofthe suggested differences between the homeopathicremedy, with its process of succussion and dilution,compared with the simple diluted material.

Homeopaths have long been at the forefront ofmedical science in allergic disease. The physician who

C H A P T E R 6 Homeopathic Research 77

Page 85: Classical Homeopathy

demonstrated that pollens cause hay fever was ahomeopath, and his findings were published in sev-eral issues of a homeopathic medical journal.69-75

Homeopaths also introduced low-dose allergendesensitization.76 Perhaps, then, it should not be sur-prising that the next important trial involved homeo-pathic treatment of airborne pollen reaction.

The publication of a study by Reilly and associ-ates77 marked the emergence of a series of investiga-tions by Reilly that only recently concluded. Thestudy involved 158 patients over age 5 with a historyof at least 2 years of seasonal rhinitis. The patientscame from two hospital-based homeopathic clinicsand 26 National Health Services general practition-ers’ offices across Britain. Recent use of allergy med-ication or immune suppressant drugs was one of theexclusion criteria.

Following randomization, the patients wentthrough a 1-week run-in period to develop a symp-tom baseline, then received 2 weeks of treatment anda final 2 weeks of observation. Patients recorded theintensity of the entirety of their symptoms on a 100-mm VAS. They also scored certain specific symptomson a 0 to 3 scale and logged the use of any of theescape medication (chlorpheniramine). These datawere recorded daily. At week three (end of the treat-ment phase) and again at the study’s end at week five,a physician assessment was also documented. Thestudy medication was a 30C dilution (1 × 10−60) ofmixed grass pollens most commonly associated withseasonal rhinitis in the United Kingdom.

The homeopathic treatment group showed a clearsymptomatic improvement. The response began inearnest in the second week of treatment and pro-gressed as the study continued. VAS scores improvedby 17.2 mm in the homeopathy group and 2.6 mm inthe placebo group (difference = 14.6 mm, 95% confi-dence interval [CI] 2.5-26.5 mm, p = .02). Althoughthe drop in symptom scores for the homeopathicgroup was significant ( p = .02), the drop in theplacebo group was not significant. Differencesbetween the patients’ prestudy and poststudy clinicalcondition by physician assessment also achieved sta-tistical significance ( p = .05). Use of antihistamineswas significantly higher in the placebo group. Thedata were analyzed after correction for pollen counts,disproving local pollen levels as a significant con-founding factor. The classic homeopathic pattern ofinitial aggravation followed by long-term ameliora-tion emerged from these corrected data.

The investigators cleverly applied homeopathicprinciples to develop another outcome measure.They used the run-in week to develop a baseline tomore clearly assess the initial response to the homeo-pathic remedy. There was a statistically significantdifference in the frequency of symptom aggravationduring the first week in the homeopathy groupcompared with placebo ( p < .05). Furthermore, thepatients who experienced an aggravation weremarkedly improved compared with the placebogroup ( p = .0004; 95% CI 18.4-52.6 mm).

There were two notable weaknesses in this trial.The first was that the principal outcome measure,the VAS, is not an objective instrument. However, thismethod of assessment is relatively common in certainstudies, particularly of allergic and rheumatologicdisease. It has the advantage of generally reflectingpatients’ perceptions of their disease state, whereasspecific symptom ranking might mislead us regard-ing the patient’s appreciation of the treatment orlack thereof. Given the controversial nature ofhomeopathy, highly objective data are most desirable.Laboratory data were collected but not reported.

The other flaw is a homeopathic matter. Theinvestigators used a homeopathic preparation madefrom material allergenic to most of the patients. Theydid not select a treatment specific to each patient’spattern of symptoms. We do not know if any of thepatients had a traditional homeopathic interview elu-cidating their symptoms. Therefore this was not atrial of classical homeopathy. This more superficialapproach was a reasonable compromise given thenearly nonexistent body of homeopathic research lit-erature of the time. In addition, although manyassume that classical methods are superior, final judg-ment on this matter awaits research confirmation. Ifthe approach used in this study (isopathy, as it is oftencalled—using something in homeopathic potency totreat reactions to material doses of the same sub-stance) is effective, it would be much easier to applyclinically than classical homeopathic practice.

In 1989, Lancet published an editorial entitled“Quadruple-blind.”78 Posing the question “Can blinddiscussion remove bias from the reader?” the writerwent on to describe a trial of an unspecifiedinfluenza treatment. After the description and a briefdiscussion of the respectable positive findings, theeditorialist closed with, “Now let the code be brok-en—the active treatment was a homeopathic prepa-ration.”78

78 C L A S S I C A L H O M E O P A T H Y

Page 86: Classical Homeopathy

The Lancet editorial referred to a study of 478patients with a clinical diagnosis of inf luenza,enrolled from the offices of 149 general practitionersin France.79 In this double-blind placebo controlledRCT, the homeopathic remedy was a preparationmade from duck heart and liver in the 200C potency(1 × 10−400). Worldwide this product is one of themost popular over-the-counter products for relievingthe symptoms of influenza.80

In the first 48 hours, patients in the active treat-ment group recovered at a rate nearly 70% greater (RR1.67, 95% CI 1.1-2.7, p = .03) than those receivingplacebo. The difference in recovery rate was strength-ened by data adjustment for covariates, includingage, intraepidemic timing of disease onset, treatmentdelay, symptom severity, and the use of antibiotics orother drugs for symptom control (RR 1.9, 95% CI 1.1-3.4, p = .02). Patients who received active treatmentalso required less medication for symptom relief ( p =.04). A significantly greater number thought theirtreatment was effective (p = .02).

Although the design of this trial was generallythought excellent, it was not perfect. Using the clin-ical diagnosis of inf luenza as the main admissioncriteria would be more acceptable for a later roundof research. Initial studies customarily involve rig-orously defined parameters (usually defined bylaboratory measures). The fact that this trial tookplace in a setting more typical of the averagepatient-physician encounter confuses interpreta-tion somewhat. On the other hand, because a “realworld” setting usually tends to weaken the treat-ment effect, it might actually strengthen the find-ing for homeopathy. Also, during the study,independent government immunologists workingin the region identified an epidemic inf luenza virus(A H1N1), thus supporting the belief that thepatients did have inf luenza.

In 1989, the British Medical Journal published PeterFisher and associates’ study of homeopathictreatment of fibromyalgia.81 Fibrositis, or primaryfibromyalgia as it called in the United States, frustratespatients and physicians alike because of the limitedeffectiveness of conventional treatments. A usefulalternative treatment would be welcome. The investi-gators also hoped to overcome the errors of previousstudies by designing a study that was truer to homeo-pathic principles and yet methodologically sound. Toa great extent they accomplished their objectives.They had previously learned that a great number

(42%) of their patients with this disease matched thesymptom pattern of the homeopathic remedyRhus Toxicodendron. This unusual congruence betweenhomeopathic and conventional diagnoses wouldallow the investigators a reasonably large pool ofpatients satisfying conventional and homeopathiceligibility requirements. In addition, the nature ofthis disease should lead to a more rapid responsethan would be expected in the arthritic conditionspreviously studied. These factors should make thestudy results more reliable.

Patients were recruited through the rheumatol-ogy department of St. Bartholomew’s Hospital inLondon. The screening process excluded patientswho did not meet conventional criteria for fibrosi-tis or homeopathic criteria for Rhus toxicodendron.Thirty adult men and women were selected and ran-domly divided into placebo and active treatmentgroups. Each patient received Rhus toxicodendron 6C(1 × 10−12) or identical-looking placebo three timesa day for 1 month and then crossed over to theother treatment. The choice of potency (low poten-cies are believed to act for a shorter period of timethan higher dilutions) and the characteristics ofthis disease minimize (but do not eliminate) errorscreated from the crossover design. Outcomes wereto be the number of tender spots, VAS measure-ment of pain and sleep, and overall assessment oftreatment.

Although patients showed a preference for thehomeopathic treatment, the difference was not sta-tistically significant; the other outcomes were sig-nificant. The number of painful spots was reducedby about 25% ( p < .005). After completing the trial,the investigators simplified the VAS data to “worse”or “better” and lumped the sleep and pain datatogether. Analyzing these data showed a significantimprovement with the homeopathic treatment ( p =.0052).

Although this study represented an improvement,it still had some problems. The crossover designcould be problematic, but if it were, the duration ofthe study would most likely bias the results against afinding for homeopathy. The VAS data processingmay be more of a problem. Post hoc alterations arealways open to criticism, as is the practice of combin-ing disparate information (the sleep and pain scores).Although it might be reasonable to attribute thesleep disturbance suffered by fibromyalgia patients topain, it might not.

C H A P T E R 6 Homeopathic Research 79

Page 87: Classical Homeopathy

1990-1994

In the 1990s, the pace of homeopathic research rap-idly accelerated. A number of important trials werepublished in many of the most prominent medicaljournals. As the meta-analysis came into vogue,academicians applied these tools to homeopathywith meta-analyses of the entirety of homeopathicresearch and of specific diseases.

Kleijnen, Knipshild, and ter Riet wrote a papertitled “Clinical Trials of Homeopathy,” published byLancet in 1991.82 The Dutch government funded theirevaluations of many different forms of alternativemedicine. Before writing this article, they had issuednegative reviews of iridology, acupuncture, andherbal medicine research. In addition to their con-ventional research expertise, these investigatorsclearly understood the issues raised by homeopathy’sunique theories. Their favorable assessment ofhomeopathic research surprised many, including theauthors themselves.

This group’s effort to uncover the maximum num-ber of homeopathic clinical trials was impressive andnecessary given Kleijnen and Knipschild’s83 later publi-cation demonstrating the limitations of searchingcomputer databases for studies of homeopathy andother CAM topics. In addition to searching MedLineindexed publications (1966-1990), they tracked downarticles referenced in those publications and in text-books. They scoured most homeopathic journals andthe records of the proceedings of homeopathic confer-ences. They also contacted homeopathic researchers,manufacturers, and libraries. Their diligence led themto 107 controlled trials worldwide.

The researchers demonstrated their knowledge ofhomeopathy with comments like, “Virtually no evi-dence exists about the correct choice of remedy andthe potency to be used (different potencies or homeo-pathic substances should be compared in controlledtrials).”82 And another: “[Homeopathy] is not justanother therapy but a distinct outlook in medicine,and several interpretations have developed, oftencontradictory to one another”82 They pointed outthat trials of classical homeopathic methods were asmall minority (14 of 107), with isopathy (like Reilly’srhinitis study) used in 9 trials and combinations ofhomeopathic remedies used in another 26. The mostcommon approach (58 of 107) was to give onehomeopathic medicine to all subjects with the sameconventional medical diagnosis.

The investigators excluded two trials from theanalysis because those trials merely compared onehomeopathic treatment with another. The trials wereranked by total scores derived from the following rat-ing categories: adequate description of patient char-acteristics (10 points), number of patients analyzed(30 pts), randomization (20 pts), well-described inter-vention (5 pts), double blinding (20 pts), relevant andwell-described effect measurement (10 pts), andresults presented in such a way that the reader couldrecheck the analysis (5 pts).

Kleijnen and associates found that the quality ofthe trials was generally not very good. For example,patient characteristics were adequately described injust more than half of the studies, and only 17 stud-ies described the method of randomization. Only oneof the trials considering classical homeopathy ratedabove 60 on the 100-point scale. To be fair, most con-ventional research from this time span was not agreat deal better methodologically. Still, the qualityof homeopathic research is clearly an important issuethat deserves the full attention of future investiga-tors.

Another problem was that the studies were typi-cally small. More than half of the trials involved sub-ject groups of 25 or less. Recruiting an adequate ofsubjects is usually problematic for any researcher.Given the controversy and lack of financial supportfor homeopathic research, performing larger trialshas been extraordinarily difficult.

Only 2 of the best 15 studies found against home-opathy. In no specific disease category did sufficientevidence exist to claim that homeopathy offeredeffective treatment for the condition. The authorsconsidered the possibility that a greater proportionof positive trials had successfully navigated the reviewprocess through to publication. Although they didnot evaluate this possibility systematically, theirintensive efforts to discover unpublished trials as wellas published ones should mitigate publication bias toan uncertain degree.

They summarized their findings as follows:

The amount of published evidence even among the besttrials came as a surprise to us. Based on this evidence wewould be ready to accept that homeopathy can be effica-cious, if only the mechanism of publication were moreplausible. . . . The evidence presented in this review wouldprobably be sufficient for establishing homeopathy as aregular treatment for certain indications. There is no rea-son to believe that the influence of publication bias, data

80 C L A S S I C A L H O M E O P A T H Y

Page 88: Classical Homeopathy

massage, bad methodology, and so on is much less inconventional medicine and the financial interests for reg-ular pharmaceutical companies are many times greater.Are the results of randomized double-blind trials con-vincing only if there is a plausible explanation? Arereview articles of the clinical evidence only convincing ifthere is a plausible mechanism of action? Or is this a spe-cial case because the mechanisms are unknown orimplausible?82

In 1991, the Scandinavian Journal of Rheumatologypublished a report by Andrade and associates of a 6-month trial of nonclassical homeopathy in the treat-ment of rheumatoid arthritis.84 The investigatorsused clearly defined clinical and laboratory inclusioncriteria to select 33 patients. Patients using steroidsequivalent to a dose greater than 10 mg of prednisonewere excluded. One homeopath saw all patients andinitially selected two homeopathic remedies for eachpatient. Homeopathic remedies were administeredtwice daily. One was prescribed based on the specificfeatures of joint symptomatology, whereas the otherwas selected by more general patient characteristics.Although the homeopath could change the pre-scribed remedy during the study, both practitionerand patient were blind as to the substance actuallyadministered to patients (i.e., whether it was active orplacebo).

The study’s results were mixed and confusing.Homeopathy achieved statistically significant im-provement in 15-meter walking time, Ritchiearticular index, functional class (Steinbrocker crite-ria), and prednisone dosage. The placebo groupachieved statistically significant improvement inRitchie articular index, prednisone dosage, andNSAID daily use. The homeopathic improvementwas superior to placebo in 15-meter walking time andfunctional class. Physician observers assessed theimprovement attributable to homeopathy as superiorto improvement attributable to placebo (59% vs 44%),but this was not statistically significant.

Careful review of the data suggests the possibilityof a type II error. In other words, there were consis-tent trends favoring homeopathy but the number ofsubjects may have been too small to demonstrate astatistically meaningful difference. The authors didnot mention a power calculation to help them prede-termine the requisite number of subjects needed todemonstrate their anticipated effect size. It would beincorrect to claim that these data would certainlysupport homeopathy if the study were larger. If a

larger study were to demonstrate statistical superior-ity over placebo, the lack of a clear difference in thistrial (small effect size) might suggest that that supe-riority would not be clinically meaningful. Anotherimportant homeopathic criticism of the study (inaddition to the nonclassical homeopathy used) is theabsence of global outcomes to measure changes inpatients’ well-being in addition to disease severity.

European medical journals have published thelion’s share of homeopathic research. In 1994,Pediatrics published the first homeopathic trial in amajor American medical journal, a study by Jacobsand associates of the treatment of acute childhooddiarrhea with homeopathic medicine in Nicaragua.40

Worldwide, the leading cause of death in children isacute diarrhea. Homeopathy is popular worldwide,including many third-world countries where thisproblem is most devastating. Homeopathy is well-suited for use in third-world countries for a numberof reasons, including its independence from labora-tory testing and its inexpensive medications. Forthese reasons and others Jacobs has conducted aseries of trials using homeopathy to treat acute pedi-atric diarrhea in underdeveloped countries.

Building on the experience of an earlier pilotstudy,85 children between age 6 months and 5 yearsreceived homeopathic treatment in Leon, Nicaragua,in a double-blind placebo-controlled RCT. Thepatients were enrolled through government-fundedclinics in impoverished neighborhoods. Childrenwithin this age range who presented with a history ofthree or more unformed stools in the previous 24hours were screened for the study. Exclusion criteriaincluded diarrhea over 1 week; receiving more thanone dose of an antibiotic, antiparasitic, or antispas-modic medication within 48 hours before the study;and World Health Organization (WHO) type C (mostsevere) dehydration. Type C patients were transferredto the hospital for treatment, as was the custom ofthese clinics.

Each child was examined according to conven-tional standards (including anthropomorphic data)and homeopathic standards. Stool specimens foreach child were analyzed for pathogenic organisms ata local hospital. At each data-collection point, inves-tigators graded the patients based on a previouslyestablished diarrhea score combining vomiting (0-2),abdominal pain by mother’s report (0-2), tempera-ture (0-3), unformed stools in past 24 hours (0-6), and WHO dehydration classification (0-2).

C H A P T E R 6 Homeopathic Research 81

Page 89: Classical Homeopathy

Experienced physician homeopaths conducted thehomeopathic evaluation, augmented by a computer-ized homeopathic expert system to maximize pre-scribing consistency.

Individualized homeopathic remedies in the 30C(1 × 10−60) dilution or an identical placebo were dis-tributed to each patient’s family. They were to givethe child one dose after every unformed stool andrecord the stool characteristics on a card.Community health workers made daily home visitswith each patient during the treatment. During thesevisits the workers reexamined the patients, answeredquestions, and reviewed the completed cards. Theyleft a new card for the parents to complete during thefollowing 24-hour period. Children whose conditiondeteriorated were referred back to the clinic. Thehomeopaths were not allowed to change their pre-scription during the course of each patient’s 5-daytreatment. Patients also received customary antidiar-rheal measures per WHO guidelines, including oralrehydration therapy and continuation of the child’snormal diet.

Of the 87 patients enrolled, 6 dropped out of thestudy (3 each in the treatment and control groups).Workers were unable to find the homes of 4, and thepatients’ parents wanted some other treatment in 2cases. The homeopaths prescribed 18 different reme-dies.

Jacobs found statistically significant differencesfavoring the treatment group for three of the fiveprincipal outcome measures: days to 2 consecutivedays of fewer than three unformed stools (1.5 days,p = .048); days to 50% improvement in unformedstools (1 day, p = .036); and mean diarrhea index score(0.4, p = .037). The intergroup difference in days tofirst formed stool (2.5 days, p = .054) andweight/height percentile change (5%, p = .30) did notachieve significance.

The data were also analyzed based on the pres-ence or absence of a pathogenic agent on culture (sev-eral strains of pathogenic E. coli, Rotavirus, Entamoebahistolytica, and Giardia lamblia). For all but theweight/height percentile change, patients infected bya pathogenic organism were much more likely torespond to homeopathic treatment than placebo,with p values ranging from .003 to .034.

I criticized the use of the diarrhea index scorebecause the WHO criteria were not weighted heavilyenough.86 Although type A patients did not have anysymptoms of dehydration and type C patients were

quite severely dehydrated (10% or more), the pointrange for this part of the scale was only 0 to 2. Lessimportant symptoms were assigned greater weight.Because the sickest patients responded most stronglyto the homeopathic treatment, correcting this bias inthe scoring system would have probably led to aneven more favorable outcome for homeopathy.

Another criticism was that the principal outcomemeasure—number of days to achieve 2 consecutivedays of fewer than three unformed stools—only nar-rowly achieved statistical significance with a p valueof .048. A p value of .05 or less has become a magicalboundary between truth and falsehood. Although itis an accepted demarcation, in reality it is an arbitrarydivision. The difference between .048 and .051,although practically ephemeral mathematically, ispsychologically massive. More recently, the sameinvestigators conducted a similar trial in Nepal; thistrial’s similar results add further weight to the beliefthat homeopathy effectively treats acute childhooddiarrhea.87 In this study, they arranged to have ran-dom samples of the study medication analyzed by anindependent laboratory, thereby short-circuiting crit-icism that the homeopathic remedies used in the firsttrial could have been adulterated.

1994 was a landmark year for homeopathic clinicalresearch. In addition to Jacob’s study, two other majorhomeopathic trials were published that year. InNovember, the British Medical Journal published deKlerk and associates’ highly labor-intensive trial ofclassical homeopathic treatment as a preventive meas-ure in children prone to upper respiratory infections.88

Many homeopaths believe that treatment strengthenspatients, thereby making them more resistant to manyhealth problems, including infectious disease. Thisstudy formally tested that assumption.

Children between 18 months and 10 years of agewho had at least three upper respiratory infections inthe prior year, or a history of two upper respiratoryinfections in the prior year and otitis media witheffusion at the time of the entry examination, werecandidates for this trial. Children who had had a ton-sillectomy, adenoidectomy, any of a large variety ofchronic health conditions, or recent homeopathictreatment for chronic health problems were excluded,as were children for whom the prescribing homeo-path was unable to confidently choose a homeo-pathic remedy.

There were two elements to the treatment interven-tion. Parents received written instructions about dietary

82 C L A S S I C A L H O M E O P A T H Y

Page 90: Classical Homeopathy

interventions to help improve their child’s health. Thehomeopathic intervention was individualized, classicalhomeopathic treatment prescribed in every case by theprincipal investigator. The investigator/clinician man-aged each patient’s care for up to 1 year.

The study ran for a bit less than 5 years. Althoughvisits typically occurred at 2-month intervals, deKlerk was personally available every day of the trial byphone and was able to change the homeopathic pre-scription at any time. However, she did not knowwhether the patient was receiving active or placebotreatment. Each patient remained in either theplacebo or homeopathy group for the duration oftheir participation in the trial.

Every 2 weeks investigators retrieved a variety ofsymptomatic and behavioral data from parentaldiaries. They used these data to develop a daily symp-tom score (DSS) weighted toward respiratorysymptoms (range 0 to 56, with respiratory symptomsaccounting for up to 42 points). The predeterminedprincipal outcome measure was the calculated meanof the DSS for individual patients and the treatmentgroup as a whole. In addition, investigators collectedinformation about other medical care. Data were ana-lyzed from the 170 patients who completed morethan 26 weeks of care (five participants dropped out:two from the homeopathy group, three from theplacebo group).

The incidence rate of possible confounding fac-tors (including family history of allergic disease,smoking in the home) was the same in each group.The difference in mean DSS favored homeopathy ineach of the three age groups (18 months to 2 years, 2to 5 years, and 6 to 9 years) for both the 1-year studyand for the other data split, which used only the datafrom the last 9 months of the trial. None of these sixcomparative advantages for homeopathy achievedstatistical significance; p values ranged from .06 to.09. The mean percentage of symptom-free days alsofavored homeopathy, but again to a degree less thanstatistical significance.

The antibiotic usage data are worthy of furtherdiscussion. The number of antibiotic courses favoredhomeopathy in all but 1 of 15 group comparisonsand in total antibiotic courses, 77 to 59. Again, thistrend was not statistically significant. Compared withpretrial history, the number of children taking antibi-otics dropped markedly in both treatment (73 to 33)and placebo (69 to 43) groups, but the differencebetween the groups was not significant ( p = .38).

The rate of surgical interventions (e.g., adenoidec-tomy, tonsillectomy, pressure equalizing [PE] tubes—also known as grommets, paracentesis, and sinusdrainage) favored homeopathy. Once again, theseresults did not reach the point of statistical signifi-cance.

This study is one of the most interesting homeo-pathic clinical trials to date because of the numerousdiscussion points it raises. A few months after publi-cation, the principal investigator presented theresults of the study at the Second HomeopathicResearch Network Symposium, held that year inWashington, D.C. The presentation engendered alively discussion. One criticism was that a singlehomeopath (the principal investigator) treated everypatient; thus the question of her homeopathic skill isvitally important. Although this particular criticismis important and has been heard many times (thefirst study criticized on this basis was published in1835), the greatest controversy centered on the inves-tigators’ conclusion that homeopathic medicinesproduce no clinically relevant improvement in recur-rent upper respiratory tract infection.

The authors themselves pointed out that the dif-ference in mean DSS could have been reduced by thedifference in antibiotic usage. Because the placebogroup used more antibiotics, the antibiotics mighthave altered the clinical course of those patients (aswas undoubtedly the intention of the prescribingphysicians), thus reducing the DSS and the differencebetween placebo and homeopathy groups. Thisexpected reduction could easily have prevented a sta-tistically significant finding in favor of homeopathy.

If the DSS scoring were reliable, there would beanother statistical issue. Many statisticians believethat best way to look at data like the DSS data is tocompare the change in DSS in each patient and thencompare changes in the weighted group mean. This isconventional procedure in studies using a conti-nuous variable such as peak expiratory f low inasthma studies.

As a clinician, one of the most striking aspects ofthis study is the significant improvement experi-enced by the placebo group. This improvementcould be the result of a declining rate of upper res-piratory infection in children as they age. It couldalso be a result of the broader components of thehomeopath’s treatments in this study. In additionto prescribing remedies, the classical homeopathtraditionally counsels patients about health-

C H A P T E R 6 Homeopathic Research 83

Page 91: Classical Homeopathy

promoting lifestyle changes and helps the patientavoid needless medication use by education. Theprincipal investigator decided to compare theentirety of the homeopathic approach with all ofhomeopathy, except the remedy. The placebo groupexperienced the intensive questioning and decision-making process all the way through remedy selection.Both homeopathy and homeopathy-without-the-remedy appeared helpful, but the importance of theremedy hovered at the threshold of respectability. Asa clinician, my primary goal is helping my patientsget better. Both patient groups in this studyachieved that goal and improved impressively.Sharing this clinical bias and considering thestudy’s other problems, the consensus of the groupof homeopathic researchers at our meeting was thatthe authors’ conclusions were unwarranted, over-simplified, and probably misleading.

De Klerk’s study was an attempt to look at theeffects entirely attributable to the homeopathic rem-edy itself. Although this was a laudable attempt,unfortunately the methods were seriously flawed.Because this was, in many ways, a good study, thecontroversy surrounding it highlights the complexityof homeopathic research and even the morefundamental question, “What is homeopathy?” Ishomeopathy the remedy, the entire classical home-opathic clinical process, or something in between?

Also in 1994, Lancet published another install-ment in the Reilly and associates’ homeopathicimmunotherapy series, including a meta-analysis ofthe series to date.89 An asthma clinic in west-centralScotland served as the recruitment center forthis trial. Eligible patients were bronchodilator-responsive adults with more than 1 year of asthmawho reacted to inhaled allergens and had positiveallergic skin tests. After being screened by a homeo-path and one of the asthma clinic physicians, thepatients received skin and pulmonary function test-ing followed by a 4-week single-blind placebo run-inperiod. The conventional and homeopathic physi-cians excluded unsuitable patients.

Investigators randomized the subjects intogroups stratified by their daily dose of inhaledsteroids and the allergen to which their skin reactionwas most pronounced. In a double-blind protocol,subjects received a homeopathic remedy in the 30Cdilution (1 × 10−60) prepared from the allergen towhich their skin test reaction was the most pro-

nounced. The study period continued another 4weeks (except for patients who wished to extend theirtreatment even longer with an additional 4 weeks).Although investigators collected a variety of data(e.g., pulmonary function testing, symptom diaries,rescue medication use, IgE antibody titers), the prin-cipal outcome measure was a VAS worded identicallyto the VAS used in the previous trials.

Although many data sets showed trends favorableto homeopathy, they did not generally achieve statis-tical significance. The blinded homeopathic physi-cian and patient rated homeopathic treatment moreeffective ( p = .04). The homeopathic doctor was morelikely to correctly identify which patients hadreceived placebo than the nonhomeopath. The VASresults strongly favored homeopathy ( p = .003), witha difference of 33%.

The authors then performed a meta-analysis bycombining the VAS data from this trial with the sameinformation from the two previous studies. The com-posite p value from the pooled data was p = .0004,leading to the conclusion that “either answer sug-gested by the evidence to date—homeopathy works,or the clinical trial does not—is equally challenging tocurrent medical science.”89

Although some trials have been quite favorable tohomeopathy, few of them have been replicated.Reilly’s series is exceptional in this regard. However,the subjectivity of the principal outcome measure,the VAS, dims the achievement in the eyes of some.Although the diseases Reilly studied were all atopic,the symptomatic manifestations of the immunologicdisturbance differ. This difference calls into questionthe decision to combine the trials in a meta-analysis.It also makes it difficult to find a unified measuringscale, thus Reilly’s use of the VAS.

Had other, more traditional measures achievedsignificance, this would not have been an issue. Forexample, the most common measure of clinical bene-fit in asthma is the forced expiratory volume in onesecond (FEV1). In this latest trial, the change in FEV1favored homeopathy, but not significantly ( p = .08).Although there is little reason for such a concern,theoretically this disparity between a patient’s subjec-tive sense of improvement and possibly unimprovedclinical condition could lead to inappropriate under-medication. Given the small size of this study, a typeII error could easily account for the insignificantchange in FEV1.

84 C L A S S I C A L H O M E O P A T H Y

Page 92: Classical Homeopathy

1995-1999

One of the most popular applications of homeopathyis for postinjury healing. Homeopathic Arnica, admin-istered following trauma, may be the most commonfirst experience of homeopathy. Kleijnen’s 1991 meta-analysis82 found that the outcomes of 18 of the 20 tri-als of homeopathy in trauma were favorable tohomeopathy. To test the efficacy of homeopathy as atreatment for acute trauma, a group of Norwegianinvestigators recruited a group of healthy youngadults facing surgery for impacted wisdom teeth.90 Ofthe 24 patients who participated in the study, 14 werestudents at the Norwegian Academy of NaturalMedicine and were therefore enthusiastic about par-ticipating in a trial of homeopathy.

The experimenters standardized the surgical pro-cedures and anesthetic for the patients. Each patienthad two surgeries, one for each side of the mouth.One surgeon performed all of the surgeries. Bothprocedures for each patient took place at the sametime of day (with two exceptions). Each patient’s pro-cedures were performed on the same day of the week.Two homeopaths treated the patients with homeo-pathic remedies selected by classical symptomaticindications. The article is unclear as to whether thehomeopaths discussed the choice of the patients’homeopathic remedies. The patients received homeo-pathic remedies at uniform intervals regardless ofclinical response. Codeine pain medication was avail-able to those patients who needed it.

The trial design included subjective and objectiveoutcome assessments. One measure was a series of 28VAS ratings of pain. Observers measured facialswelling and ability to open the mouth with mechan-ical devices. They also recorded complications, mostnotably postoperative bleeding.

Most patients received homeopathic Arnica. Thenext largest group was patients receiving phospho-rus. There was no significant crossover effect. Theonly statistically significant difference in favor ofhomeopathy was a reduction in trismus (inability toopen the mouth). The authors criticized theirown study design because a previous trial had shownArnica ineffective at the same concentration usedin this trial.91 They also noted the surprisingly lowpain levels experienced by the placebo group: “Thephysicians believe that the low pain scores and satis-faction of the patients may at least partly reflect theclinical skill of the two homeopaths.”91 Although

this interpretation, if correct, would support thebenefits of the homeopathic process, and althoughthe significant reduction in trismus might be mean-ingful, it is difficult to interpret this trial as favor-able to homeopathy. The studies’ lack of power dueto the small number of subjects might be a signifi-cant problem because intergroup differences of 30%to 40% would have been needed to achieve statisticalsignificance.

The Journal of the Royal Society of Medicine pub-lished another study of homeopathy in surgicaltrauma in 1997.92 A total of 73 patients completedthis trial of homeopathic Arnica as a specificpreventive for postoperative pain and infection fol-lowing total abdominal hysterectomy. The patientsreceived two doses of Arnica 30C in the 24 hours pre-ceding surgery, and three doses every day for the sub-sequent 5 days, or an identical placebo regimen.

There was no difference between the active andplacebo groups in pain, medication use, hospitalstay, or rate of complications. When the means wereadjusted by analysis of covariance, patients in theArnica group might have recovered more rapidly. Thisdifference could have been a result of the youngeraverage age and simultaneously longer surgical timesamong the Arnica patients. Because of the longer sur-gical times, this group may have felt worse immedi-ately following the procedure, and younger patientsare known to recover more rapidly.

As have other studies, this investigation produceddata suggesting support for the expectation ofhomeopathic aggravation. Pain scores rose in the 12hours following treatment with Arnica, although notto a statistically significant degree.

The acupuncture literature appears to show thatgeneral anesthesia might block acupuncture’s effec-tiveness in certain circumstances.93 This has yet to beinvestigated in homeopathy but could have been aconfounding factor in this trial because of the differ-ence in anesthetic usage between study groups.

The other weaknesses of this study involve thehomeopathic dose. The correct homeopathic dose isalmost entirely speculative; it is seldom researchedand is the source of many disagreements amonghomeopathic clinicians. Theoretically, the clinicaleffects of different doses should vary. Although moremodest, the effect of an imperfectly chosen doseshould still be demonstrable. If not, how could home-opathic clinicians reliably help patients to any signif-icant degree?

C H A P T E R 6 Homeopathic Research 85

Page 93: Classical Homeopathy

Another dose-related issue is the prophylacticadministration of homeopathic remedies. The indi-cations for homeopathic medicines are a patternof clinical symptoms, such as bruising or pain aftertrauma. Some homeopaths argue that using Arnicaprophylactically before symptoms are present runscounter to homeopathic theory and therefore shouldnot work.

The authors suggested that further trials ofhomeopathic Arnica focus on tissue trauma andbruising rather than pain and wound healing. Theybased their recommendation on the findings of theirtrial and others. Even this adjustment of expecta-tions, incompletely rejecting the efficacy of Arnica inthe context of postsurgical trauma, runs counter tocustomary use of homeopathic Arnica, which is prac-tically unchallenged as the correct initial treatmentfollowing physical trauma. Perhaps homeopaths havescuttled homeopathic principles in the routine use ofArnica.

There have been a series of trials of the use ofhomeopathic Arnica in distance runners. Two wereconducted at the Oslo marathon in 1990 and1995.94,95 These studies were small, and althoughall of their outcome measures demonstrated positivetrends, only one of these measures was statisticallysignificant. That advantage for homeopathy was therunners’ pain measurement immediately after themarathon ( p = .017).

A much larger English study of runners, includ-ing 262 marathon runners, was designed to duplicatethe Oslo trials.96 The only outcome favoring home-opathy in this larger trial was a 2% to 3% improve-ment in runners’ times. There was a similar reductionin homeopathically treated runners’ times in bothOslo trials. In those trials the difference was not sig-nificant, possibly because of a type II error with thesmall effect size coupled with a small study popula-tion. The sole significant finding in Oslo, the imme-diately postmarathon pain level, was not assessed inthe English study.

Although the English trial adds some additionalevidence against homeopathic Arnica generally, thematter is clearly unsettled. The favorable findings—enhanced performance and immediate pain reduc-tion—bear further investigation. Are these findingsan indication of homeopathy as an athletic perform-ance-enhancer or merely a result of the laws of prob-ability leading from multiple measurements to asolitary positive outcome?

In 1997, a German medical journal published ameta-analysis of 11 trials using a single homeopathicremedy, Galphimia glauca, for relief of eye symptomscaused by airborne pollens.97 All of these trials hadbeen conducted by the authors of the meta-analysisover a 10-year period. The trials included a total of1038 subjects. Seven of the trials were double-blindplacebo-controlled RCT design (752 subjects).Patients in the treatment group were 1.25 times aslikely to improve as those in the placebo group (95%CI 1.09-1.43).

Lancet published another meta-analysis of theentirety of homeopathic clinical trials in 1997.98

Linde and associates searched the conventionallypublished literature as well as conference proceedingsand books. They also contacted researchers, publish-ers, and manufacturers in search of homeopathicRCTs published in any language. They found 189 tri-als, 119 of which met inclusion criteria. Of thosemeeting inclusion criteria, 30 were excluded becauseof inadequate information to conduct the meta-analysis.

Linde calculated an odds ratio favoring homeo-pathy over placebo of 2.45 (95% CI 2.05-2.93).Limiting the meta-analysis to the 26 good qualitystudies reduced the odds ratio to 1.66 (95% CI 1.33-2.08). Publication bias tends to favor positive find-ings. Applying a statistical technique called funnelplotting (which is used in meta-analyses to eliminatethe effects of publication bias) to the high quality tri-als, they found an odds ratio of 1.78 in favor ofhomeopathy (95% CI 1.03-3.10). In addition, theyfound good support for homeopathic effectiveness incertain conditions (seasonal allergies and postopera-tive ileus), but the data were not strong enough toconstitute convincing evidence of efficacy.

This meta-analysis had an ambitious reach.Although 189 RCTs would have been an unimagin-able sum a decade ago, it is still a small number. As aconsequence of the relatively small number coupledwith the lack of any organized effort to selectivelyresearch certain clinical conditions, this meta-analysis had to combine data from studies of entirelyunrelated medical conditions. This approach is notunreasonable, but results must be interpreted cau-tiously. Some argue that pooling unrelated positivetrials could erroneously add up to a conclusion thathomeopathy is an effective therapy across the rangeof medical conditions. As usual, there is another sideto these arguments. Pooling data from multiple

86 C L A S S I C A L H O M E O P A T H Y

Page 94: Classical Homeopathy

clinical conditions might obscure the value of home-opathic treatment if homeopathy is effective for cer-tain of the conditions studied but not for others.

Repeating trials with closely parallel designs is animportant step in the process of proving efficacy.Seeking out more uniform data sets, Linde98 alsoclustered and evaluated the trials by disease-specificcriteria. Unfortunately, the data were too limited toreach definitive conclusions. To more fully appreciatethe tenuous state of the research, consider the twoareas of homeopathic practice with the clearestresearch support. Every trial of postoperative ileushas been positive—except one. That one study was thelargest and best designed. It found homeopathy nobetter than placebo. Pollinosis (hay fever) studiesoffered another disease-specific research cluster. Fourstudies were sufficiently similar to allow data poolingwith a reasonable expectation of accurate interpreta-tion. Although these pooled data were impressive,and were collected at multiple sites with different cli-nicians, the same principal investigator supervised allfour trials. The authors believed it necessary that atleast two independent groups of investigators repli-cate positive studies to confirm an original finding.So once again, the reliability of many homeopathicstudies is not as incontestable as would be ideal.

Linde and associates concluded that their find-ings were “Not compatible with the hypothesis thatthe clinical effects of homeopathy are completely dueto placebo.”98 They advocated continued research butonly if that research were of high quality: “We believethat a serious effort to research homeopathy is clearlywarranted despite its implausibility.”98 Specifically,they recommended that researchers attempt todevelop laboratory models to explore possible mech-anisms, replicate trials, and research clinical effective-ness rather than placebo differentiation.

Linde’s recommendations deserve further com-ment. Because the absence of a well-accepted mecha-nism of action is an insurmountable intellectualbarrier for many, discovering one would affectattitudes toward homeopathy immeasurably. It isessential that favorable clinical trials be confirmedthrough replication by independent researchers.

Linde’s final recommendation that future studiesfocus on clinical effectiveness rather than placebodifferentiation may be the most important recom-mendation to come out of this study. It is certainlycongruent with the growing movement toward out-comes research. Although demonstrating a difference

from placebo is scientifically important, the questionof the treatment’s ability to relieve the patient is farmore important to the patient and to health careproviders. If the benefit is statistically significant butclinically imperceptible, no one will be satisfied.

Weiser, Strosser, and Klein investigated a specifichomeopathic treatment for vertigo. The resultsof their investigation were published in Archives ofOtolaryngology—Head and Neck Surgery in 1998.99

Subjects were diagnosed with acute or chronic vertigoand must have had three or more attacks of moder-ate to severe vertigo in the week before entering thestudy. Exclusion criteria were newly treated chronicvertigo, vertigo caused by tumor or drug use, and his-tory of a recent myocardial infarction or other diseasecontraindicating the use of betahistine.

This was a double-blind RCT using treatmentsthat were identical in appearance and taste. Threetimes a day for 42 days the subjects received 15 dropsof a homeopathic combination or oral betahistine.Betahistine is considered an effective and standardtreatment for this condition in Europe. Investigatorsmade the decision to compare the homeopathicintervention with active treatment rather thanplacebo because denying an effective conventionaltreatment for an illness that creates significant mor-bidity would have been unethical. The homeopathictreatment was a proprietary combination of homeo-pathic remedies that are commonly used individuallyto treat vertigo or motion sickness. Each was pre-pared as a homeopathic dilution to various degrees (1× 10−3 to 1 × 10−8 [Ambra grisea 6X, Anamirta cocculus4X, Conium maculatum 3X, and Petroleum rectificatum8X]).

Predefined outcomes measures were the fre-quency, duration, and severity of vertigo episodesand, secondarily, health-related quality-of-life meas-ures. Both groups experienced adverse effects; nauseaand tremor of the hands in the homeopathy groupand headache in betahistine group. There were ninedropouts. Of the seven participants who dropped outas cured, four were from the homeopathic group. Inaddition, two patients from the betahistine groupquit because of intolerance of the medication.

All measures were improved in both groups.There was no difference in patient outcomes betweenthe groups. Although patients in the homeopathicgroup had a 60% greater reduction in the frequencyof their attacks, this difference did not achieve statis-tical significance.

C H A P T E R 6 Homeopathic Research 87

Page 95: Classical Homeopathy

Limitations of the study are common to manyclinical trials. Because many clinicians are not overlyimpressed with the effectiveness of conventionaltreatments for vertigo, a placebo group would havebeen scientifically desirable but ethically unaccept-able. 90% of participants did not have a definitivediagnosis for the cause of their symptoms, thus it ispossible that disparate clinical conditions were com-pared. However, initial empiric treatment of patientswith new-onset vertigo is customary in primarycare medicine. Because more than 70% of the studypatients had never before been treated for vertigo, thestudy reasonably mimicked standard clinical practice.

These imperfections are not significant. Thisstudy suggests that homeopathy is as good as onewidely used conventional medication for vertigo.Given the absence of dropouts from the homeo-pathic group because of adverse effects, the equalityof clinical benefit found here argues that homeo-pathic treatment may be superior to conventionaltreatment for vertigo.

In 1997, two studies of classical homeopathy as atreatment for chronic headaches were published.These trials followed a highly positive trial reportedby Brigo100 at an international homeopathic confer-ence. Although the initial trial was positive and rela-tively well designed, the follow-up trials were negativeand better designed than the original.

Walach and associates’ trial incorporated a designelement that has been a topic of discussion at a num-ber of homeopathic research meetings.101 Becauseclassical homeopathic treatment demands individu-alized treatment, it is difficult to study. However,classical homeopathy is generally considered theideal model of homeopathic practice, so this methodshould be tested despite the inherent difficulties. Astudy of classical homeopathy that uses a single pre-scribing homeopath is always open to criticism ongrounds that the homeopath’s skills are subpar andtherefore his or her treatment is likely ineffective. Toovercome this uncertainty, a panel of homeopaths,which prescribed by consensus, treated Walach’s sub-jects. There was no difference in response betweenhomeopathic medicine and placebo. One flaw in thestudy was unbalanced randomization; there was alarge numerical difference between placebo andhomeopathy groups.

Later the same year, Whitmarsh, Coleston-Shields, and Steiner’s trial of classical homeopathy asa prevention for migraines was published.102

Investigators excluded patients if the homeopathicremedy believed to be their chronic remedy (similli-mum) was not one of the 11 medicines preselected foruse in the study. Although the risk ratio was 2.13,favoring homeopathy, the 95% CI included 1; there-fore both groups could be identical, thus precludingsignificance. As did Walach’s trial, this well-designedstudy found no difference between homeopathy andplacebo. There were questions about intergroup dis-parities in the baseline status of patients, but this dif-ference was of questionable significance.

At the end of 1997, I was part of an internationalgroup of human and animal researchers thatgathered under the sponsorship of Commonweal, theHarvard Center for Alternative Medicine Research,the John E. Fetzer Institute, the Geraldine R. DodgeFoundation, and the StarFire Fund to develop a con-sensus statement on the current state, problems, andprospects of future research in homeopathy.103 Thefollowing comments from that statement are relevantto our discussion.

The first comment arose out of our recognitionof the tantalizing yet frustratingly inconclusivenature of both human and animal clinical research atthe time.

Anecdotal reports in veterinary clinical practice usinghomeopathy mirror the results in human medicine.While veterinary clinical research in homeopathy hasresulted in hundreds of citations in the veterinary liter-ature, there have been few high quality controlled tri-als.

Several hundred experimental animal studies havedemonstrated positive results but much of the researchis of low quality. The areas of study include toxicologyand biochemistry in the modulation of in vivo and invitro enzymatic activity using preparations at homeo-pathic levels of dilution. Increased excretion of toxicsubstances have been enhanced by homeopathic pre-parations.103

What follows is our comment regarding mecha-nism of action:

Theories have been proposed for a mechanism of actionfor homeopathy, yet results of basic sciences researchhave been inconclusive. No current mechanism of actionfor ultra-high dilutions is known today and there areinconsistent research strategies being pursued at thepresent time.

