This book review is reprinted from Volume 97 Number 4 Winter 2004-5 edition of American Journal of Homeopathic Medicine with permission of the American Institute of Homeopathy
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Homeopathy: How It Really Works
By Jay W. Shelton, PhD

Amherst NYP: Prometheus Books 2004. ISBN:1-59102-109-x. Paperback. 319 Pages

Reviewed by George Guess, MD, DHt

One has to say that Dr. Shelton defends his hypothesis admirably.We homeopaths most definitely have feet of clay, and in many respects, from a logical standpoint, his arguments cannot be refuted based upon existing scientific evidence. Our discipline is rife with inconsistencies, contradictions, and uncertainties, not to mention unorthodox (even for homeopaths) practices that truly seem laughable.All of these, every facet of homeopathy Dr. Shelton exposes and critiques. His is not the ranting of a "quack hunter," looking to ridicule homeopathy, but rather the thoughtful examination of a serious, supremely skeptical scientist who took the time to thoroughly familiarize himself with homeopathy.

Dr.Shelton is not prepared to entirely dismiss the possibility of homeopathic medicine's efficacy. He allows for the possibility, but existing evidence and the many contradictions of the discipline, he asserts, do little to reinforce belief in homeopathy. Let's review some of his criticisms.

The first concerns homeopathic provings and the myriad assumptions made about them. He questions the precision with which we can reliably attribute a symptom to the remedy as opposed to other factors, bringing into focus the especially improbable assertion that everything that transpires in a proving subject is the result of the remedy (an assertion I have doubted for some time).The precise designation of time of symptom occurrence is questioned, as well as remedy sidedness. Group provers' meetings are questioned as a reliable way to identily symptoms, there being the real risk that the influence of the group could create false memories.Then there are the more radical, fringe proving habits of some of us-attributing symptoms in those who did not take a remedy to the remedy; including seemingly extraneous community/world events, etc. Such habits might reflect a keen understanding of the subtle,yet powerlul influences of energy fields, but they could just as easily be considered the result of magical thinking.

To a knowledgeable homeopath some of Dr. Shelton's assertions can be disputed; a general readership, however, will lack enough knowledge to question his arguments. For instance, on page 111 Dr. Shelton asserts that homeopathic cure rates have not changed appreciably since homeopathy's inception (about 70-80%).While this may be true,he finds this puzzling since we now have so many more remedies and computer technology to refine our remedy choices. He wonders why so many fewer remedies could achieve the same results in the past; however, as a layman,he can have no appreciation for the changes society has wrought over the two centuries since homeopathy's inception, of the greater psychological complexity of patients,of the obstacles we encounter in trying to counter the suppressive effects of allopathic medicine. Our job is much harder today, and if we can maintain a similar response rate, we are doing rather well.

Another criticism he levels at homeopathy relates to the wide variety of approaches homeopaths use to both analyze and prescribe for patients.Apparently everyone claims similar response rates. If this is true, he argues, it must mean that the remedies employed in these various cases really make no difference; other factors are influencing patient recovery.Yet, even within the ranks of homeopaths, we readily recognize that there are different definitions of response. Some of us require solid evidence of improvement on many levels in the patient, including especially the presenting pathology; others seem satisfied with any minimal positive change. Claims of cure can be exaggerated and will distort profiles of homeopathic response rates; thus confusing the issue.Also, Dr.Shelton seems ignorant of the difference between a simillimum and a similar remedy. The distinction is quite important when evaluating the action of a homeopathic remedy and when distinguishing a response to a homeopathic medicine from that to placebo.

One valid criticism Dr.Shelton levels at homeopathy is the exceptional variety of excuses we can employ to explain our patients' failure to respond-antidotes; truly,some of the excuses some of us can come up with are amazing-eating processed food,drinking citrus juice,not exercising, using a cell phone, etc. Such excuses make us look rather desperate to avoid any stigma of failure.

His skepticism can, however, reach somewhat giddying heights as when, in the course of criticizing Herring's Rules of Cure, specifically the observation that correct treatment relieves deeper, more significant symptoms/conditions first, he says that it is "clearly a matter of judgment as to which symptom is most debilitating. There is also some ambiguity in deciding how much improvement in a symptom is sufficient to declare that it improved."To this specious assertion I can only exclaim,"Please!" In most cases it will be abundantly clear, even to a layman.

