In 1998, Time magazine wrote a cover story about the use of St. John's wort for depression; Kaiser Permanente now offers acupuncture; for 1999, the National Institutes of Health has granted $50 million to the National Center for Alternative and Complementary Medicine. It's clear that alternative medicine has become a major force in the United States. Last November, in an issue devoted for the first time entirely to alternative medicine, the Journal of the American Medical Association estimated that four in ten Americans used at least one alternative remedy in 1997. Visits to alternative practitioners jumped nearly 50 percent since the previous (1991) JAMA survey, exceeding all visits to primary care medical doctors.
The granddaddy of alternative medicine in this country is homeopathy, which reached these shores in 1825 from Germany, where it was conceived by Dr. Samuel Hahnemann at the beginning of the 19th century. Homeopathy heals by administering extremely small doses of a remedy that would, in a healthy person, produce symptoms of the disease being treated. The treatment became so popular at the turn of the 20th century that 15 percent of American medical doctors considered themselves homeopathic physicians, and there were 22 homeopathic medical colleges-including Boston University and the University of Michigan; even the head of clinical medicine at Stanford 100 years ago was a homeopathic doctor.
A prime mover and spokesperson for homeopathy in the United States today is Dana Ullman '75, MPH '79, who directs Homeopathic Educational Services in Berkeley and has written six books on the subject, including Discovering Homeopathy, which contains a foreword by a homeopathic doctor who is also Physician to Her Majesty Queen Elizabeth II. The son of a physician in Los Angeles, Ullman came to Berkeley in 1971. He dropped out in 1974 to study homeopathy, then returned to finish his degree, with a self-created major in human learning. "I was studying medicine, or 'healing,' but doing so as a child of the 1960s," Ullman says. "And '60s thinking meant more natural, more integrative medicine."
After graduation, he practiced homeopathy, and got into trouble for doing so. In 1976, an undercover agent came to him pretending to be a patient. "This was the only time in my entire practice that I ever sensed I was dealing with an agent," recalls UlIman. "I told him, 'I'm not doing anything illegal. You know I'm not a doctor.' And he said: 'Yes.'" Nevertheless, Ullman was arrested for practicing without a license and spent eight hours in jail (where he read Ivan Illich's Medical Nemesis), But he won in court, and his case set a precedent: he was the last person to be arrested in California for practicing "alternative medicine."
"After that court case, I decided my mission was to promote homeopathy," Ullman says. "My legal battle made me realize that health care is as much a political process as it is anything else. Homeopathy was underrepresented; it needed some affirmative action." He founded Homeopathic Educational Services in 1975, initially out of his home, then returned to Berkeley to earn a Master's in Public Health. He has lectured regularly in various Berkeley courses over the past 15 years and has co-taught a course on homeopathy at UCSF's medical school for four years. He also has a line of homeopathic medicines with his name on them and an extensive website: "I'm homeopathic.com," he says proudly.
When did you first become interested in homeopathy?
In 1972, when I was a junior at Cal. I was volunteering in the Berkeley Free Clinic and saw a little sign announcing a "study group in homeopathy." It was started by a Stanford-trained physician and a midwife. The group met weekly over a five-year period.
Don't many doctors say that homeopathy is quackery?
That's an extremely common response, for doctors to call something quackery when they don't know anything about it. I can use my own father as an example. He's a pediatrician and allergist who was a professor at UCLA and on the staff of a major hospital in Los Angeles. When I first told him of my interest in homeopathy, his response was: "Well, that's sheer quackery!" I asked: "Why do you say that?" He said: "Well, we've gone beyond it." So I said: "Do you know what 'it' is?" He said: "No." I said: "Well, that's not a scientific answer. How can you be against something, and call it quackery, when you don't know what it is?"
Over the next year or so, my father did a little research, and then he said: "It's quackery because homeopathy uses too small a dose." I replied: "You've tested it and found that the dose doesn't work?" "No," he said. "Well, then, you can't say you know; you can say you think it might not work-that would be a more accurate way of putting it. And I would agree! There are many things in nature that don't seem logical. You have to speak with humility unless you've done some kind of systematic study or review."
Was that the end of your discussion?
No. As it turns out, my younger sister around this time had a daily abdominal pain-sharp, excruciating pain. She went to five specialists. She even underwent exploratory surgery on two different occasions-without any diagnosis, let alone treatment.
I had been silent throughout all this because I don't like pushing homeopathy, especially onto my family. But I finally asked my sister if she wanted to try homeopathy. Her first response was: "No! You're my older brother." [Laughs.] "Get out of here!"
