Interview and Translation by Linda V. Nurra, Ph.D
Dr. Elio Rossi is a medical doctor with a specialization in infectious diseases who has been practicing homeopathy for 40 years. He is internationally renowned for his advocacy efforts for homeopathy, as well as his prolific work as an educator, conference presenter, editor and author of more than 250 publications. Over the past 20 years, he has been working for the recognition and integration of homeopathy and other complementary medicines within the Italian public healthcare system. These efforts have resulted in the passing of legislation at the national and regional levels and the opening of 91 complementary medicine clinics within hospitals in Tuscany alone.
In Part 1 [ http://hoacuoidep.info/homeopathy-interviews/heroic-times-italian-homeopathy-interview-dr-elio-rossi/ ] of this interview, Dr. Rossi shares his personal story of coming to homeopathy in the 1970s, which also represents an important chapter in the broader history – and the resurgence – of homeopathy in Italy. He describes these as “heroic times,” when a group of students in Milan began their gatherings with Mario Garlasco and Carlo Cenerelli, then with Jacques Imberechts, who helped them reach out to other groups across Europe, and finally with Joseph Reves. In 1992, Dr. Rossi decides to relocate from Milan to Lucca, Tuscany, making a long stop in Cuba on the way. There, he helped to catalyze a resurgence of interest in homeopathy and provide Cuban homeopaths with training and much-needed pharmacy supplies.
It sounds like your experience in Cuba was an important step towards a broader social and political engagement for you – and your move to Tuscany offered a context where it could play out. Why did you decide to move to Lucca and what happened when you got there?
I came to Lucca because I wanted to be in a smaller, more livable city than Milan. Luck would have it that Tuscany’s regional government and health institutions were significantly more open to the new, and to the integration of complementary medicines within healthcare.
When I first moved there, I worked in a much more narrow way than in Milan, where I had a thriving private practice. I started my new activity practically from scratch; no one knew me. After a year, in 1996, I was ed by a member of the regional board from the Green Party, Tommaso Franci, who wanted to include in the regional health plan something about complementary or “non-conventional” medicines, as they were called back then.
In drafting this, we made the case that there is an important percentage of the population that does not use conventional medicine and hospitals but that pays taxes, and that it would be appropriate for the region to recognize this. The case was presented to the chair of the regional health board, Claudio Martini, who understood the importance of our message. For the first time ever, a regional health plan was issued that included the term “non-conventional medicines” and argued for their importance in reducing pharmaceutical consumption and abuse. That was 1996, just the beginning of a journey that has lasted 20 years, with many changes and positive results.
What made it possible to translate the Tuscan regional health plan into a practical, clinical reality?
After the plan was made official, we formed an association called “Medicine e salute” [Medicines and health], with representatives from various complementary medicines. The association helped to prepare a conference on non-conventional medicines held in November 1997 at the seat of the regional government in Florence, with the support of Claudio Martini. At the end of this conference, Martini issued a policy statement authorizing hospital directors, if they chose, to institute complementary medicine practices.
With this policy statement in hand, I went to the Lucca hospital general director, Dr. Raffaele Faillace, to propose opening a clinic. He was very much in favor of the idea and I learned that his wife and children used homeopathy. He had no problem moving ahead if I was available and willing. Not surprisingly, I had to be willing to accept a sacrifice in pay as well.
I accepted the challenge. In 1996, the first public acupuncture clinic had opened its doors; in 1997, the first herbal medicine clinic. By September 1998, I was opening the first public homeopathy clinic in Tuscany at the Lucca hospital. I insisted that the clinic not be separate from the hospital structure itself, not so much to plant a homeopathic flag, but rather to say: “We are within this institution just like others, but simply doing something different than we have always done.”
Initially, we received nominal compensation, similar to what we earned in our student days. The patient paid a “ticket,” part of which went to the hospital and the other to the doctor. If a patient didn’t show up, you didn’t earn at all, so our income was symbolic more than substantial. It took years for this to change. In 2002, our clinic became the “regional reference center” for homeopathy in Tuscany and in 2008 we were recognized as “clinic specialists” and CM experts. This means that if a homeopathy-related issue presents itself within the regional government, or if a law needs to be passed, they ask my opinion as director of the reference center. And now we have funding.
What else has happened between 2002 and today?
Tuscany can now boast of its 91 public complementary medicine clinics within almost all hospitals in the region. Seventeen of these are dedicated to homeopathy, which is one option along with acupuncture and herbal medicine, for a total of 30,000 visits a year in Tuscany. Approximately one fifth are homeopathic visits. It’s quite a demanding reality.
