The Causes of Failure in Homeopathy
by Dr. André Saine, D.C., N.D., F.C.A.H.
The following talk was presented at the Nash Conference in New York City, September 9, 2000.
Homeopathy is becoming more and more popular. More and more people espouse the profession of homeopathy. At first glance we could suppose that this current rapid growth of homeopathy is progress.
However, we cannot evaluate the health of a profession by the number of its adherents. We just have to consider the fact that the number of homeopaths in the U.S. went from several thousands 100 years ago to a few dozen fifty years later. Numbers and enthusiasm are not signs of progress forward. In reality, we have to look at the quality of the work done and its subsequent success.
The real question to evaluate the health of our profession is how successful are we in the practice of homeopathy? How well do we practice homeopathy? Have we yet reached the promised land predicted by Hahnemann?
The history of homeopathy provides us with a good gauge to evaluate the status of our profession. It has been so far very clear throughout the history of homeopathy that the further we diverge from the fundamental principles of homeopathy as taught by Hahnemann, the least success we should expect in practice.
Our present generation is characterized by great enthusiasm for homeopathy and unfortunately at the same time great divergence from the basic principles of homeopathy. And this cannot be termed progress forward. Before we examine the causes of failure let's first examine some of the parameters of homeopathy.
The first parameter we are going to examine is the scope of the law of similars. (The word parameter is very appropriate for our examination of the law of similars, as the word parameter borrowed from mathematics means a constant whose value varies with the circumstances of its application.)
- When we homeopaths declare that the law of similars is the law of healing, what are we saying?
(The word healing literally means to become whole, or to become sound, well or healthy again.)
- Are we saying that all healing depends upon the law of similars?
- Are we saying that everyone that is sick will recover his or her health through homeopathy?
Not really. For healing to happen many factors are at play and any of them can go wrong. Also there are many different aspects to healing.
Therefore which healing is related to the law of similars?
The healing associated with the law of similars has two principal characteristics:
- The first one is that the law of similars is applicable in all cases where the causes of sickness are due to an inadequacy of the vital force.
(Inadequacy: not being sufficient for a certain purpose)
- The second characteristic of healing with the law of similars is that the healing is limited to capacity of the vital force to heal.
What is curable in Nature is curable with homeopathy if the cause of sickness is related to an inadequacy of the vital force. It would be false expectations to try to address health problems not related to an inadequacy of the vital force.
An obvious example illustrating this situation would be to attempt to heal with homeopathy someone presenting with a full-blown case of scurvy due to a completely inadequate diet. The patient's response to homeopathy can only be partial because the primary cause of the ill health is not related to an inadequacy of the vital force.
Now let's assume that our patient has a problem which is primarily related to an inadequacy of the vital force. The patient can therefore potentially be healed with homeopathy. Let's say a patient presents with, among other conditions, a chronic inflammatory condition such as M.S., or R.A. or Lupus.
We know by experience that these types of inflammatory conditions can disappear with homeopathy and the patient can recover their health, but it is unlikely that the recovery would be complete.
Why? Because the end point of inflammation is tissue destruction and/or scar tissue and there is a limit to the capacity of the vital force to heal, to return tissue to wholeness. Our experience as homeopaths is that what is potentially curable in Nature, is curable with homeopathy (as long as it is related to a primary inadequacy of the vital force). For instance, the destruction of the substantia nigra found in someone having Parkinson's is known to be irreversible in Nature therefore irreversible with homeopathy.
Again we are not dealing with failure of the law of similars but rather with wrong expectations, wrong expectations of the capacity of the vital force to heal.
Now let's assume that we have a case in which the primary cause of ill health is an inadequacy of the vital force and that the disease process is reversible in Nature. Potentially this case would be totally curable with homeopathy. From the potential of being curable to the actual cure many factors will enter nto play. And any of these factors could go wrong. Right, Murphy? Now let's examine some of these factors.
One of the greatest sources of failure is a "defective" patient. This is the patient who does not properly communicate his symptoms to the homeopath. It could be related to one's culture, to lack of self-awareness, to inadequate use of language, shyness, etc., or it could be related to a non-compliant patient.
Another great source of failure would be patients having a "defective" disease related to an apparent paucity of symptoms (ORGANON Paragraph 172).
What other major cause of failure exists besides the ones already mentioned? In fact, the greatest source of failure of all in homeopathy is the "defective" physician.
If we had to evaluate the success of individual homeopathic practitioners with more than a few years of experience we find out that the range of success varies greatly between about 20 and 85 %. What is the reason for such a big gap? We find out that success in practice greatly depends on the knowledge, skills, method, tools and experience of each individual practitioner.
