Robert Jütte, born in 1954, is currently Director of the Institute for the History of Medicine of the Robert Bosch Foundation and Adjunct Professor of History at the University of Stuttgart. From 1983 to 1989 he was Associate Professor at the Department of General History of the University of Haifa/Israel. He is a social and medical historian and the author or editor of over 30 books, the most recent a biography of the founder of homoeopathy, Samuel Hahnemann (1755-1843). He is the editor of the medico-historical journal Medizin, Gesellschaft und Geschichte and the editor of Hahnemann’s case books. He is a member of the steering committee of the Scientific Board of the German Medical Association and a member of the advisory board of the homeopathic journal Allgemeine Homoeopathische Zeitung.
S. L.: Dear Professor Jütte, we are very happy that you so readily accepted our invitation to be in our Hot Seat. It will be the very first time that the readership of the Facekom-Ezine can witness points of view given by a respected voice from Dr. Hahnemann’s native country. This is a very special time when the world of homeopathy is facing so many changes and challenges. The homeopathic community is growing fast throughout the world, which partly is the result of the search by people for more gentle and natural method of treatment for their ailments and diseases. What is your perception of the present state of homeopathy in general?
Prof. J.: One might get the impression that homeopathy is once again under siege, being attacked from orthodox medicine. The critical review in Lancet last year was used by many opponents to declare the downfall or even the very end of homeopathy. But the opposite seems to be happening. People have not been very impressed by the arguments presented in a biased meta-analysis which did not match the usual standards of biomedical research and medical statistics. In a global perspective homeopathy seems to have gained recognition (as will be shown by the forthcoming WHO-report) that is in favour of homeopathy. Within the last decade we have also noticed an increasing interest in homeopathy in Eastern Europe which always had a long tradition as far as homeopathy is concerned, going back to Hahnemann’s times. But it was only following the fall of the Iron Curtain that homeopathy could make a new and fresh start in some countries: e.g. in Hungary, the Czech Republic and in the Baltic States.
S. L.: As you have a deep insight into homeopathic evolution from the distant past until today, how would you describe the difference in practice between then and now? Do you think the homeopathic community has taken care, responsibly, of the treasures that Dr. Hahnemann has left to us?
Prof. J.: Of course, things have changed since Hahnemann’s time, but there are still many homeopathic practitioners who practice homeopathy like the founder did 200 years ago, with the exception that the materia medica has grown and that we now have computer repertories while Hahnemann used his hand-made index of symptoms to find his way through the materia medica. Patients no longer write letters to their physicians but use the phone or e-mail to communicate with their homeopathic practitioner. There is also a growing general interest in the history of homeopathy, in particular from social and medical historians. At the same time it seems that the homeopathic community itself is loosing its ties with the past. Only a few homeopaths bought copies of the Hahnemann case-journal editions published by the Institute for the History of Medicine of the Robert Bosch Foundation. One can learn a lot from peering over Hahnemann’s shoulder, noticing how he tackled complicated cases and how he finally found the medication he thought to be the most suitable for the patient’s symptoms.
Another example: The scientific board of the forthcoming LHMI-congress in Lucerne refused to have a historical section presenting recent research on Hahnemann’s case journals; this, even though it produced most interesting results which could lead to a more complex view on the efficacy of homeopathic treatment. Historical research which debunks myths in the history of homeopathy is obviously not to the liking of many followers of Hahnemann who worship him, neglecting the fact that Hahnemann was less dogmatic in his medical practice than in his writings, which served – among other things – the purpose of securing the survival of a new art of healing.
S. L.: I wanted to focus regarding homeopathy today from an ethical point of view. Dr. Hahnemann had every reason to phrase aphorisms 1 – 4 the way he did. This section of the Organon always reminds us therapists of our main and basic responsibilities. Do the first aphorisms suffice in making up the code of ethics for homeopaths?
Prof. J.: The most generally phrased codes of ethics are often the most long lasting and effective ones. The Ten Commandments and the Hippocratic Oath are good examples of effective codes. The first paragraph of the Organon “The physician’s high and only mission is to restore the sick to health, to cure, as it is termed“, is my favourite paragraph, because it shows that homeopathy is a therapy which focusses on the patient and his needs. This approach made it attractive, not only to patients in the past, but also and even more so in the present, where medicine has lost sight of the patient. Another favourite of mine is paragraph 4: “He [the homeopath, R. J.] is likewise a preserver of health if he knows the things that derange health and cause disease, and how to remove them from persons in health”. Many homeopaths rely too much on their therapeutical inventions (which by the way, are often not crowned by success!). Dietetics should be part and parcel of any homeopathic treatment. Hahnemann knew this and he was a great expert in preventive medicine or in “salutogenese” (to use term which is nowadays rather fashionable). Hahnemann and dietetics is thus a great subject, not only for historians! And also for this important trait of homeopathy applies Hahnemann’s exhortation: “Imitate it, but imitate it exactly.”
