About Us

Ann McKay, R.N.C., John McGonigle, M.D. and Mark Brody, M.D. have devoted themselves to homeopathy and related alternative medical treatments. In keeping with the spirit of homeopathy's founder Samuel Hahnemann M.D., we utilize treatments that emphasize safety and the restoration of the sick to health.

Sunday, September 20, 2009

Perceptions of homeopathy

A recent New York Times article, printed on a health blogsite, about the use of Arnica gel (Sept 17, 2009) invited all kinds of comments, both supportive and critical of homeopathy, including one from our own Dana Ullman. Homeopathy tends to evoke strong opinions. However, the strength of the opinion often has no correlation with the strength of the arguments used to support that opinion.

There are many types of reactions people have to the idea of homeopathy, far more than the types of reactions that are observed to its clinical applications, which are generally just good, bad or some mixture of these two. As a physician who has been practicing homeopathy for over 8 years, I have found it fascinating to observe the multitude of reactions that it tends to elicit, most of which are apparant in this New York Times blog/article.

First comes the superficial thinker. He knows homeopathy is wrong from the start, because it’s obvious. There’s “nothing” in it, so anyone who believes it can have any effect must be delusional. Research, scientific evidence, and clinical evidence are of no concern to this individual. Familiarity with the history, philosophy and clinical record are also considered irrelevant when nonsense of this type is being proferred as science. By these same arguments, superficial thinkers have argued in the past that the world is flat, that evolution is a hoax, that airplanes can’t fly, and that the earth is at the center of the universe.

Second comes the anti-naturalist. Pointing out that many “natural” substances can be toxic, the anti-naturalist thinker seeks to raise doubts and mistrust about natural treatments, whether they advertise themselves as such or not, because natural treatments are not universally safe.This individual ignores the fact that other (non-natural) treatments are virtually all rife with serious risks, and overall, natural treatments tend to be safer, albeit not necessarily completely risk-free. Intent on rescuing gullible souls who flock like moths to the flame to unproven treatments because of their superficially “natural” label, this individual misses a key point: that many people seek non-traditional alternatives because more conventional approaches simply don’t work for them, or because they have been alienated from conventional treatments by how technology has in general wreaked havoc with nature.

Then there are the stiff-neck thinkers who object to homeopathy based on an imagined lack or absence of scientific evidence. They are unfamiliar with homeopathy, and therefore are unaware that hundreds of studies have been published using the“gold standard” of randomized controlled trials, often in highly reputed allopathic journals (!) where homeopathy has mostly been vindicated as a scientifically valid treatment. It is ironic that sometimes these individuals state that homeopathy should be subjected to the “same” scientific standards as conventional medicine, at a time when the scientific validity of conventional medicine has been greatly weakened by reports of bias among researchers, who are paid by drug companies, by research that is suppressed that is unfavorable to drug companies, when scientific papers are frequently “ghost-written,” and when the authors are on the payrolls of drug companies, even if the drug companies didn’t do the research themselves. Homeopathic research is light-years ahead of modern medical research in terms of being free from economic bias.

There are the “what me worry” thinkers who embrace it uncritically, because it worked for them, or because they are “into” natural treatments, or because their families have used homeopathic medicines. Anecdotal evidence is not without validity, but these individuals minimize the need for more rigorous evidence. The value of anecdotal evidence is generally minimized, and I think unjustifiably so, because anecdotal evidence, when it occurs frequently, acquires a certain gravity than single case reports do not. Still, the greater worry is not so much that these thinkers will blunder into useless treatments as that they may blunder into dangerous treatments (which homeopathy has never been shown to be).

There are the “suspicious” thinkers who seem to distrust it just based on it being different from what is familiar. Any number of excuses might be brought up to question homeopathy’s validity, and they are never at a loss for another one, even if one can argue successfully against any one of them. These folks simply have irrational fears about something that is too different for them.

