Tales of the Profession, part 1

So I just finished reading the evaluation comments from an educational speech I gave back in April. Most of the comments reflected a general pleasure at an opportunity to learn more about a strange and complicated therapy that clinicians don't really get to learn about much (homeopathy). Of course there are always a few folks one can't reach--that always challenges me to consider improvements to my teaching methods.

Today I'm focused on a few specific comments that concern me, and they should perhaps concern you too.

Let me provide some background. The talk was a one hour presentation about homeopathic medicine to a group of medical providers, mostly nurse practitioners and physician assistants, some nurses and a handful of physicians. One hour. What does one talk about? There are several possibilities. One could focus on the science, such as clinical trials, or studies that summarize many trials. I could address specific criticisms of homeopathy, like the highly diluted remedies or the method of remedy selection itself. But I think that would put the cart before the horse--after all, if one doesn't even know the basics, how would one understand the criticisms? The science  would seem out of context.

I could teach the historical development of homeopathy, and that could include the "how" of homeopathy, how it works in practice. But this was a talk to clinicians, and not merely a history lesson. These people want to know how to begin to use it. When I first started out, I used simple, low potency, over-the-counter remedies for self-limiting conditions like colds and bee stings. It's how a lot of professional homeopaths begin their interest in the art.

So I decided to disclaim the science up front, and the history. That is, why not just tell folks that this is how it's done and the history and maybe a little bit of the scientific proof could be included, but I only had an hour so I'd focus on the nuts and bolts. "Try this at home!"

So, back to the comments.

Several people--and these were a minority--worried over the scientific rigor. "Where are the studies?! " Others seemed concerned with things unrelated to homeopathic medicine, such as the interactions between St. John's wort and medicines. (I was careful from the start to explain the difference between homeopathic medicine and herbal medicine, since these are often confused, even by professions who ought to know better these days!) Another: "He did not present any proof homeopathic medications work..." which is true. As I noted, I had an hour. I chose to focus on the open minds.

But wait! Isn't scientific proof important? In the 1980s the New England Journal of Medicine reported that perhaps 85% of medical practices were unsupported by any evidence. This created the "Evidence Based Practice" revolution. EBP has since spread and become the dominant force in medical practice, which is mostly a good thing. Unfortunately it's also created a rigidity of thinking, a prejudice, that closes minds to thinking outside the box. How can one listen with an open mind and an open heart if there's a requirement for a list of double-blind placebo controlled trials first? If I'd had all day, I could have provided that kind of structure, or assigned readings ahead of time. But...you work with what you have. What concerns me is that these are people who might be closing their minds to possibilities, and to the customs and habits of their patients. Instead of listening and learning, they just frown.

(By the way, a ton of medicine is still not based on clinical trials. Much is still based on expert opinion, consensus statements, and the like.)

I have learned so much from my patients, and some of the stuff they have tried that "cured" or helped them I have to admit sounds pretty weird. But medicine is weird. Humans don't read the studies and they don't follow the textbooks. Science moves ahead in small steps, and no matter how detailed it gets it'll never cover every imaginable situation in real life.

What makes me feel good about that talk and the audience comments is that a lot of the folks who attended took it for what it was: a chance to learn a little bit about a big subject in a short time. Those people aren't stupid; they will have more questions about the science and applications of homeopathy. Some might even be willing to "play around with it" safely, like I did when I was learning. Or if it seemed unappealing, well at least they understand more about what their patients might be doing!
What makes me feel bad about it is that there still people out there, practicing medicine, whose minds are still locked in a model of medical prejudice that calls Science its god. But it isn't a god. It's a method, and it worries me that there are still so many people who apply that method in a limited way.

People say they "believe in science." That's rubbish. Saying one believes in science is like saying one believes in wrenches. Both are tools. Science is a philosophical tool that enables us to probe the limits of knowledge. If one really believes in the utility of the tool, then one should profess to keep an open mind. That doesn't mean "anything goes", that we can just make up "facts" or believe in facts we like. It means we recognize the limits of our knowledge, and understand how influenced we are by our culture and by commerce. Big corporations have bought a lot of "science"; that doesn't make it good science. Just because a phenomenon cannot be easily explained doesn't mean it's wrong or without merit.

