“Life = sign activity.”

Thomas Sebeock

Recently, homeopathy and integrative medicines have come to be severely criticized. Precisely in a historical moment in which we imagined that, due to the dialogical capacity that science developed, sterile polemics would be overcome. It is worth noting that some criticisms cannot be ignored, but decontextualized attacks predominate, which, under the guise of selective skepticism, adopt an arbitrary stance, and, to a certain extent, of low scientific accuracy. 

This does not mean that there are no important gaps in the research program and in the scientific bases of medicines and integrative practices. At this point we are interested in trying to understand what is the pretext and context for warmongering? They emerged in the midst of a health crisis and in the face of the disturbing way in which techno-science has been addressing the current pandemic. It will not be bold to ask, I suppose, what would not be a “question of science?”, The platform headed by people – without any clinical experience in medicine – used to convey the objections.

Now, science is itself an issue. If it is fair to doubt “anything will do” in science – as Paul Feyrabend enunciated in his book “Against the Method” – the idea that there is only one methodology, a supreme monopsism of knowledge is laughable. That is to say, there would be a kind of “market reserve” of science, whose spokesman imagines at the same time, accusing, judging and issuing the verdict on the scientific status of a given knowledge is not only presumptuous, it exposes extremely ignorance about the functioning and historical development of scientific thought.

Health is, and will continue to be, a polysemic concept.

From the beginning: there is no consensus, neither conceptual nor terminological, on what health is, after all, because it is a truly polysemic concept. For example, is it just the absence of a disease? WHO itself denies this mechanical and reductionist version that seeks to circumscribe healing as a mere elimination of the disease. What is healing? Eliminate pathology only? Make the symptoms disappear? What about the mood, the mood, the mood? And in the field of mental health? Is it healthier for an individual more “adapted” to his environment? Some psychological currents would answer yes, while others would disagree. For integrative medicines, this adaptation is not always a health criterion and certainly removing the disease is not the only goal of therapy.

The logic of integrative medicine seeks a therapeutic action that will always be concerned with broader aspects: it takes into account the integrality of the subject’s clinical manifestations. It seeks to understand not only the clinical diagnosis and its respective treatment, but also to understand the real and imaginary idiosyncrasies, capturing through language the metaphors present in the report of the people being treated. It is not a question of stricto sensu psychotherapy , but it must be said that there are aspects beyond the physical complaints that need to be taken into account. Subjective complaints, people’s reports of life need to be accepted. They should even be used as a semiological reference. For what? So that the malaise no longer obstructs the free flow of life, one, if not the greatest harmful characteristic that the disease usually causes.

The subjective and the imaginary are part of the disease.

The professor of medicine, the neuropathologist Walter E. Maffei explained that the projection of images showing a cat was enough for those allergic to the fur of this animal to have some kind of reaction, showing that the fundamental susceptibility can start with the imaginary process of the subject. Maffei also sought to summarize the beneficial action of a successful therapy or drug as “shock organ deviation”, a process now clearly understood by modern immunology. That is, medical art, when used intelligently, would aim to produce interference which would lead the patient’s organism to a kind of “deviation” from the target organ, thus directing the organism to a safer anchorage, to a more superficial and / or less harmful. It may sound primitive, but this is how most drugs manage to relieve symptoms for most people.

Social impact and immediate resources.

In a situation like the one we are experiencing, homeopathic doctors, together with AMHB’s institutional support – in spite of government agencies and practically without financial resources – developed a care program (homeopathy at Covid) ** whose objective has been to help, provide free individualized medical support and information to the population in need of care during the pandemic.

Like Brazilian 19th century doctors who organized task forces against cholera and other endemic diseases, the understanding was that civil society actions are fundamental during health crises – but not only – especially when society is going through turbulent periods. It is a much less expensive way to offer care with a focus on primary health care.

In addition, from an integrative approach perspective, when we act on a person’s health, we also interfere with the people around them. There is already, it is assumed, a first impact on the social and support network, so that, in the end, it ends up articulating a change in the environment around the patient. This does not happen, of course, without certain clashes. In this process, a “superadapted” subject can abandon his passivity and start to have a more active attitude. And this more active attitude predicts that the conflict with the environment can end up becoming more intense. Anyway, overcoming passivity is a process that involves facing the conditions that prevent this flow.

