Talk:Homeopathy/Archive 13

Discussion of ground rules and other issues
I have removed the text below from the article, as the statements are not supported by the reference; an online link to it is now in the article. In addition, I have posted an article on Oscillococcinum.

"Some randomized controlled trials that have tested the efficacy of homeopathic medicines have reported positive results, but, as mainstream physicians contend that large randomized controlled trials have generally not shown effectiveness beyond placebo effects, except for the fact that four large trials (totaling 1,194 patients) have found efficacy from Oscillococcinum 200C in the treatment of influenza."

The text above is somewhat hard to parse, and the statistical data is a bit more than "mainstreams physicians contend." It also does not reflect the studies. There were seven, not four, trials. Four were of treatment and three of prevention; the 1,194 figure above only reflects the treatment trials, not the prevention trials in 2,265 patients.

It was the conclusion of the Cochrane reviewers that only two of the studies were statistically adequate. Looking at all seven, however, they concluded Oscillococcinum had no preventive effect, but showed enough treatment effect to warrant further studies. They did not consider it ready to recommend as first-line therapy.

I have also removed from the article "Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it."

If there is a specific homeopathic publication or presentation that counters these specific findings, it should indeed be in the article, with sourcing. The text above, however, implies that homeopaths reject the specific Cochrane study, but give no specific arguments against it.

I'm honestly puzzled, and would appreciate being educated, on why homeopathic remedies, based on symptoms, would be used as preventive measures. Honest question: does homeopathic theory say that the administration of a remedy will prevent, as well as treat, the symptoms in question? Howard C. Berkowitz 22:35, 20 October 2008 (UTC)


 * Thanx Larry. I am not at all clear how much of your comments are directed to me or to other people here.  To date, I have not engaged in any edit wars, and although I have occasionally deleted some material, I always try to add comments and discussion.  If and when I err here, please alert me.  That said, our lead previously made four references to mainstream doctors not accepting homeopathy.  This redundancy, within a short section, seemed non-encyclopedic.  Heck, one could choose to have a "skeptical" comment after every sentence here, but needless to say, that would be too too much.  Let's seek a middle ground.


 * As for the term "skeptic," I do not see that it is prejorative (in fact, many skeptics of homeopathy are very proud of their skepticism). I personally think that the term is simply descriptive of some people's attitude towards the subject of homeopathy...and it would seem that "mainstream physicians" is not an adequate description of the variety of people who are skeptical of homeopathy.


 * As for Howard's statement above, the written info on Oscillococcinum in this article is correct. I didn't highlight the "prevention" studies because the subject at the time was "large trials" that had a positive result for this medicine.  The preventional trials did not have a positive result, while the treatment trials all had a positive result.  As for prevention trials, I do not at present see any statement in our article that says or suggests that homeopathic medicines have been shown to "prevent" a specific disease.  Dana Ullman 00:28, 21 October 2008 (UTC)


 * Re the term "skeptic" and "skepticism," I am going to have to disagree and insist that we use another term. Again, Dana, the point is that the other side rejects the term, because it is used in a way that implies that there is some presumption in favor of homeopathy.  Suppose a creationist, or a tarot card reader, or some other view you had little respect for, were to insist on labelling the critics of the views as "skeptics" and never as "scientists"; they would prefer to be describe not according to their attitudes to the subject matter, but according to their qualifications: they are scientists.  Let's be very clear.  This is an expert-guided encyclopedia and it reflects the mainstream, expert view first and foremost.  For that reason alone, any presumption is frankly not in favor of homeopathy.  That is why it is crucial that there be critical remarks from the point of view of, indeed, mainstream medicine throughout the article.  This should not be done in a way so as to interrupt the flow of the narrative, or make it impossible to state the view of homeopathy clearly and even sympathetically.  Again, when the back-and-forth in the text of the article occurs, it should be as clear as possible to the reader that such a critical discussion is not done in order to recommend or refute any view of the subject, but in order to give the reader both maximum information and a robust sense that he may make up his own mind as unincumbered as possible by any dogma.


 * Let's think creatively about other possibilities we might be able to agree upon, please. I am partial to "mainstream physicians," which is precisely descriptive.  "Skeptical mainstream physicians" might work as well.  But maybe another word or phrase entirely, like "Critics in the mainstream health community" and the like. --Larry Sanger 03:57, 21 October 2008 (UTC)


 * There is a major controversy in evidence-based medicine over the selective publishing of trials. There is a particular sensitivity about sponsors deciding not to publish results that showed no efficacy, not just where there were no side effects. AIn this specific case, the Cochrane (i.e., Vickers and Smith) meta-analysis addressed both prevention and treatment trials. If the present article does not mention prevention trials, yet there were sufficently large studies to justify meta-analysis, that seems a deficiency in the article. While you might not be using homeopathic preparations for prevention, there are a substantial number of published studies that do. You may not be saying that medicines prevent things, but there are clearly homeopaths who do, and who have conducted trials to investigate that.


 * Stevinson and colleagues published "Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery" . Jacobs et al. published "Homeopathy for Attention-Deficit/Hyperactivity Disorder: A Pilot Randomized-Controlled Trial" ]. A meta-analysis of "Homeopathy for Childhood and Adolescence Ailments" specifically addressed prevention as well as treatment ].


 * Need I add more citations to demonstrate that if the article does not discuss homeopathic approaches to prevention, the problem is in the article's coverage? I'm not making any judgment if these studies showed benefit or not. The point is, Dana, that if there is significant homeopathic work in any area, that needs to be covered in the article about what homeopathy is, rather than how it is criticized. Howard C. Berkowitz 01:01, 21 October 2008 (UTC)

This article should be "about what homeopathy is, rather than how it is criticized.". I'm wondering what was wrong with "Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it."which Dana had inserted?&mdash;Ramanand Jhingade 02:52, 21 October 2008 (UTC)


 * What is wrong? It says, in very, very general, nonquantitative terms, that homeopaths don't like trials. It doesn't say how homeopathy can be validated beyond "trust me". There are statistical methods for testing individualized therapies, used in fields beyond homeopathy, but there has been no response, by homeopaths, to descriptions of such methodology. It states nothing positively about homeopathy, just negatively about evidence-based medicine. Please don't bring up the argument that people who haven't tried it can't judge it; that is meaningless.Howard C. Berkowitz 03:02, 21 October 2008 (UTC)


 * Howard, I really don't have the time (I really don't). I'm sure there are statistical methods for testing individualized therapies with respect to homeopathy; for a change why don't you look for those on the Net and include it/them here?&mdash;Ramanand Jhingade 03:15, 21 October 2008 (UTC)


 * First, Gareth and I already discussed such methods as used for pharmacogenomics, and no homeopath responded. Second, why should I go searching for proof that homeopathy is statistically effective? How did it become my problem to prove the homeopathic position from a scientific standpoint?


 * You say you are sure there are such methods. Why are you sure? Howard C. Berkowitz 03:20, 21 October 2008 (UTC)


 * I probably di'n't have time to see it. I was requesting you to do so because you have more time than me to do these things. I did see something at, 'http://www.guna.it/eng/ricerca/indice.htm'. There are other such things/sites which I don't have time to look into. Please do the needful. I'm sure you can improve this article by doing so.&mdash;Ramanand Jhingade 03:34, 21 October 2008 (UTC)


 * I'm really confused. Why should I do the research to support your point of view, when I haven't seen much evidence that it works? The reason I spend time on this is for the good of Citizendium's quality, not to be an advocate for homeopathy. Howard C. Berkowitz 03:38, 21 October 2008 (UTC)


 * It' only for the good of Citizendium's quality that I'm requesting you to do so. I also hope that you can include some matter from the memory of water article in the 'Scientific basis of homeopathy' section to make it more neutral. I also feel that you should reintroduce the sentences where the term, 'skeptic' was used - neither Larry nor I consider that term pejorative/deprecatory. Thanks in advance for all the help.&mdash;Ramanand Jhingade 04:06, 21 October 2008 (UTC)


 * Perhaps I'm confused, but Howard, it sounds to me as if Ramanand is insisting that his view, probably shared by Dana and other homeopaths, be permitted to be included in the article. Are you actually saying that, no matter how confused or misleading their view is, you have decided it can't be included?  Surely you aren't saying that, but then I can't figure out what you are saying.


