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footnote, aphorism 1 discussion

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footnote, aphorism 1 discussion

Postby admin » Thu Nov 12, 2015 10:55 pm

carried over from http://homstudies.com/forum/viewtopic.php?f=2&t=37#p74

Over at pearls.homstudies.com, I've posted the full text, in English translation, of Hahnemann's lovely ranting footnote to aphorism 1 in the Organon (this is one of the few sections of the Organon I can refer to by aphorism number and quote :oops: ). At first glance this might be (mis)interpreted to discourage our attention to a study of anatomy, physiology, and pathology, and the application of knowledge in these realms to the healing arts. I see it stating something rather distinct from this. I could go on with this and offer my take on it, and I likely will, but might I first invite some conversation on the topic?

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Re: footnote, aphorism 1 discussion

Postby admin » Thu Nov 12, 2015 11:54 pm

[re the physician's calling ...] nor is it to attempt to give countless explanations regarding the phenomena in diseases and their proximate cause (which must ever remain concealed), wrapped in unintelligible words and an inflated abstract mode of expression, which should sound very learned in order to astonish the ignorant – whilst sick humanity sighs in vain for aid. Of such learned reveries (to which the name of theoretic medicine is given, and for which special professorships are instituted) we have had quite enough
- Samuel Hahnemann, from the footnote to aphorism 1 in the Organon

First, I consider this "rant" to be "spot-on," as relevant today as it was in the 18th-19th centuries. But what does this really mean? What was / is (as I consider this a living text, not merely of historical relevance) Hahnemann referring to when he describes "theoretic medicine" or "explanations regarding the phenomena in diseases and their proximate cause" ?

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Re: footnote, aphorism 1 discussion

Postby vmenear » Fri Nov 13, 2015 9:03 pm

I'll take a stab at a response.

Constructing "empty theories", speculating and using impressive words are all things that existed then and now. But there is also good science and when you think about it it sure seems a knowledge of basic science contributes to the effectiveness of our care from evaluation to treatment.

As part of any patient evaluation is hopefully to look at them, being a student of anatomy and physiology goes a long way.
Understanding the dynamic of the heart and lungs and how its reflected in the right side of the neck for example.
( A link for the curious: http://www.ncbi.nlm.nih.gov/books/NBK300/ )

I'm sure Hahnemann and the elite of his followers were up to date on the A and P of their day. Somewhere in the recesses
of my noggin I recall an old case, by Kent perhaps, where the doc determined the patient had a blockage between the third and forth ventricles of their brain.... by examining them! ( Would have loved to be there for that ) That's some pretty sophisticated and subtle anatomical understanding.

Another example would be the helpfulness of genetics / physiology. If someone has hemochromatosis in the family, good to check that
out to know if dietary changes may help. Wouldn't make sense to give a remedy and still let the patient have a steak for dinner every night
if they had it.

As for ""theoretic medicine" was Hahnemann not referring to the practices of his time?... Salivation and sweating to eliminate the poisons of syphilis. Or bloodletting/leeches to release bad humors.

And as for identifying "causes"....whether proximate or distant... they are the elusive holy grail of satisfaction in medicine. Hahnemann was an impressively smart guy who even in his time had the wisdom to recognize the complexity and non linearity of biological systems. ( not to mention the additional complexity of pyscho-emotional dynamics). His work on miasms gave a scaffolding for understanding deeper causes and today's science gives us genetics. ( What would Hahnemann think about today's capacity to send some spit to 23 and me and find out your entire genome for 100 bucks? Hard to think he wouldn't be excited and curious. ) But neither are black and white.

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Re: footnote, aphorism 1 discussion