On the other hand, fundamental principles of home-opathy such as the biological action of the micro-dose,hormesis, and the similia principle are consistent with

88 C L A S S I C A L H O M E O P A T H Y

Page 96: Classical Homeopathy

recognized mechanisms of action of treatments that areused therapeutically in some areas of conventional medi-cine.103

In closing, the group made the following recom-mendations:

Further scientific exploration of homeopathy and itseffectiveness should be evaluated in relation to many ofthe challenging issues in health care today. These includeefficacy, safety, toxicity, prevention, cost-benefit, qualityof care and outcomes research.103

Classical homeopathy is often considered the“holy grail” of clinical homeopathy. Homeopathsexpect classical homeopathy to be the most effectivetreatment for patients. The classical method is themost time-consuming and difficult to implement.Studies of classical methodology are similarly diffi-cult and are therefore relatively rare, despite theexpectation that classical homeopathy would be opti-mal for investigating the pinnacle of homeopathiceffectiveness. In 1998, the Journal of Alternative andComplementary Medicine published Linde andMelchart’s meta-analysis of clinical trials of classicalhomeopathy.104

The authors included all studies published up toMay 1998 in their meta-analysis. They found 32 stud-ies, with 6 “likely to be have good methodologicalquality” and another 6 “unlikely to have majorflaws.”104 Overall the findings were favorable tohomeopathy (pooled rate ratio 1.62, 95% CI 1.17-2.23). Because the CI range is greater than 1, this wasa significant finding. However, restricting the pool tothe best studies did not demonstrate superiority ofclassical homeopathy over placebo (rate ratio 1.12,95% CI 0.87-1.44). Although four of the six best stud-ies found a rate ratio higher than 1, thus favoringhomeopathy, in five of the six the 95% CI included 1.Definitive answers are elusive.

When the U.S. Congress created the Office ofAlternative Medicine within the NIH, one of the pur-poses was to encourage research in CAM therapies. In1999, the results of the first homeopathic trialfunded by this office (now the National Center forComplementary and Alternative Medicine) were pub-lished.105

Mild traumatic brain injury (MTBI) affects750,000 Americans annually, and 5% to 15% ofpatients with MTBI experience persistent symptomsand disability for more than 3 months after a trau-matic injury to the brain. Although the pattern of

short-term recovery from MTBI is unpredictable,complete recovery is rare when symptoms persistbeyond 6 months. The social and economic costs ofMTBI are estimated at $3.8 billion annually.

Investigators studied 61 Boston-area adultpatients meeting standardized criteria for MTBI withsymptoms persisting more than 3 months (mean2.93 years, range 4 months to 16 years). Most of thesepatients continued to suffer deficits that impairedtheir functional ability. Investigators selected 18homeopathic remedies suitable for symptoms experi-enced by MTBI patients. The remedies were selectedbased on case reports and symptoms documented inthe homeopathic literature that paralleled com-plaints of MTBI patients. The principal investigatorwas an experienced homeopathic physician. He chosethe remedies for each patient in consultation with apsychiatrist on the staff of the rehabilitation hospitalthrough which the study was conducted. There is noreference in the article regarding the psychiatrist’shomeopathic training, if any. The patients receivedeither placebo or the selected homeopathic remedy inthe 200C potency (1 × 10−400). Most patients receivedthis dose three times at 12-hour intervals at the out-set of the study. Patients who were using conven-tional medication took the study medication (orplacebo) daily for 7 days. Every patient, even thosefrom the study medication group, then received adaily placebo for the duration of the study (4months). The homeopathic physician was allowedto change the prescriptions of patients who werenot responding adequately, but did not know whichgroup (active or placebo) the patients were assignedto.

The principal outcome measure was a scale tradi-tionally used by the staff at the study hospital toassess patients’ clinical condition. Patients in thetreatment group improved significantly comparedwith those in the placebo group. The greatestimprovement occurred in the group of patients withthe lowest expectation of improvement, those withthe longest-standing symptoms.

Only one patient experienced the classicalhomeopathic aggravation of symptoms. Approx-imately 10% of homeopathic patients experiencedsome “minimal” adverse effects, including onepatient with nausea and another with depression.Concurrent use of conventional medicine did notaugment, interfere, or apparently interact with home-opathic treatment in any way.

C H A P T E R 6 Homeopathic Research 89

Page 97: Classical Homeopathy

The authors point out that the compromises theymade to adapt homeopathy to their research model,by restricting the number of homeopathic remediesallowed and limiting follow-up to 4 months, proba-bly reduced the effect of the homeopathic treatment.They recommended a larger and longer trial allowingthe use of all homeopathic remedies. A longer trialwould also satisfy critics because placebo-inducedimprovement tends to be short-lived. This positivefinding is heartening because we lack effective treat-ment for MTBI in conventional medicine. Furtherexamination of homeopathic treatment of this con-dition appears justified.

In 1999, Linde and associates, authors of the 1997Lancet meta-analysis,98 revisited the data to considerthe effect of various indicators of methodologicalquality on study outcome.106 They found a cleartrend toward smaller effect sizes among the most rig-orous trials. Double-blinding was the most influen-tial factor. They concluded that this evidence of bias,coupled with the high-quality negative trialspublished following the 1995 cut-off date for theirmeta-analysis, meant that they likely had “at leastoverestimated the effects of homeopathic treat-ments.”106 Although the tendency for more rigoroustrials to yield more modest effect sizes is customaryin conventional medicine as well, this article serves asa cautionary reminder of the hazards of interpretingmeta-analyses.

2000-2001

In 2000, Jacobs and associates repeated their earlierstudy of acute childhood diarrhea, this time inNepal.87 Again they found significant reduction inthe duration of pediatric diarrhea in response tohomeopathic treatment. Although the reduction wasmodest, any positive effect on an illness that is theleading cause of pediatric mortality in much of theworld should be respected and replicated by inde-pendent researchers.

In August of 2000, the British Medical Journal pub-lished Taylor and associates’ study of homeopathicimmunotherapy, the final installment in the series ofReilly’s studies).107 As in the three previous trials,patients with atopic inhalant allergy received treat-ment with a 30C dilution (1 × 10−60) of their principalallergen. Patients with allergic rhinitis for more thana year who passed a variety of exclusionary criteria

(including mechanical nasal obstruction, respiratoryinfection, pregnancy, breast feeding, recent corticos-teroid use, serious illness, and recent conventionalallergic desensitization) were skin-tested to deter-mine the allergen to which they were most sensitive.Patients received three doses of placebo during a 2-week run-in period. Qualifying patients were thenrandomized to receive three doses of active or placebotreatments taken within the initial 24 hours of thestudy.

Investigators measured several outcomes. Patientsused an instrument recognized as a valid measuringdevice for nasal inspiratory flow. Previous conven-tional studies have established a range of 13 to 18.5L/min increase as an indication of significant clinicalimprovement. Consistent with previous trials, thepatients graded their general condition every day ona VAS. As with previous trials, random samples of thestudy medication were analyzed for contaminationwith conventional allergy medications or house dustmite antigen. The placebo was indistinguishable intaste, smell, and packaging. Although the placebo didnot contain the starting allergen, it was diluted andshaken in the same manner as the active prepara-tions.

Patients in the placebo group averaged 2.5L/minimprovement in nasal inspiratory peak flow com-pared with 22.3L/min in the homeopathy group ( p =.0001, 95% CI 10.4-29.1). This improvement was com-parable to that achieved by nasal steroids. Unlike pre-vious trials, the VAS data did not show a significantdifference ( p = .82, 95% CI 9.8-7.8). A greater percent-age of homeopathic patients (29%) experienced theclassic homeopathic aggravation of symptoms by 48hours than did placebo patients (7%). This differencewas statistically significant ( p = .04). The investigatorsspeculated that the high percentage of homeopathicaggravations adversely colored the perceptions of thesubjects, leading to disappointing VAS scores in con-trast with the positive objective outcome measures.

Because the ultimate outcome measure of a clin-ical intervention is always the patient’s perception,the meaning of this final chapter in the series is opento debate. Does an objective finding that is of ques-tionable health significance (nasal inspiratory peakflow) have meaning when the patients did not reportfeeling better? This is not an example of a post hocfavorable analysis. The nasal inspiratory peak flowmeasurement was predefined as one of the principaloutcome measures. This measure favored homeopa-

90 C L A S S I C A L H O M E O P A T H Y

Page 98: Classical Homeopathy

thy strongly, but would such a treatment satisfypatients and clinicians in daily practice? Althoughthis question was not the subject of this investiga-tion, it and similar questions regarding other clinicalconditions must be answered in the future to deter-mine the true worth of homeopathic treatment.

Continuing their ongoing meta-analysis, theinvestigators pooled the VAS data from this trial withthose of the three previous trials. Although there wasno significant difference between the mean active andplacebo VAS scores in this trial, pooling VAS datafrom all trials nevertheless showed homeopathystrikingly superior to placebo ( p = .0007, 95% CI 4.2-15.4). Reasonably, the authors concluded that it wasmore likely that homeopathy was having some effectthan that they had made a series of errors grandenough to falsely achieve such impressive statisticalresults.107

In Jacob’s 1992 survey, otitis media was the thirdmost common diagnosis among patients ofAmerican physicians specializing in homeopathy.108

Stimulated by this finding and by the growing con-troversy surrounding customary use of antibiotics forthis condition, Jacobs and associates examined clas-sical homeopathy as a treatment for acute otitismedia (AOM) in 75 children from 18 months to 6years of age.109

Children with clinical characteristics of AOM (i.e.,middle ear effusion with fever or pain) for less than36 hours were recruited from a conventional pedi-atric practice. The study compared individualizedhomeopathic remedies (selected in the classicalhomeopathic method) with placebo three times aday for up to 5 days. Treatment was stopped earlier ifsymptoms resolved, per traditional homeopathicpractice. The treating homeopaths prescribed a totalof eight different remedies in the 30C dilution (1 ×10−60). It is interesting to note that only four remediescovered 88% of the cases, and one of them (Pulsatillanigricans) was used in more than 60% of the cases. Inaddition to having symptoms for more than 36hours, exclusion criteria were antibiotics in the previ-ous week, a homeopathic remedy in the prior 72hours, any other current medication, ear discharge,perforated tympanic membrane, history of PE tubes,tonsillectomy, adenoidectomy, cleft palate, or Downsyndrome. Patients were allowed the use of anal-gesics.

Assessment criteria were both objective and sub-jective. Parents kept a diary of patients’ symptoms,

which were scored for evaluation, as well as a log ofmedication used. Treatment failure was identified bypersistent fever or pain as early as 24 hours into thetrial. An independent clinical audiologist evaluatedthe patients’ tympanograms. To eliminate questionsabout contamination or adulteration of the studymedication, samples were independently analyzed(using gas chromatography and bacterial inhibitiontechniques) by the Departments of MedicinalChemistry and Laboratory Medicine at the Universityof Washington.

The rate of treatment failure was higher in theplacebo group than in the treatment group at everymeasurement point. At 5 days 19.4% of the homeo-pathic patients had failed treatment, compared with30.8% of the control group (11.4% difference). At 2weeks the homeopathic group had 18.4% fewer treat-ment failures and at 6 weeks the difference was 19.9%.Despite the consistency of these figures, the differ-ence was not statistically significant. Based on thedifference in the failure rates at 5 days, the investiga-tors calculated they would need close to 500 subjectsto achieve statistical significance.

Patients in the treatment group experienced astatistically significant decrease in pain scores at the24-hour and 64-hour evaluations ( p < .05). No signif-icant adverse effects were reported in either group.Compliance with the study medication and placebowas good. Analgesic use was nearly twice as commonin the placebo group (10 of 39 vs 5 of 36). There wereno significant differences in the rate of middle eareffusion following the intervention. However, thesubgroup of patients with documented effusion atthe time of study entry had the highest rate ofresponse to the homeopathic treatment with differ-ences in failure rate of 14.7% at 5 days, 29% at 2 weeksand 33.7% at 6 weeks.

Although the design of this study reflected therealities of clinical practice, the accuracy of diagnosisin studies of AOM is often controversial and a sourceof some question here. The placebo recovery rate waslower than in the placebo group of many other stud-ies of AOM. The authors reasonably suggest this wasprobably the result of the stringent treatment-failurecriteria they used, as required by the human subjectscommittee. Although the statistically significantimprovement in pain scores at two measurementpoints was encouraging, the other seven pointsbefore and afterward did not achieve significance. Ateach point the trend favored homeopathy, so the lack

C H A P T E R 6 Homeopathic Research 91

Page 99: Classical Homeopathy

of significance could be the result of the effect sizerelative to the number of subjects. A larger studyshould follow, both to determine whether a statisti-cally significant result is achievable and if that differ-ence is clinically meaningful for the patients.

Treatment of AOM may be a very importantexample of a good role for homeopathy. It is a com-mon problem for which the efficacy of conventionaltreatment is limited.110-113 Questions about theconsequences of conventional treatment persist,especially regarding the adverse effects of antibi-otics—GI problems, allergic reactions, and rising bac-terial resistance. Other long-term concerns arecoming to the fore, particularly the growing epidemicof asthma and other atopic disease and the possibil-ity that overuse of antibiotics in young children maybe contributing to this rise in immune dysfunc-tion.114-116,118 Although the study group here wasolder than the population seemingly most suscepti-ble to interference with developing immune maturity,there is no reason to presume that younger childrenwould respond any differently to homeopathic care.Homeopathic clinical practice customarily includesthe treatment of infants.

OTHER RESEARCH

Although clinicians (and patients) prefer proof ofefficacy in human clinical investigations, most prac-titioners believe that if homeopathy works, it shouldproduce demonstrable effects on animals and on por-tions of living organisms (tissues and cells). Therehave been a number of studies of homeopathy in tis-sue and cellular research published over decades. Justas in human clinical research, the sum of these inves-tigations is both encouraging and ultimately uncer-tain. Although some homeopathic clinical trials havereceived a fair amount of attention, undoubtedly thebiggest stir was created by one of these cellular inves-tigations.

Benveniste

A team of investigators, including Dr. JacquesBenveniste, a French immunologist and an employeeof France’s National Institute of Health and MedicalResearch (INSERM), conducted a trial, the results ofwhich were published in Nature.117 This trial has

become a landmark in the scientific literature, chieflybecause of the manner in which the journal handledthe publication and subsequent investigation.

Following along the lines of an earlier pilotstudy119 Benveniste’s group prepared homeopathicdilutions of anti-IgE antiserum and measured theireffects on degranulation of human basophils. Theyfound that dilutions far beyond Avogadro’s numeri-cal limit appeared to cause degranulation in humanbasophils. In addition, they found that violating cer-tain physical conditions that are considered essentialin the production and care of homeopathic medi-cines prevented the degranulation effect. Forexample, if they did not vortex the dilution; used ahomeopathically unorthodox solvent; or heated,froze, or exposed the highly diluted product to ultra-sound, the solution produced had no effect on thebasophils.

Because these effects were so remarkable andunexpected, the editorial staff of Nature insistedthat other laboratories replicate the experiment.Benveniste selected four other laboratories, two inIsrael and one each in Italy and Canada, which thenparticipated in the trial and final publication. Naturemade publication contingent on Benveniste’s accept-ance of a team of independent investigators visitinghis laboratory to observe a replication. Nature alsoran a sidebar “Editorial reservation” on the last pageof the article, promising a report on that investiga-tion in a future issue. An editorial, “When To Believethe Unbelievable,” ran in the issue containingBenveniste’s original article. The editorial describedthe challenges raised by this research and cautionedagainst accepting the results as published.120

Unfortunately, the tenor of the debate, promi-nently including Nature’s manner of response, wasseldom either polite or scholarly. The initial editorialincluded comments such as, “there can be no justifi-cation, at this stage, for an attempt to useBenveniste’s conclusions for the malign purposes towhich they might be put.” The article reviewing thefindings of the investigative team was titled, “High-dilution Experiments a Delusion.”122 The entireprocess almost immediately degenerated to finger-pointing and name-calling.

Nature’s three investigators were the journal’s edi-tor, James Maddox, who had a background in theo-retical physics; an organic chemist, Walter Stewart, anNIH employee notorious for his aggressive hunt forscientific misconduct; and James Randi (“The

92 C L A S S I C A L H O M E O P A T H Y

Page 100: Classical Homeopathy

Amazing Randi”), a professional magician.121 Thisinvestigative team acknowledged their own lack ofexpertise in immunology research: “We acknowledgethat we are an oddly constituted group. . . . None ofus has first-hand experience in the field of work atINSERM 200.”122 Nature’s editor described his teamas “self-appointed keepers of the scientific conscience. . . with no substantial scientific publishedrecord.”123

Depictions of the investigators visit to Ben-veniste’s laboratory sound like scenes from a poorlyscripted movie. Under the direction of the Natureinvestigators, laboratory staff and the investigatorsthemselves conducted 5 days of trials that would havenormally taken the experienced laboratory workers 2to 3 weeks. Although results of three of the first fourbatches were consistent with the published data, theinvestigators insisted this was only practice andshould not count. Subsequent batches did not stainproperly, as had often been the case, but Nature’sinvestigators considered these the true results. Forthese and many other scientific reasons, Benvenisteobjected to the investigator’s determination that histeam’s findings were erroneous. However, the behav-ior of the investigative team drew the loudest criti-cism from Benveniste. The investigative teamdecided to single blind the results (to Benveniste’sstaff ) and then, apparently to elicit fraud, the magi-cian folded the code into tin foil and taped it to thelaboratory ceiling while a video camera taped theprocedure. At one point, Benveniste and Maddoxreportedly asked Stewart to stop screaming. Duringone of the most delicate parts of the testing proce-dure, Randi (the magician) started to performmagic tricks, thereby distracting the laboratorystaff. There is little wonder, then, at Benveniste’soutrage or his question:

. . . are all these results “made up” as snapped at me byStewart, the very referee who cleared the paper with rawdata and statistics in hand? Why then accept a paper on13 June to publish June 30th to destroy on 8 July data soeasily spotted as wrong or made up? Is it a display to theworld of the almighty anti-fraud and heterodoxysquad?124

When Nature printed a post hoc defense of the edi-tor’s decision to publish the original article, it carriedthe inflammatory title, “When To Publish Pseudo-science.” The storm of controversy grew and grew.The matter was discussed in the New York Times and

several popular European newspapers. One articleincluded accusations of fraud against Benveniste by aFrench Nobel laureate, against whom Benvenistelater won a libel action.

Although the director-general of INSERM chas-tised Benveniste for his penchant for media attention,he protested the investigation to Nature. He com-mented on the “oddness of the investigative panel,”the “unprecedented” decision to send such a team,the “offensive content” of the conclusions, and the“questionable ulterior justifications of the journalregarding its real motivations.”125

Five years later, Nature published an unsuccess-ful replication of Benveniste’s work by Hirst andassociates, possibly closing off this line ofinquiry.126 This group of investigators criticizedNature both for initially publishing Benveniste’swork and for then savaging it. Many commentatorsbelieved that the whole episode was essentially apublicity stunt by the editor of Nature, one with achilling effect on rational scientific discourse ofcontroversial subject matter.

Stewart continued to pursue scientific miscon-duct and was the center of other controversial allega-tions, including an accusation of plagiarism againsthistorian Stephen Oates and an investigation of a1986 paper, coauthored by Nobel laureate DavidBaltimore, published in Cell. These incidents drewattention and embarrassment to the NIH. Five yearsafter the Benveniste incident, the NIH told Stewart tostop investigating scientific misconduct and reas-signed him within the NIH.

Toxicology

The most commonly used model for investigating thebiologic effects of homeopathic dilution is toxico-logic research. Various investigators have conductedtoxicologic studies over the past 45 years, beginningwith experiments by Lapp, Wurrmser, and Ney withrats poisoned by arsenic.127 The treatment groupreceived homeopathic dilutions of arsenic 7C (1 ×10−14). Lapp compared the rate of clearance of the poi-son in homeopathically treated rats with that of theuntreated control group. Cazin and associates repli-cated this work.128 Fisher and associates unsuccess-fully attempted to extend the model to leadpoisoning treated with a postavogadran dilution200C (1 × 10−400). His group found homeopathy

C H A P T E R 6 Homeopathic Research 93

Page 101: Classical Homeopathy

inferior to a chelating agent and not significantly dif-ferent from distilled water.129

A group led by Klaus Linde conducted a meta-analysis and critical review of published and unpub-lished research on this topic, published in 1994 byHuman and Experimental Toxicology.130 They foundreports of 135 experiments, 76% of which were con-ducted by French researchers. Fewer than 10% werepublished in conventional medical journals.

Investigators obtained sufficient information forquality assessment in 116 of the experiments. The qual-ity of the experiments was quite low, although it wasimproving in the more recent publications. Fewer than2% of the experiments were randomized. Descriptionsof the dilution process were common deficiencies, withfewer than 1% describing contamination precautions.Fewer than 8% of the experiments were blinded.

Of all the experiments, 40 used dilutions beyondthe point of expected physiologic effects (12C or 24X,1 × 10−24) and had adequate quality to allow reevalu-ation. Of the 40, 27 had results favoring homeopathy,26 of the better quality experiments were adequatelysimilar to allow formal meta-analysis. Of these 26, 14studied homeopathic treatment of mercury toxicityand 12 the treatment of arsenic poisoning.

The mercury set was a series of experiments withmice that received lethal doses of mercury. The micein the nine experiments using daily injections of the15C (1 × 10−30) preparation had a 40% decreased mor-tality rate at 10 days (95% CI 21.8%-58.1%) comparedwith controls. The other five studies used a 5C (1 ×10−10) preparation to reduce mortality by 7.2% (95%CI 10.1%-24.6%) over controls.

The other series used arsenic-poisoned rats andmeasured clearance of the poison from the bodies viaurine and stool. The treatment was a 7C (1 × 10−14)preparation of As2O3 administered in a variety of pro-tocols. Compared with controls, treated rats increasedtheir elimination of arsenic by 19.6% (95% CI 6.9%-32.4%) in urine and 25.5% (95% CI 8.9%-42.1%) in stool,thereby reducing blood levels by an average of 6.1%(95% CI 3.2%-9.2%) greater than controls.

Linde identified 34 better-quality trials of inor-ganic toxins, 28 of which had positive findings. Only1 of the 22 experiments using organic compoundsmet minimal quality standards. That trial was posi-tive. Of the 26 plant studies, six were of acceptablequality, only two of which had positive results. Six ofthe seven acceptable experiments using cell orembryo cultures reached positive conclusions. The

quality of all seven studies of isolated organs was toopoor to allow for assessment.

Linde and his colleagues pointed out that studiesof postavogadran dilutions (12C or 24X, 1 × 10−24)had the highest quality. More than 70% of those stud-ies showed positive outcomes. They also commentedthat the principle of hormesis (the opposite physio-logic effect at a low dose) has been studied for manyyears and could be important to the action of homeo-pathically diluted substances. In closing, they wrote,“While current research is not conclusive in this area,there is sufficient evidence to explore SAD [serial agi-tated dilution] preparations as a possible approach toprotecting against intoxication.”130

Miscellaneous Life Sciences

Silicea as a homeopathic remedy is known usefulwhen patients experience recurrent infections charac-terized, in part, by sluggish immune response.Davenas and associates ran a series of experimentsmeasuring the activity of mouse macrophages follow-ing homeopathic doses (1 × 10−11 and 1 × 10−19) ofsilica.131 The authors concluded, “These resultsdemonstrate clear ex vivo cellular effect of high dilu-tions of silica, that cannot be explained in our pres-ent state of knowledge.”131 Oberbaum and associatesconducted another trial of homeopathic silicea.132

They found that homeopathically diluted silicea hada beneficial effect on wound healing in mice.

Experiments on the effects of homeopathicpreparations on living systems have taken manyshapes over many decades. In 1902, Jousset studiedthe effect of homeopathically diluted silver nitrate onthe growth of Aspergillus.133 Kolisko134 and Roy135

investigated the stimulatory and suppressive effectsof homeopathic dilutions on barley and wheatgrowth. Boyd demonstrated effects of postavogadrandilutions of mercuric chloride on starch enzymes.136

Endler and associates conducted a series of exper-iments using postavogadran homeopathic dilutionsof thyroxine to inhibit tadpole-to-frog metamorpho-sis.137 These studies are intriguing for two reasons.First, they demonstrated a physiologic effect from apreparation that should not have contained any mol-ecules of thyroxine. The second surprise is that thy-roxine usually accelerates the metamorphic process.Here, diluted homeopathically, it exhibited suppres-sive effects. An interesting footnote to this series is

94 C L A S S I C A L H O M E O P A T H Y

Page 102: Classical Homeopathy

the age of this line of investigation. As early as 1927,investigators began assessing the effects of homeo-pathic dilutions on developing tadpoles.138

There have been a large number of animal, organ,tissue, and cellular studies evaluating aspects ofhomeopathic principles published in scientific jour-nals, far too many to examine here. To more fullyexplore these areas of homeopathic research, refer tobooks by Bellavite139 and Endler and associates.140

Fundamental Science

Defining a mechanism of action would irrevocablyalter the debate about homeopathy. The improbabil-ity of homeopathy is such a fundamental barrier thatit stymies unbiased critical thought for many.Although some, like Eskinazi in Archives of InternalMedicine,141 argue that conventional science andpharmacologic research already encompass the mostunlikely homeopathic principles, most physicians areeither unaware of these findings or believe thathomeopathy needs additional explanation.

Similia Since the 1990s, van Wijk and Wiegant have beenresearching the similia (like cures like) principle, thecore concept of homeopathy.142,143 Their experimentsuse cultured mammalian cells measuring theresponse to a stressor, recovery rate, and resistance tosubsequent exposures to the stressor. Stressors theyhave examined include sodium arsenite, cadmium,and, broadening their approach, heat stress. Theyfound that a limited exposure to any of these stres-sors was followed initially by increased sensitivity tothe stressor but subsequently by increased resistanceto the stressor. This response was mediated by anacceleration of self-repair mechanisms in the cellsand occurred only when the cells were partially dam-aged by the initial stressor. The response was stressorspecific; arsenite exposure, for example, was not pro-tective for subsequent heat stress.

The medical literature is full of publications doc-umenting the nearly ubiquitous tendency of conven-tional medications to create paradoxic drug effects.Although hundreds of articles have touched on thisaspect of medicine, little systematic investigation ofthe general principle has been conducted. Someobservers point to paradoxic effects as support of thehomeopathic principle of like cures like. Homeopaths

may simply be focusing attention on the rare ordelayed effects of medication.

Hormesis has a great deal of research support butan inversely proportional level of awareness amongclinicians.144 Its effects are well documented in radia-tion biology, where it has been called “the issue of thedecade.”145 Recognition of the health benefits of low-level radiation is growing, as is awareness of the detri-mental effects of high doses of radiation.145-148 Thereis discussion of the role of hormesis in promotinglongevity following caloric restriction, and of thehealth effects of low-level toxin exposure.149-153

Hormesis is yet another phenomenon that suggeststhat every influence can have positive and negativerepercussions. Many questions await answers.

Potentization Although the ability of postavogadran dilutions to havebiologic effects is not the most essential tenet of homeo-pathic medicine, it does appear to be the most scien-tifically unacceptable. As Schulte wrote, “Anyfundamental research into homeopathy has to addressthe problem of apparent information transfer andinformation storage in aqueous solutions, as well as thesubsequent mechanism of transfer to a physiologic sys-tem.”154 This single element, the one explanation essen-tially absent from Hahnemann’s meticulously recordeddevelopment of theoretic and clinical homeopathy, iseither the most intriguing or the most frustratingaspect of the study of homeopathy, depending on theviewer’s perspective. The best starting point for readerswho desire to consider fundamental research pertainingto homeopathic potentization is Schulte’s paper.

Although Schulte’s article is the best summary ofrecent scientific investigations, this most perplexingfacet of homeopathic philosophy has been a populartopic in homeopathic literature for many decades.Stephenson and associates wrote several theoreticpieces published during the 1960s in the Journal of theAmerican Institute of Homeopathy.155-157 In these arti-cles and others, he attempted to summarize scientificresearch on microdilutions and use principles ofnuclear physics to explain homeopathic theory.158,159

Stanford professor William Tiller also wrote a seriesof articles considering theoretic scientific modelsthat could help explain the actions of homeopathicdilutions and the concept of similars.160,161

As early as the mid 1960s, investigators attemptedto use nuclear magnetic resonance (NMR) imaging toassay homeopathic remedies.162,163 These homeo-

C H A P T E R 6 Homeopathic Research 95

Page 103: Classical Homeopathy

pathic experimenters found no effects when thehomeopathic dilutions were prepared in plastic- orparaffin-lined glass containers. Since then we havelearned that most forms of glass release paramag-netic ions into solutions that can lead to falsechanges in NMR readings. Papers on this topic con-tinue to be published, but nearly all of them are dif-ficult to interpret because of inadequate controls forcontamination by dissolved gases and metal ionsfrom glass.164-167 In a recent issue of the BritishHomeopathic Journal, two of the foremost researchersin this field urged cautious interpretation of currentdata and called for high-quality systematic protocolsto provide better data in the future.168

David Anick, MD, PhD, has proposed severalmethods by which materials might retain chemical ifnot biologic effects as homeopathic dilutions. Oneexample is that of “water wires,” which are a well-known biologic phenomenon that allows transmis-sion of charged particles through water at a muchfaster rate than the process of dilution. Another pos-sibility discussed by Anick was the idea that aberra-tions in the length of hydrogen bonds in water couldallow marked and persistent differences betweenseemingly identical water-based solutions.169

Shui-Yin Lo has conducted a series of experi-ments in which aqueous dilutions apparently pro-duced crystalline structures in the water.170 Becauseconcentrated solutions have a high degree of inter-molecular interaction, these organized moleculesappear to be significant only in very dilute solutions.These crystals are thus vulnerable to the types ofenvironmental conditions (e.g., sunlight, heat, strongmagnetic fields) that are traditionally thought todamage homeopathic remedies.

The investigation of homeopathic principles onthe level of basic science is proceeding vigorously.Investigators have proposed a number of interestingpossibilities. None of these, with the possible exceptionof hormesis, is firmly established. No single theory ade-quately accounts for both of the essential homeopathicprinciples, similia and potentization. We remain a longway away from understanding how these extreme dilu-tions can directly create clinical effects.

Creative Homeopathic Research

Research is a creative activity. Although many falselybelieve that research is extremely straightforward and

necessitates the most linear thinking in medicine, inactuality, any good researcher must think creativelyto ask the right question and then design a protocolto answer that question. A number of creativehomeopathic researchers have taken steps to stretchtheir research designs. Several investigators havedesigned trials incorporating homeopathic princi-ples, such as using the traditional aggravation ofsymptoms as an outcome measure. One study testedthe reliability of homeopathic proving methodologyas a measure of the validity of homeopathy itself.171

Every well-trained homeopath recognizes thateach homeopathic remedy encompasses a complexpattern of symptoms. Because certain remedies aremore commonly linked to certain illness states, thefirst stage of a study by Davidson and associates wasto survey a panel of homeopathic experts to deter-mine the most common remedies for phobic anxietydisorders.172 Then, they recruited patients meetingconventional criteria for this disorder. From thepatients they collected additional information, suchas the specific characteristics of their anxiety, fooddesires, and temperature tolerance. Finally, investiga-tors applied a statistical technique (grade of member-ship analysis) to determine whether the patients’symptoms were clustered like the homeopathic reme-dies commonly prescribed for this group of patients.For example, a Lycopodium clavatum patient can expe-rience symptoms of agoraphobia, but will also usu-ally have indigestion (especially bloating after meals)and a craving for sweets, and tends to be groggy inthe mornings. However, an Arsenicum patient willhave different specific fears, greater restlessness withthe anxiety, and, usually, great sensitivity to cold thana Lycopodium patient. The study showed that patientswith phobic anxiety disorders tend to experienceclusters of symptoms that often parallel the homeo-pathic classifications.

HOMEOPATHIC RESEARCH—WHERE DO WE GO FROMHERE?

When the Homeopathic Research Network wasfounded in 1993, the organizational objective was “toprove and improve homeopathy.” Two different butoverlapping research efforts were (and are) needed.One effort is to demonstrate that homeopathy hasreal effects, to “prove homeopathy,” in other words.

96 C L A S S I C A L H O M E O P A T H Y

Page 104: Classical Homeopathy

When considering homeopathy as a clinical practice,the significance of those effects must be defined bypatient benefit. For two centuries patients and clini-cians have used homeopathy despite the absence ofscientific recognition; this itself is a form of “proof ”that it works. The community of clinical homeopathshas been arguing about the proper application ofhomeopathic methods for very nearly that entiretime. Improving the clinical practice of homeopathywill benefit patients. Settling these disputes wouldcertainly make homeopathic gatherings more peace-able, if less exciting.

Proving Homeopathy

To define a mechanism of action of high dilutions,researchers must do the following:

● Define a mechanism of action of high dilu-tions

● Continue basic sciences investigation of thesimilia principle

● Replicate trials ● Investigate patient benefit rather than

placebo differentiation Although the first two points are obviously impor-

tant, the latter two bear further comment. A single,favorable trial, no matter how elegant, means littleuntil independent investigators confirm the finding.Replication is absolutely essential. Understanding thedegree of homeopathy’s clinical effect is essential indetermining its benefit to patients. In addition, thecomplexity of the placebo response and its variabilityby disease and patient characteristics conspire to limitthe value of simple placebo-controlled trials. Placebotrials should not be abandoned, but rather examinedcarefully and used selectively.

Improving Homeopathy

Realistically, it is important to accept that regardlessof the findings of scientific research, people will con-tinue to use homeopathic medicine for the foresee-able future. One hundred highly publicized negativetrials would not end a system of medicine so wellestablished by tradition and familiar to hundreds ofmillions worldwide. Some homeopaths thereforeargue that research has nothing to offer those whowould continue to use homeopathy. However,

research can still play a role in this independent-minded community.

There are many disagreements about the correctmethods of homeopathic clinical practice, includingdisputes about dosing regimens (potency and fre-quency), the clinical effects of interactions betweenconcurrently administered homeopathic medicines,antidotes, the diagnostic accuracy of electronicdevices, adverse effects of homeopathy, and the rela-tive benefit of differing styles of homeopathic pre-scribing (classical or otherwise). Research can be apowerful tool to settle these clinical disputes.

SUMMARY

Does homeopathy work? Is homeopathy effective forcertain conditions? Research is the customary meanswe use to settle such questions. Unfortunately, it isnot easy to conduct good research in homeopathy.Furthermore, it takes a substantial mass of excellentresearch to shift the weight of medical opinion oncontroversial topics such as homeopathy. Because wedo not have such a strongly compelling body ofresearch favoring homeopathy, research has yet toprovide conclusive answers to these questions.

In some ways, research has made homeopathymore mysterious. A decade ago, very few physicianswould have predicted that any good study would pro-duce a result favorable to homeopathy. However,many good studies have done just that. At the sametime, many good studies do not support homeopathy.That homeopathy has not simply shriveled up underthe bright light of scientific examination is surprisingand intriguing. Research has given us a sense of whatneeds to be done. We have much yet to learn.

References 1. Coulter H: The origins of modern western medicine,

Berkeley, Calif., 1988, North Point Press. 2. Dimond E, Kittle C, Crockett J: Comparison of internal

mammary artery ligation and sham operation forangina pectoris, Am J Cardiol 1960:483-486.

3. Wharton R, Lewith G: Complementary medicine andthe general practitioner, BMJ (Clin Res Ed) 292(6534):1498-1500, 1986.

4. Gonzales R, Steiner JF, Sande MA: Antibiotic prescrib-ing for adults with colds, upper respiratory tract infec-tions, and bronchitis by ambulatory care physicians,JAMA 278(11):901-904, 1997.

C H A P T E R 6 Homeopathic Research 97

Page 105: Classical Homeopathy

5. Pichichero ME: Understanding antibiotic overuse forrespiratory tract infections in children, Pediatrics104(6):1384-1388, 1999.

6. Watson RL, Dowell SF, Jayaraman M et al:Antimicrobial use for pediatric upper respiratory infec-tions: reported practice, actual practice, and parentbeliefs, Pediatrics 104(6):1251-1257, 1999.

7. Conly J: Controlling antibiotic resistance by quellingthe epidemic of overuse and misuse of antibiotics, CanFam Physician 44:1769-73, 80-84, 1998.

8. Lynoe N, Svensson T: Doctors’ attitudes towardsempirical data—a comparative study, Scand J Soc Med25(3):210-216, 1997.

9. Greenhalgh T, Gill P: Pressure to prescribe, BMJ315(7121):1482-1483, 1997.

10. Wears RL: What is necessary for proof? Is 95% sureunrealistic? JAMA 271(4):272, 1994.

11. Berman BM, Singh BB, Hartnoll SM, et al: Primary carephysicians and complementary-alternative medicine:training, attitudes, and practice patterns, J Am BoardFam Pract 11(4):272-281, 1998.

12. Ernst E: Unconventional cancer therapies: what weneed is rigorous research, not closed minds, Chest117(2):307-308, 2000.

13. Ernst E, Resch KL: Reviewer bias against the unconven-tional? A randomized double-blind study of peerreview, Complement Ther Med 7(1):19-23, 1999.

14. Jonas W: Alternative medicine and the conventionalpractitioner, JAMA 279(9):708-709, 1998.

15. Schwartz MP, Wagner PJ: Which medicines do ourpatients want from us? J Fam Pract 49:339-341, 2000.

16. Jonas WB: Alternative medicine—learning from thepast, examining the present, advancing to the future(editorial), JAMA 280(18):1616-1618, 1998.

17. Crim C: Clinical practice guidelines vs actual clinicalpractice: the asthma paradigm, Chest 118 (suppl 2):62S-64S, 2000.

18. Ellrodt AG, Conner L, Erieding M et al: Measuring andimproving physician compliance with clinical practiceguidelines: a controlled interventional trial, Ann InternMed 122(4):277-282, 1995.

19. Vinker S, Nakar S, Rosenberg E, et al: Attitudes ofIsraeli family physicians toward clinical guidelines, ArchFam Med 9(9):835-840, 2000.

20. Lewis LM, Lasater LC, Ruoff BE: Failure of a chest painclinical policy to modify physician evaluation and man-agement, Ann Emerg Med 25(1):9-14, 1995.

21. Gonzales R, Barrett PH Jr, Crane LA, et al: Factors asso-ciated with antibiotic use for acute bronchitis, J GenIntern Med 13:541-548, 1998.

22. Hueston WJ, Hopper JE, Dacus EN, et al: Why areantibiotics prescribed for patients with acute bronchi-tis? A postintervention analysis, J Am Board Fam Pract13(6):398-402, 2000.

23. Worrall G, Freake D, Kelland J et al: Care of patientswith type II diabetes: a study of family physicians’ com-pliance with clinical practice guidelines, J Fam Pract44(4):374-381, 1997.

24. Zerr DM, Del Beccaro MA, Cummings P: Predictors ofphysician compliance with a published guideline onmanagement of febrile infants, Pediatr Infect Dis J18(3):232-238, 1999.

25. Seto TB, Kwiat D, Taira DA et al: Physicians’ recom-mendations to patients for use of antibiotic prophy-laxis to prevent endocarditis, JAMA 284(1):68-71, 2000.

26. van Weel C, Knottnerus JA: Evidence-based interven-tions and comprehensive treatment, Lancet 353:916-918, 1999.

27. Holdaway IM, Evans MC, Frengley PA et al: RelatedArticles Investigation and treatment of renal calculiassociated with hypercalciuria, J Endocrinol Invest 5:361-365, 1982.

28. Evans RA, Maher PO, Agostino M et al: Investigationand treatment of renal calculi, Med J Aust 143:278-281,1985.

29. Borghi L, Schianchi T, Meschi T et al: Comparison oftwo diets for the prevention of recurrent stones in idio-pathic hypercalciuria. N Engl J Med 46(2):77-84, 2002.

30. Martini LA, Wood RJ: Should dietary calcium and pro-tein be restricted in patients with nephrolithiasis? NutrRev 58(4):111-117, 2000.

31. Acupuncture, NIH Consens Statement 15(5):1-34, 1997. 32. NIH Consensus Conference: Acupuncture, JAMA

280(17):1518-1524, 1998. 33. Bareta JC: Evidence presented to consensus panel on

acupuncture’s efficacy, Altern Ther Health Med 4(1):22-30, 102, 1998.

34. Wootton J: National Institutes of Health consensusdevelopment statement on acupuncture, J AlternComplement Med 3(4):419-420, 1997.

35. Brody H: The lie that heals: the ethics of giving place-bos, Ann Intern Med 97(1):112-118, 1982.

36. Lynoe N: Is the effect of alternative medical treatmentonly a placebo effect? Scand J Soc Med 18(2):149-153,1990.

37. Joyce CR: Placebo and complementary medicine, Lancet344(8932):1279-1281, 1994.

38. Jonas WB (editorial): Magic and methodology: whenparadigms clash, J Altern Complement Med 5(4):319-321,1999.

39. Treuherz F: Correspondence and Hecla lava: the originsof Kent’s homeopathy, JAIH 77:130-149, 1984.

40. Jacobs J, Jimenez LM, Gloyd SS et al: Treatment ofacute childhood diarrhea with homeopathic medicine:a randomized clinical trial in Nicaragua, Pediatrics93(5):719-725, 1994.

41. Johnson AG: Surgery as a placebo, Lancet 344(8930):1140-1142, 1994.

98 C L A S S I C A L H O M E O P A T H Y

Page 106: Classical Homeopathy

42. Harrington A: The placebo effect, Cambridge, Mass.,1997, Harvard University Press.

43. Gotzsche PC: Is there logic in the placebo? Lancet344(8927):925-926, 1994.

44. Gotzsche PC: Placebo effects: concept of placeboshould be discarded, BMJ 311(7020):1640-1641, 1995.

45. Benson H, McCallie DP Jr: Angina pectoris and theplacebo effect, N Engl J Med 300(25):1424-1429, 1979.

46. Kleinman I, Brown P, Librach L: Placebo pain medica-tion: ethical and practical considerations, Arch Fam Med3:453-457, 1994.

47. Shapiro AK, Struening EL, Barten H et al: Correlates ofplacebo reaction in an outpatient population, PsycholMed 5(4):389-396, 1975.

48. Stagno SJ, Smith ML: The use of placebo in diagnosingpsychogenic seizures: who is being deceived? SeminNeurol 17(3):213-218, 1997.

49. Hrobjartsson A, Gotzsche PC: Is the placebo powerless?An analysis of clinical trials comparing placebo with notreatment, N Engl J Med 344(21):1594-1602, 2001.

50. Levine JD, Gordon NC, Fields HL et al: The mechanismof placebo analgesia, Lancet 2(8091):654-657, 1978.

51. Olness K, Ader R: Conditioning as an adjunct in thepharmacotherapy of lupus erythematosus, J Dev BehavPediatr 13(2):124-125, 1992.

52. Wolf S: Effects of suggestion and conditioning on theaction of chemical agents in human subjects: the phar-macology of placebos, J Clin Invest 29:100-109, 1950.

53. Coronary Drug Project: Influence of adherence totreatment and response of cholesterol on mortality inthe Coronary Drug Project, N Engl J Med 303:1038-1041, 1980.

54. Ader R, Cohen N: Behaviorally conditioned immuno-suppression, Psychosom Med 37(4):333-340, 1975.

55. Rowbotham DJ (editorial): Endogenous opioids,placebo response, and pain, Lancet 357(9272):1901-1902, 2001.

56. Rochon PA, Binns MA, Litner JA et al: Are randomizedcontrol trial outcomes influenced by the inclusion of aplacebo group?: a systematic review of nonsteroidalantiinflammatory drug trials for arthritis treatment, JClin Epidemiol 52(2):113-122, 1999.

57. Kleijnen J, de Craen AJ, van Everdingen J et al: Placeboeffect in double-blind clinical trials: a review of interac-tions with medications, Lancet 344(8933):1347-1349,1994.

58. Skovlund E: Should we tell trial patients that theymight receive placebo? (letter), Lancet 337(8748):1041,1991.

59. Rothman KJ, Michels KB: The continuing unethicaluse of placebo controls [see comments], N Engl J Med331(6):394-398, 1994.

60. Ware JE: Measuring patients’ views: the optimum out-come measure, BMJ 306(6890):1429-1430, 1993.

61. Gotzsche PC: Sensitivity of effect variables in rheuma-toid arthritis: a meta-analysis of 130 placebo controlledNSAID trials, J Clin Epidemiol 43(12):1313-1318, 1990.

62. Dean ME: A homeopathic origin for placebo controls:“an invaluable gift of God,” Altern Ther Health Med6(2):58-66, 2000.

63. Kaptchuk TJ: Intentional ignorance: a history of blindassessment and placebo controls in medicine, Bull HistMed 72(3):389-433, 1998.

64. Lown B: Preface to The lost art of healing, Boston, 1996,Houghton Mifflin.

65. Gibson RG, Gibson SL, MacNeill AD et al: Homeo-pathic therapy in rheumatoid arthritis: evaluation bydouble-blind clinical therapeutic trial, Br J ClinPharmacol 9:453-459, 1980.

66. Shipley M, Berry H, Broster G et al: Controlled trial ofhomeopathic treatment of osteoarthritis, Lancet1(8316):97-98, 1983.

67. Homoeopathy, Lancet 1(8322):482, 1983. 68. Wiesenauer M, Gaus W: Double-blind trial comparing

the effectiveness of the homeopathic preparationGalphimia potentiation D6, Galphimia dilution 10(-6)and placebo on pollinosis, Arzneimittelforschung35(11):1745-1747, 1985.