Up to 80% of our failures are related to the physician himself:
- 40% - Defective case taking
- 15% - Defective case analysis
- 10% - Difficulty searching the materia medica
- 10% - Defective tools
- 10% - Defective patient
- 5% - Defective diseases
- 5% - Wrong assessment on the follow-up
- 5% - Incurable cases
But why does the rate of success vary so much from one physician to the next? When we study the history of homeopathy we realize with great astonishment that of the many thousands of homeopathic physicians very few mastered their discipline. It is well recognized that aside from Hahnemann, the two physicians who obtained the greatest success in homeopathy were Lippe and Bnninghausen. We can say that they have both reached the promised land of homeopathy. Other great prescribers of our school would include P. P. Wells, H. N. Guernsey, Carroll Dunham and Constantine Hering.
Now let's examine what was common to all these great practitioners.
They were all Hahnemannians. They all practiced pure homeopathy, the homeopathy of Hahnemann. They all confirmed that the most successful way of practicing homeopathy is the Hahnemannian way. But what made them better than the other Hahnemannians? There are two keys common to the success of these masters. The first one is constant study of the writings of Hahnemann. It seems that the more they studied Hahnemann and understood his genius the greater was their success.
When Bnninghausen died in 1864 Lippe wrote in his memorial that after Hahnemann's death, Bnninghausen studied all of Hahnemann's writings, and by these "he became still more penetrated by and convinced of the truth of Hahnemann's observation and the great work accomplished by him."
It was similar with Lippe. He kept studying the work of Hahnemann to deepen his understanding. He read the Organon once or twice a year and in 1883 he said that "It is now over 50 years since I first read the Organon. I just begin to comprehend it." (CMA 1883; 14: 337.) The road to success is very narrow in homeopathy. These masters stayed on the path. They let Hahnemann lead them to success.
The second key of success of these masters was that they were all great students of the materia medica. The more they studied the materia medica the better prescribers they became.
Let's look again at the first point. Essentially the more these physicians understood the Hahnemannian method the more they mastered homeopathy. What Lippe once said is very characteristic of the path followed by the ones who mastered homeopathy: "Let us read the Organon, and be governed by its elementary and fundamental principles." (Hahnemannian Monthly 1875; 10: 393.)
What are the key steps of the method of Hahnemann? Let's look at the most important:
The two key qualitative aspects to every step of the Hahnemannian method are:
- In order to cure Hahnemann says first we must make a careful and thorough examination of the patient.
In the Organon, which is a blueprint of the classic way of practicing medicine, Hahnemann dedicates a large section to this aspect. In paragraph 3 he says the first prerequisite for success is to find out what needs to be cured. (The physician to be successful must first "clearly perceive what has to be cured in disease, i.e., in each individual case of disease.")
In paragraph 71 he asks how do we investigate about the disease in order to cure. Hahnemann proceeds in the following 32 paragraphs to instruct on this matter. It is the classic description of the examination of the patient. ("How does the physician ascertain what he needs to know about diseases in order to cure them?" He then proceeds to tell us in paragraphs 72 to 104.)
- Then he asks us to know about the disease producing capacity of each individual medicine. Again in paragraph 3 Hahnemann says the physician must clearly perceive what in medicine heals, i.e., in each individual medicine. In paragraph 71 he asks the question "How does he investigate the pathogenetic power of medicines, the instruments provided for curing natural diseases?" He then proceeds to tell us in paragraphs 105-145.
- Next we need to know how to prescribe successfully. In paragraph 3 he says the physician needs to know how to use these proved medicines and in paragraph 71 he asked the pertinent question how to use them. He then proceeds in paragraphs 146-285 to instruct on how to use the medicines in the most effective way, which is essentially the single remedy in an optimal posology.
- Avoidance of concurrent palliative treatment.
- Attention to the patient's hygiene. (Paragraph 3: "and, lastly, if in each individual case he knows the obstacles to cure and how to remove them, so that recovery is permanent, then he knows how to treat thouroughly and efficaciously, and is a true physician." or paragraph 7-a: "It is obvious that every reasonable physician will first of all remove the causa occasionalis;")
- Constant and strict individualization (Para. 82). Individualization at all times in the selection and administration of the remedy.
- Complete objectivity. Meaning total objectivity in our examination of the patient, in conducting of provings and in the selection of the remedy.
