But by far the most difficult and important questions are the inextricably connected theoretical one of what to measure and the technical one of how to measure it. As homeopathic clinicians, we already have a reasonably good sense of how to ascertain a working totality of symptoms tailored to our individual patients and how to follow them over time.
In studying large populations, we will eventually need to select a few key variables sufficiently broad and inclusive to reflect the most fundamental aspects of human functioning, yet also flexible enough to accommodate the infinite richness and diversity of real people. Which ones we choose will then further determine and be determined by the techniques with the requisite detail and precision for measuring them.
Probably this means that we won't really know what we need to measure until we've followed a much smaller pilot group more extensively for a shorter period of time, perhaps four or five years, and just see what happens. In any case, the homeopathic agenda -- the total health picture over time -- remains the best available methodology for such an investigation; and any progress we can make toward it will automatically contribute to research design in biomedicine generally.
How, then, is one to investigate the total health picture of large populations over time? Clearly, we need to look at the elements of the standard medical history, and to follow the incidence and severity of the usual acute and chronic diseases. Regular physical and laboratory examinations might also suggest persistent or subclinical changes of a more "constitutional" or chronic type, such as swollen nodes for rubella, abnormal white cell and differential counts for pertussis, and nonspecific developmental criteria (height and weight, dentition, gross and fine motor co-ordination, vision, hearing, etc.) for all the vaccines.
Other important variables lying outside the medical history per se se would include intelligence, language, socialization in family and school settings, and other demographic, socioeconomic, and psychological factors (poverty, race, learning disabilities, behavior and emotional problems, school attendance and performance).
On the other hand, pilot studies of the pneumococcus and influenza vaccines might need only a few simple variables, because they are given primarily to elderly people at high risk or in nursing homes, when their chronic disease structure is already more or less firmly established. Under these circumstances, a reasonable first approximation of how these vaccines act might be simply to measure their effect on the life span, the sheer ability to survive, compared to that of their unvaccinated friends and neighbors.
Finally, I want to explain why, in spite of the very considerable dangers I have been talking about (and innumerable others we all could mention), I remain strangely optimistic about the future of the healing arts. The principal reason has to do with the growing awareness of ordinary people taking more responsibility for their own health and more control over their transactions with the medical system as a whole.
In the United States, the movement for free choice in health care now includes not only such groups as DPT, but also the supporters of midwifery, home birth, homeopathy and other forms of alternative or "complementary" medicine, and even of the right to die. Within the last 20 years, all of these groups have already achieved major changes in the conventional doctor-patient relationship. Now that the American economy is manifestly unable to afford the present health care system, no matter how it is organized, it is virtually certain that these changes will continue to accelerate, and that organized medicine will face further repudiation until it accepts them.
In the meantime, lest you suppose that I am opposed to religious concepts in medicine entirely, I will cite three aphorisms of Paracelaus, which offer a practical and ecumenical theology of healing that virtually all of us of whatever discipline can accept and live by, without having to ram them down anybody's throat:
The art of healing comes from Nature, not the physician... Every illness has its own remedy within itself... A man could not be born alive and healthy were there not already a physician hidden in him (26).
Taken together, these sayings amount to a summary virtually everything that the present medical system has left out:
1. Healing Implies Wholeness
Etymologically, the verb "to heal" comes from the same Anglo Saxon root as "whole." "Healing" means simply to make whole again, is a basic attribute of all living systems, and is evident in spontaneous recovery from illness and in effective medical and surgical treatment as well. Because it represents a concerted response of the entire organism, it implies a totality, a purely qualitative integration on a deeper level than can be defined by any assemblage of parts or approximated by any quantitative measurement.
2. All Healing Is Self-Healing.
As a fundamental property of all living systems, healing is going on all the time, and thus tends to complete itself spontaneously, with or without external assistance. This means that all healing is ultimately self-healing, and that the role of physicians and other professional or designated "healers" essentially to assist and enhance the natural process that is already under way. The mechanical correction of abnormalities might be perfectly legitimate in some instances, but primarily in relation to the more fundamental standard.
3. Healing Applies only to Individuals.
Always possible but also problematic, even risky, healing applies only to individuals in unique here-and-now situations, rather than to abstract "diseases," principles, or categories. In other words, it is inescapably an art, and can never be (and should never be) reduced to a technique or procedure, however scientific its foundation.