Then I did get pushy. I said, "Look, you've done all these other things; what harm will it do?" She grudgingly said, "Okay." I took her case. And I gave her one dose of a medicine called calcarea carbonica, which is calcium carbonate.
I called her two weeks later and asked if she noticed any change. There was silence on the other end of the phone, so I repeated the question. And she said: "Oh, I guess it went away on its own." I said, "You mean that daily abdominal pain you had for the past two years went away, on its own, just now?" She said: "Yes." I asked, "Do you think the homeopathic remedy might have helped?" and she said: "No."
Nevertheless, this very much impressed my father when he heard about it, because here was a person-my sister-who totally disbelieved that homeopathy could have any effect at all. And it had had a very dramatic effect.
How would you distinguish homeopathy from regular western medicine?
I think one of the fundamental differences is in the way the two regard symptoms. In conventional medicine, symptoms are assumed to be something wrong which need to be controlled, managed, even suppressed. In homeopathy, symptoms are seen as defenses, part of the body's effort to defend itself. The word "symptom" is derived from Greek and means sign or signal. Symptoms are not the disease; they are the signs and signals of the disease. Treating them is akin to unplugging an oil light in a car because it is blinking. It may get rid of the irritating light, but it doesn't fix the underlying problem.
Can you explain that in terms of the common cold?
Okay. In conventional medicine, if you have a cold and a runny nose, you're given a drug to stop the runny nose; and that's considered a cure. But think about what a cold is. It's a response, generally, to a viral infection; the body's immune system and its white blood cells begin to attack the virus. And the viruses die, hopefully many of them; and some of the white cells die. The body then secretes this liquid substance called mucus as a way of flushing out the dead, particulate matter.
Now, when you take conventional medicine, it stops the production of mucus. You're no longer having stuffiness, you're no longer having this discharge, but you are having what's called a "side effect."
What's the side effect?
From a strictly pharmacological perspective, there is no such thing as a side effect. Drugs do not have side effects; drugs only have effects. We arbitrarily differentiate those things we like in a drug and call them the "effects" of the drug; those we don't like we call "side effects."
So, getting back to your question: when a drug stops a nasal discharge, the effect of the drug is that it stops the nasal discharge. The side effects of the drug are that it causes congestion, bronchial and various respiratory distress, and it might cause lethargy and dizziness and general fatigue. Now, all of that is not the "side effect" of the drug; it's the direct effect of the drug inhibiting the body's adoptive and self-healing processes.
If you do a double-blind, placebo-controlled study and ask "Does this drug stop the nasal discharge?" the answer is "Yes." But does it improve the person's health? Well, that question is not even asked in medical science; there's no really good measurements for overall health.
What are the basic principles of homeopathy?
The basic principle is called the "principle of similars": that is, whatever a substance causes in overdose, it will elicit a healing response when given in specially prepared microdoses. Now, this principle of similars happens also to be at the heart of two conventional therapies: immunizations and allergy treatments. And it's no coincidence that these are two of the very few methods in all of conventional pharmacology that do something to augment immune response.
How do allergy treatments work?
They give you as little bit of the hair of the dog that bit you-an old folk saying that reflected the experience of people that a small dose of what caused a problem might heal it. So, if you're allergic to cat dander, they give you a little cat dander; if you're allergic to a certain mold, they'll give you a little of that mold.My criticism of conventional allergy treatment is that it oversimplifies the law of similars.
When people are allergic to mold, each person will have different symptoms of the allergy. One person might have sneezing or a runny nose; another might have sneezing, a runny nose, and a headache in the front part of the head; another might have a runny nose and watery eyes that irritate the lower lids. Still others might have subtle or not-so-subtle additional symptoms-they might have hives or fatigue or depressive states.
And, even their particular allergy is only one part of a syndrome that represents their overall disease. Because people with allergies may also have a whole other panel of symptoms that aren't related directly to the allergy but are part of their own body-mind health. In homeopathy, we don't treat localized diseases; we treat the overall body-mind syndrome, of which the local disease is a part.
Homeopathy sounds a bit more extensive.
No, it's a lot more extensive [laughs]. A homeopath does a careful review of a person's genetics, a careful review of a person's entire health history, and a complete systems review of all physical and emotional-mental symptoms the person is currently experiencing. We then look for a medicine that would, if given in overdose, cause that similar complex and syndrome of symptoms. But, instead of giving it in toxic doses, it is given in very small and specially prepared doses.
How does a homeopath know what medicine is effective in healing?