S. L.: Homeopathy today is perceived in many different ways. We see serious homeopaths who put great effort into their study of Dr. Hahnemann’s writings and those of his contemporaries. Others have an open heart for modified, ‘enhanced’ or new philosophies, commonly promoted by their teachers. Still, there is another group of homeopaths which mainly trusts its own experience and inspiration. And finally there are those ‘therapists’ who attended an introductory homeopathic course and feel capable enough to treat members of the family in acute situations. Is it legitimate to judge one approach in comparison to the others?
Prof. J.: In my opinion there can be no homeopathy which is not based on the principles laid down by Hahnemann. These principles have been formulated in the Organon. Already during Hahnemann’s lifetime there were dissenters (the “infamous” pseudo-homeopaths in Leipzig accused by Hahnemann of medical heresy). There is no therapeutic system in which there is no conflict about right or wrong. The history of homeopathy is thus full of dynamics which look on first sight as quarrels but are expressions of an exchange of ideas which keep the system going and alive. Homeopathy works differently from the Catholic Church where you have a committee watching over the right faith and where you have finally a peremptory order by the Pope. Hahnemann tried to play the role of the pope for his followers but he did not succeed, as we know. Since then we have a number of schools in homeopathy which disagree on many issues but still adhere to the fundamentals of homeopathic therapy, i.e. the law of similars.
S. L.: We can witness the rise of more new schools of thought. Some of them are pretty well accepted in the homeopathic community while others are regarded as exotic and are discussed controversially, sometimes very emotionally. What advice would you give to students in search of their own identity as a homeopath and as trustworthy therapists for their patients?
Prof. J.: My advice is to start with classical homeopathy and to see how far one gets with it. It is like playing ball or other games. First you have to learn the rules and the essence of the game, than you can try to make the game more attractive by adding new rules and changing players. I repeat it once again: As a homeopath you should be open-minded and you have therefore to discard some beliefs which no longer seem to work in practice, adapting your approach to new developments, if you still stick to the basics. Merging homeopathy with other schools of thought and even with allopathy (as, for example, what the Eclectics in the US have done in the late 19th century) means to loose one’s homeopathic identity. The most important thing one can learn from medical history is that distinctive features of a system are needed to survive on the medical market-place. On the other hand, there is not only one truth, neither in homeopathy nor in other therapeutical systems. Look, for example, at the world religions. Syncretism is one of the striking phenomena which you can observe in every belief system. So what is wrong about syncretism in homeopathy as well?
S. L.: According to European legislature, Complex Homeopathy and Classical Homeopathy are equalized. Data on sales of homeopathic remedies show that complex remedies are clearly more frequently sold than single remedies. This seems to be an unacceptable situation, as the methods in selecting complex remedies differ completely from the traditional school by Hahnemann – which is homeopathy! How could such an inconsistent and contradictory practice, under the shield of homeopathy, become protected by law?
Prof. J.: This question has do to with economics. The pharmaceutical companies producing complex remedies are to be blamed for their successful lobbying on a European scale. But the problem starts with the homeopathic practitioner who cannot afford to prescribe single remedies for economical reasons, because this means that the patient does not have to show up in the surgery every day. This, of course, reduces the income considerably unless you have a thriving practice like Hahnemann or other popular homeopaths. In other words, it is not so easy to make a living as a homeopath if you stick to single remedies.
S. L.: There are pharmacies very active in clinical research, which produce homeopathic complex remedies. They ‘develop’ their products for treatment of given indications claiming to follow the rules of EBM (Evidence Based Medicine). This is strongly promoted by the huge pharmacies for conventional medicines and drugs to become the sole base for the treatment of patients. Do you think homeopathy in its Hahnemanian, original form can simultaneously exist with this ‘modern’ form?
Prof. J.:What is wrong about pluralism in medicine? Important is in my opinion that the healer and the patient have the choice to make use of the therapy they consider to be the best.
