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.

Monday, December 28, 2009

A Penny Saved

Amidst all of the furious negotiation going on on Capitol Hill, it is all too easy to forget that realistic health reform can (and must) occur without government intervention. As I mentioned to my colleague Dr. McGonigle, the other day, we could probably trim 25% off the health care budget if we could improve our non-technical, mundane medical diagnostic skills a notch or two. Instead of relying on a thorough history and patient and thoughtful physical examination, doctors and patients are too quick to rush to the MRI, the blood test, or the specialist referral. I doubt most physicians (I include myself) have anything more than the roughest idea how much these expensive evaluations tally in the end, but I suspect it would be thousands of dollars every day for the average primary care physician.

There are few incentives for the average doc to do so, however. It takes more time, more energy, more thinking, and results in fewer patients being seen per day to be more thorough, so as a result there is less revenue. In short, the system is rigged to perpetuate high remuneration for all corners of the medical suite -- the techies and the PCP's. The radiologists and pathologists love this system, since it creates a virtual torrent of business. The PCP's, who are already underpaid, feel they can't afford to do otherwise, and after all, it's the standard of care, isn't it? There is a sense of security that evolves that "everything that could be done" has been done. This sense of security is the same as the pleasant balminess of a warm day at the North Pole. To one who cares to think more about it, it means that a global apocalpyse is upon us, while to others it simply means respite from the cold.

These concerns are just a beginning. On a broader level our society breeds unhealth on epidemic levels by economic and social forces that help to celebrate the moral sicknesses of greed and turpitude. We see this in the food industry and the energy industry, most egregiously. Obesity, heart disease, cancer, and other chronic illnesses are becoming more common all the time, and a large proportion of these illnesses can be said to have an environmental component that is perpetuated by industry and the governmental supports that lie behind them. This would include eating too much refined and sugary food, food that creates pollutants that fouls our rivers, oceans, and the air we breathe, and results in downstream environmental illness. We could easily add to this the pharmaceutical industry, which also has added its products to our drinking water because of an inadequate waste disposal system, and the iatrogenic effects of medications. The pollutants that enter our air and water that come from carbon consumption cause a rise in respiratory illness and disturb the ecosystem. Our energy policies affect our political dealings in the middle east, which leads to wars, and death of our citizens pursuing these political-economic energy goals.

In short, it is hard, when talking about health care, to keep the topic on the health care system itself. Poverty, political maneuverings by the giants of industry, including the food industry, agribusiness, the coal and oil industries, the pharmaceutical industry and many other economic powers are linked in a massive juggernaut of illness production that helps to keep medical costs high.

We doctors spend most of our time cleaning up the mess this vast illness production system creates. And we sometimes do so in ways that contribute to it. Why do we spend our time this way instead of working to prevent illness in the first place? Are we ignorant, dumb, or just greedy? Most doctors, I believe want to do good. They want to be well paid, too, but they are willing to work hard for their money, even if working so hard isn't particularly good for their health, the health of their family relationships, or ultimately, even for their patients. I think that it comes down to there being few incentives to do the right thing, and every incentive to keep the system going as is, even as it careens towards disaster. To make a more frugal system, the system must change the rules of the game. It must incentivize salubrious behaviors on the part of the physician. And corporations must be incentivized to produce salubrious products. The system must be purged of the economic and social inequities that amount to a moral sickness. It's a dangerous self-deception to think that moral illness can flourish with no effect on physical or mental illness.

How can we incentivize doing the right thing? I can't say my vision is that broad. But I do know that it begins with acknowledging that we have incentivized the wrong thing.

Wednesday, December 16, 2009

Succussing Homeopathy

Long have been the laments about homeopathy's churlish treatment by the pseudo-scientists and second-rate journalists. Two hundred years and counting. When I first learned about homeopathy I was shocked that its practitioners hadn't contacted the media to advise them of this boon to mankind. I went from feeling that we as homeopaths were remiss in not publicizing this amazing healing practice to anger that the media were not interested. As I learned more about the powerful resistances that existed within the scientific and popular world to homeopathy, I became more accepting of the low rank homeopathy was relegated to in the great chain of medical being. Still, it has been hard to continue to patiently accept the low status of homeopathy, and not to be angry at the frequent attempts to "expose" it as fraudulent, to denigrate it, or to consign it to a state of desuetude.

