Homeopathy in Australia: Two Perspectives - David Levy D.Hom, ND and Alastair Gray

Part 1 - State of the Union; Australian Homoeopathy by Alastair Gray

Shining the torch on the state of homoeopathy in Australia and drawing some conclusions depends on who's holding the torch. Most of the time I am a fairly optimistic person. From my perspective when I look around the profession, examine my own practice, talk to the students I teach, I see a whole lot of health.

Glass Half Full

The Practice of Homeopathy

There are far fewer restrictions on what homoeopaths can do in Australia than in many other countries that I've seen.  From my teaching in America, Malaysia, the UK and Ireland there are far fewer obstacles in the way. Essentially I get up, go to work, see my clients, prescribe medicines and go home. However it's impossible to talk about homoeopathy and its position without talking about the state of play within complementary or alternative medicine in Australia

The state of complementary and alternative health in Australia
Fundamentally it's all good. The statistics are overwhelmingly positive. Billions of dollars are being spent on complementary and alternative medicines. Of course that includes supplements, vitamins and minerals as well as visits to practitioners. Happily those statistics are available for us through the Australian Bureau of Statistics. It makes for good reading and a positive future. It's a clear and unequivocal situation where natural medicine is undoubtedly one of of the growth industries of the 21st century. Patients are flocking away from orthodox medicine and towards complementary medicine. In some places like Sydney there are clinics everywhere, there are signs everywhere, there are practitioners everywhere.

In addition to that the colleges of natural medicine are busy. In Melbourne and Brisbane there is a large complementary medicine college, in Sydney there are three. The classrooms of full and  there is a lot of energy around the development of this profession. Especially in the area of massage, yoga, energetic healing and beauty, classrooms are full. International students are flocking.

Within colleges there's been a distinct and marked improvement in standards in the last few years and a move towards professionalization. Curriculums have changed. There is a deliberate attempt to create more professionalism through developing ethical and legal components of curriculums that were not there five or 10 years ago. A significant proportion of curriculum space is devoted to occupational health and safety issues, legal issues, ethical issues, research, critical thinking and a general awareness of the growing profession, and this doesn't matter if it’s a massage student, a herbal student or a homoeopathic student; they are all getting similar core units to underpin their knowledge.

At a practitioner level we see websites springing up all over the place pushing practitioners or products. And there is a great deal of energy visible in the marketplace. There is competition and clearly there is money to be made.

Homoeopathy within that context
However, homoeopathy in Australia actually struggles for the most part. Unlike the situation in the UK, the rest of Europe or America where many people know what homoeopathy is, a historical accident has meant that naturopathy is far more commonly known by the general public than homoeopathy. There are naturopaths on the television, there are naturopaths on the radio, there are  naturopaths in every pharmacy and in every health food store.

So, to the Australian perspective homoeopathy is almost always seen as a part of naturopathy and therefore it struggles for its status within the public perception. I have always perceived that homoeopaths find it more difficult to establish a practice in Australia than they would the UK. This of course seems like an irony because in Australia it's much more of a health conscious society and there are far more users of natural and complementary medicine here. But because historically homoeopathy was poorly practiced in the 50s, 60s and 70s in Australia and naturopathy became far more widely known,  homoeopaths still struggle to attract clients and sell their services in the marketplace.

That being said, there are many practitioners of homoeopathy in Sydney that are extremely busy there are a healthy group of practitioners that cannot physically see any more clients. In my own practice I reached a plateau of patients in terms of numbers a few years after arriving in Sydney and nothing has really changed since then. I haven’t advertised, used the Yellow Pages or needed to promote myself in that time. My practice flows by word of mouth and it seems to be the same across a group of homoeopaths that seemed to do very well.

Glass Half Empty
However if you have a slightly different disposition, if you're having a bad day, or if you are truly passionate about homoeopathy’s development outside of an integrative context within complementary and alternative medicine, then things might seem a little gloomier.

Homoeopathy in some ways is really struggling. There are documentaries on television and articles in newspapers, often using the negative press in the UK, where we are being challenged at every level. Educationally there are hurdles being put in place to stop homoeopathy being taught at university level.

