Monthly Archives: June 2011Video Video
Vera Resnick IHM DHom Med (Lic)
This is perhaps less of an article, more of a musing and a challenge. Part of the questions raised here are based around thoughts resulting from conversations I have had with Dr Gary Weaver and Dr George Dimitriadis, although I will not be quoting them directly in this article.
The harnessing of the Law of Similars within Hahnemann’s plan as set out in the Organon is totally dependent on provings. The only way we can reliably get information about what remedies can do is through giving them in an organized way to healthy people, and getting reports, in an organized way, as to the results. Poisonings, although usually inflicted on healthy people and drastically changing their state, do not show the influence of highly dilute potentised substances on healthy people. Clinical symptoms can demonstrate effectiveness of homoeopathic treatment, but cannot demonstrate a certain homoeopathic relationship between the remedy and the clinically named disease that was cured. If we are to work using Hahnemann’s methods, basing ourselves on the Organon, we need provings, we need that central body of Materia Medica that is a primary source and not subject to interpretations by homoeopaths.
But how objective are provings? How certain can we be of the long, soporific (it is, be realistic) shopping list of symptoms presented by the provers on taking remedies? How sure can we be about those who edited the provings, about their work and interpretations?
Inevitably when a person describes a sensation he or she is experiencing, something will be lost in translation between the experience and the words the prover finds to express that experience. Just in the same way, when a patient tries to describe his or her condition, something is lost too. This means that we must cast a critical eye on even the best of provings, and be aware that we may not be able to understand the full range of nuance in terms of the language used to describe the experience. I have not even touched on the difficulty in understanding language, the way each one of us, even within a similar culture, will understand words differently.
This underscores the need to look for certainty in the choice of symptoms which we take to guide us into a case. But even more so, it emphasizes the problems inherent within the proving process itself, even in the best case scenario of provings in Hahnemann’s Chronic Diseases and Materia Medica Pura.
If provings done under the best of conditions, with full care and correct approach, can be flawed – it seems clear that provings on the other end of the scale, carried out through meditation, dreams, pendulums or similar must be completely flawed if our goal is certainty in prescribing and results.
But what about all the provings in the middle range of the scale? All the provings carried out since Hahnemann’s time? Which ones were reliable? Which ones were clearly unreliable? What about modern provings, carried out by homoeopaths who profess to be following Hahnemann’s injunctions to the letter?
There are homoeopaths on the front line, working constantly with patients using the tools available, the most important of which are reliable materia medica based on provings. There are homoeopathy teachers (not all of whom are on the front line) who send their students out to the front line without sufficient tools to work. Without serious, considered appraisal of provings since Hahnemann’s time – no homoeopath can be considered truly able to avail him/herself of the information offered, to assess what provings can be employed usefully in prescription. Which leads to guesswork. Which is unhealthy if the goal is certain prescribing, not to mention the damage it does when it becomes entrenched as acceptable practice, which we have witnessed in our times.
The alternative is to stay within the confines of Hahnemann’s materia medica, but at what cost! Gelsemium, Medorrhinum, Kali-Bichromium, Hypericum, and many more. That is the cost.
And this is the challenge (which can also be read as an impassioned plea): Some of you have the tools, skills and experience to appraise provings. Please do it. Please teach it. Please present your opinions on sites such as this. If you have the knowledge – please share it. This is a subject that should be part of the teaching curriculum of every homoeopathy school that takes itself seriously. It has been sorely neglected and this must be remedied if homoeopathy is to survive as a medical art and science, rather than as a rather weak, ineffectual new age healing modality.
Type 2 diabetes in newly diagnosed ‘can be reversed’
An extreme eight-week diet of 600 calories a day can reverse Type 2 diabetes in people newly diagnosed with the disease, says a Diabetologia study.
Newcastle University researchers found the low-calorie diet reduced fat levels in the pancreas and liver, which helped insulin production return to normal.
Seven out of 11 people studied were free of diabetes three months later, say findings published in the journal.
More research is needed to see whether the reversal is permanent, say experts.
Type 2 diabetes affects 2.5m people in the UK. It develops when not enough insulin is produced in the body or the insulin that is made by the body doesn’t work properly.
When this happens, glucose – a type of sugar – builds up in the blood instead of being broken down into energy or fuel which the body needs.
The 11 participants in the study were all diagnosed with Type 2 diabetes within the previous four years.
They cut their food intake drastically for two months, eating only liquid diet drinks and non-starchy vegetables.
After one week of the diet, researchers found that the pre-breakfast blood sugar levels of all participants had returned to normal.
MRI scans of their pancreases also revealed that the fat levels in the organ had decreased from around 8% – an elevated level – to a more normal 6%.
Three months after the end of the diet, when participants had returned to eating normally and received advice on healthy eating and portion size, most no longer suffered from the condition.
“It offers great hope for many people with diabetes.”
Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University and lead study author, said he was not suggesting that people should follow the diet.
“This diet was only used to test the hypothesis that if people lose substantial weight they will lose their diabetes.
“Although this study involved people diagnosed with diabetes within the last four years, there is potential for people with longer-standing diabetes to turn things around too.”
Dr Ee Lin Lim, also from Newcastle University’s research team, said that although dietary factors were already known to have an impact on Type 2 diabetes, the research showed that the disease did not have to be a life sentence.
“It’s easy to take a pill, but harder to change lifestyle for good. Asking people to shift weight does actually work,” she said.
However, not everyone in the study managed to stay free of diabetes.
“It all depends on how much individuals are susceptible to diabetes. We need to find out why some people are more susceptible than others, then target these obese people. We can’t know the reasons for that in this study,” Dr Lim said.
Professor Edwin Gale, a diabetes expert from the University of Bristol, said the study did not reveal anything new.
“We have known that starvation is a good cure for diabetes. If we introduced rationing tomorrow, then we could get rid of diabetes in this country.
“If you can catch people with diabetes in the early stages while beta cells are still functioning, then you can delay its onset for years, but you will get it sooner or later because it’s in the system.”
But Keith Frayn, professor of human metabolism at the University of Oxford, said the Newcastle study was important.
“People who lose large amounts of weight following surgery to alter their stomach size or the plumbing of their intestines often lose their diabetes and no longer need treatment.
“This study shows that a period of marked weight loss can produce the same reversal of Type 2 diabetes.
“It offers great hope for many people with diabetes, although it must be said that not everyone will find it possible to stick to the extremely low-calorie diet used in this study.”
Dr Iain Frame, director of research at Diabetes UK, which funded the study, said the diet was not an easy fix.
“Such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term.”
By James Gallagher Health reporter, BBC News
Commonly used drugs – for conditions such as heart disease, depression and allergies – have been linked to a greater risk of death and declining brain function by UK researchers.
They said half of people over 65 were prescribed these drugs.
The effect was greatest in patients taking multiple courses of medication, according to the study in the Journal of the American Geriatrics Society.
Experts said patients must not panic or stop taking their medicines.
The researchers were investigating medicines which affect a chemical in the brain – acetylcholine. The neurotransmitter is vital for passing messages from nerve cell to nerve cell, but many common drugs interfere with it as a side effect.
Eighty drugs were rated for their “anticholinergic” activity: they were given a score of one for a mild effect, two for moderate and three for severe. Some were given by prescription only, while others were available over the counter.
Category one, mild
- Codeine (painkiller)
- Warfarin (blood thinner)
- Timolol maleate (eye drops)
Category three, severe
- Piriton (antihistamine)
- Ditropan (incontinence drug)
- Seroxat (antidepressant)
A combined score was calculated in 13,000 patients aged 65 or over, by adding together the scores for all the medicines they were taking.
A patient taking one severe drug and two mild ones would have an overall score of five.
Between 1991 and 1993, 20% of patients with a score of four or more died. Of those taking no anticholinergic drugs only 7% died.
Patients with a score of five or more showed a 4% drop in ratings of brain function.
Other factors, such as increased mortality from underlying diseases, were removed from the analysis.
Do not stop your medicines without taking advice first”
Dr Clare Gerada Royal College of GPs
However, this study cannot say that the drugs caused death or reduced brain function, merely that there was an association.
Dr Chris Fox, who led the research at the University of East Anglia, said: “Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects.
Dr Clare Gerada, chairman of the Royal College of GPs, said the findings of the study were important.
She told patients: “The first thing is not to worry too much, the second thing is to discuss it with your doctor or the pharmacist, and the third thing is do not stop your medicines without taking advice first.”
She said doctors reviewed medication every 15 months and were aware of the risks of combining different drugs.
Dr Fox said he wanted to conduct further research to investigate how anticholinergic drugs might increase mortality.
A more modern study is also thought to be desirable. Practices and drugs have changed since the data was collected two decades ago.
Ian Maidment, an NHS pharmacist in Kent and Medway, believes the situation may now be even worse.
He said the use of anticholinergic drugs had “probably increased as more things are being treated and more drugs are being used.”
Reduction of the neurotransmitter acetylcholine has already been implicated in dementia.
The drug Aricept is given to some patients with Alzheimer’s disease to boost acetylcholine levels.
Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said a 4% drop in brain function for a healthy person would feel like a slow, sluggish day.
“If you are at a level where one little thing pushes you over into confusion, then that is much more serious,” she added.
“However, it is vital that people do not panic or stop taking their medication without consulting their GP.”
Rebecca Wood, chief executive of Alzheimer’s Research UK, said: “This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription.”
by JENNY HOPE, Daily Mail
Homeopathy really does work and doctors should recognise its healing effects, say researchers.
