Today I want to speak about allopathic medicine, the kind we all grew up with and were trained in, a subject that homeopaths tend to find distasteful, having sacrificed more prominent and lucrative careers by rejecting major parts of it. Nevertheless, if only as moth to flame, I am irresistibly drawn to the subject for two main reasons. The first is personal, and has to do with why I became a homeopath in the first place, which was no dramatic cure that I witnessed or benefited from, but simply glaring inconsistencies in my medical training that troubled me on an intuitive level long before I could identify them.
Practical dilemmas encountered on the wards of a large city hospital led me to question the values I was being taught, and to study philosophy before going into practice, bad habits that have shaped my career ever since, and deepened my sense of estrangement from the profession I still call my own. Well before I ever saw it work in a patient, I clung to homeopathy as to a life-preserver, because it gave me a method for doing what I was already trying to do, a coherent system of thought that still works for and makes sense to me, and a practice of medicine that I could at last be proud of.
Thirty-six years of studying and applying it have only further convinced me that the homeopathic point of view and its systematic critique of medicine are even more pertinent today than when Hahnemann thought them through, a durability in pointed contrast to the system that nearly killed it, which gorges itself on a high-powered diet of rapid and constant
*Adapted from a lecture presented at the 2010 Congress of the International League
of Homeopathic Physicians, Los Angeles, CA, May 19, 2010, and published in AJHM 103:214, Winter 2010, and 104:13, Spring 2011.
change. Within a generation after the master’s death, the allopathic school had already evolved into something that he would scarcely have recognized, while since World War II it has risen to become the dominant form of medicine and indeed the model of health care throughout the world.
That is why I think we make a huge mistake in attributing our defeat and inferior status to some combination of allopathic persecution, our own internal divisions, and the public’s inability to grasp our higher truths, however relevant these factors may have been. The elephant in the room that dwarfs them all is the mighty revolution in human thought that created medical science as we know it today, a transformation so stunning in its impact and so radical in its implications that “conventional medicine,” our own tame, sanitized, and condescending term for it, is a mere euphemism for trivializing that achievement, if not the exact opposite of the truth.
This brings me to philosophy, the second reason for my talk, the purpose of which is to help us identify and articulate what we used to know but have somehow forgotten, and what we think we know but have never bothered to question. Here I use the term both in its ordinary meaning, that is, an inquiry into the most fundamental principles of a subject, and also in its narrower, more technical sense, of a methodology for fitting them together into a coherent system of thought, logically derived from a few simple axioms and postulates that cannot be proven or disproven within it, quite in the spirit of Bertrand Russell’s whimsical definition:
. . . the point of philosophy is to start with something so obvious as not to seem worth stating, and to end with something so paradoxical that no one will believe it.1
Classical homeopathy fits this description admirably, since its basic principles are all neatly laid out for us, beginning with the vital force and the totality of symptoms, both of which are essentially truisms, and the Law of Similars, which even Hahnemann admits is not wholly amenable to scientific proof,2 but then giving rise to the single remedy, the minimum dose, the concept of miasm, and the Laws of Cure, all of which seem outlandish and even incredible to most people, yet follow from the first three as irresistibly as the night the day.
Allopathic medicine I find compelling for precisely the opposite reason, that it looks like and even purports to be a non-system, a bewildering array and profusion of techniques and procedures with an avowedly anti-philosophical stance, as if conspiring to keep its basic conceptual scheme hidden from view and resistant to straightforward formulation. My task is thus to convince you of what its own practitioners are apt to deny, that allopathic medicine likewise rests upon an elaborate, pervasive, and well-defined conceptual system, but one so limiting in its methodology that we must look elsewhere for the tools to excavate and reconstruct it. That is why we owe it to ourselves as much as our allopathic colleagues to understand what they do and how they think, and to identify the underlying principles and assumptions that they themselves are reluctant to acknowledge.
Since the allopathic system has also contributed so much of lasting value, and in any case is clearly here to stay, my subject also looks far beyond itself, to a more open and inclusive conceptual scheme that can accommodate both points of view, and maybe even others as yet unknown to us. Helping to envision, identify, and elaborate this new synthesis is therefore our highest mission, which we share with like-minded physicians and healers of all persuasions, and in every part of the world.
