Homeopathy in the USA

Firstly, the dominance of conventional medicine on the cultural "psyche" of the country and secondly, the political and legal framework in which medical practices function. Americans, in general, have great faith in modern medicine. More drugs are taken per person in the USA than in any other western country. The political and social power of medicine and medical institutions is unparalleled. It is part of an ongoing belief in the power of man over nature, a "heroic" sensibility that expresses itself in a faith in technology and in socio/political and technical systems to prevail over the travails of life. For all the notions of independence and individualism, the average American is quite dependent on the power of authority - state authority and of corporations to influence the quality of life. This in turn, has allowed the dominance of a mechanistic medical mindset to maintain a relative stranglehold on what is accepted within medicine and as a result homeopathy has not garnered a great deal of respect and popularity within medical practice.

The second factor is that law through licensure mandates all medical practices. If a system of healing wants to be recognized, a law has to be passed in each state, creating a license for that profession, that license imposing standards of practice which are enforced by state boards. Only those licensed can practice that modality. The three main systems of alternative medicine that have achieved legality through licensure are Chiropractic, Acupuncture and Naturopathic Medicine. Other therapies, such as massage have their own certification standards which differ from state to state, but they are not licensed in the same way as the professions listed above.

Homeopathy is not recognized as a distinct and separate form of medicine in any state in the USA. There are 3 states which have homeopathic medical boards - Nevada, Connecticut and Arizona - but none of them actively function in evaluating competency through an examination process. Homeopathy is therefore practiced by physicians using their medical license to legitimize their practice, by people using a license in another profession e.g. Acupuncture or Chiropractic, or they practice without any license.

As homeopathy is understood to be a form of medical practice, the current political situation creates a dilemma for the growth of homeopathy. Homeopathy is also unique in alternative medicine as the Food and Drug Administration (FDA) define homeopathic remedies as a drug. A bill was passed in 1938, defining homeopathic remedies as a drug, establishing standards of manufacture, overseen by the FDA. This is a paradoxical situation, given homeopathic potentization, but it has served to protect the quality of homeopathic remedies. However, it has also had a legal consequence in defining homeopathy as medicine, as only physicians can prescribe drugs, including homeopathic ones, meaning theoretically that only physicians can practice homeopathy. Harris Coulters argument to the contrary, defining allopathy within the "rational" system of medicine and homeopathy as part of "empirical" medicine is one attempt to make a distinction between the two methodologies. Whether that would hold up in a court of law is another thing entirely.

The struggle for survival and identity:
It should be understood that licensure was not always universal in the USA, and it is only from the first years of the 20th century that medical curricula and licensure became uniform throughout the country. In the 19th century, homeopathy was very popular, being practiced by physicians in many states. Homeopathic medical schools and hospitals existed throughout the eastern states and also in the Midwest and even in California. However, as we know, the demise of homeopathy happened quite swiftly after World War One, and it was not until the 1970s that homeopathy experienced renewed popularity.

The popularity of homeopathy in Europe experienced similar declines in the first part of the 20th century and in England in particular its survival was in part because it was used and practiced by the "lay" community. (The use the term "lay" has generally meant all those doing homeopathy that are not doctors, irrespective of how much training they may be in homeopathy). However, there are no medical statutes in England that define who can and cannot practice homeopathy. The laws defining the practice of medicine in the UK are for doctors only. There are no exclusive licensure laws. In other words, the practice of various medical modalities is not monopolized by physicians, as they are in the USA, and also in France and to a lesser extent Germany. Due to the principal of common law, people can practice whatever they want unless they are attempting to practice conventional medicine, which is regulated by law. The result of this has been the growth of homeopathy within the "lay" community and the development of the "professional" non-physician homeopath. The largest growth of homeopathic practitioner in England has been within this community, and similar developments have occurred in other European countries.