Just in Lucca, there are three centers: a homeopathy clinic and an integrative oncology clinic directed by me, and a women’s homeopathy clinic directed by a colleague of mine, Dr. Marialessandra Panozzo, a homeopath and experienced gynecologist who specializes in gender medicine. Even though no one talked about gender medicine when we opened this clinic in 2002, it was clear that a women’s clinic run by a female gynecologist was appropriate, given that most homeopathy patients are women and often present typically “female” issues.
From then on, my efforts have run along parallel tracks – on one, the homeopathy work being done in the hospital; on the other, the institutional, regional work. When we started, we realized that we were lacking a general frame of reference. If you want to work in a hospital, you need a contract. What contract can be drawn up if homeopathy is not a recognized specialty?
We therefore decided to work towards the recognition of homeopathy at the regional level, which resulted in the passage of a law in 2007 and an agreement with clinic specialists stating that even in absence of a specialty, there would be a recognition of homeopathic expertise as if it were a specialty . We built a system – a small system, but also a significant and meaningful one.
What do you mean exactly when you say that you’ve built a “system”?
It’s important to understand that the Tuscan experience isn’t limited to the inclusion of complementary medicine within public clinics and hospitals. What we tried to create was a broad system of inclusion and integration at every possible level of regional healthcare. We have launched numerous educational campaigns for the general public . We regularly organize conferences and provide training for healthcare professionals. We issue a newsletter every four months that informs all CM stakeholder organizations and doctors about what is happening in the region . We also systematically share our results through scientific publications and conferences locally and abroad. My group, for example, has focused strongly on documenting and compiling outcome data on homeopathy in atopic diseases, allergies, and women’s health issues, among others.
Our professional trainings have addressed a range of topics: informational courses on complementary medicine for more than 600 specialists, Chinese Medicine and homeopathy for natural birth for obstetricians, complementary medicine in pain management for general practitioners, and clinical risk and patient safety management in complementary medicines, among others. We even had a course for prison healthcare personnel inspired by an interesting experience on the island of Gorgona, the home of an agricultural penal colony, that began with the use of complementary medicines for animals raised by the prisoners themselves. Unfortunately this project was closed by the Italian Ministry of Justice a couple years ago.
Even when they didn’t result in integration projects, these trainings have helped to create a culture of information and understanding around the philosophies and therapeutic possibilities of complementary medicines.
Part of your work has been focused on integrative oncology. Can you tell us about that?
Yes. We have been working in integrative oncology with support from the Region of Tuscany. We are helping patients better handle conventional treatments and experience improved quality of life. I’m convinced that this helps also in terms of survival and the reduction of recurrences. This area is gaining ground in the United States as well, but the challenge for us is integrating it into our own public healthcare system. Keep in mind that in Tuscany, where anyone can have an integrative medicine (or any other specialist) visit for 24 euros, low-income and cancer patient care is free.
Our work in oncology also has an international scope. We’ve had great results participating in European projects such as the European Partnership Action Against Cancer (EPAAC). Just today we were given the green light to support a workshop at the European Congress of Integrative Medicine, which will include U.S. contributors for the first time among its expected 1,000+ participants. This workshop is on integrative oncology for refugees, especially from the Middle East because there’s a network for integrative oncology in that region that brings together Israelis, Palestinians, Turks, Lebanese, Moroccans and others. The Region of Tuscany is supporting this financially because there’s strong agreement about the importance of this topic.
This is one of the characteristics of Tuscany as a region: we are a center of innovation. Interestingly, in Tuscany, 37.9% of oncology patients use CM and 66.3% tell their doctors that they are also using complementary medicines. Certainly there are people who say CM is placebo, but the great majority of people here accept it as a normal and useful thing.
You seem to represent a new kind of figure in homeopathy – that of homeopath as activist, lobbyist, and educator all rolled into one. Does this description resonate with you?
At some point, I went from being a classical homeopath interested in matching a person’s symptoms with the best remedy to being a classical homeopath interested in social homeopathy. This is the term I started to use years ago to refer to the question of what are the effects of homeopathy on society, on healthcare, on public institutions. My experience in Cuba helped me begin this reflection and we have come a long way since then.
Experience has confirmed for me that either you’re within the system or in some sense you don’t count – you stay in a sort of parallel world, perhaps doing what you want, but you’re insignificant from the broader social perspective. So we embarked on this path regarding complementary medicines, including homeopathy, as a whole. As you can imagine, it’s not easy to “hold” homeopathy together with other complementary medicines because our institutions tend to separate it out as non-scientific and non-plausible in terms of its mechanisms of action. Acupuncture and herbal medicine, on the other hand, have taken hold at all levels. For us, it has taken 20 years of experience and clinical work in which we documented everything we did. Even if we don’t have full evidence for the scientific basis and the mechanisms behind homeopathy, we have a case load of over 6,000 consecutive cases from our hospital clinic in Lucca. Sharing these results has made a big difference.
