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31
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This is to certify that the

thesis entitled

PATIENT OR CURE?
HOMEOPATHY AND THE AMERICAN HEALTH CARE SYSTEM

presented by
Liisa Marie Randall

has been accepted towards fulfillment
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PATIENT OR CURE?
HOMEOPATHY AND THE AMERICAN HEALTH CARE SYSTEM

By

Liisa Marie Randall

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS
Department of Anthropology
1990

“tot

\er

C90

ABSTRACT

PATIENT OR CURE?
HOMEOPATHY AND THE AMERICAN HEALTH CARE SYSTEM

By
Liisa Marie Randall

Homeopathy is a therapeutic system which gained great popularity in 19th century
Europe and America. Although homeopathy nearly disappeared from the American
health care scene by the 1930’s, it is cunently experiencing a resurgence in popularity.
The success of a health care system in fulfilling its primary goal of healing the patient
depends upon the degree of cognitive and communicative agreement which exists
between the patient and practitioner. The major findings of this research were obtained
through interviews with allopathic and homeopathic patients, practitioners and medical
students and a review of relevant historical and ethnographic sources. The findings
suggest that individuals who use homeopathy understand sickness differently than those
who utilize allopathy; that individuals who use homeopathy do so more for the
therapeutic relationship which is established with the practitioner than for the treatments
it administers; and that successful homeopathic treatment depends upon an effective

therapeutic relationship.

Copyright by Liisa Marie Randall 1990

All Rights Reserved

 

ACKNOWLEDGEMENTS

There are a number of individuals who have provided me with guidance and
support throughout this research. I would like to thank Judy Pugh and Lou Snow, my
guidance committee, for their insight and conceptual contributions. Howard Brody
offered insightful critiques of earlier drafts of this paper which were instrumental in
shaping the final version. I am indebted to Jennifer Bryce for the time, energy, and
prodding with which she provided me during this research. This monograph would

have taken a much longer time to complete without her encouragement and support.

Other individuals who were instrumental in this effort include my friend Daniel
Monteith. Dan was a. constant resource intellectually and never tired of my attempts
to talk through ideas, experiences, joys and frustrations. He was also a source of
personal joy. My mother, Sheila, introduced me to homeopathy. She never doubted
my ability to complete this work and helped me to keep my perspective throughout the
thesis process. Without the support and encouragement of these individuals I may

never have persevered.

iv

TABLE OF CONTENTS

I OVERVIEW AND PRESENTATION OF THE STUDY ............. 1
Introduction .................................... l
Homeopathic Theory and Practice . ., ..................... 2_
I Understanding Sickness and the
Meaning of Symptoms ......................... 2
Principles of Homeopathy ....................... 4
Taking the Case ............................. 6
Purpose of the Study and Research Questions ............... 8
Theoretical Considerations ........................... 10
Summary ...................................... 15
II METHODOLOGY ..................................... 16
Setting ................ I ........................ 16
The Practitioners ................................. 16
The Patients .................................... 18
Organizing Findings and Analysis ....................... 20
Problems and Concerns ............................. 21
III HISTORICAL OVERVIEW ............................... 22
The Age of Heroic Medicine ......................... 22
Heroic Therapy .................................. 23

Allopathic Medical Education and

Professional Organization ............................ 25
The Founding of Homeopathy ......................... 26
Homeopathy in America ............................ 29
Professional Conflict ............................... 34
Flexner and the Fall of Homeopathy ..................... 37
IV HOMEOPATHY TODAY ................................ 41
Dissatisfaction with Allopathic Medicine .................. 41
Growth of Homeopathy in the United States ................ 42
Training and Certification of
Homeopathic Practitioners ............................ 43
Homeopathic Practice .............................. 54
Homeopathy and Allopathy ........................... 47
Relationship with the Allopathic
Establishment ............................... 47
Clinical Evaluation of Homeopathy ................. 51
Homeopathy as a Placebo Response ................. 54
V THE THERAPEUTIC ENCOUNTER ......................... 58
The Setting ..................................... 58
Profile of Homeopathic Patients ........................ 64
Reasons for Choosing Homeopathy ...................... 66
Dissatisfaction and Patemalism ........................ 72
Science ....................................... 75
Summary ...................................... 78
VI SUMMARY AND DISCUSSION ........................... 79

vi

GLOSSARY ............................................. 84
BIBLIOGRAPHY .......................................... 85

vii

CHAPTER I
OVERVIEW AND PRESENTATION OF THE STUDY

Introduction

Homeopathy is a health care system which was developed in the early 19th century by
Samuel Hahnemann, a German physician. Hahnemann’s goal was to develop a more
scientific and humane system of medicine than any that existed at the time.
Homeopathy was introduced to America around 1825. At this time there was
widespread revolt against the treatments and expense associated with ’heroic’ medicine.
Americans were already experimenting with a variety of systems of health care and
homeopathy was readily accepted. Unlike other systems, homeopathy rapidly gained
popularity among all segments of American society. Homeopathy came to pose a
major intellectual and economic challenge to the allopathic establishment. From the
middle 19th century to early 20th century, changes in American medical practice were

spurred by the battle fought between the homeopathic and allopathic eStablishments.

By the 1930’s homeopathy had largely disappeared from the American scene.
Advances in scientific medicine as well as changing American life-styles made
homeopathy a less desirable and acceptable form of health care. Since the mid-1970’s,
however, the United States has witnessed a substantial rise in the use of homeopathy

as an alternative to allopathic medicine. Homeopathic practitioners and patients cite

2
an interest in health promotion and maintenance, concern over drug iatrogenesis, danger
of invasive medical techniques, and cost as reasons for the current popularity of
homeopathy. More importantly, however, they cite a dissatisfaction with the allopathic
therapeutic encounter as the major reason for some individuals’ choice of homeopathic

u'eatment.

Homeopathic Theory and Practice

Understanding Sickness and the Meaning of Smptoms

According to the theoretical principles of homeopathy, the human body is a
dynamic organism which is constantly trying to maintain a state of equilibrium
(McGary 1985:92-93; Vithoulkas 1980:21). When the natural balance of the organism
is disturbed, sickness results and is indicated by symptoms such as pain, fever, cough,
irritability, depression or even cravings for certain types of food (Panos 1980215).
Sickness, according to homeopathic theory, represents the curative effort of the
organism. Because the organism is presumed to have the best possible response to an
underlying disturbance, sickness is beneficial. Homeopathy understands symptoms as

the "working of the cure" (Grossinger 1987:172).

Homeopathy, in theory, does not recognize pathogens such as bacteria or viruses
as causative agents of sickness. Rather, an organism’s resistance to a pathogen is
reduced by a sickness which is already in place (Coulter 1981:19; Grossinger 1987:172;
Korok 1985:844; Ullman 1988:158; Vithoulkas 1980:91). It is important to remember,

however, that the theory and philosophy of homeopathy were developed nearly a full

 

3
century before the discovery and acceptance of ’ germ theory’. The homeopathic
physicians of today are well educated in germ theory and recognize the role that certain
pathogens play in the causation and transmission of illness. While this is true, modern
homeopathic practitioners continue to assert the importance of homeopathic principles
in health promotion and health maintenance. Sickness, according to homeopathic theory,
cannot be overcome by the organism when "disturbing forces are so strong as to
overwhelm an organism’s ability to meet them and respond" (Weil 1983:73). Thus,
the aim of homeopathic treatment is not to remove or destroy a pathogen directly, but
to aid the organism in increasing its resistance to that pathogen as indicated by
symptoms experienced by the patient. This is accomplished through the adminisuation
of a highly specific individualized remedy known as the ’similimum’. Homeopathic
remedies work in concert with the body’s inherent immune and defense systems

(Ullman 1988zxviii).

Homeopathic practitioners assert that they are able to treat successfully a variety
of ailments with homeopathic remedies, either alone or in combination with diet and
nutritional counselling, advice on exercise or behavioral change or other forms of
therapy. Homeopathic practitioners claim they can successfully treat chronic conditions
such as rheumatoid arthritis or bronchitis, acute conditions such as pneumonia, and
emotional disturbances such as depression and anxiety. The type of ailments which my
consultants claimed to be able to treat successfully with homeopathy varied among
practitioners.

....Homeopathy treats mental symptoms very well [like] anxiety and

grief...[but] pathological problems like schizophrenia or manic depression
I won’t treat with homeopathy. I feel like they’ll do better with lithium.

4
I also won’t touch cancer. Things like that are more appropriately
treated by more orthodox means. I know that other practitioners who
will treat these illnesses homeopathically....
Homeopathic practitioners do not claim to be able to treat conditions which require
surgical intervention. According to one consultant, "Homeopathic remedies can help
reduce the need for surgery or can aid in the recovery of a patient after surgery".

Homeopathic practitioners recognize the value of surgical intervention in certain

situations.

Principles of Homeopathy

The word homeopathy has its origins in the Greek words homios (’similar’) and
pathos (’sickness’).‘ The Law of Similars is the foundation of homeopathic practice.
Simply stated, this is the ’like cures like’ rule.

A dynamic disease in the living economy of man is extinguished in a

permanent manner by another that is more powerful when the latter

(without being of the same species) bears a strong resemblance to it in

its mode of manifesting itself (Hahnemann 1974(1842):21, Cited in Kent

1979).

It was Hahnemann’s belief that a substance which produced a certain set of symptoms
when administered to a ’healthy’ person would cure a sick person, when administered
in very small doses, who exhibited that same set of symptoms. Hahnemann,

incidentally, did not claim to have discovered the concept of ’like cures like’. One of

the earliest accounts of this principle occurs around 400 B.C. in the writings of

 

lHahnemann coined the term ’allopathy’ to refer to the methods of treatment practiced
by the orthodox medical establishment of his time. The word ’allopathy’ has its origins in
the Greek words & (’opposite’) and pathos (’sickness’). Under allopathy, treatments are
administered which are intended to counteract symptoms. The word allopathy is still used
today to refer to scientific medicine.

5
Hippocrates, "Through the like, disease is produced and through the application of the
like, it is cured" (cited in Panos 1980:11).

The Law of Potentization or ’the infinitesimal dose’ is also a central tenet of
homeopathy. This law refers to the way in which a remedy is prepared Homeopathic
remedies are prepared by a method of successive dilutions of the crude substance with
alcohol and water followed by succussion (shaking):

The changes which take place in material substances, especially in

medicinal ones...when dissolved, through a long-continued shaking with

a non-medicinal fluid, are so incredible, that they approach the

miraculous....Not only...do these medicinal substances thereby develop

powers in a prodigious degree, but they also change their physico-
chemical demeanor in such a way [as to be] wholly invaluable to the

healing art (Hahnemann 1987(1835):246).

It was Hahnemann’s contention that the more a remedy was subjected to the process
of successive dilution and succussion, the more therapeutically powerful it became.
Thus, more powerful remedies were those which had been diluted to a greater degree
by this method of preparation. Hahnemann believed that a remedy prepared in this

way became more powerful due to the fact that the energy field of the crude substance

had been "dynamized" by the preparation process (Weil 1983:18).

The Lag of Proving is the final tenet of homeopathy to be explained. This law
refers to the method by which various animal (including human), vegetable and mineral
substances used as homeopathic remedies are tested in order to determine their
therapeutic effects. The ’traditional’ method of proving involves administration of a

homeopathically prepared substance to a group of ’healthy’ subjects daily, for a period

6
of several days. All symptoms, both physical and psychosocial, reported by patients
and the context in which such symptoms are experienced are recorded. Once a
proving has been completed, symptoms which have been consistently reported by all
members of the proving sample are listed as the characteristic "remedy picture" in the
materia medica, the homeopathic practitioner’s reference. It was this method by which
Hahnemann and his disciples "proved" remedies. Homeopathic provings are still
conducted today but generally adhere to, the standard randomized, double-blind,
placebo-controlled method. Examples and discussions of contemporary provings are

provided in the section on Clinical Evaluation of Homeona_th_y.

Taking the Case

The homeopathic patient-practitioner relationship is fundamentally different than
that which exists between the allopathic physician and patient. The preliminary
examination of a homeopathic patient (weight, temperature, blood pressure) is not
performed by a nurse or other para-professional in homeopathic practices as is
characteristic of allopathic practices. In fact, the homeopathic practitioners I interviewed
do not even perform such a preliminary examination. Instead, a patient spends the
entire appointment time in direct interaction with the physician. Rather than physically
examine the patient and collect pertinent somatic data, the homeopathic practitioner
elicits as many possible somatic and psychosocial complaints as possible from the

patient.

7

Homeopathic theory asserts that each case of illness is unique (Maretzki
1985:394). Thus, treatment must be highly individualized. It is the task of the
homeopathic practitioner to select a similimum which matches as closely as possible
the symptom complex presented by the patient. Twenty-five individuals, each suffering
from what we might call a ’cold’, could all receive different remedies if their symptom
complexes were different. The homeopathic practitioner relies extensively upon
information provided by the patient. Patients present to the homeopathic practitioner

that information about their sickness which they regard as most important.

In ’taking the case’, it is imperative that the homeopathic practitioner make a
careful and detailed record of patients’ case histories. The homeopath must pay very
close attention to what patients say about their sicknesses and the way in which they
say it. The homeopath should also record what the patient says in the patient’s own
words (Blackie 1976:63). The symptom picture which the homeopath seeks to
construct can be considered to be highly subjective. For example, the practitioner is
not interested only in whether or not the patient’s appetite has changed but how it
has changed -- is it greater/less than usual? Is the patient upset by certain foods and
if so is this unusual? Does the patient crave certain types of foods? With respect
to feelings and changes in affect, the homeopath is not concerned merely with whether
a patient is feeling depressed lately but whether the patient has been feeling
particularly greedy, quanelsome, deceitful, rude, or even averse to being touched.
Furthermore, the homeopath is interested in discovering in what context these feelings

are experienced A homeopathic practitioner is concerned not only with the somatic

8
manifestations of sickness but also with the psychosocial manifestations. All
complaints are given equal priority when selecting an appropriate form of treatment.
It appears that homeopathic case-taking is of a different quality and content than
allopathic physical examination and collection of primarily somatic data. Several
patients and one practitioner whom I interviewed compared homeopathic case-taking

with psychological counseling.

Once homeopathic practitioners have gathered and recorded as much information
regarding the patient’s sickness as possible, they must then determine which symptoms
are the strongest and most important to consider in choosing an appropriate remedy
(Panos 1980:25). The appropriate remedy for a patient (the one which will most
effectively aid the body in restoring itself to homeostatic balance) is the one which has
a remedy picture in the materia medica which matches, as closely as possible, the

symptom picture presented by the patient.

Purpose of the Study and Research Questions

An increasing amount of literature related to homeopathy is being produced
A portion of this literature involves research focused on the evaluation of the clinical
efficacy of homeopathic remedies. The great bulk of the literature, however, is related
to outlining the principles and practice of homeopathy for professionals and laypersons
or the defense of the homeopathic health care system against attacks by the allopathic
establishment. There has been relatively little attention given to the ways in which

homeopathic theory and practice influence utilization of this health care system.

9

Growing numbers of Americans are turning to homeopathy for their health care
needs and are reporting successful treatment for a variety of health problems (Coulter
1981:15-16; Coulter 1984: 72-73; Cummings and Ullman 1984:26-27). In order to
better understand the current success of homeopathy, it is important to examine how
homeopathic treatment effectively meets the needs and desires of a particular group
of patients as related to health care issues. Those individuals utilizing homeopathy cite
the nature of the patient-practitioner relationship as a factor which significantly
influences their decision to use this health care system. Thus, an examination of
allopathic and homeopathic patient-practitioner relationships is key to understanding the

appeal and growing popularity of homeopathy in the United States.

The purpose of this research was threefold: l) to explore the ways in which
homeopathic patients and practitioners understand sickness; 2) to examine patient and
practitioner expectations for therapeutic intervention and 3) to show how patients’
explanatory models of sickness and expectations regarding treatment influence their
decision to use homeopathy for their health care needs. This research will address the
following questions:

1. What is homeopathy and how is it practiced?

2. In what ways does homeopathy differ from allopathic medicine? In what

ways is it the same?