Significant and meaning – language is semiology

One of the main rediscovery of the followers of this tradition initiated by the homeopathic doctor James Tyler Kent (1849-1916), was to observe that the elements that express the peculiar idiosyncrasy of each patient – sensations, imaginary contents, ideas, preferences, aversions, words, form of think etc. – can be referred to a series of minimum units, which he called themes. Accepting this point of view, the themes express, therefore, what truly disturbs the subject’s economy and can also be detected in people who received the stimulus of a drug substance.

During a treatment, it appears that people “themed”: that is, they give names to their psychic and physical, imaginary or real contents.

All communication that takes place during a medical consultation, regardless of the therapeutic orientation, ends up taking place through linguistic signs. Signs have two components: the signifier , which conveys information, and the meaning , the “message”, what the sign means. The relation of signification is not fixed: several meanings are attributed to the same signifier, and this depends on very personal references. As an old aphorism of medical experience teaches, in the clinic there is neither “always” nor “never”; all certainty depends only on the context of the subject who communicates.

In medicine, the first to use signs as semiological tools were Parmenides and Hippocrates. They used the equivalence system, signs used to code the symptoms present in clinical cases. However, they insisted on giving them an equivocal value, since the univocal value could only be attributed to the symptom in all its contextuality. It is due to Ferdinand de Saussure, however, the first linguistic conceptualization of the “sign”. This would consist of two elements: the referred concept (“meaning”) and the expression that refers to it (“significant”): sounds, words, graphic images, etc. It was Jacques Lacan, however, who broke the necessary correlation between signifier and signified (“signification”), by explaining that each subject builds his own significant chain, attributing particular meanings to the elements offered by the language of his environment (“signification”).

The immediate objective of a prescription is, therefore, to produce some kind of response through the drug stimulus. This answer is often translated by what the classic authors called “aggravation”. This would be a disorder voluntarily caused by the drug. With due proportions, it is somewhat analogous to what happens with vaccines. And it is the only way for the individual to get out of the previous conditions. A treatment can induce and cause disorders. The fabrics are ductile: they adapt easily to shapes. That is why the drug extends its action beyond the stricto sensu organs . Like a “chain reaction”, it causes changes in metabolism, sleep, dreams, and finally changes functions. When successful, the subject moves to a new homeostasis. 

Some basic researchers dedicated to the effects of infinitesimal drugs evaluate the effect of drugs in physiological terms: administering, for example, Digitalis purpurea in ultra-diluted doses to animals such as mice and frogs. They seek, for example, to measure the chronotropic and inotropic effects on cardiac musculature. Some have assessed the effects of serum serotonin levels, or how eventual “receptors” connect to mapped pharmacological sites. (Benveniste, 2002). These are truly useful contributions within a research program. 

But that is not all. It is noticed, however, that any clinical action mediated by homeopathic drugs (that is, drugs diluted and subjected to a vigorous kinetic action that contains information that produces interference in the living organism) is not limited to the punctual effects aroused by such drugs. Firstly, the differences between anima nobili (man) and anima vili (animals) must always be considered. Second, but not least, that in classical oriented homeopathy, not every individual with heart failure will take a specific medication directed exclusively to their underlying pathology. Hence, the clear limit when it comes to assessing the effectiveness of an integrative approach through the consensual gold standard for assessing the therapeutic efficacy of drugs such as RCTs (randomized clinical trials).

This was confirmed by practical knowledge: a medication is prescribed for a patient with, for example, rheumatoid arthritis, a well-known autoimmune pathology. Then, in addition to the relief of symptoms, there may be an improvement in addition, for example, alcoholism, a fact that had not even been reported to the doctor. In other words, there is strong evidence to suppose that medicinal substances, probably not only homeopathic drugs – but the therapeutic process as a whole, act in a systemic way and have repercussions beyond specific organotropic actions.

