Phenomenology, pathography, and the concept of illness

When I started my research I found that the language and concepts routinely used to describe illness are inappropriate, incomplete and often misleading. I became increasingly aware of the impoverished language used in the medical world I encountered, which, in turn, led me to suspect that an impoverished concept of illness was in the background.

(Havi Carel[ ¹ ])

“Homeopathy works!” – is the watchword in the Faculty's argument for the acceptance of homeopathy by the medical profession, and its provision in the National Health Service. And it is true. The therapeutic method of homeopathy consistently achieves excellent results in clinical outcome studies[ ² ]; health gains that exceed conventional expectations to an extent that patients sometimes reasonably describe them as ‘miraculous’. But despite evidence of the activity of high dilutions in general[ ^3–6 ] and homeopathic medicines in particular,[ ^7–11 ] which only plausibility bias,[ ¹² ] a degree of intellectual dishonesty, or wilful ignorance can deny, we have to admit that the homeopathic therapeutic process is a ‘black box’.[ ¹³ ] Which is true, of course, of all therapeutic methods.[ ¹⁴ ] That is to say, many factors contribute to the effectiveness of the whole process, of which the efficacy of the specific intervention, in this case the homeopathic medicine, is only one. And in clinical practice we can never know for sure how much each element of the black box contributes to the outcome in any individual patient.

• References

• 1 Carel H. Illness. Durham: Acumen; 2008.
• 2 Spence D.S., Thompson E.A., Barron S.J. Homeopathic treatment for chronic disease: a 6-year university-hospital outpatient observational study. J Altern Complement Med 2005; 5: 793-798.
• 3 Bastide M., Daurat V., Doucet-Jaboeuf M., Pelegrin A., Dorfman P. Immunomodulatory activity of very low doses of thymulin in mice. Int J Immunother 1987; 3: 191-200.
• 4 Daurat V., Dorfman P., Bastide M. Immunomodulatory activity of low doses of interferon-α,β in mice. Biomed Pharmacother 1988; 42: 197-206.
• 5 Doutremepuich C., de Seze O., Le Roy D., Lalanne M.C., Anne M.C. Aspirin at very ultra low dosage in healthy volunteers: effects on bleeding time, platelet aggregation and coagulation. Haemostasis 1990; 20: 99-105.
• 6 Belon P., Cumps J., Ennis M. et al. Histamine dilutions modulate basophil activation. Inflamm Res 2004; 53: 181-188.
• 7 Linde K., Jonas W.B., Melchart D., Worku F., Wagner H., Eitel F. Critical review and meta-analysis of serial agitated dilutions in experimental toxicology. Hum Experim Toxicol 1994; 13: 481-492.
• 8 Endler P., Pongratz W., Smith C., Schulte J. Non-molecular information transfer from thyroxine to frogs with regard to homeopathic toxicology. Veterin Human Toxicol 1995; 37: 259-260.
• 9 MacLaughlin B.W., Gutsmuths B., Pretner E. et al. Effects of homeopathic preparations on human prostate cancer growth in cellular and animal models. Integr Cancer Therap 2006; 5: 362-372.
• 10 Endler P., Thieves K., Reich C. et al. Repetitions of fundamental research models for homeopathically prepared dilutions beyond 10-23: a bibliometric study. Homp 2010; 99: 25-36.
• 11 Bracho G., Varela E., Fernández R. et al. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010; 99: 156-166.
• 12 Rutten L., Mathie R.T., Fisher P., Goossens M., van Wassenhoven M. Plausibility and evidence: the case of homeopathy. Med Health Care Philos 2012 Epub ahead of print DOI: http://dx.doi.org/10.1007/s11019-012-9413-9.
• 13 Swayne J. Remodelling medicine. Glasgow: Saltire Books; 2012: 396-398.
• 14 Moerman D. Meaning, medicine and the ‘placebo effect’. Cambridge: Cambridge University Press; 2002.
• 15 Swayne J. Homeopathic method. 2nd edn. Glasgow: Saltire Books; 2013.
• 16 Brody H. Stories of sickness. New Haven: Yale University Press; 1997.
• 17 Marcum J. Biomechanical and phenomenological models of the body, the meaning of illness and quality of care. Med Health Care Philos 2004; 7: 311-320.
• 18 Whitmash T.E. Phenomenology and homeopathy. Homp 2012; 102: 225-229.
• 19 Carel H. Phenomenology and its application in medicine. Theor Med Bioeth 2011; 32: 33-46.
• 20 Midgeley M. Science as salvation. London: Routledge; 1992.
• 21 Harris C.M. Seeing sunflowers. J R Col Gen Pract 1989; 39: 313-319.
• 22 Swayne J. The starting point: pathography. Homp 2002; 91: 22-25.
• 23 Barker J. Paradigms: the business of discovering the future. New York: Harper Collins; 1992.