3. How are homeopathic and allopathic theory and practice perceived by

patients who use homeopathy? Is there an association between this and

patterns of use of the two systems?

10
4. What needs or expectations do homeopathic patients have regarding their

health care? To what extent are these addressed by homeopathy?

This thesis is an effort to present and document the major findings of my research

which are:

1. The understanding of sickness and expectations for treatment for
homeopathic patients are different from those of patients of allopathic
medicine.

2. Individuals who choose homeopathy do so more for the therapeutic
relationship which homeopathy advocates and works to establish than for
the remedies and treatments that it utilizes, although these also important.

3. The success of homeopathy in treating a variety of illnesses may have

more to do with the type of therapeutic relationships it advocates than

with the intrinsic properties of its remedies.

Theoretical Considerations

A health care system should be understood not only as a means of distributing
goods and services, but also as a series of social relationships which can influence the
direction and outcome of episodes of sickness. Healing is dependent not only upon the
treatment which is administered but also upon the socio-cultural context in which it is
administered The success of a health care system in fulfilling its primary goal of
healing the patient is dependent, to a large extent, upon the degree of cognitive and

communicative agreement which exists between the patient and practitioner (Kleinman

11
1980:114). The homeopathic understanding of sickness and approach to health care
appear to be more closely aligned with the understanding and needs of the patients
who utilize this system than are those of the allopathic health care system. This
relative compatibility may explain the growing p0pularity of homeopathy in this

country and recent reports of its therapeutic successes.

Health care systems are cultural systems in the same way that language and
religion are cultural systems (Kleinman 1980:24). Cultural systems are "the fabric of
meaning" of human experience and action and they allow us to make sense of our
experiences and interactions (Geertz 1973:3-30, 144-145). Health care systems allow
human beings to make sense of the universal experience of sickness. They shape an
individual’s affective response to sickness, valuation of symptoms, and the perceptions
that others hold toward the sick individual. Health care systems also influence what
type of treatment, if any, an individual will seek and accept, compliance with the
chosen treatment, satisfaction with that treatment, and ultimately, the outcome of the
sickness episode (Kleinman 1980:26,104-114). If we accept that health care systems
are cultural systems, then we must accept that healing is a social process which is
constituted, in part, in the relationship formed between patient and practitioner. In
order to better understand the psycho-social aspects of sickness and treatment, it is

important to examine the nature of the relationship between the patient and practitioner.

How a given health care system approaches health and healing is reflected in

the definition of "sickness" supported and maintained by that system. Western

12

biomedicine makes an implicit distinction between ’disease’ and ’illness’.2 Disease and
illness are considered to be two separate entities to be addressed in treatment of
’sickness’. Disease, according to the allopathic paradigm, is materially based "Disease
refers to a malfunctioning of biological and/or psychological processes..." of the
organism (Kleinman 1980:72). Simply stated, disease refers to organic pathologies and
abnormalities of the body and mind. Illness, on the other hand,

...refers to the psychosocial experience and meaning of perceived disease.

Illness includes secondary personal and social responses to a primary

malfunctioning (disease) in the individual’s physiological or psychological

status (or both). Illness involves processes of attention, perception,

affective response, cognition and valuation directed at the disease and its

manifestations... (Kleinman 1980:72).
This distinction between disease and illness, while important to the current study, is not
necessarily culturally or socially appropriate. The meaning, or perhaps more
appropriately the perceived meaning of ’disease’ is different for the layperson than it
is for the health care professional. Understanding of ’disease’ also varies among
individuals. Furthermore, the definition of ’disease’ as a physiocherrrical process or

state is, above all else, a social and cultural. construction. It is the product of a

Western scientific ideology based both in materialism and dualism.

Disease, as defined above, is the central focus for research and treatment in
allopathic medicine (Kleinman 1980). Attention in diagnosis and treatment is focused
on the material or the ’real’ as opposed to the non-material or the intangible. In this

way, the processes and structures of the physical body are associated with the material

 

2The distinction between disease and illness has been defined in various ways in the
literature. However, I will draw largely upon Kleinman (1980) for a basic working definition.

13

and the ’real’; while thought and affect, as products of the mind, are associated with
the non-material and the intangible.

Physical reductionism is a cenu‘al tenet of biomedicine. This medicine

also radically separates body from non-body; the body is thought to be

knowable and treatable in isolation (Hahn and Kleinman 1983:313).
Central to this ideology is the belief that "the biological aspects of medical problems
are the ’real’ ones, while the psychosocial and cultural aspects are second-order
phenomena and are thus less ’real’ and. important" (Kleinman 1980:57). Until
relatively recently, the allopathic establishment has paid little attention to ’illness’ and
the way in which it influences both the treatment and outcomes of the sickness
episode. It has been usual practice for psychologically or emotionally-based complaints

(psychosomatic) to be referred to specialists such as psychiauists or psychologists as

if such problems should be treated differently and separately from somatic complaints.

Disease and illness cannot be analyzed independently of each other. For this
reason, I have chosen to use the term ’sickness’ throughout this monograph. I do not
intend the term ’sickness’ to refer to disease and illness in combination. Rather, I
have used the term ’sickness’ to refer to a process through which the feeling or
perception of ’unwellness’ as manifested somatically, cognitively, socially and culturally
is understood, experienced, and given meaning (made sense of) both by the self and
by others (family, friends, and healers).

Sickness is [not] a blanket term refening to disease and/or illness.

Sickness is redefined as the process through which worrisome behavioral

and biological signs, particularly ones originating in disease, are given

socially recognizable meanings... The path a person follows from
translation to socially significant outcome constitutes his

l4

sickness....Sickness is...a process for socializing disease and illness (Young
1982:270).

Sickness, then, is a social process.

The focus of homeopathic practice, according to both classic texts and
contemporary practitioners, is the establishment and development of social relationships,
most notably between the patient and the practitioner, which will facilitate choice and
implementation of appropriate and effective therapies (V ithoulkas 1980:169-171). It is
the nature of their relationship with a practitioner that patients most often cite as a
major reason for seeking alternative forms of health care.

...patients who turn to alternative healing systems do not do so because

they find new theories of disease causation persuasive. The one

consistent theme in consumers’ responses and in observers’ speculations

is dissatisfaction with the relationship which obtains with conventional

physicians and the attraction of a different kind of relationship with

alternative practitioners (Taylor 1984:204).

Homeopathic patients cite the nature of the patient-practitioner relationship as a major
reason for their relatively greater satisfaction with homeopathy over allopathic medicine
for their health care needs. The relationship constructed between the homeopathic
practitioners and their patients is rooted in the principles of homeopathic practice. It
is a relationship which is unique and intentionally of a different quality from that
which is established between aIlOpathic practitioners and patients. In this way, the
nature of the patient-practitioner relationship and the context in which it is built and

articulated becomes the appropriate focus of a discussion of the success and growing

popularity of homeopathy.

15
Summary

This section has provided the reader with the necessary background information
and theoretical assumptions to facilitate the presentation and analysis of the data which
follows. In Chapter II I have presented a discussion of the methods and procedures
which were used in the research. An historical overview is presented in Chapter III
so that the reader may gain an understanding of the social and historical circumstances
in which homeopathy was founded and developed This section also highlights some
interesting and important historical parallels to the circumstances under which
homeopathy is reemerging on the American medical scene today. Chapters IV and V
encompasses the presentation of my data and pertinent analyses. Chapter IV is
intended to examine the current place that homeopathy occupies in the American health
care system. In this section I have examined the ways in which the allopathic
establishment evaluates homeopathy in order to provide a broader foundation for the
examination of homeopathy and to illustrate the dynamics of the patient-practitioner
relationship. Chapter V encompasses a discussion of the therapeutic encounter, the

focus of . my examination of the efficacy of homeopathic therapeutics.

15

CHAPTER II
METHODOLOGY
Set—tin:

The research for this project was undertaken over a period of approximately 18
months in 1987-1989. The research was conducted in several different areas of the
United States and in Ontario, Canada. I conducted formal, in-depth interviews with six
health care practitioners in Ann Arbor, Michigan, suburban Detroit, Michigan and
Lansing, Michigan. All practitioners, both homeopathic and allopathic, had well-
established clientele, and had been in practice for at least 10 years in their present
location or nearby. These interviews were also followed up with one or two brief
telephone calls used either to confirm information or to obtain responses to the
conceptual framework as it developed. Telephone interviews were also conducted with
homeopathic practitioners in the cities of Berkeley, California and Seattle, Washington
and with one of the directors of a homeopathic educational institution. This last
individual was an expert on homeopathic practice, history and theory and an invaluable

source of information and counsel.

The Practitioners
As I began the research, I was concerned about the opportunities for

establishing contacts within the homeopathic community. These concerns were proven

l6

17
groundless. I was overwhelmed by the response with which my interest was met. All
of the homeopathic practitioners with whom I consulted expressed a great deal of
interest in learning more about my research and offered generous amounts of their
time. I have used the term "homeopathic practitioner" throughout my writing to refer
to health care practitioners who use homeopathy to a greater or lesser extent in their
professional practices. None of the practitioners whom I interviewed used homeopathy
as the sole method of treatment in their practice. All combined homeopathy with other
forms of treatment. The term "homeopath" therefore seemed inappropriate as it implies

that the practitioner uses only homeopathic forms of treatment.

I had somewhat more difficulty establishing contacts within the allopathic
community. Several practitioners I contacted for interviews felt that they did not have
sufficient time to become involved with the research or were simply not interested.
I had intended to conduct interviews with two or three allopathic practitioners
established in general or specialty practices. Ultimately, my three major sources of
information within allopathic medicine were drawn from university communities in Ann
Arbor, Detroit, and Lansing, Michigan. One consultant was an osteopath involved in
teaching and research on the history of medicine, one a medical doctor involved in
teaching and research in a medical school and the third an osteopath involved with
health education at a university health service. Because the focus of these consultants
was teaching and research 'as well as than clinical practice, they may not be
representative of all allopathic practitioners. They were, however, able to offer in-

deptlr information which aided me in the development of analytical categories. I am

18
confident that these practitioners have provided me with both accurate and insightful

information about the goals of allopathic medicine and its approach toward health care.

Supporting views were reflected in interviews with other allopathic practitioners
including three osteopaths, one gynecologist, two internists, one psychiatrist, two
registered nurses and two physician’s assistants. The nature of these interviews was
highly informal and could even be characterized as ’opportunistic’ insofar as many of
these practitioners assumed that I was merely curious. I also interviewed 10 medical
students and interns at the University of Michigan-Ann Arbor and Michigan State
University in order to examine their understanding of homeopathy as well as their

beliefs regarding the psychosocial dimensions of health care.

The Patients

I interviewed 15 individuals who identified themselves as homeopathic patients.
I approached many of these individuals in homeopathic practitioners’ waiting areas,
others I recruited through personal contacts. I identified myself as a graduate student
doing research on homeopathy with approximately half of these persons and asked if _
I could speak with them about themselves, their views of homeopathy and health care
in general and their reasons for using homeopathy. Before beginning the first three
interviews, I asked for permission to tape record the conversation and made them
aware that I would be taking notes. After these first interviews I chose not to use the
tape recorder as it seemed to make these individuals uncomfortable and to cause them

to self-consciously monitor their responses. It also seemed to halt a free flow of

l9
conversation between myself and the interviewee. I was able to gather much richer
and possibly more revealing data about these patients and their health behavior without
the use of the recording device. I also chose not to take notes in the presence of my
consultants as it interrupted the flow of conversation. Instead, I waited until the
completion of the interview when I could privately write notes and record my thoughts

and impressions on a tape recorder.

I did not identify myself as a researcher to the remaining patients. I assume
that these self-identified homeopathic patients merely thought that l was curious about
their health care behavior or socially gregarious. I did not ask questions in the direct
manner which I used with the other group of patient-consultants. Rather, I tried to
weave such questions into the context of the conversation, often gathering information
by presenting questions in the following way: "I have found such-and-such to be true,
what about you?" I chose to use this interview technique in order to test the
generalizability of earlier interviews as well as the validity and applicability of

analytical categories as I developed them.

I also collected information on health seeking behavior, experiences, evaluation
of health care and other related topics through interactions with many different
individuals in a variety of situations. Family, friends, colleagues, and even strangers
have provided a wealth of observations and comments that have been valuable in
helping me to gain a fuller understanding of the experience of sickness and its

treatment and the factors which influence health care behavior.

20

Opganizing Finding and Analysis
I began my research with a set of loosely defined categories of inquiry based

upon my theoretical orientation and a preliminary review of the literature. As data
were collected each piece, including comments from consultants, events or interactions
which I witnessed, quotes or thoughts from my reading or interpretive thoughts from
my field notes, was transferred onto index cards. The unit of analysis was a complete
thought, statement or observation. Each card indicated the source or context from
which it was drawn as well as the category of analysis into which I felt it most

appropriately belonged. In this way, I was able to file data in a manageable way.

As my research progressed, I gained a deeper understanding of homeopathy and
new categories of analysis emerged I allowed the data to guide me to the appropriate
categories of analysis. The index cards were an efficient way to reorganize data and
explore whether not emergent categories were able to fully account for the body of my

data.

I returned to my consultants in an effort to assess the validity and applicability
of new categories and new hypotheses as I developed them. Two of the homeopathic
practitioners and one of the allopathic practitioners, all of whom had backgrounds in

the social sciences, were most helpful in this regard.

21

Problems and Concerns

For reasons related to confidentiality, I was unable to view any patient-
practitioner interactions directly. Thus, any observations provided by patients or
practitioners regarding the nature of the therapeutic encounter are at best interpretations
and reconstructions of the third order. The process of objectifying, in some sort of
coherent way, a subjective experience to a third party necessarily changes the nature
of that experience,

Whenever an anthropologist enters a culture, he trains people to objectify

their life-world for him. Within all cultures, of course, there is already

objectification and self-reflection. But this explicit self-conscious

translation into an external medium is rare. The anthropologist creates

a doubling of consciousness...What we receive from our informants are

interpretations, equally mediated by history and culture. Consequently,

the data we collect is doubly mediated, fu'st by our own presence and

then by the second-order self-reflection we demand from our informants

(Rabinow 1977:119).
I believe, however, that it is not what has ’actually’ transpired between the practitioner
and the patient which is important, but what is perceived to have happened It is also
important to realize that in relating an experience to a third party, individuals also tend
to ’re-write’ the interaction. This refers to the fact that in relating experiences to third
parties, an individual may tell . you what they think you want to hear or what you

should hear. They may also relate only those portions of the experience which were

important to them.

CHAPTER III
HISTORICAL OVERVIEW

Physicians pour drugs of which they know nothing,

to cure diseases of which they know less,

into humans of which they know nothing

- Voltaire
_ThfeAge of Heroic Medricine3
Medicine in Europe and America in the late 18th and early 19th century lacked

any substantial body of ’scientific’ (as we understand the term) medical knowledge.
The medical profession of the time had little more knowledge regarding the cause of
disease and its treatment than did the lay public. Physicians knew nothing of the role
that bacteria and viruses play in disease. They disclaimed any belief of disease as a
specific biological entity and lacked the most basic understanding of infection
(Rothstein 1972:27). Instead, disease was believed to be a "dynamic condition",

brought about by an interaction of "mental, moral, climatic, and hygienic factors"

(Rosenberg 1987:73).

More than the cause of disease, physicians concerned themselves with effects.

A disease was thought to be the sum total of the patient’s symptoms. Thus, physicians

 

’Ihe period from approximately 1780 to 1850 is commonly referred to by medical
historians as the ’Age of Heroic Medicine’.

