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From the Townsend Letter
May 2017

For Homeopathy:
A Practicing Physician's Perspective*
by Richard Moskowitz, MD
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*Rebuttal to article, "Against Homeopathy: a Utilitarian Perspective,"
by Kevin Smith, PhD
Bioethics, February 2011, published in American Journal of Homeopathic Medicine 104:125, Autumn 2011

Unabridged version

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I am writing in response to "Against Homeopathy: a Utilitarian Perspective,"1 by Kevin Smith, Ph. D., whom I commend for the clarity of his writing and the thoroughness of his logic.   I suppose I should also derive some comfort from the fact that, contrary to the advice he gives to his readers, he takes homeopathy at least seriously enough to go to such trouble to denounce it. 
Long familiar to every homeopath, his main argument that homeopathic remedies are nothing but placebos were already current in Hahnemann's time, decades before Oliver Wendell Holmes made it famous 150 years ago,2 and has since been incorporated into the conventional wisdom.  When I was in medical school, the term "homeopathic dose" was used almost affectionately to signify an amount of medicine far too small to have any noticeable effect whatsoever; and even today, as various modalities of alternative and complementary medicine enter the mainstream, and many American physicians aspire to broaden their outlook in order to accommodate them, most would probably still agree with Dr. Smith, at least in private, that homeopathy defies common sense, ordinary logic, and some basic laws of chemistry.  
Indeed, even I feel a little uneasy with patients who can swallow the whole concept without hesitation, utterly untroubled by these profound mysteries at the very center of it.  For Hahnemann's Law of Similars,"Let likes be cured by likes," the founding principle of homeopathy, is still far from intuitively obvious, even to those of us who use it every day, and remains essentially a
postulate, by definition not amenable to conclusive proof or disproof as a scientific hypothesis must be.  Nor has anyone ever satisfactorily explained how medicines diluted beyond the level of Avogadro's number could possibly have any effect on a patient, let alone a curative one. 
CoreBioticBut the mere fact that homeopathy is based on a mystery as yet unexplained by the science we have now is by no means sufficient to prove that it is a nullity, a fake, and thus a false belief, indeed a delusion, on the part of anyone who takes it seriously enough even to entertain the possibility that there might just be something to it.  It almost embarrasses me to have to say that Dr. Smith's entire argument, like that of the distinguished Dr. Holmes before him, boils down to one defective syllogism, that because homeopathy
can't work, it therefore doesn't work.
Once that premise is accepted, to be sure, his reasoning sounds persuasive enough.   For if it could be shown that the homeopathic phenomenon does not exist, that medicines do not in fact have the power to elicit or provoke the same symptoms that they help to cure, and that remedies diluted beyond the level of Avogadro's number are simply inert and have no effect of any kind, then he would be entirely right to insist that such beliefs are utterly groundless, that those who persist in them are mired in wishful thinking, and that public funds should not be provided for the medical care of indigent people based on them, or even for further research as to their efficacy, since more than enough would already have been carried out to disprove the need or value of proceeding any further along this path.  As if all that were not enough, and saving the best for last, he adds the novel
tour de force that homeopathy is not only ineffective, but immoral as well, according to the utilitarian standard of doing the greatest good for the greatest number, mainly to the extent that it dissuades people from seeking the kind of heavy artillery that really does work. 
Such a virtuoso display of logical reasoning might have been more persuasive had he not named as authorities on the subject the likes of Wallace Sampson3 and Stephen Barrett,4 both professional 'quackbusters' who have made discrediting homeopathy their life's work, and who automatically offer the most damning possible interpretations of anything pertaining to it.  Proudly acknowledging Prof. Sampson as his chief mentor and source of information,5 and falling back on the seeming absurdity of infinitesimals, he sheds all pretense at even-handedness, making quick work of the alleged benefits of the method and deducing a litany of serious faults
ex cathedra without any knowledge of or interest in the actual practice, like how the interview is conducted, how various possible reactions to the remedy are identified, and the like.  