This brings up a second principle of homeopathy: detailed experimentation. Most people don't know this, but homeopathy represents the most detailed review of toxicology currently available in science. You can consult a homeopathic text to discover the toxicological symptoms of hundreds or thousands of plants, minerals, animals, or chemicals. And you'll find it in exceedingly more detail than in any toxicology book. You'll find what symptoms each substance causes; because once we know what it causes, then we know what is effective in treating it.
The experiments done to find these things out are called "provings," or drug provings, which are basically drug trials to find out what a particular substance causes. This information is then catalogued in books, and is now on CD-ROMS. The vast majority of homeopaths in the western world today use these expert-system software programs; homeopaths have entered the computer age full steam ahead-distinct, I guess, from your average medical doctor, who uses computer systems primarily for billing!
Homeopathy has a different way of looking at a person's disease--
Homeopathic medicines are prescribed not for a specific disease, but for a person's overall health, his or her constitutional state-which is not a term we use in American medicine, but is a common point of view in healing throughout the world. There's a difference between treating a disease and treating the person's overall state. I'm reminded of the words of Jonas Salk, who said there are two approaches to dealing with sick people: one is to attack the disease, the other is to augment host resistance, or the person's overall immune response. And this second approach is what the field of alternative medicine or holistic health or-as I prefer to call it, "natural medicine"-is all about.
I think we all know someone for whom medicine has offered some benefit. And I don't want to deny that. What I would say is that, with as much energy and resources as we put into it, the fact that America is, in terms of childhood mortality, 23rd in the world-behind Singapore, behind Spain, behind Flovenia-is abysmal. But, more important, the reason why it's so abysmal is because we still don't understand what healing and health are all about.
What do you mean?
All the language around conventional medicine is fighting language: we have to combat disease, fight it, conquer it; we have to have a "war" on polio or cancer. This is total medical machismo. This is quite distinct from natural therapies that seek to augment, nurture, and nourish the body's own defenses.
We have survived as a species in part because there's a great doctor inside of us. Conventional medicine ignores this doctor and often has disdain for it. They have an arrogance that is cloaked in scientific reductionism. In other words, they prove that their methods work-as long as you're wearing blinders.
Can you give an example to explain what you mean?
Sure. Let's take diarrhea. There was a study in one of the medical journals where they gave a bacterium that causes diarrhea to two groups of medical students. One of these groups of students was given a placebo; the other was given a drug called Lomotil. It was shown that Lomotil worked-it controlled the diarrhea.
But the study also found that the medical students who had diarrhea got rid of the bacteria faster, because that's what diarrhea does; it hastens the elimination of bacteria. The medical students given Lomotil wound up having the bacteria in their systems longer and had a whole variety of complications because of that: the bacteria was able to culture, shoot back up to the liver, cause various types of liver disease, and so forth. So, the bottom line here is that when we develop a medical system that is specifically oriented toward treating, controlling, and suppressing symptoms, we're simply pushing the disease deeper and deeper into the person.
In psychiatry, we have the concept of suppression; we understand that suppressing emotions provides a short-term benefit but a longer-term problem. But there's no writing in any American medical journal I know of that recognizes physical suppression-what happens, for example, when you suppress a cough. Or diarrhea. Or nasal discharge, as we discussed earlier. No recognition of what happens when you use anti-inflammatory drugs; according to elementary textbooks of pathology, inflammation is a defense of the body. If inflammation is a defense--the way the body seeks to wall off, burn up, and push out foreign or pathogenic material-why are you prescribing anti-inflammatory drugs?
How would conventional medicine answer that question?
"Because double-blind, placebo-controlled, scientific study shows that symptoms are temporarily reduced." That's the answer. This is what I mean by scientific reductionism: they're not looking at the person, they're looking at the symptom. When you have diarrhea, you're not a person, you're diarrhea.
What conventional medicine has gotten very good at is effectively pushing acute disease into the organism to create more chronic long-term illness. And mental illness. From a homeopathic point of view, one reason we have more mental illness is because we have effectively suppressed a variety of physical pathologies.
How does this happen?
Many drugs can elicit these mental states. If you look in the Physicians' Desk Reference, or any pharmacology text, the side effects of a drug are often more serious than the original symptoms of the illness. The homeopathic viewpoint on this is that the drug is primarily suppressing the symptom--creating the guise of temporary improvement but the creation of a more serious condition.
What's amazing is how smart American doctors are-how technologically sophisticated, how able they are to understand various biochemical and physiological processes. And how narrow their thinking has become about healing. They are smart, but not street smart.
The sad result is that it is the consumer who pays. And consumers are not getting what they're paying for. We're all paying a big price: the cost of medicine in the United States is way beyond that of any other country. But the benefits are not commensurate with that cost.
