Although prenatal testing has rarely been publicly justified in terms
of its cost-effectiveness, public health administrators and policy makers
concerned about the costs of “heroic” lifesaving interventions for
neonates could hardly be oblivious to the actual and potential savings
implicit in selective abortion. Many of the most expensive health conditions
are not, and never will be, detectable by prenatal genetic testing,
because they arise from accidents of various sorts or have complex
etiologies in which genetic variations play only a slight or probabilistic
role. Nevertheless, there is evidence that the incidence of several
diseases and impairments thought, correctly or not, to impose significant
health care costs has fallen – or has failed to increase as expected
because of other factors, such as increased maternal age – as the vast
majority of women who employ prenatal

reduce genetic diseases and defects. Rather, prenatal tests were justified
as tools for expanding individual reproductive choice. Whether this represented
eugenics “though the back door,” as some critics claimed (e.g.,
Duster, 1990), or the distinct, if still unwelcome, intrusion of a consumer
mentality into reproductive decision making (Lippman, 1991), the use of
prenatal tests soon became a standard part of medical care for pregnant
women deemed to be “at risk” of bearing diseased or disabled children.

The roughly concurrent emergence of drugs that improve the quality
of living without extending life, and of medical interventions that extend
life without improving or restoring its quality, raised issues about
the very meaning of quality of life, and about its importance as a goal
of health care practice and policy. While the growing use of treatments
that appear to improve life quality without increasing longevity suggests
a greater concern for patient welfare, the increasing scrutiny of
life-preserving and other expensive medical technologies suggests a
greater concern for resource allocation. The expense of many of these
technologies has been a major stimulus for cost containment, as well
as for a precise, objective assessment of the actual improvements that
these technologies produce. The result has been the imposition of costeffectiveness
analysis in professions where rationing had rarely been
explicit. Interventions sought by desperate patients and families, as well
as interventions opposed by patients or their families as undignified or
pointless, are routinely challenged by health economists, administrators,
and policy makers because they are not “cost-effective.”

The cruel quip “The operation was a success but the patient died” expresses
a common anxiety that medicine’s criteria of success may be too
narrow. Fixed on the goal of removing or ameliorating the symptoms – if
not correcting the underlying physiological abnormality – medical practice
can sometimes seem professionally inattentive to the impact that a
particular disease or treatment may have on a patient’s well-being beyond
the specific signs and symptoms of the disease. In response to
these concerns there has been, at least since the 1970s, growing clinical
attention to and research on the use of so-called quality-of-life (QOL)
measurements to inform treatment decisions.

Describe their sensations in distinct expressions.”
Only after taking the drug for an extended period, several weeks at least, and
reaching a point where no new symptoms were being experienced could provers
report back to Hahnemann with their records. He then “examined every
prover carefully about every particular symptom, continually calling attention
to the necessary accuracy in expressing the kind of feeling, the point or locality,
the observation, and the mentioning of everything that influenced their
feelings, the time of day, etc. When handing their papers to him, they had to
affirm that it was the truth and nothing but the truth.

Hahnemann took considerable pains to ensure that the findings in his
trials were valid. First, he employed only healthy volunteers in the provings.
Unhealthy ones would be experiencing symptoms of illness that might get
confused with any symptoms produced by the drug; the law of similars, furthermore,
specified that drugs relieved the same symptoms in the sick as they
produced in the healthy. “Our trials have been made on persons enjoying
perfect health,” Hahnemann declared, “and living in contentment and comparative
ease.”8
Once healthy volunteers were recruited, they were instructed to take
regular doses of the item being tested and to keep detailed records of all
unusual sensations they experienced while doing so. “Provers” were ordered
to practice moderation in diet (“as free as possible from spices”) and drink
(“not of a stimulating kind”), to avoid excessive physical or mental exertion,
and to deny themselves “the excitement of sensual excesses.” If any event
causing unusual merriment, anxiety, or other emotional perturbation occurred
during the trial, no symptoms were to be recorded afterward, “in order to
prevent spurious symptoms being noted as genuine.” Genuine symptoms had
to be evaluated in depth by “the experimenter assum[ing] various postures, in
order to observe if the sensation is increased, lessened, or made to vanish by
motion of the affected part; by walking in the room, or in the open air; by
standing, sitting, or lying; or whether it returns when he assumes the original
position.” Provers were expected to determine whether any symptom was
affected “by eating, drinking, talking, coughing, sneezing, or some other bodily
function.” The time of day or night at which each symptom tended to
occur was, Hahnemann instructed, to be given “particular notice.”