Other regions of Italy seem to be making progress, but none so much as Tuscany. In addition to your hard work, it seems perhaps there was a fortuitous alignment of players and situations. What really is the secret to your success in Tuscany? And what advice can you share with others wanting to replicate that success?
It is a great question that many people ask me. As you said, there are many situations that aligned. An example is the ongoing support of government officials. The chair of the health board who first supported us became the president of the region. The chair who replaced him, Enrico Rossi, followed his footsteps, so there has been a clear political continuity. Not least of all, we’ve had great support on the part of the public, which has influenced politicians. And finally, the practitioners who participated in this movement all aligned. We all worked together, even though we’re from different disciplines. We knew that there would be no future in the fight for the integration of homeopathy only, or acupuncture only or anything else, independently of the other disciplines.
One of the interesting alignments in the beginning was an initiative by the medical board of Tuscany, which sent a survey on complementary medicines to all its registered general practitioners and pediatricians. There was a very high response rate, especially if we consider that these were pre-Internet days and recipients had to mail the survey back at their own expense. Among 3,000 doctors surveyed, 80% responded, the vast majority of them in support of complementary medicine and training in that area. We also discovered that doctors were using CM for their health more than their patients: 23% vs. 20%.
Having this kind of support was invaluable. So, for our progress, we have to credit the readiness of medical practitioners and the general public, as well as the preparation of those who worked on these initiatives, the experience we gained in the social arena, and most importantly the tenacity and seriousness with which we pursued our objectives over the years.
I have to reiterate, though, that this was a 20-year process. It took that long to build an embryo of a system. Certainly, our situation in Tuscany is quite a jewel. We’re not the only ones in Italy doing this work anymore, but we’re the only ones doing it at this level. We’ve tried to export our model to other regions with varied results. One important win was a national law, an agreement between national and regional governments defining training criteria for complementary medicine, passed in 2013, which most regions have supported and are working to implement . The difficulty is that many regions are currently faced with an economic deficit.
Free healthcare for all is a positive ideal but it is difficult to achieve and maintain, as we see with the United States. Costs are very high and growing. The latest anti-cancer therapies or immunotherapies cost 30,000 to 40,000 euros per patient. It’s not possible to sustain costs like that. This is partly why complementary medicines are important in the public sector – because they help to cut costs and educate patients about maintaining health though diet, lifestyle, and so on.
There are great benefits to having homeopathy in the public healthcare system. Are there any costs? For example, are there changes you’ve had to make in the way you practice, possibly in response to pressures extrinsic to homeopathy?
We have never had external pressures. Our internal pressures are mostly related to hospital turnaround times. It’s simply not possible to do 3-hour visits. We give each of our patients a half hour for the first and second visits, which very occasionally will extend to an hour. This means that if the patient has a very complicated case, we’re not able to see them as long as we’d like.
I don’t think this is unique to the public sector, though. When I started in homeopathy, Schmidt and other masters were doing half-hour visits, some of them having to see 60-70 patients a day. Kent practiced like this too. Naturally, if you have 40 years of experience, half an hour can be enough, but not always.
My personal challenge is that we spend a lot of time documenting our results. Among my patients, I can tell you how many are doing well, how many are not, and which pathologies are showing more or less positive results. For example, we’ve had greater challenges with people who come to us with predominantly psychosomatic problems. Our time constraints simply don’t allow us to enter that deeply into a patient’s issues. Still, we would have to compare our results with those of homeopaths elsewhere to understand if the differences in results are significant.
This reminds me of a conversation between Pierre Schmidt and Jacques Imberechts in Geneva. It went something like this:
Schmidt: How many years have you been practicing homeopathy?
Imberechts: It’s been 20 years already.
Schmidt: What are your results after 20 years? How many patients are cured?
Imberechts: Well, I’d say that 70% of my patients have good results.
Schmidt: Ah, good, very good. Do you know what my results are, after 60 years practicing homeopathy? Forty percent.
“What? Forty percent? How is that possible?”, replied Imberechts with great surprise. The answer was that, the more you’re known, the harder and more complicated are the cases that come before you. Cases with complicated life stories and a preponderance of mental pathology have to be analyzed carefully. Our hospital setting doesn’t allow us to delve into people’s life stories in that way.
That said, in most cases, we don’t find this is a problem. In many ways, we have great advantages. It’s easier to work in a hospital. You’re more supported and you can count on specialized advice or help interpreting labs from your colleagues whenever you need it. Homeopathy patients often come for treatment because they want to replace their pharmaceuticals – antibiotic, psychotropic or anti-epileptic drugs, for example – with homeopathic treatment that has the same properties but without side effects or toxicity. The transition away from conventional pharmaceuticals is very delicate and it can create greater problems if not managed well. Within a hospital setting, this transition can be made more safely because you can consult more easily with your specialist colleagues to understand the best way to proceed.