Postby admin » Mon Nov 16, 2015 6:58 am

Victoria,
this is beautiful.
I think we need to begin by looking at the state of medicine and its guiding philosophies in Hahnemann's day, and consider his greatest accomplishment to medicine. We might list his contributions to hygiene and his appreciation of the germ theory of disease, contagion and epidemiology; his campaign against bloodletting and the use of injurious substances in "allopathic" practice (a term which may be applied to the use of pharmaceuticals in his day, but which really does not apply to contemporary pharmacologic medicine, better described as iatromechanical in its approach); or more central to the discipline we share, his elaboration of the principle of similars. But by far his greatest contribution was to introduce "evidence-based" medicine (which happened to highlight the principle of similars). In Hahnemann's day, Medicine was guided by 2 philosophies; the Dogmatic, purely excogitated teachings of Hippocratic/Galenic Greco-Roman medicine, essentially unchallenged since its elaboration c. 400BC/200 AD., somewhat further developed by the great physicians of the Golden Age of Islam (Rhazes, Avicenna); a true Dogma, considered beyond challenge, to be accepted on the weight of Authority; and the recently introduced philosophy of iatromechanism, following Descartes and a collection of Rennaissance physicians, up through Hermann Boerhaave and the restructuring of the medical school in Vienna, the heritage of contemporary conventional medical practice. We need to note that in Hahnemann's day, Avicenna's Cannon of Medicine remained the most widely-used medical text in Europe, following a run of over 500 years; and medical education consisted principally of listening to lectures read from the works of Hippocrates, Galen, Dioscorides, Rhazes & Avicenna.
The “theoretic medicine” against which Hahnemann ranted, and which he sought to replace, was of two sorts; one, based purely on on unobserved supposed inner processes and properties of the organism accepted merely on the weight of authority of 2200 year-old excogitation/speculation; the other on the unsupportable assertion that the living organism could be fully understood according to the principles of a simple machine, in the manner of the hydraulic animated fountains with which René Descartes was so particularly enamored and on which he based his iatromechanical speculations.
I read the footnote to aphorism 1 to address these “so-called systems [of] empty speculations and hypotheses concerning the internal essential nature of the vital processes and the mode in which diseases originate in the interior of the organism, (whereon so many physicians have hitherto ambitiously wasted their talents and their time)” - but to in no way to dampen our possible enthusiasm for gaining a more sophisticated appreciation of the workings of the living organism; tho certainly to offer caution re merely substituting other “so-called systems [of] empty speculations and hypotheses” to replace direct observation.
Hahnemann was a product of the “age of enlightnment” and the “scientific revolution,” and as such gave us a highly Scientific approach to medicine (read Science, as in Mythbusters); he was very much a Copernicus of Medicine, establishing a “medical cosmology” through carefully-recorded observation, rather than via excogitated Dogma or from theory based on overly simplistic theoretical models. and just as Copernicus would most certainly have delighted to view the findings of the Hubbell telescope, I have no doubt that Hahnemann would have been intruiged with the findings of the Human Microbiome Project.

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Re: footnote, aphorism 1 discussion

Postby admin » Mon Nov 16, 2015 6:44 pm

admin wrote:(Hahnemann) was very much a Copernicus of Medicine ...

in stature, we might assert - but unquestionably, with respect to the nature of his contribution.

Copernicus may have placed the sun in the center of the solar system, relocating the relative positions of sun & earth - but this was merely the result of his principle contribution, which was to replace Aristotlean Dogma with Observational Science as a means of knowing. Similarly, Hahnemann may have asserted the primary role of the Principle of Similars in healing - but this was merely the result of his primary contribution, which was to replace Dogma with Observational Science as a means of knowing. This was a period of upheaval in all the sciences, and simultaneously there were other efforts to displace Hippocratic dogma as the guiding principle in medicine - the major competing effort was that of iatromechanism, replacing Hippocratic humoral "physiology" with a Cartesian - inspired physiology based on simple linear reductionist explanation, applicable perhaps to simple systems but not to the complex adaptive system of the living organism, which has given birth to the iatromechanical "scientific" conventional medicine of today. We become confused with the use of the term "scientific" - often mis-applied in contemporary use, esp. in "medical science", to "explainable on basic reductionist principles" - but appropriately referring to something rather different. Conventional medicine is finally coming around to an "evidence-based" standard, more in keeping with Copernican Science, which often finds itself in conflict with the iatromechanical model - witness the "evidence-based" recommendations re influenza vaccination, which conflict with the iatromechanical analysis of slam-dunk "safe and effective," the 2004 American Academy of Pediatrics / American Academy of Family Practice Joint Commission report regarding antibiotic use in Otitis Media, which conflicts with the slam-dunk "makes sense" conclusion of iatromechanical assessment.

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Re: footnote, aphorism 1 discussion

Postby vmenear » Mon Nov 16, 2015 8:54 pm

Hi Will,

I was humming along, reading your posts with a smile on my face cause I always enjoy your skillful use of words and knowledge of the historical context within medicine. Then I hit a minor speed bump when you said conventional medicine is coming around to the "evidence-based" standard.

I don't disagree that there is the beginning of this happening.

What I am concerned about is that the evidence based, observational approach is dependent on the capacity to see and not deny what is in front of one. And I personally think that the protocol based, quota driven mentality sets a medical professional up for not always seeing what's there. ( Kinda circling back to the art class discussion).

I think that not a few clinicians have prejudices about certain interventions and don't allow themselves to see and acknowledge sequelae that fall outside of their "belief". Or the threshold of severity for something to register as significant is so high that many useful observations slip through the holes in the net. Those biases also exist in the research world in terms of what topics are deemed worthy of funding.

( In his new book, The Laws of Medicine, Siddhartha Mukherjee spends some time taking about medical bias:

http://ideas.ted.com/the-most-critical- ... uman-bias/ )

It's definitely a positive to be taking steps in the evidence based direction. I'm just not quite popping the champagne cork yet.

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Re: footnote, aphorism 1 discussion

Postby admin » Mon Nov 16, 2015 10:00 pm

vmenear wrote:I'm just not quite popping the champagne cork yet.