determine just what effects they produced and thus
what symptoms they would cure. These experiments to discover symptoms
were called “provings” in English, from the German Pru¨fung, for a trial or
test. Hahnemann personally conducted provings on a total of ninety-nine drugs
over the course of his lifetime. Other homeopaths carried out provings as well,
bringing the sum of remedies studied to more than seven hundred by the end
of the nineteenth century.7 Materials to be tested as drugs were selected from
all three kingdoms of nature. There were minerals such as natrum muriaticum
(table salt; homeopathic remedies were given Latin names), arsenicum, and
cinnabaris. Animal products included lachesis (snake venom) and pediculis
capitis (head lice). But the largest category consisted of botanicals: veratrum
album, datura stramonium, nux vomica, rhus toxicodendron, pulsatilla, and
many more

Some neurologists believe that the brain is coded from birth with a map
of the body and that the limb remains on the map even if it never develops or
1s severed. The sensations in the phantom limb, according to this theory, are
activated by nerves at the stump of the missing limb.3 This theon would bet-
Ler account for my observations in working with phantom limb patients if it
\\ere complemented by an understanding of th’e enere body I believe a
phantom limb is the energetic “double” of the missing limb

Y our energy body is the subtle counterpart of your physical body, and it is
more responsive than your physical body to many kinds of influences.
Because the energy body holds the blueprint of the physical body’s health, it
is the focus of energy medicine. Treatments that affect your energy body reverberate
throughout your entire system.
The energy body reveals itself rudely and unmistakably in phantom limb
pain, one of medicine’s most disconcerting puzzles. A person may feel terrible
and inexplicable pain in a part of the body that is no longer there. Some
300,000 people in the United States have had an arm or leg amputated, and
a majority of them report itching or pain in the area where the limb was.’ Because
of “their vivid sensory qualities and precise location in space,” notes
Ronald Melzack, a research psychologist at McGill University, phantom
limbs “seem so lifelike that a patient may try

Conventional medicine followed a different rule, Hahnemann pointed
out, seeking to overcome disease through “the use of such medicines as are
capable of producing in the healthy body a different . . . affection from that
exhibited by the disease to be cured.” Was there ever, he asked, “a more
ridiculous pretension? a more recherche´ piece of stupidity?” than this presumption
that disease had to be neutralized with something different or opposite
to it, rather than duplicated? Well versed in classical languages, Hahnemann
coined a label for the conventional approach: “allopathy,” from Greek
roots for “unlike” and “suffering.” Allopathy had acquired its misguided faith
in opposites rather than similars by trusting in theory over experience. It had
fed on “the sweet baby-food of hypotheses and pleasant figments” and been
“stunted in [its] growth by the eternal swaddling clothes of authorities that
discountenance all investigations.” Allopathic epistemology was “useless
trash,” and allopaths themselves bound in “the trammels of ignorant credulity.”
Worst of all, the therapeutic premise of “other than the disease” worked
against the healing efforts of nature. Hahnemannian practitioners “abjure Allopathia
for this,” a mid-nineteenth-century American homeopath stated; “she
ignores nature and her powers [and] in her practice violates her.” The title of
this doctor’s book said it all: Homoeopathia and Nature and Allopathia and Art.6
By the mid-1800s all irregular practitioners, not just homeopaths, would be
using the epithet “allopathy” with exactly that same understanding.