1. Is It Really a System?
Attempting to identify and characterize the philosophy of allopathic medicine as a whole begins with the obvious question, whether this vast enterprise, which has no general philosophy of health and disease, and no desire for any, can fairly be thought of as a system at all. Among the clearest and most emphatic declarations that it cannot and should not be we owe to Claude Bernard, the great French physiologist of the Nineteenth Century, who clearly envisioned and helped bring about so much of what modern medicine has since become:
Neither physiologists nor physicians must imagine it their task to seek the cause of life or the essence of disease. That would be entirely wasting one’s time in pursuing a phantom. The words ‘”life,” “death,” “health,” and “disease” have no objective reality. When a physiologist invokes the “vital force,” he does not see it; he merely pronounces a word. Only the vital phenomenon exists, with its material conditions: that is the one thing that he can study and know [Italics mine: R.M.].3
Since medicine has indeed become an empirical science based largely on experiment, it sounds reasonable enough to suppose that it would have no further need of any fixed dogma, ideology, or philosophy to adhere to, and would forfeit nothing of value by their absence. Yet today both homeopaths and allopaths, doctors and patients alike, ordinarily think and speak of medicine as if it did constitute a system of some kind, while a broad, informal consensus does appear to exist at all levels of society about what sorts of things belong to it, and what others, including various forms of “alternative medicine,” lie beyond the pale, although the boundary between them keeps changing all the time.
A similar demarcation is evident in the existence of the “medical underground,” that extensive, thriving counter-culture, with its own industries and even a black market to support it, populated by those suffering from various conditions and the innumerable patient advocacy groups created on their behalf, and extensively promoted over the Internet and elsewhere. All of these evidently spontaneous developments point to a clear or at least commonly accepted distinction between the diagnostic and treatment procedures, drugs, surgeries, and other technologies that are endorsed by the medical “establishment,” and the almost equally populous and elaborate universe of everything else which is not.
But the most conclusive evidence is the nature and extent of the medical community itself, those numberless legions of students, physicians-in-training, teachers and mentors, practicing and attending physicians, specialists, physician-assistants, nurse-practitioners, nurses, hospital employees, lab assistants, technicians, and research scientists, backed up by the vast medical-industrial complex of institutions and corporations that serve them by developing new procedures and manufacturing drugs and equipment, all of which occupy such an inordinate share of our economic and cultural life, and continue to grow and multiply exponentially, without effective regulation or restraint. Like a colossal ant colony, with satellites, branches, and spin-offs on a global scale, this self-replicating nexus of goods and services could not continue to function, let alone propagate itself down through the generations, if its diverse members did not know how to perform their assigned rôles, and understand their relationships with superiors, colleagues, and subordinates. The mere existence of a collective enterprise on such a scale clearly presupposes a basic conceptual scheme to hold it all together, to define these rôles, create these positions, and train the individuals who will eventually fill them.
If we think of the medical system as an elaborate, interlocking institutional structure, it is much easier to grasp that the conceptual glue holding it all together has less to do with its particular content, which varies considerably from one part of the system to another, than its shared methodology, the rules, techniques, and procedures governing the basic sciences of anatomy, physiology, biochemistry, microbiology, pathology, and the like, with their applications to the various clinical specialties. Taken together, these guidelines specify how we can acquire valid and useful scientific knowledge about living beings, and what other kinds of investigation are to be avoided.
Although our modern paradigm did not become dominant until the emergence of microscopic anatomy and analytic chemistry in the latter half of the Nineteenth Century, its essence was already clearly discernible in the work of the Renaissance anatomists, and immortalized in Rembrandt’s masterpiece, Dr. Tulp’s Anatomy Lesson,4 which celebrates the same genre of causal thinking that modern physicians still use in diagnosis today.
After dissecting and exposing the forearm muscles of the cadaver, the noted Professor places his clamp on the common sheath of the flexor tendons and savors the anticipation on the faces of his students at the moment before he pulls back on the clamp, and the stone-cold fingers obediently rise again in response to it.
