Talk:Homeopathy/Archive 13

Further categories added
I just added Chemistry and Health Sciences as categories most close to this topic, and I hope this stimulates some of the necessary rewriting. --Daniel Mietchen 18:22, 28 April 2009 (UTC)
 * I suggest, as a starter, that since there seem to be a number of people who feel that the Overview is buried far too far from the top, that it be either moved or the lede be rewritten. Let's start taking to heart the posted CZ Neutrality policy:
 * "Expert knowledge and opinion receives top billing and the most extensive exposition."
 * "The task is to represent the majority (scientific) view as the majority view and the minority (sometimes pseudoscientific) view as the minority view." Hayford Peirce 18:30, 28 April 2009 (UTC)


 * Think that's right, and I've moved the Overview up and tightened the wording a bit.Gareth Leng 12:03, 8 May 2009 (UTC)


 * Lately I have been reading about water memory, its scientific evidence is even less than I expected. I see clearly now that much of the discussion in the section "Scientific basis of homeopathy" is neither here nor there. Ortho/para water, isotopomers, glass chips, it is all true but what is the connection to homeopathy? We could extend the list of true, but meaningless, facts ad infinitum. So I propose to shorten this section, beginning with taking out the reference to solitons, clathrates, and nanobubbles. --Paul Wormer 12:29, 8 May 2009 (UTC)

A proposal that will, no doubt, cause consternation
I propose that we take the bull by the horns and rewrite the lede sentence to read:

Homeopathy or homoeopathy is a system of alternative medicine whose principles, however, are not accepted by most medical doctors and scientists, particularly those in the West.

Is that anything about that simple statement that is false, misleading, or unprofessional? If not, then I *strongly* urge that we begin the article with it, and then do the necessary rewriting in the rest of the article. Hayford Peirce 17:57, 8 May 2009 (UTC)


 * No, it's accurate. Still, I might be tempted to add "It is an alternative system that uses a fundamentally different model of health, and whose proponents say is difficult if not impossible to judge by standards of evidence-based medicine; it has to evaluated in its own frame of reference." That's wordy and can be improved, but I think it states a fair point. Howard C. Berkowitz 18:04, 8 May 2009 (UTC)


 * I could certainly live with that, and I think that any other fair-minded person (which, of course, defines ALL Citizens!) could too. So why don't you do the rewrite and I'll do the copyedit if needed? Hayford Peirce 18:07, 8 May 2009 (UTC)


 * What is the basis for the qualifier "particularly those in the West"? I'm aware that homeopathy is more accepted in the region of the Indian subcontinent than in the West, but I've not seen evidence that it is accepted by non-Western doctors and scientists more generally. Note that homeopaths have expressed regret that "nobody knows anything about homeopathy" in China, for example. Raymond Arritt 20:30, 9 May 2009 (UTC)
 * Further: I don't agree with the general proposal. In my view the first paragraph (and certainly the first sentence) should state what homeopathy is. We have the rest of the lead to comment on its acceptance and so on. I've done a bit of rearranging of the lead in an attempt to make it read more smoothly, but please feel free to revert my changes if you disagree. Raymond Arritt 21:02, 9 May 2009 (UTC)


 * It's certainly more accepted in India, I gather. Otherwise, I agree with you on the "non-Western" part -- I wish it could be rewritten. As to the rest, you have simply restored the old version with which we were concerned about its lack of skepticism. If, to stretch the point, we have an article about Flat Earth, we don't wait until paragraph umpty-ump to say that all mainstream scientists consider this idea to be nonsense. Everyone except you, for the last couple of weeks, has agreed that the homeopathy article waited *way* to long to point out, and then to point out strongly, that mainstream science does *not* consider it to be useful. We are, therefore, in this draft article, consciously trying to change the balance of the article. We don't "own" the article -- you're certainly welcome to make suggestions and changes, but I think that if you try to restore the old framework, you are going to run into considerable opposition. Hayford Peirce 21:20, 9 May 2009 (UTC)
 * I emphatically agree that the approved version waits far too long to state the prevailing scientific and medical view (and does an embarrassingly poor job when it finally gets there). I don't agree that it needs to be right up front in the first sentence, but if everyone else believes it should be in the first sentence I won't argue the point further. I must note that in its present form the lead paragraph is very poorly written in terms of clarity and style; it will have to be cleaned up if we expect the new draft to be taken seriously. Raymond Arritt 21:34, 9 May 2009 (UTC)
 * I think the lede para. is a perfect model of clarity and concision, saying exactly what we want it to. You obviously disagree, but how about giving us a "for instance"? Or how about rewriting it so that its "clarity and style" are improved. Not changing what it says, as you did before, but improving the existing text. I think that all of us would welcome that.... Hayford Peirce 04:04, 10 May 2009 (UTC)
 * You really don't see the style problems? I suppose everyone read things differently. For a start the use of "however" is strange, because it does not make a contrast. The paragraph also is made up entirely of loose sentences. How about something like:
 * Homeopathy or homoeopathy is a system of alternative medicine. Its principles are not accepted by most medical doctors and scientists, particularly those in the West. As an alternative system it uses a fundamentally different model of health that, its proponents say, cannot be judged by standards of evidence-based medicine and must instead be evaluated in its own frame of reference.
 * Another possibility is that the long second sentence could be tweaked to say:
 * Homeopathy or homoeopathy is a system of alternative medicine. Its principles are not accepted by most medical doctors and scientists, particularly those in the West. Its proponents say that as an alternative system it cannot be judged by standards of evidence-based medicine and must instead be evaluated in its own frame of reference.
 * No change in meaning, but (I think) either of these versions, or something similar, would read more smoothly. The main points are: (1) lead with a simple declarative sentence; (2) remove the "however"; (3) tighten to eliminate redundancy or other unnecesary words. Raymond Arritt 17:21, 10 May 2009 (UTC)