 * Perhaps it would be better to work with them on a clarified version of the claim and then, when it's as clear as it can be made, you simply add a sentence or two explaining how mainstream medical researchers would (or do) respond to such a sentiment. What's wrong with that?  In fact, isn't that what our neutrality policy requires?  Maybe I'm confused, it is a little late. --Larry Sanger 04:02, 21 October 2008 (UTC)


 * Larry, Howard - that is what all of us want, i.e.both sides views should be incorporated in this article. Howard relatively has a lot of time, so I was hoping he could improve the article by incorporating both sides views.&mdash;Ramanand Jhingade 04:11, 21 October 2008 (UTC)


 * No, I don't think all of us want. Homeopathy is not a mainstream opinion. If the homeopaths want to put out their view, and accept that it simply does not have reasonable support by the criteria that would be applied to any medical therapy, fine.


 * I don't see an equal set of views. One has testable models and consistent scientific theory. One has vitalism and spirit forces. It seems rather like religion and science; they are completely different models of thinking. As far as I can tell, you want homeopathy to be accepted on faith and testimonials. I have no idea how to improve something that has yet to give me any plausible reason that it works in any explainable way. Howard C. Berkowitz 04:29, 21 October 2008 (UTC)

(I removed a comment that concerned the qualifications of others to participate here. This sort of comment is contrary to CZ:Professionalism.)


 * I agree with your attitude on the merits of the issues 100%, Howard. That said, I'm afraid you have missed my point.  I am not asking you to endorse the position that "there is an equal set of views here," whatever that might mean precisely.  I am asking you to let homeopathy state what you regard as nonsense.  You lack the right to prevent Ramanand and Dana from expressing some view, even if it is a nonsensical view, of mainstream science and trials and so forth.  But I frankly don't understand why you don't simply say, "Fine, now let me explain how mainstream science responds to that."  After all, that is what you are, quite irrelevantly, insisting on so strongly here on the talk page.  If so, then let them have their say, and (essentially) say what you say in response to it in the article.


 * The neutrality policy means you cannot speak only for yourself here; you speak for everyone, including your intellectual sparring partners. You must try to express the homeopathic view as sympathetically as possible--while expressing the mainstream reaction to it as sympathetically as possible as well.


 * And this goes for both sides. I am tempted to remove everyone who has been disputing from this article for a time, and let others have a crack at it, simply on grounds that there is good evidence on both sides, I'm afraid, that people are trying to make the article speak with their own biases, and not working together to present the dialectic clearly.  There is far too much concern that our own biases be reflected in the article.  Anyway, enough of this--I think I've made my point (once again). --Larry Sanger 04:49, 21 October 2008 (UTC)


 * Larry, I tried to express the homeopathic view sympathetically. Remember that table where I tried to get a translation of terminology? No cooperation.


 * "'Fine, now let me explain how mainstream science responds to that.'"


 * There has been nothing to which a mainstream science response can be made. Mainstream medicine uses controlled experiments, measurable phenomena, peer review. This keeps coming back to anecdotes and "trust me". Howard C. Berkowitz 04:59, 21 October 2008 (UTC)


 * Au contraire. What you just said is a mainstream medical response, it seems to me.


 * As for that table to translate terminology, I would like to see it moved to Homeopathy/Catalogs and perfected. --Larry Sanger 13:47, 21 October 2008 (UTC)

Responses, have been indented to incoherence
First, I shall announce that yesterday, I made the best rye bread I have ever made, which is making me feel better this morning. Alas, I know of no networking technology that can transfer fresh-baked bread.

Larry, apparently I misunderstood that you wanted a much more extensive "mainstream medcine" response. I read some of the homeopathic request to mean that I was being asked "go on the net" and find evidence of solid statistical methodology and results that made the response "equal" in their responses. I was also frustrated by what seemed to be, simultaneously, citing of statistics about questionable merit such as popularity and referrals, but either selectively reporting things that were there, or denying there was any way to make homeopathy compatible with mainstream standards of substantial evidence.

Note that last: evidence, not proof. While every field has its charlatans and outright idiots, there is a trend in medicine to have the humility to accept that diagnosis and treatment need constant revision and improvement. With essentially the same genetically related heart problems, I've outlived my father for 18 years, and he spent the last several years as a cardiac cripple. I look back to what was available at the time of his serious decline in health, and most of the relevant drug classes had not been invented.

I also think of some interdisciplinary medical seminars I've attended, and was fascinated to see, for example, orthopedists and chiropractor working to bring their specialized expertise to clinical problems, with both listening to an expert in pain physiology to hear techniques that could complement their work. While I recognize there are different schools of thought in chiropractic, and $DEITY knows enough (substitute non-family-friendly term) in orthopedics, the point is that everyone was looking for, and finding, common ground. No one was saying the other field couldn't ask hard questions. Most importantly, there was an eclectic, but general consensus about using evidence, and fitting treatments to mechanisms we can always understand better.

Contrasting those workshops with the discussion here simply makes me sad. Oh, there's no question that someone may offer an aphorism, about the clinical encounter, from Osler, but no one is stuck in the professional jealousies and defensiveness of 100 to 200 years ago. While this article clearly needs some historical context, some of the most bitter statements, as well as quotes justifying homeopathic positions, are over a century old &mdash; sometimes two. Let the material about the early homeopathic and medical squabbles move to History of Homeopathy. Include enough history to understand terminology (and there's the "catalog"), but concentrate on current work. I would be delighted to explain how bad conventional medicine was at the time of Hahnemann. A century later, Osler observed that there were principally two drugs that consistently did something (digitalis and morphine), with roughly ten more that have stood the test of time. I take a sometimes daunting range of medications for the same diseases as my father, but, running through the list mentally, as many as 12 didn't yet exist at the time of his death. How often are new homeopathic methods demonstrated? How often are things added to materia medica? When do homeopaths remove remedies from use because they have been demonstrated to be unsafe (including avoiding effective non-homeopathic treatment) or to be ineffective?

There is almost nothing in the article about homeopathy as complementary medicine; there is a great deal about homeopathy as an alternative to mainstream medicine. There are some awfully vague comments about using medical testing and diagnosis, but I am still completely bewildered by how the disciplines can work together. At the same time, I have both personal and scientific exposure to very effective collaborations between mainstream and complementary practitioner.


 * I have occasionally made errors, and when it is noted, I acknowledge it. We all make errors.  I sincerely hope that Howard will acknowledge this error below.  Ramanand above noted, This article should be "about what homeopathy is, rather than how it is criticized.". I'm wondering what was wrong with "Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it."which Dana had inserted.


 * Howard then responded, "What is wrong? It says, in very, very general, nonquantitative terms, that homeopaths don't like trials. It doesn't say how homeopathy can be validated beyond "trust me".


 * My concern here is that Howard doesn't seem to understand what is meant by "external validity," which is an important statistical concept. The test of one homeopathic medicine in the treatment of a condition for which it is rarely, if ever, used is NOT a good, adequate, or "scientific" test of homeopathy or the homeopathic method.  The Shang analysis actually included one trial on the use of Thyroidinum in the treatment of "weight-loss."  This study had no external validity.  Likewise, Shang analysis included tests of Oscillococcinum in the PREVENTION of the flu...as well as a separate inclusion of a study of Oscillococcinum in the TREATMENT of the flu.  There is a long history of use and success in using Oscillo in the treatment but NOT the prevention of the flu.  A competitor (Dolisos, Inc.) to the makers of Oscillo in France funded the prevention study, which again, had no external validity.  It was no big surprise to find out that this medicine didn't prevent the flu.


 * These poor scientific studies are akin to prescribing antibiotics for viral infections and then asserting that "antibiotics do not work for infections." That statement is misinformation.


 * Ultimately, there are rare instances where one homeopathic medicine can be successfully prescribed to people with the same disease, though most of the time, effective homeopathic treatment requires individualized treatment. In sum, Howard, I certainly didn't say or infer that homeopaths do not "like trials" (we just don't like poorly designed trials that are set up to not adequately test homeopathy).  Dana Ullman 16:51, 21 October 2008 (UTC)


 * Dana, I agree that a specific trial should only be testing the homeopathic remedy for which it is designed, but it is still not clear to me whether this precludes clinical trials or not? Obviously precribing is highly individualistic so this make selecting the patients for a trial more problematic. Are there any cases of trials that have occurred where a homeopath does control the remedy but it is also blind from the perspective of the homeopath and the patients? And this comes to another issues that i have still not really wrapped my mind around.  If everything is so individialised how is it possible to have homeopathic remedies available for sale from a store?  I just can't understand how remedies are robust enough to be sold from the shelf yet a population of patients cannot be found that that all use the same remedy in a blind clinical trial. Chris Day 17:25, 21 October 2008 (UTC)

<!-- Commenting out these comments in the hope of a reply to my original questions. I think this is relevant to improving the section relating to trials


 * Chris, please see Talk:Homeopathy below, as one type of methodology that is being used, in experimental mainstream medicine, for trials of highly individualized therapy. Gareth also discussed this. It would be one alternative.


