Issue 17 / 11 May 2015

IN a way, and for a man of his time, Samuel Hahnemann was partly right.

“Samuel who?” you ask. Hahnemann (1755–1843) was a German physician and polymath who became dissatisfied with the therapeutic methods of the time, which included purging, bloodletting and emetics.
    
While translating A treatise of the materia medica, by Edinburgh professor William Cullen, one of the 18th century’s leading medical theoreticians and educators, Hahnemann started to develop the idea that substances that caused certain symptoms in healthy people could cure the same symptoms in the unwell.

This principle – “like cures like” – became the basis of homeopathy.

Now you are asking if I am seriously suggesting that the originator of homeopathy was on the right track. Well, in his own context, his suggestions made some sense.

Hahnemann was a contemporary of the early advocate of disinfection, Joseph Lister, and the pioneer of vaccination, Edward Jenner.

At the time, many of the diseases that plagued Europe were infectious, but the principles of “germ theory” and vaccination were yet to be fully developed.

Hahnemann took the principles of vaccination and applied them across the spectrum of symptoms and substances, using an early form of the scientific method to test proposed therapeutic substances through “provings”. Having no other method of attenuating the offending pathogens, he diluted them. He diligently catalogued his findings in publications that are still in use today.

His biography suggests Hahnemann was a leading thinker and innovator. Prior to the development of sophisticated technology, research could only be conducted through direct observation and deduction.

There was no electron microscopy to reveal microcellular structures, or assays to measure serum electrolytes. The body was yet to reveal the intricacies of the alveolar space or the renal tubule. Scientists of the time had not defined the electrical pathways of the heart, or the pathophysiology of asthma. There were no antibiotics and no insulin.

As an innovator, Hahnemann struggled to improve the knowledge and methodology of his time, and was dissatisfied with contemporary medical practice. He was, in fact, the antithesis of those who apply his (now discredited) model today.

How ironic 21st century followers of Hahnemann ignore nearly 2 centuries of innovation, and cling to his 19th century approach.

I suspect Hahnemann himself would be rolling in his grave.

In all areas of human endeavour, knowledge and understanding grow in increments — rarely by revolution. Evidence builds upon previous evidence, old models are tested and updated, they are occasionally discarded or reworked. Cognition and reasoning work hand-in-hand with technology.

We are no longer limited to what we perceive with our human senses, but can image and test phenomena from subcellular to population levels. We have moved on from humours, demonic possession and phrenology, just as we have left behind the horse and cart and smoke signals for motorised travel and the internet.

Some people indulge in a form of nostalgia that both endows the past with a sense of purity and idealism, as well as casting suspicion on the new.

We don’t know everything about how the human organism works — far from it — but we have a good enough understanding to know that Hahnemann’s model was wrong — it was considered reasonable for a man of his time, but has, in the meantime, been superseded.

And yet his followers, who are content to fly internationally and use the internet, remain stuck in his outdated model.

Cognitive dissonance — a great topic for another article.
 

Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.

10 thoughts on “Sue Ieraci: Time to move on

  1. Dr Paul Stevens says:

    While I have no nostalgia for Homeopathy, nor value its placebo benefit over any other medical intervention, it’s worth noting however Sue, that Hahnemann struggled for many decades with the concept and potential cure for chronic disease, which he quite clearly recognised as a separate entity from acute infectious. (The Chronic Diseases, their Peculiar Nature and their Homœopathic Cure. by Dr Samuel Hahnemann). Despite his failure in this, he created a remarkable example of parallel philosophical evolution. One can hardly blame him for failing, for here in the 21st century of ‘enlightenment’ while it is certain that public health measures, and to a lesser extent modern medical science has halted the onslaught of infectious disease in the developed world, epidemic proportions of metabolic diseases, diabetes, depression and heart disease still prevail. Pharmaceuticals have replaced heroic medicine in having suppressive effects that Hahnemann railed against, and the most important scientific discovery of late, the gut microbiome as a major “organ” and driver of chronic disease has only just been recognised. (perhaps we should have paid more attention to the smoke signals here?). Hahnemann may have even stumbled upon hormesis, (the mechanism by which plant food diets up regulate NrF2 and other protective gene response elements, in part, reducing chronic disease processes), but he likely misinterpreted hormetic effects as the manifestation of a mysterious vital force during potentisation.  

  2. Anne Cooper says:

    And while we’re at this, we can probably start considering much of what was discarded in the 19th century when science entered medicine. I’m thinking of miasma theory, which proposed that disease came from smells. We can see that smells themselves may be harmless but we can only smell that which is water soluble, when it enters the nose and nasal pharynx, so I suggest that infected airborne material from say a sewer, or rotting putrefying material, may well be a source of infection. Just not all.

    Titration of drugs has been shown to provoke a reaction from the body as the dose is reduced, but maybe not into millionths! We used to bleed people for almost anything, heaven knows why but many societies use techniques to promote a stress reaction – spooning, bleeding, cutting.