A study found that allergy sufferers who were given homeopathic treatment were ten times more likely to be cured than those given a dummy pill instead.
Doctors should be more positive about the alternative medicine, which is the only complementary therapy available on the NHS, the researchers said.
Their study attempts to settle the controversy over homeopathic treatment, which critics say is not effective because of the tiny level of active substance used in most remedies.
It works on the principle that a substance which in large doses will cause the symptoms of an illness can be used in minute doses to relieve the same symptoms.
Critics argue that the active substance is so diluted that homeopathic remedies have no more effect than placebo or dummy treatment.
The study put homeopathy to the test in 50 patients suffering from nasal allergies. They were given either a homeopathic preparation or a placebo.
Each day for four weeks patients recruited from general practices and a hospital in London measured their nasal air flow and recorded symptoms such as blocked, runny or itchy nose, sneezing or eye irritation.
Both groups reported that they got better – but on average patients who received homeopathy had a 28 per cent improvement in nasal air flow compared with 3 per cent among those in the placebo group.
The study was carried out by doctors in Glasgow, led by Dr David Reilly of the Glasgow Homeopathic Hospital, one of five specialist hospitals in Britain. He said the difference in results from the two treatments was statistically significant.
Dr Reilly said this was the fourth trial carried out by his hospital, all with similar results. In addition, there were positive findings in 70 per cent of a further 180 clinical trials.
‘I hope this will encourage doctors to examine the volume of evidence supporting homeopathy – they might be quite surprised at the positive outcome in many trials,’ he said.
He added that it would take consistent scientific investigation to persuade some doctors, but attitudes were changing.
About 20 per cent of doctors in Scotland have basic homeopathic training compared with one per cent 15 years ago.
‘It isn’t just about the remedies, which can be put to the test in trials, but about a greater holistic approach in encouraging self-healing and self-recovery.’
Dr Bob Leckridge, president of the Faculty of Homeopathy – the body for doctors, vets, nurses and other health professionals – said: ‘This latest research builds on existing evidence that homeopathy works, something that hundreds of doctors and their patients have known for 200 years.’
The author of Homoeopathy, now deceased, in his work “On Chronic Diseases” (Vol. I, page
146, and ff. in the second edition), uttered especially three warnings, and particularly enjoined
them upon his followers and declared that a neglect of the same was the greatest fault that a
homoeopathic physician could become guilty of (ibid, page 149). These warnings are the
1. “To suppose that the doses indicated in every antipsoric medicine and moderated by me
(Hahnemann) after much experience, and compelled by experience, to be too small.
2. “The wrong choice of the medicine, and
3. “The excessive hurry which does not allow every dose to finish its action.”
Whether it be superfluous and out of time to call back to mind these particular teachings and
warnings just now I may well leave to the judgment of every true homoeopath, since it is
especially these three warnings, and especially the first and third, are points in which the
practice of this later time is confessedly most at variance with the original teaching.
When some time ago the lamentable schism arose among homoeopaths and it seemed as if
the ambiguous specificism of Griesselich and Co. had already carried off the victory over the
so-called Hahnemannism, the part of Homoeopathy which had remained true to their
recognized truths for the time drew back from the theatre of action, hoping for better times to
come, and wearied out by ceaseless empty discussions, and they left it to the loquacious
champions of the newly developed school who seemed to be possessed with the itch of
writing, and they practiced as if it were a matter of conscience, the denial of the doctrinal
propositions established after long experience and provings by the author of Homoeopathy.
Instead of perusing the Organon of the conscientious and able author, which had been
uninterruptedly filed and perfected for thirty years, they read the Organon of Rau, which had
sprung up like a mushroom and as quickly passed into oblivion, and instead of the twenty
years’ investigations laid down in the work on Chronic Diseases they studied the hypotheses
and contradictions in the ephemeral sheets of the Hygeia. Who can deny and who need be
astonished that in consequence of this destructive tendency, Homoeopathy in Germany lost a
great part of the domain which the first adherents of Homoeopathy had conquered with their
successful and honorable efforts? For almost every homoeopath was seized by the whirlpool
and torn along by it. I myself own my speedy return to well established principles only to the
warnings of my never-to-be-forgotten teacher and friend, who in an uninterrupted
correspondence gave me directions how to distinguish the truth from falsity, through careful
comparative experiments and unprejudiced observations.
Many others must have passed through similar experiences with myself, though with some
they may have taken longer; for of late a number of voices have been heard, warning against
the errors committed, and which endeavored to secure again to the old teachings of the
Founder of Homoeopathy their former authority, a matter which about a year ago hardly
anyone would have dared. For the positive, bold manner of the so-called specificists, not
infrequently spiced with rudeness, had so intimidated even the most able and experienced
men that they not only kept their better convictions for themselves, but even-and here the
editors of the Archiv may contradict me if this is not the exact truth-gave the advice that it
would be best on account of these “strong men” to conceal great cures effected by minimal
and rare doses.
In these times full of disgrace and weakness, where I would have so gladly offered a friendly
hand to others of the same convictions, my circumstances had entered such a phase that I was
unable to enter with open visor into the combat for right and truth. My contributions to some
numbers of this Journal had therefore to appear under a pseudonym, * and although the
editors gave a not undeserved testimony as to my love of truth, and finally my untarnished
name was given as that of the author, there were some men at that time cowardly enough to
draw in doubt my simple statement of facts, which I can at any time prove by my physician’s
record. I was not so much aggrieved at the time about these insinuations as to my reputation
and my honor, which cannot be injured by such attacks, but by these undeniable signs of the
great decay of Homoeopathy in Germany, where cures were drawn in doubt, which even in
the times when the teachings were still more imperfect had found unhesitating credence.
If all signs do not prove deceptive, we now are at the entrance of a new epoch introduced by
the death of the founder of Homoeopathy, whose genius now hovers near us, where divisions
will be healed, excrescences excised and the scoriae be separated, which hitherto have been
obstructive to the progress of our Sciences. Let us then from this time onwards form a closer
union, which shall embrace all who honestly desire the common good, but which will rigidly
exclude all those who mock the good cause, who cause division, or who seek to put individual
views and opinions in the place of careful observation. At the same time let us honor the
memory of the immortalized reformer in a manner as useful as it is appropriate by submitting
the results of his more than fifty years’ investigations (and these carried on by a man of rare
talents) to a repeated and manifold examination, and communicate the results to each other
faithfully and honestly. This will be the best preparation for a memorial which the great man
has richly deserved from Science and from suffering humanity.
After this digression which was not only indicated by the times and the circumstances, but
demanded by them, I return to my original theme, only calling to remembrance some items
having relation thereto.
Warning: the smallness of the dose
The transactions as to the Smallness of the dose are more than ever far from being closed.
The more there has been written of late years about this subject, the more contradictions have
been heaped upon contradictions, and what is really remarkable, though not in the better use
of that phrase, is the fact that the gradual diminution of the dose and what Hahnemann has
taught about it at various times in agreement with his continued experiments, observation and
experience, has been altogether ignored. All the more, it seems to me, that the time has come
to recall at last the declarations of the great Master.
The kind reader will no doubt release me from the trouble of proving from the various
editions of the Organon, from the first to the fifth, how it was experienced which brought the
carefully observing author slowly, step by step, to that minuteness of dose, which has now
become the laughing stock of the specificists. As I may presume that this book is in the hands
of all those who deserve the name of homoeopaths, the reader will be able to read in secs. 275
to 278 (of the fifth edition) what is there said about it.
Somewhat less likely it may be, that also Hahnemann’s work on Chronic Diseases, and
especially the second edition of this work, is in everybody’s hands, as just about that time
views about it appeared which need not be mentioned here, and which the author two years
later indicated in the preface to the third part (which appeared, published by another
publisher) in a manner sufficiently plain to those familiar with the history of Homoeopathy. It
may be therefore advisable to adduce here the words of the experienced investigator.
After Hahnemann had mentioned (on page 148) homoeopathic aggravation, he thus
“But when these aggravated original symptoms appear later on in the same strength as at the
beginning, or even more strongly later on, this is a sign that the dose of this antipsoric
remedy, although it was correctly selected, was too great, and caused the fear that no cure
could be effected through it, since medicines given in so large a dose are able to establish a
disease which in some respects is similar, but even greater and more troublesome, without
extinguishing the old disease. This is caused by the fact that the medicine used in so large a
dose unfolds also its other symptoms which nullify its similarity and thus establishes another
dissimilar disease, also chronic, in place of the former.”
In the words here italicized lies a great truth, which has never been impugned and has been
verified by numerous results of the allopathic treatment of chronic diseases, and which is well
worth careful attention. Even in syphilis, which is much easier to cure, we see similar results
from the abuse of quicksilver, which are then denominated secondary syphilis. But this
appears even more plainly and most frequently from the treatment as common as it is
destructive of primary itch by using simultaneously Sulphur internally and quicksilver
externally, both in excessive doses, whereby there is produced a monster of a chronic disease,
which in the most cases would be incurable even by Homoeopathy without the use of
Causticum and Sepia.
