Richard Moskowitz M.D.

By no means the least of what homeopathy has to teach is its reaffirmation of the individual patient as the presiding genius of what the healer needs to know. Whereas modern medicine seeks to define itself quantitatively, as a set of technologies to identify and control the key numbers (antibodies, etc.), the vision of homeopathy is essentially qualitative, matching the unique energy of each patient with the singular totality of the remedy. If the following cases are acceptable evidence for my theories and speculations, they are the ultimate source of them as well.

While the DPT vaccine is specifically implicated in brain damage and a variety of other neurological syndromes, and many of these cases are amenable to homeopathic treatment, I want to concentrate today on cases that are far less serious but also more common, easier to understand, and more representative of the problem as a whole.

Both high fevers of unknown origin that were treated successfully with the corresponding nosode, my very first DPT cases illustrate the thought process by which specific symptoms may be added to the remedy picture of any given vaccine. While the history must ultimately show that the child has "never been well" or quite the same since one or more DPT injections, this connection may not be obvious or even suspected unless specific questions are asked to elicit it.

In some cases, an abnormal white count and differential may give independent pathological confirmation: other examples include tender posterior cervical or retroauricular nodes for rubella, parotid swellings for mumps, and the like. Naturally, symptoms like high fever that seem aberrant or unusual to the parent are more suspicious and therefore easier to trace. But only a curative response to the DPT nosode really suffices to prove that the illness in question was specifically related to the vaccine.

Case 1 A baby girl of 8 months had had three episodes of high fever, typically 105°F. or more, but lasting 48 hours at most. During the second episode, she was hospitalized for tests, but her pediatrician found nothing. Each time she felt quite well afterwards, and appeared to be growing and developing normally. The only other information I could elicit from the mother was that the episodes had occurred exactly one month apart, and that the first episode had come just one month after the last of her DPT shots, which likewise had been given at one-monthly intervals. With the help of these revelations, the mother was able to recall that similar fever episodes had also occurred after each injection, but her pediatrician had advised her to ignore them, since fever is perhaps the commonest reaction to the vaccine. I therefore gave a single dose of DPT 10M, and the child never had another episode.

Case 2 A 9-month~old girl was brought in with a fever of 105°F. and very few other symptoms. Two previous episodes had occurred at irregular intervals, and the parents, who felt ambivalent about vaccinations in general, had given her only one DPT shot, particularly since the first fever had come less than 2 weeks afterward. After 48 hours of high fever unresponsive to acute remedies, a CBC showed a white count of 32,000, with 43% lymphs, 11% monos, 25% polys (many with toxic granulations), and 20% bands. With only the blood picture to go on, a pediatrician friend at once suggested pertussis. After DPT 10M, the fever came down in 2 hours, and the child has been well since.

These cases are noteworthy for two reasons: first, because they exhibited a characteristic symptom or "keynote" (high fever) of the DPT vaccine; and second, because their responses to it were strong and healthy, such that their illnesses, although recurrent, soon resolved each time without chronic sequelae. But, like the brain-damaged cases, they are also the exception rather than the rule, instructive mainly in contrast with others less specific and therefore more difficult to trace.

In the following cases, the vaccine appeared to act nonspecifically, whether by exacerbating a pre-existing chronic condition or simply by casting a shadow over the background of a chronic condition that did not materialize until some time later. Because excellent results were obtained with the usual constitutional or miasmatic remedies, and the specific nosode often was not needed, the vaccine connection could not always be proved. In other instances, the nosode was used later to remove a quasi-miasmatic "block," when seemingly well-indicated remedies no longer worked or failed to hold or act deeply.

In general, these cases are reminiscent of the way that grief, physical injury, or some other stress often simply exacerbates the pre-existing miasmatic or chronic disease structure, rather than substituting the specific picture of IGNATIA, ARNICA, or the usual "never well since" remedies. In another large subgroup, the symptoms specific to the vaccine and those already latent or pre-existing in the patient are all mixed up together, and begin to disentangle only as the treatment progresses.

Far from being restricted to any particular category, vaccine related illness similarly encompasses the full range of chronic diseases in children, from asthma, eczema, and allergies to otitis media, far and away the commonest in my practice, as well as learning disabilities and emotional or behavior problems.

