Delayed responses ... was LM question

[Wendy Howard]

Hennie wrote:
waiting

I've seen a similar case published by a well-known American homeopath, and
must admit to finding this idea of the (very) delayed response rather hard
to swallow.

We are, after all, open systems. It's not like we take a homeopathic remedy
and then go sit in a box for 3 months. We're subject to literally millions
of input events every day of our lives; physically, emotionally, mentally
and spiritually, materially and immaterially. We can meet healing
opportunities in many ways: it doesn't have to be via a medicated lactose
tablet prescribed by a homeopath.

Attributing a curative reaction to a remedy given 3 months previously with
no reaction evident until that point seems to me to be stretching the
connection just a wee bit too far. How can we possibly state with any
certainty that it was the remedy that was responsible for the curative
reaction, given everything else that will have been happening in that
person's life during a period of 3 months?!

With the possible exception of circumstances in which the *patient*
(independently of any coaching on the part of the homeopath) is adamant
about the connection and has a strong conviction that it was the remedy that
helped them, I'd have enormous reservations about claiming such a sequence
of events as directly attributable to a homeopathic remedy. (Rather less
reservations about questioning the size of the ego of the homeopath who
takes the not inconsiderable trouble to write up and submit the case for
publication ...)

That's not to say that a remedy isn't capable of triggering a curative
response after 3 months ... who knows? But indeed, who *knows*?

Regards
Wendy

[Joy Lucas]

To this I would say - if something is possible then it is happening
somewhere.

Let's not dismantle "watch and wait" into "watch but do not wait" - every
case stands on its own merits. I would prefer to encourage curiosity.

Best, Joy.

on 4/28/03 11:58 AM, Wendy Howard at wendy@rachan.worldonline.co.uk wrote:

Hennie wrote:
waiting

I've seen a similar case published by a well-known American homeopath, and
must admit to finding this idea of the (very) delayed response rather hard
to swallow.

We are, after all, open systems. It's not like we take a homeopathic remedy
and then go sit in a box for 3 months. We're subject to literally millions
of input events every day of our lives; physically, emotionally, mentally
and spiritually, materially and immaterially. We can meet healing
opportunities in many ways: it doesn't have to be via a medicated lactose
tablet prescribed by a homeopath.

Attributing a curative reaction to a remedy given 3 months previously with
no reaction evident until that point seems to me to be stretching the
connection just a wee bit too far. How can we possibly state with any
certainty that it was the remedy that was responsible for the curative
reaction, given everything else that will have been happening in that
person's life during a period of 3 months?!

With the possible exception of circumstances in which the *patient*
(independently of any coaching on the part of the homeopath) is adamant
about the connection and has a strong conviction that it was the remedy that
helped them, I'd have enormous reservations about claiming such a sequence
of events as directly attributable to a homeopathic remedy. (Rather less
reservations about questioning the size of the ego of the homeopath who
takes the not inconsiderable trouble to write up and submit the case for
publication ...)

That's not to say that a remedy isn't capable of triggering a curative
response after 3 months ... who knows? But indeed, who *knows*?

Regards
Wendy
[Non-text portions of this message have been removed]

[Wendy Howard]

Joy wrote:

Joy, curiosity was exactly what I was trying to encourage !! ... rather than
unquestioning acceptance of a postulate that the connection between the
giving of a remedy and a curative response 3 months later is the only
possible causative relationship worthy of consideration.

It's all too easy from our perspective to attribute patients' progress to
our remedies because they are the focus of our relationship with the
patient. That focus can sometimes result in tunnel vision on our part. IMO
it's just as important to be aware of that as it is to consider any other
plausible potential rationale.

Please note that nowhere was I proposing that we dismantle "watch and wait".

Regards
Wendy

[Shannon Nelson]

Hi Wendy,

I think that in *most* cases it should be possible to figure out whether or
not the remedy was responsible for that three-months-later improvement!
There are *some* times when the patient starts doing other things, and it
can be for a while uncertain what has caused an improvement, but in my
experience there aren't too many things that bring about the type of changes
that a well-placed remedy does. Sure there are other things that can bring
about improvements, whether long- or short-lasting, but I think it will be
the unusual situation where we aren't able to sort out whether or not the
remedy did it. Do you disagree? (If so, could you give examples?)

Shannon
on 4/28/03 9:53 AM, Wendy Howard at wendy@rachan.worldonline.co.uk wrote:

[David Little]

At 01:01 PM 4/28/2003 -0500, you wrote:

Dear Shannon,

I have had cases where after a month a single dose of a high potency C
they would start to show subtle signs of improvement and I let the dose
continue unaided. In the second month the remedy starts to act even better
but the patient does not relate this delayed action to the remedy. This has
happen to me more than once! I could tell but the patient could not. This
is another reason to use placebo. It keeps the patient under control. They
think they are still taking medicine, remember the processes, and attribute
to the help to homoeopathy. I known in our days full discloser placebo in
not popular in some circles but it has its psychological and case
management benefits. Hahnemann used a great amount of placebo. I use
placebo occasionally.

