Disease: A General Medical Practice

¶ … Disease: A General Medical Practice and Homeopathic Medicine Perspective

General Medicine Concepts of Disease

Homeopathic Medicine Concepts of Disease

The Concept of Disease: A General Medical Practice and Homeopathic Medicine Perspective

We shall find that, even when there is no clear differentiation of the leech from other members of society, mankind has theories of the causation of disease, carries out proceedings which correspond with those we call diagnosis and prognosis, and finally has modes of treatment which, even if they have little in common with our own remedies, nevertheless may be regarded as making up a definite system of therapeutics. - G. Elliot Smith, 1915

Most people today are familiar with dozens of conditions that are certain are diseases, such as influenza, chicken pox, and cancer. Likewise, healthcare practitioners learn concepts for thousands of additional diseases such as Alzheimer's to yellow fever that may not share much in common except from a conceptual perspective. According to Van Loocke (1999), "Examination of historical and contemporary writings on disease suggests that disease concepts can best be viewed as causal networks that represent relations among the symptoms, causes, and treatment of a disease. Conceptual change concerning disease is primarily driven by changes in causal theories about diseases" (p. 215). Such causal theories about diseases have been the focus of an increasing amount of research over the last 500 years, with numerous explanations arising to help account for that which was otherwise mysterious yet life-threatening. Not surprisingly, researchers have determined that the concept of disease relates in large part to cultural factors as well as individual concepts that are both heavily influenced by the type of healthcare they receive.

According to one authority, "The dynamic process by which patients accept, reject, and adapt information provided by health care providers is exemplified in a study of middle-class women of Detroit, all of whom are diagnosed as hypoglycemic, the women incorporate the physician-provided diagnosis, adapt it to their preconceived concepts of disease, and utilize it to meet the needs and exigencies of their already established lifestyles" (Johnson & Sargent, 1996 p. 124). When these disease concept preconceptions differed, though, patients typically did not respond as well to treatment (Johnson & Sargent, 1996). Likewise, as Rosenbrock and Wright (2000) report, "Recent studies of how people perceive cancer emphasize the importance of lay concepts of disease etiology and the persistence of these concepts to this day in spite of scientifically-based explanations" (p. 94). Taken together, these issues suggest that there is more at work in diagnosing and treating diseases many observers might believe, which leads to the problem under consideration herein which is discussed further below.

Statement of the Problem

Just as humans have searched the heavens to help formulate a unified theory of how the universe operates, healthcare practitioners have been searching for a viable concept of disease to help them better understand what is taking place in the human body and how best to treat these disease processes. To date, though, a functional theory of health and disease has proved elusive for healthcare practitioners and policymakers alike (Brown, 2001); however, only if a purely factual account can be given of the concept of disease will scientific methodology be able to consistently identify and effectively treat diseases (Reznek, 1991).

Purpose of Study

The purpose of this study was to provide the relevant background and comparison of general medicine and homeopathic concepts of disease and how their similarities and differences affect the choice of treatment modalities and their effect on the patients involved.

Importance of Study

According to Carlston and Micozzi (2003), "Regardless of a physician's own interest in homeopathy, some of his or her patients are very likely to be using it. At a minimum, physicians must learn about the uses and misuses of homeopathic medicine for their patients' safety" (p. 1). Furthermore, many of these patients are simply unwilling to speak to their conventional physicians about their use of alternative therapies. In this regard, "Self-treatment predominates the homeopathic landscape and its repercussions must highlight any consideration of homeopathy by American health care providers" (Carlston & Micozzi, 2003 p. 2). Today, approximately 6 to 8 million Americans use homeopathic medicines every year without the knowledge of their conventional physician or the supervision of a professional homeopath. "Their conventional physicians therefore do not know whether the effects, beneficial or adverse, their patients are experiencing are from the covert use of homeopathy or from conventional treatment" (Carlston & Micozzi, 2003 p. 2).