22

23
reasoned, the more quickly each of these symptoms was removed, the more quickly a
patient would recover (Gevitz 1982:5). Physicians at this time made diagnoses on the
bases of statements made by the patient and easily observable symptoms such as fever,
skin eruptions, coughing, and vomiting and by analogy extended these symptoms to
internal, physiological functioning (Coulter 1982:8-15). The treatments used were ones
that produced dramatic physical effects on the body. It is likely that many physicians
"diagnosed" completely different ailments as the same because of their reliance on a
few "gross physical symptoms" (Rothstein 1972:27) to make these diagnoses.
Furthermore, it appears that even if physicians could agree on a diagnosis, they could

rarely agree on a treatment.

Heroic Thegpy
Allopathic medicine in the early part of the 19th century offered but a few

standard therapies for the treatment of any and all illnesses. Under heroic treatment
patients were regularly cauterized, blistered, purged and bled (Gevitz 1982:5-7; Jones
1978:33-42; Panos 1980:9; Rosenberg 1987:66-67). A Dr. Bischoff recommended
drawing copious amounts of blood for the treatment of cholera, "It [the blood] must
be four to five pounds. It is necessary to repeat venesection - repeat it until the
patient has fainted, even if those around him wail..." (Mitchell 1975:15). Dr. John
Lettsom had the following to offer:

When any sick to me apply

I physicks, bleeds and sweats ’em

If after that they choose to die

What’s that to me, I Lettsom

Purging by administration of huge doses of mercurous chloride was a pOpular method

24
of treatment. This treatment usually left patients continuously salivating and with
swollen tongues. Additionally, these patients almost always lost all of their teeth
(Panos 1980:17). Surgery was also common but usually resulted in the death of the
patient due to loss of blood or infection (Jones 1978:40) The treatments which
physicians recommended were conflicting and consistently unsuccessful, not to mention
highly unpleasant. Much of the literature on medicine during this time period suggests
that physicians practicing ’heroic’ therapy were probably doing their patients more

harm than good.

It is important to note here that all cases of sickness were not treated by the
administration of drugs or through surgery. It appears that if a physician had little
idea how to treat a patient, all he could h0pe to do was comfort the patient and his
family (Gerald Osborne D.O., Michigan State University, personal communication).
According to one of my informants, a medical historian, it was not unusual for a
physician to remain with a patient during the "crisis" portion of that patient’s sickness
or to visit a patient, particularly one who was chronically ill, often. Inasmuch as
physicians were dependent on patients’ statements regarding their illnesses and the
demeanor of the patient in understanding sickness, patients were active participants in
the medical encounter (Reiser 1978). The focus of the medical encounter was patients’
concerns and their satisfaction with treatment. Thus, much of a physician’s powers of

healing lay in the relationship with the patient.

25

Allomthic Medical Education and Professional Organization

According to Inglis (1965:87), "...until the end of the [19th] century, medicine
in the US. remained what might be called a private enterprise basis." Licensing did
not exist and there were no established medical standards. Anyone who wanted to take
up the practice of medicine, according to any therapeutic system, could be called
’doctor’. The existence of a few dozen medical schools in America during the first
half of the 19th century helped to regularize medical education to a small extent. The
four major competing medical schools. at this time were Harvard, Dartmouth, College
of Physicians in New York and the University of Pennsylvania (Coulter 1982:7). If
the physician had come from a family of means, it was very likely that he had
received a year or more of medical training in Europe, particularly in Paris and
Edinburgh, as physicians there were considered to be on the ’cutting edge’ of the
medical technology of the day (Jones l978:1; Starr 1982:39). Before the establishment
of the medical colleges in America, which at first offered only supplemental education
(Starr 1982:39), physicians were trained by preceptorship, with little, if any, formal
training in anatomy, chemistry and pharmacology. Even after the establishment of the
medical colleges, medical education lacked any sort of clinical or laboratory training
(Rothstein 1982:125). J. Marion Simms, upon examination of his first patient after
graduating from medical school in 1835, wrote,

I examined the child minutely from head to foot, I looked at its gums...

I saw some swelling of the gums. I at once took out my lancet and cut

the gums down to the teeth. This was good as far as it went. But,

when it came to making up a prescription, I had no more idea of what

ailed the child, or what to do for it, than if I never studied medicine.

I was at a perfect loss for what to do (Rothstein 1972:126).

Thus, after completing their medical education, which was often only a few months at

26

less prestigious schools, physicians had little if any practical experience in clinical

diagnosis, treatment, or the prescription and administration of drugs.

The cholera epidemics which devastated this country in the 19th century had an
enormous influence in promoting medical change. Rosenberg writes of the 1832
epidemic,

The conflicting and uniformly unsuccessful modes of treatment followed

by the medical profession, [coupled with]...the behavior of many

physicians during the epidemic did little to increase the prestige of their

profession. In some cases...physicians fled from the epidemic while

others were charged with profiteering (Rosenberg 1987:68).

According to Weil, (1988:20-21) "The excesses of heroic medicine and the arrogant
political behavior of its practitioners produced a strong reaction among the citizens of
the young country...," Americans joined forces to "...form a powerful political tide
known as the popular health movement." Thomsonianism, botanical treatments,
hydrotherapy, homeopathy and Indian remedies became popular alternatives to heroic
medicine in the early decades of the 19th century. All of these movements espoused
the popular belief that medical knowledge was common sense and was accessible to
everyone. By the time the second cholera epidemic hit American in the middle of the

century, however, homeopathy had come to lead the opposition to allopathic medicine

(Coulter 19826).

The Founding of Homeom
Samuel Christian Friedrich Hahnemann, the founder of homeopathy, was born

 

the son of a porcelain painter in Meissen (now in East Germany near the

27

Czechoslovakian and Polish borders) on April 10, 1755 (Haller 1981:106; Inglis
1965:79). He studied medicine at the University of Leipzig and at the University of
Erlangen. Hahnemann held a variety of medical positions but always gave them up
after a short period of time. Haller (1981:106) speculates that this was due to a
chronic lack of patients, particularly in rural areas. It seems more likely, however, that
this was due to Hahnemann’s great difficulty in coming to terms with the practices of
allopathic medicine. He strongly, and often publicly, criticized regular medicine for
its inability to recognize the varieties of illness and develop consistent rational
treatments for them. Hahnemann disapproved of pharmacology as it was commonly
practiced and opposed the standard practice of bloodletting as "excessive and
unhealthy" (Grossinger 1987:210). For example, Emperor Leopold II of Austria died
in 1792 after emergency treatment by his physicians. Shortly after his death an
account of his illness, treatment and consequent death was published Hahnemann
responded thusly:

On the morning of February 28th, the... doctor... found a "severe fever

and distended abdomen" - he tried to fight the condition by venesection,

and as this failed to give relief, he repeated the process three times

more without result. We ask, from a scientific point of view, according

to what principles has anyone the right to order a second venesection

when the first has failed to bring relief? As for the third, Heaven help

us!; but to draw blood a fourth time when the three previous attempts
failed to alleviate!...Science pales before this! (cited in Haehl 1922:35).

Hahnemann advocated better nutrition, exercise, fresh air and clean, fresh water
(Grossinger 1987:270, Rothstein 1972:152). Hahnemann wrote several educational
pamphlets on public health. This was heresy in a time of poorly ventilated houses,

contaminated food and water and fear of fresh air. Additionally, he insisted on boiling

28
utensils that had been used for patients with contagious diseases as well as isolation
of these same patients (Grossinger 1987:210). Hahnemann also insisted on cleaning
wounds, bandaging them with alcohol soaked bandages and changing the dressing
often. The usual treatment for open wounds at this time was ’healing by second
intention’, meaning that after tying off blood vessels to control hemorrhage, unsterilized
lint bandages were stuffed into the open wound to keep it open and to promote the
flow of ’laudable pus’ which was believed to indicate that healing was occurring.
Often the inflammation was treated with opium to ease the pain and asuingents to
hasten the drying of the wound. Sometimes wounds managed to heal in this manner,
but more often than not they became infected, gangrene set in and the patient died

(Jones 1978:41).

The techniques and practices which Hahnemann advocated came decades before
the germ theory of disease was understood and accepted. Hahnemann refused to
administer what he considered to be senseless and brutal treatments to his patients.

My sense of duty would not easily allow me to treat the unknown
pathological state of my suffering brethren with these unknown
medicines. If they are not exactly suitable (and how could the physician
know that, since their specific effects had not yet been demonstrated?),
they might with their strong potency easily change life into death or
induce new disorders and chronic maladies, often more difficult to
eradicate than the original disease. The thought of becoming in this way
a murderer or a malefactor towards the life of my fellow human beings
was most terrible to me, so terrible and disturbing that I wholly gave up
my practice in the first years of my married life. I scarcely ueated
anybody for fear of injuring him and occupied myself solely with
chemisu'y and writing (quoted in Haehl 1922:64).

This was particularly true after the illness and subsequent death of his children moved

Hahnemann greatly and fueled his quest for a safe and more rational system of

29

medicine.

...children were born to me, several children, and after a time serious

illness occurred, which, in tormenting and endangering my children, my

own flesh and blood, made it even more painful to my sense of duty,

that I could not with any degree of assurance procure help for

them....Whence then was certain help to be obtained? - was the yearning

cry of the comfortless father in the midst of the groaning of his children,

dear to him above all else. Night and desolation around me - no sight

of enlightenment for my troubled paternal heart (quoted in Haehl

1922:64).
Hahnemann turned his energy toward research in cherrristry, botany and pharmacology.
Hahnemann was fluent in at least nine languages including Arabic, Greek, Latin and
Hebrew (Koehler 1986:19; Rothstein 1972:152). He supported himself and his family
by translating texts in chemistry, physiology, pharmacology, practical medicine as well
as popular literary texts. It was while translating Cullen’s Materia Medica in 1790 that
Hahnemann began to develop the principles of homeopathy which were first published

in 1810 in Hahnemann’s Organon of Medicine (Weil 1983:14-17).

Homeopathy in America

Homeopathy was introduced to America around 1825. The first American
school of homeopathy was founded in Allentown, Pennsylvania in 1835 (Grossinger
1987:226; Haller 1981:117-118). Most homeopaths, however, were physicians who had
defected from the ranks of allopathic medicine. They were drawn to homeopathy by
the mildness of its remedies and also because it was highly profitable to practice
homeopathy. Patients, particularly wealthy ones, flocked to homeopaths in droves
(Kaufman 1971:29). Homeopathic practitioners considered themselves ’regular’

physicians who possessed as thorough a knowledge of the medical sciences as their

30
a110pathic counterparts (Gevitz 1987:1638; Haller 1981: 121; Inglis 1961:88; Rothstein
1972:162). Many homeopathic physicians asserted that the only difference between
themselves and their allopathic counterparts was the type of therapies which were
administered to patients. Lay practitioners were drawn to homeopathy because of the
seeming simplicity of the system. No specialized knowledged of chemistry or
physiology was required. One only needed to learn how to match a patient’s

symptoms with the repertory (Grossinger 1987:229).

Homeopathy was the first attack on allopathic medicine from within its own
ranks. Previous challenges to heroic therapy including Thomsonianism, botanical
medicine, and Graharnism were practiced by individuals who had not received any
formal education in the practice of medicine. This perhaps helps to explain the
extremely hostile reaction the allopathic profession had toward homeopathy.
Interestingly, allopathic physicians did not object so much to homeopathy’s Law of
Similars as they did the administration of ’infinitesimal doses’ of medicines (Haller
1981:109; Rothstein 1972:166). Treatment by sirrrilars had been suggested in the
writings of Hippocrates and Paracelsus (Barrett 1987:56; Ullman 1988:33) and was
therefore acceptable to allopathic practitioners. Potentization and the use of infinitesimal
doses, however, seemed absurd to allopathic physicians who advocated the ’more is
better’ attitude in prescribing and administering drugs. One popular and widely
published poem illustrates the reaction of the allopathic profession to homeopathic
therapeutics:

Take a little rum,
The less you take the better;

31

Mix it with the lakes
Of Werner and Wetter.

Dip a spoonful out —
Mind you don’t get groggy.
Pour it in the Lake
Winnipisiogee.
Stir the mixture well,
Lest it prove inferior,
Then put half a drop
Into Lake Superior (Haller 1981:119).
One physician in the 1800’s offered the following pithy comment about homeopathic
remedies: "Why not put a drop of homeopathic medicine in Lake Erie, and tum the

whole lake into a vast therapeutic reservoir?" (quoted in Weil 1983:34).

The latter half of the 19th century saw a rise in the popularity of homeopathy
due, in part, to its success in dealing with the cholera epidemic of 1849. The
mortality rate in homeopathic hospitals during the cholera epidemics of 1849 and 1866
were reported to be one-half to one-eighth of that in regular hospitals (Grossinger
1987:228; Ullman 1988:42-43). One Cincinnati hospital published daily figures during
the 1849 cholera epidemic which indicated that only three percent of over 1,000
homeopathic patients died as a result of cholera compared with 48% - 60% of
allopathic patients (Grossinger 1987:228; Ullman 1988:43). Partially as a result of these
statistics, some life insurance companies offered a 10% discount to homeopathic
patients (Ullman 1988:43). Homeopathy grew to be extremely popular as it was
relatively inexpensive, and unlike some allopathic therapies it would not "make well
men sick, nor keep sick men from getting well" (Christian Ambassador II (1849), 443;

Olive Branch (Boston), March 31,1849; Wisconsin Free Demo_cr_a_t (Milwaukee),

32
December 13, 1848. quoted in Rosenberg 1987:161). Statistics also indicate that
homeopathy may have been more successful than the allopathic practices of the time
in ueating other diseases including scarlet fever, dysentery, meningitis, and yellow

fever (Coulter 1981:5; Inglis 1965:86).

Unlike other alternatives to allopathic medicine, homeopathy appealed primarily
to the middle and upper classes of America (Rothstein 1972:160; Starr 1982:97;
Ullman 1988:42). This was true partially because homeOpathy had become extremely
popular among the nobility and upper crust of Europe whose tastes and interests were
often copied by Americans of means. Additionally, homeopathy was more acceptable
than other alternative forms of medicine to affluent Americans because the majority of
homeopathic practitioners were well-educated and cultured men.‘ According to
Rosenberg (1987:154),

In 1832, few well—educated and respectable Americans would have

consulted any but a regularly educated physician. Less than two decades

later...homeopathic physicians were welcome in some of the most

respectable American homes.
The patronage of wealthy and influential Americans assured homeopathy a level of
success which other alternative medical systems had been unable to attain. It also
assured that homeopathy would become a greater threat to allopathic medicine than any
other medical system (Inglis 1965:87; Rothstein 1972:165). It should be noted that

homeopathy also had a strong following among poor Americans. This may have been

 

‘Some notable 19th century Americans who subscribed to homeopathy included Mark
Twain, William Wadsworth Longfellow, Nathaniel Hawthorn, Julia Ward Howe, Louisa May
Alcott, Daniel Webster, John D. Rockefeller and William Seward (Haller 1981:117; Ullman
1988241).

33
partly due to the fact that free homeopathic dispensaries were established in many
American cities (Ullman 1988:42).

In the United States, homeopathy reached the height of its popularity in the
1880’s and 1890’s. At this time, homeopathic practitioners did between three and five
times more business than allopathic practitioners (Grossinger 1987:229; Weil 1983:20).
Homeopaths had gained sufficient respectability to get laws passed in several states
which officially recognized homeopathy as a legitimate system of medicine. In these
states licensing boards were directed to examine license applications from homeopaths
in addition to those of allopathic physicians. In many cities, homeopathic practitioners
established Hahnemannian societies, dispensaries, hospitals, and asylums (Haller
1981:125). Allopaths established similar organizations and institutions. Homeopathy
fought itself into a position of parity with the allopathic profession in terms of legal
entitlements and public respectability (Starr 1982:97). Many physicians practicing
allopathic medicine were regarded by the American public as incompetent and unethical
quacks based, in part, on their performance during the cholera epidemics of 1832 and

1849. Homeopaths, on the other hand, enjoyed great success and prestige.

America saw a change in allopathic medicine during this same period The
remedies employed by allopathic practitioners became increasingly mild. There were
several reasons for this change including the fact that heroic methods had proven
ineffective in combating cholera and other ailments; beliefs regarding the cause of

disease were changing; and finally and most importantly, competition from other

34
systems of healing, most notably homeopathy. "The increasing mildness of [allopathic
medicine’s] remedies was...due...to the mundane factor of competition" (Rosenberg

1987:223; see also Grossinger 1987:228; Rothstein 1972:181).