 * There is also a body of research into research methods on treating what are called "low responders". These are patients without many alternatives, but where an individualized treatment may work. I emphasize that methodologies are still being explored. If, however, there is a genetic correlation with low responders who do respond to a particular therapy, one of the approaches may be not to try to treat immediately, but first to look for the genetic pattern, and, perhaps try, in vitro, a monoclonal antibody or other agent tailored for the individual problem. Only if the circulating abnormalities can be controlled would human trials be considered. For a collaboration among homeopaths and physicians, there would have to be an investigation to find what is common, at a molecular basis, among patients with similar symptoms. I cannot believe that the number of symptom combinations come within orders of magnitude of the possible genetic combinations. Howard C. Berkowitz 19:23, 21 October 2008 (UTC)


 * Dana, first, stop personalizing what I understand and don't understand. You really would not want to hear my opinions, which would not meet standards of courtesy.


 * Second, external analysis is generally considered a statistical technique for market analysis, although it is used in some community-level needs analysis in public health.


 * To cut to the chase, if homeopathy is not going to accept being tested by statistical methods widely used in mainstream medicine, ignoring suggestions of statistical methods that mainstream medicine is using for highly individualized therapies, and have their model treated differently than any other field of health sciences, well, no. There isn't going to be any cooperation, and homeopathy is not going to be taken seriously. If you have peer-reviewed information, in a mainstream journal, on how external analysis is used in drug testing for efficacy, present it.


 * Stop condescending and making cracks about my "new found passion" or "desire to improve the citations". Give widely accepted, peer-reviewed examples where external analysis has demonstrated efficacy.


 * Which is it, Dana? In one posting, you say homeopathy has not been shown to prevent anything, but, in another posting about statistical validity you mention, IN ALL CAPS, that a different homeopathic trial focused on promotion. paging a philosopher some input, please, on the Law of the Excluded Middle? Howard C. Berkowitz 17:28, 21 October 2008 (UTC)


 * Let me underscore that all the personalization of the dispute here is out of line. It is inconsistent with CZ:Professionalism, which I urge everyone to review if you have not seen it recently.  The Constabulary would be justified in removing a number of personal remarks above, but let's just say that we won't see any more of them. --Larry Sanger 02:29, 22 October 2008 (UTC) -->

Statistic given in article does not appear in cited source
I have deleted this bit:


 * 42% of British doctors refer patients to homeopaths.

The article says that 42% of British doctors "refer patients to homeopaths." I found no such claim in this article, which was cited. All that I could find on a scan of the article was "up to 37% of British general practitioners use homoeopathy." There was also this: "Those who use homoeopathy regularly do so in about a quarter of their consultations, the proportion being higher for hospital and private specialists." A text search for the string "42" did not bring up the statistic.

Our article should note that this source is a review article and not reportage of original research findings. For that reason it is difficult to tell exactly what the statistics mean, without looking up the article's sources. Does the 37%, or 42% (???), represent the number of British doctors who regularly refer patients to homeopaths? Who have ever even once used it themselves, i.e., tried it out? Who use it personally (i.e., not to treat their patients but themselves)? Who use experimental therapies on their patients, that also happen to be used by homeopaths? What? I am sure that 37%/42% does not represent the number that regularly use homeopathy, for the simple reason that the article does also say that "those who use homeopathy regularly do so in about a quarter of their consultations," which seems to imply that there are those who use homeopathy, but not regularly.

The statistic may also not be significant (and this should be stated in the article perhaps after a little discussion) due to the nature of the referrals, i.e., it is entirely possible that people are referred to homeopaths because patients specifically ask for such referrals, not because the physician would make such referrals generally. Moreover, it would be important to know to what extent these physicians refer to homeopaths as a "last resort," after conventional medical solutions are tried, and patient and doctor are desperate to try things even if they may have no effect at all.

I dwell on this point only to underscore a point that I believe Howard, Chris, and others are making here: these sorts of statistics absolutely do not speak for themselves. If you want to make such claims in the article, they have to be either properly clarified, or else qualified, i.e., mentioning the uncertainty about how they are to be interpreted. Even if we have a neutrality policy, the license that the policy gives us all, to state our views forthrightly, does not also license us to make claims that are unsupported by the evidence (as the 42% statistic appears to be) or to make claims that are very vague and, due to their vagueness, misleading as to the evidence.

I believe that all these claims should be checked and removed if similar problems to the 42% problem are found.

Also, to the person who added the 42% statistic--may we please have an explanation?

Finally, as to the point that such statistics are trying to make--that homeopathy enjoys the status and honor of intellectual support from medical doctors in these percentages--well, that doesn't follow from the statistics cited. Someone might refer, or use, homeopathy, and do so being entirely skeptical of it--almost, as it were, superstitiously. Human beings are like that. And on that point surely surveys have been done, and I'd like to see the results. When asked directly, "Do you believe that homeopathy and its remedies are (1) always, (2) usually, (3) sometimes, (4) rarely, (5) almost never, or (6) never more effective than placebo?" what do they say (in different countries)? --Larry Sanger 14:32, 21 October 2008 (UTC)


 * Slow down, Larry. The exact source of the reference for 42% of British physicians referring patients to homeopaths is:  R. Wharton and G. Lewith, Complementary Medicine and the General Practitioner, BMJ, 292, June 7, 1986: 1498-1500.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3087494


 * Actually, simply referring a patient to a homeopath is relevant for several reasons. First, the doctor takes on liability issues in doing so, and therefore, s/he doesn't refer unless there is some type of respect or trust that the doctor has in the homeopath or the homeopathic method.  In either case, this IS relevant.  It may be of additional interest to discover how often a doctor provides a referral, and such present or future surveys that deal with this issue can be added here, but I see no reason that surveys published in high impact journals should be ignored.  Dana Ullman 17:03, 21 October 2008 (UTC)


 * Dana, as I said, the source cited by the article, marked as Fisher, did not contain the statistic. If you can support the statistic with a different source, that's great, but it does not address my point, which was serious.  I'm afraid I'll have to ask again: who put the statistic, with that citation, into the article?  I ask because I want an explanation of the error from that person.  Was it perhaps an innocent typo, somehow?


 * It seems we can say that in this 1986 survey of 145 mail-in questionnaire respondents, who were Avon, England GPs, 42% had referred at least one patient to a homeopathic doctor or non-medical practitioner. --Larry Sanger 02:56, 22 October 2008 (UTC)

Questioning the answer of 42
Doesn't anyone read Douglas Adams?

While I'd have to look for current data, entirely too many antibiotics are prescribed by mainstream physicians, often to meet the expectations of a patient or parent, but knowing full well that an antibiotic will do nothing for a self-limiting viral infection. They have, however, exposed their patients to toxicity, and the population as a whole to a source of drug-resistant bacteria. My point is that this is not a matter of pride to the medical profession, but something it is trying to fix.

Something worth knowing: how does homeopathy keep reinventing itself and improving its process? Does it?

What are the shared, not the oppositional, concepts? There has been at least one individual, Harold Griffith, fully trained in conventional and homeopathic methods, who received the Nobel Prize in Medicine or Physiology for contributions to surgical anesthesia. When does such a person not insist that homeopathic methods are the best for everything? Sorry, I'm extremely tired of asking and asking about when homeopaths refer, or use medical techniques in which they are trained, and be told "it depends". There are too many consensus guidelines, such as back pain, giving strategies for synergy, to accept that there can be no communication.

Constant repetition about popularity, about how much mainstream medicine is out to get the homeopaths, and how dangerous mainstream medicine may be is not effective communication. Howard C. Berkowitz 17:10, 21 October 2008 (UTC)


 * Howard, please note that homeopaths seem to honor the Hippocratic tradition with great rigor and vigor than conventional doctors do ("First, do no harm."). Homeopaths prefer to try and sometimes exhaust safer methods before resorting to the "bigger guns" (and more risky therapeutic measures).  That said, each situation requires its own guidelines based on the medical urgency, the degree of known efficacy of the conventional medical treatment, and the initial response to homeopathic treatment.


