introduction to integrative homeopathy - bob leckridge

8/6/2019 Introduction to Integrative Homeopathy - Bob Leckridge

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Theres been a Glasgow Homeopathic Hospital for over a hundred years. It s continuously evolved over its lifetime, but has always offered arange of orthodox and other treatments to people of all ages. It has been part of the NHS since the Health Service began. In the old building at1000 Great Western Road there was a theatre and patients would be admitted to have their operations carried out by visiting surgeons andtheir pre and post operative care provided by homeopathically qualified staff doctors. At that time, there was a separate Homeopathic ChildrensHospital, and a very busy, no appointment, Primary Care service in another building.With the custom building of the current hospital (funded solely from donations left for the purpose from the 1930s onwards) in the grounds ofGartnavel Hospital, the old hospital was sold off, and, as part of a series of NHS reforms, the present service was incorporated into the

Regional Services Division, of Acute Medicine in NHS Greater Glasgow and Clyde.The title Centre for Integrative Care on the front of the building formally declares the continued evolution of a service which is based on anintention to create greater health through aiding the re-integration of what a patient has experienced as chaotic or disintegrated using a widerange of non-pharmaceutical and non-surgical methods.The hospital is an L-shaped building with all patient areas opening directly into a garden. There is extensive use of natural materials to create alight and comforting building deliberately designed, after extensive research, as a healing place.


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Health and healing

Holism

Individualised care

integrative care

Lets explore three concepts at the heart of integrative care - health and healing, holism and individualised care. Integrative care is based onthese three concepts. The intention is to stimulate and support healing, to enable patients to experience better health, by approaching them aswhole people, not dividing them into parts, and by expecting that every individual will need their unique package of care. There is no one sizefits all.


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How do we get better?How do we heal?

How do we get better?How do we heal?If you take Davidsons Textbook of Clinical Medicine and look in the index for health, you wont find any entries. In Medicine we are trained tounderstand disease and pathogenesis. Why arent we trained to understand health and salutogenesis (Antonovskys term for the process ofhealing)


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Objective

Subjective

We tend to consult a doctor when something changes. This diagram has two axes - from left to right we can chart objective change, and frombottom to top, subjective change. Lets consider each quadrant in turn, starting with the bottom right.In this quadrant, represented by the black star, we see a situation where there has been significant physical change, but no, or little subjectivechange. Think of a woman going for a routine cervical smear. The cells may show cancerous change, but she may not have experienced anysymptoms whatsoever. What about hypertension? Most people with high blood pressure, have no symptoms to alert them to that fact. Thisquadrant represents our ability to use technology to detect pathological change, before the person develops any symptoms or signs.In the top right quadrant, represented by the red star, we see a situation where there has been both significant objective and subjective change.

Think of an abscess for example. There is something to see - a hot, red, swollen mass. And there are subjective inner experiences - pain,nausea, irritability perhaps.Doctors are most comfortable dealing with the right hand side of this chart. The objective side. But what about the upper half? In particular,what about the top left quadrant, represented by the green star? This is a situation where there are no objective changes - the tests all comeback normal and where there are no lesions to see. Yet the patient may be experiencing overwhelming pain, fatigue, nausea, dizziness orwhatever. Post-herpetic neuralgia would be an example of this. The lesions have long since gone, but the pain remains the same.


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Objective

Subjective

So what about the final quadrant? The one in pink? What is that?When I first drew this diagram I thought the pink quadrant must be health. But, immediately, that did not feel a satisfying answer. Surely healthmust be more than just the absence of the bad stuff? Surely health could be described without reference to disease or illness? Surely it couldbe described in its own right?How would you describe health, without any reference to disease,


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What is health?

