Where do the bio-sciences come in? Knowledge of the bio-sciences is of the first importance as underpinning knowledge. By joining our knowledge of the bio-sciences with a mastery of case-taking and examination of the patient, we deepen our understanding of the case. It is important to know what your patient is suffering, be it ebola (watch those body fluids!), cancer or whatever. But I prefer to think in terms of developing our understanding of disease processes rather than of making exact diagnoses. The former is appropriate for a phenomenological approach such as homeopathy, whereas the latter relies too much on standardised categories. In homeopathy we are concerned with matching patterns, patterns which contain a considerable degree of overlap.

This is a higher level of understanding than trying to fit disease into discrete categories, which can often only be done by ignoring individual variation and complexity. By understanding the disease processes at work in the patient and matching these with an understanding of the primary effects caused by the homeopathic medicines, we can see deeply into the case. We can also monitor the patient's condition more accurately and assess the need for emergency medical or surgical intervention. For this we need the skills in physical examination referred to above. To fully understand those disease processes, however, we will have to evolve a synthesis between our homeopathic understanding of disease and medical knowledge of disease processes.

We do not need to go down to the level of diagnostic discrimination that is necessary for the purposes of prescribing allopathic drugs. In conventional medicine, to decide between the use of one antibiotic and another it may be necessary to conduct pathology tests to establish the source of the patient's infection. In homeopathy, however, we should never fall into the trap of using diagnosis as the basis of our homeopathic prescription. This is one of the principal dangers of following the medical model too closely in designing homeopathic courses.

It is by matching the individuality of the patient with a similar medicine from the materia medica that we can achieve fundamental cures rather than palliation. It is sometimes argued that it is better to palliate and reduce the patient's pain, by using allopathic drugs or prescribing homeopathic medicines to lessen the symptoms of the clinical disease, than to let that pain continue. While there may be some merit in this argument, it does not let us "off the hook" — we should still aim wherever possible to effect the fundamental cure. Only in this way will we truly and permanently relieve the suffering of the patient. And the closer we match the nature of the medicine with the condition of the patient the more successfully we will be able to palliate, even when cure is no longer possible.

There is another danger — we could end up with a schizoid course if we take conventional bio-sciences as they would be taught in a medical school, and simply splice them onto homeopathic materia medica and method. The mainstream bio-sciences have reached an advanced stage of knowledge of biochemistry, microbiology and other sciences which are predicated on a view of the body as a system of interacting organs and molecules. In homeopathy, we are probably dealing with the body as a bio-electric system. It will be imperative to undertake a thorough investigation of these phenomena, and then modify as need be the bio-sciences taught in homeopathic schools to take into account the results of this research. Only then will we possibly understand why our medicines work, and only then will we be able to achieve a truly integrated course.

A third concern with following the medical model is that it leads us towards trying to treat homeopathy exclusively as a hard science. The trend in medical science itself is towards "evidence-based medicine." From one point of view this is a welcome development as it reveals the extent to which medical treatments in the past have not been supported by hard evidence, contrary to what we were led to believe. On the other hand, the use of "evidence-based medicine" could itself be misleading. On the face of it the idea that treatments should not be used (and therefore not taught) unless they have been thoroughly tested out for effectiveness is a reasonable one. But science should only go down this path if it is confident that the effectiveness tests are really reliable.

In fact the reverse may be true. It is increasingly recognised that it is very difficult to conduct experiments on living individuals in the field with the same exactitude as experiments that can be totally contained within a laboratory. The total number of variables relevant to determining whether an individual's health has been improved or not by administering a medicine is too vast to be measured in most trials. This overall question is the only one which is worth asking, but scientific trials must perforce ask much more restricted questions: Does medicine X relieve joint soreness in arthritis? Perhaps the joint soreness was relieved, but the patient fell into a deep depression, or went on to develop other auto-immune disorders? Clinical trials cannot determine these matters, and so are of very limited usefulness. They have a place in determining whether a given medicine does have some of the effects claimed for it. But they should not be used as the sole determinants of whether a medicine may be used or not. Until it is possible to answer the major evaluative question (does the patient benefit overall from the treatment?) with scientific exactitude, it would be foolish to maintain that choice of treatment should be based on quantitative studies. Quantitative studies may merely give an appearance of scientific exactitude to practices which are in fact of questionable value. (For a sustained critique of such studies see Coulter, 1991, reference below). Clinical knowledge is a grand tradition in homeopathy, and its place should remain secure in our courses into the future.

This is not to say that we should attempt to import homeopathy into the university system and resist any changes to it. The core principles and techniques of homeopathy have remained remarkably stable over the past two hundred years. Homeopathy has retained its integrity because of this conservatism. But conservatism should not harden into orthodoxy. Further research into the nature of our medicines may reveal new paths of exploration which may lead us far beyond the Hahnemann of the sixth edition of the Organon. There is great uncertainty about where homeopathic research is leading, but one thing we can be confident of is that it will certainly lead us into new and unfamiliar territory. This will present us with both dangers and opportunities.

Returning to the nature of homeopathic practice and the most appropriate way to prepare students for it, for the foreseeable future we must continue to practice homeopathy as a hybrid discipline which is as much an art as a science. Homeopathic courses should encourage what I call the "humanistic" skills: students should be taught to "get under the skin" of their patients, understand what "makes them tick," what is bugging them, how their minds work, what they are feeling, how they perceive the world. These are different skills from the scientific approach of detached measurement, and we need them to assist our analysis of the general symptoms.

The fundamental point is that the encounter between homeopath and patient is of crucial importance in our discipline. There must be a deep understanding between them, and homeopathic education must inculcate the skills in the practitioner to reach this deep understanding. It is not for us to look at some lab reports about the patient and try and match these with what we have extracted from clinical trials of a medicine.

As well as underpinning knowledge of the bio-sciences, student homeopaths would benefit greatly from supporting studies in the humanities, to give them underpinning skills. They need to be able to think both with the left and right brains. They would benefit greatly from the study of deductive logic which may be found, for example, in first-class philosophy courses. And they would also benefit from the study of literature, which leads us towards greater understanding of the human condition and of language, as well as building skills in interpretation.

At the same time homeopaths must know something of scientific method. Scientific method teaches us to recognise when outcomes of intervention differ from expectations. This is an area where I suspect many "lay" homeopaths are weak. How many practitioners really know what their success rate is? And yet if we do not know to what extent we are succeeding or failing with our approach, it is difficult to improve. So our courses should teach students to look out for that mismatch between expectations and outcomes. Scientific education encourages this in a general way. But students should be taught how to engage in systematic follow-up and how to periodically survey their patients about their satisfaction with the treatment. This approach to systematic clinical audit has not been grappled with in medical education either, and yet it is a critical aspect of good practice.

In summary, I believe that we need to develop our own model of homeopathic education. We should take the best of medical science, adapt it to our purposes, and join it with the best of the homeopathic tradition to produce an integrated whole.
 
 
References

"Universities Study Alternatives to Traditional Medicine" in Chronicle of Higher Education, 1996, 12 January.
 

Coulter, H., "The controlled clinical trial: An analysis." Centre for Empirical Medicine, Washington D.C., 1991.