69. Blackley CH: Br Homeopath J 29:238-286, 1871. 70. Blackley CH: Br Homeopath J 29:477-501, 1871. 71. Blackley CH: Br Homeopath J 29:713-736, 1871. 72. Blackley CH: Br Homeopath J 30:246-274, 1872. 73. Blackley CH: Br Homeopath J 30:417-449, 1872. 74. Blackley CH: Br Homeopath J 30:656-678, 1872. 75. Blackley CH: Br Homeopath J 31:77-103, 1873. 76. Milspaugh CF: New, old and forgotten remedies,

Philadelphia, 1900, Boericke and Tafel. 77. Reilly DT. Taylor MA, McSharry C et al: Is homoeopa-

thy a placebo response? Controlled trial of homoeo-pathic potency, with pollen in hayfever as model, Lancet2(8512):881-886, 1986.

78. Editorial: Quadruple-blind, Lancet 1:914(8643), 1989. 79. Ferley JP, Zmirou D, D’Adhemar D et al: A controlled

evaluation of a homoeopathic preparation in the treat-ment of influenza-like syndromes, Br J Clin Pharmacol27(3):329-335, 1989.

80. Personal communication with Thierry Boiron, Presidentand CEO of Boiron USA, 2000.

81. Fisher P, Greenwood A, Huskisson EC et al: Effect ofhomeopathic treatment on fibrositis (primary fibro-myalgia), BMJ 299(6695):365-366, 1989.

82. Kleijnen J, Knipschild P, ter Riet G: Clinical trials ofhomoeopathy, BMJ 302(6772):316-323, 1991 (publishederratum appears in BMJ 302(6780):818, 1991).

83. Kleijnen J, Knipschild P: The comprehensiveness ofMedline and Embase computer searches: searchesfor controlled trials of homoeopathy, ascorbic acidfor common cold and ginkgo biloba for cerebral

C H A P T E R 6 Homeopathic Research 99

Page 107: Classical Homeopathy

insufficiency and intermittent claudication, PharmWeek Bl Sci 14(5):316-320, 1992.

84. Andrade LE, Ferraz MB, Atra E et al: A randomizedcontrolled trial to evaluate the effectiveness of homeo-pathy in rheumatoid arthritis, Scand J Rheumatol20(3):204-208, 1991.

85. Jacobs J, Jimenez M, Gloyd S et al: Homeopathic treat-ment of acute childhood diarrhea, Br Homeopath J82(5):83-86, 1993.

86. Carlston M: Homeopathic diarrhea trial, Pediatrics95(1):159 (discussion 160), 1995.

87. Jacobs J, Jimenez M, Malthouse S et al: Homeopathictreatment of acute childhood diarrhea: results from aclinical trial in Nepal, J Altern Complement Med 6(2):131-139, 2000.

88. de Lange de Klerk ES, Blommers J, Kuik DJ et al: Effectof homoeopathic medicines on daily burden of symp-toms in children with recurrent upper respiratory tractinfections, BMJ 309(6965):1329-1332, 1994.

89. Reilly D, Taylor MA, Beattie NG et al: Is evidence forhomoeopathy reproducible? Lancet 344(8937):1601-1606, 1994.

90. Lokken P, Straumsheim PA, Tveiten D et al: Effect ofhomoeopathy on pain and other events after acutetrauma: placebo controlled trial with bilateral oral sur-gery, BMJ 310(6992):1439-1442, 1995.

91. Campbell A: Two pilot controlled trials of arnica mon-tana, Br Homeopath J 65:154-158, 1976.

92. Hart O, Mullee MA, Lewith G et al: Double-blind,placebo-controlled, randomized clinical trial ofhomoeopathic arnica C30 for pain and infection aftertotal abdominal hysterectomy, J R Soc Med 90(2):73-78,1997.

93. Vickers AJ: Can acupuncture have specific effects onhealth? A systematic review of acupuncture antiemesistrials, J R Soc Med 89(6):303-311, 1996.

94. Tveiten D, Bruseth S, Borchgrevink CF et al: Effect ofarnica D 30 during hard physical exertion. A double-blind randomized trial during the Oslo marathon1990, Tidsskr Nor Laegeforen 111(30):3630-3631, 1991.

95. Tveiten D, Bruseth S, Borchgrevink CF et al: Effects ofthe homeopathic remedy arnica D 30 on marathonrunners: a randomized double-blind study during the1995 Oslo marathon, Complement Ther Med 6:71-74,1998.

96. Vickers AJ, Fisher P, Smith C et al: Homeopathic arnica30x is ineffective for muscle soreness after long-dis-tance running: a randomized, double-blind, placebo-controlled trial, Clin J Pain 14(3):227-231, 1998.

97. Ludtke R, Wiesenauer M: A meta-analysis of homeo-pathic treatment of pollinosis with Galphimia glauca,Wien Med Wochenschr 147(14):323-327, 1997.

98. Linde K, Clausius N, Ramirez G et al: Are the clinicaleffects of homeopathy placebo effects? a meta-analysis of

placebo-controlled trials, Lancet 350(9081):834-843,1997 (published erratum appears in Lancet 351[9097]:220, 1998).

99. Weiser M, Strosser W, Klein P: Homeopathic vs con-ventional treatment of vertigo: a randomized double-blind controlled clinical study, Arch Otolaryngol HeadNeck Surg 124(8):879-885, 1998.

100. Brigo B: Homeopathic treatment of migraine: a sixtycase, double blind, controlled study (homeopathicremedy versus placebo). Paper presented at the pro-ceedings of the 42nd LMHI (Liga MedicorumHomoeopathica Internationalis) Congress, Arlington,Va., 1987. (http://www.lmhi.net/)

101. Walach H, Haeusler W, Lowes T et al: Classical homeo-pathic treatment of chronic headaches, discussion 01,Cephalalgia 17(2):119-126, 1997.

102. Whitmarsh TE, Coleston-Shields DM, Steiner TJ:Double-blind randomized placebo-controlled studyof homoeopathic prophylaxis of migraine, Cephalalgia17(5):600-604, 1997.

103. Consensus statement: The Commonweal Conferenceon Homeopathy in Human and Veterinary Medicine,Hom Int (2):24-25, 1998.

104. Linde K, Melchart D: Randomized controlled trials ofindividualized homeopathy: a state-of-the-art review, JAltern Complement Med 4(4):371-388, 1998.

105. Chapman EH, Weintraub RJ, Milburn MA et al:Homeopathic treatment of mild traumatic brain injury:a randomized, double-blind, placebo-controlled clinicaltrial, J Head Trauma Rehabil 14(6):521-542, 1999.

106. Linde K, Scholz M, Ramirez G et al: Impact of studyquality on outcome in placebo-controlled trials ofhomeopathy, J Clin Epidemiol 52(7):631-636, 1999.

107. Taylor MA, Reilly D, Llewellyn-Jones RH et al:Randomised controlled trial of homeopathy versusplacebo in perennial allergic rhinitis with overview offour trial series, BMJ 321:471-476, 2000.

108. Jacobs J, Chapman EH, Crothers D: Patient character-istics and practice patterns of physicians usinghomeopathy, Arch Fam Med 7(6):537-540, 1998.

109. Jacobs J, Springer DA, Crothers D: Homeopathictreatment of acute otitis media in children: a prelimi-nary randomized placebo-controlled trial, PediatrInfect Dis J 20(2):177-183, 2001.

110. Williams RL, Chalmers TC, Stange KC et al: Use ofantibiotics in preventing recurrent otitis media and intreating otitis media with effusion: a meta-analyticattempt to resolve the brouhaha, JAMA 270:1344-1351, 1993.

111. Culpepper L, Froom J: Routine antimicrobial treat-ment of acute otitis media: is it necessary? JAMA278:1643-1645, 1997.

112. Rosenfeld RM: An evidence-based approach to treatingotitis media, Pediatr Clin North Am 43:1165-1181, 1996.

100 C L A S S I C A L H O M E O P A T H Y

Page 108: Classical Homeopathy

113. Bollag U: Cause of otitis media, Lancet 357:311, 2001. 114. Droste JH, Wieringa MH, Weyler JJ et al: Does the use

of antibiotics in early childhood increase the risk ofasthma and allergic disease? Clin Exp Allergy30(11):1547-1553, 2000.

115. Wickens K, Pearce N, Crane J et al: Antibiotic use inearly childhood and the development of asthma, ClinExp Allergy 29(6):766-771, 1999.

116. von Hertzen LC: Puzzling associations between child-hood infections and the later occurrence of asthmaand atopy, Ann Med 32(6):397-400, 2000.

117. Davenas E, Beauvais F, Amara J et al: Human basophildegranulation triggered by very dilute antiserumagainst IgE, Nature 333(6176):816-818, 1988.

118. Strachan DP: Family size, infection and atopy: thefirst decade of the “hygiene hypothesis, Thorax55(suppl 1):S2-10, 2000.

119. Poitevin B, Aubin M, Benveniste J: Approach to thequantitative analysis of the effect of Apis mellifica onthe in vitro human basophil degranulation, J InnovTech Biol Med 7:64-68, 1986.

120. When to believe the unbelievable (editorial), Nature333:787, 1988.

121. Anderson C: Robocops: Stewart and Feder’s mechanizedmisconduct search, Nature 350(6318):454-455, 1991.

122. Maddox J, Randi J, Stewart WW: High-dilution exper-iments a delusion, Nature 334(6180):287-290, 1988.

123. Maddox, J: (letter) Nature 333:795, 1988. 124. Benveniste J: Dr. Jacques Benveniste replies, Nature

334(6180):291, 1988. 125. Coles P: Benveniste controversy. INSERM closes the

file, Nature 340(6230):178, 1989. 126. Hirst SJ, Hayes NA, Burridge J et al: Human basophil

degranulation is not triggered by very dilute anti-serum against human IgE, Nature 366(6455):525-527,1993.

127. Lapp C, Wurrmser L, Ney J: Mobilisation de l’arsenicfixe chez le cobaye sons l’influence des doses infini-tesimal d’arseniate, Therapy 13:46-55, 1958.

128. Cazin JC, Cazin M, Gaborit JL et al: A study of theeffect of decimal and centesimal dilutions of arsenicon the retention and mobilization of arsenic in therat, Hum Toxicol 6(4):315-320, 1987.

129. Fisher P, House I, Belon P et al: The influence of thehomoeopathic remedy plumbum metallicum on theexcretion kinetics of lead in rats, Hum Toxicol 6(4):321-324, 1987.

130. Linde K, Jonas WB, Melchart D et al: Critical reviewand meta-analysis of serial agitated dilutions in exper-imental toxicology, Hum Exp Toxicol 13:481-492, 1994.

131. Davenas E, Poitevin B, Benveniste J et al: Effect onmouse peritoneal macrophages of orally administeredvery high dilutions of silica, Eur J Pharmacol135(3):313-319, 1987.

132. Oberbaum M, Markovits R, Weisman Z et al: Woundhealing by homeopathic silica dilutions in mice,Harefuah 123(3-4):79-82, 156, 1992.

133. Bertrand G: The extraordinary sensitiveness ofaspergillus niger to manganese, Comptes RendusAcadémie des Science 154:616, 1912.

134. Kolisko L: Physical and physiological demonstrationof the effect of the smallest entities, Der Kommende Tag1-10, 1923.

135. Roy J: The experimental justification of the homeo-pathic dilution, Le Bulletin Médical 46:528-531, 1932.

136. Boyd WE: The action of microdoses of mercuric chlo-ride on diastase, Br Homeopath J 31(5):106-111, 1941.

137. Endler PC, Pongratz W, Van Wijk R et al: Effects ofhighly diluted succussed thyroxine on metamorpho-sis of highland frogs, Ber J Res Hom 1(3):151-160, 1991.

138. Konig K: On the effect of extremely diluted (“homeo-pathic”) metal salt solutions on the development andgrowth of tadpoles, Zeitschrift für die GesamteExperimentelle Medizin 56:581-593, 1927.

139. Bellavite P, Signorini A (contributor): Homeopathy: afrontier in medical science, Berkeley, Calif., 1995, NorthAtlantic Books.

140. Endler PC, Schulte J: Ultra high dilution, physiology andphysics, Dondrecht, The Netherlands, 1994, KluwerAcademic.

141. Eskinazi D: Homeopathy re-revisited: is homeopathycompatible with biomedical observations? Arch InternMed 159(17):1981-1987, 1999.

142. Van Wijk R, Wiegant FA: Cultured mammalian cells inhomeopathy research: the similia principle in self-recovery,Utrecht, Netherlands, 1994, Utrecht University.

143. Van Wijk R, Wiegant FA: The similia principle as atherapeutic strategy: a research program on stimula-tion of self-defense in disordered mammalian cells,Altern Ther Health Med 3(2):33-38, 1997.

144. Calabrese EJ, Baldwin LA: The marginalization ofhormesis, Hum Exp Toxicol 19(1):32-40, 2000.

145. Pollycove M: The issue of the decade: hormesis, Eur JNucl Med 22(5):399-401, 1995.

146. Sheppard SC, Guthrie JE, Thibault DH: Germinationof seeds from an irradiated forest: implications forwaste disposal, Ecotoxicol Environ Saf 23(3):320-327,1992.

147. Rattan SI: Repeated mild heat shock delays ageing incultured human skin fibroblasts, Biochem Mol Biol Int45(4):753-759, 1998.

148. Calabrese EJ, Baldwin LA: U-shaped dose-responses inbiology, toxicology, and public health, Annu Rev PublicHealth 22:15-33, 2001.

149. Neafsey PJ: Longevity hormesis: a review, Mech AgeingDev 51(1):1-31, 1990.

150. Turturro A, Hass BS, Hart RW: Does caloric restrictioninduce hormesis? Hum Exp Toxicol 19(6):320-329, 2000.

C H A P T E R 6 Homeopathic Research 101

Page 109: Classical Homeopathy

151. Masoro EJ: Caloric restriction and aging: an update,Exp Gerontol 35(3):299-305, 2000.

152. Kmecl P, Jerman I: Biological effects of low-level envi-ronmental agents, Med Hypotheses 54(5):685-688,2000.

153. Calabrese EJ, Baldwin LA, Holland CD: Hormesis: ahighly generalizable and reproducible phenomenonwith important implications for risk assessment, RiskAnal 19(2):261-281, 1999.

154. Schulte J: Effects of potentization in aqueous solu-tions, Br Homeopath J 88(4):155-160, 1999.

155. Stephenson JH: On possible field effects of the solventphase of succussed high dilutions, JAIH 57:259-261,1966.

156. Barnard GP, Stephenson JH: Microdose paradox: anew biophysical concept, JAIH 277-286, 1967.

157. Barnard GP, Stephenson JH: Fresh evidence for a bio-physical field, JAIH 62:73-85, 1969.

158. Stephenson JH: A review of investigations intothe action of substances in dilutions greater than1 × 10−24 (microdilutions), JAIH 48:327-355, 1955.

159. Stephenson JH: Homeopathic philosophy in the lightof twentieth century physics, JAIH 66-69, 1960.

160. Tiller W: A rationale for the homeopathic “Law ofSimilars” Journal of Homeopathic Practice 2(1):48-52, 1979.

161. Tiller W: A rationale for the potentizing process inhomeopathic remedies, Journal of Homeopathic Practice2(1):53-59, 1979.

162. Smith RB, Boericke GW: Modern instrumentation forthe evaluation of homeopathic drug structure, JAIH59:263-280, 1966.

163. Smith RB, Boericke GW: Changes caused by succus-sion on NMR patterns and bioassays of BKTA suc-cussions and dilutions, JAIH 61:197-212, 1968.

164. Sukul A, Sarkar P, Sinnababu SP et al: Altered solu-tion structure of alcoholic medium of potentized Nuxvomica underlies its antialcoholic effect, Br HomeopathJ 89(2):73-77, 2000.

165. Poitevin B, Demangeat JL: Effects of potentization, BrHomeopath J 89(3):155-256, 2000.

166. Milgrom LR, King KR, Lee J et al: On the investigationof homeopathic potencies using low resolution NMRT2 relaxation times: an experimental and critical sur-

vey of the work of Roland Conte, Br Homeopath J 90:5-13, 2001.

167. Aabel S, Fossheim S, Rise F: Nuclear magnetic reso-nance (NMR) studies of homeopathic solutions, BrHomeopath J 90(1):14-20, 2001.

168. Demangeat JL, Poitevin B: Nuclear magnetic reso-nance: let’s consolidate the ground before gettingexcited! Br Homeopath J 90(3):2-4, 2001.

169. Anick D: Complexes of short hydrogen bonds: the activeingredient in homeopathy? Homeopathic ResearchNetwork Fourth Scientific Symposium, Washington,DC, 1998, Homeopathic Research Network.

170. Lo S-Y: IE crystals and homeopathy, HomeopathicResearch Network Third Scientific Symposium, SanFrancisco, 1995, Homeopathic Research Network.

171. Walach H: Does a highly diluted homoeopathic drugact as a placebo in healthy volunteers? Experimentalstudy of belladonna 30C in double-blind crossoverdesign—a pilot study, J Psychosom Res 37(8):851-860,1993.

172. Davidson J, Woalbury M, Morrison R: Multivariateanalysis of five homoeopathic medicines in a psychi-atric population, Br Homeopath J 84:195-202, 1995.

Suggested Readings Bellavite P, Signorini A. Homeopathy: a frontier in medical sci-

ence, Berkeley, 1995, North Atlantic Books. Endler PC, Schulte J: Ultra high dilution, physiology and physics,

Dondrecht, 1994, Kluwer Academic. Ernst E, Hahn EG (editors): Homeopathy. a critical appraisal,

Oxford, 1998, Butterworth-Heinemann. Harrington A: The placebo effect, Cambridge, Mass., 1997,

Harvard University Press. Lown B: The lost art of healing, Boston, 1996, Houghton

Mifflin. Shapiro A, Shapiro E: The powerful placebo, Baltimore, 1997,

Johns Hopkins University Press. Spiro H: The power of hope: a doctor’s perspective, New Haven,

Conn., 1998, Yale University Press. Van Wijk R, Wiegant FA: The similia principle in surviving

stress: mammalian cells in homeopathy research, Utrecht,The Netherlands, 1997, Utrecht University.

102 C L A S S I C A L H O M E O P A T H Y

Page 110: Classical Homeopathy

This chapter describes the process of patientcare in a clinical setting, summarizing andexplaining the steps taken by the homeopath.

THE HOMEOPATHICAPPROACH TO THE PATIENT

The homeopathic approach to the patient is derivedfrom the goal of the homeopathic consultation, tounderstand the state of the patient well enough toselect the appropriate homeopathic treatment.Understanding a patient begins with the medicaldiagnosis and expands to include the particularaspects of the patient’s illness, history, and person-ality. The homeopath is interested in understandingthe uniqueness of the illness and the person whohas the illness. What makes this person’s illness

peculiar to him or her? What makes this persontick? What are the patient’s unique habits and atti-tudes? The homeopath will rely on observation andexamination, oral communication, and writtenrecords to make a comprehensive homeopathic eval-uation.

Initial Contact

Observation begins with the first contact betweenhomeopath and patient. In small practices, somehomeopaths schedule appointments personally,whereas in larger practices the task is delegated.Unusual patient attitudes, varying from extreme shy-ness to urgent demands for prompt appointments,are noted. It is not unusual for a homeopath with afull practice to have a waiting time of several months

7Homeopathic Principles in Patient Care

D E B O R A H G O R D O N

103

Page 111: Classical Homeopathy

for scheduling new patients, and this is quite discon-certing to some patients.

Although homeopaths vary in their routines forscheduling patients and obtaining medical histories,it is a common convention of practice that the homeo-path goes to the waiting room to greet the patientand lead the way to the consultation room. Whileapproaching the waiting patient, the homeopathseeks useful observations that express something ofthe nature of the patient, including posture, level andchoice of activity, interaction with other waitingpatients, general appearance, and whether the patienthas come to the consultation alone or with others.Although no conclusions can be drawn at this time,it may prove useful in the final understanding toremember whether the patient was humming andstaring out the window, arguing with the front desk,or quietly reading.

Most homeopaths request that the patient com-plete a history form before the appointment. Formsvary from single pages that contain typical medicalinformation (e.g., previous illnesses, surgeries, familyhistory, and allergies) to lengthy forms that introducethe patient to the homeopathic line of questioning(e.g., content of dreams, sleep patterns, details of theemotional aspects of the patient’s history).

Medical records from other practitioners, conven-tional and complementary, are important parts ofthe full evaluation of the patient.

The Homeopathic Consultation

The consultation ideally occurs in a quiet room, com-fortably furnished with chairs for all, a writing deskfor the homeopath, and reference books or a com-puter. Homeopaths who see children usually providetoys or drawing materials so the children may havesome freedom of movement or play. An examinationtable and equipment may be in a corner of the roomor may be located elsewhere. The interview may bevideotaped for purposes of case analysis and teach-ing. Informed consent is required for videotaping.

Style of Interview Throughout the interview, each line of questioning isinitiated with an open-ended approach, which allowsthe patient to express fully everything that he or shehas intended to tell the homeopath, in his or her ownwords and manner. The patient may begin speaking

without any prompting from the homeopath, or maysit quietly and wait for a question. Some homeopathsspend a minute or two looking through the patient’sforms to allow the patient time to adapt to the roomand inspect diplomas or photographs if he or she sodesires.

The homeopath will begin the interview witha simple question, “What may I do for you?” or“What brings you here today?” The question may bejoined to a brief statement about the purpose of theinterview: “I am interested in learning as much aspossible about your medical problems and aboutyou personally. Please start wherever you like andtell me about yourself.” The homeopath listens toeverything the patient says without interruption,unless the patient is drifting seriously off course.To minimize any possible inf luence on whatthe patient is saying, the practitioner’s nonverbalresponses are neutral or gently supportive andencouraging.

Content of the Examination A homeopathic interview covers three types of inform-ation:

1. Chief and secondary complaints 2. Review of systems 3. The nature of the person The order in which information is gathered varies

among practitioners and according to the way in whichthe patient reveals the information. Observationsregarding the patient’s nature are made throughoutthe interaction.

The chief complaint is usually the patient’s start-ing point. The homeopath asks patients to tell thestory of the problem in their own words. The home-opath is first interested in the patient’s perceptions—how the illness is experienced and how it affects thelife of the patient.

The patient’s answer is always helpful, even if it isnot what the homeopath has asked for. If the patientchooses to describe his or her illness by listing thedoctors consulted and what those doctors tested,diagnosed, and treated, the homeopath regards thatorientation as valuable information; for some reason,as yet unknown, the patient has chosen to talk aboutwhat medical specialists have said rather than abouthis or her own experience. That observation is filedaway and will be considered in the analysis, butimportant information is still needed regarding thecomplaint.

104 C L A S S I C A L H O M E O P A T H Y

Page 112: Classical Homeopathy

The homeopath must understand the nature ofthe complaint with great clarity to make an accuratehomeopathic analysis. Beginning with open-endedquestions and eventually becoming as specific as nec-essary, the homeopath wants to learn about the onsetof the condition, the nature of the patient’s symp-toms, and the management of the problem.

The homeopathic consideration of possible cau-sation expands on the conventional view. A home-opath will want to know about risk factors andspecific events in the patient’s history that may, froma homeopathic perspective, be associated with theproblem. For patients who lack typical risk factors,homeopaths will often discover contributing or incit-ing events that are not typically considered a “cause”of the problem. Box 7-1 provides examples of typicalquestions asked in homeopathic analysis.

For example, if an elderly, lifelong smoker devel-ops severe asthma, both traditional and homeopathicanalysis may attribute the cause to smoking.However, a similarly afflicted young nonsmoker, withno personal or family history associated with risk ofasthma, may reveal that the asthma began after a sig-nificant life event. Understanding the nature of thislife event may provide the clue to the homeopathicanalysis and successful treatment.

To understand the nature of the symptoms interms that will be useful for homeopathic analysis,the homeopath may simply pay close attention to thespontaneous telling of a related story, or may have toresort to a series of questions. Questions always be as

open-ended as possible at first, and become increas-ingly specific as key pieces of the puzzle are sought.The specific characteristics that ameliorate or inten-sify the symptoms are called modalities and are veryhelpful to the homeopath during the process of sort-ing out what is distinctive about this particularpatient (Box 7-2).

All medical practitioners are interested in whatthe patient is and has been doing for the problem.Securing information about previous and currentmedications and their benefits and adverse effects isstandard practice in conventional and homeopathicmedical consultations. In some instances the infor-mation will prove particularly useful in a homeo-pathic analysis. Differential diagnosis to select theappropriate homeopathic remedy may hinge on prior

C H A P T E R 7 Homeopathic Principles in Patient Care 105

When did the problem start? How exactly did it start? What else was happening in your life at that time

or in the preceding few months or even years? That is, did you have any preceding medical prob-

lems or medical treatments, even if they seemunrelated?

Were there any significant changes or events inyour personal life?

What was your stress level at the time the problemstarted?

How did that stress feel in your own experience? What did you think was happening before you

went to the doctor for a diagnosis?

B O X 7 - 1

Typical Questions Asked in HomeopathicAnalysis

Please describe the sensations of your problem asclearly as you can.

What is the location, nature, and timing of thepain, and what makes it better or worse? (Thehomeopath will investigate carefully this con-cept of modalities. Many patients, at first con-sideration, will simply reply that somemedication takes away the pain. However, witha little patience, and a little patient education,many patients actually reveal some amazingand homeopathically useful modalities for theirchief complaint. Homeopaths are looking forunusual and individualized modalities, such asthose illustrated by the following statements:“My period stops if I get my feet wet,” or “Mythroat feels burning hot, but the only thing Iwant to drink is tea, which makes it feel better.”These are very unusual, and therefore useful,modalities.)

Considering the modalities, is there any position,activity, rest, weather, season, or direct applica-tion that affects the symptoms?

Does the pain extend to other parts of your body? Are any other symptoms associated with the main

symptoms? How is your mental and emotional state associ-

ated with this condition? How does this condition affect your life? What is the hardest thing for you about this

problem?

B O X 7 - 2

Questions a Homeopath Asks to Understandthe Nature of the Patient’s Symptoms

Page 113: Classical Homeopathy

medical treatment. For example, exertional asthmafollowing cortisone prescribed as treatment for poi-son oak may be treated differently from exertionalasthma that followed a hysterectomy. Although theimpact of the medical problem on the patient’s life isan area of interest to conventional and homeopathicpractitioners, homeopaths may probe further to findout more about the person and how he or she han-dles the stress of illness (Box 7-3).

The attention paid to the characteristics of thechief complaint is quite time consuming. However, tofully understand the patient, the homeopath mustlearn of all aspects of the patient’s health. Thereforethe same degree of attention must be paid to anyother symptoms the patient experiences. Generallyspeaking, most of these symptoms come up duringthe investigation into the chief complaint. A formalreview of systems to uncover any omissions is still agood idea.

The homeopath makes an assessment of thenature of the patient as a person, including personal-ity, familial and other relationships, social situation,coping mechanisms, and other areas of interest asindicated in each interview. Clearly, understandingthe nature of the person is challenging, as is elicitinginformation that will lead to such an understandingand evaluating it without prejudice. The homeopathmust approach the interview with an open mind, freefrom preconceptions about the patient and his or herillness, and free from distraction with personal mat-ters. In the midst of a busy schedule, it can be diffi-cult to listen attentively and to refrain from makingundue associations or presumptions regarding thepatient’s story.

The personal nature of the interview can surprisepatients who may arrive with a list of medications,previous test results, and a series of diagnoses.Patients new to homeopathy may experience an ini-tial unease when asked to talk about themselves.After the initial surprise, most patients are gratifiedto learn that less importance is placed on the diagno-sis and more emphasis on the person who has the ill-ness. Patients find a way to tell the story that revealswho they are. The open-minded homeopath will sitback with confidence and curiosity, gleaning muchthat contributes to his or her understanding.

Every patient will reveal nonverbal information.Babies clutch a parent’s arm (fearfully? mischie-vously? angrily? jealously?) or upset the entire toybasket; children sit forward with eager involvementor absentmindedly handle books on a low shelf;adults sit back with arms folded or lay out neatlytyped lists of previous medical consultations.Nervous laughter, unconscious gestures, even thenature of clothing selected—all contain informationthat may be helpful.

Information may be solicited with a simplerequest that the patient talk about himself or herself,such as, “I think I understand quite a lot about yourphysical complaints. Now, to select the right treat-ment for you, I would like to know as much as possi-ble about the rest of you. Who are you, and howwould you describe your temperament?” For mostpatients, this is indeed a challenging task thatunfolds with the combined efforts of patient andhomeopath.

Each homeopath develops a personal interview-ing style, which may appear similar to the style of psy-chotherapeutic assessment. The following are someof the interview techniques used by homeopaths. Practicing active silence: Watching and waiting can

be a valuable tool, allowing the homeopath toobserve and the patient to decide what he or shewould like to talk about.

Eliciting a story: The homeopath may try to elicit astory (What happened at recess today? Tell meabout the last time you were really upset.) or anunconscious theme (Have you ever had anyfrightening or recurring dreams? Do you haveany fears or phobias?) It is not unusual to hearstories, perhaps previously unshared, that havetroubled a patient, or to follow the patient as heor she recognizes a recurring theme in the chainof events described.

106 C L A S S I C A L H O M E O P A T H Y

What have you done for this problem and whatwas the effect of that treatment?

What are you still doing for the problem? Are youtaking medications? Are you receiving othertherapies, either conventional or alternative?

What treatments have you pursued or are youpursuing for other conditions?

What is the hardest part of this illness in yourexperience?

What do you miss the most in your life, and whatis your feeling about that?

B O X 7 - 3

Typical Questions a Homeopath May Ask toAscertain the Effect of an Illness

Page 114: Classical Homeopathy

Asking for reports from others: What importantfriends or relatives say about the patient, or whatthe patient believes they may say, can be revealing.(What would your wife say is your best quality?Your worst?) Reports from others must always beconsidered in context, keeping in mind the pri-mary goal of the interview, which is to learn thepatient’s experience in his or her own words.Observations of others regarding the patient’sbehavior are of secondary, although sometimesquite useful, importance.

Noticing dropped clues: Inadvertent communica-tions may influence the therapist’s thinkingabout the patient. If a patient makes an offhandremark, expresses an inappropriate emotion,speaks to himself or herself as an aside, or substi-tutes one word for another, the homeopath isentitled to consider whether the “mistake” may beinterpreted as significant. For example, if apatient mistakenly refers to her husband as “myfather,” it is reasonable to learn more about herrelationship with her father and to assess whetherany unresolved themes from that relationship areexerting an influence in her current life.

The standard of practice is to start with a simplesentence or question and listen without interruptionto the patient’s answer. If more information isneeded, questioning proceeds with simple or open-ended inquiry and becomes specific only to clarifyinformation.

An important part of every medical evaluation isthe physical examination, and this is true in home-opathy as well. Important information can beobtained about the patient’s general level of healthand fitness, the accuracy of the patient’s descriptionof his or her condition, and possibly about healthconcerns that the patient is unaware of.

In addition, the homeopath may gather particu-larly useful information from items of little interestin a conventional evaluation. For example, imaginethe physician is examining two children with chronicrespiratory infections, considering which remedymight be appropriate for each. One child has a bluishtint to her sclera, an indication to consider the rem-edy Carcinosin. The other child has a streak of hairgrowing down the midline of the back, overlying thespine, an indication for the remedy Tuberculinum. Thefinal choice of remedy will be based on the totality offactors, but in these cases, the physical examinationhas added distinguishing clues.

Certain details of the patient’s nature are of pecu-liar interest to homeopaths because they correspondto indications for specific remedies. The homeopathmust inquire about that body of information referredto as generals, meaning details that describe the patient’sgeneral tendencies. Generals fall roughly into two cate-gories: preferences and modalities.

Regarding preferences, the homeopath wants toknow about food cravings and aversions, sleep posi-tion and patterns, and whether the patient is more onthe warm side or the chilly side.

Food cravings and aversions are helpful when theyreflect true choices on the part of the patient. The foodsthat a patient strongly likes or dislikes may be quite dif-ferent from the foods chosen or avoided at mealtime,because those choices may be made for health reasonsor, for children particularly, made by other people.In addition to specific food desires and aversions, thepatient is questioned regarding specific tastes: sweet,sour, salty, spicy, or smoked. The nature and intensity ofthe patient’s general thirst is also important.

Sleep patterns involve the patient’s physical posi-tion during sleep and the length and quality of sleep.Again, the question is of preference, not of selection.A patient may sleep on his back with a pillow underhis knees on the advice of his physician, but, giventhe choice or an unusual bed, he or she may find him-self on his abdomen. Other significant informationmay include the patient’s natural patterns of sleepand waking, and whether he or she feels refreshed onwaking. Napping may be soothing or only aggravatean afternoon sense of fatigue.

A simple piece of information that is sometimesdifficult to elicit is the patient’s sense of temperature,quite separate from both emotional temperamentand degree of fever or chill as measured by a ther-mometer. Some homeopathic remedies are specifi-cally indicated for people who tend to feel chillierthan others, whereas other remedies are for peoplewho are on the warm side. Most people have notreflected on this characteristic, so a bit of question-ing is needed to find out, “Are you usually warmer orcooler than those around you? Do you turn the ther-mostat up or down more often? Do you wear shortsin the winter or a sweater in the summer?”

Once the homeopath acquires information aboutthe modalities of the chief complaint and other phys-ical complaints, it is important to know whether anygeneral modalities apply to the patient as a whole.Sample modalities of a general nature include seasons,

C H A P T E R 7 Homeopathic Principles in Patient Care 107

Page 115: Classical Homeopathy

locations (e.g., the seashore or the mountains),weather conditions, time of day, particular activities(e.g., ascending stairs, reading, playing the piano),and bodily functions (e.g., diarrhea, menses, sleep).Rather than question the patient specifically regard-ing an infinite list of possible modalities, the homeo-path instead strives to notice information revealedabout these modalities during the general interview,and questions further as needed.

For example, it is not uncommon for a patientwith headaches to relate the timing of the headachesto changing weather patterns. However, if a patientsays that not only the headaches, but his or her aller-gies and general energy level become problematicwhen the weather changes, the homeopath will wantto know specifically what sort of a change and whendoes the aggravation come relative to that change.“Oh, I’m worse when it’s threatening rain, and once itstarts to rain, I feel actually a bit better.” This state-ment provides two items of information, namely thatthe patient is worse before a storm and better duringrainy or wet weather.

The homeopath is of course interested in what isrelevant in conventional medical evaluations, includinga review of systems and personal and family medicalhistories. Areas of particular interest regarding the per-sonal medical history include problems and treatmentsthat preceded the onset of the chief complaint, as wellas the history of vaccinations, injuries, and surgeries.Some remedies are particularly indicated for postoper-ative complaints, whereas others are more appropriatefor complaints associated with a recent vaccination.The family history is often contributory, because cer-tain hereditary tendencies considered in homeopathicanalysis not usually considered in conventional medi-cine. Areas of particular interest include history of can-cer, tuberculosis, syphilis, gonorrhea, and epilepsy. Alsoof interest are instances of heart disease and diabetes,particularly when such instances have an early age ofonset. Homeopaths practicing in certain locales wouldalso be interested in history of leprosy, typhoid, andother epidemic and endemic diseases.

CASE ANALYSIS AND REMEDYSELECTION

Having gathered necessary information about thepatient, the homeopath is faced with the task ofsynthesizing the information in such a way that the

correct homeopathic remedy may be selected. Caseanalysis is directed at developing an organized home-opathic picture of the patient that corresponds to asimilarly organized picture of a homeopathic remedy.

Case Analysis

The patient’s story is organized into the homeo-pathic picture, which always includes and expandsupon a conventional understanding of the patient.The physician seeks to identify all distinctive quali-ties of illness and temperament that characterize thepatient, to understand what is particular about theexpression of illness in the patient. The physicianconsiders all information gathered and must make asensible analysis by answering a series of questions.

What Is the Central Feature of the Case? The most important part of the analysis is to identifythe central feature or disturbance, which may or maynot be the same as the patient’s chief complaint. Thecentral disturbance may be on one or more of threeimportant levels—physical, emotional, or mental. Thehomeopath must identify and understand the centralfeature as the basis for selecting the appropriateremedy.

Samuel Hahnemann, in the Organon of Medicine,summarized this mandate as follows:

A physician must . . . clearly realize what is to be cured indiseases, that is, in each single case of disease. . . . It willhelp the physician to bring about a cure if he can find outthe data of the most probable cause of an acute disease,and the most significant factors in the entire history of aprotracted wasting sickness, enabling him to find out itsfundamental cause.1

Hahnemann continues over many paragraphs todescribe different aspects of what is referred to hereas the central feature. The concept of a central featureis important, and is peculiar to homeopathic analy-sis. Although there are distinguishing characteristicsamong individual homeopaths at an advanced levelof analysis, as a group homeopaths share an under-standing about health and disease that varies some-what from conventional medical understanding.

The totality of symptoms must be considered inevery case. It is important to remember that, unlikeconventional medicine, the pathologic diagnosis isonly a possible starting point for the homeopathicdiagnosis. The homeopath seeks the distinguishing

108 C L A S S I C A L H O M E O P A T H Y

Page 116: Classical Homeopathy

aspects of the complaint and the person who has thecomplaint, so that the Law of Similars may be appliedand a homeopathic remedy chosen—one that hasbeen shown to cause or cure the particular com-plaints of the patient. Totality does not necessarilyimply a complete and exhaustive review of systems,but rather the importance of the whole picture. In anacutely ill patient, it may be the intensity of symp-toms and the level of the energy or malaise that rep-resents the totality of the illness picture. However, ina case of chronic rheumatoid arthritis, much moreinformation (a complete review of systems, as well asan understanding of the patient’s nature or personal-ity) is needed, because the patient’s disease responseis all encompassing.

In chronic cases, the overview is usually quitebroad. Many aspects of the patient’s life will be con-sidered in search of emotional themes, limitations onany level, and distinguishing details that may not bepathologic but are nonetheless characteristic, such asfood preferences and sleep habits.

The consideration of acute cases is more clearlyfocused for several reasons. First and foremost, it isusually the case that when an individual is suffi-ciently ill to merit attention, the defining aspects ofthe case are often quite clear. The physician is lessinterested in a global picture of the patient and moreinterested in a snapshot that answers the question,“How are you different from your normal state?”Answers to this question include acute physicalsymptoms and important general or emotional fea-tures. For example, a patient with an acute sorethroat will usually be very clear about the nature ofthe pain and the accompanying modalities, as well ashis or her general level of heat or chilliness, thirst,appetite, and mood. “I don’t have time for these ques-tions, just get me well . . . now!” provides sufficientinformation about the patient’s emotional state, asdoes, “I really don’t know. I don’t care. Leave mealone, I want to go home.”

The totality of symptoms is organized accordingto a functional hierarchy of symptoms, from most toleast severe. In a general sense, any disturbance on amental level (e.g., dementia, thought disorder) is usu-ally the most severe and disabling, followed by emo-tional disturbance (e.g., depression, anxiety) andfinally by disease of the physical body. At each level,an appropriate internal hierarchy is structured basedon the degree to which the problem compromiseshealth, so that within the level of physical symptoms,

heart disease is more serious than skin disease. Thehierarchy is flexible and based on logic, such that forevery patient the totality of symptoms must be ana-lyzed, with due regard to severity of each symptom, inthe context of the life of the patient. Where is thepatient most restricted or disabled? What level of dys-function or suffering is most acute? What improve-ment would most benefit the patient?

Considering a totality of symptoms in eachpatient, the most crucial area or level of disturbancebecomes the central feature of the case and the key toa successful prescription. Two examples illustrate thispoint.

First, although skin disease (physical) is almostalways less disabling than mental or emotional symp-toms, a severe dermatitis, with intolerable itching,swelling, and even bleeding, is more disabling than amild case of situational anxiety, even though anxietyresides on the deeper (emotional) level.

Second, a patient’s primary complaint is chroniceczema, but further questioning reveals that he or shestruggles chronically with depression. A thoroughexploration and analysis of the depression reveals anunresolved grief in the patient’s childhood. Thehomeopath understands that the depression reveals adisturbance on a level more central than the skin, andso selects the remedy based primarily upon the under-standing of the depression. A remedy selected with thisunderstanding is most likely to address both thedepression and the eczema and lead to a successfuloutcome.

What Are the Strange, Rare, and PeculiarAspects to the Case? It is essential that the physician have an understand-ing of both medical pathology and human natureupon which to base his or her evaluation. Crucial toa correct homeopathic prescription is the identifica-tion of aspects of the case that are unexpected, dis-tinguishing symptoms that are thus consideredstrange, rare, and peculiar.

Symptoms may be considered strange, rare, andpeculiar by several different criteria. A symptom maybe quite unusual and striking by its very nature, or byits intensity or frequency, or it may be unusual onlyin the context of the particular patient and his or herillness or personality.

For example, a patient with a severe sore throatstates that the pain is eased only by eating solid foodand is made worse by swallowing liquids. This

C H A P T E R 7 Homeopathic Principles in Patient Care 109

Page 117: Classical Homeopathy

unusual modality becomes a central feature in under-standing the patient and making the correct pre-scription.

In another case, a patient with migraines since abusiness failure is presumed to be suffering financialworries. The patient reports that he or she worriesconstantly about money and making ends meet.Further inquiry reveals that because of a generousinheritance the patient has no real basis for financialconcern.

Finally, a patient with allergic rhinitis sneezes forseveral hours each morning on waking, or hiccupsafter each sneeze. Patients with allergic rhinitis areexpected to sneeze most when they are most exposedto allergens. However, patients whose sneezingbecomes strongest according to the time of day, orwho follow an allergic sneeze with a hiccup, arerevealing individual symptoms uncommon in thiscondition.

Is There Clear Causation? The homeopathic physician will inquire carefullyinto the circumstances surrounding the beginning ofan illness, looking for an event or a condition thatmay have precipitated the lapse in health. An essen-tial assumption in homeopathic perspective is that ahealthy body operates to preserve homeostasis; con-fronted with stress of any sort, the organism will seekto maintain a healthy state. When the homeostaticmechanism fails, illness ensues as a result of a partic-ular stressor affecting a particular weakness of theorganism.

To evaluate stress or causation, the homeopathexamines factors that are usually considered, such ashabits, lifestyle, and infectious disease, but expandsthe analysis to identify specific stressors. Selection ofthe appropriate homeopathic remedy will vary,depending on whether the stress is the grief of anemotional loss, the shock of a near-accident, or over-work associated with final examinations for a collegestudent. The specific nature of the stress and thepatient’s reaction to it are important factors tounderstand.

Is the Case Acute or Chronic? In most cases the answer to this question is not diffi-cult, yet it must still be carefully considered. Theimportant point is to question when the patient waslast in good health, which necessitates understandingwhat good health is for that patient. The patient’s

sense of well being is one possible guideline, thereport of family members is another.

In the case of recurring acute illness, such asrepeated otitis media in children, the homeopath willconsider whether the tendency to such problems ischronic, or whether the child is generally healthy buthas been unable to successfully heal an acute illness.If the condition is the result of a chronic weakness,consideration of the complete history may lead to atreatment that eradicates the tendency to ear infec-tions. In the second circumstance, treating it with ahomeopathic remedy as opposed to using the sup-pressive antibiotic may enable the child’s immunesystem to eradicate the infection, which then doesnot reappear.

What Other Features Are Important to theCase? While evaluating the totality of symptoms and thepatient as a whole, a great deal of information may beacquired that does not seem central to the case athand. Considering a wide variety of informationoffers the homeopath the opportunity to develop agreater sense of patience, to resist the urge to discardwhat seems irrelevant. At times what seems mostirrelevant will in fact be important to understandingthe patient or may provide an essential clue in thesearch for the correct remedy.

As the physician gains clinical experience andincreased familiarity with homeopathic medications,the process of sorting valuable information from themerely extraneous becomes more efficient. The skillof effective analysis at this level is best acquired in aclinical situation, working with the guidance of anexperienced homeopath.

What Features of the Patient’s Life or LifestyleContribute to the Disease Process? In general, the answers to this question overlapbroadly with conventional understanding of howlifestyle affects health. Lifestyle choices clearly havean influence on certain states of health or illness, andeach physician develops a personal style for advisingpatients regarding those choices. Homeopaths areusually very successful at helping patients changeunhealthy lifestyle habits.

Consider the example of a heavy coffee drinkerwho has problems with insomnia. Obviously, anyphysician would consider counseling the patient aboutthe relationship between coffee and sleeplessness.

110 C L A S S I C A L H O M E O P A T H Y

Page 118: Classical Homeopathy

However, the homeopath will also consider thepatient’s craving for coffee as a symptom, and if theremedy selected has been observed to decrease a cof-fee craving, the homeopath may choose to sit insilence while waiting to see whether the patient’scraving changes without counseling.