Hahnemann then continues in his text (ibid.):
“This-(i. e., the large dose of medicine)-finds its decision already in the first 16, 18 or 20 days
of the effect of the Medicine given in too large a dose, as it must then be checked, either by
prescribing its antidote, or when this is not yet known, by giving another antipsoric medicine,
as suitable as possible to the symptoms then prevailing, and this in a very moderate dose, and
when this is not yet sufficient for abolishing this sinister medicinal disease by prescribing a
second medicine as suitable as possible at that time.” To confirm this warning and to show
that it was drawn from experience, he adds in a note:-“I have myself had an experience of this
mistake which offers so serious an obstacle to a cure and which therefore cannot be too
cautiously avoided, when I gave Sapia, while still unacquainted with its powers, in too large a
dose; but in a still more striking manner when I gave Lycopodium and Silicea in their
billionth dilution in four to six pellets (although only of the size of poppy-seeds), Discite
moniti.” What specificist, furnished with the same amount of sagacity and the same gift of
observation, has shown by experience that Hahnemann in this point, which he proved so
carefully, was involved in error? But so long as a proof is not given with satisfactory fullness,
it seems to me at least a ridiculous assumption to suppose that we should accept an unproved
assertion to the contrary without questioning, and deny our lengthy experience. How little an
excessive dose of medicine is able to unfold its curative efficiency is manifest from the
statement made by the author of Homoeopathy immediately afterwards (ibid. p. 149). “When
the stormy assault of the excessive dose of even a correctly selected homoeopathic remedy
has been assuaged by the following use of an antidote or the later use of some other antipsoric
remedy, then this remedy which had only proved injurious through its excessive strength may
be used again, and indeed as soon as it is homoeopathically indicated with the best success,
only in a far smaller dose and in a far more highly potentized attenuation.” But it would
remain without any effect, if it had already at the first strong dose effected everything that lay
within its power.
Finally Hahnemann says in addition (ibid. p. 149), “No harm will be done if the dose given is
even smaller than I have indicated. It can hardly be made too small if only everything is
avoided that might interfere with the action of the medicine or obstruct it; this refers as well to
the diet, as to the other circumstances. They will even then do everything of good that can in
general be expected of medicine, if only the antipsoric was selected correctly in all respects as
to the carefully examined symptoms of the disease and was thus homoeopathic, and the
patient did not by his actions disturb the medicine in its action. On the other hand we have the
great advantage, that even if in some case the selection should not have been made quite
suitably, we have the great advantage that we can easily put out of action the wrong medicine
in its minimal dose in the manner indicated above, when the treatment can be continued with
a suitable antipsoric without delay.” This declaration should especially be heeded by
beginners and should be acted on, and the urgent warning of Hahnemann in the preface of his
work on “Chronic Diseases” should not be lightly neglected, where he says in reference to this
matter:-“What would they have risked if they had at once heeded my words and had first
made use of these small doses? Could anything worse have happened than that these doses
might have proved ineffectual? They could not have injured anybody! But in their
unintelligent self-willed use of large doses in homoeopathic practice they only passed again
through the same round-about route, so dangerous to their patients, which I in order to save
them the trouble had already passed through with trembling, but successfully, and after doing
much mischief and having wasted much time they had eventually if they wanted to cure to
arrive at the only correct goal, which I had made known to them long before faithfully and
openly, giving to them the reasons therefore.”
It would be testing the patience of the reader too much if I should further continue this
subject. Whoever cares to know my opinion in this matter may find this with further details in
my book: “Homoeopathy, a reader for the cultivated, non-medical public (Munster at
Coppenett’s, 1834).” On page 203 they will find a special chapter devoted to the smallness of
the doses which I must subscribe to also at this day with an experience of so many more
years, which has only more strongly confirmed my convictions: since also I, led by the almost
unanimous assertions as to the untenableness of this teaching, gave, though only for a short
time, larger doses and with bad success, especially in chronic diseases. The proofs of this are
to be found in my Physician’s Record, which since the year 1835 have now already grown to
55 thick quarto volumes, as also in my communications to this Journal, which are signed “Dr.
B. in D.” and of which I now have no more reason to conceal the authorship. Only one thing
must not remain unmentioned, namely, the unproved assertion made by the specificists that
the author of Homoeopathy himself had in the later years of his life come back from what
they call the extravagant smallness of the doses, and gave larger ones, as in the first epoch of
Even leaving out of view the fact that the preface to the last volume of the Chronic Diseases
(Second Edition) written about the year 1838 says just the opposite, I am otherwise enabled
by a correspondence carried on with him since the middle of the year 1830 up to May of this
year, thus within about two months of his death, which correspondence was carried on
without interruption and with diligence, that there is not only nothing true in this ascertion,
but that he even up to the last continued to diminish the doses.
Since very little has become known as to the cures of our deceased Master, hardly more than
two cases in the preface to the second volume of the Materia Medica Pura, and a few other
cures only incidentally mentioned, I may suppose that the communication of a few extracts
from the latest Physician’s Records, which he sent me on the 24th of April of this year and
which confirm what I have just mentioned, will be of considerable interest to most genuine
homoeopaths. I therefore give in the following a diplomatically faithful copy of it * and I
would direct the reader in order that I may not add anything of my own, with respect to some
designations not yet generally known to the sixth edition of the Organon, which was
completed by Hahnemann before his death and will appear as he himself informed me at least
in the French language in a short time. * I would only premise that wherever nothing else is
mentioned the sixtieth dynamization (potency or dilution) is meant.
Julia M., a girl from the country, fourteen years of age, has not yet menstruated, September
12, 1842. A month before she had slept in the sun. Four days after this sleeping in the sun she
had the dreadful notion that she saw a wolf, and again six days later she felt as if she had
received a severe stroke on her head. Now her mind wandered, she became as it were insane,
wept much at times she had difficulty in her respiration, she spits out white phlegm, and could
not describe her sensations.
She received Belladonna: the dynamization being rendered milder in seven spoonfuls, after
shaking this, one spoonful of this was put into a tumblerful of water, and after shaking this,
one coffeespoonful was to be taken in the morning.
September 16. Somewhat more quiet; she was able to blow her nose, which she could not do
while insane; she still talks deliriously, but does not use so many gestures. Yesterday in the
evening she wept much. Good stool. Pretty good sleep. She still moves around much; but this
was much worse before receiving Belladonna. The white of the eye is full of reddish veins.
She seems to have pain in the neck.
From the tumbler into which a spoonful was stirred she is to stir a coffeespoonful into a
second tumblerful and take from it two to four coffeespoonfuls (increasing daily by one
spoonful) in the morning.
September 20. Much better, speaks more rationally, wants to do something; she recognizes
me, calls me by name and wishes to kiss a lady who is present. From then she began to grow
tender;-she easily gets cross and takes things ill,-she sleeps well, weeps frequently, but gets
angry about trifles, she eats more than usual; when she becomes conscious, she loves to play,
but only like the children.
Belladonna, one pellet of a higher potency, seven spoonfuls shaken in two tumblers full of
water, six coffeespoonfuls from the second tumbler. Early in the morning. *
September 28. On the 22d, 23d and 24th, very much excited day and night. Great
voluptuousness in gestures and words, she lifts up her dress and wishes to touch the parts of
others; she gets angry quickly and beats everybody.
Hyoscyamus X. Seven tablespoonfuls, etc., one tablespoonful into one tumblerful of water; in
the morning one coffeespoonful.
October 5. For five days she would not eat anything; she complains of colic. Since several
days she has not been so malicious and less lewd, also more rational. The stool is too soft;
itching all over the body, especially on the sexual parts. Sleep is good.
October 10. On the 7th she had a violent attack of malignity, she wished to beat everybody.
On the following day, the 8th, she had an attack of timidity and fear, almost as it had been in
the beginning of her disease (afraid of an imaginary wolf). She fears that she will be burned
up. Since then she has become quiet and talks rationally, and there has been nothing unseemly
during the last two days.
October 14. Perfectly well and rational; on
October 18. Equally so, but she often has some headache, is inclined to sleep by day, less
Now Sulphur (a new dynamization from a minimal quantity), one pellet in three tumblersful;
early in the morning one coffee-spoonful.
October 22. Very well, but little headache.
Sulphur, the next dynamization in two tumblers.
She then continued to use some Sulphur with interruptions up to November, and she
remained a healthy, rational, dear girl.
Sore throat, fissure of anus
O—–t, an actor, 33 years old, unmarried.
January 14, 1843. For several years he has had a sore throat, so now for a month. The last
time his sore throat had lasted six weeks. When swallowing saliva, he feels a pricking
sensation of constriction and soreness.
When he is not afflicted with this sore throat, he suffers from a fissure of the anus, with
violent pain as from a chap; then the anus is inflamed, swollen and constricted, he can then
discharge his stool with great exertions, while swollen haemorrhoidal veins extrude.
January 15. He took early before breakfast a coffeesponful of a solution of one pellet of
Belladonna in seven tablespoonful of water, from which solution one tablespoonful was put
into a tumblerful of water and stirred.
January 15. In the evening the throat was worse.
January 16. The throatache is gone, but the ailment of the anus has returned, as described, an
open fissure with pain as from a chap, swelling, beating pain and constricture. Nevertheless he
had a painful stool in the evening.
He acknowledged that eight years ago he had a chancre which had been as usual destroyed
with a corrosive, after which all these ailments had set in.
On January 10 he received one pellet of Mercurius vivus I. of the lowest new dynamization
(which contains immensely less substance than the present) prepared for being taken as before
and taken as before (after shaking the bottle every time), one spoon-full in one tumblerful of
water, as with the Belladonna, well stirred.
January 20. Almost all the toothache gone. The anus is better; but he still feels a soreness
there after the stools; but there is no more pulsation there, no swelling of the anus and no
inflammation. Less constricted. One pellet of Mercurius viv., 2 dynamization, prepared and
taken in the same manner in the morning. I did not note down whether he took the Mercurius
(2) once or twice a day; usually only once early in the morning before breakfast.