Professional Conflict

Homeopathic physicians considered themselves ’orthodox’ physicians, but
disapproved of allopathic therapeutics. Allopathic physicians considered homeopaths to
be ’quacks’ and disapproved of their therapeutic practices. Both sects maintained that
the two systems were incompatible philosophically and theoretically. While this was
true, physicians who used homeopathy tended to combine the two systems in practice.
Many allopathic physicians adopted the use of homeopathic medicine in practice
because it had proven more effective, or perhaps less detrimental than heroic medicine.
Additionally, allopathic physicians who advertised that they used homeopathic
medicines attracted more patients and enjoyed greater income than those who did not
(Haller 1981:126). Homeopaths also combined the two systems in practice. This may
have been partially a result of inadequate homeopathic medical education, most
specifically the lack of appropriate textbooks. Homeopathic medical students were
often forced to rely upon allopathic textbooks, which were in opposition to
Hahnemannian principles. Professors of homeopathic medicine were also divided on
the issue of interpretation and application of Hahnemannian principles. Some
homeopaths thought it acceptable to mix allopathic and homeopathic therapeutics; other
homeopaths were divided on the issue of dilution, there were high dilutionists and low

dilutionists. Graduates of American homeopathic medical schools became increasingly

35
less able to practice homeopathy according to Hahnemannian principles (Haller
1981:124-5; Ullman 1988:45). The combination of the two systems in practice
concerned physicians from both ranks, as well as Hahnemann himself. He felt that
physicians who combined the two systems in practice were "...worse than allopaths...
amphibians...still creeping in the mud of the allopathic marsh...only rarely venture to

raise their heads in freedom toward the ethereal u'uth" (quoted in Grossinger 1987:231).

The American Institute of Homeopathy (AIH) was founded in 1844 as a
reaction to professional and educational disorganization. The goals of the AIH were
to improve medical education, thereby producing physicians who were competent in
the philosophy and practice of homeopathic medicine; to scientifically investigate drug
action and to organize the practice of homeopathy (Grossinger 1987:226; Kaufman
1971:55). The American Medical Association (AMA) was founded in 1846 largely as
a response to the founding of the AIH. The AMA may never have been founded or
at least would have been a longer time in conring had the AIH not been established.
Homeopathy became a target for the reform efforts of the AMA (Grossinger 1987:227).
In 1847 the AMA adopted a code of ethics as a pre-requisite for membership. The
code of ethics specified that the Association would not recognize and accept for
membership any but ’pmperly’ educated and graduated physicians. The code explicitly
excluded homeopaths fiem this definition. This effectively denied homeopaths access
to the organized allopathic medical profession (Coulter 1982:180 Rothstein 1972:170).
In 1855, the AMA included a ’consultation clause’ in its code of ethics. The

consultation clause provided for the expulsion of any member who consulted with

36
homeopathic practitioners. The AMA adhered so rigidly to this policy that one

Connecticut physician was expelled from the AMA for consulting with his wife who
happened to be a homeopathic physician (Coulter 1982:207; Grossinger 1987:227;
Ullman 1988:33,44). The AMA apparently intended to destroy public confidence in
homeopathy and thereby deprive homeopathic practitioners of their clientele. While the
main goal of the AMA appeared to be blocking the progress and growth of
homeopathy, allopathic physicians also realized the importance of educational, ethical
and therapeutic reform and professional organization. The AIH and AMA had nearly
identical goals. However, these organizations were able to accomplish very little in
terms of educational and practical reform and professional organization until the last

few years of the century due to a lack of legislative support and organizational focus.

As of 1900, the "medical diploma mill system", through which an individual
could literally buy medical qualifications without benefit of appropriate education, was
flourishing in the United States (Inglis 196:87). The American Medical Association’s
Council on Medical Education was called upon by the legislatures of several states to
review the curriculum, facilities, faculty and admission requirements of American
medical schools in an effort to reform medical education and monitor the ethics of the
medical profession (Inglis 1965:88; Rothstein 1972:170). The AMA graded medical
schools largely on the basis of how graduates of various schools had performed on
state licensing examinations. It is interesting to note that a higher percentage of
homeopathic medical students passed medical board examinations than did allopathic
medical students (JAMA 1909:1691). Many medical schools fared poorly in these

37
evaluations but the results were never made public due to the AMA’s code of ethics.
The AMA then invited the Carnegie Foundation to conduct an evaluation of medical
schools in the United States and Canada (Starr 1982:117-118). The Flexner Remrt

(1910) was the result of this evaluation.

Flexner and the Fall of Homeogthy

Medical schools cited in the Flexner Remrt were evaluated according to the
’Hopkins Model’. Johns Hopkins was considered the best and most prestigious
allopathic medical school in North America. Consequently, the AMA felt the
evaluation should be based on this model. In this report, it was recommended that
institutions which did not meet the Hopkins’ standards be closed. State legislatures
accepted these recommendations and, in this way, the AMA became the entity
responsible for accrediting medical schools. It is hardly surprising, given the allopathic
profession’s animosity towards the homeopathic establishment, that the AMA did not
recommend accreditation of homeopathic institutions (Inglis 196:88; Panos 1980:19;
Starr 1982:118-123). The Flexner Report hastened the demise of homeopathic
institutions already struggling with financial woes and internal divisions among faculty

and administrators.’

Allopathic medicine became more acceptable to the American public in the

early decades of the twentieth century and homeopathy began to seem outdated to

 

’It should be noted that homeopathic institutions were not the only victims of the Flexner
Report. Black and womens’ institutions, already struggling from a lack of adequate financing
closed after the release of the Flexner Report.

38
many people. Emerging medical technology and scientific discoveries contributed to
the changing image of allopathic medicine. Advancements in science, including the use
of x-rays, discovery of a diphtheria antitoxin, antisepsis and asepsis to name a few,
reflected well upon the practitioners and on medicine in general and lent greater
authority to allopathic medical science. According to Vogel (1980:62), "dramatic

treatment and likely cure reflected well on the profession... Such discoveries made

advances in diagnosis, treatment and, especially, surgery possible.

There were also social changes which were responsible for the decline in
popularity of homeopathy in the United States. Americans were adopting an
increasingly mobile lifestyle (Grossinger 1987:232; Oabis 1980:19). Homeopathic
treatment, practiced according to classical theory, demanded a great deal of time and
effort from both the patient and practitioner. Increasingly, Americans were unwilling
or unable to invest the time required of homeopathic therapy. Finally, the American
public began demanding a ’quick and easy’ cure to match their increasingly fast-paced

life-style.

Advances in medical technology and changes in social demographics in America
also had a significant impact on the patient-practitioner relationship. Increasing
urbanization shifted medical practice into the hospital where large numbers of
individuals could be cared for. Technologically based diagnoses emphasizing objective
physical measurement were the result of advances in medical technology (Osherson and

AmaraSingham 1981). The medical encounter was shifted from one which was

39
subjective and patient centered to one which was object centered, with the patient as
the object. In this format, a physician had the task of examining the ’object’ and

determining the cause of sickness.

The second scientific revolution in American medicine occurred in the years
after World War II. So-called "wonder drugs", including penicillin, other antibiotics
and the Salk polio vaccine, were products of this revolution (Gevitz 1987:1639). These
wonder drugs promised even more dramatic preventions and cures which could be
effected relatively quickly and with little effort on the part of the patient. Homeopathic
remedies, on the other hand, often worked very slowly. Treatment for some conditions

could often take a number of years.

In the 19th century the American public had perceived homeopathy as more
"scientific" than allopathic medicine because it was philosophical as well as
experimental (Starr 1982:97). Homeopathy in the 20th century, however, did not seem
to Americans to be progressing and making scientific advancements in the same manner
as allopathic medicine. Homeopaths were conducting provings on remedies by the
same methods that Hahnemann had used a century earlier. Homeopaths had discovered
nothing ’new’ about the human body and disease and treatments were not much
different than they had been in Hahnemann’s day. Allopathic medicine, on the other
hand, was almost daily making some wonderful new discovery to help Americans live
longer and healthier lives. This second scientific revolution coupled with the

expectations and demands that Americans were placing on scientific medicine did a

40

great deal to legitimate the authority of allopathic medicine. According to Starr
(19822347),

Probably no event in American history testifies more graphically to

public acceptance of scientific methods than the voluntary participation

of millions of Americans in the Salk Vaccine.
Homeopathy seemed outdated and backwards and the American public placed their
faith and health in the hands of allopathic medicine. It seemed that the allopathic

profession had finally won the victory over homeopathy it had been seeking for over

a century.

CHAPTER IV
HOMEOPATHY TODAY

Dissatisfaction with Allopathic Medicine

Today, allopathic medicine is again, under fire by the American public. The
methods and practices of allopathic medicine were most frequently criticized by my
consultants for being too dangerous and too expensive. Drug iatrogenesis appears to
be a major concern to many individuals. One recent study found that at least 36
percent of all patients hospitalized at a university hospital in Boston suffered from
iatrogenic illness (Steele 1981:638). According to another study published in American
D_r_uggis_t (September 1978),

...it has been established that during a typical hospital stay, the patient

gets an average of ten drugs and the numbers sometimes go as high as

thirty or more. Among the ambulatory non-hospitalized, it is common

for an individual to be taking as many as six prescription and non-

prescription drugs at the same time (quoted in Panos 1980:13).
There is also a great deal of concern over the danger involved with invasive medical
techniques, particularly diagnostic techniques (Weil 1983:25,83). As a consequence of
this dissatisfaction, grewing numbers of patients appear to be questioning not only the
efficacy and desirability of allopathic medical practice but also the authority and
legitimacy of physicians to determine appropriate therapy and direct health care

decision making. Consequently, the United States is presently witnessing a revolt

41

 

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42
against the allopathic medical establishment which, according to H.L. Coulter, is
"comparable to the revolt of the 1830’s and 1840’s which ensconced homeopathy on
the American medical scene" (Coulter 1981:9). Growing numbers of Americans are
seeking alternative forms of health care and are turning to many different types of

’altemative’ systems of health care for their health care needs, including homeopathy.

Growth of Homeopathy in the UnitedfiStgeg

Increasing numbers of practitioners are also using homeopathy in their practices.
At the turn of the 20th century, 15% of all physicians considered themselves to be
homeopathic practitioners (Ullman 19882xvii). By 1975, this number had dropped to
only 65 praCtitioners (Panos 1980223). In 1986 the National Center for Homeopathy
published a directory which listed 300 licensed US. health professionals who practice
homeopathy. The 1989 directory listed nearly 1,000 (Ullman 1988250). The physicians
listed in this directory ar those who describe homeopathy as their primary or only '
mode of practice. This directory does not reflect the growing number of health care
professionals in the United States, including nurses, dentists, chimpractors,
opthamologists, naturopaths, veterinarians, psychologists, herbalists and others who
utilize some homeopathic techniques in their practices. One consultant placed the
number of health care professionals who use elements of homeopathy to some extent
in their practices between 5,000 and 10,000. Still, the number of homeopathic
practitioners in the United States is small when compared to countries such as Great

Britain, which claims over 11,000 homeopathic practitioners; France, which claims over

43
14,000 practitioners; and India where it is estimated that there are nearly 100,000

homeopaths (Panos 1980:23; Ullman 1988248).

Training and Certification of Homeopathic Practitioners

In order to be certified as a homeopathic practitioner in the United States, one
must complete a course of post- graduate training offered at one of several homeopathic
institutions in this country. These institutions include the National Center for
Homeopathy in Washington DC, the International Foundation for Homeopathy in
Seattle and the Foundation for Homeopathic Education and Research in Oakland
California. Once this training has been completed, an individual must serve a

preceptorship for one or two years before being certified as a homeopathic practitioner.

Homeopathic practitioners must first, however, attend the same medical schools
and pass the same qualifying and licensing examinations as allopathic physicians. In
the United States only individuals certified as medical doctors (M.D.’s) or doctors of
osteopathy (D.O.’s) are legally sanctioned by virtue of their specialized training b0th
to diagnose and prescribe treatment. These practitioners must also be licensed by
appropriate state agencies. Consequently, homeopathic practitioners are generally
allopatlrically trained physicians who have chosen to practice homeopathy exclusively
or have incorporated homeopathy to some extent into their health care practice. In
some states, including Michigan, licensed naturopathic doctors (N.D.’s) are legally
recognized health care practitioners and are able to practice medicine appropriate to

their training. In Michigan, natumpaths can legally utilize homeopathy in their practice.

44
Other health care professionals including registered nurses, physician’s assistants and
licensed practical nurses can receive training in homeopathic prescribing but are
prohibited from administering homeopathic treatment to anyone except themselves and
their immediate families. Homeopathic remedies are approved by the Federal Food and
Drug Administration (FDA) and are available over the counter as the FDA considers

them to be non-toxic.‘5

Homeopathic theory and practice are not a standard parts of the curriculum in
any allopathic medical school in the United States today. Nearly all of the medical
students I interviewed reported that they had never heard of homeopathy before
entering medical school. Both allopathic medical students and physicians and
homeopathic physicians reported that the principles and practice of homeopathy were
generally covered in "15 minutes or less" in medical history classes. The exception
was among those students who had taken elective courses in medical anthropology,
sociology or history in which the history and principles of homeopathic practice were
covered in more depth. Clearly, then, most individuals entering medical school do not

do so with the intention of ultimately practicing homeopathy.

According to my consultants, many homeopathic practitioners report that their
introduction to homeopathy occurred in conjunction with an illness episode in their
lives that allopathic medicine was unable to deal with to their satisfaction. The

homeopathic practitioners whom I interviewed reported that they had chosen

 

“Homeopathic remedies are actually classified as ’foods’ by the FDA.

45
homeopathy over other alternatives to allopathic medicine because of the mildness of
homeopathic remedies and the fact that it "seemed to be a more legitimate system of
medicine than something like iridology or spiritual healing". I believe that these
individuals perceived homeopathy to be a more rational or ’scientific’ health care
system than some other alternatives to mainstream medicine. However, all of these
practitioners reported that they have also tried and continue to use other forms of
alternative therapy both for their own health care and for that of their patients. Most
commonly these include acupuncture, chiropractic, yoga, herbalism, ayurveda,

naturopathy, meditation and biofeedback.

Homeopathic Practice

Homeopathic theory and practice as proposed by Hahnemann are in opposition
to allopathic theory and practice. Allopathic practice depends largely on the
administration of large doses of drugs to counteract the effects of disease.
Homeopathy, on the other hand, depends on the administration of relatively small doses
of substances which aid the body in increasing its natural resistance to disease.
Allopathic practice aims to remove disease, thereby restoring health, while homeopathy

aims to restore health, thereby removing sickness.

The majority of contemporary homeopathic practitioners, however, have received
their medical u'aining at allopathic medical schools, and must reconcile the different
approaches of allopathy and homeopathy in practice. One consultant best expressed
the consensus of all those interviewed

Homeopathy is a tool...l am a physician first and a homeopath second.

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46
My main goal is to help the person. I am not so tied to the system
called homeopathy that I won’t use other things that I feel are
appropriate to the individual.
The homeopathic practitioners with whom I consulted refer to themselves as "holistic"

practitioners rather than "homeopathic", indicating their greater commitment to healing,

by whatever means, than to homeopathy as a method of healing.