Approximately 600,000 American adults were treated by homeopathic practitioners in 1990, and another 1.2 million used homeopathy for self-care; during the past decade, statistics suggest that sales of homeopathic medicine have been rising at an annual rate of approximately 20% (Carlston & Micozzi, 2003). It may well be that this attraction to homeopathy relates to its concept and treatment of disease, considered relatively benign in sharp contrast to many of the methods used by general medicine practitioners - then and now. In this regard, Easthope, Adams and Tovey (2003) report that, "Homeopathy presents a major challenge to scientific thinking because it claims efficacy for remedies that can not be assayed. However, the massive dilution that is a central feature of homeopathic remedies means that many lay people are convinced they are safe. Furthermore, the fundamental premise of homeopathy -- that like is used to treat like -- resonates with lay notions of illness and cure" (p. 16).

Rationale of Study

By putting our focus on homeopaths, we can begin to see modern medicine as having a plurality of perspectives and being a place where the boundary between alternative and orthodox becomes much more difficult to establish" (Johnston, 2004 p. 12).

Methodology

According to Gratton and Jones (2003), a critical reviewing of the timely literature is an essential task in all research. "No matter how original you think the research question may be, it is almost certain that your work will be building on the work of others. It is here that the review of such existing work is important" (p. 51). These authors note that effective literature reviews provide the background to the research to demonstrate a clear understanding of the relevant theories and concepts, the results of past research into the area, the types of methodologies and research designs employed in such research, and areas where the literature remains deficient. To this end, Wood and Ellis (2003) identified the following as important outcomes of a well conducted literature review:

It helps describe a topic of interest and refine either research questions or directions in which to look;

It clarifies the relationship to previous research and highlights where new research may contribute by identifying research possibilities which have been overlooked so far in the literature;

It presents a clear description and evaluation of the theories and concepts that have informed research into the topic of interest;

It demonstrates powers of critical analysis by, for instance, exposing taken for granted assumptions underpinning previous research and identifying the possibilities of replacing them with alternative assumptions;

It provides insights into the topic of interest that are both methodological and substantive;

It justifies any new research through a coherent critique of what has gone before and demonstrates why new research is both timely and important.

Likewise, Silverman (2005, p. 300) suggests that a literature review should aim to answer the following questions:

What do we know about the topic?

What do we have to say critically about what is already known?

Has anyone else ever done anything exactly the same?

Has anyone else done anything that is related?

Where does your work fit in with what has gone before?

Why is your research worth doing in the light of what has already been done?

Based on the foregoing guidance, the following literature review was compiled and reviewed as it pertains to the respective general medicine and homeopathic medicine views concerning the concept of disease.

Chapter 2

Background and Overview

In their book, Partnership and Pragmatism, Rosenbrock and Wright (2001) report that, "Medicine constitutes a collectively accepted body of knowledge which serves as a basis for our behaviour regarding diseases. We could hypothesize that in modern society the so-called everyday theories regarding sickness and health have become less important, given the influential role of medicine. This is, however, not the case" (p. 93). Although the modern medical terminology used to describe diseases and their etiologies have not exactly been entirely adopted into common, everyday ways of thinking by most people outside the medical field, but the manner in which people think about disease and how it affects them personally is an integral part of the concept. According to Rosenbrock and Wright (2001), "This is the case because scientific theories regard diseases and bodily processes isolated from their subjects; the personal meanings which connect the subjective experiences of life and disease are not seen as legitimate areas for medical inquiry. However, the body is not only an object of medical research, it is also the centre of self-interpretation and social orientation" (p. 94).