January 25. The throat is almost altogether well, but in the anus there is a pain as from a
chap, and severe lancinations, severe pain in the anus after stool, there is still some
constriction and heat.
January 30. In the afternoon he received the last dose (one coffeespoonful). On the 28th the
anus was better, the throatache had returned; severe chaps in the throat.
One pellet in sugar of milk for seven days, prepared and taken as before.
February 7. Severe pain as from ulceration in the throat. Colic, but good stools, but several
times in succession, with great thirst. But everything is well at the anus. Sulphur 2-0 in seven
tablespoonfuls of water as above.
February 13. He had ulcerative pains in his throat, especially when swallowing saliva of
which he now has a great quantity, especially much on the 11th and 12th. Some constriction
of the anus, especially since yesterday.
Now I let him smell of Mercurius and gave him Mercurius vivus 2-0, one pellet, as always in
seven tablespoons, one-half spoonful of brandy and to be taken as before.
February 20. The throat is better since the 18th; he suffered much at the anus; the stool pains
him when discharged; less thirst.
§-0 Sugar of milk in seven tablespoonfuls.
March 3. No more throatache. In going to the stool a haemorrhoidal vein but bloodless
extrudes (formerly this caused burning and pains as from chaps), now there is only itching in
that spot. I let him smell of Ac. nitr.
March 20. Hardly any more pain after the stool; yesterday some blood was discharged with
the stool (an old symptom). The throat is well, only when drinking anything cold there is
Now he is allowed to smell of Ac. nitr. The smelling is directed after opening a little vial
containing half an ounce of low grade alcohol or brandy, in which one pellet with medicine is
dissolved; he smells at it one or two moments.
His health was permanently restored.
While I allow my indulgent readers, also according to their good pleasure the specificists
who are not so kindly disposed towards me, to make their comments on these two cases, and
cures which Hahnemann himself in his letter of the 24th of April, styles “not the most
Warning, namely, the selection of the right remedy
First we must see what our Hahnemann says about it (ibid) page 150:
“The second great mistake is made in the treatment of chronic diseases by the
unhomoeopathic selection of medicines; this is chiefly the case with incipient homoeopaths
(many, I am sorry to say, remain all their life such beginners) through inexactness, negligence
and love of ease.”
With great conscientiousness, which more than anything else in the world the restoration of a
sick person in danger of his life calls for the homoeopath, who would prove worthy of his
calling should first of all note down the whole condition of the patient, the cause, as far as it
can be discovered, and the reasons which sustain this condition, his mode of life, the quality
of his mind, disposition and body, together with all the symptoms (according to the directions
of the Organon), and then endeavor to discover in the book of “Chronic Diseases” and in the
“Materia Medica Pura” the medicine covering all these momenta, or at least the most striking
and peculiar; for this purpose he should not content himself with the repertories that have
been prepared, a very frequent carelessness, for these books contain only slight hints as to one
or the other remedy that might be selected, but can never take the place of the careful reading
up of the fountain sources. Whoever in critical and complicated cases is not willing to take
this course with all due care and intelligence is not worthy of the honorable name of
homoeopath. A man who thus is satisfied with the vague hints of a repertory in the selection
of a remedy, and quickly gets through with one patient after the other, is rather a quack, and
will then have to give a new remedy every minute, until the patient loses his patience, and his
ailments having been, as may easily be understood, aggravated, he leaves such an aggravator
of disease who throws discredit on the art instead of merely the unworthy disciple of this art.”
“This disgraceful love of ease (just think of it in a profession which of all others ought to be
the most conscientious) causes such a would-be-homoeopath frequently to give the remedy
merely from its use (ab usu in morbis), as they are enumerated in the introduction to the
medicines, an erroneous procedure which seems to savor very strongly of allopathy, since
those definitions of use mostly indicate merely some single symptoms, and should only serve
to confirm the selection made according to the pure effect of the medicines, but Never to
permit ourselves to be solely determined through these (often only problematical) statements
of the use in the selection of a remedy, which can only cure when there is a similitude of the
homoeopathic symptoms. There are, I am sorry to say, even writers who advise this empiric
The words of our Hahnemann, in which the leading ideas are emphasized by italics, when
combined with what is said about it in the Organon, might suffice, if in considering this
caution there were not also something to be said in favor of the disciple of the art, which in
order to be impartial must no be concealed.
Looking back over former years allows us to find without long search a period where the
communications made about cases and cures offer a great difference from those of the present
time. A great part of the results gained in the later time shows an uncertainty and fluctuation
in the selection of remedies, which we do not find at least in the same measure in the former
time of the so-called childhood of Homoeopathy, and when we look at the matter more
closely, we cannot deny the fact that the increase in the size and multitude of the doses kept
equal pace with this. Can and dare we to call this change a progress? And if not, then where
are we to look for the cause?
The answer to the latter question may be found in the above quoted words of the founder of
Homoeopathy, where he warns against inexactness, negligence and love of ease in the
selection of the remedies, and those who are guilty of this justly deserve only contempt and
disgrace. But it would be unjust and not equitable to blame merely the will, for what in part is
also dependent on the ability, and I am convinced that the size and the condition of our
Materia Medica has a considerable part in this fault.
While leaving it to others to pronounce as to the uselessness of most of the later provings,
and also the fragments of symptoms of medicines otherwise unknown in their medicinal
effects, which fragments are published in various quarters and concerning the treatises as to
the mode of action of the various medicines which are surcharged with hypotheses, I would
only desire to say a few words as to the arrangement of the Materia Medica Pura, which
embody the results of a diligent study of the same as well as those of an extensive practice
which has been blessed by Providence.
Almost every incipient homoeopath will have had a similar experience with myself and many
of my acquaintances, namely, that he would think to find in almost every fully proved remedy
the elements of almost every disease. This delusion, which, however, only in part deserves
this name, will not disappear before by a comparison of the proving symptoms of two or more
medicines we have found the differences which exist between them. These differences appear
still more plainly when we come to their application, and only then we see the complete
inadequacy and incompleteness of the former pathologies, which, even at best, only sketch a
scanty outline of the genus of the disease, but never designate the varieties and the finer
shadings with the individuals, according to which alone the correct selection of the remedy
suitable for the genus of every disease can be made. What Allopathy means by an indicated
remedy is quite different from what we call a homoeopathically suitable remedy. Of the
former there are mostly a great number for every concrete case, the latter can only be one, and
even if there should be several under the former, which in various cases of disease, which are
summarized under one generic name, which might be of use in a homoeopathic, and not in an
antipathic manner, this is no way true of every case of this kind, but the choice, if it should be
homoeopathically suitable, must be so made that the remedy not only corresponds in a general
manner to the name of the disease, but also just as exactly to the accessory symptoms and
Although the preceding is known to every homoeopath nevertheless mention had to be made
of it, because from it necessary rules are derived as well for the study of the Materia Medica
Pura, as also for the selection of the remedies, rules which especially in these later days have
not been sufficiently observed and obeyed, and which in fact offer some difficulties.
In repeated and many-sided comparison of the symptoms observed by provers in several
medicines it is not indeed difficult to discover very soon quite a number of differences, but
their value is not of the same amount, and what is far worse, of very many remedies there is a
lack, just where we need it most, of that part in the observation which would serve best as a
control in the comparison. This defect which could not possibly have been thought of by the
provers in every case, because the momenta of the comparison were not yet before them, or it
was hardly possible to think of everything belonging thereto, being a lack indeed which
cleaves to everything human; this has to be supplied now, during the comparison itself, and
indeed proximately from the totality of the symptoms of every medicine and from the genius
of the same as recognized thereby. This, however, is a matter not only difficult, but also
laborious, and can only be satisfactorily accomplished by persons who combine with the
requisite mental qualifications sufficient perseverance and industry to acquire thereby
gradually a certain sort of facility in such investigations.
To make myself more intelligible, I will have to take an illustration to my aid, and I select for
this purpose (from Archiv. f. d. hom. Heilk., Vol. I, No. 3) an article by the late Franz, who
died all too early, the proving of Asafoetida, and indeed so as not to exceed a reasonable limit
the lancinating pains peculiar to this remedy. This pain, which is so characteristic for
Asafoetida, is not at all emphasized by the author in the preface (ibid., pp. 193 and 194), and I
remark particularly in order to call attention to the fact that we cannot rely upon the same,
even where they are written by distinguished men. Now if we consider what is said twenty
years later in the most complete work about it, i. e., in the “Manual of Homoeopathic Materia
Medica, by Noack and Trinks,” and in the “Symptom Codex by Jahr,” we find in the first on
page 146 under Asafoetida: “Lancinating pains, pointed prickings as from the pricking of
needles, or dull, boring, often connected with attendant symptoms; paralyzing, pinching,
convulsive, pressive, tensive, twitching, drawing pains, which readily change into different
ones.” Jahr says (ibid., page 113): “Intermittent, pulsating, or pressive stitching, also tearing
pains, passing from within outwards, changed by touch into different pains or diminished,”
etc. But when the symptoms observed in this remedy are closely compared, then the pains
which occur as well in the inner as in the external parts, lancinating frequent pains are mostly
dull and intermittent, most usual burning, more rarely pressive or tensive, most rarely drawing
and tearing, and they all have the peculiar characteristic that they pass from within outward.