Removal of para
Daniel commented out the irrelevant paragraph on "scientists may have it wrong". I agree completely.--Paul Wormer 13:44, 9 May 2009 (UTC)

To lede?
IMHO the following sentence should go from the section Scientific basis of homeopathy. As far as I'm concerned it could go to the lede, or to clinical trials, or may be deleted (because I suspect that something similar has been stated already in the present article):

''Further, homeopaths assert that the overall evidence for homeopathy, including clinical research, animal research, basic sciences research, historical usage of homeopathic medicines in the successful treatment of people in various infectious disease epidemics, and widespread and international usage of homeopathic medicines today, indeed provide the required extraordinary evidence for the benefits of this system. ''

--Paul Wormer 13:44, 9 May 2009 (UTC)


 * First, the paragraph now in the lede,

"'Classical homeopathy' or 'Hahnemannian homeopathy' refers to the original principles of this medical system in which a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing rather than only the diagnosis of a disease. 'Commercial' or 'user-friendly' homeopathy refers to the use of a mixture of remedies in a single formula containing individual ingredients that are generally chosen by the manufacturer for treating specific ailments. Such homeopathic remedies are used by consumers all over the world for self-treatment of common self-limiting ailments and injuries."
 * fits better at the end of the section "preparation of homeopathic remedies", perhaps with a little flow editing.


 * Second, if the paragraph you suggest moving to the lede were to go there, it needs to be introduced with something including the sentence "These stringent demands are often summarised by the maxim "Extraordinary claims require extraordinary proof".", and editing the paragraph so there is a transition to the "extraordinary proof" in the "homeopaths assert..." I'm not sure if the material between "extraordinary claims" and "Further" needs to be there so it's coherent. The "Further" sentence doesn't quite make sense on its own in the lede.


 * On a different subject, some material either needs to be deleted or move to history of homeopathy. Given a century of progress in immunology, is there any point to quoting Von Behring here? The only point seems to be to explain 19th century thinking, which does have the justification that 19th century medical drugs tended to be toxic and ineffective. In like manner, can we really leave "Homeopaths consider that two conventional concepts, vaccination, and hormesis, can be considered as analagous to homeopathy's law of similars and the use of small doses. " unchallenged, vaccination being a completely different and understood mechanism, and hormesis still being explored?


 * I'd also get rid of mithridization, or move it to history. There's no modern belief in that concept. Howard C. Berkowitz 17:57, 9 May 2009 (UTC)


 * The sentence that Paul mentions is very badly written in any case -- it needs to be simplified and redone so that it makes sense. Hayford Peirce 18:10, 9 May 2009 (UTC)


 * I don't want to get into a revert war here, but I think fairness does call for mentioning the basic vital force and similars principles in the first paragraph. Don't get me wrong; I don't think there's substance to homeopathy, but the current first paragraph just deprecates their model without any text about what it includes. Howard C. Berkowitz 17:30, 11 May 2009 (UTC)


 * I agree with Howard on this. In fact I was going to ask the same question myself: Daniel, why did you cut this bit out? I think that it is, in fact, important that it be restored. Hayford Peirce 18:07, 11 May 2009 (UTC)

Odd sentence
The lede contains the sentence:
 * A number of homeopaths also are strongly opposed to vaccines, which public health officials, including ones with homeopathic training, consider a danger to the community.