The wise soul, who I rarely encounter, knows that evidence is ultimately a chimera. Without leaping into the extremes of relativism, the wise soul knows that acceptability and provability are almost always to some degree in the eye of the beholder. Attitudes of blind acceptance or sweeping dismissal are generally over-reactions, whether it comes to homeopathy or anything else in life. The wise soul knows that nothing is completely certain in life, outside of the realm of mathematics. One is always left making judgments, with the imperfect instrument of our emotionally clouded perceptions.

Thursday, September 10, 2009

Who are we, the homeopathic aficionados?

Today, a friend asked me about how my transition from psychiatrist to homeopath came to be, and whether this created conflicts for me. I said that I had always had greater conflicts with my role as a conventional physician, since I wanted to accomplish deeper healing and growth in my patients than I felt was possible by the use of medications, upon which modern medicine appeared to be so dependent. Homeopathy aspires to accomplish deep healing, on physical, mental, emotional and spiritual levels. As this was revealed to me during my tutelage in homeopathy at the Hahnemann School in California, it could not have been an easier transition. The hard part, as Dr. Roger Morrison, one of my mentors there once quipped, was that once you go down that road, you can never go back. He certainly was right for me. Once you've tasted the profound changes that can result from a successful homeopathic case, it is all but impossible to settle for the palliative effects of conventional therapies.

Many homeopaths arrived on the shores of homeopathy as flotsam and jetsam from other medical fields, both conventional and alternative. The stories are similar in many cases: they are about people looking for a deeper more profound and effective way of helping their patients. But what about the patients. Who are they and how do they come to homeopaths? I've identified a number of types of patients who come to see me. If you see yourself in any of these types, you might want to call a homeopath for an appointment.

One way of identifying who homeopathic patients are is to first define who they are not. They are not persons who are satisfied with their current treatment and medical care. They are not people who are uncomfortable with novelty and the unconventional. They are not people who tend to be independent thinkers. They may be very bright. They may be very sick or very healthy. They usually are dissatisfied with their own treatment or the medical system they have encountered in their lives. They may be hippie-granola-lefty-radical types, or they may be more conservative in their political and social leanings. But they are quite sure that they want something different.

1. Homeopathic patients generally are dissatisfied with the medical care they are receiving. It didn't work, it didn't work well enough, it caused intolerable side effects, or it caused annoying side effects. These individuals often have long histories of trying numerous drugs and even alternative therapies without satisfactory results. To paraphrase a modern homeopath, Dana Ullman, who has written beautifully about homeopathy in many books, when modern medicine is failing people, that is when homeopathy comes into its own.

2. Some individuals go beyond side effects in their reactions to medication treatments. They are unable to tolerate nearly all pharmaceutical agents. These hypersensitive folks simply can't tolerate most conventional therapies, and are relegated to finding gentler alternatives such as homeopathy.

3. Some individuals don't fit into the boxes that physicians were taught to put people into. They don't have easily diagnosed problems or they have problems for which there are no well established treatments: these include fibromyalgia, chronic fatigue syndrome, chronic pain syndromes, fevers of unknown origin, irritable bowel syndrome or other treatment resistant symptoms which don't add up to any clear diagnosis. Often these individuals are made to feel like pariahs in the medical system. Patients readily perceive that their doctors don't consider their complaints to be legitimate. Many doctors regard these individuals as having psychiatric problems, to be seeking "secondary gain," or attention of some sort, to be hypochondriacs, or to be just plain nuisances, since they never seem to get better and no sense can be made of their problems. Homeopaths do well with these patients, since they have a totally different diagnostic system, which is able in most cases to make sense of what is a confusing mish-mash to the conventionally trained physician.