Therefore, the symptoms 35, 47, 48, 58, 85, 86, 88, 89, 90, 91, etc., where this is not
particularly noted, have to be completed and made more exact, as they speak merely of
lancinations without any closer particularization. Furthermore when under nose, ears, lips,
chin, teeth, etc., no symptoms of lancination are noted and mentioned, we are by no means to
conclude thence that in lancinating pains in these parts, when they otherwise correspond to the
peculiarities of this remedy and the other symptoms agree, Asafaetida might not be the
remedy, and in fact I have brought quick and permanent relief by means of this remedy even
in lancinating burning pains in the teeth, ear and face, which were intermittent, and which felt
as if they came from within outward, and where otherwise the symptoms were in agreement
or there was nothing contra-indicated.
Of almost greater importance than the variety in the sensations and external symptoms is the
aggravation and amelioration of ailments according to time, position and circumstances.
Many, yea, we might say, most of the medicines at the provings give almost all the most usual
sensations of pain, it is true, in more or less peculiar modifications, so that if we were merely
confined to this we would very often be altogether unable to determine with certainty the
remedy exactly suitable homoeopathically. Here these peculiarities usually determine the
matter as easily as reliably. While, therefore, it is of the utmost importance always to consider
each one of these conditions of aggravation and of amelioration in the most exact manner, and
while without an accurate statement as to them the image of the disease can never be said to
be complete and sufficient for the selection of a remedy, the same trouble and the same
necessity of completing according to the measure of the medicine takes place as is mentioned
above, and in this case all the more, since just in this matter the deficiencies and gaps in the
symptoms of poving are far greater than in the other.
In thus completing and more closely determining the symptoms of the provings, three points
are especially to be regarded. The first is the peculiarity constituting the characteristic of the
medicine not in increasing the totality of the symptoms at the same time or under the same
circumstances, but at the one time the one symptom, at the other time another. To give an
example: In Ammonium muriaticum the ailments in the breast and head are increased in the
morning, the ailments in the abdomen, in the afternoon, and the pains in the limbs, the skin
and the fever in the evening. The second point consists in considering which are of two
opposite ailments and circumstances, which are both of a morbid nature (213) actually
deserves the predicate of aggravation. So as is well known Nux vom has most of its
aggravations in the open air. But the coryza peculiar to this remedy is frequently of such a
nature that in the room there is a very violent fluent coryza, but in the open air this at once
changes to the less incommoding obstruction of the nose; the latter, as in general the
suppression of secretion, is one of the first effects of this valuable remedy, so that the fluent
coryza in itself is to be considered as an alleviation of the ailment. A third point, which
especially where several remedies compete, considerably furthers the selection, is the careful
investigation as to the special parts not only of the body but even of every subdivision, every
organ or every limb, also of the single parts of the mind and reason, on which every medicine
chiefly exercises its virtue, an examination of which with some medicines is the most
difficult, and in which only after many years’ sedulous exertion and continued observation a
certain facility and certainty can be attained.
In this and no other manner, unless I am totally in error, and if my never to be forgotten
friend and teacher Hahnemann showed me the right course, the Materia Medica Pura ought to
be not only read but also studied; and only then when the homoeopath who is to be has
faithfully and persistently passed through this study he will be able even without spelling
together the symptoms, which as to a large part are incomplete, to find out in every case the
suitable remedy with certainty. He will also be able to find out the differences and
characteristics of the antipsoric medicines which offer so extraordinarily many similarities-
just because they correspond to one and the same great division of diseases, and he will not be
obliged in this case, where long action is so important and necessary, to change every
moment, but his errors may be counted among the rare exceptions. Finally he will not need to
immerse himself in hypotheses, and in the genuine allopathic manner (as in the Manual of
Noack and Trinks, where, with words sounding learned and with numerous defamations and
others, applications in quite a general manner are given of a remedy which sound almost
verbatim the same in several dozens of other remedies, which are nevertheless quite different)
again institute experiments on patients which we have striven so carefully to avoid, and
instead of finding the remedy exactly suitable homoeopathically seek out one of the remedies
indicated in allopathic manner.
I come now to the third caution, namely, the warning of the old and experienced master
against the precipitation which prevents us from allowing every homoeopathically selected
remedy from finishing its action.
Let us hear first of all how Hahnemann expresses himself (ibid. page 151):-
“The third great fault, which the homoeopathic physician cannot avoid too carefully nor too
steadfastly in treating chronic diseases, is the precipitance and thoughtlessness, in giving
another remedy, so long as a carefully selected antipsoric medicine, given in a dose small
enough, has proved itself active for several days, under the erroneous supposition that so
small a dose could hardly act more than 8 to 10 days, which delusion is sought to be
supported by the fact that on the one or other of the days that the medicine was allowed to act
the morbid symptoms which it was desired to eradicate had again showed itself from time to
“But if the medicine, because it had been selected homoeopathically, acted well and
advantageously, which was seen already on the eighth and tenth days, there may nevertheless
be an hour here or there or half a day where a moderate homoeopathic aggravation may
appear; the good consequence will nevertheless not fail to appear; but these often show
themselves not before the 24th or the 30th day in their best light; such a dose will then usually
not have completed its favorable action before the 40th or 50th day, and before this day has
arrived it would be irrational and obstructive to the progress of the improvement to give
another medicine. Let no one think that we ought to barely wait until the period of action
assumed shall have passed before another antipsoric medicine should be given-that we ought
therefore to hasten with the change in order to hasten the cure. Experience altogether
contradicts this opinion and in such a way that we cannot more surely hasten a cure than by
allowing the suitable antipsoric medicine to act, as long as it continues the improvement,
(even if this were several and many days *) beyond the set putative time of its operation; we
should in such cases, therefore, give as late as possible a dose of new medicine. Whoever is
able to moderate his precipitance in this point will the more quickly reach this point. Only
when finally the symptoms diminished by the last and former doses begin for a few days to
show up again, or to be notably aggravated, then only the point of time has surely come that a
dose of the medicine most suitable homoeopathically should be given. Experience solely and
alone and careful observation can determine this matter and in my manifold and exact
observations it has so decided that there is no doubt left in my mind.”
“As a rule, therefore, antipsoric medicines act in protracted diseases the longer the more
protracted these are, but also the reverse, etc.-Hahnemann adds in a note to this (ibid page
153). ‘The avoidance of these two faults’-(namely with respect to the small dose and its long
duration) will scarcely make its way among physicians. These great and pure truths will for
some time be drawn in doubt and not exactly observed in practice.” * Nevertheless this true
proposition does not belong among those that need to be comprehended nor again among
those for which I ask a blind faith. I do not demand any faith in it nor ask that any one should
comprehend it. I myself do not comprehend it; but it is enough that it is a fact, and is not
otherwise. It is merely experience that says so, and I believe it more than I do my intelligence.
Yet who would dare to weigh and determine the invisible powers hitherto hidden in the lap of
nature, or to draw them in doubt if only they are brought out of the raw state of substance
appearing dead by some heretofore unknown invention, such as is potentizing through
prolonged trituration or shaking, as is now taught by Homoeopathy. But he who is not willing
to follow and to imitate what I am now doing after many years’ trial and experience,-what
then will a physician risk if he should imitate me exactly? He who is not willing to imitate me
exactly, he can leave the great, yea, the greatest problem of art unsolved, he can leave the
important tedious diseases uncured, as they remained up to the time when I began to teach.
More than this I shall not say. I have thought it to be my duty to give these great truths to the
world, that stands in need of them, nor caring whether they can gain it over themselves to act
exactly in accordance therewith or not. If it is not done exactly, then let them not boast of
having imitated me, nor let them expect any great effect.”
Then finally the man of experience and rare gift of observation adds (ibid. pp. 154 and 155)
the following words, worthy of being heeded:-“If, however, the suitably selected antipsoric
medicines do not act out their full time, while they are still acting, the whole cure will amount
to nothing. The new antipsoric prescribed too early and before the last has completed its
action, may it be ever so excellent in itself, or the new dose of the same antipsoric still acting
so favorably cannot make good the benefit which would have been derived by the full and
complete action of the previous dose, and this will not in all probability be made good by
anything that can be done.
