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bwv11 · #**105** (**permalink**) 17th May 2002, 02:11 AM

Hi Tom, thanks for your question. I was preparing to answer Snoopy's point about keeping treatment simple, so that's the piece that I'm posting right now, but I'll be back to post another response to you shortly.

Hi Snoopy

I looked over the RDS thread about headaches and I understand your point, I think. The complications to which you refer to are very common in my practice as well, but they don’t necessarily deter me from complicating my treatment by introducing more than one intervention at a time; they might, but not necessarily.

For one thing, when you are familiar with the various interventions, you are often able to know, almost intuitively, which factor is acting. Patients who respond well to Paxil (is that an oxymoron?) have a characteristic demeanor, posture, affect. Patients who respond well to elimination of dairy, especially if their improvement is very rapid and very dramatic, show characteristic behavioral changes, and even physical/physiological changes, such as relaxed posture, reduction in the ruddiness of their complexion, production of sinus symptoms, etc. And so on.

Often enough, though, you are right, its not possible to know for sure what’s going on, and that certainly obscures the clinical decision-making tree. But my objection to the single course of treatment idea remains, in many cases at least, and can be summarized thusly: if you ‘cure’ without removing obvious pathogens, including dairy, mercury, pesticides, etc., and your patient feels good, then you have provided a false sense of security, and placed the future at risk. If anything, removal of toxins should come first, and ‘treatment’ later. But who wants to wait? If parenting skills training can help, and diet changes can help, why not do them both and put up with the confusion? With homeopathy, the impact may be somewhat different, but I would not want to see a homeopath who told me to hold off removing my mercury fillings so he could get a clear symptom picture. Rather, I would want him to view the changes wrought with the extraction of the amalgam, as comprising a new symptom picture requiring the case to be re-taken.

The single-intervention model is most defensible, I think, in uncomplicated cases in which the elements of treatment seem fairly clear. In complicated, chronic, intractable, or severe cases, the layering of pathology and the complexity and variety of etiological factors often, to my thinking, actually demand a complex response; admittedly, though, even these cases may at times respond well to a single intervention. And in between the uncomplicated and the complicated case, all manner of variations. In all of them, clinical judgment must step in to decide the question, on the merits of the individual case, and the skill and confidence of the practitioner. I think we haven’t the time, and certainly not the opportunity, to implement the other features of the scientific method—we may be able to control variables by the single remedy, but we cannot replicate the “experiment,” since “it” needs to get on with his life.

I have been aware of homeopathy for some time, but have been investigating it intensively for only about a year. So I speak from a solid position of considerable ignorance. And yet, clinical judgment tends to be clinical judgment, and the issues in one branch of practice at least similar to the issues in another branch. My question then, back to you, I guess, is, “How do we differentiate innovation from the violation of basic principles?” I incline to the conservative side in practice: that is, honestly, I am loathe to ignore the principles you are advocating. And yet I know that innovations can be useful. Seriously, I hold on tightly to such principles, and resist the impulse to try something new, yet constantly try new things because the old are inadequate or incomplete. It’s a tense struggle, and a complicated one. I have pretty strong convictions, but many, many questions as well. On the road to knowledge, I think, a journey of a thousand miles turns out to be longer than expected.