    Our predecessors were not stupid. Historians should be looking at what they did and looking for what evidence they had for their ministrations. They were not completely deluded, nor were the quacks any quackier than the medical establishment. Indeed they all used much the same techniques and medicines. Their difference was simply class and privilege. And then along came John Snow…

     

  3. Dr. Robert Cameron Kiser says:

    Really a brilliant article. I’ve been saying the same thing for years (although you are far more eloquent). Modern medicine owes an historical debt to homeopathy–but of course it was a dead end for the most part (one could argue that vaccination and immune therapy  for allergies are examples of similar ideas that work). Homeopathy did bring us a few innovations–such as nitroglycerin, which was purified by a homeopathic chemist (for headache treatment, amusingly enough). Hahnemann did much to elevate medicine out of the humoral morass that WAS medicine for centuries, and, while not precisely science, did at least demand demonstration of efficacy.

    I do think Hahnemann would be disappointed that those adhering to his system as a tenet of faith, and in spite of the best evidence, are not really following his lead. I dare say a very similar article (and statement) could be written about osteopathy and Andrew Taylor Still.  Bravo on the article!

  4. Grace Gawler says:

    Sue – Thank you for this perspective on Samuel Hahnemann and his contributions to the medicine of his day. I find it interesting that treatments such as purging and emetics are still so popular in alt med circles today; especially as a part of cancer “cure” regimens. If Hahnemann was dissatisfied with these practices during his lifetime – it is somewhat surprising they are still in vogue in alternative healing circles in 2015! I feel for patients who are suffering from cancer and told by practitioners that they are also toxic and must detox and cleanse their bodies with harsh purging programs…sounds like (and is) medicine from the Dark Ages. At least Hahnemann took another path even if it wasn’t perfect then or now. So often nostalgia, folklore and idealism are adhered to as if a religion, despite modern advances in science and medicine that show otherwise. We should not condemn medical innovators of the past who tried to make advances in healthcare – nor should we consider them as gurus whose laws must be obeyed without applying modern scientific logic and analysis.  As you point out – what applied in the fledgling years of medicine as true; is simply outdated today. It is imperative to learn about the history of medicine, homeopathy, herbalism etc and put them in perspective. I would love to see the look on Hahneman’s face if he were alive today with all the scientific facilities and evaluation tools we have on offer.

  5. Edward Brentnall says:

    Sue Ieraci is so right!  An excellent history lesson and a pithy comment on homeopathy.

    Please keep these wonderful comments coming.  My father qualified in 1910, and was excited by the wonderful developments that he saw before he died in 1972,  Indeed our predecessors were not stupid, but they did not have our tools and insights.

  6. Christopher McGrath says:

    Thank you for an interesting article that ends by introducing ‘cognitive dissonanace’, a potentially paradoxical intellectual state where more than one conflicting idea may be entertained simultaneously, apparently often without emotional or further intellectual consequence. This is a state that lends itself to a very wide range of human thought and subsequent activities, exemplified notably in politics and in health where it is frequently axiomatic and captured by the old adage, “Do as I say not as I do.”

    Those that peddle craniosacral therapy or homeopathy or any of the range of placebo ‘therapies’ frequently enjoy the full extent of their respective institutional professional support, the same institutions that claim the high ground of ethical practice and evidence-based or practice. Cognitive dissonance? Yes. Unusual? No.

    Perhaps one of the secrets of wider human success is this very ability, the same one that enables an individual to supplant the driving basic needs of the moment with an altruistic act. The ability to maintain competing thoughts and ideologies is not only a triumph of the cortex but a triumph of the cortex over the thalamus and limbic system. Unfortunately, this same magnificent ability gives rise to the obvious discordance seen in both politics and healthcare, where actions and words are very frequently ideologically incompatible.

    The key lies in others calling out the dissonance and revealing the fallacy. Reveal the drama, it loses its power. It is seen as inconsistency, ipse facto, it becomes so.

    The key also lies in educating the public ‘BS’ meter to higher levels of gain.

  7. Joyaa Antares says:

    I enjoyed reading this article but was a little disappointed to see that the author omitted to state that she is an executive member of a certain medico-political lobby group, “Friends of Science in Medicine”.  I would have thought this worth stating in the interests of transparency?

    Source: http://www.scienceinmedicine.org.au/index.php?option=com_content&view=article&id=119&Itemid=159

  8. Sue Ieraci says:

    Hi, Jay. Yes, I am a member of the exec of Friends of Science in Medicine, also of AMA (state rep for salaried doctors), ASMOF (previous council member), Australasian Society for Emergency medicine (previous state president). I am active in various groups that oppose pseudo-science and anti-science. All of these affiliations reflect my commitment to improving community understanding of science, none of them are paid. As this article is a short opinion piece, there generally is no expectation for an entire list of affiliations, but all of mine are readily discoverable.

    Was there something in the article you felt was dishonest?

  9. Joyaa Antares says:

    Hi Sue, No, I wasn’t commenting about dishonesty in the article, just a lack of transparency about your starting perspective, which I think has relevance for any reader interested in this subject. I think that I can say without controversy that one of your affiliations is overtly anti-homoeopathic – indeed anti- quite a lot of things, and in truth I am not entirely unsympathetic. I can also say without controversy that you did not declare this affiliation when publishing the article. I think that is all I have to say, and thank you for responding to my first comment. Kind regards, Jay.

  10. Sue Ieraci says:

    Thanks, Jay. I would say that all my medical affiliations are pro-science and therefore anti-homeopathic. As I said, this is an opinion piece – it’s difficult to be “transparent”  about all the things that shape our opinions, don’t you think? I formed these views before FoSIM existed. If anything, it was the desire to expose pseudo-science like homeopathy that led to my active membership in FoSIM, rather than the other way around.

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