The fundamental rule in the treatment of chronic diseases in this respect remains: To allow
the dose of the medicine selected homoeopathically, suitable for the case carefully examined
to its symptoms, to complete its action undisturbed, so long as it visibly furthers the cure, and
the improvement of the ailment noticeably progresses-a process which forbids every new
prescription, every interruption through a new remedy, as also the immediate repetition of the
same remedy. *
If there are any truths in these words of a man grown gray in his art, to whom no one can
deny an eminent gift of observation especially in this department, truths which surely very
many of his adherents will confirm from their own experience, it is actually incapable of
explanation how specificists with their assertions to the contrary, without any sufficient
proofs, have been able to find credence with so many beginners. And why do not the older
homoeopaths make use of their rights given them by long experience, and raise their voices
loud and high in warning against directions in the latest works, where we see directions for
giving in remedies like Calc. carb., Caust., Graph., etc., the first to the third trit., repeated
daily once or twice, and where the special indications as given by Hahnemann are given, but
neither his doses nor the duration of their action are mentioned? And why are they silent,
when in their many years practice they cannot fail to have numerous proofs of the truth of
Hahnemanns teachings, in view of the manifest tendency of the specificists, to overthrow all
the former observations and to introduce their assertions by means of tales of cures, which
surely cannot serve as patterns? I would finally ask these gentlemen, homoeopaths as well as
the specificists, who formerly were homoeopaths, on their honor and conscience, whether
they, especially in the chronic diseases, since they are giving more massive doses in quick
repetition, cure more successfully, more quickly and more permanently than before, when
they walked exactly in the paths laid down openly and faithfully by the founder of
In the beginning of this paper I have already mentioned that I barely escaped the almost
general fate of German homoeopaths in giving larger and more frequent doses. I think
therefore that I owe it to my readers to make known here as briefly as possible what two cases
very closely concerning myself, besides the uninterrupted warnings of my friend and teacher,
Hahnemann, together with many other experiences, soon led me to again return to minimal
and rare doses of medicine selected exactly after the homoeopathic method, and indeed with
such conviction that all the later assertions to the contrary were without effect upon my
The first case concerned myself in May, 1833. After excessive mental exertions, too much
sedentary occupation, and night-watches in the course of the winter, caused by multiplied
official duties, which were then incumbent upon me, as I then filled a very busy station,
during which I, as it were, for recreation had pushed my studies in Homoeopathy and in
botany, by the end of February felt unwell, with loss of appetite, emaciation, indolent stool,
etc., without being actually sick. Owing to the lack of any definite symptoms, I took no
remedy, but only changed my mode of living and my diet, in the hope of thereby regaining
what had been lost by manifest errors therein before. Still my expectations were disappointed;
my ailments increased from day to day, and were increased by a convulsively constricting,
very violent pain in the right side of the abdomen, with severe distention of the same, and
total constipation. Now I once tried smelling of Nux vom. 30 but without any success. Yea,
there was an aggravation. My sufferings in the meantime continually increased; I had now not
had a stool in eleven days, the pains in the side of the abdomen were dreadful, and other signs
gave clear indication that I was suffering from a crossing of the bowels (ileus) in the region
where I suffered from these pains. This condition was the more desperate as the image of the
symptoms which I had kept with great exactness during the latter half of my disease,
completing it from day to day (though I cannot now find it, because it was written on a
separate sheet), did not resemble any of the homoeopathic remedies which had hitherto
proved useful in this kind of disease. In this distress, which now had reached the highest
point, I was visited besides the two older physicians here whom I had converted to
Homoeopathy, also by two other friends living at a distance, (who when they shall read this
will remember it with pleasure), and all of them advised me to take Nux vom. in larger doses,
as the remedy which in such cases had most frequently proved of use. I followed this
unanimous advice, though it ran contrary to my own conviction, and took on the 11th day a
whole drop of the 12th of Nux vom., but not only without success, but with an aggravation
and the addition of new symptoms which could be recognized as first symptoms of this
remedy, proving as I had foreseen the inappropriateness of the medicine. On the following
day (the 12th) my friends came back, acknowledged their mistake, and now advised
Cocculus, of which I then immediately took a drop of the 6th potency. This medicine, which
also did not correspond to the symptoms, had no effect, and at the visit which they repeated in
the afternoon, and where they with the best intentions proposed also other unsuitable
medicines for a trial, I declared to them squarely that I would not again take a homoeopathic
remedy until the correct homoeopathic selection was plainly shown to me. Thus matters stood
on the evening of the 12th, and there remained but little hope to see me preserved to my
numerous family, when, with an exertion of my whole will power, overcoming the enormous
pains in the abdomen which were continually increasing, I took the image of my symptoms in
hand, determined not to quit until I had either found the suitable remedy, or was delivered by
death from my torments. It had come to be midnight before I was enabled to find in Thuja the
medicine that contained the characteristics of my ailment so clearly that I had them hand me
the medicine-case at once, and smelled once with each nostril at the pellets which had been
moistened a year before with the thirtieth dilution. What can describe the joy of the man in
despair when he sees himself saved? In five minutes the pains began to diminish in the painful
spot of the abdomen, and in ten minutes I had a most copious discharge of the bowels, after a
constipation of thirteen days. I at once fell into a refreshing sleep which I had missed for so
long, and when my friends visited me next day they were as much astonished as rejoiced
when I told them of the events of the night before. The improvement of my condition now
progressed steadily without any further medicine, and only a few days later I was able to
advise my dear friend and teacher Hahnemann, of my rescue from threatened death. I might
here close this account, so instructive to myself and friends, if I was not impelled to give the
admirers of our late father Hahnemann a new proof of his rare medical insight, which was
called out by this very incident. My last named letter arrived, namely, at a time in Coethen,
when Hahnemann himself was very sick, so that his answer of the 28th of April came into my
hands in the first days of May, 1833. What he wrote there about his own sickness and about
mine, I shall give in his own words:
“In spite of the great care I took, some vexation about * * * ( *) may have contributed to my
getting a suffocative catarrh, which for seven days before the 10th of April, * and for fourteen
days afterwards, threatened to choke me, in momentary attacks of an unbearable tickling in
the larynx, which wanted to compel me to a convulsive cough, but took all my breath away;
only exciting vomiturition with my finger brought back the breath, with other severe morbid
symptoms, very short breath (without constriction of the chest), a total lack of appetite and
thirst, aversion to tobacco, soreness and weariness in all my limbs, constant somnolence,
inability to follow my calling, and a presentiment of death. The whole neighborhood showed
me so great a love that I felt ashamed, through their frequent inquiries as to my health. Only
since the last four days I feel myself saved. First by smelling twice of Coffea cr. X-o, then of
Calcarea; also Ambra contributed its share. And so the Supreme Protector of all that is true
and good will give me so much more life as seems best to His wisdom. * * *
I was sorry from all my heart, that you have been so sick, and * * *( *) Now if you would
have an additional advice for the restoration of the activity of your bowels, I would call your
attention to Conium and to Lycopodium, and to taking daily walks in the open air. I am glad
to see that by your example you have done justice to the useful Thuja. * * * I would add here
that a few days after sending off my letter in which I had neither asked for his advice nor
spoken of any additional treatment I had taken the homoeopathically indicated Lycopodium,
and so also about eight days before receiving the letter from our Hahnemann Conium, each in
a minimal and single dose, and nothing else at all, and next year I took once more a single
dose (minimal) of Lycopodium, after which every trace of this ailment forever disappeared.
What a mass of observations and of experience was required, together with what a rare
divining power, in order to give in advance (in a disease which had only been communicated
as to its leading characteristics and as to the mere naming of the first remedy used), two
remedies which only subsequently, through their symptoms, were so distinctly and
determinedly indicated, as homoeopathically suitable, that of all the other remedies none
could come into competition and the result had already proved the correctness of the advice
before it had become known to me!
The second case concerned my eldest son, born on the 15th of September, 1814, and at
present referendary with the royal government here.
A few months after his birth there appeared in his face an eruption like milk scurf, which
quickly increased and soon covered it with a thick crust, as this eruption is wont to appear
when in its worst form. At the same time the mother was afflicted with an ulcerating breast,
which went over into suppuration and which was only imperfectly restored after a
In spite of my repeated and urgent warnings-because I was well acquainted with several cases
where injurious consequences had appeared from the allopathic way of suppressing such
eruptions,-various good and skillful physicians recommended various remedies; “blood-
purifying infusions of herbs,” “innocent ointments of cream and oil,” “worm-killing
purgatives,” baths for “strengthening the skin,” etc., were proposed and some of them applied
without my knowledge. Obstinate as the eruption showed itself, it had at least to yield to so
manifold attacks, to the great joy of the mother. But this joy did not last long. A few months
after the disappearance of the milk-crust and when the places which had remained red for a
long time had at last begun to resume their natural color there appeared at first slight but
gradually more severe attacks of dyspnoea, which after the lapse of half a year reached such a
height that during the 8 or 14 days of the several attacks we expected every hour to be his last.
Against this ailment, endangering the life so seriously, we sought help far and near with
celebrated and uncelebrated physicians, but found none. The attacks always returned in the
same manner, and although in later years they only appeared every four to eight weeks they
would last six, eight and often more days during which the patient could only breathe while
sitting and with the greatest efforts, which pressed out a clammy perspiration. Then he would
be unable to speak nor to move at all without aggravating the convulsive asthma, as the
physicians called it; and he had to pass the whole of the eight days sitting on chair, with the
upper part of the body leaning forward, almost entirely without sleep.
While I was afflicted with this trouble in my son, then my only one, and even in case he
should survive the attacks, could not foresee any but a sad future for him, as this trouble
seemed to mock all medical art; in this sad time, the second misfortune came upon us in the
fact that a scirrhus formed in the breast of my wife that had formerly been ulcerated. All the
physicians consulted urged a speedy operation, “in order that the bad blood formed only by
the scirrhus (?) might not spread further and make the case incurable.” I knew, indeed, that the
extirpation of the scurrilous mamma could not bring any cure, but as yet unacquainted with
Homoeopathy, I knew nothing better to advise, and allowed to be done what was unavoidable.
The result was as usual; after the lapse of a year and a half I was a widower and the father of a
boy whose death was threatened every three or four weeks.
I now pass over a period of several years, during which I had entered marriage a second time,
had become father of several children, and had come into circumstances which permitted me
to consult very many other allopathic physicians as to the asthmatic condition of my son
which had remained unchanged; but without seeing the least result.
Finally in the year 1822 I was so fortunate not only to hear about the excellences and
achievements of Homoeopathy, but also to see myself, who had been given up by
distinguished allopathic physicians, saved from death. But there was a total lack of
homoeopaths, the allopaths showed a determined and obstinate opposition against
Homoeopathy, of which they did not understand anything, and after repeated vain efforts to
induce anyone of the former physicians to take up the study of the new curative method,
nothing remained but to put my hand to the work and to devote all my leisure hours to the
study of this difficult science, for which I was better fitted than most others who have not
chosen the healing art for their profession, through my studies in natural history which I had
pursued with preference from my youth, and by a pretty accurate knowledge of the Old
School of medicine, as I had formerly visited most of the lectures in the University.