The modern legal definition of disease provides a useful starting point for an examination of the concept of disease and how it is regarded by various disciplines. According to Black's Law Dictionary (1990), disease is a "deviation from the healthy or normal condition of any of the functions or tissues of the body. An alternation in the state of the body or some of its organs, interrupting or disturbing the performance of the vital functions, and causing or threatening pain and weakness" (p. 467). To ensure that the concept is readily understood by legal practitioners, the editors add that disease is also called "illness, sickness, disorder, malady, bodily infirmity," and disease is, "An illness or an abnormal state having a definite pattern of symptoms" (Black's, 1990, p. 467). This comprehensive definition would also likely satisfy most lay observers today, but over time, the concept of disease has experienced some profound changes in the past two thousand years. The manner in which healthcare practitioners in ancient Greece diagnosed and treated disease influenced colonial America and this influence lingered well into the early nineteenth century wherein healthcare practitioners continued to rely on ancient methods to diagnose and treat their patients.

The basis for these changes was the concept of disease formulated by Hippocrates and Galen, based on a miasmatic concept of disease that involved an epidemic constitution of the atmosphere, corrupted by climatic, seasonal and astronomical influences (Baldwin, 1999). In his book, Pain and Profits, Mctavish (2004) reports that, "Most doctors in the nineteenth century were mainstream (that is, regular or orthodox) physicians who shared certain notions about health, disease, and treatment that stretched back to Galen and Hippocrates. They especially prided themselves on being 'scientific,' labeling all others as empirics -- or worse" (p. 16). According to Haller (1994), during this period in Western history, general medicine practitioners "reduced their medicine to a system based on first principles, from which all other propositions logically arose through deductive reasoning. Galen's system, for example, rested on the concepts of form and matter derived from Aristotle's metaphysics -- a deductive system similar in its logical rigor to geometry" (p. 17).

The concept of disease had not differed at this point in time in any substantive way from Galenic and medieval theory and regarded illness as being an anomaly in the "state" of the individual's constitution, with therapeutic measures directed at restoring balance through a variety of intrusive and potentially harmful regimens (Haller, 1994). At this time, the concept of disease was far more nebulous than today's more comprehensive definitions, and clinicians were stuck for explanations concerning what caused diseases and how best to treat them: "Instead of recognizing distinct diseases, doctors employed such catchall words as flux, fever, and dropsy to describe these perturbations" (Haller, 1994 p. 17).

While taxonomists had started the work that would serve to identify diseases by their symptoms and to differentiate particular, specific diseases, the underlying condition of disease continued to be viewed as a morbid state of the body's so-called "humors" that required "some form of bleeding, purging, sweating, or other restorative regimen" (Haller, 1994 p. 17). In this regard, Wells (1970) reports that, "The dominant doctrine of health and disease throughout the Middle Ages was the Humoral Theory, or Doctrine of the Four Elements. Its first complete enunciation, apparently, was by Pythagoras and through Aristotle, it exerted an immense influence on later thought" (p. 647). The work conducted by William Harvey, William Cowper, Thomas Willis, Felix Platter, James Yonge, and Thomas Sydenham represented the prevailing medical philosophy concerning the concept of disease at the end of the 17th century (Haller, 1994).

Thereafter, disease concepts were alternatively presented as causal networks that represent the relations among the symptoms, causes, and treatment of a disease and as the result of unseen pathogens; indeed, the shift to the germ theory of disease produced dramatic conceptual changes as the result of a radically new view of disease causation. For example, one authority notes that, "An analogy between disease and fermentation was important for two of the main developers of the germ theory of disease, Pasteur and Lister. Attention to the development of germ concepts shows the need for a referential account of conceptual change, to complement a representational account" (Van Loocke, 1999 p. 215).

Around the turn of the 20th century, Western views of the essential elements of medicine began to regard disease as.".. A phenomenon subject to natural laws, to be treated as we treat any other department of nature. The distinction between the attitude of the modern practitioner of medicine and the magico-religious attitude depends on the difference in the concept of disease in the two cases" (Smith, 1915, p. 4). During the 1950s, a configurationist approach began to place concepts of disease within the cultural contexts in which they occurred. According to Johnson and Sargent (1996), at this time, what counted were.".. not the forms but the place medicine occupies in the life of a tribe or people, the spirit which pervades its practice, the way in which it merges with other traits from different fields of experience. This was a harbinger of a radical shift from a historical approach to research on health phenomena to an ahistorical, empirical orientation. The emerging functionalism viewed society as comprising interrelated parts, concepts of disease and its causes, and the characteristic of healers being interdependent" (p. 114).