Case 3 A girl of 6 was brought in for being "sick all the time," especially with ear infections, which she had had repeatedly since the age of 5 months, when she was given antibiotics for 4 months without interruption. Especially vulnerable in the fall and with abrupt changes in the weather, she would often become "grumpy" when ill and lose her appetite, but rarely had fever or earache. Although showing no obvious reaction to her regular DPT shots at 2, 4, 6, and 18 months, she had another ear infection for 4 months soon after her last shot, just before entering first grade. Over the next 18 months, she did beautifully on SULPHUR, PULSATILLA, and MERCURIUS constitutionally: she began to have acute illnesses from time to time, but responded well to the usual remedies, never needed antibiotics, and seemed perfectly well in between. Three years later, after a long hiatus, her mother reported that she had not missed a single day of school and required no further treatment.

Case 4 A 5-year-old girl was brought in for treatment of seasonal asthma, which had begun the previous spring, did not respond very well to the usual drugs, and worried both parents in view of their own allergic histories. When she was weaned at 13 months, her health problems began with protracted ear infections, often associated with teething, and requiring frequent antibiotics. While her first set of vaccinations were tolerated without any obvious reaction, she had recently developed pneumonia and high fever 2 weeks after her 5-year DPT booster, followed by the return of her asthma for the first time in the dead of winter. After two years of treatment, mostly with ARSENICUM ALBUM, PHOSPHORUS, and LACHESIS, her health slowly improved to the point that she no longer needed drugs or remedies, even during allergy season, and the nosode was never given.

Case 5 A 2-year-old boy was brought in for treatment of recurrent ear infections that tended to drag on for months and responded only temporarily to antibiotics. His first ear infection followed a URI at 6 months of age, and was picked up on a routine medical checkup with no symptoms whatsoever, although at other times he often complained of earache. But his worst illnesses had been acute episodes of high fever and prolonged screaming at the time of his first two DPT shots, after which he was given the DT only with no obvious reaction. While his ear infections quickly subsided with the aid of CALCAREA SULPH. and TUBERCULINUM, he developed jealousy and tantrum behavior around the birth of a baby sister a year later, and was eventually given DPT 10M when the seemingly indicated remedies failed to help. Now 4 years old, he is healthy, free of ear infections, and continuing to grow and develop normally.

Case 6 A baby girl of 10 months was brought in with acute otitis (high fever, earache, screaming), her fourth such attack since the age of 2 months, each one beginning soon after stopping the antibiotics from the one before. Weaned at 2 months when her mother returned to work, she could not tolerate lactose formulas but did well on soy milk. When her first DPT shot was followed by a week of cranky behavior, she was given only the DT thereafter and did not seem to react to it. Her ear infections stopped readily enough after CHAMOMILLA and CALCAREA CARB., but recurred 8 months later, when her parents separated and the MMR was given while she was visiting her father. Again she did beautifully on remedies, mainly LYCOPODIUM and SULPHUR, despite occasional relapses, including another following a DPT booster that the father engineered, which ended only after the DPT nosode was given. Over the last 4 years, I have continued to see her after occasional acute illnesses which her father again "took care of" with conventional treatment, with progressively longer intervals of good health between them.

Case 7 After 5 episodes of otitis media treated with antibiotics, a 16-month-old boy was referred to me for constitutional treatment. Colicky for the first 3 months of life, he developed acute otitis with fever at about 6 months, but all subsequent episodes were afebrile. He likewise reacted violently to his first DPT shot, with vomiting and "hard crying," somewhat less so to the second (with "sad" crying and general malaise), and not at all to the third or the MMR, which had just been given a week before I saw him. Less than 3 days after a dose of SULPHUR 10M, he developed a high fever and diarrhea, from which he soon recovered. Next he was given CALCAREA CARB. 10M, and CALCAREA SULPH. 12 to be used p.r.n. at the threat of a cold, and there were no more ear infections or remedies for well over a year. After another round of SULPHUR, he has been well for the past 3 years, and the nosode was never needed.

Case 8 A boy of 3 had never reacted to any vaccination, and had appeared to be in good health until 8 months prior to seeing me, when he came down with a flu-like illness, followed by otitis media, and antibiotics were prescribed. According to the mother, he seemed lethargic while taking them, and generally "not himself," with outbursts of stuttering and a foul diarrhea from which Giardia lamblia was isolated. At this point he was found to have no gamma globulins in his serum, and had to be given transfusions on a regular basis. Over the next 6 months, he was treated successfully with INFLUENZINUM, STRAMONIUM, and CUPRUM, followed by SULPHUR the following year. Within a few weeks his serum proteins rose dramatically, the stuttering subsided, and he continued to improve steadily after that. The transfusions were discontinued after a year, and he has remained well since. No nosode was needed, and no one vaccine could be implicated. Yet total unresponsiveness to vaccines and total immune collapse are two similar ways in which any vaccine could act nonspecifically to weaken the immune system of a sensitive individual.