S. L.: David Little, whose recent contributions to the Facekom Ezine were highly appreciated and praised by a great number of our readers, promotes the use of the best of Hahnemanian homeopathy together with the best of the modern schools of thought. Can there be such a development of homeopathy?
Prof. J.: This looks to me as an almost perfect form of syncretism. This goal is difficult to achieve, but one has to try hard. If this does not always work, one could find consolation in quoting Samuel Beckett’s famous phrase: “to fail, to fail again, and to fail even better“.
S. L.: In the 21st century, knowledge in homeopathy seems to have grown exponentially due to a broader recognition and practice, and due to the development of communication in modern media like the internet. Viewing homeopathy, as it exists in today’s health systems, is it reasonable to say that the Organon’s 6th Edition is still relevant? Or does it need revision in certain aspects?
Prof. J.: The Organon in its 6th edition reflects by and large the core of homeopathic treatment in present times, but one should not think that the previous editions have become useless. One can still learn at lot from comparing the various editions of the Organon. However, to have a paragraph by paragraph, line by line comment of the 6th edition in light of 200 hundred years of homeopathic practice compiled by leading practitioners in this field who still consider themselves to be classical homeopaths would be most helpful and revealing.
S. L.: Having mentioned the internet before, it comes to mind that homeopathy is increasingly discussed in public internet forums. These discussions have a number of different faces. There are those who cover the interpretation of Organon teachings in a very serious way. And there are situations where individual homeopaths praise their own methods of practice and the results they achieve in their patients. How would you rate the educational benefit that can be gathered by participating in such forums?
Prof. J.: Internet forums are a wonderful innovation, replacing the intensive correspondence among homeopaths in previous times, exchanging ideas, new methods and knowledge by writing letters. Now this process is much faster and even less expensive. However, one has to beware of the problem, computer and I.T. experts have long been aware of, and which can be summarized in the popular phrase: if you put trash in, you also get trash out.
S. L.: To go a step further, let’s have a look at the phenomenon of ‘online prescribing’. In many countries, we find homeopaths running online clinics. And we find online prescribing in public discussion forums. Opponents of such practice claim that true individualization of a case cannot be done by not knowing the patient in person. Too many limitations in case-taking lead to a subjective interpretation and perception of the patient, making it impossible to find safely the similimum.
Proponents of the method say that it offers homeopathic treatment to those who cannot afford a licensed homeopath locally, or to those who have no access to other homeopaths for geographical reasons. It is better than to have no (homeopathic) treatment at all.
Prof. J.: Online prescribing seems to me a much bigger problem in allopathy than in homeopathy in regards to the risk for the patient. Hahnemann himself treated one third of this clientele by correspondence. Except for very rare case he insisted, however, that the patient showed up in his consultation at least once, preferably at the beginning of the treatment.
S. L.: There are serious efforts being made to force therapists to exclusively treat patients according to the rules of EBM (Evidence Based Medicine). They want to go as far as to withdraw the licence of therapists who will not obey EBM. Is it possible, as a homeopath, to practice homeopathy expertly and skilfully in an individualized case within the system of EBM? Can we fulfill the criteria of EBM? Will it affect homeopathic practice if the proponents of EBM carry through what they intend to do?
Prof. J.: Homeopathy has been an EBM therapy right from the start, as can be seen from the wonderful book by Michael Dean about the long history of clinical trials (even RCTs!) in homeopathy. Homeopaths have to base their therapy on different forms of evidence, using the whole methodological spectrum which is usually defined as EBM. The problem is to make clear that the gold standard (RCT) is only one method of proving efficacy, but that there also other forms of proof which can be considered as scientific.
S. L.: Thank you professor, we have covered a wide range of our concerns about homeopathy. Before we let you go, there is one question that still thrills me with excitement:
Professor Jütte, what is your vision of homeopathy in the future world?
Prof. J.: As a historian my vision can only be that of a prophet looking backwards. I am convinced that homeopathy has a future, even a bright one, not only in developing countries where homeopathy is a cheap and powerful medicine, but also in western countries where the demographic trend and the increase of chronic diseases will lead to more and more people looking for help outside biomedicine. Thus, homeopathy, will be confronted with another big challenge after producing convincing results in the treatment of epidemic diseases in the 19th century (.e.g. cholera), i.e. the successful homeopathic treatment of the multi-morbidity and chronic diseases of the 21st century.