A House Divided
Posted by apgaylard on December 26, 2007
“…Every kingdom divided against itself is brought to desolation; and every city or house divided against itself shall not stand“.
Matthew 12:25 (King James Version)
This piece of ancient wisdom has made its way into common usage. It nicely expresses the observation that for any group to endure, let alone progress, unity is required.
This theme runs through the analysis by Thomas Kuhn of scientific communities and the progressive nature of science. In particular Kuhn took the view that different schools were “far rarer” in the sciences than in other fields; and were always in a competition that is “usually quickly ended” [p.177 – all page numbers in sqaure brackets refer to Thomas S Kuhn, “The Structure of Scientific Revolutions”, 3rd Ed., 1996 ].
A review of the schools still present in homeopathy will enable us to dismiss on purely Kuhnian grounds the idea that homeopathy has paradigms, or any claim to be mature, or a legitimate competitor to modern scientific medicine.
So, what did Kuhn have to say about the presence of different schools in a field of endeavour? He saw them as communities within a larger scientific community.
“…There are schools in the sciences, communities, that is, which approach the same subject from incompatible viewpoints. But they are far rarer there than in other fields; they are always in competition; and their competition is usually quickly ended. As a result, the members of a scientific community see themselves and are seen by others as the men uniquely responsible for the pursuit of a set of shared goals, including the training of their successors. Within such groups communication is relatively full and professional judgements relatively unanimous…”
The key points to note here is that the mature scientific community has very few competing schools. This enables the emergence of a coherent group. Such communities can pursue shared goals, train new members, communicate well and have relative unanimity of judgement. It’s easy to see why this kind of community can make progress in their field.
Now, there are examples of different schools in mature scientific disciplines. Examples include the Frequentist and Bayesian schools in statistics and perhaps the various interpretations of quantum mechanics. As Kuhn points out, they are relatively uncommon.
Conversely, Homeopathy comprises a large number of competing schools. Therefore, when claiming to be part of a Kuhnian revolution in science homeopaths and their apologists run into an insurmountable philosophical difficulty.
Let’s just see how many schools there may be. A commonly used categorisation splits homeopathy into four main schools:
Other sources include a much greater number. The British Homeopathic Library provides what should be an authoritative list under the heading “Homeopathic therapies” (additional therapies emphasised):
A commentary on the American Association of Homeopathic Pharmacists (AAHP) reference handbook “Introduction to Modern Concepts of Homeopathic Pharmacy” lists what it calls “…the various types of contemporary homeopathic practices…”. It says that these are (additional therapies emphasised):
It makes the troubling claim that “… All of these homeopathic practices coexist and are often complementary to each other…”
Other less well attested schools include Constitutional and Combination therapies. Some schools include further sub-divisions. The lists above show that Isopathy can be claimed to include both Tautopathy and Autoisopathy. Other sources would also include Nosode therapy.
There are claims that Complex Homeoapthy has several sub-schools, at least in Germany: Laienhomöopathie (Homeopathy for the layman); Wissenschaftlich-Kritische Homöopathie (“Scientific-critical” homeopathy).
Now, some of these may just be the same thing given a different name; if anyone spots any such double counting please let me know. However, it is clear that there is a very large number of competing schools.
In case anyone was wondering whether such therapies really represent different schools, the European Coalition on Homeopathic and Anthroposophic Medicinal Products in their publication “HOMEOTHERAPY – Definitions and Therapeutic Schools” list twelve “therapeutic schools” of homeopathy.
We must also make explicit a key division: the bitter professional split between the medically qualified and non-medically qualified homeopaths.
The obvious objection to the charge outline above, that homeopathy has far too many competing schools to be considered as a “mature” field is that all (or most) of these schools are complementary.
For this to be a valid objection, under Kuhn’s scheme, these schools would need to share goals, training, good communication and reach relative unanimity in their professional judgements.
It is clear that in many cases they do not. Refering to Complex homeopathy one website makes the following comment:
“…Like clinical homeopathy, this kind of homeopathy was rejected by Hahnemann…§ 123 Each of these medicines must be taken in a perfectly simple, unadulterated form (Organon)…”
“…Hahnemann, the founder of homeopathy was very clear about ‘clinical homeopathy’…Among the one-sided disease an important place is occupied by the so-called local maladies, by which term is signified those changes and ailments that appear on the external parts of the body. Till now the idea prevalent in the schools was that these parts were alone morbidly affected, and that the rest of the body did not participate in the disease – a theoretical, absurd doctrine, which has led to the most disastrous medical treatment. (§ 185, Organon )…”
So a Classical (Hahnemannian) homeopath should have no truck with either Clinical or Complex homeopathy; or any of their sub-schools.
Some in the homeopathic community deny outright that Clinical homeopathy exists:
“…The problem is there is no such thing as clinical homeopathy. No one trained and licensed in homeopathy would recommend a single, identical remedy for patients with a certain disease or condition…”
Cathy Wong, “Critics say Lancet homeopathy study flawed“
So, “ …No one trained and licensed in homeopathy would recommend a single, identical remedy for patients with a certain disease or condition…”; except the Queen’s homeopath Peter Fisher and American homeopath Dana Ullman when they both extol the virtues of the homeopathic ‘medicine’ Oscillococcinum for treating the ‘flu.