Every drug, whatever it may be, has the dreaded and unpredictable “side effects”, some are just strange, others are paradoxical. Negative semiological value can be attributed to these effects, which we can call idiosyncrasies, a very particular way of reacting. But we can value them in a very different way. It makes perfect sense to evoke these aspects especially in relation to the more this artificial controversy that has been registered about the validity or not of certain medicinal substances proposed for early treatment of symptoms produced by SarsCov2.

If there are doubts why are we so reluctant to test them without prejudice? Why certain a priori objections? Since when is this applicable within a scientific methodology? And if such drugs prove to be empirically effective, what is the problem with using them in an emergency situation, in a field where there are many more doubts than certainties, and lives could be spared?

It should be explained that according to an article published by the BMJ (British Medical Journal) in 2017, very few drugs have the certification called 1A, that is, of high relevance and statistical power, and to be more precise, only 10% of the 9451 therapeutic recommendations from the database. Dice.

Rationalists and Empiricals

The uproar surrounding the effectiveness of integrative medicines, with a false appearance of the unprecedented, is in fact rooted in aspects much earlier in the history of medicine: it is the famous, but little-publicized conflict between rationalists versus empirical. To locate the reader, I reproduce the following excerpt from the historian and researcher Harris Livermore Coulter:

“Fundamentally, what I discovered – or rediscovered – is the existence of a conflict in therapy between what is called empirical and rationalist philosophies. I use the word “rediscovered” because, in fact, doctors were aware of this conflict until the year 1800 or so, and medical histories written before that time discuss this conflict that dates back to Roman and Greek times. But after the middle of the 19th century, when medicine was dominated by technology, this primordial conflict was forgotten. However, the opposition between these two ways of thinking about medicine continued, albeit underground. Empirical and rationalist philosophies are two logical and consistent structures of thought that are, in all respects, entirely antagonistic to each other. The great medical thinkers belonged to one or the other of these two traditions. Minor thinkers, who are by definition less rigorous in their theorizing, generally represented eclectic combinations of the two main traditions. ”

And later, in the same article:

“What is the difference between the two doctrines? There are two particular factors that distinguish them from each other. Empiricism is vitalistic, while Rationalism is mechanistic in its approach to the living organism. And empirical doctrine always tends to individualize treatment, while rationalist doctrine invariably views the individual patient as a member of a group of diseases, class or entity and moves away from individualization. The representation of the primary relationship in medicine is the doctor sitting on one side of the table and the patient on the other side of the table, or the doctor standing beside the bed and the patient lying on the bed. The patient says many things to the doctor, and the doctor can see more with his own eyes. In addition, several tests can be done to develop data from and about the patient. The question is: what does the doctor do with this data when it is available? Empirical physicians saw these data as having maximum value in and of themselves. They did not try to penetrate below the surface, they did not try to speculate on what was happening inside the patient’s body, but they used the symptoms as data on which to base diagnosis and treatment. In other words, they distrusted anatomy and physiology as sources of medical knowledge – because anatomy and physiology are general and, as such, go against the empirical principle of individualization. Considering that certain physiological and pathological processes occur in humans as a class, the individual patient may or may not represent that particular class of patients. Each person is different from the average. The mean is an abstraction. Each patient is different and unique – this has always been the strong belief of empirical doctors. Thus, the only truly reliable information is that developed about that individual patient. ” The Journal of Orthomolecular Medicine Vol. 9, No.3, 1994

Although homeopathic experimental approach have peculiarities that make them much greater range of experiments, tests with medicinal substances ultra diluted – Call pathogenesis – would not be exclusive of homeopathic medicines: every time a patient ingests any drug, is making broad sensu an experiment by default, that is, it is producing symptomatology, as one of the most classic works of pharmacology teaches us:

“The application of the scientific method to experimental therapy, is exemplified in a well thought out and conducted clinical trial.” And further: “An effect of a drug that is not produced in a clinical trial can appear in clinical practice … Half or more of the beneficial and toxic effects of drugs, not recognized in the first formal trials, were later proven in practice doctor.” (Melmon et al., In: Goodman and Gilman, The Pharmacological Bases of Therapeutics, 1986: 58-9).