While most natural medicine is generally expanding, homoeopathy doesn't seem to be making similar developments. In the colleges class numbers seem to have plateaued or dwindling somewhat. Very often classrooms need to be topped up with international students and very often those international students don't really seem to be focused on homoeopathy but rather having the visa.

There are clear demonstrations that corporate values are seeping into natural medicine and homoeopathy colleges are being run now by chief financial officers and project managers as opposed to homoeopaths. Those classes that are struggling to attract clients are being cut from curriculums. As mentioned before, the growth areas are beauty, energetic healing massage and naturopathy but not homoeopathy. As a lecturer at many of the colleges in Australia I get a bit nervous sometimes.

Infighting

When will it end? Homeopaths are constantly having a go at each other. Australia is no different. And it's like any other extended family I suppose. One of the difficulties in Australian homoeopathy is that while the rest of the world was embracing the thinking of Kent and then George Vithoulkas in the 1980s Australian homoeopathy historically was going down a different path. Australia is imbued with make-do, can-do attitude and homoeopathy is no different.  So Australia seemed not to be influenced so much by the renaissance in homeopathic thought as America and Europe was in the 1970’s on.

In Australia there was greater emphasis on specifics and on the presenting complaint with an emphasis on Boenninghausen’s work and therapeutics. In the 80s and early 90s homoeopathy was taught within natural medicine colleges and often by non-homoeopaths. While there was a brief flutter with the work of people such as Sankaran and Scholten in the early 90s the emphasis of Australian homoeopathy has suffered because of the distance with the rest of the homeopathic world.  Therefore homoeopathy in Australia is not too dissimilar to the fractured nature of homoeopathy in other countries but the distance has made the divisions wider. In one direction we have a return to fundamentalists who stop at Hahnemann and Boenninghausen and in the other direction a flutter with Sankaran and Scholten without the benefit of constant teaching seminars from those people. A lot of the seminars have been held by visiting teachers but generally there is now a clear divide and not much common language. The colleges reflect this diversity with experts in multiple systems teaching at different colleges but nevertheless in print and in the journals there is a very often a lack of respect and collegial acknowledgement of professional expertise in another area. In other words there is a lot of slagging off, disrespect and conflict.

Changing Demographics
The other thing of course that I notice is the demographic of students in the colleges is getting younger and younger.  Smart natural therapy colleges are marketing to school leavers. I have heard it said that one college says that the average student is single, female and 29 years old. Because the demographic is changing within the classroom expectations are changing. Gone are the days where one begins the class with 10 minutes of meditation and Beethoven nestling into the beanbag and going to the pub for lunch as you listen to experienced homoeopath tell stories. These are the days of curriculums, learning outcomes and students that are paying the money and expects service. Gone are the days where you can make up exam questions on the spot or leave just five minutes for a remedy that doesn't take your fancy (from the teachers point of view). Discerning students are much more likely to hold you to the curriculum. ‘We have paid and we demand service.’

Academia
Conferences are every second year which is a personal annoyance. Supervision barely happens in a meaningful way. There is virtually no emphasis on the therapeutic relationship. These particular issues for me demonstrate a maturing of a profession from half science to science and which has seen great advances in both Europe and the United States. There seems to be particular reluctance in Australian schools to integrate these important aspect of practice.

Conferences
In the main seminars are poorly attended compared to the 90s. And given the perceived tyranny of distance it is a shame that a generation of Australian homoeopaths have not been exposed to Jeremy Sherr or Massimo.  There are many other excellent teachers who have not made it to Australia and correspondingly homeopaths from the rest of the world have not had much access to the incredibly valuable information from brilliant homoeopaths such as Peter Tumminello, Isaac Golden, Ken D’Aran, David Levy, John Mackintosh and many others who are not given the full value and acknowledgement of the astonishing work they do. Australian homoeopaths and students also tend to over-emphasise the big international speaker and the delusion of guru is well advanced in Australian homoeopathy.