This situation reveals one of the main historical and philosophical paradoxes of homeopathy. As homeopathy was established by a physician and seen as medicine, competing with allopathy for the definition of what medicine is and can be, its use by non-physicians has always created controversy. From the very beginnings though, homeopathy was practiced by non-physicians from Melanie Hahnemann to Boeninghausen and to Vithoulkas but many homeopathic physicians still do not recognize the legitimacy of the professional non-licensed homeopath. Certain conferences have only been open to physicians, and various medical and non-medical homeopathic organizations in the same country have very little to do with one another. This situation is a symptom of the historical and philosophical predicament of homeopathy its struggle for acceptance within society dominated by materialistic thinking, its own internal struggle to find a rational methodology without reducing it to allopathic reductionist dogma and its attempt to establish its identity as a unique system of medicine. However, it is also part of the struggle of homeopathy find its own "metaphor", to know where it belongs, and in so doing to explore the meaning of healing and who has the right to participate in this.

The result of this internal struggle has been that homeopathy has not developed in the USA as quickly as other alternative systems such as chiropractic and acupuncture as the latter modalities never tried to vie with conventional medicine for the definition of the practice of medicine. Consequently, homeopathy has not carved its own niche legally or philosophically - and has been squeezed out.

The situation today is that if a person wants to practice homeopathy in the USA, he/she has to decide whether to train as a physician to gain the license necessary, and then to train separately as a homeopath. Although, according to one study in 1995, 10% of medical schools were offering some instruction about homeopathy and 1/3 teaching something about alternative medicine, homeopathy is not offered in any serious way in any medical school. Alternatively, a person can go to a naturopathic school and gain homeopathic training there. Naturopathic medicine is part of the tradition of eclectic medicine in which the practitioner utilizes many alternative modalities, including herbs, nutrition, homeopathy, hydrotherapy, acupuncture and other "natural" modalities. Naturopathy is currently licensed in 11 states, practitioners calling themselves Naturopathic Physicians. There are 3 currently accredited schools in the USA that train Naturopaths for licensure. They are in Washington State, Oregon and Arizona. Two other schools are seeking accreditation, one in Canada, and the other in Connecticut. However, there is also a large group of non-licensed naturopaths whose training varies, but who also call themselves naturopaths. Naturopathy has a somewhat similar division as homeopathy does between physicians and non-physicians. However, at least homeopathy is offered to some extent in the licensed naturopathic schools, though as of 2001, it is debatable that any naturopathic program offers enough homeopathy to prepare for professional practice without further study.

Another option has been to practice homeopathy using another license purely as a legal cover to protect the practitioner and to allow some kind of insurance coverage. The most common licenses used are Chiropractic, Acupuncture, Physicians Assistant and Nurse Practitioner. There are many practitioners of these therapies that incorporate homeopathy but do not use it exclusively in their practice.

The final option is to practice homeopathy without any license at all, and to gain homeopathic education either through one of the homeopathic schools available or through apprenticeship or being self-taught. As mentioned, this option confronts current legal obstacles, but in spite of that, perhaps the largest growing group of practitioner in the USA is the professional "lay" homeopath. Although there is a growing interest in homeopathy by physicians, the number who currently practice homeopathy exclusively remains small.

This development brings up interesting questions regarding the amount of homeopathic and medical knowledge necessary to qualify a person for practice. One of the concerns often cited by homeopathic physicians is that non-medical homeopaths do not have the necessary medical knowledge for competent practice. The counter argument is made that to practice homeopathy does not require the same level of medical knowledge that a physician requires. Although some medical knowledge is necessary, it is a different system that can be practiced effectively with a thorough knowledge of homeopathic principles and materiamedica, and "some" medical knowledge. This argument reflects the wider argument within homeopathic practice itself, between its scientific and artistic elements and its objective and subjective analysis methods.

In other words, the fact that homeopathy is practiced actively by non-physicians, in spite of legal obstacles, shows that the development of homeopathy is challenging assumptions of the nature and definition of Medicine itself. In exploring its own paradoxes, it is exploring the broader dilemmas and struggles of what healing means and the implications of a "holistic" view in which the subjective experience is of the highest significance. As homeopathy deals with the phenomenon of experience, in that the objective and subjective experiences (sensations) of the person are the "sole" guide to find the appropriate remedy, this challenges accepted norms of medical practice, and the argument would go demands a redefining of health and disease and who can participate in this. Therefore, Homeopathy is struggling to identify itself within the context of the changing definitions of medicine and healing in general.