4. Some homeopathic patients are simply cautious and fearful about undertaking trials of medications or surgery, whether for themselves or for their children. They tend to be people who read broadly and are aware of the side-effects and risks that are down-played by the pharmaceutical industry and conventional medicine, but which keep popping up in the news. They may have had a bad experience with a medication or surgery in the past, or know of someone who did, and are leery of exposing themselves or their loved ones to the risks of conventional treatments. While the fears of such individuals tend to be pooh-poohed by some conventional doctors, or even labelled as hysteria, these people from the perspective of homeopaths are not over-reacting. They are simply respecting the basic Hippocratic admonition that doctors appear to be less mindful of these days: that first and foremost, doctors should do no harm in their healing efforts (Primum non nocere).

5. There are a certain number of people who come to me who are probably overly prejudiced against conventional or allopathic treatment. They view conventional medicine as anathema and clearly have an axe to grind. I treat these individuals anyway, because I don't take sides when it comes to helping the sick. I just do the best I can.

But I don't share these patients' complete hostility to modern medicine (some of them are taking medication anyway!), because I believe that conventional treatment does have a time and place. These individuals are always looking for another angle because of what appears to be a deep anger at conventional medicine. I too have some anger about the way a lot of conventional medicine is practiced, but I know that many modern treatments are beneficial and necessary. Conventional doctors are not evil. Lives are saved, and people do experience benefits from modern medicine. However, many are harmed unnecessarily, and it is probably only in about 10 percent of cases (my own personal estimate) that modern medicine is clearly superior to safer alternatives. In most cases, where there is not an immediate threat to life and limb, safer approaches will work as well or better, and with far less morbidity and mortality. For those who do not respond to safer approaches, more risky ones can be used, with a full disclosure of these risks. To me, it is only sane to begin with the safer options, when there is not a pressing issue of a life and death nature, even if the scientific literature may not be as strong as we would like it to be. The reason most doctors do not do this is that they have been trained to believe that safer alternative treatments such as homeopathy are not valid.

Regrettably, it is only a minority of patients, usually those who are among the most broad-minded and sensible (in my view) with regard to exposing themselves to risk, or those who have had both the worst outcomes from conventional treatment and the boldness and energy to consider other alternatives who cross the threshold of a homeopath's office. For the rest, the conventional wisdom prevails, or people continue to suffer unaware that safer more effective alternatives exist a mere phone call away.

Tuesday, September 8, 2009

Who are doctors?

The mythology around the medical profession is as powerful as it is pervasive. For many of us, images of our favorite TV doctors, who are variously lionized and humanized probably have more impact on our image of who doctors are than any reality based encounters. Doctors are as impressed with the mythology as non-physicians, in part because they helped to create it. Doctor as hero, doctor as genius, doctor as savior, doctor as god with feet of clay. The old joke goes, "What's the difference between a doctor and god?" The doctor knows he's a divine being.

The sober reality is that physicians are people like everyone else and vulnerable to the same flaws and weaknesses. One of the most pervasive and legendary characteristics of physician training is its competitiveness. Competitiveness cuts both ways: it may show how tough you are but it also shows how much you care about yourself at the expense of others. Competition begins with the pre-med courses, where getting an A or a B+ may mean the difference between getting into med school and not. Many people are unable to matriculate, and apply and re-apply. Once you are in, the competition begins in earnest. Volumes of memorization enough to blind you and bludgeon your brain into insensibility. Yet emerging from that even stronger! Then the competition continues with equal intensity for the best residency programs, at the best universities, the most prestigious faculty. Years of sleep-deprivation ensue, while managing multitudes of patients simultaneously in your sleep deprived state. Still, they are able to conjure up arcana from the vast stores of knowledge accumulated over years of immersion in medical learning. Then comes the next competition: the most lucrative jobs, the most prestigious university affiliations or medical centers, or multi-specialty groups. Who has the best cases? Who can stump his colleagues? Who can make the most subtle diagnosis? Who's on top?

The downside of this competition, for all of its impressiveness is that it tends to yield (what else) competitive doctors. Competitive doctors are interested in their own advancement above and beyond their other more humanitarian concerns. This problem affected me deeply during my medical training. Because while there certainly were caring people even among the fiercely competitive, and while some good could emerge even out of self-interested doctoring, there was a certain falseness to the myth that was being fostered in the process. The benevolent aspects of doctoring were always being discussed, but the jousting, the self-interestedness, and the competitiveness never were.