Many other choices are not so clear cut—many arecontroversial—and the decisions made by home-opaths regarding the importance and effectiveness oflifestyle counseling are as personal as the choicesmade by conventional physicians.

Selecting the Remedy: ResourceTexts

Once the patient’s information is organized into ahomeopathic picture, the physician will search for acorresponding homeopathic medicine. A homeo-pathic medicine will be sought based on its predictableeffectiveness in treating the picture of the patientarranged in the case analysis. The physician has threetypes of sources in which to search for informationabout the homeopathic remedies.

Homeopathic Provings Homeopathic medicines develop indications for clin-ical usefulness depending on their performance inclinical trials, which in homeopathic practice arecalled provings. The nature of provings has evolvedsomewhat over the 200-plus years of homeopathicpractice, but the process of information gatheringremains the same. In modern clinical provings, care-fully controlled and supervised groups of individualsingest one or more doses of an unidentified homeo-pathic remedy and carefully record all symptoms orchanges in their normal state. Symptoms will rangefrom the content of dreams, changes in emotionalstate, and physical sensations to actual physicalchanges. Symptoms are reviewed for accuracy andcollated among different provers to provide a com-prehensive list of symptoms caused by that particularremedy, arranged in groupings of body parts affected.Symptoms in the categories of mind and generalitiesmay predominate for some remedies, or other spe-cific areas, such as head, stomach, or sleep, may beaffected, depending on the scope of action of the par-ticular remedy.

Information has been retained from provings thathave varied widely in their clinical design over the last

two centuries, ranging from single provers to largegroups, from seemingly innocuous inactive sub-stances to quite potent and drastically acting ones.Information has been added in a similar fashionwhen poisonings have occurred, although poisoningsymptoms are generally less reliable for clinical appli-cations than proving ones. For example, the homeo-pathic remedy made from mercury is not toxic as aremedy (referred to as Mercurius vivus or Mercurius sol-ubilis), but elicits symptoms if administered in a prov-ing. Symptoms observed during historical episodesof poisoning from mercury (environmental or iatro-genic) are striking but are less useful in clinical prac-tice. Poisoning symptoms are retained in the clinicaltexts for the sake of completeness, interest, and pos-sible application.

The most comprehensive record of provings is a12-volume set collected by T.F. Allen, MD, which listsproving substances in alphabetical order.2 This refer-ence provides a comprehensive list of the symptomsassociated with substances at that time. For example,the listing for the homeopathic remedy made frommercury (formal name is Mercurius solubilis orMercurius vivus) is fairly long, running for 28 pages ina typical edition. Provings completed since Allen’swork was published are published individually, in col-lections, or in homeopathic journals.

The following are excerpts from the symptom listfor Mercurius vivus. The first information provided isabout the substance itself.

Hydrargyrum, an elementary body. (Mercurius vivus,Quicksilver.) Preparation for use, Triturations. Mercurius solubilis, Hahnemanni. Hydrargyrum oxydulatum nigrum (Ammonio-nitricum) N2O53Hg2O + 2NH3. Precipitated black oxide of Mercury, with varying(according to temperature) amounts of Nitric acidand Ammonia. Preparation for use: Triturations.2

General symptoms often appear in narrativeform.

After he had taken the fourth powder I was summoned tosee him, when he informed me that catarrhal symptomswere much improved, but he was then having a most violentfacial neuralgia on the right side, originating in the dentalnerve, and radiating upwards over the side of the face.

This he first felt after taking the second dose, andimmediately after each of the two last the aggravation

C H A P T E R 7 Homeopathic Principles in Patient Care 111

Page 119: Classical Homeopathy

was marked and intense, so much so, that he felt that hecould not take another dose.

I discontinued the remedy and the difficulty soonsubsided.

His teeth, which are carious, are becoming loose; thereis a white line, from undue epithelial secretions, at themargin of the gums; there are great tremors, approachingto paralysis, and an indecision in speaking, resemblingstammering.

He has lost two stone weight during the last twoyears.

The tongue is wavy from nervous debility, and he suf-fers from nocturnal perspirations; memory is rather fail-ing, and appetite is bad.

Pale, weak, and anxious-looking, with a slow but reg-ular pulse; tongue furred; teeth mostly greenish blackand carious; skin generally dry and cold.

Teeth, lower incisors, pegged, flattened at the top, thecenter brown, the enamel everywhere deficient.

All of them chipped and decayed.2

A section on generalities lists conditions affectingthe whole person, as taken from various provings,poisonings, and clinical experience.

Emaciation. He was emaciated and cachectic, and looked prema-

turely old. It is certain that the children of the workers are

affected with the mercurial poisoning; although it maybe from the poison carried by the clothing.

A daughter, born during her mercurialism, was verysmall, only learned to walk when three years old, andnever grew to be more than four feet in height; there waskyphoscoliotic curvature of the spine, the head wasdrawn to the chest and somewhat to the left side; therewas very imperfect development of the muscle andbone.2

Symptoms of emotions, mental function, anddizziness are combined in a section of symptoms ofthe mind.

Emotional. Mind, easily agitated. Occasionally his mind seemed to wander. Frightful images at night. Hallucinations day and night. Hallucination of mind, especially at night, with desire

to escape. Delirium; his speech was disconnected, and he would

not answer questions; this delirium increased to a violentrage, so that the patient was obliged to be confined in astrait-jacket, with rolling of the eyeballs, clonic spasms,discharge of yellow, frothy liquid from the mouth and

nose, and rattling in the trachea, followed by trismus andtetanus.

Delirium. Constant weeping (elder). Sadness. Low-spirited.2

The final excerpt is take from a section that ishighly characteristic for this remedy, a section refer-ring to symptoms of the mouth.

Teeth. Teeth black, loose. Teeth turn yellow and become loose. Thick gray coating on the teeth (after working four-

teen days). Teeth dirty-gray, loose. Teeth foul. Teeth thickly covered with tartar. Carious teeth. Decay of the teeth; they become loose in succession,

and at the age of thirty she had lost six; they fell out at theslightest shock (after six years); most of the teeth, espe-cially the molars, were gone; those that remained wereblackened, laid bare, loose and carious (after thirty-eightyears).

After a time, the teeth decay, become loose, of a gray-ish color, and fall out.

Since going into the works, he has been obliged tohave several teeth removed.

All the teeth were loose. Teeth loose, discolored Teeth loose; at last drop out.2

Materia Medica and Keynotes Although it is valuable for its completeness, thequoted reference for Mercurius vivus is incrediblycumbersome to use in an individual case. Over thelast two centuries, various homeopathic physiciansendeavored to create a simplified organization ofthe material in which they combined the most valu-able symptoms gleaned from the provings and fromthe clinical experience of many homeopaths. Thematerial is arranged alphabetically by substanceand often serves as the confirming reference forpractitioners.

The length and usefulness of different MateriaMedica texts varies widely and becomes a choiceguided by educational and clinical experience. Themost widely accepted and revered text is generallythought to be the Lectures on Homeopathic MateriaMedica, written by James Tyler Kent, MD, which was

112 C L A S S I C A L H O M E O P A T H Y

Page 120: Classical Homeopathy

first published in 1904 and is still completely appli-cable in modern practice.

The following excerpts from Kent’s chapter onthe remedy Mercurius demonstrate the ease of use ofKent’s presentation in a clinical setting as comparedwith the cumulative information presented in Allen’swork. The text begins with a discussion of the sub-stance and general features of its effects.

The pathogenesis of Mercury is found in the provings ofMerc. viv. and Merc. sol., two slightly different prepara-tions, but not different enough to make any distinctionin practice.

Mercury is used in testing the temperature, and aMerc. constitution is just as changeable and sensitive toheat and cold. The patient is worse from the extremes oftemperature, worse from both heat and cold. Both thesymptoms and the patient are worse in a warm atmos-phere, worse in the open air, and worse in the cold. Thecomplaints of Mercury when sufficiently acute to sendhim to bed are worse from the warmth of the bed so thathe is forced to uncover; but after he uncovers and coolsoff he gets worse again, so that he has difficulty in keep-ing comfortable. This applies to the pains, the fever,ulcers and eruptions and the patient himself.

He is an offensive patient. We speak of mercurialodors. The breath especially is very fetid, and it can bedetected on entering the room; it permeates the wholeroom. The perspiration is offensive; it has a strong, sweet-ish, penetrating odor. Offensiveness runs all through;offensive urine, stool and sweat; the odors from the noseand mouth are offensive.

He is worse at night. The bone pains, joint affectionsand inflammatory conditions are all worse at night andsomewhat relieved during the day. Bone pains are univer-sal, but especially where the flesh is thin over the bones.Periosteal pains, boring pains, worse at night and fromwarmth of the bed. Mental symptoms: The mental symp-toms, which still more deeply show the nature of themedicine, are rich. A marked feature running all throughis hastiness; a hurried, restless, anxious, impulsive dispo-sition. Coming in spells, in cold, cloudy weather, or dampweather, the mind will not work, it is slow and sluggishand he is forgetful. This is noticed in persons who aretending toward imbecility. He cannot answer questionsright off, looks and thinks, and finally grasps it.Imbecility and softening of the brain are strong features.He becomes foolish. Delirium in acute complaints. Fromhis feelings he thinks he must be losing his reason. Desireto kill persons contradicting her. Impulse to kill or com-mit suicide, sudden anger with impulse to do violence.She has the impulse to commit suicide or violent things,and she is fearful that she will lose her reason and carrythe impulses out. Impulsive insanity, then, is a feature,

but imbecility is more common than insanity. Theseimpulses are leading features. The patient will not tellyou about his impulses, but they relate to deep evils ofthe will, they fairly drive him to do something. Given aMerc. patient, and he has impulses that he tries to con-trol, no matter what, Merc. will do something for him.During menses, great anxiety, great sadness. Anxious andrestless as if some evil impended, worse at night, withsweat. All these symptoms are common in old syphilitics,broken down after mercurial treatment and sulphurbaths at the springs, with their bone pains, glandulartroubles, sweating, catarrhs and ulcerations everywhere.3

The following, for comparison with Allen, aresymptoms of the mouth.

Scorbutic gums in those who have been salivated [Editorsnote: When conventional physicians gave mercury totreat syphilis, they used the toxic effect of salivation as anindication that an adequate dosage had been adminis-tered to the patient. Thus “those who have been sali-vated.”]. Rigg’s disease; purulent discharge from aroundthe teeth. Toothache; every tooth aches, especially in oldgouty and mercurialized patients. Looseness of the teeth.Red, soft gums. Teeth black and dirty. Black teeth andearly decay of the teeth in syphilitic children, like Staph.Copious salivation. Gums painful to touch. Pulsation inthe gums and roots. Gums have a blue red margin, orpurple color, and are spongy and bleed easily. Gums set-tle away, and the teeth feel long, and are elongated. Teethsore and painful so that he cannot masticate. Abscessesof the gums and roots of the teeth. The taste, tongue andmouth furnish important and distinctive symptoms. Asthe tongue is projected it is seen to be flabby, has a mealysurface, and is often pale. The imprint of the teeth isobserved all round the edge of the tongue. The tongue isswollen as if spongy, and presses in around the teeth andthus gets the imprint of the teeth. Inflammation, ulcera-tion and swelling of the tongue are strong features. Oldgouty constitutions have swollen tongue; the tongue willswell in the night and he will waken up with a mouthful.The taste is perverted, nothing tastes right. The tongue iscoated yellow or white as chalk in a layer.3

More concise summaries of information regard-ing each remedy are compiled in collections ofkeynotes, in which data for each remedy may be lim-ited to one or two pages. Texts of compiled materiamedica and keynotes are very useful for confirmingwhich information is relevant to a particular patientand for comparing the patient’s symptom picturewith the specifics of a particular remedy. Some home-opaths prescribe primarily based on a thoroughunderstanding and grasp of the materia medica. Thisapproach to prescribing requires tremendous strength

C H A P T E R 7 Homeopathic Principles in Patient Care 113

Page 121: Classical Homeopathy

of memory, given the size of the homeopathic phar-macopoeia and the truism that any remedy may beindicated in a particular case, regardless of the chiefcomplaint.

The process of scanning all existing materia med-ica to find the material appropriate to a given patienthas been simplified by computer programs thatquickly access information matching search termsentered by the physician. However, because not allhomeopaths have access to or choose to use comput-ers, a written tool that evolved well before computershas made the work of homeopathy a little easier: therepertory.

Repertory A later development in homeopathic literature that hasproven immensely valuable to the practicing homeo-path is a book (or computer program) referred to as arepertory. The repertories most commonly in use aremodeled on a schema developed (in the original reper-tory) by James Tyler Kent. The most comprehensivemodern version derived from the Kentian tradition isThe Complete Repertory, by Roger van Zandvoort.

A Kent-based repertory is arranged in chapterscovering symptoms of particular body parts (rangingfrom Mind to Extremities) and chapters referring tostates of the entire body (i.e., Fever, Chill, Sleep, Skin,and Generalities). Within each chapter, symptoms arearranged alphabetically with extreme precision, elab-orated on with extensive subrubrics, and, in the mostmodern repertories, elegantly cross-referenced tofacilitate symptom location. For each symptom, thereis a corresponding list of remedies that have eithercaused that symptom in a proving or poisoning orcured that symptom in clinical setting. Remedies arelisted alphabetically for each symptom, and emphasisis given according to the strength of the associationbetween the remedy and the symptom.

Following are rubrics representative of the mate-ria medica and proving information for the remedyMercurius cited previously. These rubrics are from thecomputerized version of The Complete Repertory, byRoger van Zandvoort.4

From the chapter on teeth, we find such rubricsas “TEETH; DIRTY look,” with the remedies (abbre-viated) “all-c., aur-m-n., caps., merc., pyrog.” Thefourth remedy in that series is “merc.,” the abbrevia-tion for Mercurius. This rubric would be consideredany time the patient stated or the physician notedthat even cleaned teeth appeared to be dirty.

Another rubric, “TEETH; LOOSENESS of ” lists97 remedies in various type styles to indicate differ-ent emphases. The remedy Mercurius is listed in boldtype, indicating that the symptom has been repeat-edly observed in provings or poisonings and that ithas been cured in cases treated with Mercurius. (Thisrubric would be consulted for teeth which are indeedloose or for a strong sensation of looseness, regard-less of the actual state of the teeth). The full list ofremedies for this rubric is as follows:

acon., alumn., am-c., arg-n., arn., ars., aur., aur-ar., aur-m.,aur-m-n., aur-s., bar-c., bar-i., bar-m., bism., bor., bry., bufo,calc., calc-f., calc-sil., camph., Carb-an., Carb-v., carbn-s.,Caust., cham., chel., chin., cist., cocc., colch., com., con.,crot-h., dros., elaps, gels., gran., graph., hep., Hyos., ign.,iod., kali-bi., kali-c., kali-m., kali-n., kali-p., lac-c., lach., lyc.,mag-c., mag-s., Merc., Merc-c., mur-ac., naja, nat-ar., nat-c.,nat-h., nat-m., nat-p., nat-s., Nit-ac., nux-m., nux-v., olnd.,op., ph-ac., phos., phyt., plan., plat., plb., psor., puls., rat.,rheum, rhod., rhus-t., sang., scroph-n., sec., sep., Sil., spong.,stann., staph., sulph., syph., tarent., thuj., tub., verat., Zinc.,zinc-p.4

To select a mental symptom for comparison, wecan take a phrase from the paragraph on mentalsymptoms in Kent’s Materia Medica on Mercurius:“Impulse to kill or commit suicide, sudden angerwith impulse to do violence.”3 With a little experiencewe learn that the key word that guides the repertorysearch is kill, rather than impulse. Searching under therubric kill for symptoms associated with Mercurius,the findings are abundant: MIND; KILL, desire to: Many remedies, among them: merc

MIND; KILL, desire to; child, her own: androc., merc.,plat.

MIND; KILL, desire to; hysterical melancholia, with:merc. alone, no other remedies.

MIND; KILL, desire to; knife, with a: . . . merc., . . . MIND; KILL, desire to; person that contradicts her:

Only merc. MIND; KILL, desire to; sudden impulse to: . . .merc. . . . MIND; KILL, desire to; sudden impulse to; herself (See

also Fear; kill herself, that she might and Suicidal dispo-sition): . . .merc., . . .

MIND; KILL, desire to; sudden impulse to; husband,her beloved: . . .merc. . .

MIND; KILL, desire to; sudden impulse to; husband,her beloved; menses, particularly during, implores him tohide his razor: only merc.4

Familiarity with the repertory becomes one of thekey features of most homeopathic physicians’ pre-scriptive skills. The most comprehensive repertory

114 C L A S S I C A L H O M E O P A T H Y

Page 122: Classical Homeopathy

text, the computer version of which has been used forthese examples, runs a full 2830 pages in book form,and is well beyond the scope of fallible human mem-ory.4 Rubrics may contain one or hundreds of reme-dies. Careful use of the repertory by a conscientiouspractitioner reveals previously unnoticed rubricsalmost daily.

The practitioner begins with the case analysis andthe exact words of the patient, and translates thatinformation into rubrics selected from the repertory.A comparison or cross-analysis of the rubrics, doneby hand or through a computer program, will yieldone or more remedies listed in most or all of therubrics selected.

For example, a patient may offer the followingas a chief or secondary complaint: “I’m havingterrible trouble with my teeth and gums, so my den-tist thought maybe homeopathy could help me.They’re not actually falling out, but they seem looseto me and the dentist says that’s not far from thetruth. I really do brush them, but they look dirty, nomatter what I do.” Thus the rubrics are “TEETH,LOOSENESS of ” and “TEETH; DIRTY look.”The two rubrics are compared and only two reme-dies are listed in both rubrics: Aur-m-n (Aurummuriaticum natronatum) and Merc (Mercurius, as dis-cussed).

Of course, during the interview a great deal moreis learned about the patient, and the homeopath isparticularly interested in any symptoms relating toemotions, personality, and mental state. Mental char-acteristics or symptoms are often the most signifi-cant and distinguishing aspects of the case.

For example, if the patient with the dental prob-lem is encouraged to talk freely about himself, hisrelationships, and his personality, the homeopathlistens patiently and with an open mind, confidentthat close attention will yield an answer. A state-ment such as, “You know, I don’t really know whywe’re bothering with this. I don’t care much aboutanything anymore and I couldn’t care less whethermy teeth fall out or not,” would indeed be strange,rare, and peculiar, and may be translated into themental rubric, “MIND; INDIFFERENCE, apathy;recovery, about his,” for which three remedies arelisted: ars., aur-m-n., calc. The homeopath wouldexercise clinical judgment, deciding whether thisrevelation is important to understanding the char-acter of the patient. If so, the prescription is for theremedy aur-m-n.

On the other hand, the patient may mutter andspurt through an agitated depression, sortingthrough different life aspects. “My marriage? Oh, it’sgreat, I guess, wait, that’s not always true. Why justlast night we had a HUGE fight, wow, I nearly forgot.When that happens I get so mad, I have to watchmyself. I want to just run into the kitchen and grab aknife. I mean I would never kill her or anything, butthe thought crosses my mind and it’s almost as if Ihave to struggle against it.”

Our previous example of rubrics for Mercuriusincluded the rubric, “MIND; KILL, desire to; suddenimpulse to; offense, for a slight: hep., merc., nux-v.”If the physician believes that this rubric describes asignificant aspect of the patient’s character, he or shewould select Mercurius as the appropriate remedy.

After scanning the repertory to compile a com-prehensive list of remedies that may be useful in aparticular case, the practitioner returns to the mate-ria medica or provings for a fuller description of theremedy. Scores of authors have written in differentlanguages over the last 200 years, adding to thewealth of information about homeopathic remedies.Clinical experience and training will enable the prac-titioner to develop techniques for selecting reliabletexts and using keynotes, materia medica, and prov-ings to compare what is known about a given remedywith what he or she has learned from the interviewand case analysis.

Potency

After selecting the appropriate remedy, the home-opath makes a decision about the potency of the rem-edy. Homeopathic remedies in the United States areformulated in D (or X), C, and LM potencies, each let-ter the Roman numeral for a particular dilution.Thus a liquid form of the prepared medicine isdiluted in 1:10 (X potency), 1:100 (C potency) or1:50,000 (LM potency) solution of alcohol and water.With each dilution the remedy is succussed. Thenumber of dilutions is matched with the appropriateRoman numeral to describe the potency. Commonpotencies include the following:

1. 6X, 12X and 30X are most commonly availablein over-the-counter situations, and are safe forself-prescribing or beginning prescriptions.

2. 6C, 12C, 30C, 200C are commonly used byphysician prescribers and describe a range of

C H A P T E R 7 Homeopathic Principles in Patient Care 115

Page 123: Classical Homeopathy

low (6C, 12C), medium (30C), and high(200C) potencies.

3. A variation in nomenclature occurs in centes-imal dilutions (1:100) beginning at 1000 cen-tesimal dilutions; a shorthand is employed inwhich 1000C is written simply as 1M.Dilutions of higher potency continue in theshortened nomenclature; thus 10M, 50M, andCM (100M).

4. LM potencies are prepared at each sequentiallevel, thus LM1, LM2, LM3, and so on, usuallyup to LM30. These potencies are usually pre-pared for the patient in a very dilute solutionof alcohol in water, and administered in dropsdaily.

Unfortunately for the beginning practitioner,there are myriad systems to explain and advise on theselection of the correct potency. Clinical and educa-tional experience weigh strongly on the beginningpractitioner’s first choices of potency. Fortunately, itis usually true that a correctly chosen remedy will actand be helpful in any potency; often the differentpotencies affect only the duration of action.

A simplified prescription schema limited to C andLM potencies is as follows: in acute illness, considerusing the C potencies. Decide whether the key indi-cating symptoms (mental, physical, or emotional) aremild or intense. If the prescribing symptoms areintense, particularly if the mental or emotional symp-toms are intense, you may use a high potency: 200C,1M, or even 10M. A single dose of the remedy maysuffice, or it may need to be repeated. Any need forrepetition is determined by the response to the firstdose; a favorable response followed by a return ofsome or all symptoms indicates a repetition of theremedy. It is more likely that repetition will be neededin the presence of fever.

If the prescribing symptoms are mild, you will dobetter with a lower potency, such as 6C, 12C, and per-haps 30C. With milder symptoms and lower poten-cies, the response to the remedy is often moregradual. When repetition is needed, the patient willstart with a single dose and repeat that dose once ortwice daily. It is very important in these situations inwhich patients with milder symptoms use lowerpotencies to tell the patient to stop taking the medi-cine when he or she starts to notice improvement.The remedy may be repeated later if the patient ceasesto improve, but continued dosing may disrupt theimprovement to a serious degree.

In chronic illness, proper potency may be deter-mined along similar lines. Thus patients who arechronically ill, with one or a few clear symptoms thatare clear, intense, or start from a single point in time,may be easily treated with a single dose of high-potency centesimal remedies, such as 200C orhigher.

Chronic illness of an insidious, slowly evolvingnature or with daily exacerbation may best be treatedwith daily homeopathic medicines. This may beaccomplished by initiating treatment with a singledose of a high centesimal potency, and following thatdose with daily low-potency dosing, such as 6C or12C, or by using the LM potencies, which are mostoften used daily. Chronic patients who are also tak-ing conventional or herbal medicines are oftentreated most effectively with LM potencies, so thatthe homeopathic remedy may easily and safely betaken daily.

Other Instructions

A controversial area of homeopathy among practic-ing homeopaths is the question of antidotes; that is,whether certain other substances can interfere withthe curative action of the homeopathic remedy.Conventional (allopathic) medicines in someinstances interfere with the action of the remedy.Decisions about concomitant medications are madeon an individual basis, balancing two concerns. Theprime concern, of course, is the patient’s safety; manymedications are taken because they are essential forthe patient’s health and well being. Such medicationsmay be discontinued only if they are no longer con-sidered essential. The second concern is the patient’shealth: dependence on medication for symptom reliefcan interfere with the body’s ability to find its ownreservoirs of healing in response to a correct homeo-pathic remedy. The patient and physician will discussthe interaction of medications and the homeopathicremedy.

For many years, practitioners in the United Stateshave believed and observed that coffee, decaffeinatedor regular, is an antidote for homeopathic remedies.At the same time, many practitioners in Europe andIndia (and many patients in the United States) havedisregarded this caution without affecting remedyeffectiveness. These two seemingly contradictoryexperiences are perhaps both true.

116 C L A S S I C A L H O M E O P A T H Y

Page 124: Classical Homeopathy

One possible explanation is that the nature of ill-ness varies in different countries, and that illnesses inthe United States, such as digestive complaints,stress-related illness, and nervous conditions, are ingeneral more aggravated by coffee.

Another possible (or perhaps probable) explana-tion has to do with the degree of accuracy of the rem-edy. In a given case, acute or chronic, there may beone remedy that will act perfectly, yielding a gentle,rapid, and lasting cure. This remedy is considered thesimillimum, and is sometimes elusive, particularly inchronic cases. In addition to the simillimum, thereare likely many similar remedies that fall short of per-fection but will act in a helpful way nonetheless. Thesimillimum may be less influenced by antidotes thanare the similar but less-effective remedies. Thus it ismore important for a beginning homeopath to cau-tion patients about the use of antidotes, and lessimportant for a more experienced homeopath.

Substances commonly considered antidotes arecoffee, camphor (applied topically), menthol, andsome conventional and herbal medicines. Certainmedical practices are also considered antidotes,including dental procedures and certain kinds ofhands-on medical treatment such as acupuncture orchiropractic. Beliefs and practices regarding thesepotential antidotes vary widely among different prac-titioners and are a continuing area of discussion andinvestigation.

In the Organon of Medicine, Samuel Hahnemannoffered specific advice about the components of ahealthy lifestyle that contribute to prompt healing inresponse to the remedy. Hahnemann distinguishesbetween diseases improperly called chronic, whichrespond to lifestyle adjustments, and those diseasesthat are truly chronic, which necessitate medicaltreatment. For patients entering medical treatment,Hahnemann offers a list of prohibitions that arenearly impossible to follow:

Patients with chronic diseases should avoid the following:coffee, fine Chinese tea and other herb teas, beers adulter-ated with medicinal vegetable substances, spiced choco-late, highly seasoned foods and sauces, vegetable disheswith herbs; chronically ill patients should also avoid everyexcess, even that of sugar and salt, alcoholic drinks notdiluted with water, heated rooms, a sedentary lifestyle,excessive breast-feeding, long afternoon naps, etc.1

It is a rare practitioner who expects such rigidlifestyle standards of patients at this time. Ho-meopathic practitioners advise patients regarding

lifestyle issues to varying degrees, according to thetotality of their medical belief system. Thus physi-cians may advise their patients regarding alcoholicbeverages, use of vaccinations, amount of exercise,and routine physical examinations, but the nature ofsuch advice has no predictable common threadamong homeopathic physicians.

Prognosis

Part of homeopathic prognosis is the immediate andlong-term anticipated response to the remedy. Theinitial response to a correctly prescribed homeo-pathic remedy will follow one of three courses.

First, there may be no initial reaction; theresponse to the remedy is slow in onset and gradualin pace. This is the most likely response in chronicconditions that have not been treated with conven-tional, allopathic medication and that have evolved ata steady pace over the course of the illness. Chronicarthritis of a moderate degree, fatigue, and irritablebowel are conditions that may have been self-managed and slowly evolving, and may be slow torespond to a homeopathic remedy.

The second response is prompt and clear amelio-ration. A perfectly selected remedy given to a generallyhealthy patient with, at most, a few specific com-plaints is most likely to show this response pattern.

The third response is initial aggravation (worsen-ing of symptoms in a pattern atypical for thatpatient). This aggravation may be brief or may intro-duce a gradual retracing of the chronic illness. Anaggravation may apply to specific symptoms (e.g.,headache, joint pain, sneezing) or to the patient’smore general state (e.g., sleep patterns, energy levels).Patients with less vitality, multiple illnesses, or a historyof medication for the symptoms are more likely toexperience significant aggravation after the remedy.Healthy patients may also run through periods ofaggravation, although these are usually short lived. Aclear aggravation or a transient return of symptomsfrom the past are excellent prognostic signs for thefuture course of the illness.

Adverse responses or effects from the remedy arerare, but they do happen and must be distinguishedfrom aggravations. Only a return of a previouslyexperienced symptom, identical or slightly altered,may be considered an aggravation. A symptom com-pletely new to the patient is considered an adverse

C H A P T E R 7 Homeopathic Principles in Patient Care 117

Page 125: Classical Homeopathy

response. A persistent aggravation or a seriousadverse response are each an indication that the pre-scription was incorrect—either the remedy itself or itspotency.

Long-term prognosis is an extremely complicatedarea in which clinical experience is a crucial factor.Patients new to homeopathy often inquire whetherhomeopathy can help with their specific diagnosis, aquestion that is almost impossible to answer reliably.Homeopathy can help with any condition, from thecommon cold to terminal illness. On the other hand,an incorrectly selected remedy will not help either aterminal illness or a common cold. If concern is lim-ited to a select correctly prescribed remedy, which is asignificant assumption, prognosis is more favorablein vital patients with clearly defined symptoms whohave not been treated with numerous allopathic pre-scriptions, particularly immune-suppressing medica-tions (e.g., corticosteroids, methotrexate). Theprognosis is less favorable in more debilitatedpatients with vague and generalized symptoms and ahistory of using many medications.

The time course of response to a remedy varies aswell, but one rule of thumb is that a chronic illnesswill resolve over a period of months loosely equal tothe number of years the illness has been present. Thatnumber, already an approximation, may be doubledfor patients middle-aged and older. However, even anillness predicted to resolve in 5 years is expected toshow improvement, possibly significant improve-ment, in just the first few weeks of treatment.

CASE MANAGEMENT

Follow-up Evaluations

Patients with acute conditions are seen for follow-upexaminations on a schedule similar to that in con-ventional medical practice. Any potentially seriouscondition is followed quite closely; illnesses expectedto resolve without complication are treated and seenagain only if the condition worsens.

Chronic illnesses are expected to take quite a dif-ferent course under homeopathic treatment, andthus the follow-ups, at least initially, proceed at a dif-ferent schedule. In chronic cases, some improvementis expected within the first few weeks; thus patientsare typically seen for follow-up between 3 and 6weeks.

Follow-up examinations are scheduled for 15 to45 minutes, and are intended to evaluate thepatient’s response to the remedy in all areas disclosedin the initial interview. The chief complaint and othermedical conditions or complaints are inquired after,as well as the patient’s general state (e.g., energy,sleep, appetite) and specifics relevant to that patient.If a patient with a physical complaint is also found tohave a lesser emotional problem, such as irritabilityor procrastination, it is important to ask in an open-ended way about these areas as well.

If the prescription is accurate, the patient isexpected to move toward cure in a predictable fash-ion. Illness resolves in a logical fashion as the organ-ism systematically seeks a homeostasis at a level ofgreater health. As observed and repeatedly confirmedin clinical experience, a patient’s lifetime of com-plaints will resolve themselves in a sequence proceed-ing as follows: from those arising most recently tothose from the distant past; from mental to emotionalto physical complaints; from cephalad proceedingdownward; and from internal, life-threatening condi-tions to superficial conditions. (A caveat that is notalways confirmed is the expectation that the patientis not cured until the disease actually manifests onthe superficial (epidermal) layer and presents as arash.) In the mid-nineteenth century, ConstantineHering systematized these observations as the “Lawsof Cure.” This intellectual framework can be appliedto evaluate the response to any therapeutic interven-tion.

The crucial determination the homeopath makesin the follow-up evaluation is whether the patient’soverall level of health is moving in a direction ofgreater health toward cure. If the complaints havemerely shifted around or (even worse) if the patientsinitial complaint has resolved while a more seriousone has arisen (a process of suppression), the homeo-path is not pleased with the results of treatment.Quite different from conventional practice, in home-opathy the overall picture must improve whether thechief complaint improves.

For example, consider a patient with chronicheadaches who returns to say that he or she isdelighted, the headaches are much better, but thepatient had to see a psychiatrist because of the onsetof a deep depression and is now on antidepressantmedication. A conventional evaluation may not linkthe two complaints. The homeopath will considerthat the prescription was wrong, and that the

118 C L A S S I C A L H O M E O P A T H Y

Page 126: Classical Homeopathy

headaches have been suppressed into a more life-threatening condition, depression.

For another example, consider a patient withchronic headaches who reports that the headachesseem just as bad, but sleep and energy are so muchbetter that he or she goes through the day joyfullyand seems to handle the headaches much better thanbefore. Although a conventional evaluation would beequivocal, the homeopath will be pleased, and willanticipate further improvement.

Further Prescribing

The second prescription is perhaps more problematicthan the first. If the first remedy proves inaccurateand no healing response is seen, the case is consid-ered as if new, and a new “first” prescription is made.Once a remedy is seen to have a curative effect, thequestion of “second prescription” arises and involvesquestions of when to repeat the remedy and when tochange to a different remedy.

Duration of action of the initial prescriptionvaries widely, and can be assessed only on individualclinical grounds. For example, a remedy taken for hayfever may prove curative, permanently, in one dose, ormay need to be repeated twice daily at the height ofthe season and renewed annually. Given the widevariation, it is evident that communication betweenthe homeopath and patient is required for appropri-ate guidance.

SUMMARY

It is undoubtedly evident from the previous discus-sion that many variables and variations are possibleamong different homeopathic practices. The physi-cian who successfully practices homeopathy is simi-lar to archetypes of physicians from the past, whichmay be thought incompatible in a world of modernmedicine, managed care, and technologic sophistica-tion. It is true that the homeopath spends more time

with each patient than would be allowed by typicalmodern schedules, relies less on technologic diagno-sis and newly patented prescription medication, andhas idiosyncratic notions about the relationshipbetween physical and emotional symptoms and theability of the body to heal itself.

However, the practice of homeopathy provides amodel that makes sense in light of modern medicaleconomics. Clinically based research is accumulatingthat validates the “efficiency” as well as effectivenessof homeopathy. In addition, the nature of the homeo-pathic interview and the assumptions of self-healingin response to the remedy are only two of the manyfactors that contribute to the mutually satisfyingnature of the physician-patient relationship in home-opathic practice.

References 1. Hahnemann, S: Organon of the medical art, Ed: W. Brewster

O’Reilly, Redmond, WA, 1996, Birdcage Books. 2. Allen TF: Encyclopedia of pure materia medica, A record of

the positive effects of drugs upon the healthy humanorganism, 12 vols, New Delhi, India, 1988, B JainPublishers Pvt. (original 1874).

3. Kent JT: Lectures on homeopathic materia medica, NewDelhi, India, 1986, B Jain Publishers Pvt.

4. van Zandvoort R: The complete repertory, Version 3.0,MacRepertory Computer Program, San Rafael,California, Kent Homeopathic Associates (computer-ized version).

Suggested Readings Borland D: Homeopathy in practice, Beaconsfield, England,

1982, Beaconsfield. Panos MB, Heimlich J: Homeopathic medicine at home, Los

Angeles, 1980, JP Tarcher. Schmidt P: The homeopathic consultation: the art of interroga-

tion, Delhi, India, 1954, B Jain. Ullman R, Reichenberg-Ullman J: The patient’s guide to homeo-

pathic medicine, Edmonds, WA, 1995, Picnic Point Press. Vithoulkas G: Science of homeopathy, New York, 1980, Grove

Press. Weil A: Health and healing, Boston, 1983, Houghton Mifflin.

C H A P T E R 7 Homeopathic Principles in Patient Care 119

Page 127: Classical Homeopathy

WHEN IS HOMEOPATHYLIKELY TO BE SUCCESSFUL?

Consideration of any form of healing must includesome thought about conditions for which it is useful.As Hahnemann wrote in the opening line of theOrganon of Medicine, “The physician’s highest calling,his only calling, is to make sick people healthy—toheal, as it is termed.”1

What is our responsibility if not to help ourpatients? What is homeopathy good for? When is itsuse appropriate and when not?

Although these are simple questions, simple ques-tions are often the most difficult to answer andsimultaneously the most instructive. Remember thatthe view of disease in homeopathy is quite differentfrom that of conventional medicine. The very differ-ent understanding of disease and health necessitates

complicated answers to these simple questions.Simply put, because homeopaths define disease quitedifferently from conventional physicians, comparingsuccess by disease categories is problematic.

For two centuries the homeopathic refrain hasbeen that we treat the patient, not the disease. Thepoint of this statement is that all patients are unique;their conventionally labeled disease is only part of whothey are. Disease labels do not fully describe theimbalance in a person’s health. Further, each persondiagnosed with a certain conventional disease is sig-nificantly different from others with the same dis-ease. The diagnosis is an imprecise label for thetotality of a patient’s condition. Homeopathic treat-ment focuses on the unique pattern of each person’sresponse. Common aspects of that response are notparticularly helpful when choosing the homeopathicremedy.

8Homeopathy in Primary Care

M I C H A E L C A R L S T O N

121

Page 128: Classical Homeopathy

As a very simple example, consider a patient withpneumonia. A cough is quite common, indeed rarelyabsent, in this disease and thus minimally helpful tothe homeopath. Of the hundreds of homeopathicremedies recorded for use in coughs, only a handfulof them are likely to be useful for a given patient—andfor each patient, one remedy is the best. The absenceof a cough, or a cough that has unusual characteris-tics (sound, instigating or ameliorating factors) canbe quite helpful because of its uniqueness, its indi-viduality. This rich complexity of factors requiringconsideration increases dramatically when thepatient suffers from chronic health complaints andsubtle consideration of all elements of the patient’shealth become necessary.

Homeopaths rarely associate remedies with specificdiagnoses. Instead we speak of the sulphur patient or thephosphorus patient, recognizing the pattern of thepatient’s reactions and temperament as primary. A sul-phur patient can suffer many diseases, but the homeo-pathic remedy sulphur is expected to alleviate all ofthem. On the other side of the equation, in a room fullof patients with diagnosis x, perhaps only one is a sulfurpatient; the rest may need a different homeopathic rem-edy. No homeopath would expect every patient with acertain disease to respond to the same homeopathicremedy. In fact, homeopaths do not expect patients toimprove unless the correct homeopathic medicine isselected from the massive list of possibilities.

Given these constraints, it is difficult to constructhierarchic lists of diseases graded by the degree ofhomeopathic effectiveness. Some homeopathsutterly reject the effort as futile and deceiving tothose seeking to understand homeopathy. However,patients, and even many homeopaths, temper theirideology with pragmatism and recognize that certainconventionally defined diseases are more prone toresponse than others. A great number of the classicalhomeopathic texts of the past two centuries includelists of remedies recommended for consideration inpatients with certain conventional diseases.2-7

Always, however, is the essential precondition thatthe homeopath must select the correct homeopathicremedy for the individual patient.

Research Evidence of Effectiveness

One way to answer questions of effectiveness is by turn-ing to published medical research. Unfortunately, the

best homeopathic research to date has focused almostexclusively on placebo differentiation. Although thereis still insufficient research to conclusively prove thathomeopathic treatment is more than placebo, theamount of research devoted to demonstrating thathomeopathy gives patients clinically meaningfulimprovement is at best a small drop in a very largebucket.

Perhaps the best experimental evidence is thatsupporting the use of homeopathy in allergic condi-tions, particularly allergic rhinitis (hay fever). One ofthe very first homeopathic trials published in a con-ventional medical journal investigated the use of ahomeopathic medicine for hay fever symptoms.8 Thetrial used a 30C dilution of mixed pollens and founda statistically significant improvement amongpatients in the treatment group by a variety of mea-sures (see Chapter 6 for further discussion of thesestudies). The trial was one of a series conducted byReilly and associates dealing with inhalant allergicdisease. When they completed the third trial in theseries and published their meta-analysis, the com-bined p value so strongly favored homeopathy (p =.0004) that the authors concluded, “Either answersuggested by the evidence to date—homeopathyworks, or the clinical trial does not—is equally chal-lenging to current medical science.”9Although thisconclusion is rather ambitious, and somewhat weak-ened by the latest trial in the series, other human andbasic sciences studies and literature reviews supportthe contention that allergic rhinitis is the clinicalarena with the strongest evidence for homeopathiceffectiveness.10-18

Another form of allergic respiratory disease,asthma, was included in Reilly’s series with similarlypositive results. In spite of other favorable studies ofhomeopathic treatment of asthma, far too little pub-lished evidence of effectiveness exists to claim thatthe matter is settled.19-21 However, it may be signifi-cant that asthma is the most common problem forwhich patients in America seek treatment from physi-cian homeopaths.22

Ear infections (otitis media) are another respiratorydisease leading patients to homeopathy and which hasa modest amount of supporting research.23-27

A number of interesting discussion points were raisedby a trial conducted by de Klerk and published in theBritish Medical Journal.23 This study highlights someof the difficulties in conducting homeopathic clini-cal trials. Two groups of children with recurrent

122 C L A S S I C A L H O M E O P A T H Y

Page 129: Classical Homeopathy

upper respiratory illnesses (including acute otitismedia [AOM]) received a classical homeopathic inter-view and lifestyle advice. One group received a home-opathic remedy, whereas the other took placebo.Both groups had a marked reduction in upper respi-ratory illnesses, but the homeopathic remedy groupdid not achieve a statistically significant superiority.In addition to the methodologic problems in thestudy (see Chapter 6), the significant improvement inmembers of the “control group,” who received allcomponents of homeopathic treatment except themedicinal globules, raises important questions andhighlights our ignorance about the magnitude ofeffects caused by each component of a homeopathicintervention.

Additional clinical research suggests that home-opathy may be effective for rheumatologic conditionsand menstrual disorders.28-31 Some studies support,although others contradict, traditional homeopathicwisdom that homeopathy is useful for tension andmigraine headaches.32-38

Clinical Reports of Eff icacy

Homeopathy enjoys a very lengthy clinical tradition,and many cases have been recorded in precise detail.These case reports include sufficient detail to assessthe response of the patients to their homeopathictreatment. Most case reports have only short-termfollow-up and very few of them have independent ver-ification. In the absence of further objective assess-ment, and given the previously mentioned concernsabout disease categorization, the voice of clinical tra-dition deserves a critical hearing.

Traditionally, homeopaths have written thatexcessive tissue destruction, which occurs with end-stage disease, precludes a curative response to home-opathic treatment.39,40 Cancer, heart disease, andarthritis, which have created marked joint deformi-ties, are cited as examples in various texts. In spite ofthis belief, however, homeopaths commonly treatpatients with these conditions, anticipating pallia-tion rather than cure. Arthritis, for example isamong the most common diagnoses of patientsseeking professional homeopathic care in severalstudies.22,41 Many homeopathic texts address the useof homeopathy in a variety of heart conditions,including congestive heart failure, arrhythmia, andangina.42-44

A relatively large number of articles in homeo-pathic and conventional medical journals addresshomeopathic treatment of cancer.45-62 Many of thesearticles refer to the use of homeopathy as an adjunc-tive means to assist cancer patients with quality of lifeissues, such as adverse effects resulting from conven-tional cancer treatment.63-65 Homeopaths tend to beextremely careful to avoid misleading patients aboutthe abilities of homeopathy in serious diseases. Asa result, the usual application of homeopathy forpatients with cancer is as a complementary therapy.

Although somewhat tangential, there is a veryinteresting perspective on gastrointestinal cancerprevention arising from homeopathic theory.Morgan used homeopathic principles to explainthe effectiveness of aspirin as a prophylactic foresophageal and colorectal cancer.66 This action cur-rently lacks a well-accepted conventional explana-tion,67,68 as does quinine’s effectiveness in malaria;in both instances, homeopathic theory offers a rea-sonable explanation.

Homeopaths and the homeopathic clinical litera-ture indicate that homeopathy appears useful in con-junction with conventional treatments in many otherdisease conditions. Angina, carpal tunnel syndrome,elevated cholesterol, diabetes, hypertension, osteo-porosis, acute pain, chronic pain, and rheumatoidarthritis are on this list. Many common medicalproblems are believed to respond quite well to home-opathic treatment alone. Some of these problems areanxiety disorders, back pain, chronic fatigue, immunedysfunction syndrome, digestive disorders, gastro-esophageal reflux, sinusitis, and stress-related ill-nesses.

Patients appear to seek homeopathy for theirhealth problems in a pattern very much in keepingwith homeopathic opinion (Table 8-1). The diag-noses of patients seen by American physician homeo-paths in Jennifer Jacobs’ 1992 survey22 closely parallelthe preceding discussion.

For Whom Does HomeopathyWork Well?

Another way of considering homeopathy’s effective-ness is to turn the question around into a more“homeopathic” form. Because homeopathy focuseson the individual rather than the disease category,instead of asking, “For what does homeopathy work

C H A P T E R 8 Homeopathy in Primary Care 123

Page 130: Classical Homeopathy

well?” we can instead ask the question, “For whomdoes homeopathy work well?”

Homeopathy requires much of its patients.Homeopaths want to know all about patients’ symp-tom patterns, lifestyle habits, and emotional makeup.As a result, patients who are self-aware can be easierto treat.

