The Cancer Journal - Volume 8, Number 4 (July-August 1995)
editorial
Academic Medicine and Homeopathy
Homeopathy is gaining popularity. Patients disillusioned by academic medicine crowd homeopathy clinics, which is met by academic medicine with contempt: "These charlatans that treat patients with highly diluted alcoholic potions should be banned". Yet public pressure is mounting and health departments have started acknowledging homeopathy. More and more physicians seek homeopathic training and start practising it. In many instances homeopathy is effective, and can no longer be ignored by open-minded clinicians. Why and when is homeopathy useful?
Homeopathy as a placebo - Homeopaths are regarded by academic medicine as placebo providers. The word 'placebo' is a derogatory term according to academic medicine. According to Dorland's dictionary, the placebo effect is "any dummy medical treatment; originally, a medicinal preparation having no specific pharmacological activity against the patient's illness. . ."(1). In other words, the placebo effect is something non-specific which cannot be explained by pharmacology, or other medical sciences. Placebo treatment is therefore non-scientific, and even unethical because its effect is obscure and may harm the patient. Since the placebo effect does not fit into the framework of medical disciplines, e.g., pharmacology or biochemistry, why not create a new discipline, placebology, and study it scientifically? (2). Such shortcomings hinder academic medicine from appreciating what "placebo providers", like homeopaths, actually do. Academic medicine and homeopathy belong to two different thought-styles (3). A clinician can appreciate homeopathy only if operating within its thought-style, as many physicians are doing so successfully, since some of its messages are extremely valuable.
Samuel Hahnemann - Samuel Hahnemann, the founder of homeopathy, was born in 1755 in a small town in Germany. He started his career as an academic physician. He studied at the Universities of Leipzig, Vienna and Erlangen at a time when academic medicine advcocated treatments that seem to us appalling, e.g., bloodletting, cathartics, leeches, and toxic chemicals. Realizing the danger of these methods, Hahnemann stopped practising medicine for a while, and resumed it when his children became sick (4). He was first to introduce experimentation to medicine, mainly to explore the Law of Similars of Hippocrates. Hahnemann coined it "similia similibus curentur", or "like cures like" . "Any substance which can produce a totality of symptoms in a healthy human being can cure that totality of symptoms in a sick human being" (5). This is also the root of the name homeopathy: "homeo"- similar, and "pathos"- suffering. Traditional medicine is called allopathy ("other" and "suffering").
Homeopathy and allopathy - While allopathy studies disease, homeopathy is the science of health. Hahnemann's ideas were too advanced for his contemporaries, as they still are today. The sweeping success of modern medicine pushed his ideas into oblivion. Physicians like Claude Bernard, Virchow, Koch and Pasteur paved the way for the medicine of diseases, and allopathy won. Yet this approach is gradually exhausting itself. Medicine is puzzled by profound conceptual dilemmas and searches for new ideas to solve them. Homeopathy has some answers. The great success of allopathy is linked with the advancement of the exact sciences. Technology has introduced into medicine new means to study disease, and the appeal of reductionistic philosophy. Diseases are no more than genetic aberrations which will ultimately be corrected by molecular engineering. Genome mapping is therefore essential for understanding disease.
Diseases evolve - On the other hand, are diseases real entities like atoms and molecules, that can be uniquely defined? Diseases continuously evolve and change their manifestations. Are they real entities, or ways to communicate between practising physicians? Ludwik Fleck believed that diseases do not exist in nature but are constructed by physicians for didactic reasons (3, 6, 7). Diseases do not exist as such, there are only sick people; and yet our education systems produce mainly disease specialists. Technology has also revealed that diseases evolve. While ancient diseases fell upon the patient, modern diseases emerge. They start as small aberrations without clinical manifestations, while the patient feels healthy. When he feels ill, disease starts its clinical course. Advancing technology reveals more and more pre-clinical aberrations, and medicine lacks clear guidelines for dealing with them. To wait until they become more pronounced is generally regarded as malpractice. Medicine presumes that the traditional guideline "primum non nocere" results from ignorance and helplessness, and should not be practised. Yet technological innovations endow this concept with a new meaning, e.g., "Do not harm, and don't interfere until the aberration ripens for treatment". Lacking clear criteria about when to intervene, medicine tends to treat whenever an aberration is detected. Some treatments are clearly unnecessary, and yet the specialist cannot refrain from treating, since "primum non nocere" is forbidden. At best, treatment is justified as a preventive measure.
Health - Although medicine is concerned with health, its exact meaning is not clear. Actually, medicine is more interested in non-health, known as disease. Yet not every disease should be regarded as non-health. Many young adults carry in their arteries arteriosclerotic plaques without any apparent health deterioration. Are these plaques non-health and should they be treated? Obviously health and disease are not complementary. How should we handle diseases that do not impinge upon health? Since disease and non-health are not synonyms, the definition of non-health ought to be independent of the definition of disease. Medicine needs means to measure health: a scale of health that might assist the clinician to distinguish between aberrations that require treatment, and those that should be left alone. Similar arguments lead Hahnemann to create his science of health, homeopathy.
