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The Law of Similars

If this phrase sounds familiar you are either a student or acquaintance of homeopathy or an aficionado of the book stores where Chris Bohjalian's latest novel of the same title occupies premier space. This author who was reviewed on these pages some years ago for his Midwives, returns to tackle the seemingly insoluble mixture of homeopathy, murder, mystery, and medical malpractice. I would have thought that such discordant themes would be difficult to put together in novel form and the romance aspect of the story is, indeed, terribly contrived. It’s very difficult to believe that a prosecuting attorney whose day-to-day affairs involving wife beaters and drunken drivers would suddenly take an interest in homeopathic diagnosis. For such an individual to then fall in love with his homeopathic physician by the end of his followup visit gives new meaning to homeopathic proving. Bohjalian likes to put together legal thrillers with a twist: his main characters are alternative medicine practitioners. It would be worth one's trouble to read Bohjalian just to experience the novelist's art embracing alternative medicine.

For the non-homeopaths which I would consider myself part of, the law of similars is perhaps the fundamental principle of homeopathy. Without this law all other bases of homeopathy would have no foundation. In a word, it states that the symptoms a normal individual will experience if exposed to a toxic quantity of a material or substance is the remedy in infinitesimal dose in a sick individual who has an exact matching of symptoms. For example, where bee venom causes itching, burning and swelling in healthy individuals, bee venom in a diluted, very diluted, form would be the cure for itching, burning and swelling in a sick individual who was not exposed to bee venom.

This definition of the law of similars is grossly lacking in detail and it is highly recommended that the interested reader refer to homeopathy texts for better illustration and understanding. Nevertheless, at the heart of the Bohjalian novel the law of similars is given quite a testing, and for a work of fiction, the author gives a not-too-bad recounting of the homeopathic proving, concerns about antidoting, and gross misuse of the proving. I will not spoil your surprise and share these plot titillations.

The legal concerns Bohjalian contrives are food for thought not only for the homeopath but for all practitioners of alternative/complementary/integrative medicine. The very biggest concern which has haunted us throughout our careers has been the misplaced impression that alternative medicine replaces drug therapy. I cannot even begin to count the number of disastrous situations which have led to wrongful deaths based on the misdirected confidence that some cure obviates the need for necessary medication. I am not sure if this is arrogance or stupidity but innumerable practitioners suggest, even advise their patients to quit their medications. Wrong, wrong, wrong! No matter how many stories appear in the press or in drug manuals about the side effects of medications, alternative practitioners have no business recommending the discontinuation of medications. Even if it appears that the medication is causing serious side effects, such advice should be made by the MD who ordered use of such prescriptions. And when the patient is asking, even imploring, the alternative practitioner to quit the medication, he or she should be reminded that cutting off of medicine may lead to instability of their medical condition and potential medical crisis, including death. In this case an adult male asthmatic wrongly quit his Prednisone, Albuterol inhaler, and theophylline prescriptions, thinking that the homeopathic cure would replace these meds. When the asthmatic found himself in a critically allergic situation, he did not have the preventive medication in his system, and he tragically and needlessly sustained anaphylactic shock. Bohjalian's book challenges the reader to decide whether the practitioner clearly advised quitting the medication or only did not disagree with the patient's plan to quit the medication. The distinction is subtle yet very important. Are we just as guilty when patients elect to quit medications and so advise us, but we have given them no advice to continue their medication? This is only a minor point until we face the death of one of our patients.

The homeopath in Bohjalian’s novel is a devotee of Dr. Samuel Hahnemann, author of the Organon of Medicine written in 1842. Bohjalian offers us some fascinating personal history of Hahnemann who apparently developed his theories of homeopathy as a Parisian. Hahnemann married one of his earlier patients who studied the doctor's work and became a recognized homeopath in her own right. At the time Hahnemann authored his work in the first half of the 19th Century homeopathy offered a scientific leap for medicine which primarily treated with mercury purgatives and other poisoning techniques. Antidoting such poisonings and proving similars in barks and metals and various chemicals made good sense for the early 1800's. One hundred and fifty years later homeopathy is having a renaissance in the US, the UK, Europe, India and South America. The classical homeopaths who follow Hahnemann disagree with a much more complex, eclectic homeopathy now employed by German and US physicians who inject and administer multiple potency biological and chemical homeopathic remedies.

Still, for all the disagreement homeopathy remains a science based on the infinitesimal, an impossibly diluted substance which remains without scientific proof for efficacy. Yet it works, again and again. How can this be? New CAM studies intend to explore the scientific basis of homeopathy. Until that time homeopathy remains a tool of alternative medicine which offers great promise, but it should be remembered that is all – great promise. One can make no assumption up front that homeopathy will cure or help. One can only work with homeopathy to see if there is benefit, short-term and long-term. If there is demonstrable benefit which can be documented by the examining MD physician, then and only then should the drug therapy be discontinued. If homeopathy requires the elimination of medication prior to its administration, there is too much risk for homeopathic diagnosis and treatment. Some have claimed that homeopathy is completely without risk, that an infinitesimal, diluted substance could impart no toxicity. Not only does Bohjalian's fiction harpoon such folly but it rightly focuses on the risks that all alternative practitioners take in advising quitting of the patient's prescription medications.

Jonathan Collin, MD

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