What is the danger? The fact that unvaccinated people are in the community? Or the opposition of homeopaths? I don't see it.--Paul Wormer 07:46, 10 May 2009 (UTC)


 * I think what it's *trying* to say is: A number of homeopaths also are strongly opposed to vaccines, which they consider a danger to the community; some public health officials, especially those with homeopathic training, agree with them. But it's unwieldy and should be further revised, or shortened (eliminate second phrase), or just deleted. Hayford Peirce 16:34, 10 May 2009 (UTC)


 * No. Vaccination is an accepted technique, in public health, for preventing infectious diseases. A number of homeopaths consider vaccines to be actively dangerous and recommend they not be used, which presents a danger to the community. Some homeopaths advise against the use of drugs to prevent malaria, to which even the director of the Royal Homeopathic Hospital objects.. Howard C. Berkowitz 17:40, 10 May 2009 (UTC)


 * Is that your proposed rewrite as opposed to mine? If so, stick it in. Whadda *I* know about this stuff? Hayford Peirce 18:20, 10 May 2009 (UTC)

Weasel wording in the last section, "Safety"
I have done some editing here to get rid of either contradictory words and/or weasel-wording. If it's really true, and can be *shown* to be true, that only "many public health professionals" disagree about the safety of vaccines, instead of "nearly all", then change it back, slap me on the wrist, and I will depart from Citizendium forever. How can we possibly permit such weaselry in our major articles? Hayford Peirce 02:15, 13 May 2009 (UTC)

Moves to History of Homeopathy
I moved the comment of von Behring to history of homeopathy, linking it. Tomorrow, I'll put in some of Osler's comments about both the toxicity of conventional drugs at that time, and also Osler's view that both allopathy and homeopathy were "medical cults" to be superceded.

Why do we have the material on mithridization? It seems to be random, not especially tied to homeopathic concepts, other than perhaps indirectly through hormesis. While hormesis probably should be there, I'd get rid of mithridization completely. Howard C. Berkowitz 04:30, 13 May 2009 (UTC)


 * On further reflection, I moved up hormesis, but then took out the material below, which I simply can't relate to the discussion.


 * Mithridatization (which is not a term used in contemporary science or medicine) may be a better metaphor than vaccination for homeopathic treatment. Mithridatization is the chronic administration of subtoxic doses of a toxin, in an attempt to develop resistance (or "tolerance") to large doses of the toxin. It is said that Mithridates VI Eupator, King of Pontus (132-63 BC), used this technique to protect himself from his enemies . 


 * There are many different mechanisms by which tolerance can develop - and exposure to repeated small doses does not always result in tolerance. A herpetologist who receives many small doses of snake venom may indeed become tolerant to them. A beekeeper, however, may become hypersensitive'' to the venom and, after receiving a sting, go into anaphylaxis. This type of response to small, not necessarily precisely measured, doses is not predictable on an individual basis. "Allergic desensitization" is a technique used in conventional medicine to treat individuals who have a specific allergy to something that they cannot easily avoid. This involves exposing the patient repeatedly to tightly controlled doses, increasing the doses gradually over time. This treatment can be dangerous (exposure of sensitive individuals to an allergen can produce anaphylaxis), and it has very inconsistent efficacy, so is normally only attempted when the allergy poses serious restrictions on the patient's normal life.


 * Both mithridatization and homeopathy might be considered as instances of  [hormesis] Howard C. Berkowitz 21:02, 13 May 2009 (UTC)


 * I can see where the first paragraph is starting to head, but then the second paragraph wanders off... somewhere. Raymond Arritt 00:21, 14 May 2009 (UTC)


 * Still, I'm not sure homeopaths routinely refer to mithridization; I vaguely recall a non-homeopath brought it into the article.


 * Immunization is a tricky area when talking about homeopathy; yes, it involves small doses of something that could cause symptoms, but the similarity stops there, unless one wants to make the rather sweeping statement that the vital force is equivalent to the immune system. Immune response doesn't really explain homeopathic cures for non-infectious disease or symptoms. Howard C. Berkowitz 02:51, 14 May 2009 (UTC)


 * I'm the guy who kept trying to put in, "I tell the tale that I hear told, Mitridates, he died old." But, of course, as the article title says, It Never Got Me Anywhere.... John Brock, le nom de secret agent de Hayford Peirce 03:40, 14 May 2009 (UTC)


 * Seriously, does this tale come from homeopathic literature? Howard C. Berkowitz 04:00, 14 May 2009 (UTC)


 * I think it was Pierre-Alain Gouanvic who was keen to insert this. I inserted some of the second para as an explanation of tolerance in that context, I think there was discussion of desensitisation which I think Dana argued on the Talk page as an example of use of like cures like, and the insertaion on desensitisation was a summary of the outcome of that discussion.Gareth Leng 16:07, 23 May 2009 (UTC)


 * Without some serious referencing, rather than some original hypotheses, it should go, not even in history. Howard C. Berkowitz 16:15, 23 May 2009 (UTC)

Repetitiveness
It seems to me that there still are many Wikipedia-like repetitions in this article. For instance, the lede says twice: [homeopaths] use a fundamentally different model. I noticed more of these kinds of repetitions. Before re-approval we should get rid of most that because they look silly and non-professional.--Paul Wormer 07:15, 13 May 2009 (UTC)