As he would say, "In order accurately to perceive what is to be observed in patients, we should direct all our thoughts upon the matter we have in hand, come out of ourselves, as it were, and fasten ourselves, so to speak, with all our powers of concentration upon it, in order that nothing that is actually present, that has to do with the subject, and that can be ascertained by all the senses, may escape us.
"Poetic fancy, fantastic wit and speculation, must for the time be suspended, and all over-strained reasoning, forced interpretation and tendency to explain away things must be suppressed. The duty of the observer is only to take notice of the phenomena and their course; his attention should be on the watch, not only that nothing actually present escape his observation, but that also what he observes be understood exactly as it is." (The Medical Observer. Materia Medica Pura Vol. II.)
Now lets examine where does the current generation of homeopath fail? The first and most obvious one is lack of thoroughness in case taking.
How often have I heard that in front of a class or seminar a teacher has taken the case of a patient with a chronic disease in 15 or 20 minutes. When I was in school we were taught to take a case in an hour as the consultation rooms in the teaching clinic were available for an hour at a time. When I came out of school I noticed that I would take 1 1/2 hours to take a case. Then it became 2 hours. Now that I am dealing almost exclusively with very serious cases it takes me on the average about 3 hours. But cases of 4 or 5 hours are not unusual.
Let me tell you an anecdote illustrating this point: In January of this year I saw a patient suffering from a chronic disease of 15 years duration. She had consulted five other homeopaths during the previous 14 years before consulting me. Three of them were teachers of homeopathy, two from Europe and one from here in America. She traveled a lot, crossing often the continent for a 20 minute follow up visit and needless to stay spent a fortune trying to regain her health, but to no avail. In fourteen years of homeopathic treatment she received about fifty different remedies some in many potencies but without success.
I took her case which took me over five hours before I was satisfied that I had taken a complete case and had obtained a clear picture of the remedy, which by the way became confirmed only in the last hour of the five or so hours of case taking. Over the years the patient herself became interested in homeopathy and studied the materia medica. Before I prescribed she said to me "Is my remedy Natrum muriaticum?" I replied that I was quite certain that Natrum muriaticum was the most similar remedy to her condition. I prescribed this remedy and our faithful patient immediately responded curatively to the remedy as if by magic and has continued to do so ever since.
There are two interesting aspects to this story. The first one is that she had asked the last practitioner she saw, a very experienced and prominent homeopath on the West coast whether her remedy could be Natrum muriaticum. He responded that Natrum muriaticum was not at all indicated in her case and instead he prescribed a remedy having no reliable proving. It is no wonder that if teachers miss such a clear case we can not expect better of their students.
The second interesting point of this story is I asked her to tell me how much time each practitioner took to take the initial case. Her answer was that the least experienced took 2 hours while the others took between 1 and 1 1/2 hours. It was obvious to both of us that no one could have ever obtained a good picture of her case in 2 hours or less.
Let me tell you another anecdote. Recently I saw a man with a terminal lung condition. After realizing the impotence of conventional medicine to help him he sought alternatives. He sought a special clinic in Germany where three homeopathic doctors took his case. He told me that they spent about four hours to take his case. The strange aspect about this is that they didn't investigate his lung disease or his other physical complaints but limited the interrogation to his personality and his childhood. Needless to say that after two years of "homeopathic treatment" he didn't notice any improvement, just constant deterioration of his condition. This misrepresentation of homeopathy does not help our cause or the sick. One of the fundamental aspects of homeopathy is thoroughness in case taking which means getting the totality of symptoms in each and every case. The principle of prescribing on the totality of symptoms becomes meaningless unless each case has been thoroughly taken, which nowadays seems to be very rare. About fifty percent of the patients I see have been previously treated with homeopathy. Unless the case is referred to me by one of my students, I rarely notice that their case has been well taken. And this in spite of the fact that these cases have often been treated by very well known homeopathic practitioners and teachers of our current generation.
2- The second cause of failure would be using unreliable materia medica.
How often have I heard of "pretend" homeopaths doing provings by putting the remedy under the pillow or of considering part of the proving the symptoms occurring up to two weeks prior to taking the remedy, or to include in the provings the symptoms of the people surrounding the provers. Most of the current teachings on materia medica have little to do with carefully carried out provings and clinical observations. Instead it is often replaced by the free flowing imaginations, opinions, interpretations and poetic fancies of their authors.