Even a self-aware patient must convey his or herunderstanding to the homeopath or the insight islost. Some patients do not want to discuss the mostimportant concerns in their lives, a choice that obvi-ously impedes the homeopath’s work. On the otherside of the patient-physician relationship, a percep-tive homeopath can communicate with a diverserange of patients (and is expected to perceive thingsabout the patient that he or she has yet to perceive).Good communication between patient and practi-tioner is probably more important in homeopathicthan in conventional medical practice.

Some patients interpret their experience througha blanket of preconceptions that can easily lead thehomeopath astray. This is true of patients who areadamantly convinced that their problems stem froma particular source (often something they have readin a popular health book). Their opinions can beunshakable, even when many indications contradicttheir ready explanations. Such patients tend toignore these messy contradictions. As a result, thepatient presents a very neatly tied but false package ofinformation. Patients who have experienced lengthy

poor-quality psychotherapy are often in this category.Inevitably, because homeopathic patients are usuallyasked to answer questions they had not considered inthe past, they give a certain amount of incorrectinformation to the homeopath. The quantity of thismisinformation is not usually sufficient to confusean experienced homeopath.

As discussed earlier (see Chapter 7), treatments ofall sorts can be suppressive. Although the suppressivetreatment is most commonly a conventional medica-tion, homeopathy or any other therapeutic methodhas the potential to obstruct the body’s healingprocess. When obstruction occurs, the patient’s pat-tern of symptoms becomes much more difficult forthe homeopath to interpret; finding the correcthomeopathic remedy is thus much more difficult. Inaddition, nonhomeopathic medications sometimesreduce or negate the effectiveness of the homeo-pathic remedy.

Traditionally defined adverse drug effects, such asdry mouth from using an antidepressant, can con-fuse homeopathic prescribing. The homeopath mustdetermine which symptoms are true expressions ofthe body’s healing process versus which are toxiceffects from the prescription medication. Adverseeffects induced by conventional treatment can neces-sitate specific homeopathic treatment as well, butthat is a more complicated discussion and beyond thescope of this book.

BEYOND ILLNESS—DISEASEPREVENTION

Although homeopaths have traditionally claimedthat homeopathy’s health-improving effects preventfuture disease, such as cancer, only limited evidenceexists to substantiate these claims. De Klerk’s study23

is one of the few studies in which homeopathic treat-ment was evaluated over more than a few months.She found a significant reduction in rates of upperrespiratory illness among her subjects. However, boththe control and treatment groups improved, and thetreatment group’s superiority was just short of statis-tical significance.

Another study that perhaps links use of homeo-pathic or anthroposophical treatment with diseasereduction was conducted in New Zealand.69

Investigators surveyed a population (students attend-ing Rudolph Steiner schools) whose philosophy

124 C L A S S I C A L H O M E O P A T H Y

From Jacobs J, Chapman EH, Crothers D: Arch Fam Med 7(6):537,1998.

T A B L E 8 - 1

Diagnoses of Patients Seen by Homeopathic Physicians

Page 131: Classical Homeopathy

encourages the use of anthroposophical and homeo-pathic treatments in place of conventional medicationincluding antibiotics. After controlling for confound-ing factors, the children who received antibiotics in thefirst year of life were four times as likely to developasthma than the other children.

These findings add support to the growing bodyof evidence for what has been called the hygienehypothesis.70 There has been a precipitous rise inchildhood asthma throughout the wealthier coun-tries in the world. This is true despite significantimprovements in nearly all known asthma risk fac-tors. The hygiene hypothesis attributes much of thisdeterioration in the health of our children tooverzealous removal of infectious agents from ourbodies and environments. Infections appear to helpthe maturation of the human immune system.Interference with that process, no matter how wellintentioned, may lead to increased tendency to atopicdiseases, including asthma. Treatments such ashomeopathy, which offers alternatives to antibiotics,could thus play a significant part in reducing therisks of future disease.

Proof that the use of homeopathy (or avoidanceof conventional medications) leads to healthier pop-ulations would be much more than a decorativefeather in a homeopath’s cap. If the belief that home-opathy leads to greater emotional balance andimproved immune functioning is correct, a reductionin disease rates would inevitably follow homeopathictreatment. However, contentions like these should beexamined carefully and systematically before claimsare made. I have heard it said that homeopathicpatients simply don’t get cancer. I have seen other-wise. Certainly, we all share death’s end point. Moresubtle investigations of disease rates are necessary toprove or disprove the important question of home-opathy’s effect on disease prevention.

HEALTH RISK S ASSOCIATEDWITH HOMEOPATHICMEDICINE

Within the infant rind of this small f lower, poison hathresidence and medicine power.

WILLIAM SHAKESPEARE (from Romeo and Juliet)

Any substance that can heal can also cause harm.Every medicinal substance has adverse effects as well

as beneficial. Human life cannot exist without thesun, but solar radiation causes cancer. Water is essen-tial to life, but excessive amounts can kill. Love maybe the sole exception, but that is for poets to decide.The use of homeopathy must entail some risk. Whatare those risks?

When Is a Poison Not Poisonous?

First, we will consider injury from the homeopathictreatment itself. Many homeopathic medicines aremade from poisonous substances. The dilutionprocess used by homeopathic pharmacists almostalways negates this potential cause of harm.

Because of confusion about homeopathic phar-maceutic nomenclature, I used to receive many callsfrom poison control centers inquiring about pedi-atric patients who had swallowed entire bottles ofBelladonna 30C. They recognized the name Belladonna,also known as deadly nightshade, because it is toxic.Although the name justified their concern, what theydid not know was that homeopathically preparedBelladonna 30C has so little Belladonna remaining thatit would take a mass greater than that of our galaxyto contain a toxic dose. Certainly the harm fromswallowing such a mass would be the primary con-cern!

Think of the most toxic substance you know.Most of them are chemical toxins, which are poison-ous in doses on the order of a millionth of a gram.Because this is an extremely small quantity, a patientwould have to take many doses of a homeopathicallyprepared 6X-strength remedy made from that sub-stance to suffer that level of exposure. Because 6C iscustomarily the most material dose used (i.e., 1 partin 1,000,000,000,000), and 12C (1 part in 1,000,000,000,000,000,000,000,000) and 30C (1 part in 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000) doses are com-mon, conventional toxicity issues are nearly irrele-vant.

In spite of the drastic dilution involved in thepreparation of homeopathic remedies, homeopathicdoes not automatically mean safe. The smallest grainof plutonium could kill you and anyone who cameinto contact with your remains for many thousandsof years. Avoiding homeopathic medicines madefrom toxic substances in potencies less than 12C isprudent, particularly during pregnancy.

C H A P T E R 8 Homeopathy in Primary Care 125

Page 132: Classical Homeopathy

Neglect of Appropriate Care

In addition to directly toxic effects from the homeo-pathic remedy, other potential causes of harm tohomeopathic patients exist. One of these is any suf-fering the patient may experience from delaying moreeffective treatment. Although the homeopathic treat-ment itself may not cause harm, the patient’s con-dition could deteriorate during the trial ofhomeopathy.

The evidence is fairly strong that this risk is notpresently significant. Because few patients seekhomeopathic care without first trying conventionalmedicine, the possibility of homeopathic treatmentdelaying conventional treatment is quite low. In addi-tion, many homeopathic practitioners are trained inconventional medicine, and all others who completeformalized homeopathic training in the UnitedStates or United Kingdom are taught when to referfor conventional treatment. The recent Boston surveyconducted by Lee and Kemper71 (see Chapter 4)reminds us that, although the risk is small, it is notnonexistent—some homeopaths do not recognizewhen they need to refer patients for conventionaltreatment. Professional homeopaths without conven-tional medical training must know when referral isnecessary to ensure the safety of their patients. Theinadequate level of clinical supervision in homeo-pathic training, already identified as a problem by thehomeopathic community, may aggravate the referralproblem.72 Diligent efforts in the educational arenaare necessary, because the rising popularity of home-opathy seems likely to increase the number ofpatients seeking homeopathy before they have triedconventional medicine.

My own clinical experience gives me a further,potentially insoluble, cause for concern. Over theyears, a significant number of new patients havecome to see me for treatment of problems that hadbeen misdiagnosed by other conventional physi-cians. Seeking relief, these patients come to mypractice unrelieved by conventional treatment,when they actually had not yet received conventionaltreatment because they were misdiagnosed.Dissatisfaction with treatment, for whatever cause,leads patients to try other means to feel better.Although this problem begins with a misdiagnosisprovided by conventional medicine, it comes toroost in the population of patients seeking homeo-pathic treatment.

Aggravations and Provings

Homeopaths use some words with meanings uniqueto homeopathy. Two terms important to this discus-sion of adverse effects of homeopathic treatment areaggravations and provings.

The term aggravation refers to the temporary wors-ening of symptoms that commonly occurs when apatient takes a homeopathic remedy for a chroniccondition. The term is quite descriptive, and it is easyto imagine that homeopathic patients may havedevised the name. An aggravation classically proceedsalong specific lines with the “deeper” problem (i.e.,the mental/emotional or severe physical pathology)flaring up within days after beginning the homeo-pathic treatment; lesser disorders become moreintense as the more serious problems remit. Not onlyis the homeopathic aggravation a common experi-ence, it is so well recognized that homeopaths andhomeopathic patients are sometimes disappointedwhen it does not occur. The homeopathic aggrava-tion is welcomed as a herald of better times to come.

Hahnemann named his clinical trials of homeo-pathic medicines provings. Provings were experimentsto determine precisely what symptomatic responseswere characteristic of certain homeopathic medi-cines. These characteristic symptoms then becamethe indications for using that homeopathic remedyto help patients recover. A patient who takes ahomeopathic medicine for too long will developsymptoms attributable to that excessive dosage. Akinto a conventional overdose, this circumstance is alsocalled a proving. There is controversy within thehomeopathic community about whether these prov-ing symptoms will always go away of their ownaccord. Although this matter is controversial pre-cisely because it is so rarely seen, concern about thepossibility is the reason many classical homeopathsare uncomfortable with the popularity of homeo-pathic self-care. This concern is heightened with theuse of combination remedies because the greaterthe number of remedies a patient takes, the greater thelikelihood of sensitivity to one of them. Adding tothe concern is the false popular belief that homeop-athy can never cause any harm, making it unlikelythat patients will identify the cause of ill effects theyexperience.

The uncertainty and broad questions surround-ing this issue of homeopathic adverse effects can beanswered only by careful study. Several long-term

126 C L A S S I C A L H O M E O P A T H Y

Page 133: Classical Homeopathy

patient observational surveys are currently underway. Hopefully more definitive information will comeout of these surveys. Because of homeopathy’s verylong track record and reputation for safety, signifi-cant problems appear extremely unlikely; however,the matter remains unresolved.

HOMEOPATHY: FROMMEDICAL SPECIALT Y TO “DO-IT-YOURSELF”

Two apparently diametrically opposed points of viewabout the use of homeopathy exist. Accordingly,opinions about the necessary training and experienceare as contradictory. Pierre Schmidt, one of the mosthighly regarded French homeopaths of the twentiethcentury, reportedly said, “It takes five years of fulltime practice to become a competent worker inhomeopathy, ten years to become a craftsman andtwenty five years, if you have the aptitude, to becomea master.” Yet 80% of the use of homeopathy in theUnited States is now self-care. Few of the people self-medicating with homeopathy have even the mostbasic understanding of homeopathic principles. Howdo we reconcile this trend with Schmidt’s opinion,and what does this perplexity teach us about appro-priate professional use?

The deeper truth underlying this seeming contra-diction is quite simple. Although it is easy to use a fewhomeopathic remedies to treat minor acute illnessesbased upon a few symptomatic indications, the complexevaluation process required to successfully treat chronicconditions is an entirely different matter. When Dr.Schmidt spoke of the many years necessary to learn thebasics of homeopathic practice, he was acknowledgingthe quantity of information that must be mastered andthe subtlety of understanding needed to skillfully usethat information to treat chronic conditions.

Any reasonably intelligent person can quicklylearn to apply homeopathy in a limited way. Severalyears ago, the director of a homeopathic pharmaceu-tic company told me of meeting a conventional physi-cian at a Club Med. This physician learned of myfriend’s work and then showed him his kit of fivehomeopathic remedies. Although he knew only a lit-tle about when to use these remedies and essentiallynothing about any other homeopathic medicines, heroutinely prescribed those five homeopathic reme-dies in his medical practice.

As the average conventional physician starts toinclude bits and pieces of complementary medicineinto practice, homeopathy can be a piece of the puz-zle. Although useful for others, this piecemealapproach is unlikely to be of much help to the groupof patients currently seeking professional homeo-pathic treatment. Those patients are looking for helpwith chronic problems that conventional medicinehas not relieved. Homeopathic band-aids will nothelp them. They will continue to seek out physicianswho specialize in homeopathic care for much moreintensive chronic—sometimes called constitutional—care.

Physicians who specialize in homeopathy aregrowing in number, but are still quite rare in theUnited States. Our number may generously be esti-mated at nearly 1000. Because homeopathic special-ists typically spend more than an hour with each newpatient and close to 30 minutes with every returningpatient, relatively few Americans have access to ahomeopathic specialist.

How Is Homeopathy Different forthe Physician?

Although most discussions of complementary medi-cine address the differences in clinical interactionfrom the patient’s point of view, the physician’s sideof the interaction is also different. This is particularlytrue when the therapy is homeopathy. These differ-ences can have a significant impact on the physician’sability to achieve therapeutic success and enjoy his orher work.

The physician has to spend more time with eachpatient and take a much more careful history than isrequired when practicing conventional medicine.This degree of attention can be very demanding. Eachpractitioner must develop insight about the way thatpatients interact with his or her personality, andmust also learn to recognize his or her pattern ofinteraction with various types of patients, becausethese behavioral patterns are important clues to rem-edy selection. An inevitable mathematic consequenceof the time required for each patient and the limitednumber of hours in a day is that homeopathic physi-cians tend to have lower incomes than conventionalphysicians. This is true despite the fact that home-opaths often charge each patient more for their ser-vices. Other disadvantages for the physician include

C H A P T E R 8 Homeopathy in Primary Care 127

Page 134: Classical Homeopathy

the years required to learn the practice and followingthis achievement, enduring the criticism of less open-minded members of the medical community.

If these negatives were the sum total of the physi-cian experience of homeopathy, it would be difficultto imagine homeopathy surviving two years, let alonetwo centuries! However, the many aspects of homeo-pathic care that are rewarding for the physician over-whelm these few negatives.

Although some physicians do not like the depthof patient interaction necessitated by homeopathy,many others find it much more satisfying then theusual 8 to 10 minutes and out-the-door routine sadlycommon these days. Paying careful attention to eachpatient enriches the interaction for the physician andthe patient. Each patient is unique, and that individ-uality makes every clinical interaction more interest-ing. No patient is just a snotty nose or a backache.

The degree of attention necessary in homeopathyalso helps the physician learn about the process ofdisease and recovery. One simple example is the clin-ical management of AOM in children. Antibioticshave been the routine treatment for decades. Asresearch evidence accumulates that antibioticsshould play a more limited role, conventional man-agement is slowly evolving. For even longer than con-ventional physicians have been using antibiotics forAOM, clinical records show that homeopaths havesuccessfully managed these patients without antibi-otics. Following my conventional training I was veryuncomfortable learning to manage AOM withoutreverting to antibiotics. However, I quickly learnedthat my patients did well without antibiotics. In fact,my clinical experience is that they appear much lesslikely to develop subsequent episodes of AOM if Imanage the case without antibiotics.

Along these lines, homeopathy has a lengthy tra-dition of reducing patient use of prescription med-ication. If this can be done successfully, ashomeopaths maintain, limiting only the use of need-less antibiotics could be very beneficial to our societyat a time when we face a rising, and very frightening,tide of antibiotic resistance. Taken a step further, if aphysician can successfully treat a patient withoutexposing him or her to potentially significant adversedrug reactions, is it ethical not to make the attempt?

One reason that homeopathy helps reduce theuse of conventional medication is that it offers thephysician a therapeutic choice. Although conven-tional medicine provides fantastic tools to help

patients, especially those with end-stage disease, toooften the adverse effects of those powerful tools out-weigh the benefits for common minor problemsexperienced by many of our patients. A few years ago,when I was developing a course introducing comple-mentary medicine to primary care physicians, I askedconventional colleagues what problems were mostfrustrating in clinical practice. Dismayingly, their listwas nearly identical to the National AmbulatoryMedical Care Survey list of the 10 most commonconditions seen by U.S. primary care providers.

Antibiotic overuse is one of the most seriousproblems facing conventional medicine today, partic-ularly in the pediatric population. Among parentsand physicians, many conflicting views contribute tothis overuse.73-78 Similarly, adult patients and theirphysicians appear to have difficulty reaching anunderstanding about appropriate antibiotic use, inpart because of poor communication and unrealisticor even contradictory expectations.79-81 Physiciansoften justify inappropriate antibiotic prescriptions byreporting that they feel pressured by their patients’demands for antibiotic treatment.82 For homeo-pathic patients, homeopathy is an acceptable or evensought-after alternative to antibiotics. Certainly noevidence exists at this time that choosing homeopa-thy as an alternative to inappropriately prescribedantibiotics is harmful to patients. The oppositeappears far more likely.

The clinical experience of homeopathy is differ-ent from the clinical experience of conventionalmedicine. This is true for the physician and for thepatient. Although it is true that homeopathy canplace more demands on the practitioner, manyclinicians so strongly prefer the homeopathic clinicalrelationship that the disadvantages becomeinsignificant.

SUMMARY

A person who wishes to investigate homeopathy needgo no further than the office of a homeopathic spe-cialist to grasp the unique qualities of the therapy.Details of homeopathic theory and findings of mod-ern scientific investigations of homeopathy help usunderstand homeopathy. However, the heart ofhomeopathy is most easily examined in the clini-cian’s office. The clinical experience calls patient andphysician back to an earlier age, when the healing

128 C L A S S I C A L H O M E O P A T H Y

Page 135: Classical Homeopathy

relationship was built less upon technology and moreupon human qualities.

The primacy of the clinical relationship is home-opathy’s most essential, most appealing, and mostfrustrating characteristic. It is entirely in keepingwith Hahnemann’s advocacy of healing the patient, asthe physician’s sole responsibility. It is what attractspatients and physicians hungry for an alternative tomodern medicine’s worst techno-failings. Its softsubjectivity appalls scientists who are firm in theirconviction that all gaps in our knowledge will befilled by finer instrumentation. In many ways, it rep-resents the essential conflict between the art and sci-ence aspects of medicine.

References 1. Hahnemann S: Organon of medicine, ed 6, Los Angeles,

1982, JP Tarcher. 2. Agrawal YR: Homeopathy in asthma, Delhi, 1985, Vijay

Publications. 3. Borland D: Homeopathy in practice, Beaconsfield,

England, 1982, Beaconsfield. 4. Burnett JC: On neuralgia: its causes and its remedies, with a

chapter on angina pectoris, New Delhi, 1990, B Jain. 5. Dewey WA: Homeopathic therapeutics, ed 3, New Dehli,

1975, B Jain. 6. Farrington EA: Therapeutic pointers (to some common dis-

eases), New Delhi, 1988, B Jain. 7. Hering C: The homeopathic domestic physician, ed 14

(American), New Delhi, 1984, B Jain. 8. Reilly DT, Taylor MA, McSharry C et al: Is homoeopa-

thy a placebo response? Controlled trial of homoeo-pathic potency, with pollen in hayfever as model, Lancet2(8512):881-886, 1986.

9. Reilly D, Taylor MA, Beattie NG et al: Is evidence forhomoeopathy reproducible? Lancet 344(8937):1601-1606, 1994.

10. Weiser M, Gegenheimer LH, Klein P: A randomizedequivalence trial comparing the efficacy and safety ofLuffa comp.-Heel nasal spray with cromolyn sodiumspray in the treatment of seasonal allergic rhinitis,Forsch Komplementarmed 6(3):142-148, 1999.

11. Ludtke R, Wiesenauer M: [A meta-analysis of homeo-pathic treatment of pollinosis with Galphimia glauca],Wien Med Wochenschr 147(14):323-327, 1997.

12. Poitevin B, Davenas E, Benveniste J et al: In vitroimmunological degranulation of human basophils ismodulated by lung histamine and Apis mellifica, Br JClin Pharmacol 25(4):439-444, 1998.

13. Sudan BJ: Total abrogation of facial seborrhoeic der-matitis with extremely low-frequency (1-1.1 Hz)“imprinted” water is not allergen or hapten dependent:

a new visible model for homoeopathy, Med Hypotheses(6):477-479, 1997.

14. Linde K, Clausius N, Ramirez G et al: Are the clinicaleffects of homeopathy placebo effects? A meta-analysisof placebo-controlled trials, Lancet 350(9081):834-843,1997 (published erratum appears in Lancet 1998351[9097]:220,1998).

15. Linde K: [Are there proven therapies in homeopathy?],Internist (Berl) 40(12):1271-1274, 1999.

16. Kleijnen J, Knipschild P, ter Riet G et al: Clinical trialsof homoeopathy, BMJ 302(6772):316-323, 1991 (pub-lished erratum appears in BMJ 302[6780]:818, 1991).

17. Taylor MA, Reilly D, Llewellyn-Jones RH et al:Randomised controlled trial of homeopathy versusplacebo in perennial allergic rhinitis with overview offour trial series, BMJ 321:471-476, 2000.

18. Lancaster T, Vickers A: Commentary: larger trials areneeded, BMJ 321:476, 2000.

19. Campbell JH, Taylor MA, Beattie N et al: Is homeopa-thy a placebo response? a controlled trial of homeo-pathic immunotherapy in atopic asthma, Am Rev RespirDis 141:A24, 1990.

20. Lewith GT, Watkins AD: Unconventional therapies inasthma: an overview, Allergy 51(11):761-769, 1996.

21. Lane DJ, Lane TV: Alternative and complementary medi-cine for asthma (editorial), Thorax 46(11):787-797, 1991.

22. Jacobs J, Chapman EH, Crothers D: Patient character-istics and practice patterns of physicians using home-opathy, Arch Fam Med 7(6):537-540, 1998.

23. de Lange de Klerk ES, Blommers J, Kuik DJ et al: Effectof homoeopathic medicines on daily burden of symp-toms in children with recurrent upper respiratory tractinfections, BMJ 309(6965):1329-1332, 1994.

24. Friese KH, Kruse S, Moeller H: [Acute otitis media inchildren. comparison between conventional and home-opathic therapy], HNO 44(8):462-466, 1996.

25. Friese KH, Kruse S, Ludtke R et al: The homoeopathictreatment of otitis media in children—comparisonswith conventional therapy, Int J Clin Pharmacol Ther35(7):296-301, 1997.

26. Harrison H, Fixsen A, Vickers A et al: A randomizedcomparison of homoeopathic and standard care for thetreatment of glue ear in children, Complement Ther Med7(3):132-135, 1999.

27. Mudry A: [Controversies concerning acute otitismedia], Arch Pediatr 6(12):1338-1344, 1999.

28. Gibson RG, Gibson SL, MacNeill AD et al: Homeo-pathic therapy in rheumatoid arthritis: evaluation bydouble-blind clinical therapeutic trial, Br J ClinPharmacol 9:453-459, 1980.

29. Fisher P, Huskisson EC, Turner P et al: Homoeopathictreatment of fibrositis, Lancet 336(8720):954, 1990.

30. Seidl MM, Stewart DE: Alternative treatments formenopausal symptoms. systematic review of scientific

C H A P T E R 8 Homeopathy in Primary Care 129

Page 136: Classical Homeopathy

and lay literature, Can Fam Physician 44:1299-1308,1998 (published erratum appears in Can Fam Physician44:1598, 1998).

31. Kass-Annese B: Alternative therapies for menopause,Clin Obstet Gynecol 43(1):162-183, 2000.

32. Whitmarsh TE: When conventional treatment is notenough: a case of migraine without aura responding tohomeopathy, J Altern Complement Med 3(2):159-162, 1997.

33. Whitmarsh T: Evidence in complementary and alterna-tive therapies: lessons from clinical trials of homeopa-thy in headache (editorial), J Altern Complement Med3(4):307-310, 1997.

34. Walach H, Haeusler W, Lowes T et al: Classical homeo-pathic treatment of chronic headaches, Cephalalgia17(2):119-126, 1997.

35. Ernst E: Homeopathic prophylaxis of headaches andmigraine? a systematic review, J Pain Symptom Manage18(5):353-357, 1999.

36. Vernon H, McDermaid CS, Hagino C: Systematicreview of randomized clinical trials of complemen-tary/alternative therapies in the treatment of tension-type and cervicogenic headache, Complement Ther Med7(3):142-155, 1999.

37. Straumsheim P, Borchgrevink C, Mowinckel P et al:Homeopathic treatment of migraine: a double blind,placebo controlled trial of 68 patients, Br Homeopath J89(1):4-7, 2000.

38. Whitmarsh T: More lessons from migraine, BrHomeopath J 89(1):1-2, 2000.

39. Kent JT: Lectures on homeopathic materia medica, NewDehli, 1971, B Jain.

40. Roberts HA: The principles and art of cure by homeopathy:a modern textbook, Rustington, England, 1936, HealthScience Press.

41. Goldstein MS, Glik D: Use of and satisfaction withhomeopathy in a patient population, Altern Ther HealthMed 4(2):60-65, 1998.

42. Swayne JM: Survey of the use of homeopathic medicinein the UK health system, J R Coll Gen Pract 39(329):503-506, 1989.

43. Clarke JH: Diseases of the heart and arteries, New Delhi,1987, B Jain.

44. Small remedies and interesting cases II: Proceedings of the1990 Professional Case Conference, Seattle, 1990,International Foundation for Homeopathy.

45. Flinn JE: Bromium in acute lymphatic leukemia, J AmInst Homeopath 58(7):213-214, 1965.

46. Bond W: Pathological prescribing, J Am Inst Homeopath59(11):327-329, 1996.

47. Trexler HL: Carcinoma of the breast also treated byhomeopathy, J Am Inst Homeopath 59(5):165-167, 1966.

48. Belloni L: [The intraorbital tumor of Field MarshalRadetzky cured by homeopathic therapy], Gesnerus42(1-2):35-46, 1985.

49. Bradley GW, Clover A: Apparent response of small celllung cancer to an extract of mistletoe and homoeo-pathic treatment, Thorax 44(12):1047-1048, 1989.

50. Ehring F: [Regression of over 150 skin metastases ofmalignant melanoma with complex homeopathic ther-apy], Hautarzt 40(1):23-27, 1989.

51. Mellor D: Mistletoe in homoeopathic cancer treatment,Prof Nurse 4(12):605-607, 1989.

52. Report of the joint Commission of the Royal Academyof Medicine on the analysis of publications concerningthe study of homeopathic preparations aimed atimmunotherapeutic treatment of AIDS and cancer, BullMem Acad R Med Belg 147(3-5):190-191, 1992.

53. Hauser SP: Unproven methods in cancer treatment,Curr Opin Oncol 5(4):646-654, 1993.

54. van der Zouwe N, van Dam FS, Aaronson NK et al:[Alternative treatments in cancer; extent and back-ground of utilization], Ned Tijdschr Geneeskd 138(6):300-306, 1994.

55. Crocetti E, Crotti N, Feltrin A et al: The use of comple-mentary therapies by breast cancer patients attendingconventional treatment, Eur J Cancer 34(3):324-328, 1998.

56. Grootenhuis MA, Last BF, de Graaf-Nijkerk JH et al:Use of alternative treatment in pediatric oncology,Cancer Nurs 21(4):282-288, 1998.

57. Cassileth BR: Complementary therapies: overview andstate of the art, Cancer Nurs 22(1):85-90, 1999.

58. Kasmann-Kellner B, Graf N, Elflein E et al: [Follow-upof retinoblastoma during homeopathic therapy], KlinMonatsbl Augenheilkd 214(4):aA12-aA16, 1999.

59. Van Dam FS: [Increased use of alternative diets andother alternative treatments for cancer patients:Houtsmuller (diet) is in, Moerman (diet) is out], NedTijdschr Geneeskd 143(27):1421-1424, 1999.

60. Malik IA, Khan NA, Khan W: Use of unconventionalmethods of therapy by cancer patients in Pakistan, EurJ Epidemiol 16(2):155-160, 2000.

61. Montfort H: A new homeopathic approach to neoplas-tic diseases: from cell destruction to carcinogen-induced apoptosis, Br Homeopath J 89(2):78-83, 2000.

62. Thompson E, Kassab S: Homeopathy in cancer care, BrHomeopath J 89(2):61-62, 2000.

63. Thompson EA: Using homoeopathy to offer support-ive cancer care, in a National Health Service outpatientsetting, Complement Ther Nurs Midwifer 5(2):37-41, 1999.

64. Thompson E, Hicks F: Intrathecal baclofen and home-opathy for the treatment of painful muscle spasmsassociated with malignant spinal cord compression,Palliat Med 12(2):119-121, 1998.

65. Oberbaum M, Yaniv I, Ben-Gal Y et al: A randomized,controlled clinical trial of the homeopathic medicationTRAUMEEL S in the treatment of chemotherapy-induced stomatitis in children undergoing stem celltransplantation. Cancer 92(3):684-690, 2001.

130 C L A S S I C A L H O M E O P A T H Y

Page 137: Classical Homeopathy

66. Morgan G: Aspirin chemoprevention of colorectal andoesophageal cancers: an overview of the literature andhomeopathic explanation, Eur J Cancer Prev 5(6):439-443, 1996.

67. Vainio H, Morgan G: Mechanisms of aspirin chemo-prevention of colorectal cancer, Eur J Drug MetabPharmacokinet 24(4):289-292, 1999.

68. Sandler RS, Galanko JC, Murray SC et al: Aspirin andnonsteroidal anti-inflammatory agents and risk forcolorectal adenomas, Gastroenterology 114(3):441-447,1998.

69. Wickens K, Pearce N, Crane J et al: Antibiotic use inearly childhood and the development of asthma, ClinExp Allergy 29(6):766-771, 1999.

70. Strachan DP: Family size, infection and atopy: the firstdecade of the “hygiene hypothesis,” Thorax 55(suppl1):S2-S10, 2000.

71. Lee AC, Kemper KJ: Homeopathy and naturopathy:practice characteristics and pediatric care, Arch PediatrAdolesc Med 154:75-80, 2000.

72. Kreisberg J: Trends in homeopathic education: a surveyof homeopathic schools in North America 1998, JAIH93:75-84, 2000.

73. Liu HH: Overuse of antimicrobial therapy for upperrespiratory infections and acute bronchitis: who, why,and what can be done? [editorial], Pharmacotherapy19(4):371-373, 1999.

74. Barden LS, Dowell SF, Schwartz B et al: Current atti-tudes regarding use of antimicrobial agents: results

from physician’s and parents’ focus group discussions,Clin Pediatr (Phila) 37(11):665-671, 1998.

75. Palmer DA, Bauchner H: Parents’ and physicians’ viewson antibiotics, Pediatrics 99(6):E6, 1997.

76. Pichichero ME: Understanding antibiotic overuse forrespiratory tract infections in children [comment],Pediatrics 104(6):1384-1388, 1999.

77. Schwartz RH, Freij BJ, Ziai M et al: Antimicrobial pre-scribing for acute purulent rhinitis in children: a surveyof pediatricians and family practitioners [see com-ments], Pediatr Infect Dis J 16(2):185-190, 1997.

78. Watson RL, Dowell SF, Javaraman M et al: Antimicrobialuse for pediatric upper respiratory infections: reportedpractice, actual practice, and parent beliefs [see com-ments], Pediatrics 104(6):1251-1257, 1999.

79. Gonzales R, Steiner JF, Sarde MA: Antibiotic prescrib-ing for adults with colds, upper respiratory tract infec-tions, and bronchitis by ambulatory care physicians[see comments], JAMA 278(11):901-904, 1997.

80. Britten N, Ukoumunne O: The influence of patients’hopes of receiving a prescription on doctors’ percep-tions and the decision to prescribe: a questionnairesurvey, BMJ 315(7121):1506-1510, 1997.

81. Greenhalgh T, Gill P: Pressure to prescribe [editorial;comment], BMJ 315(7121):1482-1483, 1997.

82. Macfarlane J, Holmes W, MacFarlane R et al: Influenceof patients’ expectations on antibiotic management ofacute lower respiratory tract illness in general practice:questionnaire study, BMJ 315(7117):1211-1214, 1997.

C H A P T E R 8 Homeopathy in Primary Care 131

Page 138: Classical Homeopathy

INTRODUCTION

Homeopathic education and certification have evolvedsignificantly over the last 200 years. Homeopathy orig-inally developed as part of the medical practice ofphysicians. Homeopathic physicians were required tohave the same medical knowledge as any other physi-cian, but applied homeopathic remedies based onhomeopathic principles as opposed to allopathic med-icines given for specific disease conditions. In theUnited States, as homeopathy became popular in thesecond half of the nineteenth century, homeopathy wastaught in homeopathic medical schools. In most partsof Europe where homeopathy was practiced, a similarstandard of training was established. As a distinct formof medical practice, homeopathy had its own licensingboards that defined standards for the profession.However, because homeopathy was not fully recognized

in all states, common standards of practice were neverfully established and regulated.

Medical licensure was not integrated into law inthe United States until the second half of the nine-teenth century, and even then standards varied con-siderably. It was only in the twentieth century thatmedical curricula and licensure became more uni-form throughout the country.

As homeopathy became more popular, it waspracticed not only by physicians but by many peoplewho did not hold a medical license. This practicebegan with Samuel Hahnemann’s second wife,Melanie. She continued to work in Paris afterHahnemann’s death, although the authoritiesattempted to curtail her practice.1 That homeopathyis practiced outside of medical licensure has sincebecome one of the most contentious aspects ofhomeopathic history.

9Homeopathic Education andCertif ication

R I C H A R D P I T T

133

Page 139: Classical Homeopathy

This controversy has grown in the last 20 yearsbecause many more nonmedical or lay homeopathshave trained and become practitioners. In the UnitedStates, there are probably more professional homeo-paths (the term given to nonlicensed homeopaths)than licensed practitioners. This has occurred for anumber of reasons. First, the growth of homeopathywithin the ranks of physicians has been very slow.Although homeopathy was developed by a physicianand was understood to be the practice of medicine byits adherents, it has struggled to be widely accepted.The dominant form of medical practice, known tohomeopaths as allopathy, has come to define the prac-tice of medicine. Homeopathy, whose philosophy andrationale challenges some fundamental tenets ofmodern science, has been unable to grow within thepresent framework of medicine. However, becausehomeopathy has always been defined as medicine, ithas not created a separate legal identity outside ofmedical practice.

Therefore a nonphysician interested in practicinghomeopathy must decide whether to become a physi-cian to do so. A growing number have decided not tobecome physicians and have instead trained in pri-vate homeopathic institutions; they then practicewithout a medical license. This trend is compoundedbecause no medical school in the United States hasoffered substantial training in homeopathy since the1930s.

This predicament reveals fundamental questions.What is medicine, and how can it be defined, bothlegally and philosophically? Where does homeopathy,with its very different philosophy and methodology,fit into the conventional practice of medicine? Howcan people who want to practice homeopathy get thehomeopathic and medical training necessary tobecome competent, recognized, and professional?

HOMEOPATHY, MEDICINE,AND THE L AW

Except for three states—Nevada, Connecticut, andArizona—there are no licensing standards for homeo-pathic practice in the United States today. Thesestates have homeopathic licensing boards, but nonehas been active in defining homeopathic standardsand assessing professional levels of competency. As of1999, to become certified through the Arizona licens-ing board, a licensed physician needs to complete just

40 hours of classical homeopathy training and 300hours of some other form of alternative medicine, oronly 90 hours of classical homeopathy. There is noactual examination process and no evaluation ofhomeopathic training. Arizona has established a pro-fessional designation for Homeopathic MedicalAssistant, who can work under the direct supervisionof a physician if 180 hours of homeopathic traininghas been completed. The other two states have notdefined any homeopathic standards. Apart from theassistant category established in Arizona, theseboards are open only to physicians.

In the United States, standards regarding theeducation and certification of homeopaths arelargely established by various professional organiza-tions working independently of regulatory bodies.People who want to practice homeopathy mustdecide whether they will gain a license as a medicaldoctor or another medical professional, or work as ahomeopath without a license. Working with a licensedoes not necessarily ensure any higher standard ofhomeopathic competency than working without one.Any health care license holds the practitioner to cer-tain professional standards, which vary depending onthe profession being licensed, and is also an assur-ance of certain formal education, but it does notensure any particular competency in homeopathy.

In the United States, homeopathy is consideredthe practice of medicine, partly because the legalstatutes determining medical practice of each stateare extremely broad and partly because the Food andDrug Administration defines homeopathic remediesas drugs. In the California Business and ProfessionsCode, Sections 2050-2079 pertain to medical prac-tice. Section 2052 says the following:

Any person who practices or attempts to practice, or whoadvertises or holds himself or herself as practicing anysystem or mode of treating the sick or afflicted in thisstate, or who diagnoses, treats, operates for, or prescribesfor any ailment, blemish, deformity, disease, disfigure-ment, disorder, injury, or other physical or mental condi-tion of any person, without having at the time of doingso a valid, unrevoked or unsuspended certificate as pro-vided in this chapter, or without being authorized to per-form such act pursuant to a certificate obtained inaccordance with some other provisions of law, is guilty ofa misdemeanor.

Section 2068 states that nutritional advice can begiven without being a medical doctor. In contrast to thedefinition of homeopathic remedies, herbs, vitamins,

134 C L A S S I C A L H O M E O P A T H Y

Page 140: Classical Homeopathy

and other “natural” substances are defined as foodsupplements. Although homeopathic medicines areavailable over the counter, defining them as drugsinfluences the legal definition of homeopathic prac-tice. However, the basis for giving a homeopathicremedy is generally very different from that associ-ated with conventional drugs. As often stated byhomeopaths, homeopathy treats the person, not thedisease. The basis for choosing a particular remedydepends on individual characteristics of the wholeperson and not just the common symptoms of agiven disease. Also, homeopathic remedies do not gothrough the same safety testing as conventionaldrugs, because their use was established prior to theFDA Act that “grandfathered” homeopathic medi-cines, recognizing their general acceptance as safe.Reassuring many, most homeopathic remedies are“potentized” to the point where the “energy” of thesubstance remains, but probably none of the physicalsubstance from which the remedy is derived.

Homeopathic remedies therefore do not have thesame potentially dangerous toxic side effects as con-ventional drugs; however, as with any substance thatcan have a powerful therapeutic effect, they can stim-ulate a strong response that, if not handled properly,can be dangerous in exceptional circumstances.

Defining homeopathy as medicine establishescontradictions that are not easy to resolve. In thenineteenth century, homeopathy and its philosophystruggled with an allopathic methodology that wasunderpinned by a traditional Newtonian perspective,an approach fundamental to all the physical sciences.Homeopathic philosophy did not fit into this modelbecause of its radical position in believing in the con-cept of energy or vital force, and therefore it couldnever truly belong.

So if homeopathy is not medicine, as it has sincecome to be understood and defined legally, what is it,and how should its practice be defined? This ques-tion has not yet been resolved, and homeopathy findsitself still divided between two identities, one histori-cal and the other philosophic.

HOMEOPATHY IN THEUNITED KINGDOM ANDEUROPE

It is interesting to compare the situation in theUnited States with that of England. In 1946, when

the National Health Service (NHS) was created in theUnited Kingdom, homeopathy was included amongthe methods of medical care available. Physicianswho train in homeopathy can practice homeopathywithin the NHS. These physicians pass an assessmentprocess and are registered with the Faculty ofHomeopathy. They are still accountable as physi-cians, but are allowed to practice homeopathy.

However, no legal medical statutes in Englanddefine who can or cannot practice homeopathy. Thelaws defining the practice of medicine in the UnitedKingdom are for doctors only. The concept of licen-sure for all professions is not applied. People can prac-tice whatever they want under common law unlessspecific laws exist to the contrary. They cannot callthemselves doctors or prescribe allopathic medicineswithout a medical license, but they can practicehomeopathy. Therefore the largest growth of homeo-pathic practitioners in the United Kingdom in the last20 years has been in the number of professional (non-medical) homeopaths. Professional organizationshave been established to support the profession anddefine standards. New homeopathic schools worktogether to define curricula and are now are beingaccepted within the university system in England.

Early this century, as homeopathy declined in pop-ularity in England as elsewhere, it was salvaged by non-medical homeopaths. Most homeopathic medicaldoctors did not want anything to do with nonmedicalhomeopaths, but the most famous homeopathic doc-tor of his era, John Clarke, taught many nonmedicalhomeopaths and actively encouraged them to practice.This led to his estrangement within the homeopathicmedical field, yet his influence ensured homeopathy’ssurvival in the United Kingdom. The different legal sit-uation in England, which didn’t restrict the practice ofhomeopathy, aided the development of the nonmed-ical homeopath. Therefore the practice of homeopathyin England has always been divided between physiciansand professional (lay) homeopaths, much as it is inHolland, Norway, Sweden, Australia, and NewZealand.

In Europe, only France and Austria have a situa-tion similar to the United States, where, strictlyspeaking, homeopathy can be practiced only byphysicians. In Germany, homeopathy can be prac-ticed by physicians or by a separate category of practi-tioner called a Heilpraktikur, which is similar to anaturopathic physician in the United States orCanada.

C H A P T E R 9 Homeopathic Education and Certif ication 135

Page 141: Classical Homeopathy

MEDICALLY TRAINED VSNONMEDICALLY TRAINEDHOMEOPATHS

In the United States, the main difficulty with home-opathy being practiced under a medical license isthat the doctor’s homeopathic competency is neverassessed; the system defines only the physician’s legalright to practice medicine. This is not necessarily thesame thing as practicing homeopathy.

Some homeopathic physicians believe (from botha legal and professional point of view) that a personshould be a physician to practice homeopathy. Theybelieve that people who are not trained as physicianscannot be as competent as those who are; that theywill not have the knowledge to treat more complexpathologic conditions and therefore will not do home-opathy justice. They believe also that homeopathy ismedicine in the finest sense and that one has to be aphysician to do it. Furthermore, they point out, it isnot legal to practice without a license.

Professional homeopaths respond to this by stat-ing that practicing homeopathy effectively does notrequire as much knowledge of medicine as does allo-pathic medicine. Homeopathy’s unique philosophyand practice can be effectively applied with a rela-tively superficial (from an allopathic point of view)amount of medical knowledge. Most people seeingprofessional homeopaths already consult with a reg-ular physician and often come with diagnosis inhand. The job of the homeopath is to take these peo-ple further than allopathic medicines have been ableto take them. Professional homeopaths contend thata deep knowledge of homeopathy enhances theirunderstanding of disease processes; therefore themost important thing is to be thoroughly trained inhomeopathic principles.

A common point of view among professionalhomeopaths is that some physicians trained inhomeopathy may tend to look at the patient from anallopathic perspective and apply homeopathic reme-dies from that point of view; such a practice, theybelieve, compromises the holistic viewpoint of home-opathic philosophy. This point was in fact emphati-cally stated many times by Samuel Hahnemann, thefounder of homeopathy,2 and has since been a majorpoint of contention within homeopathic practice.Hahnemann had strong views regarding the damagecaused by allopathic treatment, and was critical ofany homeopath practicing homeopathy from an

allopathic perspective. This perhaps necessarilyextreme stance that Hahnemann took continues toaffect homeopathy today, both within the professionand homeopathy’s relationship to allopathy in gen-eral.

Therefore the debate as to how much medicalknowledge is necessary to practice homeopathy isinfluenced by historical debates within homeopathyitself, and also reveals the different approacheswithin the umbrella of homeopathic prescribing.One approach emphasizes the importance of under-standing the whole person and prescribing a remedymatching that subtle complexity (see Chapter 7). Inthis approach the medical diagnosis is unimportant.This approach can be contrasted with one that ismore “medicalized,” with remedies selected chieflyon the basis of allopathic diagnosis and pathologicchanges. Although by no means mutually exclusive,these differing approaches reflect the different clini-cal directions within homeopathy and obviouslydemand markedly different conventional medicaltraining for the homeopath.

For homeopathic physicians, one of the mainchallenges has been increasing awareness of homeop-athy within conventional medicine. Until recently,not many conventional physicians knew what home-opathy was, and the attitude toward alternative med-icine, including homeopathy, was generally negative.This lack of recognition and hostile attitude createda unique challenge for committed homeopathicphysicians who looked for greater recognition ofhomeopathy but faced prejudice and antagonismwithin the profession. With the recent surge of inter-est in alternative medicine, this is now beginning tochange; however, homeopathy is still not widelyunderstood within mainstream medicine.

Although treated with greater tolerance in othercountries, physicians who practice homeopathyabroad are also somewhat marginalized. One countryin which homeopathy is well established within med-ical practice is India. There are over 100 homeopathicmedical schools there, and graduates achieve thesame status of physician as allopathic doctors. Indiais known for a greater mutual acceptance amongmedical professionals, and each modality is seen as adifferent aspect of medical practice. However, thestandards of homeopathic knowledge do vary widelyin India. Other countries in which homeopathy ismore accepted within medical practice are Mexico,Argentina, Brazil, France, and England.

