Safety in Clinical Practice

By Dr. William Shevin, M.D., DABHM

Homeopathic drug products (HDPs) are commonly thought to be extremely, if not absolutely, safe. Although HDPs have a very low risk profile based on reports of adverse events or calls to Poison Control Centers’ hotlines, safety may not be absolute. In this section, I consider the safety of HDPs in the treatment of the sick. I assume that all issues of quality, purity, identity of starting materials, and compliance with the Lowest Permissible Attenuation (LPAs) listed in the the Homeopathic Pharmacopeia of the United States (HPUS) are satisfactory, as described in Dr. Hoover’s description of what might be called “intrinsic safety.”

It must be understood that the practice of homeopathy is the application of the Principle of Similarity, using medicinal substances prepared in a specific manner, with a few other guidelines, commonly called “classical homeopathy.” Following the Similia Principle is fundamental. Homoeopathy’s long record of safety emerged from more than 200 years of “classical” practice. Practicing outside of the Similia Principle has no equivalent historical record and should not be assumed to be safe. Without such understanding and the skill to properly apply the Similia Principle, subsequent treatment with HDPs cannot properly be called homeopathy.

The following points are basic to classical (and ethical) practice, leading to good results and avoiding harm.

The Similia Principle derives from drug discovery by first conducting “provings,” in which healthy individuals take a homeopathically prepared substance repetitively, stopping when symptoms begin to appear. The symptoms that develop are carefully noted, reviewed, and analyzed by trained supervisors and lead investigators. Provings are conducted with multiple individuals. The resulting symptoms are collated and analyzed to form a “symptom picture.” That picture (a group of symptoms that are characteristic of the medicinal substance) must sufficiently conform to the particular patient’s picture to justify its administration.¹

• A practitioner should have a basic understanding of the seriousness of the patient’s problems (not just their chief complaint). If not, consultation with, or supervision from, a medically qualified provider is advised. In the current environment, practitioners have varying degrees of training in both homeopathy and basic medical sciences. The same is true of licensure and its resulting accountability.
• Understanding the patient’s level of “vitality is important.” In general, the lower the vitality, the more treatment should be administered with “delicacy” (lower attenuations, low frequency of administration, and careful monitoring). Evaluating “vitality” from the perspective of homeopathy is also a complex subject. A casual assessment of the patient’s demeanor and presentation is not always sufficient.
• Understanding the patient’s degree of “sensitivity is important.” Sensitivity, considered from the perspective of homeopathy, is also a complex concept. Sensitivity can be considered from a physical, emotional, or mental perspective. Examples might include, respectively, being allergic to external factors (allergens, weather changes, etc.), easily depressed or angered (especially as reactions to minor stresses), and an ecstatic hyperactivity in response to music. Sensitive patients are more likely to overreact, even to the administration of a well-selected medicine.
• The selection of the appropriate HDP is also important. When the selected medicine is far from being similar, the less likelihood of any subsequent reaction, unless it is administered frequently, in which case a “proving” of the HDP may occur. When “sensitivity” is high, there is a higher likelihood of a non-therapeutic reaction regardless of the appropriateness of the medicine selected.
• Selecting the appropriate attenuation level and frequency of administration is important. When the medicine is at or near a high degree of appropriateness (at or near the correct choice according to the Law of Similars), a lower attenuation may not produce an adequate response, while a much higher attenuation may produce an excessive response, commonly called an “aggravation.” Selecting the correct attenuation level is another complex subject, but the level of vitality and sensitivity are important considerations. Hahnemannian (“C” or “X”) and Fifty Millesimal (LM) attenuations are used with their own set of rules. Mild and brief aggravations that are of the patient’s presenting symptoms are acceptable and usually presage a good therapeutic effect.
• The practitioner must correctly evaluate the patient’s response. This depends on understanding basic principles, the “direction of cure,” and other aspects. The response to treatment in acute and chronic disease may require different evaluations. Any significant worsening of symptoms or the patient’s general energy, mentation, or emotional state should cause concern, and treatment should be suspended for re-evaluation.

Well-educated practitioners are taught the above principles and guidelines, and more. Manufacturers who provide limited training to practitioners for the use of specific protocol-based treatments which are not based upon the Similia Principle may incur liability should harm occur.

The views, thoughts, and opinions expressed in the following article are solely those of the individual author and do not necessarily reflect the official policy or position of the American Association for Homeopathic Products, or any other individuals or entities associated with the author.