Organon of Medicine - Homeopathy is like a sleeping beauty which missed the exciting developments in medicine and science during the last 150 years. Its bible, The Organon of Medicine (8), written by Hahnemann applies concepts of the 18th century. It is concerned with an outdated allopathy that no longer exists. Homeopathy is waiting to be rejuvenated in a modern form, which was attempted by Vithoulkas (4). "The Science of Homeopathy" applies the language of physics to explain homeopathy. Unfortunately, the physical models applied by Vithoulkas are too simplistic and fail to convey its depth. He would do better to adopt the concept of state. The state of the organism consists of several dimensions: 1. Mental, emotional, and physical, and 2. Predisposition to disease, or miasma, that includes: psoric, syphilitic and sycotic miasms. Each dimension is structured into levels or planes. This multi-dimensional organism functions as a whole and cannot be understood otherwise. At birth, the organism is endowed with a vital force, "that connects the individual with the ultimate Unity of the universe" (9), as conceived by the philosophy of "vitalism". It is an external force that unites the universe. It "behaves in an analogous way to the electromagnetic fields" that also permeate the universe (10). The organism is also endowed with a defense mechanism that depends on its state. Morbific stimuli interact with the organism and change its state. Each state is susceptible to different diseases and resistant to others."Most morbific stimuli are managed successfully by the vital force without producing symptoms. If the morbific stimulus is stronger than the defensive mechanism" the organism enters a new state (11). "Diseases are nothing more than alterations in the state of health of the healthy individual which express themselves by morbid signs." (12).
"When a person falls ill, it is only this . .vital force, everywhere present in his organism, that is primarily deranged" (13). Illness affects the vital energy of the organism (14).
Diagnosis and treatment - At each state the individual is susceptible to certain morbific agents and resistant to others. Each state of the organism can be evoked by a combination of drugs, a process that is called "proving". The compendium of all states and their evoking agents is called Materia Medica. In order to treat properly, the homeopath evaluates the state of the patient and uses the drug listed in the Materia Medica that evoked a similar state in a healthy individual. This drug is then applied in a highly diluted form, which is the essence of "Like cures like". Treatment changes the patient's state and has to be modified accordingly so as to obey the "like cures like" principle. In summary, homeopathy studies two basic phenomena of medicine, which are still ignored by academic medicine: health, and the placebo effect. Homeopathy is a theory of health and placebo. Diseases are not real entities. They serve as indicators of the state of the organism. This multi-dimensional state cannot be reduced to its elements. Homeopathy attempts to tackle the complexity of the organism but lacks modern means to achieve it. Unless it updates its theory it will not succed it.
Inconsistency of homeopathy - For 150 years, the theory of homeopathy remained frozen exactly as Hahnemann conceived it. Only its body of knowledge, the Materia Medica, grew. It still ignores the tremendous medical and scientific changes which have taken place and are relevant for correct treatment. It lacks means to handle acupuncture and Chinese medicine, that are practiced by many homeopaths theoretically. How does one apply "like cures like" to acupuncture? This inconsistency is conspicuous among trained physicians-homeopaths, who are overwhelmed by alternative medicine, and its useful methods (15). Every physician carries a secret bag of miraculous drugs and rules of thumb, that work wonders, while theory is lacking. The time has come to open academic institutions and let alternative medicine in. To enlarge medical practice by a modern theory of medicine that will embrace all treatment modalities.
G. Zajicek
1 Dorland's Medical Dictionary. 27th Edition. W.B. Saunders Co. Philadelphia, 1988.
2 Zajicek G. Placebo effect is the healing force of Nature. Cancer J. 1995 8, in press.
3 Zajicek G. Ludwik Fleck: Founder of the philosophy of modern medicine, Cancer J. 5, 304-305, 1992.
4 Vithoulkas G. The science of homeopathy.
Thorsons, Hammersmiths London, 1981 p. 95.
5 Vithoulkas G. ibid. p. 92.
6 Fleck L. Genesis and development of a scientific fact., The University of Chicago Press, Chicago USA, 1977.
7 Cognition and fact. Materials on Ludwik Fleck. Cohen R.S. and Schnelle T. Eds. , D. Reidel Publishing Co, Boston, USA, 1986.
8 Hahnemann S. Organon of Medicine, translated by W. Boerrricke. Indian edition, Indian Books, P.O. Box 2524, Karol Bagh, New Delhi.
9 Vithoulkas G. ibid. p. 59.
10 Vithoulkas G. ibid. p. 75.
11 Vithoulkas G. ibid. p. 86.
12 Hahnemann S. ibid. p. 103.
13 Hahnemann S. ibid. p. 96.
14 Hahnemann S. ibid. p. 99.
15 Burton Goldberg Group. Alternative Medicine., Future Medicine Publishing, Inc. Puyallup, Washington, 1993.