This questioning does not diminish the significance of medical knowledge requisite for responsible practice of any medical modality and that this knowledge does not belong to the domain of any one methodology. It merely puts it into a broader context in questioning the larger question of redefining health and disease beyond the narrow constraints of the mechanistic medical model.

Homeopathy and its relationship with other alternative practices:
In the USA, Homeopathy has found itself with one foot in its history as medicine and the other foot in the camp of alternative medicine/therapies. More than in other western countries an explosion of alternative therapies has occurred, some gaining widespread popularity throughout the country. A plethora of bodywork therapies has developed as well as the huge phenomena of "therapy", including all forms of counseling, psychotherapy, transpersonal psychology etc. Whereas in other countries, people seeking a holistic alternative that incorporates an emotional perspective may go to a homeopath, in the USA they are more likely to see a therapist, especially in more liberal and middle class areas where homeopathy is also more widely practiced. It is part of the cultural evolution of America where the original religious influence has been transformed and transmuted into the moral uplift of daily life. Therapy could be said to be the secular expression of religious experience, the therapist functioning as priest, similar to that of the physician. Much of the particular expression of religion in America has been the individual experience of God, the idea and experience of individual divinity, clearly seen in the evangelical experience of fundamentalist Christianity as well as in sects like the Mormon Church. Outside of religious experience, a similar attitude has developed, with a focus on personal experience and moral uplift, where people seek intrinsic "religious/moral value in their daily experience and seek the help of "experts" to validate their experience. Whilst not wanting to denigrate this phenomena, as some extraordinary therapeutic innovations have come from the USA, it has led to a therapy centered society, therapy not just on a personal level, but also within the interpretations of personal and social experience. Everything has to have some therapeutic value to it, even Bill Clintons confessions.

Many physicians who have shown interest in a more holistic view and the idea of "energy" medicine are often drawn to the therapeutic effects of meditation, prayer and the more psychic parts of healing, than in homeopathy. In attempting to explore a more holistic view of healing, they separate both parts, maintaining their identity as allopathic physicians whilst exploring more esoteric alternatives. This way, one does not have to challenge the other. Homeopathy may be too close to home, and with the historical animosity and challenge that Homeopathy created, many physicians do not want to become identified with this. It may also be partly be due to a lack of understanding of the depth of homeopathy and that on the surface it may not look much different than allopathic practice. Ironically, it may look old fashioned to some progressive physicians. Another aspect of this is the use of the word "Integrative Medicine", a term developed by Andrew Weil, a physician from Arizona. He has become extremely popular expounded the benefits of alternative medicine, whilst maintaining loyalty to his allopathic roots. It all seems to make sense, to integrate the best of both worlds, to be equally open to the benefits and limits of various modalities. However, as with discussion of the words "alternative" and "complementary", homeopaths may say that "integrative" is a euphemism for "absorption". It brings up the same debate of how to clarify ones own philosophy and practice without getting stuck in the state of victim marginality that homeopaths have struggled with since Hahnemanns time.

There has also been a growing interest in "green" medicine in the politically progressive world of environmentalists, which is a very big movement in the USA. However, there has been much more focus on the use of plants and herbs and little on homeopathy and the implications of its "energetic" philosophy of healing. In many ways, green medicine is still adhering to a mechanistic model of thinking and attempts to integrate homeopathy into a more green worldview have not been very successful.

Therefore, as result of the growth of other alternative therapies and the dominance of a reductionist philosophy within allopathy, Homeopathy has not yet been recognized as a viable and profound alternative to conventional medicine.

In terms of the type of homeopathy being practiced in the USA, classical homeopathy is by far the most popular. The major organizations and certifying boards that certify homeopaths focus on classical methodology. However, in retail areas, far more combination remedies are used than single remedies, and the major homeopathic pharmacies depend on this for much of their income. The use of homeopathy by health professionals that have little training in homeopathy is harder to evaluate, but it is fair to say that very eclectic methods are used. Many naturopaths, acupuncturists and chiropractors use homeopathy to a limited extent, but rarely addressing a more constitutional approach. Although the largest pharmacies in the USA are Boiron and Dolisos, "French" styled homeopathy is not practiced widely. There has to be quite a number of practitioners using Voll machines and other types of diagnostic tools, but again it is not widely publicized and authorities in various states have taken a harder line with this type of practitioner than classical homeopaths who work without a license.