In your view then, is the integration of homeopathy within public healthcare systems the answer for homeopathy, for our sustainability? Is this the future of homeopathy?
This question you’re asking is the fundamental question for all of us. Is integration the future? I don’t know if it’s the future, but I know that without it, there is no future. I think that the way we began practicing homeopathy years ago – in a parallel world where everything is homeopathic, where patients don’t get vaccinated and they’re eating organic food, but then they don’t have access to a homeopath at night or on the weekends – is not destined to survive on its own, at least not in Europe.
Why do you think that is?
There are many challenges on the horizon right now. In all of Europe, there is a lack of youth who are interested in learning homeopathy. The medical schools are increasingly focused on technical knowledge rather than cultivating a humanistic perspective, which is necessary in homeopathy. Second, there have been massive denigration campaigns across Europe and the United States, along with initiatives aimed at limiting access to remedies. Third, there is a lack of research, especially on the mechanism of action of homeopathic remedies, which strengthens our critics. Many homeopaths are not interested in documenting their daily results, and this does not help us.
Recent developments in homeopathy haven’t facilitated our outreach to potential students either. Many homeopaths spend time sharing success cases with small or unknown remedies or with what I call “artistic” prescriptions. Those of us who have been doing this work a long time know that you need more than imagination (but rather, a huge amount of study) behind what you do. In recent years, we’ve also seen an esoteric wave based on interpretation with minimal proving data, with prescriptions relying on remedy “signatures” rather than experimentation. If this doesn’t push people away, it certainly doesn’t help to attract them to homeopathy.
Still, even in this worrisome situation, you have made impressive progress, at least in the Italian context. Does that make you even slightly optimistic about the potential of homeopathy globally?
If we’re talking about homeopathy like I knew and practiced it many years ago, I’m pessimistic. The number of practitioners interested in it and patients seeking it out is dwindling. I think we need to broaden our horizons and find ways to integrate and include ourselves – even as we preserve homeopathy’s priorities – within a dialogue with the public healthcare system.
Because there are many active and powerful forces working against homeopathy, in part due to errors and inadequacies in our own sector, I think we must all work together on common goals. One of these is integration through models like Tuscany’s or others, depending on what makes sense in each context. For example, there is an integrative oncology clinic in Northern Italy, in Merano, that is influenced by German methods and uses many different systems of homeopathy with success. It’s different from what we’re doing but it’s working.
Because of all the work we’ve done, and because homeopathy is an efficient and sustainable medicine, the system we’ve built in the past twenty years here in Tuscany has a strong probability of staying. We are working especially for this, to leave a legacy.
Each territory must find its own specificity, but we must do this within a common journey of integration, research, and scientific validation of results that is greater than what we have done so far. If we can understand and embrace this, then I can say I’m quite optimistic about the future of homeopathy.
Editor’s Note: See part two of this interview also: http://hoacuoidep.info/homeopathy-interviews/heroic-times-italian-homeopathy-interview-dr-elio-rossi/
Notes Region of Tuscany, Regional Law No. 9, 2007: “Regulation of the practice of complementary medicine on the part of medical doctors, dentists, veterinary doctors and pharmacists.”  An example of these informational campaigns for the general public was launched by the Region of Tuscany in October and November 2005. Its goal was to inform citizens about the integration of three CM therapies (acupuncture, homeopathy and herbal medicine) within the regional health system. Citizens were encouraged to call a free number for more information and hundreds of phone calls came in. Incidentally, this happened the day following the Lancet’s publication of Shang’s meta-analysis declaring “the end of homeopathy,” which was reported on the front pages of newspapers in Italy and around the world. Timing would have it that Tuscany was responding with more than 2,000 posters appearing all over cities in the region: “For allergies, now you can choose. Including homeopathy, if you want. Just call this free number…”  The Region of Tuscany’s newsletter on complementary medicines can be found at  Agreement between the State and the Regions and Autonomous Provinces regarding “National rules for education in complementary medicine” (2013). The agreement defines the training and accreditation of complementary medicine professionals and educational institutions and provides for the establishment of lists of CM professionals who practice acupuncture, herbal medicine, and homeopathy. Those wishing to register must have a certificate issued by accredited public and private training centers and must have completed a course of no less than 500 training hours, including 100 hours of clinical practice, after having passed a theoretical and practical exam and discussed a thesis. Courses for medical doctors cannot last less than 3 years.
Linda V. Nurra, Ph.D.
Linda Nurra is an independent scholar and homeopath-in-training with the School of Homeopathy (UK). She has a background in humanities, with a focus on linguistics and semiotics. Her past work includes university teaching, corporate training and management, and higher education administration. She has translated, edited, authored and co-authored publications in semiotics and homeopathy.