 * Charles Frederick Menninger (1862-1955), the founder of the famed Menninger Clinic, was the head of his local (Topeka, Kansas) homeopathic society. He asserted, "It is imperatie that we EXHAUST the homeoapthic healing art before resorting to any other mode of treatment if we wish to accomplish the greatest success possible." (1897)...quoted on page 124 of my book, "The Homeopathic Revolution" (I can provide the original reference if desired).  Dana Ullman 00:22, 22 October 2008 (UTC)


 * Dana, I believe the ground rules were to state what homeopaths did, not continue a struggle against mainstream medicine.


 * Charles Menninger was a great psychiatrist, who died around the time the first effective drugs for mental illness were being introduced (i.e., chlorpromazine) in 1952. Have you some equivalent works of homeopathy from prestigious psychiatrists in current practice, equipped with a bit more understanding of brain chemistry? While I think Menninger was a distinguished physician for his time, and set standards for ethical practice, the main therapeutic technique he introduced, and is still found valuable, is art therapy. Were he to be reincarnated, I'd greet him with joy, and then suggest he take a year or two of current clinical science, and probably two years or so of supervised fellowship, before I'd want him to treat anyone whom I cared about.  Bluntly, I don't much care what he had to say about homeopathy, because he was unaware of sixty years' better understanding of neuroscience, cognition and psychopharmacology &mdash and I am not referring to drugs alone. Cognitive behavioral therapy and other methods also have replaced many of the psychodynamic methods he used. Howard C. Berkowitz 00:44, 22 October 2008 (UTC)


 * Er...guys? This doesn't have anything to do with the article.  It seems to be a pointless debate, unless a particular part of the text rests on its outcome, which I doubt... --Larry Sanger 03:00, 22 October 2008 (UTC)

Homeopathy/catalog added
At Larry's suggestion, I created the subpage "Homeopathy > Catalog" at http://en.citizendium.org/wiki/Homeopathy/Catalog (how do you wikilink to a subpage?). It is intended to compare and contrast terminology used in homeopathy and mainstream medicine. It has a basic assumption that, in certain cases, there are either terms of art, or words that are used differently.

If mutually agreed words can be found for the same concept, that would be a pleasant surprise. What I do hope to accomplish is, effectively, a dictionary between different systems. Some terms may not translate or be rejected by one side or the other; making that clear would be useful.

Howard C. Berkowitz 18:23, 21 October 2008 (UTC)

Homeopathy/Catalogs --Larry Sanger 03:03, 22 October 2008 (UTC)

Statistical methods for testing highly individualized therapies
It's probably easier to create some notes again than find the previous postings in the archives. Gareth had some very eloquent things to say on the topics.

There are emerging areas of medicine where the traditional randomized controlled trial has methodological problems. Among them is pharmacogenomics, in which therapy is individualized not only based on the medical history, physical examination, and routine laboratory and imaging studies, but also on genetic analysis and specialized laboratory tests suggested by such analysis. Among a group of patients with similar symptoms, it may be found that a specific bad protein is causing damage, but the reason for the protein being damaged could be controlled by a number of different genes, each responsible for an intermediate step in the synthesis of the final protein.

Approved immune-based treatments, such as monoclonal antibodies to tumor necrosis factor-alpha in rheumatoid arthritis, reduce the level of the final protein. By concentrating on that final protein, a large enough group can be collected for a conventional clinical trial.

Increasingly, however, we are aware that the protein synthesis error could happen at an intermediate step, controlled by one of a long list of genes. The least invasive and most effective treatment may be to administer a neutralizing agent that only affects the step where some protein is not created correctly, as defined by genes.

At present, the trial approach being considered is to have a clinical team examine the patient, and prescribe what they consider to be the appropriate treatment. That prescription goes to the pharmacy, where the pharmacist opens the next sealed envelope, which says if this patient is to be assigned to the control group or to the experimental group. If the patient is assigned to experimental, then the exact prescription, individualized to that patient, is made up; otherwise, it will be a control treatment or placebo.

At the end of the trial, measurable outcomes of success &mdash; not subjective measures such as "satisfaction" &mdash; are compared between the experimental and control groups. Every patient in the experimental group may have received a different, personalized modified monoclonal antibody. If there are better outcomes in the experimental group, the trial confirms the methodology of selecting treatments rather than the treatment proper.

Such an approach, it would seem, could be applied to homeopathy. Has it? Howard C. Berkowitz 19:23, 21 October 2008 (UTC)

Specific immune benefits of chickenpox and measles?
There is a reference to Randall Neustaedter's The Vaccine Guide which is cited for a homeopathic belief that there are immunological benefits from contracting measles and chickenpox, rather than immunizing against them. Could someone, with access to this book, describe these benefits?

Have the benefits of chickenpox been weighed against the future risk of herpes zoster? Howard C. Berkowitz 22:19, 21 October 2008 (UTC)


 * Howard, this subject doesn't have a place on THIS article. I have, however, read studies that show that people who experience measles have a statistically significant reduced rate of atopic disorders.  Although one might conclude that measles provides some type of immunological benefit here, another interpretation could be that the measles vaccination increases atopic states. There is a body of literature on the "hygiene hypothesis."  Dana Ullman 00:29, 22 October 2008 (UTC)


 * Are you ignoring the first paragraph and answering the second? If you are answering the second, fine. Your call. I might point it out myself.


 * As far as the first point, are you saying the inadequately sourced claim about advantages of measles and chickenpox should go? If so, I agree. This is an encyclopedia: if controversial things are said, they need verifiable sourcing. They indeed may be controversial and stay, but there should be readily available information from credible sources.


 * Or did you want to talk about atopy, the Prausnitz-Küstner reaction, and better in vitro alternatives? Howard C. Berkowitz 00:51, 22 October 2008 (UTC)

Editing "Trials in humans" section for flow and citations
Just to keep everyone informed, I have made several edits on the "Trials in humans" section, first trying to clarify the flow. While I'm still working on it, I tried to move the introductory text by a CZ contributor to the beginning of the section, and put the various trials under subsections below them. Of course, when there is CZ commentary on a particular trial or meta-analysis, the comment belongs in that subsection.

Material on The Lancet controversy was especially hard to follow, because multiple references were all under the same footnote number. I broke them into separate footnotes, and added at least some material about what each author(s) actually said; it was otherwise very confusing.

With respect to the Cochrane meta-analysis of Oscillococcinum (I've started an article on this preparation), I found the actual conclusions of the free summary to be a bit different than the one word, "promising", that described the work.

There was a section under "trials in humans" that was not about trials, pertaining to over-the-counter remedies. I moved it to be with other material on nonprescription remedies, and changed the section from "Popularity of Homeopathy" to a more comprehensive and neutral "Popular opinion and over-the-counter homeopathic remedies". "Popularity", like "Criticism", may not be the best of encyclopedic headings. "Public opinion" may be even more neutral than "Popular opinion".

The last paragraph, under the "Lancet" subheading, appears to be text from a CZ contributor. In its first sentence, it contains a value judgment (my emphasis) that I believe needs to be sourced and explained: "Several of these published responses remarked (incorrectly) that the researchers evaluated only those studies that met certain criteria for “high quality” scientific investigations."


 * That text ((incorrectly)) was mine. This criticism is repeated in several sources but is simply wrong. The authors used a hierarchical approach - they looked at the outcomes of all studies and then looked at the outcomes if only large high quality studies were considered. Their hypothesis was that if there are factors like publication bias that lead to the selective publication of studies with positive outcomes, then size of effect should be inversely related to sample size and study quality. So it's a common criticism but reflects a fundamental misunderstanding of the study. How would you phrase it? I didn't expand because the preceding text explained the study in terms that I thought made it clear that the reported remark was transparently incorrect. I didn't see it as a value judgement, simply a statement of demonstrable fact. Gareth Leng 15:57, 22 October 2008 (UTC)


 * Thanks. My first thought would be to take the explanation you just wrote, edit it slightly, and either put it as a subhead of randomized controlled trial, or one of several very short articles (the sort I'm always arguing are too short to need definitions) on trial methodology. Thinking of some of my own edits in totally different areas, I've written articles that state the facts of a matter, and linked to them, making them reusable. Perhaps we need some sort of mini-article format that is variously a FAQ, or a "common error". I can definitely think of things in my computer science book, where I'd insert sidebars explaining that I knew the main text was counterintuitive, but there was a reason for it -- and then either a quick explanation or a citation.