Homeopathic Certification Organizations.
There are five organizations that are recognized to be in the business of defining and measuring standards of homeopathic competency in North America. Each of these has different levels of requirements for certification. The following is a description of each organization and their specific requirements.

The oldest organization is the American Board of Homeotherapeutics. (ABHT). This organization was formed in 1959 and originally certified Medical and Osteopathic Doctors only. However, in 1999, they decided to accept other licensed primary health care providers. There are presently 70 diplomates of this board. Historically, it was members of this organization that helped keep homeopathy alive earlier this century. Another certifying body is the Homeopathic Association of Naturopathic Physicians (HANP). They represent Naturopathic Physicians who practice homeopathy. Naturopathy is licensed in 11 states and homeopathy is included to varying degrees in the curriculum of Naturopathic Medical Schools. Some Naturopaths practice little or no homeopathy where others practice it exclusively. Most naturopaths who do practice homeopathy at all use more combination remedies and "homotoxicology" style prescribing. The HANP began to certify naturopaths that practiced homeopathy in 1989 and currently have 66 board certified homeopaths who practice classical homeopathy.

The North American Society of Homeopaths (NASH) is a certification and professional organization that was established to define professional standards and represent the "Professional Homeopath" who does not practice under any other licensure. They used to be called "lay" homeopaths but have been active in gaining legitimacy for their own standards of competency, irrespective of the legal ambiguity in which they practice. This organization was modeled after a British organization called the Society of Homeopaths. This latter organization is the largest professional membership organization in the United Kingdom, its membership being exclusively non-medically licensed homeopaths. It has to be remembered that in the United Kingdom, everyone is free to practice homeopathy. There are no licensing laws that limit its practice. Standards are regulated within the profession and as long as a professional homeopath does not pretend to be a medical doctor, there are no restrictions on the ability to practice.

Many professional homeopaths in the USA feel they should have the same right to practice as in the UK and do not think that defining homeopathy under current medical statutes is an appropriate way to control the practice of homeopathy. It is a good example of how different political climates determine the legitimacy of its practice, without having anything to do with actual homeopathic standards.

Professional homeopaths have felt the need to define their own standards and to support their practitioners in the United States and Canada. Because the North American Society modeled themselves on their English counterparts they have functioned as both a certification and professional membership organization. The Naturopathic board also doubles their function in this way. The other boards function exclusively as certification boards.

The Council for Homeopathic Certification (CHC) was established in 1991 to establish a standard of professional competency for all practicing homeopaths. It is represented by homeopaths from all the various professions in which homeopathy is practiced in an attempt to establish one level of professional competency. In recognizing the great variety of practitioners in North America the CHC saw the need to establish one standard that could be accepted by all homeopaths, an important step in unifying the profession. It recognized that there were many people practicing homeopathy under licenses of other professions such as Acupuncture, Chiropractic, Nurse Practitioners, etc, who have had no other representation or professional evaluation. It also represents a large number of professional non-licensed homeopaths. As of January 2002 it had 230 certified homeopaths as part of the organization, fairly evenly divided between licensed and non-licensed practitioners.

The homeopaths certified with the CHC come from the following professions and backgrounds - Doctors, Naturopaths, Physician Assistants, Nurse Practitioners, Registered Nurses, Chiropractors, Acupuncturists, British trained homeopaths of the English society and Indian trained physicians, professional non-licensed homeopaths and others.

All the professions that are certified through the CHC represent the board of the CHC. This was established for equal representation within the homeopathic profession.

One other organization is the National Board of Homeopathic Examiners (NBHE). This organization was originally formed to establish a national standard for the profession in the same way as the Council for Homeopathic Certification. Since then, this organization has mainly represented chiropractors and acupuncturists and its board has been historically dominated by chiropractors.