136 C L A S S I C A L H O M E O P A T H Y

Page 142: Classical Homeopathy

Given the complexities of legal definitions ofhomeopathic practice, the history of homeopathy’sfight against allopathic dominance, and the matterof homeopathy being practiced by nonphysicians, itis quite a task to achieve consensus as to the stan-dards of professional competency needed to definehomeopathic practice. It is also a challenge to estab-lish professional training programs, especially in theUnited States, when there is no licensure for the pro-fession. This obstacle has the direct effect of limitingpeople’s ability to make a living from homeopathicpractice. It is also difficult to interest many physi-cians, who have already endured many years of study,to study for a few years more to attain adequatehomeopathic skills.

Therefore, until homeopathy can establish itsown standards and find a way to bridge the philo-sophic and political divisions it has faced for 200years, it is hard to see how it will establish itself as amajor healing system of health care.

THE PRACTICE OFHOMEOPATHY: PRESENTREALITIES

In the United States, homeopathy is practiced by peo-ple of all backgrounds, some licensed, some not.Apart from medical and osteopathic doctors whopractice homeopathy, the main licenses under whichhomeopathy is practiced are acupuncture, chiroprac-tic, physician’s assistant, nurse practitioner, andnaturopathy. Practitioners in these fields may prac-tice homeopathy exclusively or in the context of theirlicensed profession. The state boards of each profes-sion have scopes of practice that define what practi-tioners can do within their licensure. Some boards,especially acupuncture and chiropractic, have statedthat homeopathy does not fall within their scope ofpractice. This means that in some states practitionersrisk their license by practicing homeopathy.

Apart from a case in North Carolina, no medicaldoctor has been challenged for practicing homeopa-thy. The North Carolina Medical Board orderedGeorge Guess, MD to desist from using homeopathyand to practice only conventional medicine, arguingthat homeopathy was not within the scope of medicalpractice. Instead, he moved to Virginia. In part becauseof this case, a law was then passed in North Carolinamaking it unlawful to censure a physician solely for

practicing unconventional therapy. Since then, NorthCarolina reinstated Dr. Guess’ full license to practicehomeopathy or conventional medicine as he chose.

Some physicians who practice homeopathy do soexclusively. They do not practice allopathic medicinebut use their medical license to practice homeopathy.Other physicians see homeopathy as an adjunct totheir regular practice and incorporate it into theirpractice to varying degrees. Opinions as to whetherhomeopathy is a profession in its own right or anadjunct to conventional practice vary from practi-tioner to practitioner.

Some physicians see homeopathy as a specialtywithin medicine, and believe homeopathic physiciansshould be seen as specialists. This position gives agreater credibility to the profession than the viewthat homeopathy is merely an adjunct modality sub-sumed within conventional medicine. However, otherpeople argue that even this view obscures the funda-mental differences of philosophy between homeopa-thy and allopathy.

Some homeopaths therefore believe that some kindof legitimacy needs to be created for homeopathy dis-tinct from allopathy and medicine at large. Most peo-ple who follow this line of thinking are professionalhomeopaths and do not have any other medical license.Professional homeopaths do not see homeopathy as aspecialty of medicine, because they cannot practicemedicine and do not have any legal recognition forwhat they do within the medical licensing system.

Whatever freedom professional homeopaths have topractice depends on the state and to some extent thetown and county in which they practice. Because theypractice in the gray area of the law, their situation issomewhat unpredictable; no legal precedent has beenestablished regarding professional homeopathic prac-tice. In California, the State of California threatenedto take a professional, nonlicensed homeopath tocourt for practicing medicine without a license, butthe practitioner did not pursue the case and ceasedpracticing. The only other legal incident involving aprofessional homeopath was in Connecticut, which,ironically, has a homeopathic medical board. A pro-fessional homeopath was reported to the Con-necticut Department of Health, which instructed theConnecticut Homeopathic Medical ExaminingBoard to come to a legal determination of whetherthe practitioner was practicing medicine without alicense. The Department of Health had previouslytaken a very aggressive position against the practice

C H A P T E R 9 Homeopathic Education and Certif ication 137

Page 143: Classical Homeopathy

of midwifery but eventually lost the case in thecourts. Eventually, the case against the homeopathwas dropped because the Department of Health couldnot prove that she was practicing medicine without alicense. The lawyer representing the homeopath madethe case that the Connecticut Homeopathic MedicalExamining Board had no jurisdiction over the home-opath in question, because she was not licensedthrough the board.

Although all nonlicensed professional home-opaths face this risk in practicing homeopathy, mostfeel safe enough to practice. They cannot accept insur-ance, and many make it clear that they are not prac-ticing medicine and do not diagnose disease. Somepractitioners require that their patients have a regu-lar physician and undergo relevant diagnostic proce-dures before coming for homeopathy. The challengemany homeopaths face is to make a living by practic-ing a discipline that is relatively unknown and not eli-gible for insurance benefits.

The interest of professional homeopaths lies indefining homeopathy under either a separate home-opathic medical license or certification, mandated bythe state, or by establishing self-regulation for theprofession without state licensure. The latter optionappeals to some homeopaths who feel that conven-tional medicine claims an unwarranted monopolisticpower to define what is good in healing practices.This population of homeopaths would also supportthe idea that licensure of any kind does not necessar-ily benefit the profession—that if homeopathy wereto have its own medical license, the profession wouldbe accountable to the dictates of the state, whichcould enforce standards that compromise homeo-pathic philosophy. State regulation could also imposelimits of practice that are antagonistic to ideas of free-dom of practice.

However, every profession needs to have stan-dards. Without clearly defined and applied standardsof practice, homeopathy cannot seriously be called aprofession. But given the diversity of homeopathicpractitioners in the United States and the historicaland political realities, defining a single professionwith one level of professional competency has notbeen achieved.

This situation is further complicated by the factthat many practitioners may practice what they callhomeopathy, but what they practice is fundamen-tally different from the principles of classical home-opathy laid down by Samuel Hahnemann. Using

low potencies only, combination remedies, or reme-dies given for “drainage” or for specific diseases,they classify their practice as homeopathy, althoughmany homeopathic professionals would not. Callingthe practice homeopathy just because homeopathi-cally potentized remedies are used is not acceptablefor many classical homeopaths and threatens to fur-ther confuse the problem of defining homeopathicpractice.

HOMEOPATHICCERTIFICATIONORGANIZATIONS

Five organizations are recognized as playing a role indefining and measuring standards of homeopathiccompetency in North America. Each has different lev-els of requirements for certification. The following isa description of each organization and its require-ments.

The oldest organization of the five is theAmerican Board of Homeotherapeutics (ABHT). Thisorganization was formed in 1959 and certifies med-ical and osteopathic doctors only. There are presently70 diplomates (D.Ht.) of this board. Historically, itwas members of this organization that helped keephomeopathy alive earlier this century.

Another certifying body is the HomeopathicAssociation of Naturopathic Physicians (HANP).HANP represents naturopathic physicians who prac-tice homeopathy. Naturopathy is licensed in 11states, and homeopathy is included to varyingdegrees in the curriculum of naturopathic medicalschools. Some naturopaths practice little or nohomeopathy, whereas others practice it exclusively. In1989, the HANP began to certify naturopaths prac-ticing homeopathy and now has 66 certified home-opaths (DHANP).

The North American Society of Homeopaths(NASH) is a certification and professional organiza-tion established to define professional standards andrepresent professional homeopaths who do not prac-tice under any other licensure. Professional homeo-paths, who used to be called lay homeopaths, havebeen active in gaining legitimacy for their own stan-dards of competency, irrespective of the legal ambi-guity in which they practice. This organization wasmodeled after a British organization called theSociety of Homeopaths. Although its membership is

138 C L A S S I C A L H O M E O P A T H Y

Page 144: Classical Homeopathy

exclusively professional homeopaths without medicallicenses, the Society of Homeopaths is the largestprofessional organization in the United Kingdom. Inthe United Kingdom, everyone is free to practicehomeopathy and other nonmedical forms of healing.There are no licensing laws that limit its practice.Standards are regulated within the profession; as longas a professional homeopath does not pretend to be amedical doctor, there are no restrictions on the abilityto practice.

Many professional homeopaths in the UnitedStates believe they should have the same right topractice as in the United Kingdom, and they do notthink that defining homeopathy under medicalstatutes is an appropriate way to control the practiceof homeopathy. It is a good example of how differentpolitical climates determine the legitimacy of home-opathy’s practice, without regard to actual homeo-pathic standards.

Professional homeopaths have felt the need todefine their own standards and to support their fel-low practitioners in the United States and Canada.Because the NASH is modeled its English counter-part, it functions as both a certification and profes-sional membership organization. The HANP alsoserves both functions. The other boards function exclu-sively as certification boards. As of July 2001, NASHhad 148 certified members (RSHOM). In May 2000,NASH enacted a change in its policy by allowing bothlicensed and nonlicensed practitioners to join, thusoffering membership to all practicing homeopaths.

The Council for Homeopathic Certification(CHC), established in 1991 to set up a standard ofprofessional competency for all practicing homeo-paths, is represented by homeopaths from all profes-sions in which homeopathy is practiced. Recognizingthe great variety of practitioners in North America,the CHC saw that establishing one standard thatcould be accepted by all homeopaths would be animportant step in unifying the profession. It recog-nized that many people practicing homeopathyunder licenses of other professions, such as acupunc-turists, chiropractors, and nurse practitioners, havehad no representation or avenue for professionalevaluation. The CHC also represents a large numberof professional nonlicensed homeopaths. As ofDecember 2000, it had 218 certified homeopaths(CCH) as members.

The homeopaths certified by the CHC come fromthe following professions and backgrounds—doctors,

naturopaths, physician assistants, nurse practition-ers, chiropractors, acupuncturists, British-trainedhomeopaths from the Society of Homeopaths,Indian-trained physicians, professional nonlicensedhomeopaths, and others. The board of the CHCincludes representatives of all the professions that arecertified through the CHC. This breadth was estab-lished to ensure equal representation within thehomeopathic profession. In May 2000, NASH andthe CHC agreed to use exactly the same certificationprocess. This agreement allows applicants to undergoa single process to be certified through the CHC andregistered and certified through NASH. BecauseNASH is a professional membership association andthe CHC is solely a certifying agency, this arrange-ment clarifies and complements the function of eachorganization.

Another organization is the National Board ofHomeopathic Examiners (NBHE). Like the CHC, thisorganization was originally formed to establish anational standard for the profession. Since then,NBHE has mainly represented chiropractors and itsboard has been dominated by chiropractors. Althoughthis group formerly certified all homeopaths, it nowcertifies only homeopaths who practice under someform of health care licensure. Many of those certifiedhave gone through educational programs connectedto NBHE. This has raised some questions regardingconflict of interest. As of 2000, NBHE had approxi-mately 160 certified homeopaths (DNBHE), 80 ofwhom practice in Florida.

One of the continuing difficulties involved inestablishing closer relationships among the certify-ing organizations is the issue of medical standards.This issue has been a source of disagreementamong the various communities in the UnitedStates and Europe. The problem is compounded bythe legal definition of homeopathic practice in theUnited States. Also, because each organization hasits own agenda to support its own community, ithas been difficult to establish a closer working rela-tionship.

One other issue among the various organizationsis the level of homeopathic competency each seeks tomeasure. The process of defining a suitable profes-sional standard for practice is open to much debate.How much knowledge should a person have to bedeemed competent? How much experience and train-ing should a homeopath have? How much medicalknowledge? Given the diversity of homeopathic prac-

C H A P T E R 9 Homeopathic Education and Certif ication 139

Page 145: Classical Homeopathy

tice, these issues are not subject to easy agreement;thus the various organizations have different levels ofeducational requirements and standards of evalua-tion.

CERTIFICATION STANDARDS

The following is a list of certification requirementsfor the various certifying organizations. 1. Prerequisite hours of training: All the organiza-

tions require a certain number of hours of train-ing in classical homeopathy. More specificinformation about this training appears later inthis chapter. ABHT: 150 hours (from an approved school or

course) HANP: 350 hours (from an HANP-approved

school) NASH: 500 hours (from established training

programs or a combination of trainingprograms and seminars; up to 250 hourscan come from approved correspon-dence training, with 1 hour of creditgiven for every 4 hours of training)

CHC: 500 hours of training (subject to thesame qualifications as for NASH)

NBHE: 300 hours of training 2. Prerequisite level of practical experience and/or

clinical training: Each organization requires a dif-ferent level of experience. Because they are estab-lishing levels of professional competency andthere are few internship programs, actual practi-cal experience is required. Individuals can be inpractice prior to being certified because no legallicense is being issued. ABHT: Homeopathic practice for 3 years HANP: Homeopathic practice for 1 year and 100

hours of preceptorship NASH: Homeopathic practice for 1 to 2 years or

a combination of formal clinical super-vision and clinical practice

CHC: The same as NASH NBHE: None required

3. Medical training prerequisites: ABHT: Proof of medical license, open only to

MDs and DOs HANP: Proof of naturopathic license, open to

NDs only

NASH: Proof of cardiopulmonary resuscita-tion certificate and college-levelanatomy and physiology certificate; apathology program is also required ifthe anatomy and physiology is com-pleted through an approved correspon-dence program

CHC: Same as NASH NBHE: Proof of health care license

4. Case submission requirements: This criterion isto provide evidence of clinical experience andcompetency. ABHT: 10 chronic cases are to be submitted, five

with 1 year of follow-up analysis and fivewith 3 years of follow-up analysis

HANP: 5 chronic cases with 1 year of follow-upanalysis

NASH: 5 chronic cases with 6 months of follow-up analysis (until 1999 NASH alsorequired two video cases with 6 monthsof follow-up analysis)

CHC: 5 chronic cases with 6 months of follow-up analysis

NBHE: Must take a live case before examinersduring the oral examination

5. Curriculum vitae requirements: Each organiza-tion requires certain information on its appli-cants: ABHT: References from two current members HANP: References from two current members NASH: Details of training and experience in

homeopathy and other fields, details ofcurrent practice, and three professionalreferences

CHC: Details of training and experience inhomeopathy and other fields, details ofcurrent practice, and three professionalreferences

NBHE: Details of training and experience inhomeopathy and other fields, details ofcurrent practice, and 1 professional ref-erence

6. Examination process: ABHT: A 3-hour examination, mostly multiple-

choice questions on homeopathic phi-losophy, case management, repertory,and materia medica

HANP: The same examination process as theABHT

NASH: Since 1997, same as the CHC examination

140 C L A S S I C A L H O M E O P A T H Y

Page 146: Classical Homeopathy

CHC: A 7-hour examination involving a multi-ple-choice section on homeopathic phi-losophy, materia medica and medicalsciences, and an essay section on homeo-pathic case analysis. Applicants mustpass each section in sequence beforeattempting the next

NBHE: A 6-hour examination, mainly multiple-choice questions

7. Oral examination process: ABHT: A 2-hour review of submitted cases, a

review of live cases, and other practicemanagement issues

HANP: A review of submitted cases and practicemanagement issues

NASH: Same as the CHC examination CHC: A 1-hour phone interview to review

practice management issues, profes-sional practice concerns, and theapplicant’s general biographic infor-mation

NBHE: Required to take a live case in frontof two examiners, analyze relevantissues, and recommend appropriateremedy

8. Continuing education requirements: ABHT: Every 3 years, those certified must sat-

isfy all of the following: complete 30continuing medical education credits(e.g., seminars), submit one article to theJournal of the American Institute ofHomeopathy, perform a preceptorship forat least one student, and give a lecture orpresentation

HANP: Every year, 12 hours of training from sem-inars, or 12 hours teaching or supervisingstudents, submitting articles, or writingexamination questions

NASH: Every year, 14 hours of training need tobe completed, or 14 hours teaching, sub-mitting articles to journals, doing ahomeopathic proving or other research,or writing examination questions

CHC: The same requirements as NASH NBHE: Every year, 12 hours of training are

required from an approved program,and also one of the following: submit-ting an article, writing 20 questions,teaching in an approved school, or sub-mitting a case study

HOMEOPATHIC EDUCATION

Because homeopathy does not have a distinct licensein the United States, from legal and economic pointsof view it cannot be defined as a separate profession.Therefore the structural resources and economicincentives to establish full-time professional trainingprograms leading to a career and sustaining wage donot exist.

A person who wants to study homeopathy in theUnited States has certain choices. First, he or shemust decide whether to be licensed in a particularprofession. Because there is no license in homeopa-thy, a license as some sort of health professional canbe an umbrella for practicing homeopathy. Thechoice of licensure depends on many factors. Peoplecommonly choose one of the following: medical orosteopathic doctor, physician’s assistant, nurse prac-titioner, acupuncturist, or chiropractor. There areadvantages and disadvantages to each choice. However,once a person has obtained a license, he or she muststill learn homeopathy, which is equally or more dif-ficult to study and practice.

An already licensed person who wants to studyhomeopathy has a variety of choices. The most com-mon form of professional homeopathic study are 3- to 4-year part-time programs that allow studentsto continue to work in existing jobs. Most studentscoming to these programs have jobs and families andneed the flexibility to study at home. These programsnormally meet once a month on a weekend, or for 3days, with the rest of study being done at home. Thehomework requirements for successful completion ofthese programs are considerable. Graduates may ormay not be granted a specific certification on com-pletion. Most of these programs give only a certifi-cate of completion and recommend that graduatesgain certification through one of the five certifyingorganizations.

This model of training is based on schools estab-lished over the last 20 years in England and the restof Europe. However, in Europe, because homeopathyand homeopathic education have become moreestablished, there are now full-time programs. Grantsare now available in England, because some programsare linked to the university system.

If homeopathy was a legally licensed or certifiedprofession in the United States, homeopathic schoolswould develop full-time programs, obtain funding andstudent loans, and be able to attract larger numbers of

C H A P T E R 9 Homeopathic Education and Certif ication 141

Page 147: Classical Homeopathy

students. Many homeopaths dream of the idea ofhomeopathic medical schools, but this possibility is sti-fled by the political and legal situation. However, evenin regard to this vision, there are arguments over howmuch medical knowledge would be taught in propor-tion to the amount of homeopathic knowledge. One ofthe observations that homeopaths have made of otherprofessions, such as naturopathy, acupuncture, andespecially osteopathy, is that in their attempt to becomemore acceptable to the mainstream medical model theyhave emphasized conventional medical knowledge atthe expense of their own therapeutic model. Thismakes some homeopaths wary of making homeopathymore “medical.”

This last point is fundamental in understandinghomeopathy’s relationship with allopathic medicine.Hahnemann railed against the homeopaths he saw ascompromising homeopathic principles and copyingallopathic methods. This polarization, perhaps nec-essary in Hahnemann’s day to establish the distinctidentity of homeopathic methodology, created anantagonistic and competitive relationship betweenhomeopathy and allopathy. It also created antago-nism among homeopaths.

The weakest part of most homeopathic education,both in the United States and abroad, is in clinicaltraining and evaluation. Graduates leave a programwith varying degrees of homeopathic knowledge buthave not had the opportunity to practice under super-vision and gain the evaluation necessary to define pro-fessional competency. This means that graduatesentering practice must learn as they go. This limitationis being rectified as more schools are implementingclinical work into their programs. However, it is fair tosay that most schools do not have the resources to givestudents the kind of individual mentorship necessaryfor entering professional practice.

Homeopathic Training Programs

There are approximately 10 professional part-timeprograms in the United States and another 5 inCanada. Some of these programs accept only licensedpractitioners. Most, however, accept people with orwithout a medical license. Criteria for joining theprogram are usually 2 years of college, age of 21 yearsor older, and a willingness and ability to study. Someschools include human sciences training if notalready completed, but most ask students to get

anatomy and physiology from local colleges and mayoffer a correspondence pathology program.

Homeopathic Training inNaturopathy Schools

Naturopathic programs are the only licensed programsin which homeopathy is included substantially in thecurriculum. Three accredited schools in the UnitedStates—in Washington, Oregon, and Arizona—trainnaturopaths. A naturopathic school in Connecticut isseeking accreditation, and a Canadian naturopathicschool is also seeking accreditation in the UnitedStates.

Homeopathy is included in the curriculum of allthese schools, but to varying degrees. Homeopathy isonly one modality of many in which a licensed natur-opath can practice. Most of the schools offer homeo-pathy as an elective for those who want to study itmore deeply. However, it is debatable whether any ofthese programs alone are enough to give the level ofhomeopathic training, including clinical work, neces-sary for professional competency. Most naturopathswho want to study homeopathy also do extra semi-nars to complete their training. The naturopathicschool in Seattle offers up to 200 hours of lectures,50 to 100 hours of supervised case analysis, and up to180 hours of homeopathic clinics. The naturopathicschool in Oregon offers 144 hours of homeopathywith an elective of another 144 hours. Students canthen do up to 200 hours of homeopathic clinics.

Although practiced throughout the UnitedStates, naturopathic medicine is licensed in only 11of them—Alaska, Arizona, Connecticut, Hawaii,Maine, Montana, New Hampshire, Oregon, Utah,Vermont, and Washington. It is also licensed inPuerto Rico and registered in the District of Co-lumbia. There are lobbying and popular movementspushing for naturopathic licensure in California,Colorado, and Minnesota.

Naturopathy’s struggle is similar to homeopathy’s;many people who practice naturopathic methods arenot licensed and do not believe they have to be licensednaturopathic physicians to do their work. This contro-versy has affected the drive toward licensure in variousstates. The concern has been whether naturopathiclicensure would create an exclusivity of practice fornaturopaths. Recently a naturopathic bill was intro-duced in North Carolina that distinctly creates an

142 C L A S S I C A L H O M E O P A T H Y

Page 148: Classical Homeopathy

exclusive right to practice all modalities listed withinthe naturopathic bill, which includes homeopathy.The bill has not currently become law. In California,another naturopathic bill has been written that statesthat no monopoly would be created of any modalitymentioned in the bill. The movement toward the licen-sure of naturopathy throughout the United States hasfaced determined opposition from other naturopathswho oppose this whole process and, as they see it, themonopolization of naturopathic techniques to oneschool of thinking.

Some naturopaths who learn naturopathy apartfrom a licensing program do so through correspon-dence training programs. One of the criticisms fromlicensed naturopaths is that these programs are inef-fective and superficial. There are obvious limits tomost types of correspondence programs, an issuefaced by homeopathy as well.

Correspondence Training andApprenticeship

Quite a few people in the United States and Canadatrain through homeopathic correspondence programs,often because there are no on-site homeopathic pro-grams available in many parts of the country. As withmany on-site programs, the quality of correspondenceprograms varies considerably. The major criticism ofthese programs is that correspondence learning is notsufficient. An evaluation of skills gained through anongoing, personal relationship with teachers is a morerigorous approach to homeopathic education. The lackof a major clinical component is also a significant prob-lem, as it is with all schools.

Traditionally, one way in which homeopathslearned was through apprenticeship. Spending timewith experienced homeopaths and observing theirpractice has always been an important experience fordeveloping homeopaths. This tradition goes all theway back to Samuel Hahnemann, the founder ofhomeopathy. However, today this is rarely a majorform of learning for aspiring homeopaths.

Homeopathic Training in MedicalSchools

Various forms of alternative medicine are now beingincluded into conventional medical training. A 1995

study by Michael Carlston, MD, the first nationalsurvey of alternative medical education in the UnitedStates, revealed the extent of this inclusion. At thetime of the study, one third of medical schools wereteaching something about alternative medicine. Anadditional 5% of medical schools planned to begininstruction, and another 7% were considering alter-native medicine instruction. Nearly 10% of Americanmedical schools were offering some instructionabout homeopathy. One third of the schools plan-ning to expand their alternative medicine instructionintended to include homeopathy as a part of thatexpansion.3

Other surveys have since demonstrated morethan a doubling in the number of U.S. medicalschools offering instruction in complementary andalternative medicine, confirming the expansionisttrends evidenced in Carlston’s survey.4,5 The evidencesuggests that the homeopathic presence in conven-tional medical schools has expanded even more rap-idly than CAM overall. A 1997-1998 AMA surveyfound that 71 medical schools (56.8%) taught medicalstudents about homeopathy. Sixteen of those (12.8% ofall U.S. medical schools) included instruction abouthomeopathy within required coursework.6

Homeopathic Seminars andLectures

The final way of studying homeopathy in NorthAmerica is through various seminars or accumulatinghours through a combination of programs. Althoughmany such programs are designed to be postgraduateor continuing education seminars, students can learntheir homeopathy this way in combination with self-study. In the past, when even fewer training programswere available, many homeopaths had very little in theway of educational choice. Even some of the mostrespected homeopaths of this generation had to learnhomeopathy in this piecemeal approach. Seminars areoffered in many different ways. Weekend seminars withparticular teachers, 1-year postgraduate programs inthe form of 3 to 5 weekends of instruction, summerschool programs through the National Center ofHomeopathy, and intensive 1-week workshops areavailable. All contribute toward the education of thehomeopath, yet none can be described as a school thatshould or could take responsibility for the evaluationand development of a student’s learning.

C H A P T E R 9 Homeopathic Education and Certif ication 143

Page 149: Classical Homeopathy

The Future of Education

Although homeopathic education has come a longway in the last few years, it is in need of further devel-opment. Full-time schools cannot be created at themoment because homeopathy does not have the kindof legitimacy and popularity to create demand forsuch programs. For students to commit time andmoney to the study of homeopathy, they need someform of assurance that a living can be made once theyare qualified. Unfortunately this is not the case at themoment.

There are four main options for further establish-ing homeopathic education:

1. Include homeopathy as a fundamental part ofmedical curriculum for doctors and nurses.Homeopathy would therefore grow within themedical practice of physicians, nurses, andothers.

2. Create a medical license for homeopathy andhave separate homeopathic medical schoolssimilar to those established by naturopathy.

3. Create an alternative form of legitimacy, suchas certification or registration, under the lawsof each state, and create schools to teach tothe appropriate level.

4. Establish a political climate in which home-opathy, among other alternatives, can be prac-ticed freely without restriction and stateregulation.

Arguments for and against each of these optionsexist.

The major risk of the first option is that home-opathy would be subsumed within an allopathicmodel of thinking and its philosophic integrity com-promised, similar to the process that has afflictedother professions that took this path. On a positiveside, the integration of homeopathy within conven-tional medical practice would allow homeopathy togain acceptance among medical professionals andwith the general public.

The biggest obstacles to the second option arepolitical and financial. Creating a separate licensureis extremely expensive and complex. Homeopathyneeds significantly more practitioners and a greaterdegree of unity than is presently the case.

The third and fourth options bring up challengessimilar to the second, but on a lesser scale. Some peo-ple fear that an alternative form of certification woulddiminish homeopathy to the level of a profession such

as massage, and that homeopathy would thereby giveup its struggle as a viable medical alternative to allo-pathic medicine. This option could separate the med-ical and nonmedical parts of the homeopathiccommunity. For most practitioners without a med-ical license, one of these options would provide anappropriate form of legitimacy, because it defineshomeopathy as separate from existing medical licen-sure. It would not preclude medical doctors frompracticing homeopathy and working within thescope of medical practice, but it would establish aparallel legitimacy, with a practitioner’s scope ofpractice being defined according to the level ofhomeopathic and medical training he or she hasreceived.

THE DEBATE ON LICENSUREFOR HOMEOPATHY

Given the political reality of medical licensure in theUnited States and the definition of homeopathy asthe practice of medicine, homeopathic education willnot change dramatically until homeopathy can beestablished legally through legislation. However, that isnot likely in the near future in most states. Homeopathydoes not have the resources, the professional unity, orthe popularity within mainstream society to achievethis.

However, each state has its own political dynamic,and various options are available. In April 2000, a lawcalled the Complementary and Alternative HealthCare Freedom of Access Bill was passed in Minnesota.Its focus is to address the legal barriers that limit con-sumer access to complementary and alternative formsof health care. The bill affects licensed physicians whowish to offer alternative therapies, and also unlicensedpractitioners in fields that do not have licensure (e.g.,naturopathy, homeopathy, massage, and body work).The bill does not enforce standards of practice uponthese professions but establishes the right of people tochoose these therapies and to practice them as long asno harm is done. A practitioner has to submit certaindocumentation to a client as to the nature of his or herpractice and get written informed consent, but that isbasically all that is required. This bill is radical becauseit circumvents existing medical licensure. It is focusedon the freedom of access; its only concern being thatpeople can choose whomever they want to see as longas no harm is done.

144 C L A S S I C A L H O M E O P A T H Y

Page 150: Classical Homeopathy

This bill may bring into question the traditionalroute that various professions have taken to establishlegitimacy.7 Acupuncture and chiropractic became legalthrough licensure. Licensure establishes the right topractice a therapy by establishing state and federal sanc-tion of standards of practice and professionalism.Practitioners with a particular license have to practicewithin certain established guidelines, and are account-able to the profession and, to some extent, to the statesanctioning bodies that monitor the profession.However, licensure establishes the exclusive right topractice that therapy. No one else can practice it. Theexclusivity of licensure is criticized in many circles. Inthe nineteenth century, state licensing laws for medicinewere often revoked because of the monopoly it created.8

Nearly five centuries ago, Henry VIII’s pronouncementestablishing the right of all of his citizens to responsiblyattempt to provide health care to each other was insti-gated by the perception that the orthodox physicianswere taking financial advantage of patients throughtheir monopolistic power. A common criticism of licen-sure is that rather than protect the public againstunscrupulous and unqualified practitioners, it actuallyserves to protect the economic and political power ofthe profession licensed. This accusation has been leveledat the medical profession, among others.

This exclusive right and power leads many inalternative medical professions to fear that theirprofession will become subsumed under generalmedical practice, with the right to practice alterna-tive therapies limited to medical doctors. The exclu-sivity clause has also been criticized from aconstitutional point of view, especially from a morelibertarian standpoint.9

Also, instead of protecting the public from unsafepractice, it can be argued that professional licensureinstead subverts real accountability for damage done topatients. A professional monopoly allows one group toprotect its own and persecute outsiders. Licensure canallow the medical profession to dictate what is goodand not good for our health, establishing dependencyon the medical profession and the economic and polit-ical systems that support it. This culture of dependencywas stated in a seminal work by Ivan Illitch,10 in whichhe stated that iatrogenic (drug- or medicine-induced)disease has three strands—physical, social, and cultural.His main point is that the political consequences ofinstitutional power and authority create a dependencyon the authority of the expert, a process that has seri-ous personal and collective ramifications.

HOMEOPATHY ANDMEDICINE: THEDEVELOPMENT OF THEHOMEOPATH

Putting the philosophic and political argumentsabout licensure aside, the question still arises as towhether a homeopath should be governed by the samerestrictions and responsibilities as a medical doctor.Does what we do as homeopaths involve the samekind of risk as what most physicians do? Many home-opaths would answer no. Although a person comingto see a homeopath may have a serious problem thatmany need immediate medical intervention, is thatthe reality of everyday practice for most homeopaths?

In one study,11 79.8% of homeopathic patientshad previously seen a conventional doctor for theirproblems, 91% had received nonhomeopathic treat-ment, 91% saw another health provider first, and80% were using some form of self-help. Most peopleseeing a homeopath have seen other medicalproviders first and are coming to the homeopath foran additional form of treatment. This means thatthe homeopathic role is not primarily diagnosticand disease centered, but is “complementary” to therole of the physician. Therefore, given the levels ofskills required, it can be said that the homeopathneeds to know enough medicine to understand nor-mal and pathologic processes within the body, butdoes not need the same knowledge as a physicianunless he or she functions in a primary care medicalcapacity.

Also, because homeopaths do not give drugs witha specific toxic effect, but rather a homeopathic rem-edy that stimulates the body’s own healing capacity,it can be argued that the risks involved in homeo-pathic practice are generally less than for a physician.This is not to say that homeopathic remedies areharmless and involve no risk (because any therapythat can do good has the potential to do harm), butthat the risks are of less consequence.

Therefore most professional homeopaths wouldlike to see homeopathy legitimized, either by using afreedom of access model such as in Minnesota or bybeing certified in each state. These solutions allowthe profession to maintain primary responsibility forits standards of practice and do not create an exclu-sive right to practice. This system would mirror howhomeopathy is practiced in England. The homeo-pathic profession therefore needs to develop its own

C H A P T E R 9 Homeopathic Education and Certif ication 145

Page 151: Classical Homeopathy

standards and establish organizations that can sup-port the necessary professional structures.

In Europe this is being done through two organi-zations—The European Council for ClassicalHomeopathy and the International Council forClassical Homeopathy. These councils have prepareda document that outlines the amount of homeo-pathic and medical knowledge necessary for ho-meopathic practice; this document can serve as atemplate for homeopathic schools and professionaland certifying bodies. In the United Kingdom, thereare now professional nonmedical homeopaths work-ing within the National Health System. In Europe,each country has its own standards and professionalorganizations. Some have a more formal relationshipwith government than others. However, with thegreater centralization created by the EuropeanUnion, it is likely that homeopathic levels of educa-tion and practice will become more standardized inthe next few years. In the United States and Canada,there have been recent attempts to follow theEuropean model and create a broad document thatcan help define standards of practice and educationfor the whole profession. These attempts have beeninitiated by the Council for Homeopathic Education(an organization created to accredit homeopathiceducational programs) and supported by the CHC,NASH, and ABHT, among others. Homeopathy inthe United States and Canada is generally some yearsbehind Europe, but in the last few years the explosionof interest in homeopathy and other alternative sys-tems of healing is propelling the profession to defineits standards of practice more clearly.12,13

FUTURE CONFLICTS ANDCHALLENGES

The greatest challenge to homeopathy today is toproduce skilled practitioners. Dedicated study formany years is required to consistently provide goodhomeopathic care. History has shown that physiciansdo not necessarily become better homeopaths thannonmedical homeopaths. It is important to maintainstandards of homeopathic practice and createschools that can offer a high level of training.

A threat to homeopathy is the dilution of stan-dards of practice to make homeopathy more accept-able to the general culture and mainstream medicine.This struggle is similar to the struggle of 100 years

ago. Some homeopathic principles are not easy toreconcile with prevailing views of health and disease.The holistic view of homeopathy, with its emphasison treating the whole person and its critique of thesuppressive effects of many modern medical drugs,still does not fit into conventional thinking. Somebelieve that homeopathy will not thrive until a philo-sophic shift occurs in medical and scientific think-ing, a shift that is consistent with homeopathic andholistic thinking.

Another challenge, from the more conservativemedical circles, is the “debunking” of homeopathy.As more people seek treatment from various practi-tioners of alternative medicine, the economic conse-quences of this trend will draw more attention toalternative practices. This will include homeopathy,which already has had a tumultuous relationshipwith allopathic medicine.7 In the last few years, vari-ous legal actions have been filed against individualhomeopaths and homeopathic pharmacies, andresearch that purports to show the ineffectiveness ordanger of homeopathy has been published. Onerecent study, published in the Archives of Pediatrics andAdolescent Medicine,14 asked questions of 38 home-opaths, including a question regarding a hypotheticalmedical scenario of high fever in a newborn child andanother regarding advice given about vaccination.

The study was designed to assess the medicalknowledge of licensed and nonlicensed homeopathsand also their opinions on the subject of vaccination,a controversial subject within many fields of alterna-tive medicine. The study revealed that a high numberof nonlicensed homeopaths did not make the rightdecision regarding the treatment of fever and alsogave “negative” opinions regarding the issue of child-hood vaccination. Although there may be some useto the first question, the second reveals the underly-ing agenda of the study, which is to expose the “ques-tionable” practices of professional homeopaths andbasically cast homeopathy in an unfavorable light.This is only one of many studies in which the agendaof the researchers was not impartial, but rather toundermine homeopathy.

Other studies that seemed to validate homeo-pathic methodology have been severely criticized bymainstream medical thinkers,15 even when they con-form to conventional double-blind methodology.Such critics often reveal their own prejudices, thinlydisguised as objective science. Many homeopathsbelieve that homeopathy will be truly accepted only

146 C L A S S I C A L H O M E O P A T H Y

Page 152: Classical Homeopathy

when advances in pure science are able to prove thevalidity of the concept of energy or vital force and theeffect of homeopathic potencies. Others believe thathomeopathy will always remain a marginalized sys-tem of practice because it demands too much of thepractitioner and client.

The practice of homeopathy illustrates a broaderstruggle in defining who has the right and the skill toheal. Good health is not a right determined by law ormedical knowledge, but by a combination of many fac-tors, perhaps the most important of which is encour-aging people to take a greater responsibility for theirown health and well-being.

Fundamental to homeopathic philosophy is theprinciple of self-cure. Also fundamental is the ideathat health is not merely an absence of symptoms buta dynamic state of physical and mental equilibriumin which an individual is able to establish and main-tain health without dependence on drugs, doctors, ortherapy. Health is a process toward freedom, notgreater dependence, and homeopaths say this is whatdistinguishes homeopathic thinking from that ofallopathic medicine and the limits of a materialistic“Newtonian” model.

SUMMARY

Given the challenge it faces, it is imperative thathomeopathy define itself politically and legally tocarve its appropriate identity in our society—an iden-tity consistent with the principles and practice of this200-year-old system of healing.

To do this, the profession must produce compe-tent practitioners. We need schools that can offer abudding homeopath the level of education necessaryfor professional practice. The difficulty in creatingthe needed level of education is the lack of an appro-priate legal definition for homeopathy. The profes-sion must establish the unity necessary to defineitself and work toward legitimacy as it creates com-petent practitioners. This will require that certifica-tion and professional organizations work moreclosely together on standards of practice and educa-tion so the profession can be strong enough todefine itself. It will require the various organizationsto do the legal work, state by state, to determineappropriate forms of legitimacy. It will also requirethe medical and nonmedical parts of the homeo-pathic community to come together and create a

united front to give the necessary strength to theprofession. This will help not only unite the homeo-pathic profession, but also redefine medicine andhealing and establish the role of homeopathy in thefuture.

References 1. Handley R: A homeopathic love story: the story of Samuel

and Melanie Hahnemann, Berkeley, Calif., 1990, NorthAtlantic Books.

2. Hahnemann S: Organon of the medical art, O’Reilley WB,editor, Decker SR, translator, Palo Alto, Calif., 2000,Birdcage Books.

3. Carlston M, Stuart MR, Jones W: Alternative medicineeducation in US medical schools and family practiceresidency programs, Fam Med 29:559-562, 1997.

4. Association of American Medical Colleges: Curriculumdirectory 1997-1998, Washington, DC, 1997, Associationof American Medical Colleges.

5. Wetzel M, Eisenberg DM, Kaptchuk TJ: Courses involv-ing complementary and alternative medicine at USmedical school, JAMA 280:784-787, 1998.

6. Barzansky B, Jonas HS, Etzel SI: Educational programsin US medical schools, 1997-1998. JAMA 280(9):803-808, 827-835, 1998.

7. Shoon CG, Smith IL, editors: The licensure and certifica-tion mission—legal, social and political foundations, NewYork, 2000, Professional Examination Service (pub-lished by Forbes Custom Publishing).

8. Coulter H: Divided legacy: the conflict between homeopathyand the American Medical Association, vol 3, Berkeley,Calif., 1982, North Atlantic Books.

9. Young D: The rule of experts—occupational licensing inAmerica, Washington, DC, 1987, Cato Institute.

10. Illitch I: Medical nemesis, the expropriation of health, NewYork, 1975, Pantheon.

11. Goldstein M, Glik D: Use of and satisfaction withhomeopathy in a patient population, Altern Ther HealthMed 4:60-65, 1998.

12. Eisenberg D, Kessler RC, Foster C et al: Unconventionalmedicine in the United States, N Engl J Med 328:246-252, 1993.

13. Eisenberg DM, Davis RB, Ettner SL et al: Trends inalternative medicine use in the United States, 1990-1997: results of a follow-up national survey, JAMA280:1569-1575, 1998.

14. Lee AC, Kemper KJ: Homeopathy and naturopathy:practice characteristics and pediatric care, Arch PediatrAdolesc Med 154(1):75-80, 2000.

15. Davenas E, Beauvais J, Arnara M et al: Human basophildegranulation triggered by very dilute antiserumagainst IgE, Nature 333(6176):816-818, 1988.

C H A P T E R 9 Homeopathic Education and Certif ication 147

Page 153: Classical Homeopathy

INTRODUCTION

Homeopathic pharmacy, like homeopathy itself,was the creation of Dr. Samuel Hahnemann.Hahnemann’s first empiric discovery was the Law of

Similars, which he first described in 1795.1 This lawstates that to cure a patient of a particular set ofsymptoms, the correct prescription is a medicine thatwill cause the exact same set of symptoms in ahealthy person. In the beginning, homeopathic phar-macy was indistinguishable from traditional phar-macy. Hahnemann practiced homeopathy for severalyears using conventional doses of medicines beforehe developed the unique methods used in homeo-pathic pharmacy.2 Because Hahnemann was adminis-tering medications that were capable of causing thevery symptoms his patients suffered, it was necessaryto deviate from the contemporary practice of givinglarge doses. Hahnemann’s next line of research was todiscover how small a dose he could give while main-taining clinical activity. In contrast, in allopathicmedicine, the question of dosage is more often howlarge a dose can be given without reaching the point

10Homeopathic Pharmacy

M I C H A E L Q U I N N

149

I f every substance is capable of causing symp-toms when the dose is high enough, and if a poi-

son is a substance that causes symptoms, then everysubstance is a poison. Therefore every drug is a poi-son. Therefore the practice of medicine, or medicinaltherapy, is primarily the selection of the correct poi-son for each patient, and secondarily a question ofdosage. �

Page 154: Classical Homeopathy

where the drug causes more problems than the dis-ease. Hahnemann succeeded in developing a systemthat allowed him to dilute the drug to such a lowlevel that it had no toxicity and yet retained its abili-ty to relieve symptoms.

By 1799, Hahnemann had developed his uniquemethod of making homeopathic medicines,2 meth-ods that have been both a blessing and a curse uponhomeopathy to this day. The methods of homeo-pathic pharmacy are a blessing because they allow usto prepare medicines of great efficacy and low toxi-city; they are a curse because the practice of drastical-ly diluting medicines appears so irrational that mostobservers have concluded a priori that the methodsof homeopathic pharmacy result only in placebodoses. Homeopathic medicines appear to be placebodoses because of the great dilutions employed intheir preparation. However, the experience of homeo-pathic physicians around the world for 200 yearssuggests that they are not placebos.

Great caution should be exercised before declar-ing any superficially unexplainable or implausiblephenomenon a fraud or placebo. Declaring thatsomething doesn’t work because it is not understoodis naïve and unscientific. Homeopathic physiciansand pharmacists, whose common experience is thathomeopathic medicines do work, spend little timewondering what the mechanism of action of homeo-pathic remedies is. Like their busy clinical brethren inallopathic medicine, homeopathic physicians andpharmacists spend most of their time prescribingand dispensing the very best medicine for theirpatients.

More than 2000 substances from the mineral,vegetable, and animal kingdoms have been used ashomeopathic medicines. The definition of what is oris not a homeopathic medicine relies more upon theway in which it is prescribed than the way in which itis prepared. In fact, a new medicine must firstbe demonstrated useful when homeopathically pre-scribed before it is accepted for inclusion in theHomeopathic Pharmacopoeia of the United States(HPUS),3 the Food and Drug Administration’s (FDA)recognized compendium for the production ofhomeopathic medicines in the United States. Inother countries, such as Germany, the regulation ofhomeopathic medicines is oriented more to how theyare prepared rather than how they are prescribed.

The fundamental processes employed in homeo-pathic pharmacy today are identical to those that

Hahnemann developed. Although they have evolvedin the last 200 years, the goals of these processes areremarkably consistent with the goals of the proce-dures that Hahnemann described. In general, theseprocedures may be described as follows:

Step 1: Prepare a relatively concentrated solutionof the chemical, animal, or plant extract.

Step 2: Dilute the concentrated solution in wateror a water-ethanol mixture.

Step 3: Vigorously pound the vial holding thesolution against a firm but resilient surface;this pounding is referred to as succussion.

Further steps are simply the alternating repetition ofSteps 2 and 3.

To prepare a homeopathic medicine from tablesalt (sodium chloride), these steps are accomplishedin the following manner:

Step 1: Prepare a 10% weight/volume solution ofsodium chloride in water (i.e., dissolve 0.5 g ofNaCl in water sufficient to yield 5 ml).

Step 2: Prepare a 1:10 dilution of the solution pre-pared in Step 1.

Step 3: Vigorously pound the solution preparedin Step 2 ten times against a firm but resilientsurface, such as a book or hard rubber pad ona counter.

Now label the solution prepared in Step 3 Natrummuriaticum (Latin for “sodium chloride”) 1C.