It is difficult to generalize about homeopathic practice because the ways in
which it is practiced are probably as numerous as the number of practitioners.
According to my consultants, all contemporary homeopathic practitioners subscribe to
the basic tenets of homeopathy. Like Hahnemann, they are also advocates of proper
nutrition, exercise and stress reduction. Homeopathic practitioners differ, however, in
the ways they prescribe homeopathic treatment. Some homeopathic practitioners use
only high dilution remedies, some only low, some use combinations of high and low
dilution remedies. Classical homeopathic practitioners use only a single remedy in
treating a patient. Other practitioners use several remedies in succession or
combinations of remedies simultaneously. According to my consultants, it is common
for homeopathic practitioners to combine several different types of therapy in their .
practices or to recommend different types of therapy according to what is most
appropriate for the patient’s illness and/or acceptable to the patient. Some homeopathic
practitioners are proficient in administering other therapies. Others either practice with
an associate who administers other therapies or will refer patients to other practitioners
depending on the name of the problem and the needs of the patient. Homeopathic

practitioners also refer patients to allopathic specialists such as cardiologists,

47
gynecologists or psychiatrists when it is appropriate. Thus, while the allopathic
establishment tends to classify homeopathy and its practitioners under the rubric of
"altemative" medicine, it seems more appropriate to classify them under

"complementary" medicine.

Homeopathy and Allopathy

Relationship with the Allopathic Establishment

The allopathic establishment today seems to maintain a laissez—faire attitude
towards homeopathic practitioners, so long as they make appropriate referrals to the
allopathic establishment. According to one homeopathic practitioner,

....there have been a couple of doctors who have been negative... but

generally I have been left alone and leave other people alone....I make

appropriate referrals when I feel that...I’m beyond my expertise and I

drink that my cautiousness is appreciated by most orthodox physicians.
According to my consultants, some allopathic practitioners accept that their pau'ents
patronize alternative practitioners, including homeopaths. However, I found that only
two of my allopathic consultants would actively encourage patronage of alternative
practitioners by their patients or make referrals to homeopaths or other alternative
practitioners. These two practitioners, however, perceived themselves to be atypical of
their colleagues and stated that their openness to alternative methods was related to
their background as instructors and researchers rather than clinicians. Chiropractors
seem to be the one exception in allopathic referrals. All of my allopathic consultants

in clinical practice indicated that they had referred patients to chiropractors in the past

or would consider doing so where appropriate.

48

The patients that I interviewed who used homeopathy or other types of
alternative health care report that they generally have not made their allopathic
practitioners aware of this. They reported that they believe that the allopathic physicians
would accept their patronizing alternative practitioners. Some individuals report the
experience of having disclosed use of alternative forms of health care to an allopathic
physician and literally being laughed at for spending money on "quackery". One
consultant stated that "...he [the allopathic physician] laughed and said ’Well, if you

want to waste your money on that worthless crap, it’s up to you’".

Given the attitude of the allopathic establishment towards homeopathy, it is
hardly surprising that allopaths rarely consider actively referring a patient to a
homeopath. The homeopaths that I interviewed report that they have occasionally had
difficulty in referring patients to allopathic specialists.

Over the years...I have learned which physicians are open minded

people....I have a whole network of specialists that I refer to...if I feel

that my expertise can’t handle it or I need to get diagnostic work

done....They are not necessarily holistic practitioners but they are Open

minded people and are willing to accept what I do and work with me.

These practitioners have worked rather hard to establish a referral network of allopathic

specialists who are willing to accept referrals.

My homeopathic consultants also indicate that they and their colleagues have
occasionally had allopathic physicians refuse to treat patients whom they have referred,
simply because these patients were referred by a homeopathic practitioner. One

practitioner established in the Northwestern suburbs of Detroit, an area considered by

49
some to have some of the most prestigious medical practitioners and facilities in this
part of the country, reports having more difficulty in this respect than his colleagues.
Allopathic practitioners in this area may be more closed to alternative forms of health
care than in other areas or they may be less open to referrals from this particular
homeopathic practitioner because he is a naturopathic doctor (N .D.) rather than a
medical doctor MD.) or doctor of osteopathy (DO) and is therefore not considered

by his allopathic counterparts to be a legitimate practitioner.

It is reasonable to assume that allopathic physicians do not actively refer
patients to homeopaths because homeopathy is not well understood by the allopathic
establishment. The allopathic physicians who reported negative impressions of
homeopathy also reported that they actually knew very little about the principles and
practice of homeopathy. In describing homeopathy allopathic physicians and medical
students often confused or associated it with herbalism or naturopathy. This confusion
may be a result of homeopathy’s utilization of many herbal substances as remedies.
It is interesting that the majority of my allopathic consultants dismissed homeopathy
so readily without knowing a great deal about it. This may be due to an attitude
prevalent within the allopathic profession that allopathy is the only legitimate system
of medicine because it can be validated "scientifically". Any system of health care
which cannot be validated through clinical and laboratory investigation is not
considered to be a legitimate form of health care. Few of my allopathic consultants in
clinical practice reported having investigated homeopathy or any other "alternative"

system ’scientifically’ or at all.

50

The osteopathic physicians with whom I consulted seemed to be more accepting
of homeopathy as a legitimate alternative to mainstream medicine than other
physicians (i.e., M.D.’s).

I really don’t know much about it except that some doctors have gotten

really good results with it ..... with a variety of illnesses ..... My impression

of it has been generally favorable....l don’t really know much about its

clinical efficacy or anything so I can’t condemn it on that level.

However, it seems to work for some people and I accept that.
Osteopaths may be more familiar with homeopathy both historically and as it is
practiced today. The osteopaths with whom I consulted reported an interest in
alternatives to mainstream medicine as a motivation for their choice of osteopathy over
strict allopathy. Such interest may contribute to their relatively greater acceptance of

homeopathy. One osteopath reported having practiced at facilities which also employed

homeopathic physicians.

While these earlier generations of osteopaths seem to hold a more liberal
attitudes regarding homeopathy, osteopaths currently entering the medical field may
hold more conservative attitudes which resemble those of their more orthodox
counterparts. The curricula of osteopathic medical schools increasingly resembles that
of strictly allopathic medical schools. This is particularly true at universities such as
Michigan State University which operate both allOpathic and osteopathic medical
schools. Such medical schools often share classes between the two schools because
it is more economical than maintaining separate facilities and faculties. It is likely that
allopathic and osteopathic medical students will become more similar in their

orientation and approach to health care. The opinion of homeopathy held by new

51
generations of osteopaths may increasing resemble that currently held by their more
orthodox counterparts. Alternatively, the more orthodox practitioners could come to

hold more favorable opinions of homeopathy.

Clinical Evaluation of Homeopathy

The allopathic establishment has charged that homeopathy is not a legitimate
form of health care as it cannot be validated clinically. Allopaths argue that
homeopathic therapies are clinically ineffective. They believe that homeopathic
remedies do not possess biochemical properties which enable them to act directly upon
the cells and tissues of an organism. A recent survey of faculty members at 49 U.S.
pharmacy schools found that "[v]irtually all said the remedies were neither potent nor
effective, except possibly as placebos for mild, temporary ailments that commonly
resolve on their own" (Consumer Reports 1987:62). The criterion used by the
allopathic establishment to measure effectiveness, however, is verifiable chemical
activity leading to physiological changes in the organism. This assumes that it is the
material property of the substance being administered to the patient which is
responsible for the cure. The allopathic establishment cites the dilution of homeopathic
remedies as the reason why these remedies cannot be biochemically active. The
dilution of homeopathic remedies often exceeds Avogadro’s limit. Western science
recognizes this to be the limit to ,which any substance can be diluted and still retain
its molecular su'ucture. Once this limit is surpassed, no molecules of the original

substance remain in the solution and the substance is rendered inactive biochemically.

52

It is inappropriate to evaluate homeopathic therapeutic effectiveness on the basis
of the clinical or laboratory evaluation of homeopathic remedies. Homeopathic
practitioners do not prescribe homeopathic remedies because of a belief that these
remedies possess a biochemical property which acts directly upon the organism to
effect a cure. (Weil 1983237) Homeopathic remedies are used to "boost" the healing
powers of the organism. Homeopathic practitioners believe that the body has the
ability to heal itself in most instances but that occasionally, due to external stresses,
it has difficulty in returning itself to a homeostatic balance. This is when homeopathic
remedies are needed. Furthermore, homeOpathic treatment is not limited to
administration of remedies. Diet, exercise, and personal and family counseling are
integral parts of homeopathic therapeutics. In response to the argument that dilution
past Avogadro’s limit renders a substance ineffective, homeopaths contend that they are
not concerned with the molecular substance or more specifically, the biochemical
properties of the substance, but rather the "energy pattern" or the biophysical properties
of the substance (Ullman 1988263).

An increasing number of studies are being conducted on homeopathic remedies
to determine their biochemical action. Several randomized, double-blind, placebo—
controlled studies on homeopathic remedies have recently been completed that support
the homeopathic claims for efficacy. Gibson and his colleagues (1980) found that 82%
of patients involved in a rheumatoid arthritis study achieved improvement in patient
and physician assessed levels of subjective pain, stiffness, grip strength and articulation

of involved joints with ueatrnent by individualized homeopathic remedies. Only 21%

53
of the patients receiving inert placebos were reported to have achieved similar
improvements in health. Reilly, Taylor, McSharry and Aitchison (1986) reported
similar positive results for a study on homeopathic treatment of hayfever. The
homeopathically treated group showed a more significant reduction in patient and

physician assessed symptoms than did the group which was treated with the placebo.

The publication of the latter study (Reilly, et. al., 1986) in the Lam caused
a backlash in the allopathic medical community. One physician wrote to the Lang,
"....1 was astonished to see the tail of absurdity wagging the sick dog of rationality
quite so obviously in your column. Dr. Reilly and his colleagues’ study is the first
randomized, double-blind trial of one placebo against anorher" (November 8,
1986:1106—07). Another physician wrote, "Such a belief system could not be
meaningfully tested by trials conducted by the adherents of the system. Numerous
trials by uncommitted physicians failed to substantiate hOmeopathic claims." (Lancet,
November 8, 1986:1107).

Homeopathy does not lend itself well to traditional double—blind, randomized, '.
placebo-controlled studies. This is true because homeopathic ueatment depends upon
highly individualized prescribing for highly unique episodes of siclmess. It is not
appropriate, then, to give each individual involved in such a study the same type and
dilution of a remedy as it may not be the appropriate remedy for their particular
sickness. Furthermore, some homeopathic physicians often change remedies several

times during the course of treatment as the patient’s symptom complex changes.

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54
Traditional experimental design does not allow for such individualization. This may
partially account for the results obtained in a study by Shipley (1983) which suggested
that homeopathic treatment was not more effective than a placebo in treating
osteoarthritis of the hip and knee. Patient preference during this study was for the use
of allopathic anti-inflammatory medication. Gibson’s (1980) clinical trial can be
considered to be a better indicator of the clinical efficacy of homeopathic remedies, at
least in the treatment of rheumatoid arthritis, because individually chosen homeopathic

remedies were used in this study.

Homeopathy as a Placebo Resmnse
Allopathic medicine, as evidenced by the commentary on Reilly’s (1986) trial,

seems intent on attributing the successes of homeopathic treatment to a placebo effect.
It is important to examine what a placebo response is in order to determine whether
this is an appropriate evaluation of homeopathic treatment. Brody (1977243) defines
a placebo as,
...a form of nredical therapy. 01' an intervention designed to stimulate
medical therapy, that at the time of use is believed not to be a specific
therapy for the condition for which it is offered and that is used either
for its psychological effect or to eliminate observer bias in an
experimental setting.
A reaction or change is usually attributed to a placebo effect when a tangible cause for
that change or reaction cannot be found The placebo effect has been largely

associated with psychological and sociological factors of sickness and therapeutic

intervention.

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Psychological or sociological explanations for change in disease or reaction
to therapeutic intervention have been held, until recently, in relatively low esteem by
the allopathic medical community and have been considered acceptable only until "real"
explanations in physical or chemical terms can be determined through research and
experimentation (Brody 1977227). The use of homeopathy by some patients,
particularly what one of my allopathic consultants referred to as "troublesome" or
"neurotic" patients, is considered by some allopathic physicians to be acceptable. This
may be largely due to the belief that if such patients are satisfied by encounters with
homeopaths and experience relief from conditions considered to be "psychosomatic",
the allopathic physician is relieved of responsibility for dealing with the patient and his
sickness. In this way, a placebo effect takes on a negative connotation. "Placebo"
also has devious and deceitful connotations. It seems to infer that the patient’s body

is being tricked into wellness by a mind which has been tricked by the practitioner.

The problem with this view of the placebo response is that it neglects to
address the psychosocial dimensions of sickness and treatment. Allopathic medicine
concentrates primarily on the material cause and physical manifestation of sickness and
minimizes the cognitive and social dimensions as "important determinants of health,
illness and response to treatment" (Weil 19832257). With respect to the placebo
response, allopathic medicine has not begun to consider fully the effect that the context
of the therapeutic relationship and healing encounter has on treatment and outcome of

the illness episode.

56

There are both positive and negative placebo responses. Administration of a
placebo pill resulting in a total cure can be considered to be an example of a positive
placebo response. A further decline in health or manifestation of new symptoms even
after administration of appropriate therapy can be considered to be a negative placebo
response. A negative placebo response may be the result of disparity between the
explanatory models of sickness and treatment used by the patient and the practitioner
or an outcome of the lack of faith in the efficacy of treatment being offered Benson
and Epstein (1975:1225-1226) cite the demeanor of the practitioner toward the patient
as an important factor influencing the response to therapeutic treatment. In relating a
discussion with her physician, one of my consultants reported that she remarked to her
physician, "1 would heal better if you’d only stop insulting me!" In this example, the
patient may have been more consciously aware than some patients of the negative
effects that the disagreement over type of treatment may have on the outcome of the

sickness episode.

Diagnosis, or the act of placing a name on the ailment may be enough to
initiate the placebo response.

If...patients come to physicians largely to confer meaning on the illness

experience, this function has been completed once the physician

pronounces a diagnosis and reinforces it by writing a prescription; the

actual taking of the drug may be less important (Brody 1977:120).
Treatments such as surgery may be considered to involve a placebo component both
because "they impress the patient and because allopathic doctors have the greatest faith

in techniques with high impact upon the physical body" (Weil 1983:226).

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57

Allopathic practice, until relatively recently, has largely disregarded the
psychosocial dimensions of illness and treatment as important influences on treatment
and the outcome of sickness episodes. In this way, it has also failed to consider fully
the implications of both positive and negative placebo response both in allopathic and
in homeopathic practice. A placebo response may be responsible for cure in
combination with, independently of or even in spite of the direct effect of treatment.
"Any direct beneficial effect of treatment can therefore be enhanced by an additional
indirect effect - a halo of placebo response" (Weil 19832220). If we define a placebo
response more fully to refer to psychosocial and cultural aspects of illness and healing
which cannot be directly observed or measured then we realize that so—called placebo
responses are an integral part of all sickness and treatment interactions. If scientific
medicine persists in attributing the success of homeopathic therapy to placebo response
then, according to this broader definition, it would be at least partially correct because
homeopathy recognizes and actively integrates this understanding of the psychosocial

dimensions of sickness and treatment into practice.

At this point we will turn to an examination and discussion of the way in
which homeopathic practice addresses and integrates an understanding of the
psychosocial dimensions of sickness into treatment and practice. The analysis will
focus on the way in which the therapeutic encounter or the patient-practitioner
relationship influences relative patient satisfaction and the outcome of the sickness

episode.

CHAPTER V

THE THERAPEUTIC ENCOUNTER

The Setting

The milieu in which a treatment or therapy is administered may have great
influence over the response to that treatment (Benson and Epstein 1975:1225-1226).
The way in which a homeopathic practitioner approaches a patient and the milieu in
which this occurs are oriented toward establishing a relationship between the patient
and the practitioner which allows the homeopath access to the elaborate personal
history necessary to successful homeopathic treatment. "The relationship between the
practitioner and patient is essential to the healing process; confidence and trust are
taken to be as important as pills and good surgical technique" (Taylor 19842196).
Thus homeopaths are interested in creating as congenial and familiar an atmosphere as
possible for their patients. In his textbook on homeopathy for health care
professionals, The Science of Homeopathy (1980:171-172), George Vithoulkas writes,

...attention must be paid to the setting in which the interview is

conducted. The environment should be quiet, with harmonious, simple,

aesthetic decor. Interruptions should be minimized, and the patient
should not feel rushed....The prescriber’s attitude is a very important
factor in taking the case- It is of the utmost importance that the

interviewer be interested in and concerned with the welfare of the
patient.