One of the continuing difficulties of a closer relationship between the certifying organizations is the issue of medical standards. As already mentioned this has been an area of disagreement between the various communities, both in the USA and in Europe. This is compounded by the existing legal definition of homeopathic practice in the USA. Also, as each organization has its own agenda to support its own community, it has been difficult to establish a closer working relationship. However, it should be noted that in some ways there has been more communication and reciprocal recognition between physician and non-physician homeopaths in North America than in England and other parts of Europe. This is a promising development, one which organizations like the CHC see as vital for the future of the profession.

One other issue between the various organizations is the level of homeopathic competency it is seeking to measure. The defining of a suitable professional standard for practice is open to much debate. How much knowledge should a person have to be deemed competent? How much experience and training should people have? How much medical knowledge should people have? These are issues which, given the diversity of homeopathic practice, are not easy to agree on, but which each certifying organization has had to grapple with.

One important recent development has been that the North American Society of Homeopaths and the Council for Homeopathic Certification has established a closer relationship in which homeopaths wishing to become certified through the CHC and registered through NASH only have to take the CHC certification exam process, as apposed to two separate examinations. NASH now works with the CHC examination committee, and the role for each organization has been clarified. The CHC only functions as a certifying board, establishing a level of professional competency, the standards being created by all the representative professions on the board. NASH functions as the professional membership organization to support the professional homeopath in his/her practice and professional development. The CHC has also been in discussion with other professional organizations, such as the naturopathic and medical community of homeopaths to try and establish similar or the same standards of certification.

One other development that occurred at the same time has been that NASH voted to open its membership to licensed practitioners. Although originally created to support the needs of the growing number of professional non-licensed practitioners, a number of other practitioners wanted to join NASH and it was decided that their mandate could include representing all professional homeopaths, whether licensed or not. This development created some division within NASH, the fear being that it would dilute the focus on the needs of the professional non-licensed homeopath, the history of being marginalized within the community not easily forgotten. Advocates of the change cited that this development supports the vision of a united profession, irrespective of current political and legal dynamics that maintain separate identities.

Standards of Certification.
One of the biggest problems in establishing and evaluating standards is the current level of education in North America. As mentioned, the only formal homeopathic education within accredited licensed schools is in Naturopathic programs. The other major programs are all part-time 2-4 year programs, none of which are able to give a license or legal right to practice on completion. The quality of the schools varies, but there are probably about 10 schools that offer a reasonable level of training.

All the certification organizations require some pre-requisite study to take the certification process. The CHC requires 500 hours, equivalent to a 3-year part-time program. HANP and ABHT require 250 hours. All the organizations also require practice experience or clinical supervision prior to acceptance. This varies from 3 years for ABHT to 1-2 years for the other organizations.

The certification organizations use an examination process for at least part of their evaluation. In the case of the CHC, part of this is in a multiple-choice format and part in an essay format, when evaluating cases. A separate requirement of submission of 5 cases with evaluation and a 6-month follow-up is required to complete the examination process. A phone interview is the final part of the process. The examination process itself is now done over a two-day period.

The validity of using exams, especially multiple-choice questions is part of an ongoing debate within the profession, both in the USA and in Europe. There is generally more focus on exams in the USA than in Europe and given the diversity of homeopathic training, it allows for an objective evaluation of basic levels of knowledge, which ideally are complemented by the more subjective analysis of case management and professional skills in the other part of the certification process. The move away from examinations in England may be part of a necessary reevaluation of measurement methods but given the current level of resources in the homeopathic community in the USA, and the different levels of training, the current situation will likely remain for the foreseeable future.

However, much work is currently going on into the examination procedure, to help establish an effective and balanced examination that adequately evaluates both objective factual knowledge, and the more subjective skills of homeopathic practice.

Given the limited number of schools in the USA and the sheer size of the country, correspondence schools of training are fairly popular. They can serve a useful purpose in giving basic training, but as with other "onsite schools, unless complemented by clinical training and individual supervision, will only partially prepare for practice.

In the last few years, various schools have implemented much more clinical training and this has been encouraged by the CHC, allowing formal clinical supervision to be used in lieu of actual practice toward certification.