In terms of postgraduate education there are a couple of options with one of them emphasizing homoeopathic philosophy and is run by myself. There is another postgraduate course emphasizing the philosophy and clinical specifics by followers of Dr Parimal Banerjee from India.

Remedy Regulation and the Future
It's always been a surprise to me since I been in Australia that there isn't a higher profile homoeopathic pharmacy here. There are two dispensing pharmacies, one in Melbourne, and one out of Adelaide. The structure of homoeopathy remains sound. While there are different homoeopathic associations representing different points of view, there is a peak body, a registering body that lobbies government and that is a sound structure that other countries don't seem to have.

Regulation is on the horizon for us all and homoeopathy will definitely be a part of that. I am definitely on the side of welcoming regulation, even with the likely restrictions placed on us in terms of scope of practice. I am in favor of good practice as opposed to the poor practice across both orthodox medicine and alternative medicine. Regulation seems a natural part of that process and in order to gain the respect of a medical colleagues and to gain a higher profile within the community it seems natural to me to expect and welcome government regulation.

Empty and Full at the Same Time
So shining the torch on homoeopathy in Australia depends on your glass being half empty or half full. I have good days and bad days, but mostly good. If there is an hour between clients then I go to the beach. If there is two hours between clients I might sit and plan an article or continue working away at my masters from the University of Lancashire, UK. There are classes to be taught at colleges and those colleges for the most part seem to be doing well. These colleges are producing graduates that have met government endorsed education competencies and that have been accredited by our  regulating peak body, the Australian Register of Homoeopaths. I teach in those colleges and am astonished at the quality of the work. I actually believe that the Australian curriculums are the best in the world from what I've seen, and on balance produced extremely competent but sometimes not confident homoeopathic students. But what I also noticed however is that learning homoeopathy has got very little to being a homoeopath. Therefore I notice that there is a gap in the market which my postgraduate course attempts to fill and that is one of clinical confidence. In homoeopathy as a profession we have competence but not necessarily clinical confidence. And of course, because all homoeopaths have to earn a living and that means running a private practice many competent homoeopaths fall by the wayside and drift off into other areas because it was too difficult to earn a living in the early days of their practice.

It sometimes seems overwhelming that there is so much work to do. Sometimes it seems a fractured world. Sometimes it feels like a hard way to earn a living. Patients don't get better. Sometimes you read the paper and read that apparently the industry is filled with mavericks and charlatans. But then the sun shines. The baby's eczema gets better, that patient’s depression lifts and its the best best job in the world. And Australia is a fine place to do it.

Alastair Gray practices and teaches homeopathy in Sydney, Australia.  He is the author of many provings.

Part 2 - STILL IN THE DARK? by David Levy

OPINION PIECE

Homeopathy is alive and well in Australia, at least from my perspective. I am an Australian-trained homeopath, in practice more than 20 years. Yet I have colleagues who struggle to develop and sustain their practices. This is a source of deep concern for all and a problem that is echoed in other countries.

Questions remain in the public domain: ‘what is homeopathy?’ and ‘what do homeopaths do that distinguishes them from all other methods of health care?’ The public perception of homeopathy in Australia is still vague, uncertain, lacking clarity. Homeopaths are frequently subsumed under the ‘naturopath’ or ‘natural therapist’ mantle, except amongst a minority of educated middle class users. Consequently, this translates into a profession which caters largely for this same demographic, many of whom choose homeopathy as a means of primary health care. However, the same cohort of well educated, middle class users of homeopathy is generally healthier and less likely to need homeopathy for major, more serious health problems. Consequently, homeopathy (like other modalities) is criticised as being a therapy for the ‘worried well’ rather than a means of treating genuinely diseased people.

EDUCATION
Homeopathic education in Australia continues to be transformed. Twenty years ago training was implemented in small, privately-owned and funded colleges. Today, the majority of students train for 3 to 4 years in colleges which are affiliated with and accredited by Australian universities. Whilst students are fully fee-paying, some are eligible for financial assistance from the Australian government. The standard of homeopathic education has evolved through the development of a nationally accredited competency-based training system. This system ensures that professional standards of training are implemented, translating into a much higher level of professional practice. In turn, this ensures the public choosing homeopathy will be serviced by a growing body of well-trained professionals. Professional homeopaths are supported by professional associations (the largest being the Australian Homeopathic Association with some 670 members). They must however also register with the Australian Register of Homeopaths, which maintains and administrates professional practice standards for homeopaths.

