– The paradigm dispute in medicine (H. L. Coulter)
 Harris l. coulter, ph.d.  april, 1997

 Harris Coulter is the undisputed senior advocate-scholar for homeopathy in America. Having written prodigiously on the subject for nearly three decades, he has introduced the gentle art and science of homeopathy to generations of families, worldwide. Having been schooled at Yale and Columbia Universities, Coulter was awarded a Ph.D.  from Columbia in 1969 for his dissertation entitled, Political and Social Aspects of Nineteenth-Century Medicine in the United States: The Formation of the American Medical Association and its Struggle with the Homeopathic and Eclectic Physicians. His scholarly writings have clarified the colorful history, and dynamic principles of homeopathy for all who would wish to benefit from its therapeutic values (See “Coincidental Man” an interview with Harris Livermore Coulter, PhD., in the 1995 American Homeopath), and “additional biographical notes” below.
 Harris suffered a catastrophic stroke on June 20, 1997, and has been convalescing under the homeopathic care of Randy Neustadter. He is doing well in spite of a lingering left-sided paralysis. Harry can be reached online through his son, Andrew Coulter, at emptherapiesearthlink. net.
 The 1998 issue of The American Homeopath is hereby dedicated to Harris Livermore Coulter, in appreciation of his monumental work for the progress of homeopathy, and bottom-line truth in medical ethics.
 The obstinate unwillingness of physicians to accept new knowledge has been a commonplace of medical criticism since the time of Moliere and before. The reason is self-evident: acquiring medical knowledge and skill demands a major investment of time and money by the physician, and a very different manner of performing these same professional functions is both an economic and a psychological threat. Hence the reluctance to deviate from what was originally learned.
 The way medical knowledge is organized for practical application in a given socio-economic context-incorporating technical, socio-economic, and psychological elements-is the medical “paradigm.”
 The main function of the paradigm is to enable its exponents to earn a respectable living. Technical elements taken from the “auxiliary sciences” are intermingled and combined in such a way as to promote this end.
 The paradigm also has a psychological dimension. Patients, alas, must often die, and the physician who adheres scrupulously to the paradigm is consoled by the knowledge that he has done “everything possible”-meaning everything prescribed by the paradigm. The tenacity of physicians’ adherence to the current paradigm is often, for this reason, likened to a religion, with deviants being seen as “heretics.”
 Not all paradigms are equal. The one preferred by the majority today, and for the past several centuries, is the “allopathic” or Rationalist medical paradigm -known as “scientific medicine.” Allopathic physicians see themselves as “scientists,” and they fantasize that they embody and expound some objective truth-like the priests of a religious cult which justifies their legally privileged and protected position in society. Since adoption of the Medical Practice Acts by state legislatures in the 1920’s, a U.S.  citizen has not been permitted to practice medicine without being a certified exponent of this paradigm, meaning that he or she must have graduated from a state-approved and professionally sponsored allopathic medical school and have passed an allopathic state licensing examination.
 Proponents of a different medical paradigm (chiropractors, osteopaths, naturopaths) have automatically been classified as “unscientific.”
 Of course, the designation “scientific medicine” is incorrect. Whatever the scientific status of the knowledge developed in anatomy, biochemistry, pharmacology, and the like, its application to the practice of medicine is not a “science” at all. Medical practice is best described as a sort of social science, taking bits and pieces of knowledge from a number of areas and crystallizing them into a pattern which facilitates earning a living in the particular socioeconomic context.
 But whether or not the dominant paradigm is “scientific,” incorporating new knowledge into it is always problematical.
 In general, new technical (“scientific”) elements are readily accepted when they facilitate the economic or business side of medicine and do not contradict existing doctrinal guidelines, but they are cheerfully ignored when their incorporation would be economically disadvantageous. When greatly at variance with existing doctrine, they are seen as an actual threat to the physician’s status, leading to loss of income and prestige. They may hint at the need to go back to the school bench and even unlearn knowledge earlier regarded as doctrinal. They may involve explicit or implicit criticism of the old paradigm-meaning acceptance of responsibility, or even guilt, for procedures now seen to have been wrongheaded or actually harmful.
 The practice of “scientific” medicine constantly confronts physicians with the need to absorb new knowledge, and they learn to live with this exigency. But no one yields gladly to the demand for radical alteration of his most profoundly held views.
 Now and again ideas appear which are so novel as to compel a re-evaluation of much, or all, learning previously viewed as “scientific” and thus fixed. This is the “paradigm dispute,” meaning a clash between incompatible or mutually exclusive systems of thought, such that recognizing one system undermines the legitimacy of the other. These clashes often reflect the ongoing friction between Rationalist and Empirical thought structures in medicine.
 In the following we attempt to isolate and illustrate the dynamic features of three paradigm disputes in medicine-between homoeopathy and allopathy in the nineteenth century and, in the twentieth, between “scientific medicine” and two novel cancer treatments, Krebiozen and the Antineoplastons.
 The confrontation between allopathy and homoeopathy in the nineteenth century was a paradigm dispute in the purest sense of the term, since homoeopathy challenged every aspect of allopathic theory and practice. More recently a French biologist, Jacques Benveniste, has resuscitated this controversy in an area of homoeopathy-the “ultra-molecular dilution”-which “scientific medicine,” biology, and physics have found particularly difficult to accept.
 The cancer treatments, Krebiozen and Antineoplastons, can also be viewed as paradigm disputes, even though not as extreme in their implications for the dominant paradigm as was homoeopathy. Krebiozen, which came into prominence in the early 1950s, was an immunologic treatment for cancer at a time when oncology was dominated by surgery and radiation, and immunologic therapeutics was not yet even in its infancy. 1
 The Antineoplastons, developed in the 1970s, were another immunologic treatment for cancer which threatened (and threatens) to cut into the $50 billion/year cancer chemotherapy business. The clash between their discoverer, Stanislaw Burzynski, and the cancer establishment also deserves qualification as a paradigm dispute because he hypothesized the presence of a secondary or subsidiary immune system-a major challenge to immunologic theory.
 In these pages the paradigm dispute in medicine is described in four stages:
 I. Emergence of the minority paradigm within the majority and its eventual separation and expulsion;
 II. Ideological warfare of the majority against the minority;
 III. Professional or economic coercion of the minority by the majority; and
 IV. Administrative or legal coercion.
 There may be some overlap among the stages, with III and IV occurring simultaneously with II.
 I assume that these three paradigms-homoeopathy, Krebiozen, and the Antineoplastons-are all effective therapies, since, if they were not effective, the representatives of the majority paradigm would not be so aroused. Ineffective therapies are no threat to anyone. I also conclude that Benveniste’s experiment did, in fact, “work” and for that very reason aroused such hostility among biologists and physicists faced with the need to alter cherished doctrines. 2 

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Dr.Devendra Kumar MD(Homeo)
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