By the 1980s, disease was assumed by most mainstream healthcare practitioners to belong to the biomedical model and diseases were classified by only one set of (presumed) universally valid that were separated into such culture-independent categories (Keck, 1993). For example, according to Keck (1993), "In the 1980's the concept of disease is linked to the professional sector and its practitioners, who in the Western world belong to the biomedicine. The term illness, on the other hand, refers to the culturally defined perceptions and experiences of the patient and his/her social group" (p. 294). The mid-20th century was not exactly the precise demarcation point for this shift in concepts of disease by general medicine practitioners though. In fact, the need to take into account cultural contexts in formulating concepts of disease was made early on by Smith (1915), who emphasized, "It is evident that when we speak of the concept of disease held by such a people as the Melanesians we mean no exactly formulated definition, but a more or less vague system of ideas, which, though not distinctly formulated by a people, yet directs their behavior-their reactions towards those features of the environment which we have classified together under the category of disease" (p. 6). As Keck also emphasizes, "Judgments of suffering, being ill or well in an ethnic group are culturally defined, as they are closely connected to the view members of each culture take of life -- i.e. The way people perceive and structure their environment -- and to the characteristics of their social and religious system as well as their social values. There is also a connection to the concept of the person, including the dimensions of definition of the self" (p. 295).

The importance of these cultural aspects of the concept of disease has been borne out by a number of studies, including Frye (1991), who found that Cambodians immigrants are not assertive in seeking healthcare in since their arrival in America. "This lack of assertiveness has been attributed to high levels of depression, lack of English language abilities, and a cultural bias toward avoidance of confrontive situations," the authors note, and add, "Further, there is widespread misunderstanding among American health-care providers of Cambodian concepts of disease causation and traditional health modalities" (p. 36). These findings suggest that even the most advanced tertiary healthcare facility, replete with sophisticated (and expensive) diagnostic equipment and the best-trained general medicine practitioners may be missing something when it comes to the concept of disease in a multicultural society, and these issues are discussed further in Chapter 3 below.

Chapter 3

General Medicine Concepts of Disease

Christopher Boorse criticizes the idea that health and disease are evaluative concepts. In his view, this relativizing of the concepts leads to absurd consequences. Assume, for instance, that one defines disease in terms of unwanted things which are candidates for medical treatment (Boorse, 1977). He claims that many recognized diseases are not really treatable. On the other hand, practices such as circumcision, termination of pregnancy or plastic surgery are not good reasons for considering the possession of foreskin, being pregnant or having ears that stick out to be diseases. Another possibility is that one invokes pain or suffering as a criterion for calling something a disease; however, Boorse emphasizes as well that medical textbooks frequently describe instances where the absence of subjective discomfort is accompanied by serious internal injury; by contrast, some people tend to experience severe pain and discomfort during entirely normal processes such as menstruation, teething and childbirth. In this regard, Boorse's theory attempts to show that health and disease are neutral concepts: "Disease and health can be objectively established and exhaustively characterized with the help of empirical science" (Drees, 2003 p. 180).