Sincerely, David
---------------
"It is the life-force which cures diseases because a dead man needs no more
medicines."

Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic
Academy at
http://www.simillimum.com
David Little © 2000

[Wendy Howard]

Hi Shannon

or

Really? I wish I shared your confidence and certainty. To me any such
figuring out seems rather heavily dependent on a number of pretty subjective
factors -- like what the practitioner will accept as a valid potential
healing stimulus according to their belief system, and what the patient
feels is relevant enough to their symptoms to have a connection worth
reporting to the practitioner, not to mention how conscious they were of
what was going on for them throughout those 3 months and/or how willing they
are to divulge this information to a relative stranger.

Take the instance of a patient on long-term medication which has evidently
failed to progress them towards cure so far. They come to a homeopath. They
take a remedy. 3 months later they start to improve. The homeopath shouts
"result!". But the MD shouts "result!" too. The homeopath thinks the MD is
labouring under a sorry delusion: it was the remedy that did it because
conventional medication is only ever suppressive and nothing else is as
powerful as homeopathy. The MD thinks the homeopath is labouring under a
sorry delusion: it was the conventional medication that did it because
conventional medication is scientifically proved and powerful and homeopathy
is mumbo jumbo.

What if the patient went to visit a faith healer the day before they started
to improve, but felt way too reticent to mention it to either homeopath or
MD? What if their primary relationship has gone through a change thanks to
their partner responding well to therapy, but the patient doesn't see that
as being in the least connected to their own symptoms so doesn't mention it?
What if a frequent dietary item has gone out of season, but because the
patient hasn't made any *intentional* changes to their diet, they're not
sufficiently aware of the change to report it? What if ...

These are the realities of practice. What our patients tell us is what comes
into their awareness and what gets past their filters in that brief period
they spend with us once every month or so. We get momentary glimpses, edited
highlights, from which we try and piece together the picture. Sometimes that
picture is very clear right from the start. Sometimes the pieces we have to
work with could be any one of several very similar patterns so we have to
persevere by trial and error until we get more of the picture. And sometimes
during that process we become aware of where we've inadvertently
superimposed our own preconceptions onto the case, or followed a rationale
that turned out to be incorrect.

It's a simple fact that the more time that elapses between the giving of a
remedy and a positive response, the more possible alternative explanations
there are to take into account. A lot can happen over 3 months. Homeopathy
is a fabulous and effective catalyst towards health, but it's not the only
one. I just think we need to be very, very careful before making claims --
to others *or*, just as importantly, to ourselves -- that homeopathy was
responsible for an improvement that didn't show any signs of occuring until
3 months after the remedy.

Regards
Wendy

[Shannon Nelson]

Hi David,

I know, that's the potential "downside" of such a gentle healing!
Just to mention another helpful tool for keeping the patient engaged and
"believing", is to run thru a list of their prior complaints: "How has your
_____ been; any improvement with that?" "Oh yeah, I *was* having trouble
with that, wasn't I?" "So that's better? Good. And what about ______?"
In my early days as a pt my h'th did this with me, and sometimes it was
eye-opening, LOL! "Wow, I guess the remedy *did* work, didn't it?"


Shannon
on 4/29/03 2:20 AM, David Little at litle@del2.vsnl.net.in wrote:

[Shannon Nelson]

Hi Wendy,

I surely can't disagree that inadequate information leads to inadequate
conclusions! Nor with the idea that "inadequate information" is easily come
by. If we maintain a comfortable and non-judgmental interest in the
patient, then often the patient is more likely to feel comfortable in
divulging whatever else might have happened.

If *I* think a remedy has worked, but the patient ascribes it to something
else (yep, I've had that happen too), I prefer to say, "Well, maybe that was
it. Let's just watch and see what happens. If everything's fine from here
out, then great. If the problem comes up again, we'll take it from there."
I find it very useful not to "need to be right", and *never* to argue with
the patient! If they insist that day is night, well, perhaps that's between
them and God (smile).

Beyond that, what can one do? I've already said that *in most instances*
I'm skeptical that any well-chosen remedy needs three months to begin
acting. I've also said that I can believe there are certain types of case
where I could believe a three month wait -- e.g. with a "slow" remedy and
deep pathology, perhaps like the Helleborus case that was mentioned.
Something like this would really test my patience and faith, and unless the
patient was not suffering (or even complaining!), I could very well race by
and re-prescribe too early for such a situation. It's a risk I'm very aware
of, for which reason I *do* prefer "waiting too long" over "moving too
fast", *if* circumstances permit that.

And this is I guess the reason that I have been eager to understand this
"waiting" thing -- and am gratified at David's agreement that three months
is outside the pale for most situations... Personally, I *hate* the waiting
part, when nothing is happening...