Many homeopathic students and practitioners also gain many hours of training through the various seminars being offered throughout the year.

The legal recognition of homeopathy:
It is hard to see standards of education grow in North America until the legal situation changes. There are 4 main options that could help further establish homeopathic education:

  1. To include homeopathy as a fundamental part of medical curriculum or doctors and nurses. Homeopathy would therefore grow within the medical practice of physicians, nurses and others.
  2. To create a separate medical license for homeopathy and have separate homeopathic medical schools similar to naturopathy and Chiropractic.
  3. To create alternative form of legitimacy such as certification or registration that would fit within the laws of each state and create schools to teach to the appropriate level.
  4. To establish a political climate in which homeopathy, amongst other alternative natural therapies, could be practiced freely without any restrictions.

The first option may happen if the cultural climate of medicine changes and although there are signs this is occurring, it will be some time before homeopathy is offered to a professional level. As of now, some medical schools are offering a 40-hour program in homeopathy, being sponsored by the American Institute of Homeopathy.

Given the current legal obstacles in creating licensure, it is virtually impossible for homeopathy to get licensed as a distinct system of medicine. The profession is not strong enough and the influence of state medical organizations is so strong that they would likely quash any attempt at licensure. In American politics, the American Medical Association and state medical associations hold extraordinary influence and have no interest in seeing homeopathy and other modalities flourish.

The latter two options are more viable and there are moves now to establish a greater level of freedom and autonomy for alternative models of healing. One major way this is happening is through laws being passed based on the concept of consumer choice, advocates arguing that people should have the right to choose whomever they want for their health concerns, that this shouldnt be dictated to them through the vested interests of powerful organizations and government legislation. These issues reveal the struggle for a balance between protecting the consumer against unqualified practitioners and potentially harmful therapies on the one hand, and protecting the right for people to take responsibility for their own health. In 1999, a bill was passed in Minnesota called the "Complementary and Alternative Health Care Freedom of Access Bill." The result of this bill passing is that alternative health practitioners can practice freely without threat of prosecution as long as they disclose honestly their level of training and experience and get written informed consent from the patient/client. The bill also allows medical doctors to use alternative therapies, where previously they could have their own medical boards prosecuting them. A similar bill is currently moving through the California legislature and is even more "libertarian" than the Minnesota bill as it would leave discretion totally up to the patient/client, with only a simple disclosure statement from the practitioner.

These bills do not pertain particularly to homeopathy but to all alternative therapies, and whilst they dont address all the issues needed to validate homeopathy, they are a first step at defining the legality of professional non-licensed homeopaths.

In the last 3 years, three professional non-licensed homeopaths, all certified by the CHC and registered through NASH have been notified to State Medical Boards for practicing medicine without a license. None of them had a patient complaint made, it was based solely on them practicing homeopathy, even though they stated clearly that they were not physicians or diagnosing disease. In the first case in Connecticut, the State finally backed down, but leaving the homeopath emotionally and financially exhausted. In the second case, the homeopath left the state. The third case is still in progress, but in any situation like this, the trauma and risk to the homeopath is extreme. In most states, this crime is a misdemeanor, and if found guilty would not lead to a prison sentence but current law creates this possibility for all practicing non-licensed homeopaths. However, even homeopaths that practice under a license, including an MD, can potentially be charged for practicing a system outside the scope of practice of their license. This possibility varies from state to state as each state board of each profession has different practice stipulations but the fact remains that ALL practitioners of homeopathy endure some risk of legal action against them.

Aside from the political issues of practicing homeopathy, the question still arises as to whether homeopathy should be governed by the same restrictions and responsibilities as a medical doctor. As homeopaths, are we assuming the same risks as the role most conventional physicians? The answer partly depends on the nature of each practitioners practice and those homeopathic physicians who work in a primary care situation may say yes. For many other homeopaths, the answer would be no. Although any person coming to see a homeopath may potentially have a serious problem that may need immediate medical intervention, is that the reality of everyday practice for most homeopaths? In one particular study, 79% of patients/clients had previously seen a conventional MD for their problem prior to seeing a homeopath and 91% had done non-homeopathic treatment first.