 * I agree -- please do as much editing on this stuff as you can! Hayford Peirce 16:04, 13 May 2009 (UTC)

Retitled section
I changed the section title "Attempts to provide a scientific foundation for homeopathy" to "Proposed scientific foundations for homeopathy." To my ears "attempts to..." sounds a little more judgmental than we probably want, while simply saying "proposed" doesn't imply anything either favorable or unfavorable. Is this OK? Raymond Arritt 00:28, 14 May 2009 (UTC)


 * It's fine by me, and I agree with your reasoning. Hayford Peirce 01:32, 14 May 2009 (UTC)

Ortho-para water
The difference between ortho-para water is due to the Pauli principle: protons are fermions and have a totally (spin + space) antisymmetric wave function. Ortho stands for spin triplet (is symmetric in spin and antisymmetric in space); para stands for spin singlet (antisymmetric spin, symmetric space). The ratio 3:1 is the triplet(3) : singlet(1) ratio. I removed nuclear because these spins can be flipped by paramagnetic interactions on a molecular level. If a homeopathic tincture contains an open-shell, paramagnetic, transition-metal center, then it is conceivable that it can change the 3:1 ratio. Also some catalysts (e.g. active charcoal) may change the ratio. That is why I added the proviso that even if such a change happens its healing power is still unclear.

Personally I see isotopologues as something completely different from ortho/para, which is why I put them into two different paragraphs. I realize that this view is academic and that seen from a distance the two concepts belong in the same remote corner of molecular physics.

--Paul Wormer 06:11, 14 May 2009 (UTC)

First paragraph
I'm still dissatisfied with the first paragraph. Currently it reads:
 * Homeopathy or homoeopathy is a system of alternative medicine whose principles are not accepted by most medical doctors and scientists, particularly in the West. As an alternative system, it uses a fundamentally different model of health that, its proponents say, cannot be judged by standards of evidence-based medicine and must instead be evaluated within its own frame of reference.

My proposed revision is:
 * Homeopathy or homoeopathy is a system of alternative medicine. As an alternative system, it uses a fundamentally different model of health whose principles are not accepted by most medical doctors and scientists, particularly in the West. Its proponents say that cannot be judged by standards of evidence-based medicine and must instead be evaluated within its own frame of reference.

The main points of my revision are: (1) it starts with a simple declarative "what it is" sentence; (2) the next two sentences state the scientific and medical view in its own sentence, contrasted with the homeopaths' response in its own sentence. Comments? Raymond Arritt 17:43, 14 May 2009 (UTC)


 * Assume this is the first paragraph. I think it's essential, then that it transition to a second paragraph that, as succinctly as possible, defines the fundamentally different model. Howard C. Berkowitz 18:31, 14 May 2009 (UTC)


 * It looks as if the Bug is back! I put in a comment here about half an hour ago, it shows up on my Contributions log, but it's gone! It's that rat Howard, deletin' my stuff! Anyway, here's what I said, if I can recall: "Your suggestion looks fine to me if you think that's an improvement. But there should be an it after Its proponents say that".... Hayford Peirce 18:42, 14 May 2009 (UTC)
 * On this note I'm 99.9% certain that I signed my comment below under "Reapproval" in the usual way, but apparently it didn't show up. Has anyone noticed signatures getting dropped off? Raymond Arritt 16:48, 15 May 2009 (UTC)
 * I *think* that what you did was maybe just type three tildes instead of four -- the date was there, but not your name.... Hayford Peirce 17:04, 15 May 2009 (UTC)

...particularly in the West
I have deleted the qualifier "particularly in the West." The qualifier was added by Martin Cohen in this edit. In looking at the Talk page around that time I see no specific argument favoring this statement (here is a snapshot of the Talk page around that time). Homeopathy has no general non-Western prevalence; for example, homeopaths themselves have lamented that "nobody knows anything about homeopathy" in China. From what I've been able to find out it appears the correct form of the qualifier would be "outside the Indian subcontinent" but do we want to be that specific? Raymond Arritt 00:56, 15 May 2009 (UTC)


 * No. I'm glad to see that it's gone. Your next project, should you accept it: check the verifications of the weird (to me) statements about the percentage of French and German doctors who believe in it, or don't disbelieve in it. I lived in Tahiti for 25 years, a French territory, and knew about half the non-hospital doctors there and was close friends with a number of them. There was *never* a homeopath in Tahiti, none of the doctors ever mentioned them, and I find it hard to believe that 30 or 40 percent of French doctors believe in this. Hayford Peirce 01:31, 15 May 2009 (UTC)


 * I haven't been able to find these figures. There's an interesting article in BMJ that estimates one-year prevalence of CAM use in various countries as of 2000, but homeopathy is only one part of CAM.
 * I wish Homeopathy stated where those numbers came from. While Wikipedia uses far too many references, I often think Citizendium uses too few. But that's another conversation for another day.
 * In any event I'm going to stop editing the article for a while so it will be stable enough for the approvals manager to have a look at it. Raymond Arritt 04:01, 18 May 2009 (UTC)