I should like to add a fourth principle governing the doctor patient relationship, which is not exactly theological, but may is have to be affirmed as a fundamental political and legal right, as in Magna Carta or the American Bill of Rights:
Health, illness, birth, and death are inalienable life experiences belonging wholly to the people undergoing them. Nobody else has the right to manipulate or control them, or any part of the body involved in them, without their explicit request or that of somebody authorized by them to act on their behalf.
My concluding principle was contributed by Lao Tzu, and supplies an appropriate "bottom-line" criterion:
A leader is best when people barely know he exists,
Not so good when people obey and acclaim him,
Worst when they despise him.
Of a good leader, when his work is done and his aim fulfilled,
The people will say, "We did this ourselves." (27)
*Lecture presented at the annual conference of the Society of Homeopaths, Manchester, UK, September 1991. Published in The Homoeopath 12: 137-144, March 1992.
1. Tyler, A., "Vaccination: the Hidden Facts," London Evening Standard Magazine, Sept. 1991, p. 74.
2. Mendelsohn, R., Confessions of a Medical Heretic, Contemporary Books, Chicago, 1979, pp. xiv et seq.
. Bernard, C., An Introduction to the Study of Experimental Medicine, H. Greene trans., Dover, New York, 1957, pp. 6567, passim.
4. Cherry, J., "The New Epidemiology of Measles and Rubella," Hospital Practice, July 1980, p. 49, and Markowitz, L., et al., "P terns of Transmission in Measles Outbreaks in the U. S.," New England Journal of Medicine 320: 77, Jan. 12, 1989.
5. Nkowane, B., et al., American Journal of Public Health 77: 434-38, 1987.
6. Gustafson, T., et al., "Measles Outbreak in a Fully Immunized Secondary-School Population," New Enuland Journal of Medicine 316: 771-74, March 26, 1987.
7. Chen, R., et al., American Journal of EoidemioloqY 129:17382, 1989.
8. Medical Tribune, Aug. 26, 1987, p. 2.
9. Markowitz, et al., op.
10. Cherry, op. cit. 1980, p. 52. cit. 1989, pp. 75-81.
11. Edmondson, M., et al., "Mild Measles and Secondary Vaccine
Failure During a Sustained Outbreak in a Highly Vaccinated Population," Journal of the AMA 263: 2467-71, May 9, 1990.
12. "Measles: Los Angeles County, 1988," MMWR Report, Journal of the AMA 261: 1111f., Feb. 24, 1989.
13. Family Practice News, April 1,
1990, p. 3.
14. LSC ll9 0911-l, Sub. H. B. 168, Ohio General Assembly, 19911992.
15. Boston Globe, June 11, 1991, p. lf.
16. Medical World News, April 14, 1986, p. 53.
17. Simberkoff, M., et al., "Efficacy of Pneumococcal Vaccine in High-Risk Patients," New Enqland Journal of Medicine 313: 1318-27, Nov. 20, 1986.
18. "Medical News and Perspectives," Journal of the AMA 262: 2055, Oct. 20, 1989.
19. Vaccine Adverse Event Reporting System (VAERS), Public Health Service, 1986.
20. "Reportable Events Following Vaccination," VAERS op. cit., Table 1.
21. Griffin, R., et al., "Risk of Seizures and Encephalopathy after Immunization with the DTP Vaccine," Journal of the AMA 263: 1641-45, March 23, 1990.
22. Cherry, J., "Pertussis Vaccine Encephalopathy: It's Time to Recognize It as the Myth that It Is," Editorial, Journal of the AMA 263: 1679-80, March 23, 1990.
23. "Pertussis Surv [lance: U. S., 1986-1988," MMWR Report, Journal of the AMA 263: 1058-69, Feb. 23, 1990.
24. FamilY Practice News, Nov. 15, 1990, p. 6.
Family Practice News, Dec. 15, 1990, p.
26. P. A. T. B. von Hohenheim, Selected Writinqs of Paracelsus, J. Jacobi ea., N. Guterman trans., Bollingen Series XXVIII, Pantheon, New York, 1958, pp. 50, 76.
27. Lao Tzu, The WaY of Life, W. Bynner trans., Perigee Books, New York, 1972, p. 46.