Therefore, it is well understood why new symptoms take time to be included in the list of side effects of a drug, which, over the years, only increase, as the use of the drug becomes popular.

The same criticism also applies to homeopathic medicines. The German doctor who systematized the use of substances based on a similar rule, Samuel Hahnemann, as well as later researchers experimentally observed that the spectrum of action of the drugs was much greater than he had initially supposed.

Why do idiosyncrasies matter for therapy?

It is a particularly complex issue for homeopathy. In his book Organon in paragraph 112 the (July 1991) relates to primary and secondary effects produced by homeopathic medicines. The primary effect of a drug is its action and the secondary effect, shows the reactivity of the subject who received the drug. 

Organon – Word of Greek origin ( ὄργανον ), whose closest meaning is “instrument”. The first Organon was written by Aristotle and, according to Lalande, inaugurates formal logic. Francis Bacon writes Novum Organon , a book that roughly rejects accidental inferences and knowledge not supported by methodical empirical observations. Hahnemann publishes the “ Organon da Arte de Curar”, whose subsequent editions underwent successive changes in its paragraphs until reaching the sixth and last edition.

For example, if the primary effect of Belladona , ( Atropa belladona ) in weighted doses, is a vasoconstriction, the secondary response will be a vasodilation. This is useful from a toxicological point of view: the same concept can apply to hyperacute intoxications with opiates. However, and this is what is decisive here, the secondary response is characterized by presenting itself with a kind of “personal signature”. Vaso-dilation, a reaction, does not come without added values: for example, it can be “hot”, “in tightness”, “oppressive”, “acidic”, “irritating”, “hammering”, “as if by a screw ”or be aggravated or relieved by“ sitting down ”,“ eating ”,“ climbing stairs ”,“ when crying ”,“ by the sea ”,“ when reading ”etc. The name “reaction or side effect” would be a mixture of the action of the drug and the particular reaction that the subject presents when exposed to the drug. This is of extraordinary value, because it is essential. It shows that a strict division between primary effect – secondary effect is not useful, because what essentially interests are the modalizing attributes of the action, of each response in totum .

The toxicologist Legrain would make an important collaboration when referring to the weight of the individual reaction in the intoxications, affirming the following:

“Finally, we would mention the vital importance of the individual reaction, which profoundly changes the clinical picture of the same intoxication and decreased the clinical value of toxic insanity as a morbid entity, making it just a modification, varying according to personal idiosyncrasies.” ( apud Tuke, 1892: 974).

Investigations that began in the nineteenth century and that extended to contemporary times showed that different toxics used by the same individual trigger similar psychic conditions; however, the somatic pictures produced are different, corresponding to each toxicant. In the opposite situation, when the same drug is used in different individuals, we will observe different psychic conditions – one for each individual – and a similar somatic condition for all those who have been subjected to the action of the toxic. These observations of experimental toxicology allow us to infer that the psychic susceptibility to the toxic substance depends rather on the individual mental peculiarity than on the toxic action itself.

These rules are found in the chapter on “Mental Syndromes in Intoxications”, in the Medical-Surgical Encyclopedia, written by Fournier and Gorceux, and were repeated in 1973, by JP Soubier and F. Caroli and C. Bismuth, who confirmed the hypotheses of work in an analogous chapter. Many of these doubts, extended to the use of synthetic drugs for clinical use, have also been stated in therapeutics and clinical trials (Coulter, 1992; Tallaway et al., 1964; Modell, 1960; Chassan, 1960). For homeopathy, however, these findings, instead of interfering with understanding as enigmas, have enabled an approach to this theoretical problematization area with some efficiency: homeopaths base their prescriptions on a semiological model that is centered on individual differences to build the model that will guide the therapeutic elaboration. In other words, there was a positive connotation to the idiosyncrasies, the mental and subjective state of the patients.