 * I found in Ref. [36] of the draft (BMJ 1994;309:107-111  Education and debate. Medicine in Europe: Complementary medicine in Europe by Peter Fisher and Adam Ward):
 * Over a third of France's 54500 general practitioners use complementary methods: 5% exclusively, 21% often, and 73% occasionally.
 * and:
 * In the Netherlands 47% of general practitioners use complementary therapeutic methods, most commonly homoeopathy (40%); 9% use manipulation and 4% acupuncture. Manipulation and acupuncture are more commonly used by health professionals other than doctors and by non-medically qualified practitioners. In Germany 77% of pain clinics use acupuncture,11 and up to 37% of British general practitioners use homoeopathy
 * The draft refers to [36] with the sentence
 * In some countries, all (or virtually all) professionals that use homeopathic treatments are MDs (such as France, Spain, Argentina, Colombia)[36].
 * I read and searched Ref. [36], Argentina and Colombia are not mentioned at all. About France and Spain the following is stated:
 * In most member states of the European Union, including Belgium, France, Spain, Italy, and Greece, the practice of medicine, except by statutorily recognised health professionals, is illegal.
 * Further Ref. [36] states:
 * It [an EU proposal] also demanded an end to prosecutions of non-medically qualified practitioners in countries such as France and Spain, and for a pan-European system of regulation of non-medically qualified practitioners along the lines of the British Osteopaths Bill.
 * To conclude from these sentences that "all professionals in France, Spain, Argentina, Colombia using homeopathy are MDs" is stretching Ref. [36] further than I believe is honest. This makes me wonder: how relevant/pertinent/accurate are the other references in the draft?
 * --Paul Wormer 09:40, 18 May 2009 (UTC)


 * Thanks for tracking all of that stuff down! I remember, months ago, that Dana kept putting this stuff in and other people kept trying to modify it. Could you now make some sort of decision about what to do with it all? Thanks! Hayford Peirce 17:24, 18 May 2009 (UTC)


 * It's probably worth asking for the purpose of the material. I have no objection to saying that some people and cultures, more than others, like homeopathy. There seemed an effort, at times, to push homeopathy both by endorsements and numbers, or by citing work by physicians who had done both homeopathic and non-homeopathic things, but only citing the former.


 * One claim was made that homeopathy was the third most common form of alternative medicine, and I did a little calculation given the numbers of homeopaths and the claimed number of patients. Poor fellows would have needed to see around 1000 patients a day to keep up the encounter lengths.


 * It's one thing to say a physician uses homeopathy at all, and another thing to say a physician endorses homeopathy. Just as physicians, in the U.S., inappropriately use antibiotics due to patient pressure, I wonder how many European physicians use homeopathic preparations due to patient pressure. Oscillococcinum seems widely used. Actually, I saw it in a U.S. drugstore, prominently advertised, and could not help but think of the sound made by its principal ingredient (when alive). Howard C. Berkowitz 17:51, 18 May 2009 (UTC)

Reapproval?
Does anyone think the current draft is essentially ready for reapproval? There have been significant changes that have (in my view) gone a long way toward fixing the most glaring problems with the original approved version. I think there's something to be said for reapproving the article at incremental points (say every few months or so) rather than springing a wholesale rewrite on people, especially with a controversial topic like this. Raymond Arritt16:07, 15 May 2009 (UTC)
 * Yes, you're probably right. Also, we don't want to keep the improved version away from the general public for too long. I'll ask Joe Quick, the Approvals Manager, to take a look and tell us what he thinks needs to be done. Hayford Peirce 16:40, 15 May 2009 (UTC)

Text in footnotes
Given that this is a hyperdocument, not a professional journal, I don't like the practice of putting any substantial amount of text (e.g., measles or gangrene) into footnotes. An online reader is not necessarily going to get to endnotes, and there's no way the reader can know that a given footnote is more than bibliographic.

My rule is that any substantive text either belongs in the article, or in a linked subarticle. Howard C. Berkowitz 20:30, 15 May 2009 (UTC)


 * I don't quite know what Howard is referring to here, but I certainly agree with him -- text should be in the article or a related subarticle except for the minor sort of footnote material that we all learned about in school. Hayford Peirce 20:53, 15 May 2009 (UTC)


 * I never liked these footnoted comments but thought "maybe that's the way it's done around here." I'm glad to see others agree.  Most of these footnoted remarks have little or nothing to do with the topic at hand and can simply be deleted. The few that are on point are best merged into the text, per Howard. Raymond Arritt 21:05, 15 May 2009 (UTC)


 * Allez-y, mon pote! Hayford Peirce 21:06, 15 May 2009 (UTC)

Confused on source
In the section "a typical homeopathic visit", we have:

"At other times, a professional homeopath will often treat these patients with a constitutional remedy based on the patient’s genetic history, health history, and present overall physical and psychological state, with the intent to strengthen the person’s general health, thereby reducing the frequency or intensity of the symptoms of hay fever.[44]"

with the source information: ↑ Dennis Chernin (2006) The Complete Homeopathic Resource for Common Illnesses. Berkeley: North Atlantic. Stephen Cummings and Dana Ullman (2004). Everybody's Guide to Homeopathic Medicines. New York: Jeremy Tarcher/Putnam.