Case 9 A girl of 15 months was brought in for repeated ear infections and antibiotics since her first round at 4 months of age. Associated with typical URI symptoms, ear involvement was often signaled by pain, but she had never had a fever in her life. An hour after her first DPT shot, she woke up from a nap screaming, and soon developed her first cold. Another followed her second dose, with earache 2 days later, around the time when her mother weaned her to go back to work and put her on milk-based formula. Yet another followed the third dose, the eardrums failed to improve on antibiotics, and the mother decided to try homeopathy eight months later, when myringotomy was proposed. Responding miraculously to CALCAREA CARB., her ears cleared up, and she cut 3 teeth in less than 2 weeks, but then developed persistent diarrhea after a bottle of cow's milk. Less than an hour after the nosode was given, she came down with a high fever, the diarrhea was gone by the next day, and her health has improved steadily ever since, with no ear infections reported or new remedies needed in the past 5years.

As documented in many of these cases, the evolution of otitis media in recent years exactly parallels the theoretical concerns outlined above. In the early 1960's, as a medical student, I saw acute ear infections daily in the emergency room, with high fever and violent earache. Almost always, they would respond dramatically to penicillin at levels of 100,000 units daily or less. If the eardrum had already burst, as often happened, the child would recover promptly and completely without any treatment at all.

Today, although such cases are still seen occasionally, otitis media is predominantly a chronic or relapsing illness, with significantly less fever and pain than in the past. In a surprising number of cases, there are no symptoms whatsoever, and the diagnosis is made solely on morphological grounds at the time of a routine examination. For presumably the same reasons, it is much less likely to heal spontaneously or to respond favorably to antibiotics, has a much greater tendency to relapse soon after the drugs are stopped, and is more often associated with chronic or residual symptoms such as behavior problems, learning disabilities, swollen tonsils, and hearing loss. Recent studies further indicate that tubes inserted to facilitate drainage, the most advanced technology presently available, are themselves an important cause of permanent hearing loss, the spectre always used to justify them (25).

To be sure, many immunosuppressive factors other than vaccines also have to be considered, such as the widespread use of antibiotics, the development of resistant organisms, urban and industrial pollution, and doubtless many more.

But my fear is that any other chronic disease would tell the same tale. In addition to their specific effects, only a few of which have yet been identified, each vaccine probably has immunosuppressive or nonspecific effects that would look quite different for each patient, promoting chronic at the expense of acute responses, i.e., having to do with "style" rather than content. In the case of the DPT vaccine, and probably for the rest as well, the net will have to be widened to include enuresis, eczema, asthma, allergies, nervous and mental diseases, autoimmune phenomena, cancer, and indeed the whole spectrum of pediatric and adult medicine.

In conclusion, I want to address the most important and difficult problems of all: the research that will have to be done in the future, and the political will that will be needed to carry it out. Both questions are inseparably connected, and both will need radically new models to succeed.

Because current studies ignore and indeed preclude any concept of the total health picture over time, they cannot provide unambiguous information about how vaccines act. At the same time, controlled scientific investigations based on the totality of symptoms will require a large population of unvaccinated kids, just what the existing laws are designed to prevent. To those parents who decide not to vaccinate we therefore owe a considerable debt of gratitude.

Similarly, the accusation that unvaccinated children help propagate the various diseases and thus threaten the rest of the population cuts both ways. For the extent to which this argument is true also admirably quantifies the ineffectiveness of the vaccines: if the "immunity" they conferred were genuine and lasting, the unvaccinated kids would pose a threat only to themselves.

Furthermore, it will not be possible to study each vaccine independently unless we legally authorize parents to choose some vaccines but not others. At present, even the most liberal states allow parents to refuse all vaccinations across the board, on religious or philosophical grounds, but not to make informed medical decisions for their children. Once the vaccines are made totally optional, as in the UK, the experimental and control groups can become purely self-selecting for each vaccine, with those receiving it matched as closely as possible to those exempted.

Once these groups are in place, it will be necessary to follow them prospectively for at least a generation, if not a lifetime. For the present, pilot studies could also be done retrospectively, using older kids with known vaccination histories.

But by far the most difficult and important questions are the inextricably connected theoretical one of what to measure and the technical one of how to measure it. As homeopathic clinicians, we already have a reasonably good sense of how to ascertain a working totality of symptoms tailored to our individual patients and how to follow them over time.

In studying large populations, we will eventually need to select a few key variables sufficiently broad and inclusive to reflect the most fundamental aspects of human functioning, yet also flexible enough to accommodate the infinite richness and diversity of real people. Which ones we choose will then further determine and be determined by the techniques with the requisite detail and precision for measuring them.