58

59
It is presumed that a greater level of comfort will facilitate the interaction necessary

for successful homeopathic treatment.

The nature of the homeopathic encounter seems to be markedly different from
that of an allopathic encounter. The differences begin with the practitioner’s office or
the setting in which the patient and practitioner interact. The offices of the
homeopathic practitioners whom I interviewed were very unlike those of their
allopathic counterparts. Upon my first visit to a homeopath I was most surprised at
the arrangement of the office and waiting area. The waiting area resembled a family
den or study. It was relatively small and furnished with eight cloth-upholstered chairs.
With the exception of the light coming through the front door, three ceramic-based
lamps on end tables provided all of the light for this waiting area. An array of
holistic health, homeopathic, and news magazines as well as a large assortment of
pamphlets on health promotion, preventative medicine, self-care, nutrition, exercise and
yoga were displayed on an oak magazine rack. There was a box of children’s toys
and books on the floor beneath the magazine rack. The walls were painted a soft
yellow color and on them hung 3 colorful prints of herbal medicine and a Peter Max
poster. Near the fient door was an large oak study desk at which a receptionist,
dressed in slacks and a blouse, was seated. The receptionist was friendly, outgoing
and actively engaged clients in conversation. There were three rooms off of the main
reception area. Two served as combined examination rooms/offices for the

practitioners who were partners in this practice. Remedies were prepared and stored

in d

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and \
(hfia
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60
in the third room. This homelike atmosphere was characteristic of the offices of all

the homeopathic practitioners who participated in this research.

The arrangement of the reception and waiting area at the offices of the
allopathic physicians that were interviewed was strikingly different. The waiting rooms
of these practitioners, with the exception of one, were furnished with vinyl and chrome
chairs and sofas. Current glossy magazines were provided. The walls were painted
or papered in white or beige. One of the most important and noticeable differences
between the arrangement of the allOpathic and homeopathic professional ’space’ is the
door and sliding window commonly found in allopathic medical offices. These doors
and windows literally and symbolically separate the patient from the clinical part of the
office -- from the ’business’ part of the office - the business, of course, being the
patient’s health. The message that they send out is that patients have no expertise
once they have crossed the threshold. This is ironic as it is their own health which
patients have come to discuss and it is behind this window or door that the ’business’
of their health will be conducted. It is privileged territory and the only way to gain
access to it is to possess the specialized knowledge necessary to claim a place on the _
other side of the window or submit to the authority which allows one temporary access

it.

The ’examination’ rooms used by homeopathic practitioners interviewed for this
research were quite different from those used by their allopathic counterparts. This is

partially due to the purposes for which they are used both symbolically and practically.

 

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61
The homeopathic practitioners combined their offices with examination rooms. Each
of the homeopathic practices had only one examination room per practitioner. A
description of one homeopathic examination room will serve as an example of those
which I was able to view. The examination room doubled as the practitioner’s office.
In this room there was a sofa, an armchair, shag carpeting, a heavy, dark, antique roll
top desk piled high with papers and books. In front of this desk, the practitioner sat
in a large, antique wooden chair on rollers. Above the desk were book shelves laden
with books about any subject imaginable: homeopathy, history, novels, pharmacology,
astrology, yoga, and psychology, to name but a few. Above the desk and on the
walls were diplomas and finger paintings by children. I felt as if I was entering a
university professor’s private study. Along the far wall was an examination table and
a small table holding a stethoscope, a blood pressure cuff, thermometers, rubber gloves
-- the standard tools for a medical examination. Lighting came from a desk lamp and
a high window, the length of the room. Although there were fluorescent ceiling lights,

they were not turned on.

The allopathic examination rooms which I visited were much different in
appearance than those of the homeopathic practitioners. The examination rooms used
by the allopathic physicians, as stated earlier, were physically cut off from the view
of the reception areas. Separate rooms were maintained as offices for the physicians.
All of the allopathic practitioners interviewed for this research had several examination
rooms even if they were in solo practice. The examination areas were very impersonal

and ’sterile’. They were brightly lit with overhead fluorescent lighting and most had

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62
additional lighting, usually an examination lamp. These rooms were furnished with an
examination table, a cabinet for medical instruments, a sink, a chair, possibly a scale
and a trash can. The floors were not carpeted and were either porcelain tile or
linoleum. Two or three of these examination rooms had posters or small framed

pictures on the walls.

The homeopathic practitioners interviewed for this research did not employ
nurses or physician’s assistants. Patients are escorted to the examination room by the
practitioner after which case-taking begins almost immediately. Patients reported that
they are not asked to disrobe for the examination. If some physical examination is
required, they are asked by the practitioner to remove only as much clothing as is
absolutely necessary. The homeopathic practitioners whom I interviewed dressed more
casually than their allopathic counterparts. My consultants dressed in pullover sweaters

or button down shirts open at the collar. White lab coats were noticeably absent.

Allopathic patients report being led into an examination room by a nurse,
physician’s assistant or receptionist who nearly always wear the traditional white
uniforms of the medical profession. The patients I interviewed report being instructed
to disrobe completely and cover-up with a paper sheet. After a period of time, a nurse
or assistant returns to record pertinent data about the patient’s visit such as reason for
coming, temperature, blood pressure and weight. After this information is obtained, the
patient is again left alone in the examination room until the physician returns to

perform the examination.

 

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63

Benson and Epstein (1975:1226) have cited the length of time which is spent
with a patient and the demeanor of the physician as factors which significantly
influence illness and treatment. The homeopathic practitioners with whom I consulted
cited the greater amount of time that they spend with their patients as one of the
reasons for their patients’ relatively greater satisfaction with homeopathy over allopathic
practice. Homeopathic case taking can be an extremely time consuming process. My
homeopathic consultants indicate that it is desirable to spend at least one hour with a
new patient in order to take as complete a personal history as possible and to develop
an effective therapeutic relationship. One homeopathic practitioner stated,

A close doctor-patient relationship is essential in homeopathy. We treat

the patient, not the disease, which means getting to know the person’s

feelings, thoughts and family situation.
Return visits reportedly average about 20 minutes. These observations are supported

by a study by Avina and Schneiderrnan (1978:368).

In 1973 allopathic physicians averaged 12 minutes in face-to-face interaction
with patients for all visits across all specialties (U .S. Department of Health, Education
and Welfare: 1973 Summary l975:7). This figure was based on estimates provided by
physicians after patient visits. The average amount of time reportedly spent by
allopathic physicians in direct face-to-face contact with patients in 1988 has increased
by nearly one full minute since the 1973 study (Mitchell, Schurman, Cromwell
1989:580). This increase may be due to physicians adding some form of counseling
to office visits on the issues of diet, nutrition, stress reduction and exercise and to an

influx of female physicians who consistently spend more time with patients than do

64
male physicians (Mitchell, Schurman, Cromwell 1989:580-5). Patients often estimate
that much less time is spent in direct interaction with allopathic practitioners. Three
patients that I interviewed reported that allopathic practitioners have spent as little as
three minutes in direct interaction with them. Such a figure may or may not be
accurate. It is possible that patients who are dissatisfied with an interaction may
perceive the amount of time spent with them by a practitioner to be significantly less
than it actually is. It is also possible that physicians overestimate the amount of time

spent in direct interaction with their patients.

Profile of Homeopaflric Patients

The homeopathic physicians with whom I consulted reported that it was rather
difficult to generalize about the type of patients who use homeopathy. My consultants
reported that their patients come from all segments of society and that these patients
are fairly well educated in matters of health and health care.

In my kind of practice I see people who are fairly well educated to

health. That doesn’t mean that they all went to college. There are

pe0ple who are pretty intuitive who haven’t had much [formal] education

and I get these patients too. Most are people who are interested in their

health and want to take responsibility for it. Homeopathy lends well to

that kind of person.
This statement represents the way in which the homeopathic practitioners I interviewed
characterize their patients. However, spending many hours in the waiting areas of
homeopathic practitioners offices reveals some more obvious characterizations. Based
on observations and interviews, homeopathic patients tend to be younger than age 45,

white, female, middle to upper-middle class, and have a relatively high level of formal
education. This profile is supported by Avina (19782367).

65
Holohan (198721641) asserts that patients using alternative therapies instead of
or in conjunction with more orthodox therapies tend to have achieved a higher level
of formal education than those patients relying only on allopathic therapies. Holohan’s
characterization may not be fully accurate as he does not distinguish between different
types of alternative therapies and does not consider ethnic or religious beliefs as

motivating factors for choosing particular health care systems.

Individuals with higher levels of education may be more likely to use
homeopathy and other forms of alternative health care because of a relatively greater
awareness that alternative sources exist. One recent study (Ende et. al., 1989:27)
indicates that younger patients with higher levels of formal education show a stronger
preference than older individuals, especially those with lower levels of formal
education, for assuming responsibility for gathering information on health care issues
and for making treatment decisions. Such individuals may be attracted to homeopathy
because homeopathic treatment offers a greater opportunity than allopathic treatment

for exercise of autonomy and decision-making related to health care issues.

It is not surprising that the majority of homeopathic consumers tend to be
women as women constitute the great majority of consumers of all health care in the
United States (Todd 1989:23). Most of the male patients I saw in homeopathic offices

were accompanied by a woman.

66

Individuals from the middle socio-economic classes may be more likely than
either upper-class or lower-class individuals to seek less expensive, alternative forms
of health care because they are most likely to be financially pinched by the rising costs
of allopathic medical care and limited health care insurance coverage or the inability
to afford such insurance. Those individuals in the upper economic classes can more
easily afford allopathic medical care and may be less likely to seek alternative health
care for economic reasons. Those in lower socioeconomic classes who use public
assistance health programs such as Medicaid may be less likely to seek alternative

medical care as their health plans may not cover the cost of alternative medical care.

Reasons for Choosing Homeopathy

The homeopathic patients with whom I consulted indicated that they were
introduced to homeopathy primarily through friends and co-workers who utilize
’ homeopathy but some learned about homeopathy through holistic health guides,

publications or other alternative practitioners such as chiropractors and naturopaths.

Many of the homeopathic patients with whom I consulted reported that they
use homeopathy because they were "dissatisfied" with one or more aspects of allopathic
medicine. According to one study of patients of a homeopathic clinic, 81% percent
reported that they initially sought help from homeopaths due to "dissatisfaction" with
some aspect of allopathic practice (Avina and Schneiderman 1978:368; also see
Fumham and Smith 1988:689). Nearly all of my homeopathic consultants reported

seeking homeopathic assistance for the first time after exhausting all resources within

67
the a110pathic establishment and having either been dissatisfied with the treatment
offered or having been unable to receive treatment for their particular complaint. The
homeopathic practitioners whom I interviewed reported that the majority of patients
who utilize homeopathy do so for the treatment of a chronic illness. Avina and
Schneiderman (1978:367) reported that 74% of all new homeopathic patients presented

with a chronic condition which had persisted for one year or longer.

Homeopathic patients and practitioners interviewed for this research cited an
interest in health promotion and maintenance as a reason for seeking homeopathic
treatment. This is supported by a study by Avina (19782368) which found that a
significant percentage (54%) of patients were attracted to homeopathy because of its
emphasis on health maintenance and health education. The homeopathic patients I
interviewed appeared to be skeptical about the efficacy of allopathic medicine in
general and believed that preventative medicine or health maintenance is more effective
in dealing with sickness than is taking any sort of medication. On the other hand,
patients who use allopathic medicine exclusively believe that taking medicines is more
successful than any other form of treatment in treating sickness (Fumham and Smith

1988:688).

The homeopathic patients whom I interviewed cited relative cost as one reason
for using homeopathy. The cost of office visits to a homeopathic practitioner is
significantly lower than that of the majority of allopathic practitioners, particularly

specialists. The homeopathic patients and practitioners whom I interviewed reported

68
an average fee of $25 for a 20-30 nrinute office visit, in which the cost of remedies
is included This is compared to a $60 - $80 fee for a 10-15 minute office visit
reported by allopathic practitioners and patients.7 Additional costs are incrnred in
allopathic practice because of the costs of drugs, laboratory tests, x-rays, and other
diagnostic procedures. Homeopathic practitioners also use such tests but report using

them to confirm rather than to make diagnoses.

While it is easy to say that the expense and potential dangers associated with
allopathic medicine are sufficient reason for the expressed dissatisfaction with this
health care system, this may be too superficial an analysis. The dissatisfaction with
allopathic medicine, as expressed by the homeopathic patients and practitioners with
whom I consulted, seems to have less to do with the treatments that are offered and
administered to a patient than with the context in which they are administered.
Satisfaction with treatment of sickness, and ultimately the outcome of the sickness
episode, are directly related to the degree of cognitive and communicative agreement
which exists between the patient and the practitioner (Kleinman 19802114). The more
closely aligned a patient’s and practitioner’s understanding and expectations of sickness
and treatment, the more successful the treatment will be and the more satisfied a

patient will be with the healing intervention.

 

7Costs for allopathic consultations probably vary geographically. Thus, the figures cited
above may be high for some areas and low for others. Fees also vary according to specialty.

69

In order to understand better the source of dissatisfaction with allopathic
medicine, it is important to examine its theory and practice. Under the biomedical
paradigm, health is considered to be a more or less static state. Health is the absence
of disease (Weil 19832114). "Disease...is a disordered biological state, described in
terms of physical science and treated generally independently from social behavior and
intrapsychic processes..." (Salmon 1984:8). An individual does not experience
’relative’ health. One is either well or one is sick to some degree. The foci of
research and therapeutic intervention of allopathic medicine are the physiological,
biochemical or pathological processes which are "really there". Treatment, under this
paradigm, is a technical endeavor. A physician’s task is to seek out the material cause
of the sickness and either remove it or destroy it. Until recently, little attention has
been paid to the way in which a person experiences sickness and what effect this may

have on treatment and the outcome of the sickness episode.’

Individuals may turn to homeopathy and continue to use it because the model
and understanding of sickness and treatment by which homeopathy operates is more
closely aligned with the patient’s own model of sickness and expectations for
ueatment. Lay individuals possess a variety of models for understanding sickness and
treatment which are influenced by such factors as educational or ethnic background

Some individuals have a more ’scientific’ or ’clinical’ understanding that is more

 

1’See Kimball (1981) for an excellent examination and discussion of the need for
allopathic medicine to implement a more holistic approach to patient care through the
restructuring of the therapeutic relationship. Dr. Kimball presents and discusses specific
training strategies for medical students and clinicians. The approach to patient care which
Kimball advocates closely resembles that of homeopathy.

70
closely aligned with the biomedical model of sickness and treatment. Most people
probably do not understand why they are sick in such a clinical sense. When asked
about their reasons for seeking health care intervention, the patients with whom I
consulted reported that they were "feeling run down lately", had "a sore throat",
experienced "pain" somewhere or were "feeling depressed". Rather, they understand
that they are not feeling well and want relief. Thus, symptomatic complaints (physical
and psychosocial) which are the catalyst for seeking health care are the language by

which people understand their sickness.

Patient complaints are not merely ’lists’ of physical or psychosocial complaints,
however. They are often embedded in a social context. For example, one patient who
had recently begun homeopathic treatment for persistent and debilitating headaches
described the context in which she sought homeopathic treatment.

...I started getting these horrible headaches about three months after

Jenny’s wedding. The doctor [an allopath] gave me some pills just

before my folks flew in for the holidays. I would get sick at work... get

dizzy...lie down....We go to Texas every Easter...that’s when I got
numbness in my arm...
The individual in this example could simply have provided a list of her symptoms in
the context of onset and duration but instead placed them within the social milieu of

family and work. This was a common form of expression among my consultants.