 * I know you have time constraints, but I find you more eloquent than I on describing study methodology. Thinking about it, there were two problems. First, I was sensitized to some cases where others were throwing in unsupported, sometimes angry comments. Second, I was not sure if the antecedent (referent?) of "incorrectly" was to interpreting publication bias, to the idea of the inverse relation you mention, or something else entirely. Howard C. Berkowitz 16:40, 22 October 2008 (UTC)

I am continuing to follow the citations in the last two sections. Some appear to be evaluating patient satisfaction or subjective assessment as endpoints. While that is a perfectly legitimate thing to study, it should not be confused with the type of endpoint that is generally used in evidence-based medicine.

If I do find subjective endpoints, I propose to create a subsection under what may be renamed again, currently the "Popular opinion..." If formal studies of individual patient subjective response to treatment, as opposed to general opinions of homeopathy, were done, those are significant and need to stand apart from general opinion surveys. Howard C. Berkowitz 02:35, 22 October 2008 (UTC)

Other meta-analyses
Going through some of the trials (see "Other Meta-analyses") that showed promise, but not necessarily statistical confidence, a number of the researchers suggested that perhaps the wrong things are being studies. There may be more to be learned from the quality of interaction between homeopath and patient than there is from deeper insight into the memory of water, or even some large-scale on homeopathic remedies for self-limiting conditions, or where there are generally acceptable treatments.

These arguments tie strongly into a number of conventional medical and nursing arguments for improving the quality of care.

I did remove two items (below) that did not perform a meta-analysis:


 * A meta-review of homeopathy in dementia did not actually analyze any studies. The investigators were unable to find papers that met their inclusion criteria, and said they could not assess the extent of homeopathic treatment of dementia.


 * One reference was not from a journal, but a lay health encyclopedia produced by the National Health Service. : . It could not be considered a meta-analysis, as it contained little quantitative information.

Howard C. Berkowitz 14:10, 22 October 2008 (UTC)


 * Good sleuthing Howard. I'm sorry that I didn't catch these ones. Dana Ullman 02:43, 23 October 2008 (UTC)

Text cut
I cut a few lines from the secton on regulation because they didn't seem to belong there, but in Memory of Water, I've placed them pro tem on the Talk page of that article.Gareth Leng 13:18, 23 October 2008 (UTC)


 * There remains an issue that deals with (diluents? vehicles?) other than water. The introduction says water or ethanol. Plausible ethanol solvents, especially if there are limits on over-the-counter concentrations as in the U.S., have enough water so memory of water, if it exists, could apply.


 * In the body of the article, however, remain references to lactose and quartz. These were taken out of the earlier introduction. Can we have a decision? If there are homeopathic diluents (yes, they are diluents as pure chemicals before mixing) other than water, let's be consistent between the lead and the body.


 * Certainly, lactose is very common in mainstream pharmaceuticals, simply to bind small anounts of drug into a tablet large enough to handle. I don't find it implausible that it could be used in preparing a remedy, but that does suggest that memory of water isn't the mechanism. Quartz seems a little more unlikely, but I suppose it's safe if sufficiently powdered; still, it's usually not the greatest idea to put insoluble substances into the gastrointestinal tract.Howard C. Berkowitz 15:28, 23 October 2008 (UTC)


 * Don't know about quartzm, but it's obviously common to use lactose/sucrose in powder or tablet form. These dry forms contain no water, so I don't know what homeopaths think may be the mechanism in this case; I've added a few simple lines about this.Gareth Leng 15:53, 23 October 2008 (UTC)

Text reverts on 12 October...ongoing

 * " because homeopathic remedy selection may take time ; homeopathic remedies may be used after an asthmatic episode to optimize the immune system and prevent recurrences."

Of course homeopathic remedy selection takes time; most non-emergency selection of medical drugs take time. Even in an acute asthmatic attack, it may take corticosteroids, even intravenously, 8 hours to have an appreciable effect. Saying it may take time to select long-term drugs simply adds words without adding information

As far as "optimize the immune system", that has no meaning in the general scientific usage of "immune system". Why is it wrong to remove those words and leave "prevent recurrences", which is presumably the objective?

If you are using "immune system" in a special homeopathic way, such as the way it has been suggested as a synonym for "vital force", say so. Otherwise, and this is probably not the place in the article, describe exactly what happens in the immune system, as the term is generally accepted. Mast cell desensitization? Neutralization or movement of immunoglobulins? Causing the inflammatory cells, such as leukocytes, to move out of the inflamed area?

Please don't take well-defined medical terms and give them new meanings, or use oversimplifications. Doing so breaks down any hope of communication between conventional and homeopathic participants here. Truly, I would not object if you had said "vital force" rather than "immune system". I don't know what a vital force is and whether it exists, but I am quite willing to accept that it is meaningful to homeopaths, and saying a remedy increases it does not conflict with medical terminology. Without insisting on a definition of vital force, if it were substituted for immune system in several places, I think the article would be more readable for all disciplines. Howard C. Berkowitz 17:17, 12 October 2008 (UTC)

Quite a few reverts later. The inclusion of "because homeopathic remedy selection may take time" has been removed by Howard, Gareth and myself. An explanaition for why this is a critical sentence other than "this is how I treat myself" would be useful to move us forward. Chris Day 14:03, 15 October 2008 (UTC)


 * Just got reverted again, is "I use it in acute attacks also-most homeopaths do; justify deletion (if you do) on the Talk Page " a convincing explanation? One that convinces Gareth and Howard? Is CZ comfortable "messing with anaphylactic shock"? I thought Gareth made a reasonable point, not to mention the addition seems redundant with the sentence that follows. Ramanand seems to imply that remedy selection does not take much time since he seems to be describing the use of homeopathy to control anaphylactic shock/acute attacks of ashma. I saw that Ramanand reduced the typical time for consultation with a homeopath from one hour to fifteen minutes, I assume with this scenario of "acute attacks" in mind (since it was the edit right after his revert). How do we know this is not an exaggeration or is there no consultation with "acute attacks" (even 15 minutes sounds on the long side here)? And if this remedy for "acute attacks" works so well, have any trials been done to prove to the skeptics that homeopathy is effective, at least for this type of case? This remedy would seem to be a perfect candidate for a double blind trial since individualisation appears not to be required in these cases and alleviation of the attacks should be easy to quantify. Chris Day 04:14, 16 October 2008 (UTC)


 * Part of the problem is that the severity of the attack is not clear. Is it, as you suggest, anaphylactic shock? Status asthmaticus? Things where it's a minute-by-minute call on whether to intubate, because laryngeal edema is one possibility? Do you have a rapid sequence intubation kit open and ready? Are arterial blood gases available? Even for a relatively mild but urgent case, that patient needs pulse oximetry, O2 by nasal cannula and by more intrusive means if the SpO2 drops.  Nebulized albuterol,probably with intermittent ipratropium bromide, is almost certainly appropriate, while establishing IV access for epinephrine (unless it's intratracheal). Again assuming a serious event, a loading dose of methylpredisolone should be going on board. Howard C. Berkowitz 04:34, 16 October 2008 (UTC)


 * Gareth was the one that brought up anaphylactic shock, ramanand uses the phrase acute attacks. You tell me if they are the same? Either way, if homeopathic remedies can alleviate acute attacks in minutes, I'm impressed. That's definitely quantifiable and publishable. Chris Day 04:42, 16 October 2008 (UTC)


 * I've been verifying this with a reasonably current Lange emergency medicine text, and, while there are similarities between anaphylactic shock and the most severe form of exacerbation of asthma, there are differences.


 * In both, you want tight monitoring of the airway, but laryngeal edema is far more a threat in anaphylactic shock than status asthmaticus. The tendency to secure the airway by intubation is greater in anaphylaxis, because with sufficient edema, you may not be able to intubate -- you may have to do cricothryotomy or something more invasive. Epinephrine is the first-line drug for analphylaxis, with antihistamines (H1 and H2 both). and beta-adrenergic agonists as backup drugs; in severe asthma, beta-adrenergic agonists are the first-line, supplemented with anticholinergics. Both call for parenteral corticosteroids, but those take hours to take effect.