Recently, I had a bit of an epiphany. As my partners in alternative practice, the honorable John McGonigle, MD, Julien Ginsberg-Peltz, MD, and Ann McKay, RNc, who do, in addition to homeopathy, acupuncture, functional medicine, Reiki, nutritional counseling and allopathic primary care medicine in various combinations, contemplate with me expanding our size and our numbers, it has dawned on me that size creates opportunity but also problems.

There is something comfortable and friendly about smallness. I'm aware of this because for many years I had at most one office-mate with whom I shared a much smaller space. Since joining forces with another three, I'm aware of a slight decrease in the level of coziness and intimacy. At our present size, we are small, and overall, our office still feels very comfortable to me. As a foursome, I think we still create an atmosphere that is conducive to the healing work we do. But as I envision our numbers growing, and the size of our office expanding, it concerns me that some of the virtues of smallness may get lost in the expansion. A recent New York Times article describing the architectural and design problems that the giant Kaiser-Permanente group have tried to remedy in order to promote a more salubrious environment for healing sensitized me to how much your size can affect your style.

By extrapolation to the practice of homeopathy, I would predict that greater popularity, visibility and more favorable coverage in the press would have its own downside too. Fame comes at a price, as Tiger Woods would have no trouble telling us. For those who have been following his story in the media, it is not hard to see that his interpersonal pratfalls have become awkward, embarrassing and costly to him, thanks to his being so famous. Be famous and you, too can appear on the pages of the National Enquirer. If homeopathy were to become more popular, it might become less effectively practice, it might be cheapened, and ultimately (horribile dictu) McHomeopathized.

If we can look at the allopathic world out of a perspective less colored by envy, we can see that the flaws of the system are laid bare for all to see. The fact that "alternative" medicine is pursued by millions of Americans who spend billions of out-of-pocket dollars on it is testimony to the dissatisfaction that exists with conventional medicine. Recent health care news indicates that there are (shockingly, it is said) many Americans who refuse to take drugs that research has indicated might reduce their risk of developing cancer, or refuse to get vaccinated against H1N1 even though the vaccines are shown by research to be "safe" and "effective." These reporters do not seem to be aware that Americans have also been reading their articles about the numerous other research-backed treatments that have been ultimately scuttled because the research turned out to be flawed. These would include Diethylstilbestrol, Thalidomide and Bendectin in the past, and more recently, HRT and Vioxx. Fame gives the opportunity for you to be seen under a microscope, warts and all.

So, wonderful as homeopathy is, do we homeopaths really want this kind of scrutiny? Are we that sure of ourselves that we do not think our work can not be criticized, if more visible, not for what it is imagined to be, but for what it really is? And do we want to risk developing an Icarus syndrome, where we become so big, and so strong that we must inevitably fall? I think there is much to be said for the quieter subtler approach. The marquee lights that draw attention can certainly stir up a great deal of envy, but all that glitters is not gold.

One of my many wonderful erstwhile mentors, Roger Morrison, MD, once told me that the best way to popularize homeopathy was to "be successful in your practice." At the time, this seemed to me to be too modest. Surely, homeopathy deserved more credit than the small penumbra of popularity that glowed around a private practice could bring, no matter how successful it was. Now, I begin to see more clearly the perils of size, and the wisdom of smallness. In England in the seventeenth century, there was a relatively quiet change of power, the Glorious Revolution, accomplished with only a few skirmishes, not much to write home about when compared to the American Revolution or the French Revolution. This "bloodless" revolution was achieved by some strategic political moves, and was able to accomplish a change of power in a more quiet way than almost any other historical political revolution. It is this type of quiet revolution, achieved by the power of success, that I think offers homeopathy the best chance of achieving more currency and popular acceptance. It is indeed, to paraphrase what Roger Morrison wisely said, our own success that will succuss us into power. There was also a guy named Hahnemann who came before Morrison who had a few things to say about less being more.

Tuesday, December 8, 2009

Identity Crisis

Those medical practitioners who fall outside of the mainstream have an identity problem of sorts. First of all, do we practice "alternative" or "complementary" medicine, and how are these different? Second, are we "holistic" in our approach or "integrative" and does this matter? Maybe some of us do not wish to have any of these labels applied to us. For some, any of these labels may bring with them pejorative connotations, suggesting that these treatments are in some way less valid or more "out there." For others, they may be a banner of humanism or progressive thinking.