150 C L A S S I C A L H O M E O P A T H Y

Homeopathic Terminology

Term Definition

AAHP American Association ofHomeopathic Pharmacists

AHPA American HomeopathicPharmaceutical Association

Attenuation Process of preparing homeopathicremedies

Continuous Continuous-flowing-waterfluxion method

Dilution Decreasing concentration of rawmaterial

Dynamization Process of preparing homeopathicremedies

(Continued)

Page 155: Classical Homeopathy

The solution prepared in Step 3 is called 1C: Cbecause it represents a 1:100 dilution of the sodiumchloride and is therefore a centessimal, or C, dilution,and 1 because it is the first vial so prepared. To pre-pare the 2C from the 1C, repeat Steps 2 and 3 withthe following change. In Step 2, prepare a 1:100 dilu-tion rather than a 1:10 dilution, because Step 1 iseliminated. Then succuss this vial ten times and labelthe vial Natrum muriaticum 2C.

All subsequent vials are prepared from the previousvial (i.e., the 3C is prepared from the 2C, the 4C is pre-pared from the 3C, and so on). Each preparation cycleconsists of two steps, a 1:100 dilution followed by suc-cussion of the new vial. The concentration of sodiumchloride in the 2C vial is thus one part in 10,000, andthe concentration of sodium chloride in the 3C vial onepart in 1 million. This process is often referred to aspotentization, or attenuation, of the raw material, and theresulting medicines are referred to as potencies, or atten-uations. Thus the 3C vial could be referred to as the 3Cpotency of Natrum muriaticum or the 3C attenuation ofsodium chloride.

The process described above is the core process ofhomeopathic pharmacy. This process should be usedin every homeopathic pharmacy in the world and hasbeen used as described for 200 years. Every otherprocess used in homeopathic pharmacy either pre-pares materials for this core process or uses the solu-tions prepared by this core process. This process maybe continued without end. Homeopathic physiciansin the United States regularly use homeopathicmedicines that have been carried to 10,000 cycles ofdilution and succussion. Paradoxically, most homeo-pathic physicians agree that homeopathic medicinesbecome clinically stronger with increasing cycles ofdilution and succussion (i.e., a medicine so preparedgives greater relief in more severe illnesses than oneprepared with only a few cycles of dilution and suc-cussion).

C H A P T E R 1 0 Homeopathic Pharmacy 151

FDA Food and Drug Administration

Fluxion Flowing-water method ofpotentization

Hahnemannian New-vial-each-step preparationmethod

HPUS Homeopathic Pharmacopeia ofthe United States

Korsakovian Single-vial preparation method

Maceration Soaking of raw material in alcohol

Mother tincture Source alcoholic liquid

OTC Over-the-counter

Potentization Process of preparing homeopathicremedies

Succussion Forceful pounding of vial againstresilient material such as book orrubber pad

Tincture Alcoholic liquid

Centessimal One to one hundred (1:100)

Decimal One to ten (1:10)

Quinquageni- One to fifty thousand (1:50,000) millesimal

LM Quinquagenimillesimal dilutionprocess

Q Quinquagenimillesimal dilutionprocess

X Decimal dilution process

C Centesimal dilution process

K Korsakovian dilution process

CH Centesimal Hahnemanniandilution process

CK Centesimal Korsakovian dilutionprocess

D Decimal dilution process

M 1000C

1M 1000C

10M 10,000C

XM 10,000C

50M 50,000C

LM 50,000C (technically correct, but confusing usage)

CM 100,000C

MM 1,000,000C

Page 156: Classical Homeopathy

Homeopathic physicians and pharmacistsacknowledge that the chemical concentration of theoriginal substance in such a preparation is so diluteas to be physiologically inactive after only a few cyclesof dilution and succussion, and that the concentra-tion will reach zero after 12 such cycles. After 12cycles of 1:100 dilution, the theoretic concentrationof the original substance is (1 × 10−2)12 (or 1 × 10−24),a dilution sufficient to remove every molecule of thestarting substance according to the limit suggestedby Avogadro’s Number (6.02 × 1023), the number ofatoms in 12 g of carbon. However, because it is thecommon, everyday experience of thousands of home-opathic physicians and pharmacists that homeopath-ic medicines do in fact work after more than twelvecycles of dilution and succussion, most of thembelieve that the activity of homeopathic medicines isattributable to some as yet unrecognized phenome-non that occurs in the solvent. Does water have theability to store information? Well, do sand and rusthave the ability to store information? Sand and rustdo indeed store vast amounts of information as sili-con chips and the iron oxide coating on computerhard disks. If information can be stored in sand andrust, it is premature to assume that information can-not be stored in water. Some physicists now believethat water can store information, specifically infor-mation contained in stable crystalline structures.4,5

The entire process of making a homeopathicmedicine consists of the following steps:

1. Selection of a raw material 2. Trituration of raw material (if not soluble in

water or alcohol) by grinding with mortar andpestle

3. Preparation of liquid potencies by dilution andsuccussion

4. Medication of blank pellets with liquid potencies

5. Drying of medicated pellets 6. Packaging of medicated pellets in vials for use Homeopathic pharmacists obtain raw materials

as described in the HPUS. Homeopathic manufactur-ing laboratories purchase the exact materials neededto make homeopathic medicines out of metals, salts,elements, and compounds of the materia medica. Forexample, very-high-purity gold leaf is used to preparehomeopathic gold, or Aurum metallicum, the Latinname for metallic gold. (Because Latin names ofhomeopathic remedies were used in Hahnemann’sMateria Medica Pura6 in 1811 and have been in contin-

uous and unchanged use internationally for 191years, they are generally used for most homeopathicmedicines. As in the case of species names for plantsand animals, the use of Latin names has provenadvantageous.)

Botanical and animal sources are collected fromclean healthy specimens free of infestation with par-asites, and prepared according to the traditionalmethods described in the HPUS. Most plants are pre-pared for use as homeopathic medicines by firstmaking a hydroalcoholic extract. The correct part ofthe plant is collected at the right time of the growingseason, according to traditional homeopathic prac-tice and as described in the HPUS. The plant materi-al is cleaned of any dust, dirt, or insects; finelychopped; and thoroughly mixed. A small sample ofthe mixed plant material is weighed and dried in anoven to calculate its water content. Once the dryweight of the plant material is known, alcoholand/or water is added to the wet mixed plant mate-rial to produce a 10% dry plant weight/volumepreparation (Table 10-1). This preparation is shakendaily and stored for 1 to 2 weeks before filtering andcollecting the filtrate. This filtrate is referred to asthe mother tincture. A tincture is a substance that con-tains ethanol, and this one is called the mother tinc-ture because all of the other dilutions come from thisoriginal source.

All chemical substances readily soluble in waterare prepared exactly as previously described forsodium chloride. For all substances readily soluble inwater/ethanol mixtures, the process is exactly asdescribed, but a water/ethanol mixture is substitutedfor water. For substances that are not soluble in wateror water/ethanol mixtures, Hahnemann developedanother process that converts insoluble substancesinto a form amenable to the core process. To make ahomeopathic medicine out of an insoluble substancesuch as gold, the material is triturated. Trituration isa prolonged grinding of the material mixed with lac-tose, using a mortar and pestle. Gold is triturated byplacing 1 g of highly pure gold leaf and 99 g of lactoseinto a clean mortar and grinding with the pestle for1 hour. Because the gold has been “diluted” by a fac-tor of 100, the material prepared by this trituration islabeled Aurum metallicum 1C. To prepare gold 2C, 1 gof the 1C is added to 99 g of lactose in a clean mortarand pestle and triturated for 1 hour. This material iscollected and labeled Aurum metallicum 2C. One g ofthe gold 2C and 99 g of lactose are added to a clean

152 C L A S S I C A L H O M E O P A T H Y

Page 157: Classical Homeopathy

C H A P T E R 1 0 Homeopathic Pharmacy 153

T A B L E 1 0 - 1

Homeopathic Pharmacy Any substance can be made into a homeopathic remedy.

Question: Is the substance readily soluble in water or ethanol?

YES (e.g., salt, pulsatilla) NO (e.g., gold, silica)

Steps Needed to Make X and C Potencies from the Mother Tincture

X potencies C potencies

Dilution # of Suc- New Dilution # of Suc- New Grams of ingredient/1g Ratio cussions Potency Ratio cussions Potency of finished product

1:10 10 2X = 1:10 10 1C 0.010000000000 10 mg 1:10 10 3X 0.001000000000 1 mg 1:10 10 4X = 1:100 10 2C 0.000100000000 100 μg 1:10 10 5X 0.000010000000 10 μg 1:10 10 6X = 1:100 10 3C 0.000001000000 1 μg 1:10 10 7X 0.000000100000 100 ng 1:10 10 8X = 1:100 10 4C 0.000000010000 10 ng 1:10 10 9X 0.000000001000 1 ng 1:10 10 10X = 1:100 10 5C 0.000000000100 100 pg 1:10 10 11X 0.000000000010 10 pg 1:10 10 12X = 1:100 10 6C 0.000000000001 1 pg

Preparation of LM Potencies (Quinquagenimillesimal or Q Potencies)

Start With Add To Of Number of Succussions Yields

0.062 g of 3C 500 drops 18% ethanol 0 Solution A 1 drop of Soln A 100 drops 95% ethanol 100 LM 1 liquid LM 1 liquid #10 pellets (soak and then dry) 0 LM 1 pellets 1 LM 1 pellet 1 drop water 0 Solution B 1 drop of Soln B 100 drops 95% ethanol 100 LM 2 liquid LM 2 liquid #10 pellets (soak and then dry) 0 LM 2 pellets 1 LM 2 pellet 1 drop water 0 Solution C 1 drop of Soln B 100 drops 95% ethanol 100 LM 3 liquid LM 3 liquid #10 pellets (soak and then dry) 0 LM 3 pellets

Prepare the mother tincture = 1X potency Prepare a 10% (w/v) solution (e.g., 10 g NaCl) in a

total of 100 ml water, or use 200 g of a plantcontaining 50% water (and therefore 100 g waterand 100 g plant substances) in the fresh state in1000 ml water and ethanol

10 g NaCl/100 ml = 10% (w/v) 100 g dry plant/1000 ml = 10% (w/v) Plants should soak in the water/alcohol for 7-14

days and are then filtered to obtain the mothertincture

Triturate in mortar and pestle for 1 hour at each step

Start with Mix into and New grind into Potency

1 g raw material 99 g lactose→ 1C 1 g of 1C 99 g lactose→ 2C 1 g of 2C 99 g lactose→ 3C

Add l g of the 3C to 100 ml water to make the 4Cand continue as under C potencies

Page 158: Classical Homeopathy

mortar and pestle and triturated for 1 hour. Thismaterial is then collected and labeled Aurum metal-licum 3C. At this point the “dry” dilutions of gold canbe converted into liquid dilutions, which can thenenter the core process of liquid dilution and succus-sion. This conversion is made by adding 1 g of theAurum metallicum 3C powder to a sufficient quantityof water/ethanol to total 100 ml. After the 3C powderdissolves, the solution is succussed ten times andlabeled Aurum metallicum 4C. The 5C is preparedexactly as described in the core process.*

Trituration by hand is a laborious process thatcan be accomplished more efficiently and safely withvarious mechanical means. One such device is calleda ball mill. A ball mill is similar in design to a rock pol-isher or rock tumbler. It consists of a cylindricalporcelain jar with a tight lid. The material to be trit-urated is placed into a jar along with 99 times asmuch lactose and the extremely hard “balls” that willgrind the material (small cylinders are now usedbecause they grind more effectively than balls). Theclosed jar is placed on two horizontal rollers. Whenthe motor is turned on the rollers turn, forcing thecylindrical jar to rotate also. The porcelain or car-borundum rollers roll over the material and lactoseconstantly for hours, reducing the material to a veryfine powder. Ball mills are extensively used in scienceand industry to grind materials wherever exception-ally fine powders are needed. The use of a ball mill fortrituration produces better results than hand tritura-tion and is also much cleaner for the workplace andsafer for the pharmacist or technician. Homeopathicmaterials are triturated for many hours to producethe final 3C triturate that is used to prepare liquidpotencies.

Centessimal medicines are prepared as describedabove, diluting the raw material at a ratio of 1:100,followed by succussion at each step. One variation inthe core process that is widely used is to substitute a1:10 dilution ratio for the 1:100 ratio. Medicines pre-pared with a 1:10 dilution are succussed 10 times ateach step, just as centessimal medicines are suc-cussed. Medicines prepared with a 1:10 dilution ratioare labeled with a 1X, 2X, 3X, etc., or (as more com-

monly used in Europe) with a 1D, 2D, 3D, etc., andare known as decimal medicines.

Another variation, which is used to prepare LM, 50millessimal, Q, or quinquagenimillesimal medicines,adds a 1:500 dilution step to the 1:100 dilution step ofthe centessimal process to achieve a dilution ratio of1:50,000 at each step. The 1:50,000 dilutions are thensuccussed 100 times at each step rather than the 10times used for centessimal and decimal medicines. LMmedicines are used much less often than centessimalor decimal medicines, but their use has increased sig-nificantly in the last 15 years. These methods are sum-marized and compared in Table 10-1.

Centessimal and decimal medicines may be pre-pared in either Hahnemannian or Korsakovian meth-ods. The Hahnemannian method uses one vial foreach step, whereas the Korsakovian method uses onlyone vial no matter how many steps are carried out. Tomake a Hahnemannian 12C, twelve vials will be used.In the preparation of a Korsakovian 12C only one vialwill be used. In the Korsakovian method, the dilutionis carried out by emptying the vial of 99% of its con-tents, refilling it, succussing it, and so on. In general,the Hahnemannian method is used for the first 12 to200 steps, and the Korsakovian method is used there-after. The addition of the letter H or the letter K tothe label indicates which method has been used toprepare that medicine.

The HPUS recognizes 16 classes, Class A to ClassP, in the method of preparation of the raw materialfor entry into the core process of centessimal or deci-mal dilution and succussion.3 Each medicine ismonographed in the HPUS so that all the particularand pertinent details of its preparation are described.The official names of homeopathic medicines aredefined in the HPUS as well.

The repetitive nature of the decimal and centessi-mal preparation processes allows them to be easilyperformed by machines designed for that purpose.In his elegantly illustrated article, Winston7 describesthe various types of automated systems used over theyears. Because the mechanism of action of homeo-pathic remedies remains uncertain, it seems prudentto use mechanical processes that simulate as closelyas possible the manual processes that have been usedsuccessfully for 200 years.

In the laboratory in which I work, the productionequipment was designed by engineers who measuredmy arm from elbow to closed hand in order to builda mechanical arm of the same length. They measured

154 C L A S S I C A L H O M E O P A T H Y

*To be true to Hahnemann’s instructions for preparing tritura-tions, the 99 g of lactose is added in three additions of 33 g, eachfollowed by 20 minutes of mixing and grinding after each of thethree additions. His method ensures a more uniform and completemixing of the raw material into the lactose.

Page 159: Classical Homeopathy

how far up and down I moved the vial while vigor-ously succussing it, and how fast I moved. These datawere used to produce the drive system that poundsthe mechanical arm against a firm rubber pad from aheight of 5 inches, 20 times in 2 seconds. The force ofthe succussion is equivalent to dropping, by gravityalone, your closed fist against a table from a height of15 inches. The blow is powerful enough that youwould never put your finger between the vial and therubber pad! To prevent cross-contamination, eachproduction machine is in a separate room that is sup-plied by highly pure, HEPA-filtered air (i.e., air thathas passed through high-efficiency particulate air fil-ters).

Homeopathic medicines are prepared for use bypatients as hydroalcoholic liquids or in dry forms.The dry forms are commonly either lactose powder orsucrose/lactose pellets that have been medicated withthe hydroalcoholic liquid solution of the desiredhomeopathic remedy. For example, to prepare thepellet form of a homeopathic medicine in the 30Cstrength, the 30C alcoholic solution of at least 88%alcohol is added to a quantity of sugar pellets in a 1%volume/weight ratio. For example 10 ml of 30C solu-tion added to 1000 g of sugar pellets medicates thepellets to the 30C strength. This is a sufficient quan-tity of alcoholic solution to moisten the entirequantity of pellets. The medicating solution needs tobe at least 88% alcohol to prevent the dissolution ofthe sugar pellets. The mass of pellets is then shakenso that the medicating solution is evenly distributed.The solution is allowed to soak into the pellets for atleast 5 minutes, and the pellets are then dried.However, a small quantity of the hydroalcoholic solu-tion remains trapped inside the sugar pellets. Thedried pellets are then packaged and labeled as the30C strength.

FOOD AND DRUGADMINISTRATIONREGUL ATIONS

Homeopathic medicines have been used in theUnited States continuously since 1835.8 The Foodand Drug Administration of the United States wascreated by the Food, Drug, and Cosmetic Act of 1906.Homeopathic medicines were not specifically men-tioned in the 1906 Act. The HPUS was added to thelist of official compendia for the manufacture of

drugs in the United States in the revisions to theFood, Drug, and Cosmetic Act enacted in 1938.9 Inthe 1980s, the FDA met with representatives of thehomeopathic pharmaceutical industry and withhomeopathic physicians to establish an updated reg-ulatory position regarding homeopathic medicines.In 1988, the FDA published a set of guidelinesdefining the conditions under which homeopathicmedicines can be produced and sold in the UnitedStates.10 This document reaffirms in the modern erathe legality of the manufacture and sale of homeo-pathic medicines in the United States. It also reaf-firms the primacy of the HPUS in determining whatis a homeopathic medicine and defining the methodsof preparation of homeopathic medicines in theUnited States.

The toxicity of homeopathic medicines is depend-ent on the specific toxicity of their source materials,the potency or level of dilution of the preparation,and the size of the dose administered. A quick com-parison of the toxicity of common over-the-counter(OTC) medications with one of the most toxichomeopathic products listed in the HPUS demon-strates the inherent safety of homeopathic medicines.Arsenic is used as a homeopathic medicine to treatthe various symptoms found in patients exposed totoxic amounts of arsenic when those symptoms arisein the course of disease, but not necessarily during anacute arsenical intoxication. The HPUS states that thelowest potency (the closest concentration to the rawmaterial) of metallic arsenic that can be sold OTC is8X, or its equivalent, 4C. As shown in Table 10-1, theconcentration of metallic arsenic in the 8X or 4Cproduct is 10 ng (nanograms) per gram of drug prod-uct. This is equal to 10 parts per billion (ppb), whichis less than the 50 ppb allowed in drinking water.Table 10-2 lists comparative values for commerciallyavailable bottles of aspirin, acetaminophen (Tylenol),and homeopathic metallic arsenic in the mostconcentrated OTC dosage allowed by the HPUS.No homeopathic pharmaceutical firm is actually sell-ing homeopathic metallic arsenic at this concentra-tion. From Table 10-2, it is clear that homeopathicmedicines are far safer than these common OTCdrugs. Clinical statistics bear this out. In 1995, therewere 2 million contacts with Poison Control Centersin the United States. There were 1 million emergencyroom visits for treatment of poisoning, of which79,000 were for poisoning from analgesic, antipyretic,and antirheumatic medications.11 A MedLine search

C H A P T E R 1 0 Homeopathic Pharmacy 155

Page 160: Classical Homeopathy

in June 2000 uncovered no reports of poisoning froma homeopathic medicine in the United States from1995 to 2000.

The FDA and the homeopathic pharmaceuticalindustry have worked closely together because of theirmutual concern for the proper and safe manufactureand use of homeopathic medicines. One concern thatthe FDA and the HPUS committee share is thatsome drug manufacturers of nonhomeopathic prod-ucts might try to use the HPUS to circumvent theextraordinarily expensive new drug approval channelsof the FDA. The HPUS has adopted guidelines forreview and acceptance of new medicines submitted toit to ensure that any new medicines are indeed homeo-pathic medicines and not conventional medicationsseeking to avoid the proper channels for new drugapprovals. The Compliance Policy Guideline pub-lished by the FDA in 1988 specifically states that“agency compliance personnel should particularlyconsider whether the homeopathic drug is beingoffered for use or promoted significantly beyond rec-ognized or customary practice of homeopathy.”10

The HPUS defines the homeopathic strengths atwhich each homeopathic medicine may be sold inboth prescription and nonprescription channels. Thesale of a homeopathic medicine in nonprescriptionchannels is generally allowed only when the chemicalconcentration of the medicine is so low that it posesa very low risk—even if a small child were to consumethe entire contents of the package. The scrupulousconcern for the welfare of the general public exhibit-

ed by the homeopathic pharmaceutical industry,homeopathic physicians and pharmacists, and theHPUS committee, as well as the intrinsically safenature of homeopathic medicines, have yielded anextraordinary safety record for homeopathic medi-cines in the past 165 years.

References 1. Hahnemann S: Essay on a new principle for ascertain-

ing the curative powers of drugs, and some examina-tions of the previous principles, Hufeland’s Journal11:391-439, 456-561, 1795.

2. Haehl R: Samuel Hahnemann: his life and work, NewDelhi, 1985, B Jain (originally published in 1922).

3. Homeopathic Pharmacopoeia Convention of theUnited States: Criteria for eligibility of drugs forinclusion in the HPUS, Homeopathic pharmacopoeia of theUnited States, Washington DC, 1996, HomeopathicPharmacopoeia Convention of the United States.

4. Lo Shui-Yin: Anomalous state of ice, Modern PhysicsLetters B 10(19):909-919, 1996.

5. Lo Shui-Yin: Physical properties of water with IEstructures, Modern Physics Letters B 10(19):921-930,1996.

6. Hahnemann S: Materiamedica pura, New Delhi, 1995, BJain (originally published in 1811).

7. Winston J. A brief history of potentization machines, Br JHom 78(2):59-68, 1989.

8. Coulter HL: Divided legacy: the conflict between homeopathyand the American Medical Association, Science and Ethics inAmerican Medicine 1800-1910, Berkeley, Calif., 1982,North Atlantic Books.

156 C L A S S I C A L H O M E O P A T H Y

T A B L E 1 0 - 2

Comparative Values for Aspirin, Acetaminophen, and Homeopathic Metallic Arsenic Aspirin Acetaminophen Homeopathic Arsenic

Common dose 325 mg 325 mg 10 ng per g of 8X (theoretical maximum)

Quantity of doses per container 100 tabs 100 tabs 100 g Quantity of drug per container 32.5 g 32.5 g 1 μg (1/1,000,000 g) Number of doses needed to produce 5 tablets 5 tablets 10,000 g

severe toxicity in a 10-kg child (1-year-old) (200 mg/kg for aspirin or acetaminophen, and 1 mg/kg for homeopathic arsenic)

Number of toxic doses per container for 20 20 0.00001 (1/10,000) 10-kg child

Ratio of toxicity compared to homeopathic 200,000 times 200,000 timesarsenic 8X more toxic more toxic

Page 161: Classical Homeopathy

9. Middleton R: Regulation of the homeopathic industry,CJHP 5(12):8, 1993.

10. Food and Drug Administration: Compliance PolicyGuideline 7132.15 (5/13/88), Conditions under whichhomeopathic drugs may be marketed, Washington, DC,1988, Food and Drug Administration.

11. McCaig LF, Burt CW: Poisoning-related visits to emer-gency departments in the United States, 1993-1996. JToxicol Clin Toxicol 37(7):817-826, 1999.

Suggested Readings Kayne S: Homeopathic pharmacy—an introduction & handbook,

Edinburgh, 1997, Churchill Livingstone.

C H A P T E R 1 0 Homeopathic Pharmacy 157

Page 162: Classical Homeopathy

Most physicians believe that the theories of homeop-athy are so contrary to conventionally accepted scien-tific principles that they simply must be false. Someresearch suggests otherwise. If favorable results con-tinue to accrue in clinical homeopathic research,attention will focus on basic science investigations tohelp us understand how homeopathy works. If basicscience research eventually provides sound explana-tions for the clinical effects of homeopathy, theimplications will be remarkable. This scenario, how-ever, is a collection of ifs—not an inevitability.Furthermore, establishing such a formidable base ofevidence will require a great deal of time. Althoughmore likely than even a few years ago, this still-distantpossibility and its repercussions will not be discussedfurther in this chapter.

What is the ideal role of homeopathy in healthcare? The consensus answer of conventional physi-

cians has long been a simple, “None.” Many in thehomeopathic community have argued thatconventional medicine is inherently damaging topatients’ well-being and should be abandoned. As isusually the case when otherwise rational peopleassume such extreme and mutually exclusive posi-tions, a middle ground is likely to emerge. Where isthis middle ground?

SELF -CARE

Homeopathy’s identity as a viable self-care choicewas established long ago. On the American frontierin the nineteenth century, conventional physicianswere a rarity. Homeopathy was one of the few med-ical treatments available to a mother forced to pro-vide health care to her family. Conventional

11The Future of Homeopathy

M I C H A E L C A R L S T O N

159

Page 163: Classical Homeopathy

medicine of the day was an unwelcome expense andrelatively ineffective, or even harmful, by today’sstandards.

The rapid growth of homeopathy today is largelya result of the influence of the self-care market.Although patients have many health care choices,homeopathy is attractive, because to many it repre-sents a gentler option. Homeopathy seems to be moreharmonious with the view shared by many that con-ventional physicians are too eager to use needlesslystrong medicines. This population prefers gentleroptions such as homeopathy.

The sociologist Paul Ray recently defined a grouphe called cultural creatives.1,2 This segment of thepopulation is characterized by their values, includingenvironmentalism, feminism, concern about globalissues, and the importance of spiritual matters. Theyare affluent, well educated, and like to explore new cul-tural experiences. They center their lifestyle choices onhealth and ecological advocacy. Cultural creatives are alarge and expanding segment of the American popula-tion (44 million in 1997, per Ray’s estimate).2 In a 1999survey, 71% of this group reported buying homeo-pathic remedies.3

Patients who treat themselves and their familieswith homeopathy do so almost exclusively for minorproblems. Because the effectiveness of most conven-tional therapies for minor problems is limited andprone to causing adverse effects, homeopathy may bea better choice. Even if homeopathy is of no benefit,clinical trials and lengthy clinical experienceshow that it is much less likely to cause adverseeffects than over-the-counter products and conven-tional medicines. Self-care has been an importantniche for homeopathy and might be a good role forhomeopathy in the future.

WELLNESS/HEALTHPROMOTION AND DISEASEPREVENTION

Homeopathic philosophy defines illness more broad-ly than conventional medicine. Homeopathic treat-ment attempts to alleviate many minor dysfunctionsthat are believed precursors to more serious disease.If homeopathy successfully treats such precursors,homeopathic treatment can both promote healthand prevent disease; however, this has not beenproven.

The most pervasive belief of homeopathicpractitioners and patients is in the importance ofminimizing the use of medications. Avoidingadverse effects caused by conventional medicine is,by definition, health-promoting. We know thathomeopathic patients do not utterly reject conven-tional medicine. With a fair degree of certainty, wealso know that they almost always choose profes-sional homeopathic care after conventional medi-cine has failed. It is reasonable to assume thatoverall, the use of homeopathy currently has apositive effect on health, if only by preventingthe adverse effects of needless conventional med-ication. For example, tracking my prescribing pat-terns of children with acute otitis media,community prescribing patterns, and research dataabout antibiotic response, I have been preventingwell over 100 needless antibiotic prescriptions ayear for this condition. Responsible homeopathiccare significantly reduces adverse effects of medica-tion.

Does avoiding the overuse of prescription med-ication improve community health? One study inNew Zealand suggests it does.4 Investigators stud-ied children attending Waldorf Schools because thestudents’ families generally preferred homeopathicand anthroposophical medicines to conventionalmedicines, including antibiotics. The investigatorscompared students who had received antibioticswith those who had not. Controlling for other riskfactors, they found that children who receivedantibiotics in the first year of life were four timesmore likely to develop asthma than the other chil-dren. Children who received antibiotics only aftertheir first birthday were 1.6 times as likely to devel-op asthma as antibiotic-free children. This singlestudy is inadequate to draw broad conclusions, butother studies suggest the same interpretation.5-8 Toraise an even more controversial topic, anotherrecent study suggests that immunizations maymake children more likely to later develop asthma.9

Medical research is acquiring evidence that showsthat getting sick can be good for us. The homeo-pathic philosophy of minimizing treatment insteadof needlessly interfering with the process seems tobe congruent with this new understanding.Similarly, the principle of using like to cure like,acting directly along the lines of the body’s ownresponse, makes sense and may facilitate theimmune system’s process of learning.

160 C L A S S I C A L H O M E O P A T H Y

Page 164: Classical Homeopathy

Although these are the homeopathic ideals, wemust recognize that reality can be more complicated.Homeopathic adherents can be tempted by subtleindications and sometimes use homeopathicremedies when no treatment is necessary. I have seenpatients take a remedy after slightly bumping a toeand then another a short time later because they satin an air conditioner draft. Clearly no interventionwas needed for either experience. People who usehomeopathic remedies in this way simply tradeone form of overmedication for another. Becauseof homeopathy’s lower rate of side effects, homeo-pathic overtreatment may be preferable to allopathicovertreatment, but this misuse subverts some of thebenefits of homeopathy.

Does suppression (hampering the body’s expres-sion of symptoms and its fight to regain equilibrium)cause harm? Homeopaths believe so. My clinicalexperience convinces me that it can. Adverse effectsfrom suppressive treatment are subtler or less com-mon than my homeopathic training indicated, butthey are evident. Homeopathy is not blameless.Improper use of homeopathy can suppress and injurepatients. If homeopathy can stimulate healing, thereis no theoretic reason that it could not cause harm.

COST EFFECTIVENESS

There are preliminary data from England and Franceregarding cost effectiveness of homeopathictreatment. Fisher surveyed patients at the LondonHomeopathic Hospital and compared the cost oftheir treatment with that associated with the stan-dard local treatments.10 He found that homeopathiccare significantly reduced expenditures over a 1-yearfollow-up. General information from the Frenchnational health service indicates similar savings.11

Homeopathic care saves money by reducingpatient expenses for medication. Jacobs and associ-ates found that physician homeopaths used conven-tional medicine 60% less often than conventionalphysicians.12 Swayne documented a similar trend inthe United Kingdom.13 The 100 or so needless antibi-otic prescriptions for otitis media that I do not pre-scribe each year may save the patients’ familiesapproximately $2000 in medication costs.

Jacobs’s survey also documented other practicepatterns with the potential to cut costs. Physicianhomeopaths ordered laboratory tests less than half as

often as conventional physicians. Even more dra-matic was the difference in the use of other diagnos-tic services; conventional physician use is nearly fivetimes higher than that of homeopathic physicians.

If patient outcomes are similar, homeopathyshould reduce health care costs solely on the basis ofreducing use of conventional health care systemresources—prescription medications, laboratory andother diagnostic testing. If, as believed by homeo-pathic practitioners and patients, use of health careservices drops following homeopathic treatment,health care costs would further decline.

The number of ifs in the preceding paragraph is agood indication of our uncertainty about this issue.The few findings we have are open to alternativeinterpretations. Because most patients seek profes-sional homeopathic treatment after already tryingconventional medical care, conventional physiciansmay have already completed diagnostic evaluationsby the time patients first visit a homeopathic physi-cian. In fact, it may be possible that homeopathsorder additional tests, thereby actually increasingdiagnostic expenses. Homeopathic remedy selectionis almost entirely uninfluenced by conventionallaboratory diagnostics, so it is easy to assume thathomeopathic care would reduce diagnostic costs.Despite this assumption, we have no firm evidencethat a homeopath seeing the same patient at thesame stage of diagnostic evaluation would order anymore or less testing than a conventional physician.

Another caveat arises when we consider visitcosts. Homeopathic physicians on average chargemore for each visit than conventional primary carephysicians. This is probably a result of the muchlonger duration of homeopathic visits. This increasetempers our cost-saving optimism. If homeopathictreatment causes patients to use fewer medical ser-vices overall, homeopathy could still prove more costeffective in spite of the higher per-visit charge.

There are no published data on the incomes ofhomeopathic practitioners. However, my informalsurveys suggest that the income of an averagephysician homeopath is roughly half to two thirdsthat of a primary care physician practicing in thesame locale. Although a conventional physician maysee three times as many patients and receive onlytwice the income, is it accurate to say this physician ismore cost effective if he or she also orders more testsand prescribes more-expensive medication? At thispoint it is not possible to draw any conclusions. We

C H A P T E R 1 1 The Future of Homeopathy 161

Page 165: Classical Homeopathy

can neither advocate nor abandon homeopathy onthe basis of cost considerations.

AN EXPANDING ROLE FORHOMEOPATHY

Just as many cultural creatives choose homeopathy forself-care, they also embrace professional homeopathyfor their medical care when the need arises. The stressof serious illness does not transform them into hyp-ocrites. As this group ages and its enthusiasm for allforms of complementary medicine continues to spreadto other segments of the population, there will be a ris-ing demand for complementary medicine services,including homeopathy, among hospitalized patients.

Perhaps the area of greatest concern is the inter-action of complementary medicines with conven-tional treatments. Whereas evidence accumulatesthat some herbs alter human metabolism and thusthe action of some prescription medications, thereis no evidence that homeopathic medicines do so.Interactions are important when the medications aremost necessary and the patients are the sickest. If wecontinue to gather evidence of homeopathy’s effec-tiveness and the absence of harmful reactions withconventional medications, homeopathy could moveto the forefront of the movement of complementaryand alternative medicine therapies into hospitals.

It would be misleading to consider cultural cre-atives as the only group driving the popularity ofhomeopathy. Ray identifies another group he callstraditionalists, or heartlanders. This group, whichrepresents 29% of the American population, sus-tained homeopathy over many decades. Although thegrowth of homeopathy in the past 15 years has beenremarkable, all indications are that it will continue togrow at a significant pace in the coming years.

EDUCATION

Homeopathy has much to offer physicians-in-train-ing. The homeopathic interview teaches respectfuland concentrated attention to the patient’s prob-lems. The thoroughness of the classical homeopathicinterview demands that the practitioner work care-fully. This careful process helps lead the physician orother health care practitioner to the correct conven-tional diagnosis and homeopathic remedy.

All health care providers must learn from ourpatients if we are to help them. There are far toomany unknowns to allow us to stop learning aftercompleting professional training. Homeopathy con-tinues to teach practitioners by forcing us to think alittle differently and observe the results of our inter-ventions. By challenging our assumptions, homeopa-thy helps us learn the best ways to help our patientsand challenges our tendency to use a particular treat-ment just because it is the status quo.

Patients also learn from homeopathy. Gaining atool to use for minor illnesses when conventionaltreatments have little to offer can be helpful.Learning about health and self-care techniques is use-ful. Perhaps most important is the self-empowermentpatients experience as they begin to take responsibil-ity for their health in even a limited way. Instead ofcontinuing as passive consumers, they become activeparticipants and often implement other healthfullifestyle habits.

WHAT CAN HOMEOPATHYOFFER?

As a profession, homeopaths often express alterna-tive views about other health practices—fromHahnemann’s contrarian advocacy of exercise toquestions about long-term effects of antibioticsraised by today’s homeopaths. The homeopathiccommunity is not the only group to question ortho-dox standards, but the consistency with which it hasdone so has created a dissident identity for homeop-athy. This dissident tradition has raised the hacklesof conventional physicians for generations.

Criticism can create a beneficial dialog. Even ifthe orthodox position eventually proves correct, theprocess of critical examination forces us to applycareful scientific methods and consider alternativeexplanations. Homeopathy and other forms of alter-native medicine ask questions that continuallyrequire conventional medicine to define itself and toconfirm that correct choices are made. Historically,sometimes these alternative opinions have beenproven correct. How many physicians today advocatebloodletting for pneumonia? Against a storm of con-troversy, homeopaths argued that conventional prac-tice was not only ineffective, but harmful to theweakened patient. There have been many other exam-ples of orthodoxy being proved wrong through the

162 C L A S S I C A L H O M E O P A T H Y

Page 166: Classical Homeopathy

decades; the most recent example is always the mostcontroversial, because it lacks the objectivity thatcomes only with the passage of time.

In recent decades, conventional medicine’sfocus has become increasingly technologic. Scientificadvances have dramatically changed our lives and inmany ways improved our health. The promises oftechnology are exciting. However, the realities of theadverse repercussions of our advanced technology aredisappointing to many.

In an exuberant rush to embrace technology,physicians increasingly rely on it to diagnoseand treat our patients. Unfortunately, this relianceappears to have blunted our clinical acumen. Manybelieve that medicine has become depersonalized as aresult and that we must find a better balance betweenheart and mind. Much to our detriment, the art oflistening to the patient has withered, damagingthe relationship between patients and physicians.Homeopathy can help us sharpen the clinical skillsneglected in recent decades.

Homeopathic values emphasize that the pa-tient’s inner being is of paramount importance.Traditionally, this means the patient’s mental andemotional functioning are considered more subtleindications of well-being than physical symptoms.Health does not end with the body, and most homeo-paths do not believe that disease starts thereeither. Beginning with Hahnemann, many of themost important homeopaths in history loudly pro-claimed the paramount importance of a person’sspiritual well-being. Disease and health originatefrom that most essential core of a human being.Hahnemann wrote:

When man falls ill it is at first only this self-sustainingspirit-like vital force (vital principle) everywhere presentin the organism which is untuned by the dynamic influ-ence of the hostile disease agent. It is only this vital forcethus untuned which brings about in the organism thedisagreeable sensations and abnormal functions that wecall disease.14

Few conventional physicians disregard the impor-tance of their patients’ thoughts and feelings. Medicalresearch continues to demonstrate the impact of emo-tions on physical illnesses. Similarly, many conven-tional physicians consider spiritual wellness animportant aspect of their patients’ health. However,Hahnemann went a step further by formally incorpo-rating this perspective into homeopathy’s foundingdocument, thereby institutionalizing the belief.

In addition to the desire to minimize the use ofmedication, so fundamental to homeopathy, otheraspects of homeopathic philosophy offer potentialbenefit to modern patients and physicians. Onesuch belief is in the importance of the long-term view.Homeopaths believe that homeopathic treatment forchronic conditions takes a long time. Patients are toldto expect to feel worse in the first few weeks of treat-ment but to look for lasting improvement overmonths. There are many repercussions of an attitudeshift that accepts or even extols short-term sufferingas a means to achieve long-term relief. Althoughdeveloping patience is beneficial for many of life’s cir-cumstances, it is a great challenge to many patients inthis impatient time. Observing the healing processand seeking to work in concert with that clinically vis-ible process, physicians can also learn patience.

In the final analysis, the term complementarymedicine describes homeopathy quite succinctly.Homeopathy is a counterbalance to orthodox medi-cine. It brings different qualities to the healing partner-ship and the health care delivery system. Homeopathy’sstrengths are conventional medicine’s weaknesses, andvice versa. Although the marked difference betweenconventional medicine and homeopathy can lead toeasy rejection of homeopathy, it may just as easily bethe very reason homeopathy is so valuable.

References 1. Ray PH, Anderson SR, Anderson R. The cultural creatives:

how 50 million people are changing the world. New York,2001, Three Rivers Press.

2. Ray PH. The emerging culture. American Demographics,February 1997. Available at www.demographics.com.Accessed April 10, 1998.

3. Food Marketing Institute: Shopping for health, 1999: thegrowing self-care movement, Washington, DC, 1999, FoodMarketing Institute.

4. Wickens K, Pearce N, Crane J et al: Antibiotic use inearly childhood and the development of asthma, ClinExp Allergy 29(6):766-771, 1999.

5. Droste JH, Wieringa MH, Weyler JJ et al: Does the useof antibiotics in early childhood increase the risk ofasthma and allergic disease? Clin Exp Allergy 30(11):1547-1553, 2000.

6. Gemmell CG: Antibiotics and neutrophil function—potential immunomodulating activities, J AntimicrobChemother 31(suppl B):23-33, 1993.

7. von Hertzen LC: Puzzling associations between child-hood infections and the later occurrence of asthma andatopy, Ann Med 32(6):397-400, 2000.

C H A P T E R 1 1 The Future of Homeopathy 163

Page 167: Classical Homeopathy

8. Strachan DP: Family size, infection and atopy: the firstdecade of the “hygiene hypothesis,” Thorax 55 (Suppl1):S2-S10, 2000.

9. Kemp T, Pearce N, Fitzharris P et al: Is infant immu-nization a risk factor for childhood asthma or allergy?Epidemiology 8(6):678-680, 1997.

10. Fisher P: Cost effectiveness of homeopathy, presentedat Homeopathic Research Network’s Fourth Sci-entific Symposium, Homeopathic Research Network,Washington, DC, 1998.

11. Boiron T, President and CEO of Boiron USA: Personalcommunication, November 15, 1998.

12. Jacobs J, Chapman EH, Crothers D: Patient character-istics and practice patterns of physicians using home-

opathy, Arch Fam Med 7(6):537-540, 1998. 13. Swayne J: The cost and effectiveness of homeopathy, Br

Homeopath J 81:148-150, 1992. 14. Hahnemann S: Organon of medicine, ed 6, Los Angeles,

1982, JP Tarcher.

Suggested Readings Garrett L: The coming plague: newly emerging diseases in a world

out of balance, New York, 1994, Penguin Books. Ray PH, Anderson SR, Anderson R: The cultural creatives: how

50 million people are changing the world, New York, 2001,Three Rivers Press.

164 C L A S S I C A L H O M E O P A T H Y

Page 168: Classical Homeopathy

Hahnemann used the motto Aude sapere (“Dareto taste and understand”) in his advocacy ofhomeopathy. Following Hahnemann’s ad-

monition, this appendix provides specific informationthe reader can use to experience a small dose of home-opathy. The following examples are simplistic and donot reflect the full complexity of classical homeopathicmedicine, particularly as it should be applied in chron-ic conditions. In each instance many other possibleremedy selections exist. However, as “tastes” they mightwhet the reader’s appetite for a fuller consideration ofclinical homeopathy in more complicated circum-stances. Other texts (a good recent example being theseries of case conferences published by theInternational Foundation of Homeopathy in Seattle)provide detailed examples and discussions of the use ofclassical homeopathy in clinical practice.

In addition, please be advised that these sugges-tions are not intended to take the place of profes-sional medical care. My assumption is that the readeris a health care professional seeking information totest homeopathy on himself or herself, patients, orfamily members.

DOSAGE GUIDELINES

Aphthae—Canker Sores

In acute episodes, particularly when the origin isinfectious (e.g., herpes stomatitis), Mercurius vivuscan be useful. These patients usually drool quite alot, have bad breath, and feel worse during thenight.

APPENDIX

Simples Tastes of Homeopathy M I C H A E L C A R L S T O N

165

Page 169: Classical Homeopathy

Croup

There are three homeopathic remedies most com-monly used to treat croup. When fear is a definingcharacteristic, Aconitum napellus given hourly is thefirst choice. If it is not helping after two doses, eitherSpongia tosta or Hepar sulphuris calcareum is likely tohelp. Hepar is the better choice if the child is chillyand quite irritable.

Ear Infections—Otitis Media

The sicker the patient, the more rapid the response.A child with a high fever and crying with ear painshould be significantly improved in less than 1.5hours. Give the medicine (as indicated by pain)from every hour, when the picture is as intense asdescribed above, to once a day, when the childis nearly well and spontaneously complains ofmomentary ear pain only occasionally. It is quiteimportant to avoid giving the remedy when thepatient is symptom free, because given withoutregard for the patient’s clinical improvement, theremedy will cause the patient to become sick again.If no improvement is elicited after two doses of themedicine, change the prescription.

Although the most certain way to end the recur-rent cycle of acute otitis media is with the child’schronic medicine, finding that medicine requiresa good deal of training. Unlike other chronic com-plaints, curing the patient of the tendency towardrecurrence is often accomplished by the successfulhomeopathic treatment of a single episode of acuteotitis media.

Belladonna. Symptoms are sudden in onset withhigh fever and much pain, flushed cheeks, and coldfeet with hot body during the fever. Problems tend tobe on the right side. Patient is bothered by noises andlight.

Chamomilla. Very irritable. Capricious mood.Patient wants to be carried around (but nothing sat-isfies). Often needed when the ear infection occursduring teething.

Hepar sulph. Very chilly and irritable. Ear worsewith any touch or cool air. Often associated with sorethroats. Ear infection often associated with hard, drycough (e.g., croup).

Mercurius vivus. Ear infection with very badbreath, sore throats, and drooling. Often worse at

night. Can be associated with oral aphthae (e.g., her-pes stomatitis).

Pulsatilla. The patient is clingy but sweet. Patientdesires attention but demonstrates little (or no) irri-tability. Ear infection occurs at the end of a cold withthick nasal discharge. Little thirst (otitis probablydue in part to dehydration). As slow in onset as theBelladonna type is fast. Manifests on the right side.Symptoms of upper respiratory infection includecough that might make the patient retch. Feels betterwith open air.

Silica. Difficult to prescribe, because the patientand the clinical picture are mild and typically unex-pressive. Slowly developing ear infection. Patients areoften chilly but have a sweaty head and/or feet.Prominent, swollen glands.

Acute Emotional Distress

Aconitum napellus is indicated for patients in a stateof hysterical fear. Often useful following a traf-fic accident or disaster (e.g., earthquake) when thepatient is convinced death is imminent. (Also oftenneeded in croup when the child wakes in a similarstate of panic.)