I'm confused -- we have three sources, none easily checked, with no page references. Look at the quote: is it plausible that homeopaths are really using genetic history? Howard C. Berkowitz 02:45, 16 May 2009 (UTC)


 * No, that's not plausible. I suspect "genetic history" should be "family history" (see e.g., here).Raymond Arritt 03:45, 16 May 2009 (UTC)

Causes of disease
While I agree the rewrite involving vital force improved the text, we can't ignore that homeopathy really does reject the theory of a disease etiology, such as disease being caused by a pathogenic organism, and appropriate treatment to kill that pathogen. Their main model is to strengthen vital force so that the body, perhaps through immune response, kills the pathogen. An antibiotic, however, is outside their model unless, perhaps, it produces the disease effect in provings. Howard C. Berkowitz 21:01, 16 May 2009 (UTC)

Support among medical doctors
Wearing a homeopath's cap I tried to find some numbers in the literature for support of homeopathy among MD's. So far I came up with the following:

--- In the USA there is some  support for homeopathic medicine among physicians. One survey1

found that 39% of the faculty of a medical school for primary care physicians considered use of homeopathic medicine legitimate, although only 8% had personal experience with such medicine. A survey of physicians representing a broad variety of specialties in a mid-sized southeastern US city found2

that 17% of the respondents considered homeopathy legitimate medical practice, but only 1.4% of the respondents had actually prescribed such medicine.

 References  1. S. M. Levine, M. L. Weber-Levine, and R. M. Mayberry, Complementary and Alternative Medical Practices: Training, Experience, and Attitudes of a Primary Care Medical School Faculty, J. Am. Board Fam. Pract. vol. 16, pp. 318–26 (2003)

2. J. Jump, L. Yarbrough, S. Kilpatrick, and T. Cable Physicians’ attitudes toward complementary and alternative medicine, Integrative Medicine, Vol. 1, pp. 149–153, (1998)

-

Apart from the low percentages of MD's that actually used homeopathic medicine, our homeopath friends won't object against including these numbers in the article, I guess. For the sake of objectivity I will look further.

--Paul Wormer 12:13, 19 May 2009 (UTC)


 * I checked the literature somewhat further and could not find any other numbers than the ones I quoted above. A long time ago I added a number to the article that  has been removed in the meantime. This is Knipschild et al. who found that about  45% of the Dutch GP's  thinks  that  homoeopathic  remedies  are efficacious  in  the  treatment  of  upper  respiratory  tract infections  or  hay  fever.  For  chronic  joint  problems this  is  30%. The article by Knipschild et al. is famous, I see it referenced over and over again.


 * I hope that our homeopathic colleagues will come up with one or more references to back up their claims, if not --and let's wait a while-- we will have to do some rewriting without them on basis of Fisher & Ward, the two references about the US situation, and Knipschild et al. about Dutch GPs.
 * --Paul Wormer 14:17, 19 May 2009 (UTC)

Use of homeopathy by MDs
Looking for recent objective assessment of the attitudes of practising physicians to homeopathy I found This survey in Germany which reported responses indicating that about 50% of respondents (GP physicians in Germany) judged homeopathy to be “rather credible”, 6% used it “very often” and another 32% “at times”. This seems consistent with the high rate of use of homeopathy by MDs in Germany reported elsewhere. Thus for example this study reported that Paediatric homoeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status, and  found that “Almost half of homoeopathic preparations were obtained by prescriptions either from medical doctors (25.7%) or from Heilpraktiker (nonmedical practitioners) (23.1%), while one-third of them were bought as OTC drugs (Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).Du Y, Knopf H (2009) Pharmacoepidemiol Drug Saf 18:370-9. PMID 19235777

A 2009 study by Münstedt K et al. in Forsch Komplementmed PMID 19420957 aimed to assess the use of complementary and alternative medicine (CAM) methods in German departments of obstetrics. ..” The most commonly used CAM therapy was acupuncture (available in 97.3% (366/376) of departments) followed by homeopathy (offered in 93.4%)”

On use in India, its been the subject of a special report in the Lancet (Prasad R (2007) Homoeopathy booming in India. LancetNov 17;370(9600):1679-80. PMID 18035598 ("In India, where homoeopathy is a national medical system, the market is growing at 25% a year, and more than 100 million people depend solely on this form of therapy for their health care")



The Faculty of Homeopathy in the UK was incorporated by an Act of Parliament in 1950. which gave the Faculty a role in regulating the education, training and practice of homeopathy by the medical profession, and gives details of GPs who provide homeopathy

In Europe, homeopathy is probably strongest in France, where two of the major manufacturers of homeopathic pharmaceuticals, Boiron and Dolisos, are located; homeopathic remedies prescribed by MDs are (partially) reimbursed by the State Medical system, and seem to be[ http://www.boiron.com/en/htm/01_homeo_aujourdhui/realite_eco_homeo.htmquite commonly prescribed there]. The second largest market is Germany.