All of these aspects are essential to bear in mind that homeopathic treatment has a polysemic action over the whole. The clinician must know the action of each drug, but must also have an empirical notion of the vitality of the patients, that is, the operational way in which the mood and the individual disposition and the medication response of each sick person are manifested, in the here and now .

In short, what the theoretical and empirical developments in homeopathy have been progressively revealing, is that the identity of the suffering that leads a subject to seek assistance and, therefore, also the therapy that should be prescribed, can only be established when it is interpreted. the individual’s unique situation in his reactions and relationships. Its surroundings, history and context. And that should be universal, that is, applied to all medicine regardless of the type of medicine used.

Supported by narratives experimentally produced by experimental induction, which show peculiar and singular forms of discourses and subjective expressions, in the vitality (understood as this physical, mental and relational totality) of each subject. And this is only possible in the interaction between the therapist, the drug (s), the subject and their feelings and experiences. If there was nothing else that integrative medicines could contribute to science, they would at least have offered the purest rescue of the doctor-patient relationship. And homeopathy was lavish in this rescue because it made this relationship an essential part of its methodology.

Therefore, we affirm that the semiological act, as well as the therapeutic of homeopathy, only takes place as an authentic hermeneutic process. For they are always processes of elucidation of the meanings of the signs that body and mind, in their relations with the world, are emitting on the mode and degree of convenience of the state of both regarding the purposes and functions for which they turn. And this clarification is always reframing, since it can only happen in the context of the dialogue with the doctor.

This, through his own experiences and repertoires, the anamnesis he will use and the drugs he will prescribe, will make the patient’s speech, the narrative of his experiences and impressions, gain unprecedented conditions to express himself.

It was agreed to call the symptom note sheet “ record ”. In it, all patient data should be noted, along with the medications considered in each consultation, the semiological references used, repertorization and all the words, speeches, contexts and narratives with which the patient refers to his objective and subjective complaints.

Thus, paradoxically, the supposed epistemological “weakness” of this type of approach ends up being its main strength. This means that its methodological weakness would function as a humanizing element in the doctor-patient relationship. As if forcing the clinician to prolong and deepen the dialogue in search of more consistent semiological elements to prescribe, since technology and armed propaedeutics would only be subsidiary instruments for therapy. This, but not only this, would be one of the reasons for its permanence as knowledge, and, at the same time, it will continue to be a source for the attacks directed against it. Now, since the famous WHO Congress Alma-Ata, as well as in the report published in Geneve in 1988, there is a worldwide outcry for more “human” medicine with the forgiveness of the use of this euphemism. Where the quality of the therapist’s presence is a requirement. This characteristic, therefore, should not be ammunition for hostilities, but an extra quality to be revered within the integrative medicines.

It is, therefore, a legitimate fusion of horizons what happens in an integrative approach. With special emphasis on how this relationship occurs during a consultation in homeopathic medicine. That is why it is so important for an operating science – a term used by several epistemologists to define medicine – that it is recognized that there are other scientific models and epidemiological conceptual dignities in health sciences such as qualitative research, historical epistemology, narrative-based medicine. , patient-based medicine, health-related quality of life research, psychometric tests and scores – which have sufficient capacity to promote scientific validation of knowledge. 

Therefore, yes, one must use all types of journalistic vehicles, including those of great penetration, so that the non-specialized reader, before forming any judgment on a set of knowledge of a practice of two and a half centuries, is informed in a more comprehensive and honest.

It would also be appropriate to ask readers, when possible, when they hear criticisms against integrative medicines – usually without a right of reply – to also consult the contradictory arguments. For one can always give the false impression that science has a single voice, when in fact each arm of scientific research is, by definition, just another part of the score. It is there that the scientific spirit, knowing since the polyphony of knowledge will always be unfinished, and aware of its incompleteness, will seek the remaining musical notes, some forgotten in the past, to fit them in the symphony. 

* Article adapted from the doctoral thesis defended at FMUSP “ Between Art and Science: hermeneutic foundations of homeopathic medicine ”. Received the publication by Editora Hucitec, 2005, São Paulo. (“Health in Debate” collection)
** Also published on the AMHB (Brazilian Medical Homeopathic Association) website