In any case, all his excellent reasoning goes for naught because the postulates that it is built upon, the implausibility of the Law of Similars, and the common assumption that the remedies are nothing but blanks, turn out to be simply and demonstrably false.  The basic "law" of homeopathy, for example, the phenomenon that medicines tend to elicit or provoke the same symptoms that they are meant to relieve, is widely familiar even in allopathic circles, where "paradoxical" effects, such as antihypertensives raising blood pressure, antidepressants making depression worse to the point of suicide, and so on, are commonplace and well-documented in standard reference texts like the
Physicians' Desk Reference,6 albeit not yet proclaimed as a general rule. 
As for those notorious infinitesimal doses, experiments have repeatedly shown that highly diluted remedies are capable of both stimulating and inhibiting colony growth in bacterial cultures,7
in vitro enzymatic activity in tissue culture and cell-free extracts,8 seed germination and growth in various plant species,9 and various global properties of higher animals.10  While equally unambiguous results are naturally much more difficult to attain with human subjects in clinical situations, it is nevertheless irrefutably clear that highly diluted homeopathic preparations are capable of significant biological activity.
No matter what the correct explanation of these mysteries may prove to be, it is also undeniably true that dedicated physicians have continued to follow the same principles and to practice medicine on the basis of them for more than two hundred years, and now do so on every continent and in most countries of the world.  In the face of determined opposition, general ridicule, and the sacrifice of more prominent and lucrative careers, the mere fact that homeopathic medicine has managed to survive intact for so long and even continued to grow and develop under such adverse conditions is sufficient answer to the unexamined faith of Dr. Smith and the quack-busters that it is a delusion and nothing more, and indeed suggests precisely the opposite conclusion.  Its singular propensity to attract qualified doctors from almost every country at a time when allopathic medicine has become the dominant model of health care in the world represents not only a significant historical achievement in its own right but also a persuasiveargument for the validity of the Law of Similars, the efficacy of Hahnemann's infinitesimal doses, and the ultimate authenticity of the homeopathic phenomenon itself.   
I have practiced general and family medicine for 44 years.  No matter what type of treatment we prefer to use, all physicians are obliged to know and live by what Dr. Smith seems to have overlooked: our reputations and livelihoods depend on the extent to which our patients are benefited by our efforts on their behalf.  For the past 37 years, I have treated mine with homeopathic remedies exclusively, not because I believe that pharmaceutical drugs have no value; I often refer patients whom I've not been able to help to my allopathic colleagues, and am more than grateful for what they do.  I choose to practice homeopathy in part because I prefer to try a gentler and safer approach first, whenever possible, but mainly because matching the treatment to the individuality of the patient allows and encourages a deeper and more comprehensive level of healing than is possible with drugs that merely counteract a specific symptom or correct a particular abnormality by applying superior chemical force at that strategic point.
I will give a few examples from the early years of my practice. The first was an eight-pound baby girl who was born covered with thick meconium, took one gasp, and then breathed no more. Brisk suctioning produced only more of the same. At this point the child lay limp, white, and motionless with a heartbeat of 40 per minute, responding feebly to mouth-to-mouth resuscitation but incapable of breathing on her own. I put a few tiny granules of
Arsenicum album 200C on her tongue,11 and almost instantaneously she awoke with a jolt, crying and flailing, her heart pounding at 140 per minute, her skin glowing pink with the flame of new life.  The whole evolution took no more than a few seconds. After a night in the hospital to be on the safe side, mother and baby went home in the morning with no outward sign that anything untoward had happened. Experiences like these are imprinted for life in every practitioner's mind.12
Of course, I am well aware that this could have happened spontaneously without any remedies at all, for the child was well-formed and appeared normal in every other respect; and anyway, it was just one patient, a mere "anecdote," utterly without statistical significance.  But all of us who were present, including my nurse, the baby's mother and father, and I daresay the child herself, by now fully-grown and undoubtedly steeped in the legend of her birth, know as surely as we can know anything that the conjunction of the infinitesimal dose and her abrupt awakening was no mere coincidence. 