When I tell my medical colleagues that I have become a homeopath, it does not surprise me that many of them are uncomfortable. It took me some time to understand this, but I believe that the discomfort arises out of the competitive culture of medicine. The notion that you might have an edge, even by knowing something that other doctors know nothing about, because it wasn't part of their training strikes a blow into the soul of every doctor with an ounce of competition. This may explain the stunned and awkward silence of my fellow doctors on finding out that I have something I know that I feel confers an advantage to me over what they do. It probably explains the hostile reception homeopathy has had over two centuries from mainstream medicine. In the world of medicine, I regret to say, defeating the competition sometimes seems more important than being a good doctor.

Monday, September 7, 2009

National Health Insurance

Yesterday, I received in the mail yet another solicitation to join Physicians for a National Health Plan (PNHP). I used to belong, in the days when simple solutions seemd to me to be simply right. Since starting down the unconventional road of homeopathy, I have been more wary, and their applications have for the most part ended up in the recycle bin. But occasionally, I write them a letter, explaining my reservations about joining. In the letters, I express a number of worries that keep me from joining their well-subscribed to but as yet politically unsuccessful organization. First of all, PNHP never really says exactly what it is proposing. In its newsletter it posts massive volumes of clippings the editors have gleaned from newspapers and journals around the country, depicting the economic wastefulness of the current system. It then cites examples of systems, such as Canada's or other European nations', where their national health insurances have far less administrative costs. But PNHP never describes what kind of national health care system they endorse. These details are presumably too trivial to warrant our consideration.

Being against national health insurance simply means you are pro big-business, right? But what would a national system actually actually look like? Would it mean that only doctors and approved medical clinicians could do treatment? What about chiropracters, acupuncturists, osteopaths, or homeopaths? What would become of them? Would they be considered part of the waste too, since the evidence for their treatments is held in lower repute by mainstream medicine than that for more conventional treatments? Although trained as a psychiatrist, I have studied homeopathy in its application to primary care type problems for over 7 years, even though I have not done a family medicine residency. Would I be permitted to charge for my services? Or perhaps I would be banned from these practices altogether, relegated only to treating conditions that have been narrowly defined as "psychiatric."

In short, I worry about what would become of alternative medicine in general, and I also worry about what would become of my own practice. The PNHP literature does not address these issues, nor does it address the issue of how to handle the high costs of prescription drugs and medical devices, the high fees charged by physicians, particularly specialists, the low fees awarded to primary care physicians, the rising costs of treating self-induced medical problems (those based in behaviors or life-style choices), the effects of high malpractice insurance rates, and the impact of outlandish medical student debts on the practice of medicine. It does not address the issue that neither doctors nor patients have or wish to have any restrictions on the tests, procedures and treatments open to them, regardless of costs. Yet the costs are killing us.

National health care appears to be a Gordian knot kind of solution. It actually has a limited though valuable contribution to make, because waste does increase costs. but it can only be part of a broader solution. It addresses only one part of the problem, because national health insurance has no relationship to the underlying causes of our expanding health care system. The bureaucracy that adds costs to the system is not expanding, but costs are. And the reason is that doctors are prescribing more and more expensive tests, drugs, and other treatments, and patients are agreeing to more and more expensive drugs, tests and treatments. If we were to enact a national health insurance plan, we would soon find ourselves confronting these problems head on, and the system would be forced into rationing. And rationing might be done along any kind of guidelines, since PNHP and other advocates of national health insurance haven't evidently thought much about this. It might well be the death knell for many types of alternative medicine, including homeopathy. It might lead to a narrowing of all of our choices for health care. This would not necessarily be entirely a bad thing. But lets talk about what kinds of rationing we might favor, when we talk about national health insurance before it is enacted, not afterwards. Otherwise, we don't know what it is we are endorsing.