Allopathic physicians make diagnoses on the basis of symptoms. Allopathic
physicians, however, are trained to identify specific, primarily physical symptoms which

are clinically relevant and may indicate the existence of a particular disease or

71
condition (Beckman and Frankel 1984:694). Symptoms which the patient may regard
as important may be disregarded by the physician if they n0t perceived by the
physician as relevant to diagnosis. One recent study (Beckman and Frankel 1984)
reported that in only 23% of visits to allopathic physicians were patients provided the
opportunity to complete their opening statement of concerns, let alone provide a full
accounting of all the aspects of his sickness which were troubling them. This suggests
allopathic physicians shift from a patient-centered format to one which is physician-
centered in collecting diagnostic information. This may lead to the loss of potentially
relevant information and leave sorrre patients frustrated or angry and may influence
compliance with prescribed treatment. In allopathic practice, it is the physician who
possesses the specialized knowledge required to determine which symptoms are relevant
for making diagnoses and prescribing treatment. The patient is not believed to possess

sufficient or appropriate knowledge for making such decisions.

Homeopathy, on the other hand, relies heavily upon patients’ knowledge of their
sickness .in determining appropriate treatment. One important aspect of homeopathic
prescribing is the agreement between the patient and practitioner on the uniqueness of
the patient’s symptoms. The patient makes the decision about what information is
relevant to choosing an appropriate form of therapy, not the practitioner.

The primary concern of the homeopathic method is patient

"idiosyncrasy". It begins with a restructuring of the patient—practitioner

relationship toward the acquisition and use of an elaborate history. This

concern for the individual patient yields a marked degree of intimacy
responding to a factor the [American] public has complained is absent

in conventional medical practice (Salmon 198423).

It seems clear, given the concentration on complete symptomatology and agreement by

72
patient and practitioner on the uniqueness of the patient’s sickness, that the disparity
between the homeopathic practitioner’s and patient’s understanding of sickness and
expectations regarding treatment is relatively small. This shared understanding may be
a major contributing factor to the repeated use of and reported satisfaction with

homeopathic medicine arnon g those who utilize it.

Dissatisfaction and Patemalism

 

Homeopathic patients appear to be strongly against leaving the responsibility for
determining and dealing with their health care needs in the hands of a physician.
According to one homeopathic practitioner with whom I consulted, individuals who use
homeopathy are "...interested in their own health, are educated about health and take
responsibility for it." In contrast, Fumham and Srrrith (1988:687-688) report that
patients who use allopathic physicians exclusively for their health care needs are more
or less indifferent to ceding responsibility for their health and health care to their
physicians. Individuals interested in maintaining control over health care treatment
decisions may be attracted to homeopathy as it offers a relatively greater opportunity

for exercise of autonomy in decision-making related to health care issues.

Patemalism is pertinent to a discussion of dissatisfaction with scientific
medicine. In allopathic practice, physicians assume ultimate authority on sickness and
its treatment by virtue of the specialized knowledge which they possess. This
knowledge is considered to be largely inaccessible to the patient Thus, the allopathic

physician assumes a great portion of responsibility for choice and administration of

CE

Ci‘.

or,

73
treatment. This may encourage patient passivity in treatment because sickness has been
removed from the patient’s realm of understanding. Transfer of responsibility for
health care to the physician may lead to decreased feelings of autonomy on the part
of patients with respect to their sickness, and may ultimately affect such factors as
compliance with treatment, the outcome of the sickness episode as well as future health
care seeking behavior. One homeopathic patient with whom I consulted reported an
experience with an allopathic practitioner,
She didn’t listen to what I was telling her [the physician]. It was like
she had already decided what was wrong....and what she was going to
do about it. She made me so mad I never even bothered to have the
prescriptions filled....and I got so sick that I finally came here to Dr. C
[a homeopathic practitioner].
It is interesting that the patient in this example chose to change practitioners in an

effort to regain lost autonomy rather than to directly confront the practitioner with

whom she was dissatisfied.

Todd (1989251) suggests that a patient’s source of power in the health care
encounter may be in choosing or not choosing to come to a practitioner and in
chOosing to or not to comply with a physician’s recommendations and instructions.

She asserts that it is rare for a patient to challenge a physician directly. Few of the
patients I interviewed reported having directly confronting an allopathic physician over
disS atisfaction with an encounter or prescribed treatment. An alternative view is that

medical paternalism relieves the patient of assuming responsibility for health care
deciSion making by shifting that responsibility to the health care practitioner
(Blue-twich and Ehrenreich 1978260). Brody (1977:125-126) suggests that if a patient

74

feels that a practitioner has assumed responsibility for decision making this may be

sufficient for a placebo response to occur.

This type of paternalism appears to be largely absent from homeopathic practice.
This is primarily due to the fact that successful treatment relies heavily upon
specialized knowledge which is possessed by both the patient and practitioner. Both
are authorities of nearly equal importance in the therapeutic encounter. In fact, the
patient may be considered to possess more ’specialized’ knowledge because it is only
the patient who can communicate the symptoms and concerns to the practitioner in a
way which will allow an appropriate and effective remedy to be chosen. Thus,
homeopathic patients may retain greater responsibility for their health and health care
than do allopathic patients. "The notion of the passive patient is explicitly rejected and
the patient is encouraged to participate in defining symptoms and evaluation therapy"
(Berliner 1984244). Both homeopathic theory and contemporary practice assert that
homeopathic practitioners possesses specialized knowledge only insofar as they are

Practiced in choosing appropriate remedies. The homeopathic practitioner appears to

assume the roles of facilitator and educator.

Based on my interviews with homeopathic practitioners and patients,
diss atisfaction with allopathic encounters is expressed by patients when their
understanding or views about their complaints are either unsolicited or ignored in part

or in total by the physician. Satisfaction with a therapeutic encounter appears to be

i
11 part dependent upon patients being allowed to fully communicate their understanding

75
of their sickness to the physician. It also seems to be dependent on how fully the
doctor is able to communicate information about diagnosis and treatment in a way

which the patient can understand.

_S_c_ie_-I_ce

The features of allopathic medicine which cause some patients to seek
alternative forms of health care lead others to believe that scientific medicine is the
only legitimate system of health care. The authority and power that scientific medicine
maintains over health care in our country is legitimated by its association with science.
In American society faith in technology and the importance of physical reality as part
of the scientific paradigm make relatively traumatic procedures more acceptable than

milder ones, such as those administered by homeopathy,

[tlhe development of medical technology has produced a fantastic rise
in expectations of what the medical system has to offer. Medical

’miracles’...promote
the idea that any problem can be cured (Ehrenreich and Ehrenreich 1978:53).
Tl'lis may be true because more invasive, technological procedures seem more like the

Pinnacle of human progress and achievement while the milder therapies administered

by homeopathy, which have remained essentially unchanged for nearly 200 years, may

seem to be "backward" or "old-fashioned".

While many of the homeopathic patients that I interviewed claimed that they
he Vel- wanted to have anything to do with another [allopathic] doctor, unless it was
Something serious" SUCh as a broken leg or trauma due to an accident, their reasons for

co - I ’ o o
inlng to homeopaths over other types of ’altematrve practitioners were very

76
revealing. Some of the homeopathic patients with whom I consulted who have had
unsatisfying interactions with allopathic medical practice, report that they want to " get
as far away from it as possible". Sixteen percent of the patients in Avina and
Schneiderman’s study (19782368) reported that they would not use or recommend an
allopathic physician for any reason at all. Many of my consultants who chose
homeopathy report that they did so because it seemed to be a polar opposite to
allopathic medicine in terms of treatment. _ Interestingly, and perhaps ironically, many
of these individuals reported going to homeopaths over other ’altemative’ practitioners
because homeopathic practitioners are "real doctors". It appears that homeopathic
practitioners are far enough removed from allopathic medical practice in terms of their
basic methods for treatment to satisfy patients looking for a more "holistic",
"individualistic" or "humanistic" health care system. Homeopaths are, however, still
closely enough aligned with scientific medicine "just in case it’s something serious".
Homeopathic practitioners may be viewed by their patients as having more authority
over issues of health care than other alternative practitioners by virtue of the

specialized medical knowledge which they possess.

It seems that few of the patients who use homeopathy do so because of a
strong or explicit belief in the theory and philosophy of this health care system. Many
of the patients that I interviewed reported that they possess only a basic understanding
of homeopathic history and theory. This is not to say that there are not homeopathic
patients who do not thoroughly understand the theory and philosophy of homeopathy.

In fact, of the patients I interviewed, those who patronize homeopaths exclusively or

 

 

 

77
nearly exclusively seem to be the most knowledgeable in this respect. Nearly all of
the homeopathic patients whom I interviewed report that they do not use homeopathy
exclusively for their health care needs. Most are what I refer to as ’mixers’ and
utilize a variety of different types of practitioners and therapies depending upon the
nature of their particular complaint. Avina and Schneiderman (1987:368) report that
nearly 77% of all the home0pathic patients in their study were also involved in some
other form of ’altemative’ health care including acupuncture, yoga, massage therapy
and, especially, chiropractic. The use of other forms of health care is not incompatible
with homeopathy insofar as Hahnemann was an advocate of health maintenance and
promotion though proper nutrition, exercise and spiritual counseling. It is likely that
had Hahnemann been familiar with yoga or massage therapy he would have approved

of these as treatments for some complaints.

It appears that individuals who utilize homeopathy do so more because of the
approach which homeopathic practitioners take towards patient care than because of any
explicit belief in the theoretical foundation and orientation of home0pathy. This is
supported by the fact that many patients report choosing homeopathy for the mildness
of its remedies, "holistic" approach to patient care, or its relative inexpensiveness rather

than because they believe in the clinical efficacy of the "infinitesimal dose".

78

Summary

The understanding of health and sickness and expectations for treatment of
sickness are different for patients who use homeopathy for at least some of their health
care needs than for patients who use utilize allopathic medicine exclusively. These
individuals appear [to choose homeopathy over allopathic medicine more for the
approach which homeopathic practitioners take to patient care than because of any
explicit belief in the theoretical foundations and orientation of homeopathic
therapeutics. Further, homeopathy may be more appealing than other alternative forms
of health care to some individuals because many of its practitioners have allopathic
training and are thus perceived to be legitimate practitioners. These individuals may
also prefer homeopathic therapeutics over allopathic medicine for reasons which are

related to autonomy and control in health care issues and decision making.

 

«=3

CHAPTER VI

SUMMARY AND DISCUSSION

Homeopathy was introduced in the 19th century in reaction to perceived
inadequacies in the existing medical system. Homeopathy offered an acceptable
alternative to the heroic practices of the time and developed a strong following in all
segments of society soon after its introduction to this country. It was also able to
successfully compete with other alternatives to heroic medicine by appealing to a wider
audience of health care consumers. Eventually homeopathy developed a following
strong and influential enough to challenge the allopathic establishment. It was largely
as a result of the battle fought between the homeopathic and allopathic establishments
that changes in medical education and licensure were made. Additionally, the
competition spurred the growth of an organized medical profession in this country.
Although homeopathy was highly successful for almost a century, advancing medical
technology made homeopathy seem outdated to many Americans after the turn of the
century and ’scientific’ medicine became favored. Homeopathy nearly disappeared

ficm the American medical scene by the 1930’s.

The American public has long invested their faith in technology, the hallmark

of allopathic medicine. Health care consumers appear to be increasingly voicing their

79

80
concern over drug iatrogenesis, dangers involved with invasive medical procedures and
the ever increasing expense of medical care. There is also a growing recognition
among the American public and the medical profession of the importance of
considering the psychosocial aspects of sickness. In recent years, there has been a
resurgence of interest in homeopathy in the United States. In the 19th century,
homeopathy gained favor with the American public due, in part, to the gentleness and
safety of its remedies. Today, homeopathy also satisfies the health care consumer
looking for a gentler, safer alternative to allopathic medicine. Homeopathy also shifts
focus from the tangible causes of sickness and its physical manifestations to
examination of the psychosocial components of illness and the influence that these have

on the outcome of the sickness episode.

More importantly, however, homeopathy advocates a resu'ucturing of the
traditional doctor-patient relationship from one in which the physician takes
responsibility for the patient’s health care and related decision-making and shifts it to
one in which these responsibilities belong to the patient. Restructuring this relationship
empowers patients to take responsibility for health and decisions related to health care.
For some individuals this increased autonomy may lead to a more satisfying therapeutic
relationship. This, in turn, may positively influence the outcome of the sickness
episode. A good patient-practitioner relationship is integral in health care. Patients
and practitioners must negotiate health care decisions in ways which are mutually
satisfying. This, however, is made more difficult as such negotiation often occurs in

the context of dissimilar understandings of sickness and expectations for treatment.

81

The findings of this research suggest that there is a need to change the ways
in which both physicians and patients approach the health care encounter. Some
patients who are dissatisfied with their health care find it preferable and/or easier to
change practitioners rather than to directly challenge a physician and renegotiate a
therapeutic relationship and course of treatment. This suggests that health care
consumers could benefit from learning strategies which would aid them in negotiating
health care interactions. Similarly, physicians could benefit from education aimed at
improving patient-practitioner relationships through the shifting of attention to the social
context of sickness and restructuring the patient-practitioner relationship to one which

is more egalitarian.

We can expect to see continued growth in the popularity and acceptance of
homeopathy as the American public realizes that homeopathic practitioners are
legitimate licensed practitioners who can effectively utilize science and technology yet
maintain a patient-focused system of therapeutics. The growing recognition among the
allopathic profession of the importance of the psychosocial dimensions of sickness may
also lead to increased acceptance of homeopathy by health care consumers and .
incorporation of some aspects of homeopathic practice into mainstream medicine.
More people may turn to homeopathy as health care costs continue to rise with
increasing specialization in the allopathic profession. Specialization and technological
advances are not always able to deal effectively and satisfactorily with some health
care needs and thus, some health care consumers will be forced to seek out other

options.

82

Major health concerns in the let century are likely to be very different from
those in this century just as the major health care concerns of the 19th century have
been eradicated or have become only minor concerns in this century. Immune
dysfunctions and viral conditions are becoming more common. Bacterial infections are
becoming increasingly resistant to treatment with antibiotics. Allergies to food and
common household substances are on the rise (Ullman l9882xiv-xv; Weil 1983283). In
1986, 52% of all deaths in the U.S. were related to one of nine chronic diseases
(stroke, heart disease, diabetes, obstructive pulmonary disease, lung cancer, female
breast cancer, cervical cancer, colorectal cancer and cirrhosis) (Centers for Disease
Control 1990:17). The number of deaths related to chronic conditions is expected to
continue to rise in proportion to other causes of death. Many of these conditions
cannot currently be treated satisfactorily with conventional medical technology.
Chronic conditions are affecting younger and larger segments of the American
population. Finally, our population is growing proportionately older thus creating new
health care concerns. Technology can keep elders alive but it is presently unable to

effectively cope with illnesses created by prolonging life.

Homeopathy offers a unique and possibly a very useful approach to health care
both in terms of the treatments which it administers and the approach to health care
which it advocates. Homeopathic therapeutics are appealing to and meeting the health
care needs of a growing segment of the American population. This suggests that
further investigation of homeopathy is warranted. Homeopathy, like all health care

systems, has certain limitations. It is important to focus more broadly on examination

83

of a variety of ’altemative’ health care systems in an attempt to understand what it is
about these systems that appeals to health care consumers, how they address the needs
of patients and what makes them successful in dealing with sickness. We should also
do the same with allopathic medicine. In doing this, we can attempt to integrate and
implement a variety of the most successful approaches to understanding sickness and
in this way develop a health care system which is successful in dealing with sickness

both from a physical and a psychosocial perspective.

The presentation of this research is not intended to illustrate universals about
homeopathy or allopathy or more generally about health care in the United States.
Rather, I have used the observations and research included here to examine patient-
practitioner relationships and how homeopathy fits into the scheme of American health

care in the past and present and its possibilities for the future.