Another homeopathy site specifically criticises this remedy:
However widespread the use or history of Oscillococcinum (remedy for flu, prepared from Duck), the homeopathic view remains:…§ 162 Sometimes happens, owing to the moderate number of medicines yet known with respect to their true, pure action, that but a portion of the symptoms of the disease under treatment are to be met with in the list of symptoms of the most appropriate medicine, consequently this imperfect medicinal morbific agent must be employed for lack of a more perfect one…§ 163 In this case we cannot indeed expect from this medicine a complete, untroubled cure; for during its use some symptoms appear which were not previously observable in the disease, accessory symptoms of the not perfectly appropriate remedy. (Organon)…Homeopaths normally treat patients according to the Law of Similars searching for the simillimum. When a remedy is just subscribed on the diagnosis “flu”, then this aspect is not met and results are dubious according to this vision.
Isopathy is also controversial for many of the other homeopathic schools:
“…Isopathy, giving nosodes or other remedies supposing to be equal to the disease is not according to traditional theory of homeopathy, therefore the therapy is not “homeopathy” but related to homeopathy and often used with it. Hahnemann:…§ 56 Sixth Edition A third mode of employing medicines in diseases has been attempted to be created by means of Isopathy, as it is called – that is to say, a method of curing a given disease by the same contagious principle that produces it. But even granting this could be done, yet, after all, seeing that the virus is given to the patient highly potentized, and consequently, in an altered condition, the cure is effected only by opposing a simillimum to a simillimum. (Organon)…”
Unsurprisingly the sub-schools of Isopathy, like Tautopathy, are also subject to similar critisms:
“…Tautopathy (Tauto-same) is a method of curing or removing bad or side effects of drugs by isointoxication i.e. curing by means of the identical harmful agent in potentised form. It is not the science of similars but that of identicals.”
Dr Ramanlal P. Patel, Hahnemann Homoeopathic Pharmacy, 6th Ed., 1988. Pp. 111
One group of homeopaths say “…all homeopathy medicines are given in a very low dosage…”, keeping their faith. Yet some clinical homeopaths use potencies varying from D1 (1/10) to C30; a D1 potency has a 10% concentration of the active ingredient. This is clearly not infinitesimal.
Even when practitioners claim complimentarity it is clear that this is false.
Isopathy clearly contradicts the so-called “law of similars“; employing the causative agent rather than an agent that allegedly induces similar symptoms in a healthy individual. Therefore any claim that this, or related therapies, are not in conflict with other homeopathic schools is demonstrably false; a delusion employed to reduce apparent conflict by denying it.
In fact, some homeopaths periodically embrace the conflict when trials of Isopathy fail as a damage limitation strategy. Here’s an example:
“…Essentially, the study by Lewith and colleagues (2) was not truly an evaluation of homeopathy per se, but of isopathy. The medication used was not prescribed according to the fundamental principles of homeopathy and therefore would not be expected to work…”
Mitchell A. Fleisher, Homeopathy or isopathy? – Letter to the Editor, Journal of Family Practice, Nov, 2002
This objection could be employed to negative trials of any homeopathic therapy that is not Classical.
It is clear that the profusion of homeopathic schools means that the field is not mature in the Kuhnian sense. Only mature groups can claim to have paradigms:
“…Paradigms are something shared by the members of such groups…”
What does the homeopathic community need to do? Rather than claiming that they are an alternative to scientific medicine; or that they represent some new healing paradigm, they need to get their house in order.
Until they properly reconcile or remove the vast majority of their competing schools, they are not ready to compete against modern scientific medicine in what Kuhn called the battle of “good reasons“.
How should this reform of homeopathy be carried out? Kuhn would suggest the following:
“…a number of schools compete for domination of a given field. Afterward, in the wake of some notable scientific achievement, the number of schools is greatly reduced, ordinarily to one, and a more efficient mode of scientific practice begins…”
One of the schools needs to make a “notable scientific achievement”. What could that be? Providing clear and consistent evidence that they can cure a non-self limiting illness has been suggested by some sceptics. Being able to distinguish between different high-potency remedies has been proposed as another.
Certainly determining the mechanism for homeopathy would be a pivotal achievement. To further illustrate that homeopathy does not possess exemplar paradigms consider this quote, reviewing some of the current hypotheses:
“…The book Homeopathy, Frontiers in Medical Science gives a wonderful overview of theories that are being considered and investigated. It includes a discussion of research on the ability of water molecules to hold memory, and an overview of principles in quantum physics, information systems theory and chaos theory and how these areas apply to the energy medicine paradigm.”
No matter what that author believes there can be no paradigms in the absence of a clear scientific understanding. A plethora of wild speculations cannot be the basis of Kuhn’s concrete examples.
Once the number of schools has been scientifically culled, a transition to maturity could take place. This would, finally, put homeopathy in a position to form some paradigms:
“…the transition need not (I now think should not) be associated with the first acquisition of a paradigm…”
Then homeopathy would have one, or more, concrete exemplars of homeopathic science. Then, and only then, could the claim to be a ‘new paradigm‘ be any more than ill-informed rhetorical posturing.
If this doesn’t happen their house is doomed to fall.
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