Have these teachers not read the first paragraph of Hahnemann's favorite paper, "The Genius of the Homeopathic Healing Art", which says, "It is impossible to guess at the internal nature of diseases, and at what is secretly changed by nature in the organism, and it is folly to attempt to base the cure of them on such guess-work and such proportions; it is impossible to divine the healing-power of medicines according to chemical hypothesis or from their colours, smell, or taste; and it is a folly to use these substances for the cure of diseases based on such hypotheses and such propositions."
Have these teachers forgotten to read paragraph 144 of the Organon:
"All conjecture, everything merely asserted or entirely fabricated, must be completely excluded from such a materia medica: everything must be the pure language of nature carefully and honestly interrogated."
Or the footnote to paragraph 285 (a):
"It is a cardinal principle that distinguishes the homeopathic physician from all so-called physicians of the old school that he never uses on any of his patients a medicine whose pathological effects he has not previously determined by careful proving on the healthy."
Or in the introduction to Camphora:
Camphora "must have a sort of general pathological action, which, however, we are unable to indicate by any general expression; nor can we even attempt to do so for fear of straying into the domain of shadows, where knowledge and observation cease, whilst imagination deceives us into accepting dreams as truth; where we, in short, abandoned by the guiding of plain experience, grope about in the dark, and with every desire to penetrate into the inner essence of things, about which little minds so presumptuously dogmatize, we gain nothing by such hyperphysical speculations but noxious error and self deception."
Another interesting anecdote on this subject relates to P. P. Well. When he first started to study homeopathy in 1841 Hahnemann's materia medica had not yet been translated so he had to first learn German to read Hahnemann. About forty years later when asked by a younger colleague which materia medica should he studied he answered Hahnemann's Chronic Diseases and Materia Medica Pura. When the student asked "What else?", Wells answered, "That is enough."
At the bottom of all this development and use of unreliable materia medica is the lack of understanding of the strict inductive method of Hahnemann which essentially consists in finding the truth through the most careful observation and meticulous experimentation. It consists of deriving principles from facts as compared to the common deductive approach which consists of using your imagination, opinions, hypotheses, suppositions, poetic fancies, extrapolation to constantly interpret what is partially observed. There is a French historian of science who wrote a book on the history of errors in science. The tittle of the book is "I Think Therefore I am Wrong".
3- Poor knowledge of basic sciences:
The more you practice with very sick patients, the more you realize that this work cannot be done properly without a thorough knowledge of anatomy, physiology, pathology, ethology, psychology and other biological sciences. The less you know about these basic sciences the more difficult it will be to develop accurate clinical judgement, and therefore the greater will be the mistakes and the more time and life will be wasted. It is a great delusion to pretend to practice homeopathy without a sound knowledge of the basic and diagnostic sciences. Lippe, the best prescriber of our school, often repeated that the more one knows about pathology the better homeopath he can become.
Today we are pumping people out of school with very little knowledge of how to conduct a thorough physical exam of the patient and with insufficient knowledge of basic sciences. The more one is ignorant of physiology and pathology the greater will be the mistakes in evaluating the symptoms which is totally crucial in determining the most similar remedy. This is because we prescribe on peculiar symptoms, not on symptoms common to a disease. If you don't know which symptoms are common, how can you know which are peculiar? Without that crucial knowledge, judgement becomes even more difficult. What Hippocrates said 2500 years ago still holds, "the art is long, life is short and judgment is difficult".
In order to really fulfill the promise of homeopathy, here are solutions to our current difficulties:
- Rediscovering the strict inductive method of Hahnemann. Read Hahnemann, Lippe, Bnninghausen, P. P. Wells, Dunham. Never forget the last admonition of Hering to the profession: "If our school ever gives up the strict inductive method of Hahnemann, we are lost, and deserve only to be mentioned as a caricature in the history of medicine."
- Rediscovering the basics in taking a thorough case as instructed by Hahnemann.
- Rediscovering the study and use of the reliable works of materia medica. The rest needs to be sent to the paper shredder, as Lippe often said when referring to the unreliable texts.
- Obtaining the necessary knowledge in basic sciences of anatomy, physiology, pathology, differential diagnosis, etc.
Before taking your questions and comments, which I warmly invite you to do, I will leave you on this little story: Once towards the end of a meeting of the International Hahnemannian Association, Kent who was the President for that year, saw P. P. Wells in the back of the room get up to go catch his train and interrupted the meeting to ask him for a few words of advice for the coming twelve months, and Wells said: "The great principles of the greatest master of healing that ever lived should be just those that we would take into our hearts, stick to them, defend them, and practice upon them, and live them, and we are sure in the end to live by and by a life which will be a life full of usefulness."
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