In the same fashion, Reznek (1991) argues that, from the conceptual perspective, if something has a disease, then it must be a bodily part because the metaphysical premise is that the mind is not actually a "bodily" part at all and therefore the mind cannot be "diseased." For example, this author reports that, "The conceptual premise assumes that it is part of the meaning of the term 'disease' that only bodily conditions can be diseases," and adds that, "But no argument is provided for this assumption. In fact, on either of the two most plausible accounts of the concept of disease, not only bodily things can be diseased" (Reznek, 1991 p. 72). In his essay, "Mental Disorders Are Not Diseases," Szasz (2000) chimes in that, "The core medical concept of disease is a bodily abnormality. Literally, the term 'disease' denotes a demonstrable lesion of cells, tissues, or organs. Metaphorically, it may be used to denote any kind of malfunctioning of individuals, groups, economies, etc. (substance abuse, violence, unemployment, et. al.)" (p. 30). While the American Medical Association and DSM-IV assert that conditions such as substance abuse are in fact "diseases," this concept appears to stretch the strict medical definition that differentiates the brain from the "mind" and "soul": "The psychiatric concept of disease rests on a radical alteration of the medical definition. The mind is not a material object; hence, it can be diseased only in a metaphorical sense" (Szasz, 2000 p. 30). In this regard, the first concept defines the concept of "disease" in terms of how it adversely affects the patient: "Some process is a disease, on this definition, if and only if it disrupts some function (Boorse, 1976 cited by Reznek, 1991 at p. 72). According to this author, "TB is a disease because it leads to the lungs malfunctioning, and haemophilia is a disease because it leads to a clotting malfunction. But notice that no assumption is made that the disruption must be of a bodily rather than a mental function. On this definition, there is no reason to exclude mental illnesses. Schizophrenia is a disease because it is a process that causes delusions, hallucinations, and jumbled thinking-i.e. because it disrupts mental functions. Thus it is correct to classify it as a disease, albeit a mental one" (Reznek, 1991 p. 72).

The second concept defines "disease" in terms of the amount of harm being caused: "Something is a disease if and only if it produces discomfort, disability or death-all forms of harm. Trigeminal neuralgia is a disease because it produces discomfort, polio a disease because it produces disability, and lung cancer a disease because it causes death. But on this definition too, there is no reason to exclude mental illnesses. Just as there are processes producing physical disabilities and physical pain, there are processes causing mental disabilities and mental pain" (Reznek, 1991 p. 72). Likewise, a condition that is characterized by progressive intellectual impairment, personality deterioration and memory loss-causes mental disabilities and mental anguish is Alzheimer's disease; therefore, it is correct to classify it as a disease, albeit of the mind. "So on either of the most plausible accounts of the concept of disease," Reznek concludes, "there is no reason to deny that there are diseases of the mind" (1991 p. 73). This point is echoed by the editors of the Journal of Sexual Behavior (2002), who advise:

Paradoxically, if one examines the history of the development of the concept of disease in the field of drug dependence, it has been a long struggle to have society and medicine conceptualize drug dependence as being a disorder or disease, rather than a moral or criminal problem, and this conceptualization has led to the development of more understanding and tolerance, better criteria for the development of research, and a search for more effective treatments. (Peer commentaries, 2002 p. 479)

The development of the concept of disease among general medicine practitioners has been a rocky road in most other areas besides just substance abuse though. According to Van Loocke, "Transition from the humoral to the germ theory of disease required a major conceptual revolution, involving many kinds of conceptual change including a fundamental shift in how diseases are classified. Less radical conceptual changes occurred in the twentieth century" (pp. 215-6). From a general medicine perspective that relies on the traditional, purely linguistic view, a concept is given by a definition that specifies necessary and sufficient conditions for its application. Using this algorithmic framework for diagnosis and treatment of disease, then, it should be possible to provide definitions such as X is a disease if and only if __, and X is tuberculosis if and only if __; however, like other concepts, the concept of disease has not been amenable to this type of linguistic analysis (Van Loocke, 1999). In this regard, the author adds that, "Cognitive science has offered a different view of the nature of concepts, understanding them as mental representations; but the nature of conceptual representations has remained controversial. Theorists have variously proposed that concepts are prototypes, sets of exemplars, or distributed representations in neural networks" (Van Loocke, 1999 p. 216).