It is clear to this reviewer that while Dr. Shelton has an extensive familiarity with homeopathy, his knowledge of our art and science remains somewhat superficial.As he raises doubt about every aspect of homeopathy from provings to clinical studies to patient response, he reveals his failure to comprehend some essential aspects of our discipline- strange, rare and peculiar symptoms, for instance. On page 181 he asserts,"Many of the common remedies have thousands of symptoms.A thorough case-taking garners dozens or hundreds of symptoms.The homeopath will typically select only five to fifteen patient symptoms as important to the case,and usually many of these symptoms are not represented at all in the chosen remedy. I estimate that the patient often has less than 1 percent of the remedy's symp- . toms, and often the remedy, depending primarily on its size, may have less than half of the patient's symptoms." Where he gets such a figure, I can only imagine. In this criticism the author displays his ignorance of the whole concept of remedy image, of the separation of common symptoms (which have no value to the homeopath) and those uncommon, peculiar symptoms that express the individuality of both the patient and the remedy.These profiles of peculiarity are what we merge when matching a remedy to a patient, not the myriad common symptoms that reside unreliably in abundance in both patient and remedy.Additionally, in a couple of places his definitions of homeopathy and the Law of Similars are not precisely correct, and he spins off some criticisms of homeopathy using these flawed definitions. Dr. Shelton would do well to fine tune his education in homeopathy.

The author does offer an interesting analysis of homeopathic clinical studies, an area which most of us, I believe, feel needs considerable strengthening. For instance, he pointed out the fact that the degree to which homeopathic treatment favorably differed from placebo in studies declined relative to the increasing quality of the study.This is an interesting and confounding statistic,one which I suspect given my bias for homeopathy, based on experience-reflects more upon the way those conventionally higher quality studies evaluated patients and applied homeopathic. treatment than upon the questionable efficacy of homeopathic medicine per se- Dr. Shelton's preferred conclusion.

Dr. Shelton appears a quintessential skeptic and sophist, in addition to being a very capable and objective scientist. His core negative impression of homeopathy has made him, I believe, too readily dismissive of existing evidence favoring homeopathy. His treatment of animal studies and homeopathys success with infants, for instance,strikes me as biased. Furthermore, he provides almost no mention of the many in vitro studies that at the least demonstrate a potentized solution's physical, chemical and biological activity. Nonetheless, he does make many convincing arguments against homeopathy's effectiveness. I found myself, as I read becoming defensive and conjuring up, from my clinical experience and familiarity with our science, my own justifications for knowing homeopathy to be effective.

Setting aside clinical studies as being inconclusive,I would first emphasize the in vitro studies that to date have demonstrated that homeopathic medicines have a capability to effect physical,chemical,and/or biological changes on systems. This fact demonstrates objectively homeopathy's potential medicinal capacity. Next I would point out the impact our remedies have on infants and animals, mentioning quite compelling examples of cures that in no way could be attributed to increased parental,etc. nurturing as Dr. Shelton at one point considers. Then I might describe several patients I have managed over a lengthy period with little or only lukewarm response to remedies given previously who subsequently manifest a profoundly curative reaction to a newly prescribed homeopathic medicine. Such occurrences tend to dispel the placebo responder hypothesis in that all previous parameters of possible health-altering influences pre-existed for many months; nothing whatsoever had changed in their lives or our interaction other than the specific medicine prescribed.Then, to counter Dr.Shelton's requirement that a scientific theory be able to predict outcomes, I would mention the uncanny ability of our best practitioners (as I witnessed George Vithoulkas do on many occasions) to accurately predict patient response to a correct remedy, e.g., eactly which of many symptoms would improve and by what percentage and which would remain,as well as the likely follow-up remedy.(The problem with the great variability in our discipline, with regard to its predictive value is the requirement that practitioners acquire considerable skill,knowledge and experience in homeopathic medicine before they can achieve predictably reliable results

At the end the author,in fairness to homeopathy calles for more high-quality research to settle the question of homeopathy's efficacy.Also, he finishes with several interesting appendices wherein issues of purity and contamination,some fallacies of the water cluster model of homeopathy, etc. are discussed.

I think it is constructive to have one's beliefs challenged.It forces us to re-examine our science, correct our deficiencies, and refine our understanding. Dr. Shelton in "Homeopathy: How lt Really Works" presents us with quite a few challenges and points out more than a few of our weaknesses; consequently I believe it serves a useful purpose for all homeopaths willing to critically reappraise our science,as well as those interested in gaining some perspective on how some external observers view us.