In total agreement re the Champaign corks. Good to see tho, an acknowledgment of evidence-based (used to be called "anecdotal") challenge to iatromechanical justifications - a toe in the door perhaps to the eventual necessary dismantling of a 400 year (post-Descartes) myth. Clearly the subjectivity of "evidence" poses a problem - note in the Cochrane reviews on influenza vaccination, the disparity in reported efficacy between industry-funded, and publicly-funded studies. It's far too easy to see what one believes, esp. when subjectivity is cajoled by the bottom line - and when belief is constrained by a widely-accepted explanatory model. Paradigm-shift is a bitch. ;)

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Re: footnote, aphorism 1 discussion

Postby admin » Tue Nov 17, 2015 6:10 am

vmenear wrote:( In his new book, The Laws of Medicine, Siddhartha Mukherjee ...

Just downloaded & devoured the Kindle version - magnificent! - thanks

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Re: footnote, aphorism 1 discussion

Postby vmenear » Thu Nov 19, 2015 3:11 am

Glad you enjoyed Siddhartha's book.

You mentioned during the "hang out" to send any other stuff your way.

Do you know of John Ioannidis at Stanford? He is, amongst other things, a mathematician and a research analyst at Stanford who some years back threw a monkey wrench into the assumptions of medical research.

Atlantic Monthly did a nice article on him:

http://www.theatlantic.com/magazine/arc ... ce/308269/

And here is an essay of his, Why Most Published Research Studies are False:

http://robotics.cs.tamu.edu/RSS2015Nega ... 020124.pdf

He lists a number of corollaries about the probability that a research finding is true. I am not a statistician so my eyes start to cross when he gets detailed but its interesting reading.

During the hang out you touched on bias and the need for everyone, homeopaths included, to try to step back and recognize biases held. Along those lines you mentioned the vanilla provers who curiously discovered similar symptoms in the provings of different remedies. ( I had also read some time ago that Stapf ( ?Sp) one of Hahnemann's provers produced similar symptoms for different remedies ). You have also mentioned the bias towards mental symptoms in quite a few of the modern provings.

Over the years I have been exposed to and adopted some biases that I eventually discovered were false. For example the concept of antidotes. I remember a patient who was responding well to opium forget to tell me for a few months that she had been having occasional Camphor massages ( without apparent ill effect on her improvement).

Are there other biases within homeopathy that you've become aware of and taught about over the years?

Interesting to ponder what biases we might have that are so entrenched that seeing them is as difficult as the fish recognizing its wet.
Last edited by vmenear on Mon Nov 30, 2015 8:05 pm, edited 1 time in total.

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Re: footnote, aphorism 1 discussion

Postby admin » Sun Nov 29, 2015 9:54 pm

vmenear wrote:Are there other biases within homeopathy that you've become aware of and taught about over the years?

Interesting to ponder what biases we might have that are so entrenched that seeing them is as difficult as the fish recognizing its wet.


Scads of them!
Just to get started,

"Antidoting" - when teaching at the Naturopathic College, there was a stock printed handout for clinic patients listing "antidotes" to homeopathic treatment - 2 columns, including the "standard" camphor, mint & coffee, along with essential oils, EMFs from the refrigerator & other household appliances, meditation, chiropractic manipulation, travel, dental work, emotional trauma, ... All good "fallback" excuses for when your "brilliant" prescription failed to act. Belgium has one of the highest rates of use of homeopathy per capita; ever try to suggest a Belgian give up coffee? (or bringing this closer to home, 2 of the "hotbeds" of the use of homeopathy in the US are Seattle Washington & Portland Oregon; "LatteLand")

"Suppression" - a term most often applied to therapies you hold objections to, or applied to palliative therapies, rather than to the occasionally-observed phenomenon it was intended to describe.

"Hearing's 'Laws' of Cure" - we focused on this in a "Hangout" Session, these are neither Hering's, nor Laws.

Many surrounding Hahnemann's descriptions of Chronic Disease (Chronic Miasms) - the fundamental meaning of "Miasm;" the identity of Sycosis; the identity of Psora; ...
Including modern/introduced "additional miasms"

Distorted notions re the Primacy of Mental/Emotional symptoms; a Swedenborgian reading of aphorisms 210-230, adopted from that source by many contemporary "alternative" healing philosophies.

Kent's writings re "rule from center to circumference"

Lots of Mythology surrounding Dose & Potency

"Paper remedies"
Remedy "cloning"

The often-taught seriously oversimplified concept of "Layers"

Many of our remedy "descriptions" - based on other-than-reliable Hahnemannian Prüfungen ("provings")
Kent's "New Remedies" as obvious examples

Many contemporary teachings re the legitimacy of various "ways of knowing" the medicinal properties of substances ("signatures," mythology/folklore, "source" information, "the other song", Periodic Table arrangements, group triturations, "seminar provings", &c.)

The often-heard statement that homeopaths "treat the Patient, and not Disease" (the most commonly-encountered word in Hahnemann's Organon is "Disease")

The very nature of "Homeopathy" as a discipline; we need to recognize that Hahnemann did not intend to develop an "alternative" system of healthcare with its own peculiar identity, as many regard homeopathy these days; He was making an attempt to reform Medicine as a discipline, and his work/writings pertain to Medicine in general, not merely to an "alternative" practice.


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