The fact is that most people seeing a homeopath have seen other medical providers first and are coming to the homeopath for an "alternative" form of treatment. This means the homeopathic role is not going to be primarily diagnostic and disease centered and the role of the homeopath may be "complementary" to that of the conventional physician. This is not to diminish the role of the homeopath, limiting them to only superficial, functional and neurotic conditions but to describe the realities of everyday practice. It is clear that homeopathy can work in complex pathologies. The level of medical knowledge depends on the level of responsibility taken. It is important that each practitioner works within their level of knowledge and the risk of a potentially serious condition requiring immediate medical intervention is always there, both for the non-licensed practitioner as well as homeopathic and conventional physicians. However, extensive medical knowledge is not a substitute for a lack of homeopathic knowledge and many well-trained professional homeopaths feel competent to deal with serious pathologies because their understanding and confidence in homeopathy is solid.

This discussion, concerning medical and homeopathic knowledge necessary to help define the level of knowledge necessary for homeopathic practice has been part of the dialog within the profession for a number of years now. The documents produced by the European Council for Classical Homeopathy outlining standards of education were also duplicated in the USA, organized through the Council for Homeopathic Education. Intense meetings and discussions over a number of months went into producing a similar standards document for the whole profession. However, at the current time, no homeopathic school is near offering the ideal level of training outlined in the document.

The ongoing challenge:
The greatest challenge today is in producing skilled homeopathic practitioners. It is a difficult task to persuade many people today to commit the years necessary to become competent, when there is little social and scientific recognition for homeopathy, and where it can be challenging to make a reasonable living practicing this art. In the USA, homeopathic practitioners in general charge more than in Europe, but it seems there are fewer people seeking homeopathic treatment as a whole. There is a tendency, both in the USA and to some extent in Europe, for homeopathy to be exclusively used by upper middle class people who can afford the fees. In the USA, many professional practitioners of many therapies charge very high rates, which may often be covered by insurance. It is part of the growing crisis in American health care where health practitioners of all stripes seek to maximize their return through charging insurance companies as much as they can for their services. However, one consequence of this is making homeopathy unavailable to poorer people and those without insurance, and for it to become somewhat precious and exclusive. It also makes it challenging for non-licensed professional practitioners to make a living, as they cannot get insurance companies to pay for their services.

A threat to homeopathy is in the dilution of standards of practice to make homeopathy more acceptable to the general culture as well as mainstream medicine. Americans in particular, want a quick fix and are unwilling often to endure much suffering on the way to cure. Some homeopathic principles are not easy to reconcile with currently accepted views of health and disease. The holistic view of homeopathy, with emphasis on the whole person and its critique of the suppressive effects of modern drugs do not fit into conventional thinking. Even within various alternative therapies, homeopathy seems to be more critical of established conventional practice, as it has historically always been. Some think that homeopathy will not thrive until a wider philosophical and scientific breakthrough occurs, one consistent with homeopathic thinking.

As mentioned earlier, the practice of homeopathy reflects a broader struggle in determining who has a right and the skill to heal. The establishment of health is not a right determined by a law or just by medical knowledge but by a combination of many factors, the most important perhaps being to encourage people to take greater responsibility for their own health and well-being. This responsibility forces us to question the underlying social, economic and political reasons for sickness and not just the individual sickness of one person.

Central to homeopathic philosophy is the principle of self-cure, the idea that health is not merely the absence of symptoms but a dynamic state of equilibrium, both mental and physical, in which an individual is able to establish and maintain health without dependence on drugs, doctors or any therapy. It is the process toward freedom and independence, an increased consciousness on all levels, one that challenges many of the results of modern medicine, which exists in an economic and political reality where dependence on experts results in an increasing medicalization of every aspect of life.

This is the challenge facing us today. In many ways, despite the fact that homeopathy is still a minor blip on the map of health care options, it is in an extremely vibrant state. The forging of working relationships between various organizations, the defining of clear standards for the profession, the movement toward greater unity, not to mention the fact that many excellent homeopaths are continually being taught, in spite of a currently unfavorable working climate, is a testament to what is possible and what is yet to come.