There've been older surveys by the AMA of CAM use by family practitioners in the USA, must be somewhere in the history of the article. When I fisrt looked into it I recall I was very surprised by how many GPs were willing to refer patients to homeopaths or prescribe homeopathic remedies themselves. The impression I got was that most family doctors were quite relaxed about it.Gareth Leng 09:35, 22 May 2009 (UTC)


 * We didn't hear from Dana and Ramanand during this revision discussion, but it seems to me that we have now enough material to write honestly and well-documented about the use of homeopathy by physicians, even without them. What do you think?--Paul Wormer 10:28, 22 May 2009 (UTC)
 * Well I trawled through PubMed and don't think I've missed anything recent at least. I think there's enough here to provide an objective documentation, so I suggest you just go aheadGareth Leng 13:14, 22 May 2009 (UTC)


 * I edited in your references and a few others I found. I tried to reproduce the numbers that I found in the references as factually as possible (with the risk of being accused of "fringeness") --Paul Wormer 09:46, 26 May 2009 (UTC)

Essential point
''Dilution often continues to the point where none of the original substance remains in the remedy. '' is essential but incomplete. I believe it is correct to say that homeopaths believe the "remedy" need not have any of the original "substance"; the usable remedy is modified water (or other vehicle).

Perhaps analogies help. In mechanical engineering/manufacturing, a template or jig is essential to making the desired part, but it no longer is present in the part. In various chemical syntheses, precursors are essential but no longer present. The analogies get more strained when thinking of things like primers in polymerase chain reaction, or antigens in medical remedies that work by passive immunization -- providing antibodies.

The key difference, of course, is that in each one of the analogies, we can reasonably well trace the relationship from the substance to the final product, and how the product works. In homeopathy, we get to the classic line "and here a miracle happens", whether it be memory of water, etc. Howard C. Berkowitz 15:55, 22 May 2009 (UTC)


 * The essential unbelievable point is that water is a liquid. For solids memory is well documented and usually called hysteresis in science. There is magnetic hysteresis and form hysteresis. Use of plaster models in art goes back to antiquity.--Paul Wormer 16:14, 22 May 2009 (UTC)


 * Perhaps it may not be the best example, but there's an old electronic engineering lab practical joke -- throw a charged electrolytic capacitor to someone and say "CATCH"! On a more routine basis, if one wishes to be an old engineer, one takes great precautions with high-voltage systems that are not "on".


 * How do we, succinctly and vividly, make this point about liquid in the context of homeopathy? Howard C. Berkowitz 16:28, 22 May 2009 (UTC)


 * Because I'm not a physicist I have no reason to know that it's not credible that water may have something analagous to hysteresis in aspects of its structure (of course I'm happy to accept this is so). What I find not credible is that we have could have evolved a mechanism to recognise and respond adaptively to differences in water structure. So for me, it's by the way whether water has a memory or not. Gareth Leng 14:04, 23 May 2009 (UTC)

size of atoms
I don't know who entered the statement about Loschmidt and the size of atoms, but I liked the sentence because after the size of atoms (or, as we say now, molecules) was determined, it became clear that matter is not continuous, not infinitely divisible, and not infinitely dilutable. Loschmidt was the first to give an estimate of Avogadro's number and Avogadro's number is crucial, of course, in the discussion. Maybe we should write something like: "after it was established by Loschmidt in 1865 that a given volume of matter consists of a finite, albeit large, number of molecules, it became clear that a finite volume of solvent cannot be diluted infinitely." What do you think Raymond? --Paul Wormer 14:38, 23 May 2009 (UTC)


 * That's fine. It captures the important point, which is that matter is not infinitely divisible. Whether the size of the indivisible chunks is 10-11 m or 10-10 m or whatever doesn't seem relevant here. Raymond Arritt 14:54, 23 May 2009 (UTC)

Re section on conflict with conventional medicine
I read that section as delivering largely a point of view, and somewhat selective in its negative implications of conventional medicine. Anthony.Sebastian 01:20, 25 May 2009 (UTC)


 * Anthony, what keeps you? You can adapt the text of the draft, as long as you are fair to homeopathy (and to conventional medicine as well, of course).--Paul Wormer 16:16, 25 May 2009 (UTC)


 * I think Paul meant to type "you can EDIT the text", but I won't edit his own text, hehe. Hayford Peirce 16:21, 25 May 2009 (UTC)


 * I know nothing, I'm a foreigner, I don't even know what is wrong with "adapt".--Paul Wormer 16:39, 25 May 2009 (UTC)


 * I sure wish that my French was one-tenth as good as your English! But in this case, "adapt" would mean that he is copying, and then possibly changing, the text in question for some private use of his own, not just changing the text that everyone else can see. Hayford Peirce 16:46, 25 May 2009 (UTC)

Reapproval
To me it is important that Dana Ullman is willing to approve the revised version. We tried hard to be unbiased and I hope that Dana indeed reads it that way, which would mean that we have succeeded in writing a balanced article.

