Friday, July 6, 2012

Putting Homeopathy in a Historical Context Part 4

Welcome to the conclusion of a long series on homeopathy. We’ve talked about the practice of medicine in the 17th century, homeopathy’s empirically-based beginnings, some of the field’s more difficult concepts, and why it held so much appeal in the 18th century. What a wild ride it’s been.

The Early 20th Century

In 1900, homeopathy was still riding high, and in fact, a monument was built just a few blocks from the White House in Washington, DC, to honor the contribution that Samuel Hahnemann had made to the practice of medicine. President William McKinley was the guest of honor at the monument’s dedication.

Ten years later, Abraham Flexner issued a report on medical education in the United States with endorsement from the Carnegie Foundation. The report urged medical schools to adopt stricter admissions standards, place stronger emphasis on scientific education, and lengthen training. These recommended changes are now standard in all doctoral-level clinical degree programs (MD, DO, ND), and have lead to an increase in quality of education. However, though the long-term benefits have been great, the short-term results were devastating. Many, many medical schools were forced to shut their doors – naturopathic medical schools, osteopathic medical schools, chiropractic schools, and homeopathic medical schools were especially hard hit, but the number of institutions granting MDs was cut in half in the two decades following the Flexner Report, and the number of MDs graduating each year decreased nearly by half. Additionally, in the wake of the report there was a decrease in women, racial and ethnic minorities, and people of lower socioeconomic status entering the medical profession, reversing a trend that had been underway throughout the 19th century. The quality of medical education went up, but so did the price of education, and so the number of providers went down.

So homeopathy, like many other medical fields, was crushed. The osteopaths and chiropractors were slowly able to regain their strength throughout the 20th century, and the naturopathic profession was eventually able to regain a foothold and come roaring back in the late 20th century, but the homeopaths really suffered, and have never been able to regain the strength they once held.

As it was a movement driven by physicians seeking a pragmatic approach, pragmatism was also the downfall of homeopathy. It was harder to learn homeopathy, and so it lost some adherents, and certainly new practitioners. Additionally, in the age of rampant infectious disease, the allure of homeopathy was undercut by the invention of antibiotics in the early 20th century. Obviously, chronic diseases did exist in the early 20th century, but the biggest health problem was infectious disease, and the invention of antibiotics offered a solution that was beyond belief. If the identification of infectious organisms was revolutionary in the world of medicine, the development of antibiotics was earth-shattering. Additionally, the development of novel vaccinations was similarly staggering. In a world in which even the President wasn’t immune to polio or other infectious diseases, these advances were awe-inspiring. If homeopathy offered order and methodical practice in the Enlightenment, pharmacology was the medicine that gained ascendancy in the technologically-minded 20th century. It offered the promise of a brave new world that homeopathy simply couldn’t compete against.

A Revival in the 1970’s

There were few homeopaths still in practice in the early 1970s. I’ve heard those stragglers compared to The Mystics from the movie The Dark Crystal – wizards of nature who engaged in the dusty, arcane rituals of a forgotten age. Had things continued on the same course, homeopathy would likely have been a footnote in the history of medicine, forgotten and ignored. Instead, it’s a bit of a hot button issue, especially in certain circles. This status comes largely from homeopathy’s revival in the mid-1970s. Let’s look at the historical how and why.

As I said, in the 1970s, homeopathy was largely consigned to libraries and not active practice. However, the 1970s were also a time of rediscovery and exploration in America, and especially in California. The Bay Area was a hotbed of experimentation, and just about everything was an alternative to how things were done elsewhere. Radical politics, communal living arrangements, and new age spirituality were the milieu in which homeopathy re-emerged.

Homeopathy had a strong mind in the form of George Vithoulkas, a Greek homeopath who had gained quite a reputation for his clinical skill. Much in the same way that their colleagues were travelling to India to learn from gurus, a number of Californians would travel to Greece to learn from Vithoulkas and bring his teaching back to the Bay Area. However, the context they came from and brought their lessons back to redefined homeopathy significantly – it was now truly ‘alternative’ medicine. Homeopathy as it came to be practiced was now consciously and deliberately separate from the general practice of medicine, and indeed opposed to it at many points.

The conflict between homeopathy and general medical practice is as much a cultural dispute as scientific. Homeopathy became its modern self in a specific context, and though homeopathy has grown and changed in the last 40 years, it has ever since born the stamp of being ‘alternative’, as well as retained some unique ‘Californian’ attributes. Modern homeopathy, in the broadest sense, is heavily informed by new age views of the mind and the universe, by a suspicion of scientific practice, and by counter-cultural attitudes. Gone is the emphasis that Hahnemann (and 19th century physicians) placed on experimentation and empirical evidence, it having been replaced by intuition and (if I can say so myself) somewhat sloppy thinking. In fact, some of the practices that Hahnemann specifically railed against have re-emerged in homeopathy. It’s worth noting that George Vithoulkas (an engineer by training) has disowned much of what has happened in the homeopathic revival that he is in part responsible for.

So contemporary homeopathy was created in the context of ‘alternative’ medicine and counter-culture – a very different context than the one that Hahnemann was working in. The disputes between conventional medicine and homeopathy have to be understood through the lens of the history that it takes place in; given that contemporary homeopathy is based on a rejection of conventional medical thought, are we surprised that there’s conflict?


Though this series has been long, I’ll try to keep the conclusion short. I’ve endeavored to show that homeopathy has deep roots, and bears more resemblance to modern medicine than many docs would care to admit. In most ways, homeopathy prefigured modern scientific medicine. That said, it’s gotten significantly off-track, as its reinvention has taken it far from its prior forms.

The final question I’ll ask is this: Is there a place for homeopathy in our modern world?

I think the answer is yes. In Hahnemann’s time, infectious disease and acute illnesses were the most important problems physicians had to tackle. Homeopathy evolved to treat these illnesses, but was eclipsed when we discovered bacteria, and more specifically, how to kill them. Now, though, we are facing different challenges – we’re facing chronic diseases, mental health problems, and other issues that are multi-factorial in origin. When you’re dealing with a disease that has a single discrete cause, it’s easier to devise a cure – this is the medicine of bacteria and antibiotics. However, when you’re dealing with something that has no clear cause, things get much more complicated. Many contemporary drugs alleviate symptoms, but don’t cure (at least not in the finite way that antibiotics cure infections). In a previous post, I discussed the appropriate and inappropriate use of homeopathy, but I’ll go on record as saying that homeopathy has an important role to play in the management of chronic disease. Given that most drugs are designed to reduce symptoms, not cure the disease, I think it’s important to consider treatment through non-pharmacologic means when the circumstances permit – this is in line with my interpretation of primum non nocere.

That said, the practice of homeopathic medicine must regain its strong tradition of documented experimentation. Scientific endeavor was one of the founding principles of homeopathy, but it’s been lost as the recent generation has picked up homeopathy as a new-age, non-scientific practice. Old medicines need to be re-evaluated, new medicines need to be examined, and the testing process needs to be given a modern make-over.

To look at it, homeopathy is a pretty darn ugly duckling. It’s got a long neck, weirdly-colored down, and it’s a bit ungainly on land. Even so, I think it could become quite a magnificent creature – it just needs some help growing up.

(As in the first of this series, I’d like to thank my teachers Dr Paul Herscu and Amy Rothenberg of the New England School of Homeopathy.)