 * On occasion, my ex-wife managed both. Howard C. Berkowitz 04:56, 16 October 2008 (UTC)


 * There is some, 'individualization' involved even in acute attacks (of Bronchitis) - & no, I'm not talking of anaphylactic shocks. I did mention some remedies earlier (like Ars.Alb., Nat.Sulph & Ipecac), but it's difficult to explain all that to non-homeopaths, so I haven't included it in the article.&mdash;Ramanand Jhingade 03:11, 17 October 2008 (UTC)


 * Why is it so difficult to explain? I can give a mechanism of action for most pharmacologic drugs, or at least a reasonable approach to one? Perhaps the homeopathic model that there are no causes and effects are making it hard to explain. Howard C. Berkowitz 04:56, 16 October 2008 (UTC)


 * In any event, if it cannot be explained, and can only be taken on faith, it belongs in a CZ article in much the form "Creationists believe that all forms were created by the deity and there has never been evolution." Try that. "Remedies", as opposed to non-homeopathic-lingo "symptoms", do not explain anything.


 * Please do not tell me I'd understand if I tried it -- oh, and I happen to consider "skeptic" a compliment, so if you are trying to intimidate me with that, it's a waste of time. Howard C. Berkowitz04:37, 17 October 2008 (UTC)

Latest iteration. Gareth removed it again with the following edit summary: "don't imply homeopathy is a substitute for necessary medical treatment". Chris Day 21:05, 22 October 2008 (UTC) ( for the record, I have removed it twice, Gareth has removed it twice, Howard has removed it once. Ramanand has added it back mulitple times. )


 * Add one more for Ramanand
 * "it was agreed to let this be, so why was it deleted? Use the Talk Page!"
 * And one more for Howard
 * "yes, do see the talk page. Chris, Gareth and I, have all removed it, and will keep removing it. With whom did you think you had an agreement?"
 * This needs to be decided on the talk page. As yet, i see no agreement for the inclusion of this sentence. See above for reasoning. Chris Day 15:51, 23 October 2008 (UTC)

All homeopaths use it in acute Bronchitis (for both themselves and patients), not just me. I'll have to report this to a constable if the 'ground rules' laid down by Larry aren't followed.&mdash;Ramanand Jhingade 03:06, 24 October 2008 (UTC)


 * Anything other than anecdotal evidence? Chris Day 03:40, 24 October 2008 (UTC)


 * As Chris said, your unsupported word is not adequate. Even if you can put an available source next to it, it is also acceptable, within the ground rules, to put well-established medical guidelines for dealing with something of this type, and I believe that it can also be documented, from standard emergency medicine texts, that delay to definitive treatment of severe respiratory distress can be quickly fatal.


 * Part of the problem is there is no understandable definition of the clinical picture of this patient. If you can, Ramanand, describe, in detail, the status of the patient. Even at the EMT-Basic level, I would expect respiratory rate, pulse, blood pressure, skin color, and a description of the visible and audible mechanics of breathing: stridor? cough? discharge? What's the age and body habitus of the patient? Any immediate significant history such as insect bite? Visible swelling?


 * At a more advanced level of training, I would expect much more. Since you haven't given any details, I'm going to assume a child, and quote from the eMedicine tutorial on stridor: "If distress is moderate to severe, further physical examination should be deferred until the patient reaches a facility equipped for emergent management of the pediatric airway." You said "all homeopaths" use this. What are the qualifications and equipment of "all homeopaths" to manage an airway? Rapid sequence intubation? Cricothyrotomy?


 * The ground rules absolutely allow objective, sourced criticism to be side-by-side with a not-widely-aceepted assertion. I believe a reasonable interpretation would also consider that the patient presentation is so vague that no one versed in mainstream medicine can even begin a primary assessment. Howard C. Berkowitz 04:02, 24 October 2008 (UTC)

Two points here. First, if you spot edit warring going on (repeated insertion and deletion), please let me know. As it appears everyone knows, a point should be fully discussed rather than allowing the edit war to go on, and if that does not result in a suitable compromise (is a compromise possible in this case?), then contact me immediately, please. I will tell you in most cases that you must find a mutually agreeable compromise. While that is being worked out, one side must be big enough to let the text stand while the issue is discussed. If you need a way to decide that, I'd say to go with the editors--Gareth Leng is a healing arts editor.

Second, to Howard, Chris, and Gareth, let me say that it seems to me that you need to decide what the problem with the disputed text is. Gareth says the problem is that the text implies that homeopathic treatments should be made before conventional treatments, which is dangerous; Chris and Howard then say that the problem is that the mentioned treatment for bronchitis is idiosyncratic and not a common homeopathic treatment (or they are skeptical of this, on grounds unclear to me). The two issues would require two different solutions. If the problem is danger, then as I said below, the text needs to be expanded and clarified and surrounded with clear warnings from the point of view of conventional medicine. If the problem is idiosyncracy (i.e., if it really is true that the mentioned treatment for bronchitis is not in common use by homeopaths), then the whole discussion of the treatment could be removed, and then there'd be no more problem. But, obviously, some research will have to be done to settle the latter question. --Larry Sanger 14:57, 24 October 2008 (UTC)


 * Very briefly -- one of the biggest question is "bronchitis", or sometimes "bronchitis and asthma" (which may or may not be related) is being used as if it is self-explanatory. Ramanand is not giving enough information to judge if the situation is potentially life-threatening, so a medically-oriented person is going to judge pessimistically. We also don't know what advanced life support equipment and skills are present in Ramanand's office. If he has suction, intubation, several standard drugs, etc., and is qualified to use them, that would be a different matter. Most office physicians in the U.S. do have such equipment, although it might be scary for someone to try to intubate, not having done it in a few years. Anesthesiologists and emergency physicians, and experienced paramedics make it look easy -- most of the time. Even they can have troubles. I know the principles of cutting through the cricothyroid membrane and establishing airway, but I'm not licensed for it and I hope I never am faced with the moral choice of being the only person in range that knows a maneuver that could be lifesaving. Howard C. Berkowitz 15:43, 24 October 2008 (UTC)

Miasms
From the main article lead, I moved the discussion of "miasms" for a bit of reexamination. The article text said "Most also accept the concept of 'miasms', a homeopathic concept of disease in which the symptoms of an organism’s imbalance indicate that a specific anti-miasmatic remedy is sometimes needed."

Purely from a standpoint of sentence structure, I look at that and say "huh?" What information is that sentence imparting? It seems completely circular and information free: a miasm seems to be a set of symptoms indicating that an anti-miasmic remedy is needed. No more, and no less, information would be conveyed if "evil", "trigonometry", or "Francisella tularensis" were substituted for miasm; there is no additional definition in the article.

In the current History of Homeopathy article, it is said Hahnemann defined "three fundamental 'miasms' underlie of all the chronic diseases of mankind: 'Syphilis', 'Sycosis' (suppressed gonorrhoea), and 'Psora'. Miasma, from the Greek for 'stain', was an old medical concept, used for 'pestiferous exhalations'. In Hahnemann's words: '...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property...'"

Again, I must say, "huh"? Treponema pallidum, Neisseria gonorrheae, and something else underlie all the chronic diseases of mankind? True, gonorrhea is showing multidrug resistance, but, by the April 2007 CDC recommendations a single intramuscular dose ceftriaxone, 125mg., should kill two-thirds of the ills of mankind. Not sure about "Psora" though; Is there a more modern name for it? Variola virus and Measles virus don't have anything to do with transmission of the others?

May I assume that homeopaths accept Koch's postulates, by which cause and effect of everything except psora have been thoroughly demonstrated? If not, I think it's important to have it stated just what homeopaths do, or do not, believe about infectious disease. If homeopaths don't believe in it, that's their privilege, but an encyclopedia article needs to make a clear statement of that.

Now, if these are symptom complexes and homeopaths agree have nothing to do with the pathogens mentioned, fine. If that is the case, then if miasms stay in the article, could we have a definition of the symptoms? Sorry, if the answer is "it's too hard to explain to a non-homeopath", even people with a bit, here and there, of biological background, it is too hard to have in the article.

There is nothing wrong with this article having clearly stated homeopathic beliefs, with a notation that the belief is incompatible with mainstream thinking. If the belief cannot be stated well enough to be evaluated, then there is a problem. Howard C. Berkowitz 01:28, 24 October 2008 (UTC)

Ground rules, criticism, and removal with no discussion
It is a goal of Citizendium to avoid "encyclopedese", while presenting different views fairly. Toward the end of the article, I placed, with appropriate disclaimers, an assessment from a reputable source, who emphasized that to use, or not to use, is an individual choice &mdash; but one that he himself would not take.