Disease concepts are particularly interesting from this theoretical perspective, because they display a rich causal structure schematized in Figure ____ below. From this perspective, symptoms are the observable manifestations of a disease that can develop over time in particular ways that comprise the anticipated course of the disease (Van Loocke, 1999). The symptoms that occur from the cause or causes, or the etiology, of the disease mean that the treatment of the disease should affect the symptoms and course of the disease; this is frequently accomplished in general medicine settings by affecting the causal factors that produce the symptoms (Van Loocke, 1999). In this regard, Van Loocke (1999) reports that:

For example, tuberculosis has a set of typical symptoms such as coughing and the growth of tubercles (nodules) in the lungs and elsewhere, along with a course that before the twentieth century often included wasting and death. The disorder most commonly affects the lungs, but tuberculosis can also infect many other parts of the body. In 1882, Robert Koch discovered that the cause of tuberculosis is a bacterium, now called Mycobacterium tuberculosis, and in 1932, Gerhard Domagk discovered that this microbe can be killed by the drug Prontosil. The drug streptomycin was discovered in 1944 and proved effective in treating the disease. Hence today tuberculosis has a well-understood cause and a kind of treatment that is effective except for the emergence of bacterial strains resistant to antibiotics. (p. 216)

Understanding a disease concept as a causal structure like that shown in Figure 1 below is consistent with aspects of prototype and exemplar theories of concepts; for instance, some patients may experience symptoms that approximately match a set of symptoms that typically occur in people with a particular type of disease. Therefore, "Medical personnel may have in mind particular examples of patients with a particular disease. But a disease concept is not fully captured by a set of typical symptoms or exemplars, because the causal relations are an important part of the conceptual structure" (Van Loocke, 1999 p. 217).

Figure ____. The causal structure of disease concepts.

Source: Van Loocke, 1999 at p. 216.

To this end, Thagard (1992) identified nine degrees of conceptual change summarized in Table 1 below; in this case, conceptual change is not simply a matter of belief revision, since concepts are not simply collections of beliefs. Rather, they are mental structures that are richly organized by means of relations such as kind and part (Van Loocke, 1999 p. 217).

Table 1.

Degrees of conceptual change in classifying a disease.

Description/Rationale

Adding a new instance of a concept, for example a patient who has tuberculosis.

Adding a new weak rule, for example that tuberculosis is common in prisons.

Adding a new strong rule that plays a frequent role in problem solving and explanation, for example that people with tuberculosis have Mycobacterium tuberculosis.

Adding a new part-relation, for example that diseased lungs contain tubercles.

Adding a new kind-relation, for example differentiating between pulmonary and miliary tuberculosis.

Adding a new concept, for example tuberculosis (which replaced the previous terms phthisis and consumption) or AIDS.

Collapsing part of a kind-hierarchy, abandoning a previous distinction, for example, realizing that phthisis and scrofula are the same disease, tuberculosis.

Reorganizing hierarchies by branch jumping, that is shifting a concept from one branch of a hierarchical tree to another, for example reclassifying tuberculosis as an infectious disease.

Tree switching, that is, changing the organizing principle of a hierarchical tree, for example classifying diseases in terms of causal agents rather than symptoms

Source: Van Loocke, 1999 at p. 217.

Such changes are far more important, both psychologically and epistemologically, than mundane changes such as adding new instances or even adding new concepts. The most radical kind of conceptual change is tree switching, which changes not only the branches of a hierarchy of concepts but also the whole basis on which classifications are made. Although such changes occur infrequently, they have taken place throughout history and the changes that took place during the Darwinian revolution when the theory of evolution by natural selection brought with it a new principle of classification is a good example (Van Loocke, 1999). Prior to Darwin's work, species were largely classified in terms of similarity; however, the theory of evolution added a more fundamental mode of classification in terms of how species ascended the evolutionary ladder (Van Loocke, 1999). According to this author, "Darwin's trees of kinds of organisms were based on history of descent, not just on similarity.