Finally the time approached when my son was to attend the University, and since a few
remedies of short duration of action which I had given him as it were tentatively were without
success, and the ailment remained in its customary bounds, and I had become convinced that
the cure could only be effected through a continual and carefully conducted treatment, I
determined to wait until he should have returned to the bosom of our family, and I myself
should have in the meantime so enlarged my knowledge of Homoeopathy that I might be safe
When then finally the moment approached, it was just at the time when the misfortune-I can
not call it otherwise-of the large and oft repeated doses had broken in on Germany and had
also seized upon me. I must indeed call it a real misfortune for me; for in spite of having
selected the right medicine, which was Phosphorus, I not only saw no result from the doses of
the low potencies which I repeated every eight days, but considerable aggravations and the
appearance of a number of Phosphours symptoms never before noticed by my son. Of the
latter I should only mention (counting by the second edit.) No. 10, 17, 21, 44, 87, 190, 105,
118, 141, 147, 245, 300, 390, 455, 580, 625, 665, 668, 931, 933, 950, 971, 1009, 1012, 1032,
1034, 1075, 1084, 1126, 1140, 1140, 1153, 1202, 1303, 1210, 1221, 1225, 1226, 1232, 1252,
1266, 1508, 1530, 1555, 1615, 1670, 1685, 1686, 1725, 1753, 1781, 1791, 1822, 1823 and
1886; and I would at the same time remark that the chest-symptoms there adduced were not
present before this time outside of the asthma-periods, or only in a very slight measure, but
now they continued without interruption.
I was insensate enough to continue in this manner and only then noticed the great mistake
which I had made. What bitter repentance would I have been spared, if a warning friend had
then been by my side! For acquainted with the views and teachings of Hahnemann who
continued to be closely intimate with me, I had not dared at first to tell him, and later on I was
still more loth to do it. The whole illness of my son was through my fault very much
aggravated and the attacks which now returned at every slight cause, and more frequently and
more violently than ever, even outside of the customary time, and which agitated my mind
most severely, may have contributed to make me recognize my fault sooner. May a kind
Providence protect every homoeopath from such remorse as I had to suffer at that time. But
the next thing was to make good the injury which I had caused. Repeated doses of Coffea and
Nux vom., then later on Ipecac., Chin., Veratr. and Arsenicum, all did something but only a
little, and many months passed before all the attendant symptoms which had not before been
noticed had again disappeared and the old asthma stood there again in its former form.
When this condition at last appeared, I left my son for three months quite without medicine,
and only after this period had passed I began the treatment anew, which I initiated with a
small dose of Sulphur 60 for four weeks and a dose of Nux vom. 30 for fourteen days (only
two pellets of each). Then I again took up an exact image of the disease, which coincided
exactly with the one taken up a year before, for a sure sign, not only that Phosphorus was
indicated now as before, but also that Phosphours had made no improvement in the large
doses I had repeatedly given before. Not without trembling and fear of an action too violent, I
now gave him immediately after an attack of the usual kind a small dose of Phosphorus 30,
namely, two pellets of the smallest size, * and the result showed that my apprehension had not
been without foundation, for after five days a violent first action of the old ailment and also of
the symptoms of Phosphorus, all those italicized, i. e., Nos. 21, 100, 105, 118, 245, 625, 933,
971, 1202, 1203, 1210, l221, 1225, 1226, 1232, 1252, 1686 and 1791, and several of the
others reappeared. Still this homoeopathic aggravation did not last long, and immediately
afterwards a visible improvement set in, which, with only a few interruptions lasting only a
few hours, and with a decrease of the duration and violence of the usual asthmatic attacks,
continued for over three months.
Thus Phosphorus which, in the excessive doses, although in comparison with allopathic
prescription doses of unheard of minuteness, had made so great and so lasting an injury, was
still the true homoeopathic remedy as being the most suitable homoeopathic medicine and
prove completely what the sagacious Father of Homoeopathy has taught in the first volume of
his book on “Chronic Diseases,” page 149, for such cases.
I will now only add in a few words that Phosphorus remained, to the end of this treatment,
the only indicated remedy and the only one furthering the cure. This was continued, after
three to four months, such a minimal dose being given, with a few interposed doses as they
seemed needed of Nux vom. and Hepar sulph. calc., each in just as high an attenuation and as
small a dose. After a year and a half I had the great joy of seeing my son so thoroughly cured
from his asthmatic ailment of the chest, although Allopathy had not been able to touch it, and
this cure is so perfect and permanent that at present not the least trace of it can be seen. He
can now undergo any exertion, foot-tours, hunting and dancing, without any injury; he can
expose himself to heat or to cold, can drink a glass of wine extra with friends; all this which
formerly always brought on an attack of asthma now does not injure him in the least. Even the
peculiar habitus of asthmatic persons, the sunken breast, the drawn up shoulders, the forward
stoop of the body, etc., have all disappeared in the course of the treatment, so that no one now
seeing him would dream that he had from his youth up suffered from such an ailment.
From the preceding the unprejudiced reader, though he will have seen only a small part of my
numerous experiences as to the three warnings of Hahnemann, will nevertheless be easily
convinced that I have had all possible cause to hold fast to these teachings as well as to many
others lately rejected by many, and which have been promulgated by the experienced sage.
Whether others, and specially the so-called specificists, have as weighty and tenable reasons
for their contrary belief, neither they nor we, but posterity, will have to decide, for they will
be able to compare whole masses of facts. Only so much is plain, that there is no cause of
persecuting us, who have remained true to the original teachings of Homoeopathy, with
contumely and mockery and to demand of us that we should follow the course of the
renegades, before these have indisputably proved their superiority. We, on the other hand, are
fully within our rights in offering a vigorous resistance, in revealing the shortcomings of our
opponents with frankness, as they are doing, and to demand instead of bold assertions facts,
and in ignoring injurious witticisms and insolent defamations, so long as they are meant to
supply the part of binding demonstrations. But we have no desire of avoiding the open and
honest combat for the truth, which is wont to ever appear more plainly after such contests, so
long as we are convinced that the truth is on our side. Therefore I would meet every champion
with the motto of our Master: Aude sapere.
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.
In 2001, rumors were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. “I also discovered that I really liked research.” Good thing, because the study had actually been a sort of audition. The professor, it turned out, had been putting together a team of exceptionally brash and curious young clinicians and Ph.D.s to join him in tackling an unusual and controversial agenda.
Last spring, I sat in on one of the team’s weekly meetings on the medical school’s campus, which is plunked crazily across a series of sharp hills. The building in which we met, like most at the school, had the look of a barracks and was festooned with political graffiti. But the group convened in a spacious conference room that would have been at home at a Silicon Valley start-up. Sprawled around a large table were Tatsioni and eight other youngish Greek researchers and physicians who, in contrast to the pasty younger staff frequently seen in U.S. hospitals, looked like the casually glamorous cast of a television medical drama. The professor, a dapper and soft-spoken man named John Ioannidis, loosely presided.
One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti’s study didn’t address the fact that drug-company research wasn’t measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn’t hurt as much today”). Another pointed out that Salanti’s study ignored the fact that when drug-company data seemed to show patients’ health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal.
Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can’t prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?
That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.
The city of Ioannina is a big college town a short drive from the ruins of a 20,000-seat amphitheater and a Zeusian sanctuary built at the site of the Dodona oracle. The oracle was said to have issued pronouncements to priests through the rustling of a sacred oak tree. Today, a different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I take all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me, as we contemplate the tree the day after the team’s meeting. “‘Will my research grant be approved?’” He chuckles, but Ioannidis (pronounced yo-NEE-dees) tends to laugh not so much in mirth as to soften the sting of his attack. And sure enough, he goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research.
He first stumbled on the sorts of problems plaguing the field, he explains, as a young physician-researcher in the early 1990s at Harvard. At the time, he was interested in diagnosing rare diseases, for which a lack of case data can leave doctors with little to go on other than intuition and rules of thumb. But he noticed that doctors seemed to proceed in much the same manner even when it came to cancer, heart disease, and other common ailments. Where were the hard data that would back up their treatment decisions? There was plenty of published research, but much of it was remarkably unscientific, based largely on observations of a small number of cases. A new “evidence-based medicine” movement was just starting to gather force, and Ioannidis decided to throw himself into it, working first with prominent researchers at Tufts University and then taking positions at Johns Hopkins University and the National Institutes of Health. He was unusually well armed: he had been a math prodigy of near-celebrity status in high school in Greece, and had followed his parents, who were both physician-researchers, into medicine. Now he’d have a chance to combine math and medicine by applying rigorous statistical analysis to what seemed a surprisingly sloppy field. “I assumed that everything we physicians did was basically right, but now I was going to help verify it,” he says. “All we’d have to do was systematically review the evidence, trust what it told us, and then everything would be perfect.”
It didn’t turn out that way. In poring over medical journals, he was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.
But beyond the headlines, Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.
This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”
Perhaps only a minority of researchers were succumbing to this bias, but their distorted findings were having an outsize effect on published research. To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else’s results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions.