The revolutionary concept of mechanical causality exemplified by these discoveries, which inspired great painters like Leonardo and Michelangelo to traffic in stolen bodies in order to explore them first-hand, received perhaps its classic formulation two centuries later, once again in the words of Claude Bernard, who elegantly summarizes the scientific truths we still live by in medicine today:
What we call the immediate cause of a phenomenon is nothing but the physical and material condition in which it exists or appears. The object of the experimental method, and the limit of every scientific research, is therefore the same for living as for inanimate bodies: it consists in finding the relations which connect a phenomenon with its immediate cause, or, to put it differently, in defining the conditions necessary to the appearance of the phenomenon. When the experimenter succeeds in learning the necessary conditions of a phenomenon, he is in some sense its master: he can predict its course and appearance; he can promote or prevent it at will. We shall therefore define physiology as the science whose object is to study the phenomena of living beings, and to determine the material conditions in which they appear [Italics mine: R. M.].5
No longer content merely to heal the sick, contemporary medicine is driven above all to achieve effective dominion and control over every identifiable aspect of the life process. What Bernard foresaw and his successors still routinely seek to accomplish is to acquire the knowledge and devise the means to regulate biological phenomena artificially and more or less at will, on the assumption that our prior, more subjective goals will eventually follow. Now as then, the experimental method in human biology still consists of the same simple steps:
1) characterizing the phenomenon to be studied;
2) identifying its component parts;
3) isolating its physicochemical “causes;” and
4) devising appropriate technologies for manipulating them,
5) with as little disturbance as possible to the remainder of the organism.
In another brilliant passage, Bernard understood with perfect clarity that the path to scientific knowledge in medicine lies in number, quantification, and measurement, no less than in physics and chemistry:
Health and disease are not two essentially different modes, as the ancient practitioners believed. These are obsolete medical ideas. In reality, between these two modes there are differences only of degree: exaggeration, disproportion, and discordance of normal phenomena constitute the diseased state. [Italics mine: R. M.]6
Easily overlooked in these statements is their important subtext, that whatever cannot be subdivided, objectified, and quantified in such ways need not and should not be studied at all, since it cannot as yet be defined rigorously or thus understood in any useful or meaningful sense. I now realize that I became a homeopath in part to reinstate the subjective aspects of human experience that have been demoted and largely banished from medical practice. Much as I admire and still try to achieve the careful reasoning and yogic discipline that experimental science requires, I cannot accept a philosophy of healing the sick that seeks to override the individuality of the patient and the beauty and richness of human life that emanate from it.
In what follows, I will argue that this sin of omission is also inherently dangerous to the patient, not only because it makes human error more likely and more serious, and is very likely to fail or fall short, but also and especially when its prized objectives are successfully attained. For no matter how noble its motives and how favorable its outcome, the ambition to control life processes by force automatically creates insoluble ethical and practical dilemmas that go a long way toward explaining the current crisis in our embattled, dysfunctional, and badly mis-named “health-care” system.
2. Hidden in Plain Sight: Adverse Reactions to Vaccines.
I will start with the example of vaccines, a subject which I have thought about for most of my career, not least because the United States requires them of all children to an extent that is unparalleled in the developed world, a circumstance that dramatizes and gives real immediacy to the same problem I have been speaking of. The vague unease I have always felt about mandating them began to make more sense when I became interested in homeopathic medicine, which reminded me of the obvious but unremembered truth that medicines have the power to elicit a totality or array of symptoms, not just the one we happen to be interested in at the moment. In contrast, vaccines need achieve just two limited and predefined goals to be deemed effective, namely,
1) a significant reduction in the incidence of the corresponding natural disease, and
2) a measurable titer of specific antibodies in the blood.
But how they achieve these results — their actual mechanism of action — and whatever else they do along the way, are not thought to be interesting questions, or in any case are rarely talked about.
How much this simple schema leaves out is evident in the tale of a 10-year-old boy who developed the nephrotic syndrome soon after his MMR vaccination. One of the clearest and most obvious examples of an adverse reaction that I am personally acquainted with, it was nevertheless adamantly denied to be so by every one of the doubtless sincere and well-meaning physicians who cared for him. Although he lived nearly a thousand miles away, and I know of him solely from his mother’s letter, her words were so heartfelt and so congruent with the rest of my experience that I cannot imagine them to be anything but the honest truth:
My son Adam was healthy until his first MMR at 15 months. Within 2 weeks he had flu and cold symptoms, which persisted for 6 weeks, at which point his eyes became puffy, he was hospitalized with nephrotic syndrome, and a renal biopsy showed “focal sclerosing glomerulonephritis.” When it didn’t respond to steroids, I asked if it could be related to the vaccine, but they told me it couldn’t, and we accepted that. Over the next 4 years he was hospitalized repeatedly, and missed many months of school, but finally went into total remission, seeming normal and healthy and staying off all medications for about 5 years.