Today, the relatedness of different species can be identified by the degree of similarity of their DNA, providing researchers with a genetic, historical basis for classification that sometimes overrules more superficial similarities that has contributed to the emerging concept of disease amongst 21st century general medicine practitioners. According to one authority, "All of these kinds of conceptual change occurred in the development of the concept of disease, particularly during the transition to the germ theory" (Van Loocke, 1999 p. 218). Based on the foregoing, it would appear that a consensus has therefore emerged among many general medicine practitioners concerning the nature of diseases and how best to treat them today; however, such a consensus has also long existed among homeopathic practitioners as it relates to the concept of disease and how to treat them and these issues are discussed further below.

Chapter 4

Homeopathic Concepts of Disease

In his encyclopedic entry on homeopathy, Trimmer (1970) reports that, "Like many branches of fringe medicine, homeopathy was introduced, developed and made popular by one man: Samuel Christian Friedrich Hahnemann" (p. 1336). Disillusioned with general medicine concepts of disease and treatments during the late 18th and early 19th centuries, Hahnemann sought an alternative to these approaches which he believed "knew no treatment except to draw from diseases the injurious materials that are assumed to be their cause. The blood is made to flow mercilessly by bleedings; leeches; cuppings; scarifications, to diminish an assumed plethora which never exists" (Trimmer, 1970 p. 1336). Because the treatment modalities used by homeopaths typically did not produce any discernible physiological effect, and because the treatments were applied with complete confidence, the results compared favorably with the best treatments of the regular physicians, who favored what they termed the "heroic" method of treatment: massive doses of mineral and plant medicine, bleeding, and blistering (Arieti et al., 1975).

According to these authors, "Some physicians recognized that this heroic style might seem excessive, but they argued that America was a young, vigorous land with tough diseases that required measures of equally heroic proportions. Traditional medical treatment, therefore, helped create a willing clientele for those who instead treated mildly and supportively" (Arieti et al., 1975 p. 39). Furthermore, there were even more pleasant treatment alternatives available to patients subscribing to general medicine tenets concerning the concept of disease and how best to treat it, depending only on how much the patient could afford: "For those who could afford it, a change of scene or climate achieved the same goal far more agreeably: traveling for the sake of one's health was a fashionable, if expensive, therapy very popular with the leisured classes in all eras. But when prevention failed, the repertoire of pukes, purges, blisters, and lotions was waiting in the wings" (Mctavish, 2004 p. 25).

Given the gruesome nature of these practices and their apparent lack of efficacy in treating diseases that were not completely understood at this point in history, it is little wonder that Hahnemann was in earnest to identify superior alternatives; however, many of his contemporaries and mainstream healthcare practitioners since have consistently questioned the fundamental logic behind these methods. For instance, "Many doctors who are introduced to homeopathy dismiss it out of hand because of its sheer implausibility. For some the implausibility lies in the proposition that medicines that contain no detectable trace of their source material can possibly have any biologically active properties" (Harris & Swayne, 1998 p. 5).

Other clinicians may have difficulty accepting the viability of the individualized prescription process as well as the diversity and subjective detail of the symptomatology required to identify the correct medicine for the individual patient in each case (Harris & Swayne, 1998). Some practitioners may also have problems accepting the rationale behind the alleged relationship between this detailed clinical "picture" and the precise active properties of the source material itself (Harris & Swayne, 1998). Likewise, Fernandez-Madrid (1989) points out:

Homeopathy is a system of treatment developed by Samuel Hahnemann on the assumption that large doses of a certain drug given to a healthy person will produce certain symptoms which, when occurring spontaneously as manifestations of a disease, can be relieved by the same drug in small doses. Another idea behind homeopathic treatment is that dilution of a drug, and hence very small amounts, enhances the power of the drug. Neither of these assumptions has ever been demonstrated. Homeopathy has generally been regarded as a demonstration of the healing power of nature or of the value of placebos in treatment (emphasis added). (p. 93)