Now on a related topic, I gather there are *people* who make take three
months and more to begin *admitting* to improvement, either because they
need to feel "sure" and/or don't want to let the h'th off the hook. We were
taught this about e.g. Nit-ac. The speaker said that a nit-ac patient may
report "no change", even tho they *look* better, sound better, etc. --
partly because of the deep anxiety about their health, they sort of can't
*believe* that it's really working, and partly because they may like to see
the doctor squirm.

This is not the same issue, but I think related. If the patient is saying
"no change", we need to not simply take their word for it! We need to use
our senses (do they look any better, etc.), ask questions ("What about your
______, how is that going?), maybe even ask family members etc. whether they
have seen any improvement or worsening in the patient?

And (I want to put this to rest) I *know* homeopathy is not the only thing
that "works". What I said is that *not many* things will produce the *type*
of changes that a well-chosen remedy will. A good religious conversion
might indeed be one, or a faith healing, or certain other healing
modalities. And if rapport with the patient is good, and if the prescriber
is open to hearing the *truth* of what the patient has been doing, and if
the stars are lined up right , there is a hope of finding out just
what "worked" -- if not now, then later. And "later" is okay too.

And sometimes we won't know for sure what happened.

Cheers,
Shannon
on 4/29/03 5:36 AM, Wendy Howard at wendy@rachan.worldonline.co.uk wrote:

[Joy Lucas]

But Wendy, this is bordering on metaphysical conundrums - in this case we
cannot tell if it is the remedy that is working if improvement takes place
within minutes or hours. I think homeopathy is far more robust than this and
it places great emphasis on how much clarity and expertise is required in
the follow up interviews. Vagueness needs to be expelled and if one cannot
be 'sure' what is happening and what is causing it to happen then further
time will usually tell.

Regards, Joy

on 4/29/03 11:36 AM, Wendy Howard at wendy@rachan.worldonline.co.uk wrote:

Hi Shannon

or

Really? I wish I shared your confidence and certainty. To me any such
figuring out seems rather heavily dependent on a number of pretty subjective
factors -- like what the practitioner will accept as a valid potential
healing stimulus according to their belief system, and what the patient
feels is relevant enough to their symptoms to have a connection worth
reporting to the practitioner, not to mention how conscious they were of
what was going on for them throughout those 3 months and/or how willing they
are to divulge this information to a relative stranger.

Take the instance of a patient on long-term medication which has evidently
failed to progress them towards cure so far. They come to a homeopath. They
take a remedy. 3 months later they start to improve. The homeopath shouts
"result!". But the MD shouts "result!" too. The homeopath thinks the MD is
labouring under a sorry delusion: it was the remedy that did it because
conventional medication is only ever suppressive and nothing else is as
powerful as homeopathy. The MD thinks the homeopath is labouring under a
sorry delusion: it was the conventional medication that did it because
conventional medication is scientifically proved and powerful and homeopathy
is mumbo jumbo.

What if the patient went to visit a faith healer the day before they started
to improve, but felt way too reticent to mention it to either homeopath or
MD? What if their primary relationship has gone through a change thanks to
their partner responding well to therapy, but the patient doesn't see that
as being in the least connected to their own symptoms so doesn't mention it?
What if a frequent dietary item has gone out of season, but because the
patient hasn't made any *intentional* changes to their diet, they're not
sufficiently aware of the change to report it? What if ...

These are the realities of practice. What our patients tell us is what comes
into their awareness and what gets past their filters in that brief period
they spend with us once every month or so. We get momentary glimpses, edited
highlights, from which we try and piece together the picture. Sometimes that
picture is very clear right from the start. Sometimes the pieces we have to
work with could be any one of several very similar patterns so we have to
persevere by trial and error until we get more of the picture. And sometimes
during that process we become aware of where we've inadvertently
superimposed our own preconceptions onto the case, or followed a rationale
that turned out to be incorrect.

It's a simple fact that the more time that elapses between the giving of a
remedy and a positive response, the more possible alternative explanations
there are to take into account. A lot can happen over 3 months. Homeopathy
is a fabulous and effective catalyst towards health, but it's not the only
one. I just think we need to be very, very careful before making claims --
to others *or*, just as importantly, to ourselves -- that homeopathy was
responsible for an improvement that didn't show any signs of occuring until
3 months after the remedy.

Regards
Wendy
[Non-text portions of this message have been removed]

[Rosemary Hyde]

Just an added penny's worth on this subject. David's comment about "keeping
the patient under control" is paramount, I think. Another contribution to
this effect, besides using placebo, is having the patient check back with
you fairly frequently at the beginning of treatment. That way, you're much
more likely to become aware of subtle healing signs that will not make much
of an impression on the patient's awareness otherwise. I have found it
extremely difficult with many new patients, especially if they are not very
self-aware, to figure out if the remedy has worked or is working, unless
I've been in touch with them at least biweekly. For what it's worth...

Rosemary