My second case was that of a 34-year-old RN who had been plagued with severe endometriosis since her teens.  Already a veteran of four surgeries to remove large blood-filled cysts from her bladder and pelvic organs, and several courses of male hormones to suppress the condition, she came seeking only to restore her menstrual cycle, having long since abandoned any hopes of childbearing.  While intensely painful at first, her periods had become "dead," dark-brown, and scanty from so many years of surgery and hormonal treatments in the past.
After a few remedies, her menstrual flow became fuller and richer; and within six months, she was pregnant. By the next time I saw her for a different ailment nearly eight years later, she had had two healthy children after uncomplicated pregnancies and normal vaginal births, and had remained in good health ever since.13  While no one can attribute such an outcome to a homeopathic remedy or any other agency in precise, linear fashion, my patient has never stopped thanking me for it, which is reason enough to be grateful for a process that is inherently catalytic and persuasive, rather than forcible or compulsory.
Still less can these happy endings be imputed to any unusual skill of mine since they are entirely comparable to what every competent prescriber has seen or could easily duplicate; and I could just as well have cited other patients whose conditions were far from hopeless, who believed in the remedies and in me, but whom I was nevertheless unable to help. 
As Dr. Smith is at pains to insist, homeopathic remedies are safe, economical, simple to use, and gentle in their action, with notably few serious or prolonged ill effects. What he does not say and clearly does not know is that they are also capable of acting thoroughly, deeply, and for a very long time, requiring only infrequent repetition of the dose, and posing minimal risks of chronic dependence.  Patients, friends, and loved ones alike often notice a general improvement in vitality and a sense of well-being, such that recurrence seems less frightening and, indeed, less likely. 
To be sure, it is far from a panacea for all ills.   Homeopathy is a difficult and exacting art; and even after years of study and practice, a skilled prescriber may need to try several remedies before obvious benefit is obtained. In some cases, despite the most devoted efforts, there is little or no benefit at all.  But if the ultradilute remedies can be seen to have worked well and often enough to sustain me in a general practice for 45 years, like so many others over the past two centuries, that too is more than enough to refute Dr. Smith's bland assumptions that they are no treatment at all.   Although deeply flattered by his insinuation that we heal our patients solely by some kind of magic or shamanic spell that we cast over them unawares, I continue to believe what my experience has taught me, that the "placebo effect," that starved and tattered remnant of the innate self-healing capacity, is an essential component of
all healing, even with pharmaceuticals, but by no means the whole of it.     
For medicinal substances, the reigning standard of efficacy is the Random Controlled Trial, or RCT, in which subjects are randomized into two groups, one receiving the drug, the other only a placebo or inert imitation, with both patients and doctors kept blinded as to who gets which.  In these experiments, the causal power of any drug against a particular symptom or abnormality equals the extent to which patients actually taking it outperform their placebo controls; and rather than an optimal
qualitative fit with the illness of each patient as a whole, as homeopaths aspire to, the best drugs and the ones most diligently sought after are simply the most potent ones, those with the most chemical power to compel the organism to function in whatever minutely targeted ways the profession decrees that they should. 
Thus, modern physicians are duly equipped with the latest chemical weapons to attack a vast array of diseases and abnormalities as if they were enemies on a battlefield:
antibiotics to kill bacteria, antihypertensives to lower the blood pressure, anticonvulsants to control seizure activity, antimetabolites to destroy cancer cells, antihistamines to suppress the allergic response, and so forth, all developed to act as selectively as possible, with little or no regard for the individuality of the patient.  In advanced cases, such drugs may indeed save life, give miraculous relief, buy valuable time, or do the best that can be done under adverse or extreme circumstances.
Leaving aside the bottom-line question, whether most patients taking such drugs will actually feel better, live longer, and suffer fewer complications as a result of taking them, I am prepared to stipulate what is not always true in practice, that many of the drugs in common use do indeed have the power to accomplish at least some of what we ask and expect of them, in the hope that those more subjective and personal goals will eventually follow. But the high and often exorbitant price that we have to pay for such seemingly precise and overriding causal power comprises three huge, hidden cost and risk centers that are seldom recognized or talked about. 

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