Probably this means that we won't really know what we need to measure until we've followed a much smaller pilot group more extensively for a shorter period of time, perhaps four or five years, and just see what happens. In any case, the homeopathic agenda -- the total health picture over time -- remains the best available methodology for such an investigation; and any progress we can make toward it will automatically contribute to research design in biomedicine generally.

How, then, is one to investigate the total health picture of large populations over time? Clearly, we need to look at the elements of the standard medical history, and to follow the incidence and severity of the usual acute and chronic diseases. Regular physical and laboratory examinations might also suggest persistent or subclinical changes of a more "constitutional" or chronic type, such as swollen nodes for rubella, abnormal white cell and differential counts for pertussis, and nonspecific developmental criteria (height and weight, dentition, gross and fine motor co-ordination, vision, hearing, etc.) for all the vaccines.

Other important variables lying outside the medical history per se se would include intelligence, language, socialization in family and school settings, and other demographic, socioeconomic, and psychological factors (poverty, race, learning disabilities, behavior and emotional problems, school attendance and performance).

On the other hand, pilot studies of the pneumococcus and influenza vaccines might need only a few simple variables, because they are given primarily to elderly people at high risk or in nursing homes, when their chronic disease structure is already more or less firmly established. Under these circumstances, a reasonable first approximation of how these vaccines act might be simply to measure their effect on the life span, the sheer ability to survive, compared to that of their unvaccinated friends and neighbors.

Finally, I want to explain why, in spite of the very considerable dangers I have been talking about (and innumerable others we all could mention), I remain strangely optimistic about the future of the healing arts. The principal reason has to do with the growing awareness of ordinary people taking more responsibility for their own health and more control over their transactions with the medical system as a whole.

In the United States, the movement for free choice in health care now includes not only such groups as DPT, but also the supporters of midwifery, home birth, homeopathy and other forms of alternative or "complementary" medicine, and even of the right to die. Within the last 20 years, all of these groups have already achieved major changes in the conventional doctor-patient relationship. Now that the American economy is manifestly unable to afford the present health care system, no matter how it is organized, it is virtually certain that these changes will continue to accelerate, and that organized medicine will face further repudiation until it accepts them.

In the meantime, lest you suppose that I am opposed to religious concepts in medicine entirely, I will cite three aphorisms of Paracelaus, which offer a practical and ecumenical theology of healing that virtually all of us of whatever discipline can accept and live by, without having to ram them down anybody's throat:

The art of healing comes from Nature, not the physician... Every illness has its own remedy within itself... A man could not be born alive and healthy were there not already a physician hidden in him (26).

Taken together, these sayings amount to a summary virtually everything that the present medical system has left out:

1. Healing Implies Wholeness Etymologically, the verb "to heal" comes from the same Anglo Saxon root as "whole." "Healing" means simply to make whole again, is a basic attribute of all living systems, and is evident in spontaneous recovery from illness and in effective medical and surgical treatment as well. Because it represents a concerted response of the entire organism, it implies a totality, a purely qualitative integration on a deeper level than can be defined by any assemblage of parts or approximated by any quantitative measurement.

2. All Healing Is Self-Healing. As a fundamental property of all living systems, healing is going on all the time, and thus tends to complete itself spontaneously, with or without external assistance. This means that all healing is ultimately self-healing, and that the role of physicians and other professional or designated "healers" essentially to assist and enhance the natural process that is already under way. The mechanical correction of abnormalities might be perfectly legitimate in some instances, but primarily in relation to the more fundamental standard.

3. Healing Applies only to Individuals. Always possible but also problematic, even risky, healing applies only to individuals in unique here-and-now situations, rather than to abstract "diseases," principles, or categories. In other words, it is inescapably an art, and can never be (and should never be) reduced to a technique or procedure, however scientific its foundation.

I should like to add a fourth principle governing the doctor patient relationship, which is not exactly theological, but may is have to be affirmed as a fundamental political and legal right, as in Magna Carta or the American Bill of Rights:

Health, illness, birth, and death are inalienable life experiences belonging wholly to the people undergoing them. Nobody else has the right to manipulate or control them, or any part of the body involved in them, without their explicit request or that of somebody authorized by them to act on their behalf.

My concluding principle was contributed by Lao Tzu, and supplies an appropriate "bottom-line" criterion:

A leader is best when people barely know he exists, Not so good when people obey and acclaim him, Worst when they despise him. Of a good leader, when his work is done and his aim fulfilled, The people will say, "We did this ourselves." (27)

*Lecture presented at the annual conference of the Society of Homeopaths, Manchester, UK, September 1991. Published in The Homoeopath 12: 137-144, March 1992.

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