CLASSICAL TRAINING – MODERN PRACTICE

As is the case elsewhere in the homeopathic world, models of practice continue to change and evolve, precipitated in large part by the prevailing models and prejudices of the teachers of the day. The ‘old guard’ protects itself from new models of practice. In some instances, homeopaths are known to resist recent developments in applied homeopathy, such as those developed by Dr Parimal Banerji in India. Other homeopaths refuse to consider philosophical changes, practicing strictly according to the method of homeopaths such as Dr Böenninghausen; conversely, there are homeopaths utilizing a range of unproven remedies and unverified theories, mixed together with astrology, kinesiology, aura reading and more. Arguments abound: should homeopaths be denied the right to utilize other modalities? At present, although professional standards are commendable, protection of professional title for homeopaths does not exist. In other words, non-homeopaths can still call themselves ‘homeopaths’, a predicament detrimental to homeopaths and the public alike.

These problems are not new to homeopathy. In the California Homeopath, a case from Dr Charles Millspaugh is given courtesy of the Medical Advance (1886 vol. 16). In this brief case we learn of a woman suffering ‘spasms’. After a number of questionably selected remedies (of which Dr Millspaugh himself doubted the efficacy), the patient begins to get well some days later after a prescription of Pulsatilla. Though beautifully recorded, Millspaugh admits (Millspaugh, 1886) “if we desire to curare, tuto cito et jucunde (cure quickly, safely and pleasantly), we must work! Work! Work!”

The problem today is that most patients new to homeopathy seldom permit the homeopath a second or third opportunity to prescribe. Millspaugh’s patient had little choice. Remedy selection number one needs pinpoint accuracy! Faulty prescribing and shoddy work tend to be punished by a return to regular, allopathic medicine. The genuine hard work of some homeopaths is sometimes displaced by shortcut methods of would-be homeopaths, not inclined to study cases carefully in order to find the best indicated remedy. Instead, the application of complexes, creams and quick fixes abound, confusing the homeopath, the patient and the public alike. In these situations, the patient and general public never really know or understand homeopathy, its healing potential and how it ought to be applied.

Where does this place the Australian homeopath in 2008? How will he/she practice in 2028? In a world in which the modern homeopath can not feel certain of his/her future, under repeated media and orthodox medical attack (note the current debate in the UK), it is difficult to project or predict. Professional associations need to remain strong in number and well supported by their members. The perpetual drain on volunteer organizers is a continual complaint amongst state homeopathic bodies struggling to reduce operating costs as well as the cost to members. Professional practice needs to be rigorous, research needs to be carefully conducted and debate must be open and honest.

THE FUTURE
The future of homeopathy in Australia is mainly in the hands of homeopaths. Although educational foundations are sound, with face to face and distance education studies available, professional auditing demonstrates that very few homeopaths are successful in practice beyond the critical 5-year phase. What is meant by ‘successful homeopath’? Is success measured quantitatively or qualitatively? By the gross income of the homeopath or the variety of patients and illnesses successfully treated? The employment market does not advertise ‘homeopath’ under medical appointments. Focused study, hard work and dedication are required to establish, build and sustain homeopathic practices. And yet, and yet … I manage an established practice and have done so for many years. I also have the privilege to mentor many excellent students and new practitioners. Each of these must take steps to develop grounded practices and solid businesses in order for homeopathy to secure a certain future.

Millspaugh, C. F. (1886). An Odd Case. The California Homeopath, 11(1), 36-38.


David Levy MHSc (Ed), D. Hom, N.D.
Sydney Australia – David has been in professional practice since 1986. He is both lecturer and clinical educator at two Sydney homeopathic colleges. In 2001 he completed a Masters Degree in Health Science Education. He is currently undertaking PhD research, investigating the nature of clinical thinking and reasoning in homeopathic practice.