Whatever we call ourselves or others call us, it is important to be clear about what we mean by our different monikers. For me, "alternative" implies a different choice, a kind of "either-or" relationship with conventional medicine. It implies a different way of thinking, a different approach, and a different model of healing. Contrast seems to be the key concept.

"Complementary" implies a dovetailing or consanguinity between differing approaches. The type of healing in "complementary" medicine may come from an unconventional tradition, but it at least compatible if not synergistic with conventional approaches. A happy mutuality seems to be the key concept here.

What one calls oneself, therefore, in my mind, is a statement about one's feeling about conventional medicine. The more hostile one is to it the more likely one is to want to identify oneself as a practitioner of "alternative" medicine. The more one wants to be embraced and accepted by conventional medical specialists or those who favor conventional approaches, the more likely one is to view oneself as a practitioner of "complementary" medicine.

The converse also may apply: conventionally oriented individuals who regard unconventional treatments with suspicion or disdain would probably prefer to label them "alternative" medicines. Those who are more open and welcoming to multiple perspectives on healing would want them referred to as "complementary."

Holistic and integrative have similar meanings, but there are separate connotations for me. One who uses the term "holistic" tends to differentiate oneself from conventional treatments, which are viewed as dualistic, Cartesian, and intrinsically more limited in healing potential. Holism implies an attitude that embraces mind, body, spirit, family, community, culture, and environment together. It holds itself up as a contrast to the conventional model, where a perspective on the larger context of healing is deemed to be absent. The term "integrative" comes close to "complementary" in emphasising the joining together in a kind of melting pot of different healing approaches. Compatibility, rather than difference is emphasised.

These terms are meant to identify discreet phenomena, but life is not always so neat and tidy. At its best holistic healing truly advances an ecumenical view of health and helps to avoid the narrow views that lead to personal, public or familial disasters. It promotes the health of the individual within the realms of the emotional, spiritual, and interpersonal, and takes into account the wider context of the society, culture and environment. At its worst, holism merely is an advertising tool for promoting a certain modality endorsed by the practitioner to the gullible few. Allopathic medicine, similarly, at its best can make use of the "biopsychosocial" model, which though taught in medical school, is all too often ignored. The biopsychosocial model, which might be the conventional version of holism, attempts to broaden the perspective of the practitioner in a way similar to that of holism, but, unlike holism, it does not feel the need to differentiate itself from conventional treatment.

Integrative medicine at its best, brings together disparate approaches to produce better outcomes for patients. At its worst, it leads to disagreements and lack of cohesion in the treatment team, with people sometimes working at cross-purposes. So to advocate holistic or integrated is not enough. What is your underlying agenda in promoting it, cooperation or cooption?

Hahnemann gave birth to homeopathy in a spirit of conflagration. Homeopathy was in many ways a declaration of war against allopathy. Integrative or complementary are terms Hahnemann would have for the most part reviled, I believe, because he felt that the fundamental approach of allopathy was flawed. Yet in spite of these deep differences between the Hahnemannian approach to healing and the "old school" or allopathy, Hahnemann did allow for certain occasions when allopathic healing would be appropriate. Thus even such a firebrand as Hahnemann was forced to permit some "integration" of allopathy into his system. There is a tendency among many homeopaths to be critical of the allopathic approach, to emphasise its weaknesses, and long history of obvious misjudgments -- obvious, at least, when viewed from hindsight. Yet if we are true followers of Hahnemann we must allow for some role for allopathic treatment. How much can be debated, but the monomaniacal pursuit of homeopathic healing to the exclusion of all other types, including allopathy is clearly at odds with what Hahnemann himself said and with the homeopathic tradition. I emphasize here the capacity for integration, whereas others might rightly wish to emphasize the differences between homeopathy and allopathy. I would say that the difference in emphasis springs largely from personal feelings. It is intrinsically subjective. There remains an identity crisis of sorts within the ranks of homeopaths, and it would probably behoove homeopaths in terms of our relationship with other healing modalities to spend more time clarifying our role. Are we complementary or not? Are we against all non-holistic approaches, or are we able to work with them? Are we with allopathy or are we against it? Are we truly holistic, or are we advancing this approach as a form of self-promotion?

Who are you, and what are you, homeopaths?