In the late 1990s, Ioannidis set up a base at the University of Ioannina. He pulled together his team, which remains largely intact today, and started chipping away at the problem in a series of papers that pointed out specific ways certain studies were getting misleading results. Other meta-researchers were also starting to spotlight disturbingly high rates of error in the medical literature. But Ioannidis wanted to get the big picture across, and to do so with solid data, clear reasoning, and good statistical analysis. The project dragged on, until finally he retreated to the tiny island of Sikinos in the Aegean Sea, where he drew inspiration from the relatively primitive surroundings and the intellectual traditions they recalled. “A pervasive theme of ancient Greek literature is that you need to pursue the truth, no matter what the truth might be,” he says. In 2005, he unleashed two papers that challenged the foundations of medical research.
He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John’s calculations, but it’s hard to argue that the essential ideas aren’t absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine.
Still, Ioannidis anticipated that the community might shrug off his findings: sure, a lot of dubious research makes it into journals, but we researchers and physicians know to ignore it and focus on the good stuff, so what’s the big deal? The other paper headed off that claim. He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals. These were articles that helped lead to the widespread popularity of treatments such as the use of hormone-replacement therapy for menopausal women, vitamin E to reduce the risk of heart disease, coronary stents to ward off heart attacks, and daily low-dose aspirin to control blood pressure and prevent heart attacks and strokes. Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. That article was published in the Journal of the American Medical Association.
Driving me back to campus in his smallish SUV—after insisting, as he apparently does with all his visitors, on showing me a nearby lake and the six monasteries situated on an islet within it—Ioannidis apologized profusely for running a yellow light, explaining with a laugh that he didn’t trust the truck behind him to stop. Considering his willingness, even eagerness, to slap the face of the medical-research community, Ioannidis comes off as thoughtful, upbeat, and deeply civil. He’s a careful listener, and his frequent grin and semi-apologetic chuckle can make the sharp prodding of his arguments seem almost good-natured. He is as quick, if not quicker, to question his own motives and competence as anyone else’s. A neat and compact 45-year-old with a trim mustache, he presents as a sort of dashing nerd—Giancarlo Giannini with a bit of Mr. Bean.
The humility and graciousness seem to serve him well in getting across a message that is not easy to digest or, for that matter, believe: that even highly regarded researchers at prestigious institutions sometimes churn out attention-grabbing findings rather than findings likely to be right. But Ioannidis points out that obviously questionable findings cram the pages of top medical journals, not to mention the morning headlines. Consider, he says, the endless stream of results from nutritional studies in which researchers follow thousands of people for some number of years, tracking what they eat and what supplements they take, and how their health changes over the course of the study. “Then the researchers start asking, ‘What did vitamin E do? What did vitamin C or D or A do? What changed with calorie intake, or protein or fat intake? What happened to cholesterol levels? Who got what type of cancer?’” he says. “They run everything through the mill, one at a time, and they start finding associations, and eventually conclude that vitamin X lowers the risk of cancer Y, or this food helps with the risk of that disease.” In a single week this fall, Google’s news page offered these headlines: “More Omega-3 Fats Didn’t Aid Heart Patients”; “Fruits, Vegetables Cut Cancer Risk for Smokers”; “Soy May Ease Sleep Problems in Older Women”; and dozens of similar stories.
When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you’d think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.
For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death. Instead, they track easily measurable health “markers” such as cholesterol levels, blood pressure, and blood-sugar levels, and meta-experts have shown that changes in these markers often don’t correlate as well with long-term health as we have been led to believe.
On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven’t convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer.) And these problems are aside from ubiquitous measurement errors (for example, people habitually misreport their diets in studies), routine misanalysis (researchers rely on complex software capable of juggling results in ways they don’t always understand), and the less common, but serious, problem of outright fraud (which has been revealed, in confidential surveys, to be much more widespread than scientists like to acknowledge).
If a study somehow avoids every one of these problems and finds a real connection to long-term changes in health, you’re still not guaranteed to benefit, because studies report average results that typically represent a vast range of individual outcomes. Should you be among the lucky minority that stands to benefit, don’t expect a noticeable improvement in your health, because studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller. “The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.
And so it goes for all medical studies, he says. Indeed, nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest. The exciting links between genes and various diseases and traits that are relentlessly hyped in the press for heralding miraculous around-the-corner treatments for everything from colon cancer to schizophrenia have in the past proved so vulnerable to error and distortion, Ioannidis has found, that in some cases you’d have done about as well by throwing darts at a chart of the genome. (These studies seem to have improved somewhat in recent years, but whether they will hold up or be useful in treatment are still open questions.) Vioxx, Zelnorm, and Baycol were among the widely prescribed drugs found to be safe and effective in large randomized controlled trials before the drugs were yanked from the market as unsafe or not so effective, or both.
“Often the claims made by studies are so extravagant that you can immediately cross them out without needing to know much about the specific problems with the studies,” Ioannidis says. But of course it’s that very extravagance of claim (one large randomized controlled trial even proved that secret prayer by unknown parties can save the lives of heart-surgery patients, while another proved that secret prayer can harm them) that helps gets these findings into journals and then into our treatments and lifestyles, especially when the claim builds on impressive-sounding evidence. “Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.”
Though scientists and science journalists are constantly talking up the value of the peer-review process, researchers admit among themselves that biased, erroneous, and even blatantly fraudulent studies easily slip through it. Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.” What’s more, the peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs—as with the exciting-sounding gene linkages (autism genes identified!) and nutritional findings (olive oil lowers blood pressure!) that are really just dubious and conflicting variations on a theme.
Most journal editors don’t even claim to protect against the problems that plague these studies. University and government research overseers rarely step in to directly enforce research quality, and when they do, the science community goes ballistic over the outside interference. The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.
But even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited.
Doctors may notice that their patients don’t seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings. Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed. That we’re not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.
Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right). And needless to say, things only get worse when it comes to the pop expertise that endlessly spews at us from diet, relationship, investment, and parenting gurus and pundits. But we expect more of scientists, and especially of medical scientists, given that we believe we are staking our lives on their results. The public hardly recognizes how bad a bet this is. The medical community itself might still be largely oblivious to the scope of the problem, if Ioannidis hadn’t forced a confrontation when he published his studies in 2005.
Ioannidis initially thought the community might come out fighting. Instead, it seemed relieved, as if it had been guiltily waiting for someone to blow the whistle, and eager to hear more. David Gorski, a surgeon and researcher at Detroit’s Barbara Ann Karmanos Cancer Institute, noted in his prominent medical blog that when he presented Ioannidis’s paper on highly cited research at a professional meeting, “not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings.” Ioannidis offers a theory for the relatively calm reception. “I think that people didn’t feel I was only trying to provoke them, because I showed that it was a community problem, instead of pointing fingers at individual examples of bad research,” he says. In a sense, he gave scientists an opportunity to cluck about the wrongness without having to acknowledge that they themselves succumb to it—it was something everyone else did.
To say that Ioannidis’s work has been embraced would be an understatement. His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work—that would be a paper he published in Nature Genetics on the problems with gene-link studies. Other researchers are eager to work with him: he has published papers with 1,328 different co-authors at 538 institutions in 43 countries, he says. Last year he received, by his estimate, invitations to speak at 1,000 conferences and institutions around the world, and he was accepting an average of about five invitations a month until a case last year of excessive-travel-induced vertigo led him to cut back. Even so, in the weeks before I visited him he had addressed an AIDS conference in San Francisco, the European Society for Clinical Investigation, Harvard’s School of Public Health, and the medical schools at Stanford and Tufts.
The irony of his having achieved this sort of success by accusing the medical-research community of chasing after success is not lost on him, and he notes that it ought to raise the question of whether he himself might be pumping up his findings. “If I did a study and the results showed that in fact there wasn’t really much bias in research, would I be willing to publish it?” he asks. “That would create a real psychological conflict for me.” But his bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”
As helter-skelter as the University of Ioannina Medical School campus looks, the hospital abutting it looks reassuringly stolid. Athina Tatsioni has offered to take me on a tour of the facility, but we make it only as far as the entrance when she is greeted—accosted, really—by a worried-looking older woman. Tatsioni, normally a bit reserved, is warm and animated with the woman, and the two have a brief but intense conversation before embracing and saying goodbye. Tatsioni explains to me that the woman and her husband were patients of hers years ago; now the husband has been admitted to the hospital with abdominal pains, and Tatsioni has promised she’ll stop by his room later to say hello. Recalling the appendicitis story, I prod a bit, and she confesses she plans to do her own exam. She needs to be circumspect, though, so she won’t appear to be second-guessing the other doctors.
Tatsioni doesn’t so much fear that someone will carve out the man’s healthy appendix. Rather, she’s concerned that, like many patients, he’ll end up with prescriptions for multiple drugs that will do little to help him, and may well harm him. “Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line. What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.
Later, Ioannidis tells me he makes a point of having several clinicians on his team. “Researchers and physicians often don’t understand each other; they speak different languages,” he says. Knowing that some of his researchers are spending more than half their time seeing patients makes him feel the team is better positioned to bridge that gap; their experience informs the team’s research with firsthand knowledge, and helps the team shape its papers in a way more likely to hit home with physicians. It’s not that he envisions doctors making all their decisions based solely on solid evidence—there’s simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn’t good, doctors should know that, too. And so should patients.”
In fact, the question of whether the problems with medical research should be broadcast to the public is a sticky one in the meta-research community. Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. Ioannidis dismisses these concerns. “If we don’t tell the public about these problems, then we’re no better than nonscientists who falsely claim they can heal,” he says. “If the drugs don’t work and we’re not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn’t mean we have a right to overstate what we’re accomplishing.”
We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”