Symptoms & Behavior

Ok, so what goes through my mind when I'm waking up this morning? I was thinking about a patient who has been having some problems lately, and her problems led me to think about many similar patients' problems, problems that are somewhat particular to a homeopath's concerns.

Patients come in with various problems, like migraines, menstrual pain, rashes, and even more serious conditions like rheumatoid arthritis or heart disease. When a homeopath takes a case, he or she is trying to determine in what way the person's system is "misregulating" itself. The  we want to find the remedy that would cause symptoms of such a misregulation in a healthy test subject. This is laid out in my main website, as well as all the homeopathic references going back to Hahnemann's Organon. To that end the practitioner considers a host of data points such as temperature responsiveness, appetite, sleep patterns, and of course specific symptoms. He also consider behaviors that give clues to the system's--the person's--imbalance.

Most of us are accustomed to thinking of behavior as a thing we control all the time. Someone who displays "bad" behaviors, such as dependency, meddling, lust, or impatience, for example, we tend to think of as a normal person with a "bad personality" or a flaw of character. In short, we view the physical body's manifestations of imbalance as natural and only partly controllable, while we view behavior as under the person's control.

There's a lot of evidence that strongly suggests that a lot of human behavior isn't under our direct control. A complex interplay of neurological impulses, hormonal fluctuations, and reflexive responses to environmental stimuli directly affects our behaviors. I would argue that there are two ways to view the behaviors patients display in the clinic, and report on during the case. (Sometimes, it's a spouse or parent who reports adverse behaviors, much to the indignation of the patient!)

The first way to appreciate behavior is as the native and evolving personality of the person. The second way to appreciate behavior is as a reaction the system has to stressors in the environment. In the first case, consider that the best things we are consist of a mix of positive, adaptive impulses that contribute to the survival of the person and her potential for contributing to the social welfare of all. In the second case, consider that our problem behaviors are a mix of those things we need to work on and can change, and behaviors that are reflexive responses to stressors in our environment. This says that some of the "bad" stuff we do is really just bad stuff that we have the capacity to change and some is stuff out of our direct control (or control of it is so difficult that we are only partially successful at doing so).

As an example, consider a person who is ardent and passionate about justice. Perhaps she becomes a lawyer and argues causes for the poor or other unjustly treated. She's a bit abrasive, but that's understandable, given that she's working under difficult circumstances and probably sees a lot of injustice. Maybe she drinks a bit too much at the end of the day, to ease her mind. For the homeopath, the love of justice is not something we want to change--after all, isn't justice what we all want for the world? The abrasiveness and drinking? Let's consider the latter first. She can control her drinking, and indeed maybe she does to the extent that she's overconsuming, but it's not directly affecting her work. It is affecting her health. It raises her risk for breast cancer, accidents, and other problems. The former, the abrasiveness, is something she'd like to control, but it gets away from her, and she snaps at co-workers, and is described by friends and family as "difficult" and "combative." She may consider this something she'd like to dial down, but also as something that makes her tough.

This case could be described by the picture of the remedy Causticum: passionate, tough, "hard", and strongly affected by perception of injustice and harm to others. These sound like they are sort of "good" things, until one sees them harden to passion beyond reason, toughness to the point of inflexibility, hardness that infuses every fiber of the system (typically, stiffening of tendons and ligaments), and being affected by things in the environment so much that the person becomes a kind of "walking open sore", subject to experience every slight as great pain. Isn't this something we'd like to relieve?

Patients are often surprised at their behavior changes. Frequently a patient reports that their spouse sent them back "for more of those little pills, because I'm acting like a..." well, you get the idea! We aren't really accustomed to thinking of who we are in the world as perhaps a maladaptive behavior that arises without our control. This is the mind-body separateness that is the culture we have been given, an outlook that regular, technological medicine reinforces.