Sunday, December 6, 2009

Rodney and us

Homeopaths have struggled for two centuries to obtain validation from the conventional medical world. Hahnemann and his early homeopathic colleagues faced vicious opposition within their own lifetimes, and it's been an uphill struggle since then. Today, homeopaths still face the indignity of being described in the popular and medical press as tantamount to charlatans, and our mighty protests to the contrary notwithstanding, there seems to be little hope that this will change in the future.

This struggle is to some extent shared by our brethren in other branches of alternative medicine, but homeopaths have been especially vulnerable, perhaps in response to Hahnemann's early salvos against allopathy, which he savaged in numerous articles and lectures. Keeping up this spirit of strong dissent, modern homeopaths continue to decry the pitfalls of suppression and promote their cures as superior to what is possible in allopathic medicine. Claiming to be superior to another group is surely no way to win friends among members of that group, so perhaps we have ourselves to thank in many ways for our plight. Nonetheless, it is a rare homeopath who does not bemoan the woeful state of disrespect homeopathy finds itself in in the modern world. We are the true Rodney Dangerfields of alternative medicine.

Homeopaths have long emphasised the virtues of their unique therapeutic approach. It is virtually devoid of side effects, divorced from noxious commercial influences, capable of promoting health more generally, and inducing cures in some cases. It can benefit the treatment resistant and the undiagnosable. While these virtues have never been successfully challenged, there have been objections that those who see homeopaths may experience delays in obtaining needed and potentially helpful treatment of a more conventional nature. In Hahnemann's time, this all too often consisted of blood-letting or exposure to powerful cathartics or emetics. However, in our times, the allopathic alternatives, for all of their dangerousness are not so obviously wrong-headed. So we need to be able to counter this objection persuasively.

This type of criticism, which might apply to allopaths as well, as has been seen many a time in the past, with regard to controversial disorders such as Lyme Disease, Chronic Fatigue Syndrome, Bipolar Disorder, and chronic pain syndromes. Allopaths differ widely amongst themselves about the proper treatment for many illnesses and are just as happy to string each other up by the neck as they are any vulnerable homeopath or other alternative medicine practitioner. But homeopaths need to guard more carefully against this allegation than other specialties because we have been contenders for the throne. We hold ourselves forth, however guardedly, as better than the allopaths in so many way.

In this area, I feel that I myself and many of my colleagues are vulnerable. Our vulnerability lies in not having demonstrated our ability to correctly diagnose and manage serious illness. Management includes above all knowing when to refer out, and knowing when to refer out implies an understanding of the allopathic as well as homeopathic diagnosis and the multiplicity of diagnostic and therapeutic options that should be considered if the initial treatment fails to effect a positive outcome. While I have had the good fortune to receive quality homeopathic education at the Hahnemann School of Homeopathy, under the tutelage of such great homeopaths as Roger Morrison, Nancy Herrick, Jonathan Shore and Todd Rowe, and at the Dynamis School, with the inimitable Jeremy Sherr, and during seven years of such training, I came to understand how to manage illnesses of all types that might be seen in a primary care setting using homeopathy, I still lack the fundamental grounding in the diagnosis and management of serious physical illness, because my allopathic training was as a child psychiatrist. And many of my colleagues lack the training in psychiatry and child psychiatry to have this perspective when more severe mental symptoms are part of the case.

This might not be an issue if we homeopaths cured 100% of our cases, but we don't. And the thing we hate most is when the patient/client leaves us to undertake a course of allopathic treatment. We may regard this as a sign of impatience or failure to understand the virtues of our peculiar specialty. But the fact is, we need to know when we are failing and what to do next, even if it means referring out for allopathic treatment. We need to show ourselves and the allopaths that we can handle most problems as an allopath would, treating optimally and then referring out when we've reached the limits of our expertise.

All too often we rely on the allopaths to make the diagnosis for us and then we happily proclaim our success in treatment after the allopathic treatment has fallen apart. But we need to show ourselves to be exemplary diagnosticians as well, if we are to win the trust of allopaths and the community. Speaking for myself, I feel I could use a tune up in my allopathic diagnostic skills. Perhaps we all could, in one way or another. This is the point of CME. But having some kind of certification process within the homeopathic community, demonstrating a minimal level of competence in diagnostic skills, not just of the homeopathic variety, but of the allopathic variety as well would go a ways towards establishing this sort of confidence. I feel I need this kind of certification. I think it would help homeopathy in general if we all had it.