Integrative flow - Flexible, Adaptive, Coherent,Energised, Stable

Vitality + Resilience

Adaptation, Creativity, Engagement

Human beings are dynamic, energetic complexes of interconnected cells and systems. One concept of health might be when there is anintegrative flow present in the whole organism. An integrative flow can be considered to have certain characteristics - it is flexible, adaptive,coherent, energised and stable. Think of a river as a metaphor for this idea.Another way to consider health is from the positive qualities of vitality and resilience. Vitality isnt a word we use a lot these days, but it capturesthat sense of being alive and energised. Healthy living creatures dont stay they same, and they dont resist the changes in their environments.Rather, they have resilience - the capacity to self-defend, to adapt and to cope with changes, along with the ability to recover when damagedor injured.

A third way to consider health is from the three attributes of adaptation, creativity and engagement. All healthy beings adapt. They respond tochanges both within and outwith themselves in ways which maintain their coherence and their integrity. However, living forms dont maintain astatus quo. They continuously grow, develop and evolve. In other words they demonstrate creativity. Finally, no living creatures exist inisolation. They are engaged. Engaged in responding to, and communicating with, the environments in which they exist, and engaged withothers in complex social networks


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Flow

Chaos

Rigidity

The river of flowIf we take the idea of a healthy state being one of flow, like the flow of a river, then we can consider that illness tends to emerge in one of twopatterns, represented by the banks of the river.On one bank is chaos. This is where the person experiences dis-integration, where things fall apart. The way to heal this state is to re-integratewhat has become dis-integrated.The other bank is rigidity, where the person experiences a stuckness. The way to heal this state is to unstick them, to stimulate and encourageflow and movement.


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Complex AdaptiveSystems

Adaptive elements

Simple rules

Non-linearity

Emergent behaviour, novelty

Not predictable in detail

Inherent order, self-organisation

Context and embeddedness

Complex Adaptive SystemsA biological model of living creatures has been described using the term complex adaptive systems. When approaching a consideration of lifeforms from this perspective we can see certain important characteristics.Probably the most significant of these is that of self-organisation. It is this characteristic which lies behind healing. When we considered thecase of the woman with cystitis, it is her whole beings capacity to self-organise which is the source of her return to health.Two other characteristics are worth pointing out - all complex systems are made up of huge numbers of inter-related components - cells,molecules, communication channels etc. These elements are all connected, but in non-linear ways. In other words, a does not always lead to

b. The connections are more complicated than that. The other characteristic is one of emergence. This is a fairly new term in biology and itcaptures the manifestation of new behaviours or new characteristics in a life form. Between them, non-linearity and emergence show theuniqueness of every single creature, and make it impossible to predict in detail any outcomes of either diseases, or treatments.


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The Anatomy Lesson of Dr Tulp, by RembrandtThis painting, from 1632, depicts the moment when our understanding of health and disease changed from a holistic, embedded one, to aphysical, reductionist alternative. Once dissection of cadavers became routine, disease became a thing, a lesion, something which could beheld in one hand, weighed and measured. Prior to this, illness was conceived of as a imbalance of humours, or fluids within the body, and thisimbalance was often thought to be the result of misalignment between the individual and their community, society or their gods.But is illness a thing? Can we say that pathology = disease?


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As doctors we are interested in patients reports of their symptoms. We have been taught to consider that symptoms are signposts topathology. However, it turns out that this is not quite the case.Kroenke has spent a lifetime researching symptoms. His various studies show that symptoms are extremely common, that in many cases theyare not related to the presence of a pathology, and that they should not, therefore be considered as simplistic signposts to disease.The ten commonest symptoms in patients presenting to doctors are, chest pain, fatigue, dizziness, headache, swelling, back pain, dyspnoea,insomnia, abdominal pain, and numbness.In all of these, in Kroenkes studies, the majority were not related to the presence of a medically explained disease when the patients were

followed up in a three year study.