My emphasis on introductory comment to emphasize individual choice; Sagar's agreement, in the "quote from current article"

"While he is a critic of homeopathy, and this quote is not intended to say that homeopathy is or is not a placebo effect, Sagar sums the choices with a bit of humor:"The choice is entirely with the individual. Those who believe in the power of undetected subatomic fields may continue taking homeopathic medicine with an excellent placebo effect, but at a financial cost that cannot be ignored. Those who maintain faith in today’s science may continue to see their physician and receive conventional medication proven in clinical trials, rather than in succussion. However, if you choose to save money and avoid side effects, a teaspoon of honey (composed mainly of sugar and water) may be more attractive—unless, of course, you are allergic to bees or pollen.""

Ramanand removed that material, without discussion, just an edit note saying he was replacing a critic with a "fact". I agree that the material below is a fact, and it would not have been unreasonable to add the comment.

"Qualified health professionals practising homeopathy, on the other hand, believe they can not only diagnose the disease, but also treat it."

It would be equally reasonable to respond to this with a comment that mainstream physicians seriously doubt homeopaths can diagnose or treat disease, which would seem self-evident given their claim that there is no such thing as disease, only individual complexes of symptoms.

Personally, I think Dr. Sagar summed up the individual choices quite nicely. If there is a homeopath with a similar flair for words, I'd be delighted to see it here.

Call whoever you like, Ramanand. The ground rules say that homeopaths can say what they believe, and it would have been appropriate for you to add that &mdash; and for someone to make an alternate statement. There is absolutely nothing in the ground rules that bars criticism, especially when the "critic" freely acknowledges that people may choose homeopathy. Howard C. Berkowitz 04:21, 24 October 2008 (UTC)


 * Ramanand, this is a perfect application of the rule that criticisms must be allowed. You are absolutely not free to remove such criticisms. --Larry Sanger 14:31, 24 October 2008 (UTC)

Controversial text
The text that is subject to an edit war is the following "Situations for which homeopathic practitioners work in a manner complementary to that of conventional medical practitioners include asthma and acute bronchitis, where immediate and certain temporary relief from metered-dose inhalers, nebulizers, or parenteral drugs is sometimes necessary, if homeopathic remedy selection is going to take time. I have deleted and will continue to delete the section in bold, because it implies that homeopathic treatments are an effective substitute for conventional, effective drugs, and suggests that this is accepted by conventional medical practitioners. Homeopaths are notworking in a manner complementary to conventional medical practitioners if they are substituting homeopathic remedies for conventional approaches rather than providing remedies as adjuncts to conventional treatment. What I cannot accept in this article is a) anything that looks like treatment advice b) anything that suggests that homeopathic remedies are considered by conventional practitioners to be an acceptable substitute for conventional treatments. The text as written suggested that a) homeopathic remedies might be acceptable substitutes and implied (by the use of the word complementary) that this was accepted by medics.


 * I am happy for a statement to appear that homeopaths do use remedies as substitutes for conventional treatment even when the conventional treatment is known to be effective and urgently indicated; perhaps this statement is needed and should be inserted. That must be followed directly by a statement strongly dissociating conventional medical opinion from such practices.

Gareth Leng 11:04, 24 October 2008 (UTC)


 * I concur. Not suggesting that homeopaths do or do not do this, but the thinking has to be understood. Knowing if the approach will be optimistic (the body will usually heal itself) or pessimistic (the patient's airway could block completely in the next minute -- what do I do?) would help. Howard C. Berkowitz

Isn't this just a matter of crafting a slightly longer text? Surely we can write something to the effect that, while (1) some homeopaths will sometimes advert to conventional treatments for bronchitis if homeopathic treatments will take too long (i.e., place the patient at risk, by waiting), (2) conventional physicians strongly insist that the conventional treatment for the condition be done immediately, and that any homeopathic treatment be done as an adjunct. Have I got that right?

We should, of course, allow homeopaths to state how they treat bronchitis. But, if conventional physicians find this treatment actually dangerous, it is just as obvious (or more so) that we must place in blinking lights (so to speak) warnings to the effect that conventional physicians find the treatment to be dangerous. Moreover, we should say why we find that dangerous. There is no point to skirting around the issue of why it is considered dangerous by conventional physicians. Spelling out the danger is essential to understanding the full range of thinking on the issue. --Larry Sanger 14:20, 24 October 2008 (UTC)


 * I think you have got it right; I'm hesitating to alter the text myself first because I don't know myself that homeopaths generally would delay conventional treatment, and until I understand exactly in what conditions they might delay treatment, it would be premature to contemplate the possible consequences. I can be certain that conventional physicians would consider any delay in treatment to be disadvantageous, whether there is any evidence that it might pose real risks I'm unsure of. It depends. I'm more concerned aboutthe message for acute asthma "A severe asthma attack is a life-threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death." . We really cannot give the impression that such attacks can be treated by homeopathy; to do so would be irresponsible.Gareth Leng 15:02, 24 October 2008 (UTC)


 * Clearly, we need to hear more from Ramanand, or perhaps Dana. In the meantime, I think you as Healing Arts Editor would be justified in removing the problematic text provisionally and subject to discussion. --Larry Sanger 15:21, 24 October 2008 (UTC)


 * Many of these blinking lights are on, in . I don't think you want books on management of emergent respiratory distress, so I'll just repeat something from up there; more specifics available if you want. I don't know this patient has stridor, but I don't have enough information to know he doesn't.


 * "If distress is moderate to severe, further physical examination should be deferred until the patient reaches a facility equipped for emergent management of the pediatric airway."


 * At the EMT level, from Emergency Care and Transportation of the Sick and Injured (4th ed), a standard EMT text from the American College of Surgeons, speaking of a patient in the field, in moderate respiratory distress of uncertain etiology:"In the absence of coma, the EMT must be prepared to handle the production of large amounts of mucus with appropriate suctioning, and administer oxygen. If the patient is in a coma, airway maintenance may be needed. Occasionally, full CPR is required for an episode of anaphylaxis. (p. 333)"


 * I'd be much more comfortable saying "sure, try homeopathy, it doesn't seem to be an emergency" if I had enough history and physical to make that as a reasonable decision. Obviously, thousands of physicians handle mild respiratory distress in their offices every days. Most physician offices, however, also have a considerable amount of advanced life support equipment in a closet. Howard C. Berkowitz 15:24, 24 October 2008 (UTC)

The bronchitis business
Sometimes, as I was just telling Howard ;-), the sheer quantity of text on the talk page gets in the way of our properly communicating.

So let me state very briefly what I want. --Larry Sanger 16:06, 24 October 2008 (UTC)
 * Ramanand, please answer this question: what do you mean by bronchitis? If "bronchitis" is not adequately descriptive, then, in more words, what sort of condition are you saying here that homeopathy can treat?
 * Also please answer this: do you believe that homeopathy is a suitable treatment alone, in cases of emergency situations, in which the patient is faced with imminent death without effective treatment?
 * Once we have these questions answered from Ramanand, I propose that someone who understands the issues (maybe Gareth) write a compromise text. Maybe a "compromise" won't be necessary because we'll realize that this was a big misunderstanding.


 * Thanks Larry. I've done some hunting and it is clear that Ramanand is right in that homeopaths do indeed widely recommend their remedies for acute asthma attacks in the first instance; it's not an isolated practise but widespread. It is also clear that conventional medical organisations are concerned enough to issue warnings to patients that there is no evidence that these homeopathic remedies are effective and that it might be dangerous to substitute these for conventional treatment (I've given two examples of links). So I've modified the text to try to follow Larry's very sensible guidance here.Gareth Leng 16:57, 24 October 2008 (UTC)


 * Homeopaths are not wrong in thinking of Hippocrates' maxim, "first, do no harm". Especially in emergency medicine and trauma, the outstanding people I know are not necessarily taking drastic steps, but are, rather like a fighter pilot or chess player tries to stay ahead of his opponent, constantly thinking "I'll wait for now, or do this for comfort...but I must be ready if A or B or C suddenly happens".