When patients come in to see me for a rash or headaches or high blood pressure, I'm interested in that, and getting those problems to go away is a goal. What they are often not used to thinking of is that their behaviors may also be expressions of those more physical symptoms, rather than separate, untreatable issues. In homeopathic medicine, much behavior is a reaction to stressors, but it's abnormal behavior. Our lawyer: we want her to be tough, but not so tough she's inflexible. The drinking? It's an example of a behavior that may be a volitional act. That is, she drinks because it works to relieve her stress. Here, if the remedy is working, her reaction to stress can change and she may be less inclined to drink--but, she also has to be willing to engage in consuming less alcohol or abstain altogether. In this behavior, the strength of the adaptive parts of the personality can help her change, while the remedy addresses the internal stress response that leads to a tendency to be over-stressed.

In this example, the native personality is not only something we don't want to change. The over-reaction to the world's injustices and bad stuff is the imbalance we do want to change. And the drinking as an act of self-medication is a secondary behavior that we do want to change, and will be easier to change with the right support (homeopathic and motivational), and will ultimately help her to be the person she wants to be: acting positively in the world and as healthy as she can be.

In short: behavior is part of who we are and is a neuroendrocrine reaction to the world. When that latter "reaction" is pathological, that's what we need to fix, and should improve with the right remedy.

Zika Virus

I'm going to dispense with the basic schtick about this. Zika's a virus that's been around for some time, and for a long time was confined by geography to a small-ish area in the Pacific region. Now, it's out, and this was inevitable in a world that gets smaller with every intercontinental flight.

Zika is mostly a modest disease, although as we see with everything, some people do suffer catastrophic results. Homeopathically, of course, I'd take the case, although one would consider China, Belladonna, Ferrum phos, or Gelsemium as possible presentations. In regular medicine, treatment at this time is mainly supportive. The paralytic syndrome Guillain-Barre is reportedly more common in Zika infection. Conium or Curare come to mind as possible remedies.

The eye-catching message is when we see that pregnant women's babies may be affected. A firm biological connection between Zika and babies being born with small heads and underdeveloped brains has not been conclusively established. Recently a student asked me about the possibility that vaccines are responsible. I have an article on my main website that explains in detail, but in short, it's possible. But it isn't very likely. I told the student that microcephaly can have other causes, such as mercury toxins. Many parts of the world are badly polluted with industrial waste, especially many of the Southern Hemisphere countries here in the the Americas.

It's rational to have concerns about something like Zika. Commonsense measures can be found at the CDC website. Yet we shouldn't lose sight of other possible causes, some that are bigger and more complex than a mosquito-borne germ. Yes, Zika's occurring in the U.S., but as an import. It's not native yet. It's also rational to look ahead. Trash, warming temperatures, heavy rains, and poverty all have their roles to play, and by working to ameliorate these things we can leverage our efforts into greater gains for our safety. They are bigger, more imposing challenges than simply trying to come up with a new antiviral or vaccine. (Zika's been resistant to formulation into a vaccine, so far.) Restrictive immigration polices don't solve the problem--people don't disclose when they fear deportation.

Advice 

If you are pregnant, it's not unreasonable to change your travel plans if they are to areas identified as Zika-active. Alternatively, protection can be afforded from mosquito netting at night, covering clothing, and possibly bug repellents. These latter recommendations apply even to the non-pregnant, although most people won't get very ill from Zika. A variety of herbal antivirals may help: Astragalus may help if one becomes ill. Echinacea may help, although I would not use this in cases of Guillain-Barre syndrome (might aggravate the autoimmune nature of this disease). If you have access to homeopathic medicines, I listed some starting points above, although individual case-taking is the rule.

As for insect repellents, yes, they are toxic. At this moment, all of the ones said to be good for repelling mosquitoes are man-made neurotoxins. These things aren't ruthlessly unsafe...but they aren't without their hazards for some people. So far, my research hasn't turned up any alternatives. If I find any I will post them here. If my travels come across any cases treated successfully with homeopathic medicine, I will also pass this along (for educational purposes).

I decided it's about time I started sharing what I've learned with more than my patients and my students. Look for more posts coming soon.