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Number of

symptoms

Time

Individuality increases with chronicity

Uniqueness.On this chart, the vertical axis represents the number of symptoms, and the horizontal, the passing of time.On the left we see an example of acute disease. Consider, status asthmaticus. Imagine 100 children presenting to hospital in their first episodeof status asthmaticus. The blue circle represents the set of symptoms they present in common and the slightly larger yellow circle representsthe unique symptoms they present. The blue circle represents the symptom set pathognomic of asthma. Pretty much all the children presentthe same symptoms.Now follow up these 100 children for 10 years and lets see them in a paediatric clinic. This is the circle to the right hand side of the chart. Here,

there is still a subset of common symptoms which we would attribute to asthma, but now the stories are very different, as represented by themuch larger yellow circle. Now some of the children only cough or wheeze in the summer, others only in the winter. Some only with exertion,some only when eating certain foods. The factors which provoke or alleviate symptoms are also very diverse.As time passes, as a condition becomes chronic, the individual adapts, and copes with it in their own, unique way. This produces a high degreeof individualisation in chronic patients and this is what increases the need for individualised treatments.


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The FieldAntony Gormley is an English sculptor. One of his creations is The Field. When you see it in a gallery, you peer into a room filled withterracotta creatures. At first, you think, look at all these hundreds of l ittle creatures all the same, then, as you start to look more carefully, yourealise that no two are the same. This is because Gormley had each one made by a different person.This image comes back to me every day. This is the essence of the issue we face in daily clinical practice. With this patient before me, what isit that they have in common with others? In other words, what diagnosis can I make? But, to take this further, what is it that this person has tosay which is unique? What makes them different from all the other people I ve seen with this diagnosis?


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What is homeopathy?

Like cures like

Minimum effective dose

There are two fundamental principles on which the practice of homeopathy is based.The first is Like cures like.Homeopathy was discovered by a German doctor, named Hahnemann. He lived in the late 18th through to the early 19th centuries and shortlyafter qualifying he became shocked by the harms caused by treatments used at that time. So much so that he stopped practising as a doctor,and to support his family, began to translate texts into German. He was translating Cullens Pharmacopoea when he read that Peruvian TreeBark was a good treatment for Swamp fever because it acted as an astringent - it dried the body up. Hahnemann wondered if this was trueso decided to take some of the medicine and observe its effects on himself. He discovered that not only did it not dry his body up, but that he

got all the symptoms of someone who had swamp fever. That was his discovery of like cures like. As he thought of it at the time, a medicinewhich has the potential to cure, can induce a like disease when given to a healthy subject. (We now know that swamp fever is malaria, andthat Peruvian Tree Bark contains quinine).He went on to study other medicines used at the time and found a number of other instances of like cures like.He then decided to try to find the least amount of medicine which could bring about a healing result, with the least amount of harm.So far, this is pretty uncontroversial. Here s where the controversy begins. He made two observations which dont make sense in modern,biomolecular terms. First, he said, the more dilute the medicine, the greater the clinical effect, and, second, he prepared his dilutions to wellbeyond Avogadros number, thereby removing most, if not all, of the starting molecules. Surely, this means, his medicines are nothing otherthan water, and that their effects must simply be placebo effects?


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Shang meta-analysis

The Shang meta-analysisThere have been a number of meta-analyses of the around 200 randomised controlled trials of homeopathic medicines versus placebo. Theone most often cited by critics of homeopathy is the Shang one(Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Shang A, Huwiler-

Mntener K, Nartey L, Jni P, Drig S, Sterne JA, Pewsner D, Egger M.)

This study was a little different. It compared 110 homeopathic trials to 110 matched orthodox ones. This graph is taken from that paper. Its ascatter graph of the odds ratios of each trial. In one graph we see 110 homeopathic trials, where each dot is a trial. Any trial to the left of the

vertical line means an outcome where the treatment effect was greater than the placebo effect. The further left the dot, the greater thesignificance statistically. The other graph shows the 110 orthodox trials.

If it is true that there is no evidence that homeopathy is more effective than placebo (unlike the case for orthodox drugs) then it should beobvious to you which one of these graphs represents the homeopathic trials and which represents the orthodox ones. It isnt obvious, is it? So,we cannot dismiss homeopathic medicines as just placebo on the basis of the published evidence.

(the lower graph is the orthodox trials)

introduction to integrative homeopathy - bob leckridge

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