 * It has not come across, and may be a misunderstanding, that homeopaths start conservatively and want to thoroughly exhaust each remedy before trying something else. I simply have no sense to what extent they are thinking ahead -- both in knowledge and preparation -- of potential catastrophes. I take a lot of advice from the writings of Ken Mattox, who is probably the dean of trauma surgery. Ken not only has the judgment, but the incredible teaching skills, to get across when watchful waiting is appropriate, and when fast and drastic action is necessary. It wasn't with him, but only once have I seen a chest opened in a hallway (I'd prefer not to watch it again); the patient had a gunshot wound to the chest, with pulse stopping in the ambulance that did a lot of other correct things (such as "scoop and RUN"). Saved the patient, but a minute or two of hesitation would have been too long. Without manual heart compression, the patient didn't have enough blood to pump to the brain.


 * I may be too busy for the next few hours, but I'll try to do a starter article on assessment and emergency management of respiratory distress, from the perspective of emergency medicine.Howard C. Berkowitz 16:33, 24 October 2008 (UTC)


 * Thanks Gareth, Howard and Larry, I hope things are resolved now.&mdash;Ramanand Jhingade 03:36, 25 October 2008 (UTC)

Friends, I am concerned that Gareth above says that there is "no" research that shows any benefits from homeopathic medicine in the treatment of acute asthma. In the future, it might be better to ask IF there is such research first before making such a categorical statement...and/or one might consider doing some searches. Below is some info from my ebook that references 150+ clinical trials.

Research conducted by professors at the University of Glasgow indicates that those patients given exceedingly small homeopathic doses of whatever substance to which they are most allergic can experience significant relief within the first week of treatment (Reilly, 1994). The authors called this unique method of individualizing medicines "homeopathic immunotherapy."

This double-blind, placebo-controlled trial showed that over 80% patients given a homeopathic remedy improved, while only 38% of patients given a placebo experienced a similar degree of relief. A homeopathic physician and a conventional physician assessed the patients. When the patients and doctors were asked if they felt the patient received the homeopathic medicine or the placebo, both the patients and the doctors tended to guess correctly.

The experiment was relatively small, with only 24 patients. In order for statistically significant results, such experiments must demonstrate a very large difference between those treated with a medicine and those given a placebo. Such was the case in this study.

The researchers utilized conventional allergy testing to determine the substances to which the asthmatic patients were most allergic, and then gave a 30th potency of this substance to half of the subjects (neither the experimenters nor the subjects knew who was given the medicine and who was given a placebo).

A double-blind, randomized, placebo-controlled trial was conducted in Cuba on patients with bronchial asthma (Riverson-Garrote, 1998). In this study 63 patients (34 children and 28 adults) participated, 39 of whom were given individualized homeopathic treatment and 24 were given a placebo.

In the treated group, 97.4% improved and 2.6% worsened. 87.2% reduced their use of conventional medication. In the placebo group, 12.5% improved, 16.7 stayed the same, and 70.8% worsened. None of the subjects given a placebo reduced their conventional medication.

Another study prescribed a homeopathic combination remedy (a mixture of various homeopathic medicines) to asthma patients who were dependent upon corticosteroid drugs. This double-blind, placebo-controlled randomized study treated 40 asthma patients on corticosteroid drugs, and it showed that the 20 patients given the homeopathic medicine experienced greater improvement than those given a placebo and were able to reduce the dosage of their conventional drugs (R. Matusiewicz, 1997).

A study in Norway of 200 patients suffering from hypersensitivity illnesses, including asthma, eczema, urticaria, hay fever and other allergies, showed that homeopathy was at least as effective as conventional medical treatment (Launsø, Kimby, Henningsen, 2006). The study was retrospective and comparative, and it evaluated everyday clinical practice of general practitioners and classical homeopaths. Most patients who were treated by conventional medical doctors experienced an aggravation of their symptoms when stopping conventional drugs, while only 1/3 of patients in the homeopathy group experienced such an aggravation (P = 0.002). Only one patient on conventional treatment experienced improvement of symptoms after stopping medication, compared to improvement in 2/3 of homeopathy patients. Patients in the homeopathic group also reported a larger improvement in their general state of health, with 57% improving, compared to 24% in the conventional group (P=0.004). Homeopathic patients also experienced substantially more positive change in their psychological state (P<0.0001). For quality of life 53% in the homeopathy group improved, compared to 15 % in the conventional group.

REFERENCES: Launsø L, Kimby CK, Henningsen I, Fønnebø V. An exploratory retrospective study of people suffering from hypersensitivity illness who attend medical or classical homeopathic treatment. Homeopathy (2006) 95, 73-80.

Matusiewicz, R, “The Effect of a Homeopathic Preparation on the Clinical Condition of Patients with Corticosteroid-dependent Bronchial Asthma,” International Journal of Biological Therapy and Integrated Medicine, 1997,15:70-4.

Reilly, D, Taylor, M, Beattie, N, et al., "Is Evidence for Homoeopathy Reproducible?" Lancet, December 10, 1994, 344:1601-6.

Riveron-Garrote, M, “Ensayo clinico aleatorizado controlado del tratamento homepatico del asma bronquial,” Boletin Mexicano, 1998,31:54-61.Dana Ullman 14:46, 25 October 2008 (UTC)

Allegations/Criticism
I see that a lot of 'negative statements' are being included in this article. If one keeps inserting all the allegations/criticism one can find on the Net, the credibility of Citizendium will be lost.&mdash;Ramanand Jhingade 03:40, 25 October 2008 (UTC)
 * Without specific examples it is hard to comment. Chris Day 03:50, 25 October 2008 (UTC)


 * Rather than start a new section, I reverted out the addition of "although it is practised worldwide.", with the edit comment "the survey says it".


 * First, the survey does not say it. The survey speaks of homeopathy in a list of countries, a list far smaller than the number of countries in the world. Second, I see no information added by the survey. Third, the survey itself is non-notable; the survey firm has 600-odd occurrences on a Google search; its website has no indication of any qualifications in health matters; the survey itself is written as an advertisement and does not give any methodological information -- but phone numbers to call if you want the company's services.


 * I think the process in place can give the appropriate credibility for CZ.Howard C. Berkowitz 04:19, 25 October 2008 (UTC)

Some thoughts on compromise
At the end of the section on the Lancet controversy, I tried to flow into some thoughts that arose from a recent paper on external and internal validation in conventional surgery. I freely admit it's near my bedtime, and perhaps I should have put this all on the talk page, but I felt it really flowed from comments in the text, and perhaps complemented them.

Perhaps we are approaching some of this in the wrong way. While I still contend the statistical trial method that has been mentioned for pharmacogenenomics could well work for prospective randomized controlled trials of homeopathic remedies, presumably versus a drug control group, there may be another model from evidence-based medicine. It's often not realized that surgical procedures do not need the approval that is required for drugs and medical devices. There is something in common between surgery and homeopathy: it is the profession that decides if a technique is effective.

The difference I see, however, in the approaches of surgeons and homeopaths are that surgeons are not necessarily hostile to attempts to get more statistical rigor into after-the-fact review. The personal, subjective impression of Howard C. Berkowitz is that the homeopaths here, and in citations, seem utterly appalled by the idea that anyone might suggest that any two patients are treated in a compatible manner -- yet there are over-the-counter homeopathic remedies, and there are at least some relatively widely used remedies such as Oscillococcinum. Some homeopaths say that remedies can be preventive, while others deny it, and I must confess that cannot, as Chris put it, wrap my mind around the idea that if symptoms are required to select a remedy, prevention is done before symptoms occur, than how could a simillium be selected?

Anyway, I hope there might be some constructive observations here. It doesn't prove or disprove homeopathy, but I think it gives me insight into why homeopathic and evidence-based medicine people can't seem to communicate. Where alternative medicine has become complementary, it always required both disciplines agreeing on some things. When I read things like miasms, even in the newer discussions I searched, I don't know where to start, and I read so much anti-medicine anger in some of those articles I sense little interest in trying to find common thinking. Can that be fixed?

I might suggest something that would help in this article: move the things 50-200 years old to the history article, other than a brief historical note. No modern physician will argue that the "mainstream" physicians of Hahnemann's day were totally incompetent by current standards. The problem, in my mind, is that there's little homeopathic recognition that medicine has learned by its errors. Pardon me, but homeopathy seems largely stuck in Hahnemann's model -- if there has been progress and reinterpretation, will some homeopath please, please discuss it in terms that a biomedical scientist can understand? Howard C. Berkowitz 05:39, 25 October 2008 (UTC)