Friday, December 4, 2009

Club Med

There is a famous quip that most medical students have heard at some point prior to graduation, usually in response to their anxieties about surviving the rigors of medical education. It goes something like this: "What do they call the medical student who graduates last in the class? (Answer) Doctor!" I remember hearing this humoresque while a medical student myself and feeling something sinking in my stomach at the time. I suppose the intention had been to quell my worries, but instead I was left feeling that the system was rigged to shepherd through even the worst of us. Was this some kind of hubris on the part of the medical school admissions committee? Were they simply unwilling to admit that at least in some cases they had made a mistake? While we were on the one hand being trained to respect the gravity of the task before us, taking, as we were, others' lives into our own hands, on the other hand, there seemed to be a reluctance to acknowledge that action might be required to protect patients from those who did not meet certain safety standards. Where was the bottom line? Or wasn't there one?

Stanley Wolfe, a physician who writes for Public Citizen, and edits the newsletter "Best Pills, Worst Pills," which recently published a predictably poorly argued and researched piece critical of homeopathy, has latched onto the weakness in medical self-regulation. He regularly publishes in his newsletter, in truly absurdist over-reactionary style, a list of the disciplinary actions by the departments of health in each of the 50 states, rank ordering them so that the "best" states have the most disciplinary incidents of physicians. By his cockamamie logic, the states with the best medical climate have the most disciplinary actions. The more the better! His assumption appears to be that bad medical practice is more or less uniformly spread amongst the various states, and that those states that have more disciplinary incidents are necessarily more vigilant about keeping the profession clean of the bad eggs than those states that have fewer incidents. Of course, this is just an assumption. It is possible that some states have more errant physicians and that some health departments have overly punitive health commissioners or regulatory boards. But forget about this, Dr. Wolfe presumably would say.

Nonetheless, the difficulty that the medical profession has regulating itself has become an embarrassing showpiece for the media, usually rising to our attention when some egregious action by physicians of great sensational import fly onto the media's radar screen. What I first tasted in medical school, I now see, was the immense clubbiness of the medical profession. The reluctance to take regulatory action against its members was just one example of this clubbiness. It was also visible by the negative attitude that the medical profession had towards competing health care fields. Polite tolerance seemed to be the most that most of my mentors could muster up towards osteopaths, chiropracters, and even in some cases nurses or allied medical professionals. At times polite tolerance gave way to dismissiveness or even supercilious disdain. It was clear that they were not part of the club. Evidence, argumentation, and open discussion were not considered to be germane, since these outsider's approaches were so manifestly misguided, if not outright dangerous or harmful.

In a recent book on Lyme Disease, Cure Unknown, by Pamela Weintraub, this clubbiness is revealed in an even more sinister form. Physicians who have specialized in treating Lyme Disease over the past two decades have often faced vilification and even legal indictment by their colleagues for practicing in ways that were outside the accepted standards. Some of them were forced by medical authorities to stop treating patients diagnosed with Lyme Disease or close down their practices. Weintraub details how some of those physicians who led the attack against the so-called "Lyme doctors" often had conflict of interests, having fiduciary relationships with insurance companies, who had a stake in limiting treatment, or who had monstrous speaking fees because of their reputations as experts in Lyme Disease.

To me, this is a frightening scenario, where the medical profession goes to the darkest aspects of clubbiness: attacking those who would differ from the accepted standards, regardless of the merits of those standards. In the medical profession, the "standard of practice" is considered to be the basis of good practice, and is the legal guidepost by which malpractice is often determined to have occured or not. Like in organized religion, there is a certain orthodoxy in the medical establishment which does not admit to faults or dissent. Those who are seen as heterodox are guilty of a kind of heresy -- the heresy of non-adherence to the standards. Such heretics must be disciplined or expelled.

While this Inquisition-like attack is not a common occurence within the medical profession, it is frightening to one such as myself who has embraced a number of non-traditional treatments into my practice. While I have studied both homeopathy and Bowenwork in an effort to bring more to my patients than I have been able to with conventional treatment alone, this would appear to matter little to those who are on witch hunts. Nor would evidence that would suggest that these treatment modalities are safe and effective. That these treatments are not part of the club appears to be the more decisive factor. Getting into a club, as it turns out, is easier than getting out.