Let me ask a more general question: If there was a contest 100 years ago between homeopathy and conventional western medicine, wasn't it decided in favor of western medicine by the germ theory of disease?
Sure. The germ theory really did give conventional medicine its domination. And if the germ theory was right, it should continue that domination.
It's not right?
No. Germs do not cause disease. Germs are co-factors in disease. Now, I believe as much as anyone else that bacteria and viruses can lead to disease, that they are part of disease. But it's simplistic and inaccurate to say that they directly cause disease.
Right now, in your throat, you have streptococcus. And I have streptococcus. And we may have a pneumococcus in our bronchials. We may have cancer cells in our body. But that doesn't mean we have a sore throat, pneumonia, or cancer.
Infectious disease depends upon infection and it depends upon host resistance. As Pasteur-a discoverer of the germ theory of disease-said at the end of his life, host resistance, the body's own immuno-defense system, plays a much larger role than the microbe itself in disease.
So, I don't mean to say that germs-bacteria and viruses-are not involved in disease. But I think of them as co-factors, and the more important factor is susceptibility.
If we didn't have the germs-if we could stamp them out-who cares how susceptible we are?
Well, germs are very important for immunological development. The British Medical Journal published an article in 1996 that showed that children who experienced measles had considerably fewer allergies than those given a measles vaccine. This suggests one of two things. Either there's something about measles itself that is a challenge to the immune system, which is important for immunological development; or there's something about the measles vaccine that creates allergies. Either way, I don't like the vaccine.
The immune system is a bit like a muscle-it needs to be exercised. Pediatricians today recognize that when a child gets an ear infection, you shouldn't immediately rush to antibiotics; there's something valuable about the inflammatory process-it's a way the child's body gets to learn so that it can mount a more effective response the next time. The reason kids get more colds and whatnot is because they're learning what the particular bacteria or virus is, so that they can deal with it more particularly in the future.
If you suppress these efforts, you're going to end up with children who get more frequent infections. In fact, research has shown that if you give kids with sore throats antibiotics immediately, they are two to three times more likely to get another sore throat than if the child had just been allowed to inflame.
I have a four-year-old child. I've vaccinated him for tetanus-because tetanus is a disease that can come on in a 24-hour period of time, and my son is a very active little boy; and for polio, because we do some international traveling. But I want my child to have measles, chicken pox, mumps. For me, these are important ways of strengthening his immune system.
I should also say-we were talking about history a while ago-one fact that's ignored my most medical historians is the fact that homeopathy developed its greatest popularity in Europe and America for one reason. And that reason is that homeopathy was incredibly successful in treating the infectious disease epidemics of the time, including cholera. On average, the deaths were 2 to 8 times greater in allopathic hospitals than in homeopathic hospitals.
What scientific evidence today is there that homeopathy works?
Most recently, on September 20, 1997, the Lancet published a meta-analysis of 89 clinical trials that were double-blinded or randomized. The researchers found that patients given a homeopathic medicine were two and one-half times more likely to experience a therapeutic benefit than were those given a placebo. On February 9, 1991, a group of skeptical scientists published, in the British Medical Journal, a review of homeopathic clinical research. They concluded, "The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would be ready to accept that homeopathy can be efficacious, if only the mechanism of action was more plausible."
Is there a known mechanism of action for homeopathy?
No. Although there are some compelling theories and some extremely interesting new studies that have been published, we still don't know for sure how it works. But let me add: it wasn't until very recently that scientists understood how aspirin worked-but no one refused to take aspirin because we didn't know its mechanism of action!
Where would you say homeopathy is today?
Homeopathy is the leading alternative medicine in Europe today. Over 40 percent of French doctors and 20 percent of German doctors use homeopathic medicines in their practice. Over 40 percent of British physicians refer patients to homeopaths, and almost half of Dutch doctors consider these natural medicines to be effective.
But homeopathy is still very much a minority school of thought in the U.S., even in alternative medicine. Recently, I think alternative medicine has gotten a lot or notoriety from herbalism and from chiropractic. But homeopathy represents a bigger change of paradigm. It's a paradigm that on the one hand is more ancient and on the other is much more futuristic.
How is homeopathy futuristic?
I'm reminded of the Star Wars phrase: "May the force be with you." Because underneath that view is the concept of energy medicine, the concept of an energy that flows though you, which is like a "vital force," which is the word we use in homeopathy. "May the vital force be with you."
I guess I would say in closing that right now the history of homeopathy as written by medical historians suggests that homeopathy is a medical heresy that has risen and that has fallen. Of course, history is written by the dominant paradigm. I believe I can say with some confidence that history will be rewritten, that, eventually, homeopathy will win out.