In this regard, Arieti, Dryud and Freedman (1975) report that, homeopaths believed in "vitalism," which was "a conviction that the body has a nonmaterial ability to change food into body parts -- and was associated with a broader definition of 'soul'" (p. 39). As noted above, the best known aspect of Hahnemann's approach to diagnosis and treatment of diseases was the belief that one should use drugs that evoked the same symptoms as the disease being treated; furthermore, it was believed that the more dilute the drug, the more powerful the effect on the body: "Dilutions of millions, billions, and even trillions of a particular drug would be carefully administered" (Arieti et al., 1975 p. 39). Therefore, it would appear reasonable to assert that the concept of disease that emerges from a homeopathic diagnosis would be fundamentally different from that of general medicine, but it would seem that these concepts share some common ground and the true differences can be found in the two approaches' respective philosophies about treatment.

According to Carlston and Micozzi (2003), "The name for conventional medicine's therapeutic philosophy is allopathy, meaning against suffering, whereas homeopathy's philosophy is based on the concept of similar to suffering. Although homeopathy is almost purely homeopathic, allopathic medicine is far from truly allopathic. Allopathic medicine includes a philosophic hodgepodge of methods, including some that could even be called homeopathic" (emphasis added) (p. 3). Because general medicine has also experienced some profound changes over the past two hundred years, its concept of disease has also changed while homeopathy has remained essentially true to its founding roots. In this regard, the authors add that, "Uncomfortably, it was Samuel Hahnemann, the founder of homeopathy, who named allopathic medicine. In many ways homeopathic medicine has helped allopathic medicine define itself over the past two centuries by providing a clear-cut and consistent model of what allopathic medicine is not" (Carlston and Micozzi, 2003 p. 3).

Other similarities in the concept and treatment of disease between general medicine and homeopathic approaches can be discerned in Hahnemann's original position concerning the efficacy of vaccinations. For example, according to Johnston (2004), "In the first four editions of the Organon, the homeopathic bible, he viewed the procedure as, in essence, a homeopathic treatment since it is based on the principle of administering a remedy similar to the disease, which can then intervene in physical processes" (p. 13). This author cites a letter to Dr. Schreeter on December 19, 1831, wherein Hahnemann writes: "In order to provide the dear little Patty with the protective cow pox, the safest plan would certainly be to obtain the lymph direct from the cow; but if this cannot be done... I would advice you to inoculate another child with the protective pox, and as soon as slight redness of the punctures shows it has taken, I would immediately for two successive days give Sulphur l-30, and inoculate your child from the pock that it produced" (quoted in Johnston, 2004 at p. 13).In a note to the letter from Hahnemann, Schreeter commented that he found this advice "to be true and acted upon it in vaccination with good results"; however, "not all homeopaths agreed. Even while Hahnemann was still alive, several of his followers in Europe came out against the use of vaccinations" (Johnston, 2004 p. 13).

By the end of the 18th century, homeopathy was "received with especial unction and favor, by the more intelligent and better educated classes; and particularly by persons, the tendencies of whose minds are towards ultra and abstract principles in politics and morals, and rational mysticism in religion" (Haller, 1994, p. 27). According to Carlston and Micozzi (2003), "Homeopathy's most unique capability is to alleviate chronic illness; because treatment of chronic illness is conventional medicine's greatest weakness, homeopathy may be the ideal form of complementary medicine" (p. 1).

By the turn of the 20th century, homeopaths represented an important and powerful force in the medical world of the United States; however, these clinicians, like their mainstream counterparts.".. had to grapple-as did conventional doctors-with significant changes in matters of health and society in their attempts to establish their professional status and define their professional identity" (Johnston, 2004 p. 12). Here again, there were some similarities between general medicine practitioners and homeopaths, but even these created antipathy between the different schools of thought. On the one hand, general medicine practitioners believed the homeopathic preparations to be preposterous on their face, but both homeopaths and general medicine practitioners emphasized the need for using unadulterated preparations that were purchased from sources of known quantity and quality. For example, according to Mctavish (2004):