When he turned 10, his pediatrician recommended a booster, saying that a rise in measles cases made it dangerous for him not to be protected. Checking the PDR and other sources, I found no contraindication for kidney disease and no listing of nephrosis as a possible adverse reaction, so I agreed to it. In less than 2 weeks he relapsed, with 4+ protein in his urine, swelling, and weight gain, signs that we recognized immediately. He got worse even on Prednisone, and was admitted in hypertensive crisis, with blood in his urine, fluid in his lungs, and massive edema. On Cytoxan, high doses of Prednisone, and three other drugs, he slowly improved, but missed another 7 months of school.
It’s been 2 years since that horrible episode, and he still needs Captopril daily for high blood pressure and spills 4+ protein every day. The doctor says that he sustained major kidney damage, will always need medication to control his blood pressure, and will worsen as he grows older, necessitating a transplant eventually. This time I was sure that his condition was related to the vaccine, but still the doctors didn’t take me seriously, and told me it was a coincidence.
I began searching for information, and even contacted the manufacturer of the vaccine. Finally they sent me two almost identical case reports of nephrotic syndrome following the MMR vaccine. It’s difficult for laypeople to get information or even ask questions, since we don’t use correct medical terms and are made to feel stupid. Please tell me if my ideas are reasonable.
I don’t think my son could tolerate another episode, and I think he’d have normal blood pressure and kidney function today if not for that second vaccination. I also have a great concern for other children who develop nephrotic syndrome some weeks after receiving the MMR and whose doctors never make the connection. They could all be at great risk if revaccinated. I realize that this letter has taken up a great deal of your time, and I’d appreciate any help you can give me. If we were closer, I’d make an appointment to see you in person, so please feel free to charge me. Thank you.7
This woman no longer doubted that her son’s life had been ruined and indeed cut short by the vaccine, yet had no thought of suing the drug company that made it, the doctor who prescribed it, or the Federal Vaccine Injury Compensation Program (VICP), as she was legally entitled to do, a lack of ulterior motive that only lends further credence to her story. She wrote solely for independent validation of what she had witnessed first-hand on two separate occasions and had been forced to endure the consequences of ever since, a causal link that would be obvious to any eighth-grader of average intelligence. Yet even when the vaccine manufacturer belatedly provided two almost identical cases of their own, each of the boy’s physicians independently and without hesitation continued to dismiss his misfortune as a coincidence. Today, almost twenty years later, renal failure has still not been recognized as an adverse effect of the MMR vaccine, an omission that would also have assured the boy’s defeat in court, had his mother chosen that route. This glaring discrepancy between the boy’s catastrophic illness and the ease with which the doctors and vaccine manufacturers escaped having to take any responsibility for it will serve to introduce the profound mystery that inspires my talk today.
According to the official guidelines, damages from a vaccine merit compensation if they can be shown to be a necessary and predictable effect of that particular agent. With one or two exceptions, all of the listed complications are sudden, acute, and catastrophic events that appear full-blown within hours or at most a few days after the vaccine and result in death or permanent injury. The classic example is anaphylaxis, which oddly enough can occur after any vaccine, and thus has no specificity whatsoever.
Reportable Events Following Vaccination:8
Vaccine or Toxoid Event Interval (Post-Vaccine)
DTP, Pertussis, DPT & Polio, Anaphylaxis, shock 24 hours
DT, Tetanus Toxoid Encephalopathy 7 days
Shock, collapse, hypotonia 7 days
Acute complications or sequelæ No limit
MMR Anaphylaxis, shock 24 hours
SSPE (encephalopathy) 15 days
Oral Polio (OPV) Paralytic poliomyelitis 30 days
Inactivated Polio (IPV) Anaphylaxis, shock 24 hours
As for chronic conditions, only two have ever occurred with sufficient frequency to be considered seriously for inclusion, namely, “DPT encephalopathy” and “autism,” both of which tend to appear somewhat more gradually, with a time lag of days or weeks after the vaccine, and to follow a chronic course, like ongoing, self-sustaining illnesses. In both cases, physicians advocating compulsory vaccination, many with financial and other ties to the industry, have succeeded in keeping them off the list, or at least tightening the eligibility rules so drastically that almost all damage claims against them are defeated, however catastrophic the outcome.