Arsenicum album. Fearful like aconite but associ-ated with extreme restlessness. Often needed withfood poisoning. Worse from midnight to 2 AM. Verychilly.

Gelsemium is a common homeopathic prescrip-tion for stage fright. Its characteristic symptoms arefamiliar to most people—weakness (especially felt inthe knees or abdomen) with trembling. This fearstate usually comes about in anticipation rather thanin response to a frightening event. Gelsemium is alsooften used in acute influenza, because the pattern ofsymptoms is quite similar—weakness and trembling.

Ignatia amara can be very useful for patientswho have recently suffered a significant personal loss.Common symptoms include weeping easily (oftenthe tears will appear at unexpected times), tightnessin the throat (globus hystericus), sighing, andmyoclonic jerks when falling asleep.

Gastroenteritis

Although homeopathic medicine does not obviatethe need for proper rehydration feeding practices,

166 C L A S S I C A L H O M E O P A T H Y

Page 170: Classical Homeopathy

research confirms the experience of two centuriesthat remedies can assist this process.

Arsenicum album is undoubtedly one of the mostcommon remedies for this variety of problems partic-ularly when food poisoning is the cause. The patientis chilly, restless, and has profuse watery, acrid diar-rhea. Nausea can be quite pronounced with ineffec-tual retching. The patient can be quite weak and isoften fearful. Although the pains are burning,warmth (drinks or environmental heat) often makesthe patient feel better. They tend to be worse duringthe night (midnight to 2 AM).

Carbo vegetabilis is for conditions characterized byabdominal distention and eructations with rumblingin the abdomen and nausea. It is as if something isrotting in the digestive tract. Food poisoning oftencreates a Carbo vegetabilis state. Although chilly,patients strongly desire open air and loosening oftheir clothing.

Phosphorus is very similar to Arsenicum. Thesepatients experience profuse watery diarrhea, whichcan be acrid or even bloody at times. Symptoms comeon or are greatly aggravated right after eating. A clas-sic Phosphorus symptom is that of digestive upsettriggered after drinks warm up in the stomach. Anunusual but memorable characteristic (like Veratrumalbum) is simultaneous vomiting and diarrhea. Thesepatients crave cold drinks and salty foods. LikeArsenicum, fear is common, particularly when alone,but Phosphorus patients are easily reassured and quitepleasant company.

Phosphoricum acidum is much like Phosphorus,but these patients are considerably more debilitatedand feel weak immediately after an episode of diar-rhea. They crave moist fruits.

Podophyllum’s hallmark is painless yellow diar-rhea at 4 AM. The illness most often comes on aftereating fruit in hot weather. Eating often triggers aloose stool.

Mercurius vivus diarrhea is very acrid, creating agood deal of irritation and discomfort, occasionallyincluding rectal spasms. Bad breath is common, andthese patients are worse during the night, includingprofuse night sweats. These patients tend to be verythirsty for cold drinks.

Nux vomica is indicated for stomach pain andindigestion brought on by excess—overwork oroverindulgence. These patients are chilly, irritable,and sensitive to noises, lights, and odors. They findtheir abdominal pains difficult to relieve because of

ineffectual retching and rectal urging. They desirespicy foods, cold drinks, and alcohol. Food poisoningcan be causative factor.

Sulphur, perhaps the most common homeopathicremedy, inevitably has a role to play in digestive com-plaints. An irritable, perhaps fearful patient with acrid,excoriating diarrhea that drives him or her out of bedat 5 AM is classic symptom picture. These patients feelhot and dislike warm foods or environments.

Sepia’s principal digestive indications are nauseaand sensitivity to odors. Homeopaths often use Sepiafor nausea during pregnancy, in addition to gas-troenteritis when the characteristics match.

Veratrum album patients are similar to Phosphoruspatients but lack their fears. They have copious pain-less watery diarrhea, sometimes at precisely the sameunfortunate moment that they vomit. The vomitingcan be painful. They have an unquenchable thirst forcold drinks, which aggravate the vomiting. Patientsexperience extreme restlessness, particularly reflectedin their mental state.

Headaches

Belladonna patients have headaches, often pounding,on the right side with flushed, hot face. Patients arevery sensitive to noises and light.

Bryonia alba should be considered when motionmarkedly intensifies the headache and firm pressurerelieves the headache.

Nux vomica is indicated when the headache comeson following a time of overwork or overindulgence(alcohol or food). Often the patient needing this rem-edy for a headache will suffer from concurrent gas-trointestinal distress of some sort.

Injuries

Homeopathic remedies are expected to alleviate dis-comfort and accelerate healing. As with all other con-ditions, the remedies are taken as indicated by theseverity of the injury (e.g., broken leg: q15min; mus-cle strain: tid).

For injuries with bruising, think Arnica montana.The classic indication for Arnica is such sensitivitythat the bed feels too hard. For good or ill, Arnica isoften given routinely for injuries without considera-tion of more specific features. If it does not help,

A P P E N D I X Simple Tastes of Homeopathy 167

Page 171: Classical Homeopathy

further consideration regarding the precise quality ofthe symptoms is necessary.

Bryonia alba is used for sprains or injuries aggra-vated by motion. The patient wants to hold the areaquite still. Symptoms are improved by pressure.Patient is often irritable when spoken to. The patientmight bring the image of a hibernating bear to themind of the physician.

Rhus toxicodendron is indicated for sprains orother injuries that feel better with motion. Symptomsare worse when beginning to move, but are betterwith continued motion (like a rusty hinge). Also,patients feel better from warmth. (Do not ignorethe conventional use of cold to treat acute injuries.Although these patients might feel better immediate-ly with warm applications, like everyone else, cold isstill better to treat acute injuries.) These patients areoften remarkably restless.

Ruta graveolens can be useful for sprains and stiff-ness of tendons and injuries to the periosteum. Thesepatients feel bruised and lame in limbs and joints.These patients feel worse in cold and wet conditionsand when beginning to move. Like Rhus tox, they feelbetter from continued motion, although heat doesnot make them feel so much better as it does for Rhustox patients.

Menstrual Cramps

Although dysmenorrhea is a chronic condition andrightfully the province of a professional homeopath-ic consultation and constitutional prescription,many patients can gain short-term relief simply withthe use of Magnesia phosphorica. The principal rele-vant indications for this remedy are cramping painsthat respond well to pressure and heat.

Motion Sickness

When the primary symptom is dizziness, treat withCocculus; when the primary symptom is nausea, useTabaccum.

Teething

Sleepless nights caused by teething may be the mostcommon and powerful inducement for parents of

young children to try homeopathy. Although thepopular over-the-counter homeopathic combina-tions for teething have earned a following, selectingthe precisely indicated remedy should generate themost optimal response.

Chamomilla is the homeopathic teeth remedy parexcellence. The indications are the same regardless ofthe diagnosis for which it is used (see also EarInfections). The child is restless, changeable, andquite irritable. He or she wants to be carried but thenwants to get back down, only to demand to get pickedup again. When you give the favorite toy for whichthe child has been crying, he or she throws it acrossthe room. This is Chamomilla. The child often experi-ences diarrhea that appears like chopped spinach (asign of gastrointestinal distress).

Calcarea phosphorica can be useful for teethingwhen the child is not so irritable as Chamomilla.These children spit up a great deal, and the vomitusis often sour smelling.

Urinary Retention in Newborns

Aconitum napellus. Crush 2 pills between two spoonsand administer once by sprinkling into the new-born’s mouth. Aconite’s apparent success in thesecases suggests that fright induced by the birthingprocess could be the cause of the urinary retention.This is not too surprising, given the nature of theevent.

THINGS TO KNOW

Administration

Because the sense of taste can interfere with theaction of homeopathic medicine, patients should nottaste food or toothpaste when they take the homeo-pathic remedy, nor should they smell strong odors inthe room. The patient should not touch the remedy.Using the bottlecap or a clean metal spoon is cus-tomary. Some manufacturers have designed theirbottles specifically to allow easy administration ofany desired number of pellets. The patient shouldallow the remedy to dissolve under the tongue andthen wait a minimum of 15 minutes before eating ordrinking anything other than water. The remediesmust be stored carefully, away from heat (over 110° F)

168 C L A S S I C A L H O M E O P A T H Y

Page 172: Classical Homeopathy

and sunlight. As with any medicinal substance, keep-ing homeopathic remedies out of the reach of inquis-itive children is always a good idea.

Dosages

Potency issues are complicated and controversial. Thesimplest course is probably to use 12C, 30C, or 30Xpotencies to limit the frequency of repetition and toeliminate any possibility of adverse effects from thecrude source material. A few guiding principles willassist you: 1. Always administer homeopathic remedies with an

eye on the patient. Adjust potency and dosage reg-imen accordingly. The frequency of doses is deter-mined by the severity of the illness or injury andthe patient’s response.

2. Potency is based upon the following factors: a) Availability: The correct remedy will work

regardless of potency, although the frequencyof administration may need alteration.

b) Prescription certainty/remedy fit: A remedythat is an excellent fit will create a healingresponse in the patient in an extremelydilute/potentized dosage. A mediocre fitrequires a more physiologic dose.

c) Physicality: Many homeopaths believe thatmental and emotional problems (e.g., anxietyor depressive states) require higher potencies(e.g., 1M, 200C) to be effective.

3. Dosage regimen a) As a very crude measure (for a problem of

average severity), use one of the followingdoses: 30C three times/day; 12C (30X) fourtimes/day; or 6C (12X) four to five times/day.

b) Wean treatment as symptoms abate. c) Two to five pills is an adequate dosage for any-

one, infant or adult.

Response

The speed of the patient’s response to treatment isproportional to the speed and intensity of the ill-ness. Aphthous sores that developed during illnessgo away over days (the pain should dissipate inhours), whereas a teething child will be better, eithersleeping or in a significantly improved mood, in 5 to30 minutes.

Suggested ReadingsCummings S, Ullman D: Everybody’s guides to homeopathic

medicine, Los Angeles, 1997, Tarcher.Hering C: The homeopathic domestic physician, ed 14(Am), New

Delhi, 1984: Jain Publishing (reprint)(original 1835).Leckridge B: Homeopathy in primary care, Edinburgh, 1997,

Churchill Livingstone.Jonas W, Jacobs J: Healing with homeopathy, New York, 1996,

Warner Books.Ullman R Reichenberg-Ullman: The patient’s guide to homeo-

pahtic medicine, Edmonds, Wash., 1995, Picnic Point Press.

A P P E N D I X Simple Tastes of Homeopathy 169

Page 173: Classical Homeopathy

Page numbers followed by f indicate figures; t, tables;b, boxes.

A

A H1N1, 79ABHT. See American Board of Homeotherapeutics

(ABHT).Acetaminophen, 52, 156tAconitum cammarum, 55Aconitum ferox, 55Aconitum lycoctonum, 55Aconitum napellus, 55, 166, 168Active silence, 106Acupuncture, 41Acupuncture points injected with diluted substances,

14Acute diarrhea, 81-82Acute emotional distress, dosage guidelines for, 166Acute otitis media (AOM), 91, 122-123, 128, 160Advisory Board on the Registration of Homeopathic

Products, 57AFH. See American Foundation for Homeopathy

(AFH).Africa, homeopathy in, 58Aggravations, 73, 126-127Agoraphobia, 96AIH. See American Institute of

Homeopathy (AIH).Alaska, licensing of naturopathic medicine in, 142All Nigeria Homeopathic Medical Association, 58Allen, T.F., 111Allentown Academy, 23Allergen desensitization, low-dose, 78Allergic disease, 77-78Allergic rhinitis, 90, 110, 122Allopathic consultation, disenchantment with, 48

Allopathic medication, dissatisfaction with efficacyof, 48

Allopathy, 3, 17, 134Alternative medicine, 37Alternative Medicine Interest Group of the Society of

Teachers of Family Medicine, 43AMA. See American Medical Association (AMA).Amazing Randi, The, 92-93Ambra grisea, 54American Board of Homeotherapeutics (ABHT), 29,

138, 140, 141, 146American Foundation for Homeopathy (AFH), 26American Institute of Homeopathy (AIH), 23, 25,

42, 63American Medical Association (AMA), 3, 23, 42, 63

Consultation Clause of, 3Council on Medical Education and Hospitals of, 27

American Rheumatism Association, 76Angina

homeopathy and, 123internal mammary artery ligation for, 64

Anick, David, 96Anthroposophists, 11Antibiotics

acute otitis media and, 128, 160homeopathy as alternative to, 128

Antidotes, 116-117Anti-IgE antiserum, 92Antimonium, 55AOM. See Acute otitis media (AOM).Aphthous sores, dosage guidelines for, 169Apis mellifica, 54Apprenticeship, correspondence training and, 143Appropriate care, neglect of, 126Aphthae–canker sores, dosage guidelines for, 165Arcanum of medicine, 20

Index

171

Page 174: Classical Homeopathy

Archivesof Internal Medicine, 95of Otolaryngology–Head and Neck Surgery, 87of Pediatrics and Adolescent Medicine, 146

Argentina, homeopathy in, 60, 136Arizona

licensing of naturopathic medicine in, 142licensing standards for homeopathic

practice in, 134naturopathic school in, 142

Arnica montana, 52, 85, 86, 167-168Arrhythmias, homeopathy and, 123Arsenic, potency of, 155Arsenicum, 96Arsenicum album, 166, 167Arthritis

homeopathy and, 123rheumatoid, 76, 81

Asia, homeopathy in, 58-59Aspergillus, 94Aspirin

colorectal cancer and, 123compared to homeopathic metallic arsenic, 156t

Asthma, 67, 104-106, 122, 160Atropa belladonna, 54Attenuation, 151Aude sapere, 165Aurum, 55Aurum metallicum, 152-154Australia, homeopathy in, 59Australian Homeopathic Association, 59Australian Faculty of Homeopathy, 59Aversions, food, 107Avogadro’s constant, 4Avogadro’s hypothesis, 4Avogadro’s number, 4, 13, 40, 152

B

B vitamin supplementation, 41Ball mill, trituration and, 154Balmain Hospital, 59Baltimore, David, 93Barium, 55Barnes, Joseph K., 3Baryta, 55Baryta Carb, 59Bastyr, John, 30Bastyr University, 30Belladonna, 54, 125, 166, 167Benveniste, Jacques, 92-93

Berman’s Chesapeake Bay Area survey, 41Bernard, Claude, 24Besluit Homeopathische farmaceutische producten, 57Beta carotene, 65Betahistine, 87BHomP. See British Homeopathic Pharmacopoeia

(BHomP).Biofeedback, 41Black water fever, 11Blinding, placebo studies and, 67Boericke, Garth, 28Boyson, William, 30Brazil, homeopathy in, 60, 136British Association of Homeopathic Veterinary

Surgeons, 53British Faculty of Homeopathy, 58British Homeopathic Journal, 96British Homeopathic Manufacturers’ Association, 56British Homeopathic Pharmacopoeia (BHomP), 55-56British Homeopathic Society, 55British Medical Association, 4-5British Medical Journal, 39, 53, 79, 82, 90, 122-123Bromatums, 54Bryonia alba, 167, 168Buyer characteristics in homeopathy, 52

C

Cactus grandiflorus, 54Cadmium, 95Calcarea fluorica, 54Calcarea phosphorica, 168Calcium, 55c, 65Calcium carbonicum, 54Calcium fluoratum, 54Calcium fluoricum, 54Calcium fluoride, 54Calcarea, 55California Business and Professions Code, 134-135Calms Forte, 39CAM. See Complementary and alternative medicine

(CAM).Canada, naturopathic school in, 142Cancer

gastrointestinal, homeopathy and, 123homeopathy and, 123

Canker sores–apthae, dosage guidelines for, 165Cantharis, 54Carbo vegetabilis, 167Carcinosin, 54-55, 107Carcinosinum, 54-55, 107

172 I N D E X

Page 175: Classical Homeopathy

Care, appropriate, neglect of, 126Caribbean, homeopathy in, 59-60Carlston, Michael, 143Carnegie Foundation, 25Case

acute, 110central feature of, 108-109chronic, 110clear causation for, 110important features of, 110strange, rare, and peculiar aspects to, 109-110

Case analysis and remedy selection, 108-118Case management, 118-119Causticum Hahnemanni, 55Cell, 93Cenchris, 54Centessimal medicines, 154Central feature, 108Centre for Rheumatic Diseases, Royal Infirmary,

Glasgow, Scotland, 76Cercus grandiflorus, 54Certification organizations, homeopathic,

138-140Certification standards for homeopathy, 140-141Chalmers, Ian, 66Chamomilla, 54, 166, 168Chase, Sandra M., 30CHC. See Council for Homeopathic Certification

(CHC).Chemical sources, remedies from, 54Chesapeake Bay Area survey, 41Chief complaint, 104-105Children, homeopathy in, 34-35Chlorpheniramine, 78Chopped liver homeopathy, 165-169Chronic care, intensive, 127Chronic diseases, 117Chronic Diseases, 28CI. See Confidence interval (CI).Cinchona pubescens, 55Clarke, John, 30, 135Classical homeopaths, 53Cleveland Homeopathic Medical College, 27“Clinical Trials of Homeopathy,” 80Cocculus, 168Coccus cacti, 54Coction, 20Cod liver oil, 72Commonweal, 88Complaint, chief, 104-105

Complementary and Alternative Health Care Freedomof Access Bill, 144

Complementary and alternative medicine (CAM), 34,47, 64

demographics of users of, 35-36reasons for using, 37

Complementary medicine, 37, 163Complete Repertory, The, 114Complex prescribing, 53-54Compliance Policy Guideline, 156Confidence interval (CI), 76Congestive heart failure, homeopathy and, 123Connecticut

licensing of naturopathic medicine in, 142licensing standards for homeopathic practice

in, 134naturopathic school in, 142

Connecticut Homeopathic Medical Examining Board,137-138

Connecticut Homeopathic Medical Society, 27, 28Constitutional care, 127Consultation

allopathic, disenchantment with, 48homeopathic, 104-108

Consultation Clause of American MedicalAssociation, 3

Contact, initial, with patient, 103-104Content of interview, 104-108, 105b, 106bControversies in Health Care Policies, 49Controversy, homeopathy and, 3-5, 21Copeland, Royal, 26Copperhead snake, 54Correspondence training and apprenticeship, 143Corticosteroids, 118Cost effectiveness, 49, 161-162Costa Rica, homeopathy in, 60Cough, pneumonia and, 122Coulter, Harris, 25Council

for Homeopathic Certification (CHC), 139, 140,141, 146

for Homeopathic Education, 146on Medical Education and Hospitals of American

Medical Association, 27Cramps, menstrual, dosage guidelines for, 168Cravings, food, 107Creative homeopathic research, 96Creatives, Cultural, definition of, 160Crisis, healing, 20Crotalus, 54

I N D E X 173

Page 176: Classical Homeopathy

Croup, dosage guidelines for, 166Crutcher, Lewis P., 29Cuba, homeopathy in, 59Cultural Creatives, definition of, 160Cultural reasons for homeopathy, 49Cyclophosphamide, 72, 73

D

Dactylopius coccus, 54Daily symptom score (DSS), 83de Santana, Antonio López, 60Deadly nightshade, 125Death, voodoo, 73“Debunking” of homeopathy, 146Decimal medicines, 154Demographics

CAM, 35-36homeopathic, 36

Department of Family and Community Medicineat the University of California, San Francisco, 67

Depression, 118-119Detwiller, Henry, 23DHt. See Diplomate of Homeotherapeutics (DHt).Diarrhea, acute, 81-82Diarrhea index score, 82Dietary supplementation, 41Diplomate of Homeotherapeutics (DHt)Directive 92/73/EEC, 57Disease, homeopathic view of, 14-15Disease labels, 121Disease prevention, 124-125, 160-161Disease process, features of patient lifestyle

contributing to, 110-111Disenchantment with allopathic consultation, 48Disraeli, Benjamin, 4, 63, 64Dissatisfaction with efficacy of allopathic medication,

48District of Columbia, licensing of naturopathic

medicine in, 142Doctors, 135Doctrine of Signatures, 11, 19-20Domestic Physician, 35Dosage, 68

guidelines for, 165-168homeopathic, 8

Dosage guidelines, 169Double-blinding, 90Drogeries, 60Dropped clues, noticing, 107

Drug risks, perceptions of homeopathy in, 48DSS. See Daily symptom score (DSS).Duck heart and liver, preparation made from, 79Dunham, Carroll, 24Dysmenorrhea, 168

E

Ear infections, 122-123, 166Eastern Europe, homeopathy in, 60ECH. See European Committee for Homeopathy

(ECH).Education, homeopathic, 14, 42-43, 133-148, 162Effectiveness, homeopathic research and, 122-123Efficacy, clinical reports of, 123, 124tEisenberg, David, 2, 34Emerson, Ralph Waldo, 69Emotional distress, acute, dosage guidelines for, 166Endorphins, placebo treatment and, 72England, homeopathy in, 136Euphorbium resiniferum, 55Europe, homeopathy in, 135European Committee for Homeopathy (ECH), 54European Council for Classical Homeopathy, 146European Directive, 56European Economic Community, 56European Parliament’s Directive number

92/73/EEC, 56European pharmacopoeia, 55European Union (EU), 56

F

Facultyof Homeopathy, 53, 135of Homeopathy Malaysia, 59

Fantasy names, 57FDA. See Food and Drug Administration (FDA).Fear, hysterical, 166Felix domestica, 55Fenoprofen, 77Fibromyalgia, 79Fibrositis, 79Financial considerations of homeopathy, 49, 161Fisher, Peter, 58, 79Flexner, Abraham, 25-26Flu epidemic of 1918, 26Fluoratums, 54Follow-up evaluations, case management and, 118-119Food, Drug, and Cosmetic Act, 26, 155Food and Drug Administration (FDA)

Compliance Policy Guideline of, 156

174 I N D E X

Page 177: Classical Homeopathy

Food and Drug Administration—cont’dcreation of, 26, 155definition of, of homeopathic remedies, 134regulations of, 39, 150, 155-156, 156t

Food aversions, 107Food cravings, 107Food poisoning, 167France, homeopathy in, 136French Pharmacopoeia, 56Fundamental science, homeopathy and, 95-96Funnel plotting, statistics and, 86

G

Galen, 12, 18-19Galphimia glauca, 77, 86Gastroenteritis, dosage guidelines for, 166-167Gastrointestinal cancer, homeopathy and, 123Gelsemium, 166Generals, 107Geraldine R. Dodge Foundation, 88German Homeopathic Pharmacopoeia, 55Gladish, Donald, 29Gold, trituration of, 152-154Gram, Hans Burch, 23Gray, Bill, 30Green, Julia M., 26, 30“Green” association of homeopathy, 48Group on Alternative Medicine of Society of Teachers

of Family Medicine, 43Guiding Symptoms, The, 24

H

Hahnemann, Melanie, 133Hahnemann, Samuel, 3, 5, 7, 8, 9-10, 12, 108, 117, 121,

133, 136, 138, 143, 149, 152, 163experiments of, with quinine, 10homeopathy before, 17-23Lesser Writings, 9-10, 28principles of, 10-11teachers of, 22

Hahnemann Medical College, 24, 27, 28Hahnemannian method, 154HANP. See Homeopathic Association of Naturopathic

Physicians (HANP).Harrington, Anne, 70Harvard Center for Alternative Medicine Research, 88Havana International Airport, 59Hawaii, licensing of naturopathic medicine in, 142Hay fever, 78, 87, 119, 122Hayes, Royal E.S., 27

Headaches, 108, 118-119, 167Healing

natural, 8postinjury, 85

Healing crisis, 20Healing process, relationship aspect of, 75Health, homeopathic view of, 14-15Health practitioners, 53Health promotion, 160-161Health risks associated with homeopathic medicine,

125-127Heart arrhythmias, homeopathy and, 123Heart disease, homeopathy and, 123Heart failure, congestive, homeopathy and, 123Heartlanders, 162Heat stress, 95Heilpraktikur, 53, 135Hepar sulph, 166Hepar sulphuris calcareum, 166Hering, Constantine, 22, 23, 24, 35, 118Hering’s Laws of Cure, 2, 2b, 69, 118Herpes stomatitis, dosage guidelines for, 165Herzog, Lucy Stone, 27“High-dilution Experiments a Delusion,” 92Hippocrates, 11, 18-19Hippocratic Oath, 75History, 104Homeopathic Association of Naturopathic Physicians

(HANP), 138, 139, 140, 141Homeopathic certification organizations, 138-140Homeopathic consultation, 104-108Homeopathic Domestic Physician, The, 24, 35Homeopathic dosage, 8Homeopathic education, 14, 42-43, 133-148, 162Homeopathic interview, 2-3, 67, 75, 105, 105b, 106,

106b, 162content of, 104-108, 105b, 106bstyle of, 104videotaped, 67

Homeopathic lectures, 143Homeopathic Medical Assistant, 134Homeopathic Medical College of Pennsylvania, 24Homeopathic medicine

administration of, 168-169health risks associated with, 125-127process of making, 152

Homeopathic Pharmacopoeia of the United States(HPUS), 150, 152, 154, 155

Homeopathic pharmacy, 149-158Homeopathic provings, 111-112

I N D E X 175

Page 178: Classical Homeopathy

Homeopathic Recorder, 29Homeopathic remedies, 31, 54-58

from chemical sources, 54licensing of, 56-58manufacture of, 55-56prophylactic administration of, 86regulatory affairs and, 56-58selection of, case analysis and, 108-118

Homeopathic research, 63-102creative, 96effectiveness and, 122-123future of, 96-97in New Zealand, 160placebos and, 68-75published human trials of, 76-92

Homeopathic Research Network, 96-97Homeopathic seminars, 143Homeopathic training

in medical schools, 143in naturopathy schools, 142-143programs of, 142

Homeopathic trial, 67Homeopathic veterinary surgeons, 60Homeopaths

classical, 53development of, 145-146lay, 138medically trained versus nonmedically trained,

136-137nonlicensed, 134professional, 134unicist, 53

Homeopathy, 1-3, 10in Africa, 58as alternative to antibiotics, 128approaches to practice of, 53-54in Asia, 58-59in Australia, 59buyer characteristics in, 52in the Caribbean, 59-60case analysis and remedy selection in, 108-118case management in, 118-119certification in, 133-148certification organizations for, 138-140certification standards for, 140-141in children, 34-35chopped liver, 165-169and controversy, 3-5cost effectiveness of, 161-162cultural reasons for, 49

Homeopathy—cont’d current state of, 33-46debate on licensure for, 144-145“debunking” of, 146definition of, 8, 8b, 15, 18development of homeopath, 145-146in disease prevention, 124-125, 160-161disenchantment with allopathic consultation,

48dissatisfaction with efficacy of allopathic

medication, 48dosage guidelines in, 165-169in Eastern Europe, 60education in, 133-148, 162in Europe, 135expanding role for, 162financial considerations of, 49future conflicts and challenges in, 146-147future of, 159-164global perspectives on, 47-62greater attention to symptoms in, 48“green” association of, 48before Hahnemann, 17-23Hahnemann’s teachers, 22health risks associated with medicine used in,

125-127Hippocrates and, 18-19history of, 17-32improving, 97influence of opinion leaders on, 49international demand for, 49-52, 50t, 51fin Latin America, 60law and, 134-135lessons from, 75like cures like in, 11likelihood of, to be successful, 121-124media encouragement for, 49medical profession and, 39-43from medical specialty to do-it-yourself, 127-128medically trained versus nonmedically trained,

136-137medicine and, 134-135minimal dose of, 13-14nomenclature of, 54-55as “other,” 69-70Paracelsus and, 19-21patient approach in, 103-108perceptions of drug risks in, 48persons who use, 34-37pharmacy in, 149-158

176 I N D E X

Page 179: Classical Homeopathy

Homeopathy—cont’d for physicians, 127-128practice patterns of, 36-37practitioners of, 52-53present realities of, 137-138in primary care, 121-132principles of, in patient care, 10-11, 103-120provings in, 11-13, 97published human trials of. See Published human

trials of homeopathy.questions used in, 105, 105b, 106, 106brapid growth of, 34reasons for learning about, 1-3reasons for using, 37-38remedies in, 54-58research on, 63-102response to, 68, 68fself-care and, 159-160self-care in, 35single medicine and, 13survival of, 15Emanuel Swedenborg and, 21-22toxicology and, 93-94in United Kingdom, 135in United States, 23-31, 34-43view of, of health and disease, 14-15wellness/health promotion and, 160-161for what problems, 38, 38twhy patients choose, 47-49worldwide, 58-60

Homeopathy: The Rise and Fall of a Medical Heresy, 29, 31Homeopathic terminology, 150-151Hormesis, 95HPUS. See Homeopathic Pharmacopoeia of the United

States (HPUS).Hubbard, Elizabeth Wright Hubbard, 29Human and Experimental Toxicology, 94Human trials, published, of homeopathy. See Published

human trials of homeopathy.Hydrargyrum, 55Hygiene hypothesis, 125Hyland’s Teething Tablets, 39Hypericum perforatum, 19, 59Hysterical fear, 166

I

Ignatia amara, 166IHA. See International Hahnemannian Association

(IHA).Illitch, Ivan, 145

Immune-suppressing medications, 118Immunizations, asthma and, 160Improving homeopathy, 97India, homeopathy in, 136Infections, ear, 122-123, 166Influence of opinion leaders on homeopathy, 49Influenza, 79Initial contact with patient, 103-104Injuries, dosage guidelines for, 167-168Inner essence of medicine, 20INSERM. See National Institute of Health and Medical

Research (INSERM).Integrative medicine, 37Intensive chronic care, 127Internal mammary artery ligation for angina

pectoris, 64International Code

of Botanical Nomenclature, 55of Zoological Nomenclature, 55

International Council for Classical Homeopathy, 146International demand for homeopathy, 49-52, 50t, 51fInternational Foundation of Homeopathy in

Seattle, 165International Hahnemannian Association (IHA), 24, 25Interpersonal theory, 72Interview, homeopathic. See Homeopathic interview.Iodatums, 54Ipecac in treatment of nausea, 72Isopathy, 78Israel Association of Classical Homeopathy, 58

J

Jacobs, Jennifer, 70, 123JAIH. See Journal of the American Institute of Homeopathy

(JAIH).Jamaica, homeopathy in, 60James, Henry, Sr., 22, 69John Bastyr College of Naturopathic Medicine, 30John E. Fetzer Institute, 88Journal

of Alternative and Complementary Medicine, 89of the American Institute of Homeopathy (JAIH), 26, 28,

29, 95of the Royal Society of Medicine, 85

K

Kali, 55Kalium, 55Kaufman, Martin, 29, 31Kent, James Tyler, 15, 22, 24, 67, 112-113, 114

I N D E X 177

Page 180: Classical Homeopathy

Kidney stones, urinary calcium and, 65Korsakovian method, 154

L

Lac felinum, 55Lancet, 4, 86, 90Landmark Healthcare, 2, 34Latin America, homeopathy in, 60Latrodectus mactans, 54Law(s)

of Cure, 2, 2b, 69, 118homeopathy and, 134-135

Lay homeopaths, 138Layman’s leagues, 30Leary, Timothy, 29Lectures

homeopathic, 143on Homeopathic Materia Medica, 112-113on Homeopathic Philosophy and Lectures on Materia

Medica, 24Lesser Writings, 9-10, 28Licensing Authorities, 57Licensure for homeopathy, debate on, 144-145Life sciences, miscellaneous, homeopathy and, 94-95LIfestyle, patient, features of, contributing to disease

process, 110-111Like cures like, 10, 11, 66-67, 95Lincoln, Abraham, 3Linde, Klaus, 94London Homeopathic Hospital, 161Low-dose allergen desensitization, 78Lown, Bernard, 75Lycopodium clavatum, 96Lytta vesicatoria, 54

M

Maddox, James, 92-93Magnesia phosphorica, 168Maine, licensing of naturopathic medicine in, 142Malaria, quinine and, 10Malaysia, homeopathy in, 59Materia Medica, 10, 152Materia medica, 112-114Materia Medica Pura, 12, 13, 23, 28, 152Matricaria chamomilla, 54McCarthy, Joseph, 29McCormack, J.N., 25Media encouragement for homeopathy, 49Medical profession and homeopathy, 39-43Medical schools, homeopathic training in, 143

Medically trained homeopaths versus nonmedicallytrained homeopaths, 136-137

Medication, allopathic, dissatisfaction with efficacyof, 48

Medicinealternative, 37centessimal, 154complementary, 37, 163decimal, 154homeopathic. See Homeopathic medicine.homeopathy and, 134-135, 145-146inner essence of, 20integrative, 37natural, 31single, 13traditional, 59

Medicines Act of 1968, 56Medicines Control Agency, 57Medicines Evaluation Board, 57MedLine, 66, 80Medorrhinum, 54-55, 58Member of the Faculty of Homeopathy (MFHom), 58Menstrual cramps, dosage guidelines for, 168Mercuric chloride, 94Mercurius, 55Mercurius Hahnemanni, 55Mercurius solubilis, 55, 111-112Mercurius vivus, 111-112, 167

for aphthae–canker sores, 165for ear infections, 166

Mercury, 10, 113Metallic arsenic, homeopathic, compared to aspirin

and acetaminophen, 156tMethodology issues, 66-68Methotrexate, 118Mexico, homeopathy in, 60, 136MFHom. See Member of the Faculty of Homeopathy

(MFHom).Migraines, 110Mild traumatic brain injury (MTBI), 89Minimal dose, 13-14, 13bMinnesota, licensure for homeopathy in, 144, 145Misattribution theory, 71Miscellaneous life sciences, homeopathy and, 94-95Modalities, 105, 107-108Montana, licensing of naturopathic medicine

in, 142Morbilinum, 58Morrison, Roger, 30Moskowitz, Richard, 30

178 I N D E X

Page 181: Classical Homeopathy

Mother tincture, 152Motion sickness, dosage guidelines for, 168MTBI. See Mild traumatic brain injury (MTBI).Mycobacterium tuberculosis pulmonis macerati hominis

mortis, 55

N

Naja, 54Naloxone in treatment of pain, 72Naproxen, 74, 74fNASH. See North American Society of Homeopaths

(NASH).National Ambulatory Medical Care Survey,

38, 128National Board of Homeopathic Examiners (NBHE),

139, 140, 141National Center

for Complementary and Alternative Medicine(NCCAM), 8, 89

for Health Statistics, 38of Homeopathy, 143

National College of Naturopathic Medicine, 30National Health Service, 53, 56, 59, 135National Health System, 146National Institute of Health and Medical Research

(INSERM), 92National Institutes of Health (NIH), 8, 66, 89National School of Medicine and Homeopathy, 60Natrium, 55Natrum, 55Natrum muriaticum, 150, 151Natural healing, 8Natural medicine, 31Nature, 92, 93Naturopathic physician, 135Naturopaths, 31Naturopathy schools, homeopathic training in,

142-143NBHE. See National Board of Homeopathic Examiners

(NBHE).NCCAM. See National Center for Complementary and

Alternative Medicine (NCCAM).Neglect of appropriate care, 126Nepal, homeopathy in, 82Nesbit, Edwin Lightner, 26Netherlands, 51Neuberger, Julia, 49Nevada, licensing standards for homeopathic practice

in, 134New England Journal of Medicine, 34

New Hampshire, licensing of naturopathic medicinein, 142

New York Homeopathic Medical College, 27New York Medical College, 27New Zealand, homeopathic research in, 160Newborns, urinary retention in, dosage guidelines

for, 168Nicaragua, homeopathy in, 81-82Nigeria, homeopathy in, 58Nightshade, deadly, 125NIH. See National Institutes of Health (NIH).Nineteenth Century American prominence,

homeopathy and, 23-24NMQPs. See Non-medically qualified professional

homeopaths (NMQPs).NMR. See Nuclear magnetic resonance (NMR).Nocebo versus placebo, 73Nonlicensed homeopaths, 134Non-medically qualified professional homeopaths

(NMQPs), 52-53Nonmedically trained homeopaths versus medically

trained homeopaths, 136-137North American Society of Homeopaths (NASH),

138-139, 140, 141, 146North Carolina Medical Board, 137Norway, homeopathy in, 85Norwegian Academy of Natural Medicine, 85Nosodes, 54-55Nossaman, Nick, 30Nuclear magnetic resonance (NMR), 56, 95-96Nux vomica, 59, 167

O

OAM. See Office of Alternative Medicine (OAM).Oates, Stephen, 93Odds ratio (OR), 76Office of Alternative Medicine (OAM), 8, 8b, 89Opinion leaders, influence of, on homeopathy, 49Opium, 54OR. See Odds ratio (OR).Oregon, naturopathic medicine in, 142Organon of Medicine, 10, 21, 23, 28, 108, 117, 121Oscillococcinum, 39Osteoarthritis, 77Other Healers, 31Otitis media, 110, 122-123

acute, 91, 122-123, 128, 160dosage guidelines for, 166

Outcomes measures, 66, 87-88Outcomes research, 66, 87-88

I N D E X 179

Page 182: Classical Homeopathy

P

“p” value, 76Pain

placebo treatment and, 72, 73postpartum uterine, 74

Panos, Maesimund B., 30Paracelsus, 11, 19-21Paracetamol, 52, 74, 74fPatient

features of lifestyle of, contributing to diseaseprocess, 110-111

self-awareness of, 124sense of temperature of, 107

Patient history, 104Patient interview. See Homeopathic interview.Pediatrics, 81Pharmacopoeia. See also Homeopathic Pharmacopoeia

of the United States.European, 55French, 56

Pharmacy, homeopathic, 149-158Phase I trial, 12Phosphoricum acidum, 167Phosphorus, 85, 167Phosphorus patient, 122Physical examination in homeopathy, 107Physicians

homeopathy for, 127-128naturopathic, 135

Physicians’ Desk Reference, 3Placebo, 67, 68-75, 74f

adverse effects of, 73-74, 74fdefinition of, 70-72lessons from, 75limitations of, in research, 74mammary artery ligation for angina pectoris

and, 64Placebo response, characteristics of, 72-74Placebo theories, 71-72Placebo-reactor, 71PLRs. See Product Licences of Right (PLRs).Plumbum, 55Pluralist prescribing, 53Plutonium, 125Pneumonia, 122Podophyllum, 167Poisons, 125Poitevin, Bernard, 54Pollinosis. See Hay fever.

Polychrest homeopathic medicines, 52Post Graduate School of Homeopathics, 24Postavogadran dilutions, 13Postinjury healing, 85Postpartum uterine pain, 74Potency, 115-116, 151Potentization, 95-96, 151Power of Hope: A Doctor’s Perspective, 75Practice patterns, homeopathic, 36-37Practitioners, homeopathic, 52-53Prednisone, 81Preferences, 107Pregnancy, 125Prescribing

complex, 53-54pluralist, 53

Primary Care Certificate, 58Primary fibromyalgia, 79Prince Charles, 4-5Product Licences of Right (PLRs), 56Professional care, homeopathy and, 38Professional homeopaths, 134Prognosis, homeopathic, 117-118Proof

nature of, 64-66stages of, 65-66

Proving homeopathy, 97Provings, 11-13

aggravations and, 126-127homeopathic, 111-112making patient worse, 68

Pruefung, 11-12Psorinum, 54-55, 58Published human trials of homeopathy, 76-92

1980-1984, 76-771985-1989, 77-791990-1994, 80-841995-1999, 85-902000-2001, 90-92

Puerto Rico, licensing of naturopathic medicine in, 142Pulsatilla nigricans, 52, 91, 166Pulsatilla pratensis, 55

Q

“Quadruple-blind,” 4, 78“Qualifying Course for Laymen,” 30Questions asked in homeopathic analysis, 105, 105b,

106, 106bQuinine, 10, 11

180 I N D E X

Page 183: Classical Homeopathy

R

Rabe, Rudolph, 27, 28Randi, James, 92-93Randomized placebo-controlled trial (RCT),

64, 65, 74Ray, Paul, 37, 160RCT. See Randomized placebo-controlled trial (RCT).Referral, homeopathy and, 41Registered Malaysian Homeopathic Medical

Practitioners Association, 59Relationship aspect of healing process, 75Relative risk (RR), 76Relaxation therapies, 41Remedies, homeopathic. See Homeopathic remedies.Repertory, 114-115Repertory of the Homeopathic Materia Medica, 24, 67Reports from others, 107Research

homeopathic. See Homeopathic research.outcomes, 66, 87-88statistics and, 65

Resina laricis, 54Resource texts for selection of remedy, 111-115Response expectations, change of, with passage of

time, 68, 68fResponse of homeopathic medicine, 169Rheum palmatum, 55Rheumatoid arthritis, 76, 81Rhinitis

allergic, 90, 110, 122seasonal, 78

Rhus tox, 52, 168Rhus toxicodendron, 77, 79, 168“Rise and Fall and Persistence of a Medical Heresy,

The,” 31Robinson, Karl, 30Roper Starch Worldwide, 34Royal London Homeopathic Hospital, 77RR. See Relative risk (RR).Russian Homeopathic Association, 60Ruta graveolens, 168

S

SAD. See Serial agitated dilution (SAD).Sankaran, Rajan, 19Scandinavian Journal of Rheumatology, 81Schmidt, Pierre, 127Schools

medical, homeopathic training in, 143naturopathy, homeopathic training in, 142-143

Sciencefundamental, life, miscellaneous, 95-96life, miscellaneous, homeopathy and, 94-95

Seasonal rhinitis, 78Secale cornutum, 54Second Homeopathic Research Network

Symposium, 83Self-awareness of patient, 124Self-care, 35, 159-160Self-treatment, homeopathy and, 38Seminars, homeopathic, 143Sepia, 167Serial agitated dilution (SAD), 94Seward, William, 3Shakespeare, William, 125Shamanic rituals, 72Shupis, Anthony, 28Sickness, motion, dosage guidelines for, 168Signatures, Doctrine of, Paracelsus and, 11, 19-20Silence, active, 106Silica, 166Silicea, 94Silver nitrate, 94Similars, 149Similia, 21, 95. See also Like cures like.

Paracelsus and, 19-20Simillimum, 117Single medicine, 13Sleep patterns, 107Snake venoms, 54Social Security Act, 27Society

of Homeopaths, 138-139of Teachers of Family Medicine, 43

Sodium arsenite, 95Sodium chloride, 150Sores, aphthous, dosage guidelines for, 169South Africa, homeopathy in, 58Spiro, Howard, 75Spongia tosta, 166St. John’s Wort, 19Stage fright, 166Standards, certification, 140-141StarFire Fund, 88Statistics

funnel plotting and, 86research and, 65

Steroids, 81Stewart, Walter, 92-93Stibium, 55

I N D E X 181

Page 184: Classical Homeopathy

Stomatitis, herpes, dosage guidelines for, 165Stress, heat, 95Style of interview, 104Sulphur, 122, 167Sulphuratums, 54Suppression, 161Surgical trauma, homeopathy in, 85Swedenborg, Emanuel, 21-22Symptoms

greater attention to, in homeopathy, 48hierarchy of, 14

Syphilis, tertiary, 10

T

Tabaccum, 168Technikons of Natal, 58Teething, dosage guidelines for, 168Tertiary syphilis, 10Thalidomide, 56Thyroxine, 94-95Tiller, William, 95Time, change of response expectations with passage of,

68, 68fTincture, mother, 152Totality, 109Toxicology, homeopathy and, 93-94Traditional Medicine, 59Traditionalists, 162Training

correspondence, and apprenticeship, 143homeopathic. See Homeopathic training.

Trauma, surgical, homeopathy in, 85Trituration, 152-154Trousseau, 72Tuberculinum, 54-55, 55, 107Twain, Mark, 4Twentieth Century decline and resurgence of

homeopathy, 24-31

U

U.K. Medicines Control Agency, 57U.K. National Health Service, 49Unicist homeopaths, 53United Kingdom, homeopathy in, 135

United States, homeopathy in, 23-31, 34-43University of California, San Francisco, Department

of Family and Community Medicine at, 67Urinary calcium, kidney stones and, 65Urinary retention in newborns, dosage guidelines

for, 168U.S. Bureau of the Census, 38U.S. Homeopathic Pharmacopoeia, 56Utah, licensing of naturopathic medicine in, 142

V

van Hohenheim, Philippus Aureolus TheophrastusBombastus, 19

van Zandvoort, Roger, 114VAS. See Visual analog scale (VAS).Veratrum album, 167Verdi, Tullio, 3Vermont, licensing of naturopathic medicine in, 142Vertigo, 87-88Vespa cabro, 54Veterinary surgeons, homeopathic, 60Videotaped homeopathic interviews, 67Vipera, 54Visit costs, 161Visual analog scale (VAS), 77Vitamin B, 41Vitamin C, 41Vithoulkas, George, 30Voodoo death, 73

W

Waldorf Schools, homeopathic research in, 160Washington

licensing of naturopathic medicine in, 142naturopathic school in, 142

Washington Medical Society, 3“Water wires,” 96Wellness/health promotion, 160-161Wember, Dave, 30Wesselhoeft, William, 23“When To Publish Pseudoscience,” 93Wilkinson, John James Garth, 22, 69Winston, Julian, 58Witwatersrand, 58

182 I N D E X