GLOSSARY

case-taking: The interview process used in homeopathy to determine an appropriate
homeopathic remedy.

materia medica: The homeopathic practitioner’s reference. It includes indices of
symptom pictures and remedy pictures.

potentization: The process of preparing a homeopathic remedy by repeatedly diluting
the crude substance in water with succussion.

proving: Administration of a substance to healthy subjects in an effort to determine
the remedy picture of that substance.

remedy picture: The characteristics of a homeopathic remedy’s action as determined
through provings.

similimum: The homeopathic remedy whose remedy picture most closely resembles the
symptom complex of the patient.

succussion: This is part of the process of potentization during which the dilute
substance is shaking by striking the container against a firm surface.

symptom portrait/picture/complex: The totality of physical and psychosocial
symptoms experienced and expressed by an individual.

84

BIBLIOGRAPHY

BIBLIOGRAPHY

Amato, I
1986 "Molecular Divorce Gives Strange Vibes." Science News, November 1.

American Medical Association
1909 "Medical Education and State Boards of Registration: State Board
Statistics for 1908." Journal of the American Medical Association 52
(May 22):]691-1713.

Anderson, David, Dale Buegel and Dennis Chemin

1978 Homeopathic Remedies For Physicians, Lamen and Therapists.
Honesdale, Pennsylvania: Himalayan International Institute.

 

Avina, Robert L. and Lawrence J. Schneiderman
1978 "Why Patients Choose Homeopathy." Western Joumalf of Medicine
128(4):366-369.

Baaumans, V., C]. Bol, et. al.
1987 "Does Chelidonium 3x Lower Serum Cholesrerol?" British Homeopathic
Journal 76(1). Reprinted in Homeopathic Research Rems Summer
198722.

Baehr, Bernhard

1869 The Science of Theragutics According to the Principles of Homeopathy.
Volumes I & II. New York: Boericke and Tafel.

 

Barrett, Stephen
1987 "Homeopathy: Is it Medicine?" The Skeptical Enguirer 12(1):56-62.

Beckrnan, Howard B. and Richard M. Frankel
1984 "The Effect of Physician Behavior on the Collection of Data." Annals
of Internal Medicine 101(5):692-696.

Benson, Herbert and Mark D. Epstein

1975 "The Placebo Effect: A Neglected Asset in The Care of Patients." The
Journal of the American Medical Association 232(12):]225-1227.

85

 

86

Berliner, Howard S.
1984 "Scientific Medicine Since Flexner." In Alternative Medicines: Popular
and Policv Perspectives. ed. Warren J. Salmon, 30-56. New York:
Tavistock Publications.

Blackie, Margery G.
1976 The Patient Not the Care: The Challenge of Homeopatma London:
MacDonald’s and Jane’s.

Boyd, H.
1985 "Homeopathic Medicine." In Alternative Therapies: A Gage to
Complementary Medicine for the Heflh Professional, ed. G.T. Lewith,
150-177. London: William Heinemann Medical Books.

Brody, Howard
1977 Placebos and the Philosophy of Medicine. Chicago: The University of
Chicago Press.

Callinan, P.
1985 "The Mechanism of Action of Homeopathic Remedies: Towards a
Definitive Model (Section C: Mode of Action)" Journal of
Complementary Medicine 1235-56.

Centers for Disease Control
1990 "Chronic Disease Reports: Deaths from Nine Chronic Diseases - United
States, 1986." Morbidig and Mortality Weekly Remrt 39(2):l7-29.

Cherkin, Dan, Fredede MacComak and Alfred O Berg
1989 "Family Physicians’ Views of Chiropractors: Hostile or Hospitible."
American Journal of Public Health 79(5):636-637.

Chemin, Dennis and Gregory Manteuffel
1984 Health: A Holistic Approach. Wheaton, Illinois: The Theosophical
Publishing House.

Chou, Jessica
1986 "A Biological Investigation of Succussed serial Microdilutions." Journal
of the American Institute of Homeopathy 79(3).

 

Consumer Reports
1987 "Homeopathic Remedies." Consumer Reports. Januaryz60-62.

Coulter, Harris L.

1981 Homeopathic Science and Modern Medicine: The Physics pf Healing
with Microdoses. Richmond, California: North Atlantic Books.

 

87_

1982 Divided Legacy, vol. III, The Conflict Between Homeopathy and the
American Medical Association. Berkeley, CA: North Atlantic Books.

1984 "Homeopathy." In Alternative Medicines: Popular and Policy
Pegpectives, ed. Warren J. Salmon, 57-79. New York: Tavistock
Publications.

Crellin, J .K.
1987 "Should Homeopathy Be Reconsidered?" North Carolina Journal of
Medicine 48(9):447-450.

Cummings, Stephen and Dana Ullman
1984 Even/body’s Guide to Homeopathic Medicines. Los Angeles, California:
Jeremy P. Tarcher, Inc. -

Daniels, George H.
1971 Science in American Socieg. New York: Alfred A. Knopf.

Day, Christopher
1986 "Decrease in Stillbirths in Pigs." The Veterinag Record 14(9). Reprinted
in Homeopathic Research Reports Summer 198722.

Donsbach, Kurt W.
1985 Homeopathy. Huntington Beach, California: The International Institute of
Natural Health Science, Inc.

Ehrenreich, John, ed. .
1978 The Cultural Crisis of Modern Medicine. New York: Monthly Review
Press.

Eluenreich, John and Barbara Ehrenreich
1978 "Medicine and Social Conu'ol." In The Cultural Crisis of Modern
Medicine, ed John Ehrenreich, 39-79. New York: Monthly Review Press.

Ende, Jack eta].
1989 "Measuring Patients’ Desire for Autonomy: Decision Making and
Information-seeking Preferences among Medical Patients." Journal of
General Internal Medicine 4(1):23-30.

Engle, George .
1977 "The Need for a New Medical Model: A Challenge for Biomedicine."
Science 196:129-136.

English, John M.
1986 "Homeopathy." The Practitioner 230(1422)21067-1071.

 

88

Firman, Gregory J. and Michael S. Goldstein
1975 "The Future of Chiropractic: A Psychosocial View." New England
Journal of Medicine 293(13):639-642.

Flanagan, Virginia
1983 "A Little Goes a Long Way." Let’s Live! May255-64.

Foucault, Michel

1975 The Birth of the Clinic: An Archaeology of Medical Perception. New
York: Vintage Books.

1984 The Politics of Health in the 18th Cenm. In The Foucault Reader, ed.
Paul Rabinow, 273-289. New York: Pantheon Books.

Fumham, Adrian and Chris Smith
1988 "Choosing Alternative Medicine: A Comparison of the Beliefs of Patients

Visiting a General Practitioner and a Homeopath." Social Science and
Medicine 26(7):685-689.

Geertz, Clifford
1973 The Integpretation of Culture}. New York: Basic Books.

Gevitz, Norman
1982 The D.O.’s: Osteopathic Medicine in America. Baltimore: The Johns
Hopkins University Press.
'
1987 "Sectarian Medicine." Journal of the American Medical Association
257(12):1636-1640.

Gibson, R.T., et. al.
1980 "Homeopathic Therapy in Rheumatoid Arthritis: Evaluation by Double-
Blind clinical Therapeutic Trial." British Journal of Clinical
Pharmacology 9:453-459.

Glymore, Clark and Douglas Stalker.
1983 "Engineers, Cranks, Physicians, and Magicians." The New England
Journal of M_edicine 308:960-964.

Greene, Michele G., Susie Hoffman, Rita Charon and Ronald Adelman
1987 "Psychosocial Concerns in the Medical Encounter: a Comparison of the
Interactions of Doctors with Their Old and Young Patients.“ m
Gerontologist 27(2):164-168.

Grossinger, Richard

1987 Planet Medicine: From Stone Age Shamanism to Post-Industrial Healing.
Berkeley, California: North Atlantic Books.

 

89

Haehl, Richard
1922 Samuel Hahnemann His Life and Work, Vol. 1. London: Homeopathic
Publishing Company.

 

Hahn, Robert A.
1984 "Rethinking ’Illness’ and ’Disease’." Contributions to Asian Studies 18:1-
23.

Hahn, Robert A. and Arthur Kleinman
1983 "Biomedical Practices and Anthropological Theory: Frameworks and
Directions." Annual Review of Anthropology 12:305-333.

Hahnemann, Samuel _
1974 The Organon of Medicine. 6th edition. New Delhi: B. Jain Publishers.
(reprint original published in 1842).

1987 The Chronic Diseases: Their Peculiar Nature and Their Homeopathic
Cure (Theoretical Part). Reprint, with Introduction by Shanti Dev. New
Delhi: B. Jain Publishers Pvt. Ltd. (original published in 1835).

Hastings, Robert C. ed.
1980 331th For The Whole Person. Boulder, Colorado: Westview Press.

Haug, Marie
1979 "Doctor Patient Relationships and the Older Patient." Journal of
Gerontology 34(6):82-860.

Hendrick, George .
1987 "Washington Irving and Homeopathy." In seudo-Science in Nineteenth

Cean America, ed Arthur Wrobel, 166-179. Lexington, Kentucky:
University Press of Kentucky.

Herbert, Solomon J.
1988 "Homeopathy: A New Look at an Old Form of Medicine." Let’s Live!
August262-63.

"Homeopathy: Better Health With Long-Lived Cures." Let’s Live!
Septemberz65.

Holohan, Thomas V.
1987 "Referral by Default: The Medical Community and Unorthodox Therapy."
The Joml of the Ameripan Medicri Association 257(12):]641-1642.

Illich, Ivan .
1976 Medical Nemesis: The Expropriation of Health. New York: Pantheon
Books.

 

90

Inglis, Brian
1965 The Cge for Unorthodox Medicine. New York: Putnam’s Sons.

Inglis, Brian and Ruth West
1983 The Alternative Health Guifi. New York: Alfred A. Knopf Publishers.

Jones, Russel M. ed.
1978 Notes and Introduction to The Parisian Education of an American

Surgeon: Letters of Jonathan Mason Warren 11832-1835). Philadelphia:
The American Philosophical Society.

Kaufman, Martin

1971 Homeopathy in America: The Rise and Fall of a Medical Heresy.
Baltimore: Johns Hopkins Press.

Kent, James Tyler

1979 Lectures on Homeopathic Philosophy. Reprint, with Forward by Dana
Ullman. Berkeley, California: North Atlantic Books. (original published
in 1900).

Kimball, Chase Patterson

1981 The Biopsychosocial Apmach to the Patient. Baltimore: Williams and
Wilkins.

Kleinman, Arthur
1980 Patients and Healers in the Context of Culture. Berkeley, California:
University of California Press.

Koehler, Gerhard
1986 The Handbook of Homeopathy: Its Principles and Practice. Rochester,
Vermont: Thorson’s Publishing Group.

Korok, Milan.
1985 "Is There a Future for Homeopathy?." Canadian Medical Association
Journal 132:840-849.

Ledermann, E.K.
1986 Philosophy and Medicine. Cambridge, England: Gower Publishing
Company.

Lock, Margaret M.
1980 East Asi_an Medicine in Urban Japan. Berkeley, California: University of
California Press.

91

Maretzki, Thomas W. and Eduard Seidler
1985 "Biomedicine and Naturopathic Healing in West Germany: A Historical
Etlrnomedical View of A Stormy Relationship." Culture Medicine and
Psychiag 9(4): 383—423.

 

McGary, William A.
1985 "An Adventure in Health." New Realities, pp. 51-52, 89-91.

McKee, Janet
1988 "Holistic Health and The Critique of Western Medicine." Social Science
and Medicine 26(8):775-784.

Mitchell, G. Ruthven
1975 Homeopathy. London: W.H. Allen.

Mitchell, Janet B., Rachel Schurman, and Jerry Cromwell
1988 "The Changing Nature of Physicians’ Office Visits." H_e_al_tl_;_§gryi_c_e
Research 23(4):575-59l.

Osherson, S and Lorna AmaraSingham
1981 "The Machine Metaphor in Medicine." In E.G. Mischler, et. al., Social
Contexts of Health Illness and Patient Care. Cambridge: Cambridge
University Press.

 

 

Panos, Maesimund D., and Jane Heimlich

1980 Homeopathic Medicine at Home: Natural Remedies for Evegyday

Ailments and Minor Inipries. Los Angeles: J.P. Tarcher, Inc.

Parker, Gordon and Hilary Tupling .
1976 "The Chiropractic Patient: Psychosocial Aspects." MW
. Australia September 4 (2):373-376.

1977 "Consumer Evaluation of Natural Therapists and General Practitioners."
The Medical Journal of Australia April 23 (1):619-622.

Parsons, Talcott
1951 The Social System. New York: The Free Press.

Patel, Mahesh S. . .
1987 "Problems in the Evaluation of Alternative Medicine." Socral Scrence and

Medicine 25(6):669-678.

Rabinow, Paul . . . .
1977 Reflectian on Fieldwork in Morocco. Berkeley, Calrfonrra: Unrversrty

of California Press.

92

Reilly, David Taylor, et. a1.
1986 "Is Homeopathy a Placebo Response?" Lancet October 18:881-885.

Reiser, SJ.

1978 Medicine and the Reign of Technology. Cambridge: Cambridge
University Press.

Rosenberg, Charles E.
1987 The Cholera; Years: The United States in 1832 1849 and 1866.
Chicago: University of Chicago Press.

 

Rothstein, William G.
1972 American Physicians in the 19th Centpry: From SectsL to Science.
Baltimore: The Johns Hopkins University Press.

Sacks, Adam

1983 "Nuclear Magnetic Resonance Spectroscopy of Homeopathic Remedies."
Joum_al of Holistic Medicine 5(2):]72-175.

Salmon, Warren J.
1984 "Defining Health and Reorganizing Medicine." In Alternative Medicines:
Popular and Policy Perspectives, ed Warren J. Salmon, 252-288. New
York: Tavistock Publications.

Shipley, Michael, et. a1.
1983 "Controlled Trial of Homeopathic Treatment of Osteoarthritis." m
Lancet January 15, 1983:97-98, 482.

Steele, Knight, et al.
1981 "Iatrogenic Illness on a General Medical Service at a University
Hospital." New England Journal of Medicine 304(11)2638-642.

Taylor, CR.
1984 "Alternative Medicine and the Medical Encounter in Britain and the

United States." In Alternative Medicines: Popular and Policy Per_sp_e_ctives
ed. Warren J. Salmon, 191-228. New York: Tavistock Publications.

Thomas, W.E.
1986 "Homeopathy." Australian Fa_rr_rily Physicia_n 15(6):803.

Todd, Alexandra Dundas
1989 Intimate Adversaries: Cultural Conflict Between DmtorLand Wong

Patients. Philadelphia: University of Pennsylvania Press.

Ullman, Dana
1981 "Homeopathy in First Aid" Let’s Live! March: 146-149.

93

1988 Homeopathy: Medicine for the 21st Centug. Berkeley, Califonria: North
Atlantic Books.

U.S. Department of Health, Education and Welfare

1975 The National Ambulatm Medical Care Survey: 1973 Summapy. Report
prepared by James E. DeLozier and Raymond O. Gannon. DHEW

publication no. (HRA) 76-1772, series 13(21). Rockville, Maryland.

Vithoulkas, George
1980 The Science of Homeopathy. New York: Grove Press, Inc.

Vogel, Morris J.

1980 The Invention of the Modern Hospital: Boston 1870-1930. Chicago,
University of Chicago Press.

Weil, Andrew.
1983 Mthgand Healing: Understanding Conventional and Alternative
Medicine. Boston: Houghton Mifflin Co.

Whorton, James C.
1987 "Traditions of Folk Medicine in America." The Journal of the Ameripap
Medical Association 257(12):1632-1635.

Young, Allan
1982 "The Anthropologies of Illness and Sickness." Annual Review of
Anthromlogy 11:257-285.

Young, T.M.
1975 "Nuclear Magnetic Resonance Studies of Succussion on In-Vitro Activity
of Potencies of Pulsatilla." Journal of the American Institute of

Homeopathy 68(1):8-16.

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