“DPT encephalopathy” achieved considerable notoriety in the 1980’s, when thousands of brain-damaged children won large court awards or settlements against the manufacturers, and this broad, nondescript entity was reluctantly accepted as a bona fide complication of the triple vaccine, particularly its whole-cell pertussis component. Here is a typical case, sent to me by the lawyer who represented him, involving a 3-year-old boy who reacted badly to his first DPT shot and suffered permanent brain damage after the second:
Our firm represents a child who was born normal and healthy in every way. After his first DPT at 6 weeks, he began falling off growth charts, exhibited multiple develop-mental delays, and was diagnosed as “failure to thrive,” but then slowly began to recover. At 5 months he received a second DPT, and his delays became much more extreme. He has never recovered. He is now 3 years old, with the mental capacity of an infant of a year and a half. I am convinced that his problems came about as a result of the DPT. In view of what happened after the first shot, he should not have had the second, or at least the pertussis component of it.9
While the information provided was very limited, the boy’s serious and prolonged reaction to his first DPT, from which he eventually recovered, should have warned and indeed did warn his pediatrician against giving him the second, but it was merely postponed for a few months. This tragic pattern of a warning ignored — a lesser version of the same illness with eventual recovery, followed by death or irreversible brain damage after a subsequent vaccination — helped fuel a major public uproar, in response to which Congress passed the Vaccine Injury Compensation Act of 1986, which created a Federal reporting system and no-fault hearings for all vaccine injuries, and authorized compensation for damages at taxpayers’ expense when vaccines were shown to have been at fault. In reality, however, the effect was just the opposite, a precipitous decline in the number and size of awards, a further tightening of the guidelines, and a vigorous counterattack by physicians of the vaccine establishment like this one, who rejected even the concept of DPT encephalopathy as essentially a coincidence:
Dr. [Edward] Mortimer’s article is the third controlled study in recent months to examine the risk of seizures and other acute neurological illnesses after the DPT. In these studies, involving 230,000 children and 713,000 vaccinations, no evidence of a causal relationship was found between the vaccine and permanent neurological illness. It is clear from these recent studies that the major problem has been the failure to separate sequences from consequences. Now is the last decade of the 20th Century, and it’s time for the myth of “DPT encephalopathy” to end [Italics mine: R. M.].10
By 1996, with the scandal largely contained, the CDC and its Advisory Committee on Immunization Practices (ACIP), led by the same coterie of physician-advocates, published its official Report on DPT Encephalopathy. Rather more judicious in tone, this policy document briefly acknowledged the fact of ruined lives, but then blithely concocted three distinct levels of possible causal influence, concluded that it was impossible to tell them apart, and jumbled them all together into a tangle of obfuscations, equivocations, and government bureaucratese:
Rare but serious neurological illnesses, including encephalitis, encephalopathy, and prolonged convulsions, have been anecdotally reported following the whole-cell DPT. Whether the vaccine causes such illnesses or is only coincidentally related to them has been difficult to determine precisely.
The National Childhood Encephalopathy Study and others have provided evidence that the DPT can cause encephalopathy. This occurs rarely, but children who had a serious neurological event after DPT were significantly more likely than their controls to have chronic CNS dysfunction 10 years later and to have been given the DPT within 7 days of its onset.
The Committee proposed three possible explanations for this association:
1) the illness and dysfunction could have been caused by DPT;
2) the DPT could trigger these events in children with brain or metabolic abnormalities who might also experience them if other stimuli such as fever or infection are present; and
3) the DPT might cause the acute event in children with underlying abnormalities that would inevitably have led to the chronic dysfunction even without it.
The data do not support any one explanation over the others. The balance of evidence was consistent with a causal relationship between the DPT and CNS diseases in children who developed acute neurological illness after the vaccine, but insufficient to determine whether it increases the overall risk of them 10 years later. SIDS is listed on death certificates as cause of death for 5000-6000 infants each year in the United States. Because the peak incidence is at 2-4 months of age, many instances of a close temporal relationship between the DPT and SIDS are to be expected by simple chance [Italics mine: R.M.].11
The ACIP Report gives lip service to the possibility of a chronic reaction, but only if the vaccine forces it to occur: the only type of “cause” that it allows is one powerful enough to compel the desired effect to occur in a preponderance of cases, using the same standard that Claude Bernard had proposed so long ago. According to the Report, DPT encephalopathy falls well short of it, because the authors claimed they could not distinguish between patients victimized or passively acted upon and those with pre-existing tendencies to react in the same way, either to a precipitating cause in those already mildly or potentially ill, or merely to one incidental cause among many other possibilities in those predestined to get sick.