Somebody put the chemistry category to this article, which implies that formally I could be an approving editor, but I would prefer that editors from health science (or whatever it is called)  approve it, as  the article contains little chemistry. --Paul Wormer 14:29, 27 May 2009 (UTC)


 * I do not agree that it is important for Dana Ullman or any other particular individual to approve the article. We should adhere to the stated approval process without deferring to any specific person. Raymond Arritt 15:40, 27 May 2009 (UTC)
 * Seconded. John Stephenson 10:14, 28 May 2009 (UTC)


 * Seems to me you've done a fine job here, conscientiously neutral, and the re-ordering works for me. I don't see anything lost that I'd worry about, the simplifying is good as is avoiding redundant adjectives. You've removed some text that was intended to emphasise the non-dogmatic and open nature of science, and that's fine, I don't think it was really needed because the article doesn't read like a lecture, which was something I was overanxious to avoid. I'm happy to support reapproval. I think Dana should be alerted and like Paul, I hope he will also find it an improvement. Dana has been a conscientious supporter of honest efforts at balance and neutrality here.Gareth Leng 13:03, 28 May 2009 (UTC)


 * First, I agree that the Approval process should not depend on a single person. Even if Dana were not available, it's not unprecedented to get external reviews from a non-citizen expert, which can guide one or more Editors with some expertise.


 * Gareth, have you considered writing an essay on that non-dogmatic position of science, especially vis-a-vis what may be considered fringe assertions, and creating it as a Signed Article to which multiple articles can link? It's not quite a policy statement, but neither is it specific content to articles where I've seen variants on it. Howard C. Berkowitz 15:35, 28 May 2009 (UTC)

[unindent] I don't want Dana to approve the draft as a person, but as a homeopath. It is easy enough to write about homeopathy in a manner that all non-believers will nod and agree that it is a good piece of work. It is much more difficult to have both parties agree that the work is honest and balanced. How do we know that the point of view of homeopaths is represented fairly and squarely other than by approval of a representative of the homeopathic community? --Paul Wormer 16:13, 28 May 2009 (UTC)


 * We should of course give due consideration to whatever points Dana might raise with respect to the draft. In any event I hope that a new draft can be approved in some form. As a physical scientist I cannot help but wince when reading the "Scientific basis of homeopathy" section in the approved article. Citizendium's aspirations toward being recognized as "reliable and of world class quality" are not furthered by having such material in one of its articles, much less an approved article. Raymond Arritt 01:49, 30 May 2009 (UTC)


 * I left a short note for him asking him to stop by if he has a chance. --Joe (Approvals Manager) 02:20, 30 May 2009 (UTC)

(undent) I haven't been able to look over all the changes, but from what I've seen so far, it looks good to me. I'm not comfortable with the lead yet, though. Comparing the lead from the approved version to the draft, I'm not sure it is an improvment from a copyedit perspective. I think we can probably clean it up some. For example, we use the word 'akin' twice. Our first sentence seems to put the skeptical view before the horse. We appear to be discounting the practice before we even define it. Anyone have an issue with me removing it to the end of the fourth paragraph moving it? This is what we have now:


 * Homeopathy or homoeopathy is a system of alternative medicine. As an alternative system, it uses a fundamentally different model of health whose principles are not accepted by most medical doctors and scientists. Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.

D. Matt Innis 04:08, 30 May 2009 (UTC)
 * This is what I changed. Feel free to revert).


 * Looks OK to me. Maybe Hayford can do some final touch-ups on the writing style, if we ask him nicely. Raymond Arritt 04:10, 30 May 2009 (UTC)


 * (edit conflict)"Use" is fine with me, English is my other language - southern is my first :)


 * I, too, would like to see that we have a homeopath review our (mostly your) work. Dana would be great. I also feel good that Paul is satisfied with the chemistry portion and Gareth has looked over the science stuff.  Why am I here? :-) D. Matt Innis 04:21, 30 May 2009 (UTC)


 * Y'all, suh, are heah because while you are not a homeopath, you also have a somewhat different perspective than a pure medical clinician on things that may be good, but not EBM, medicine. I'm a tangent on the biomedical side, but you might be surprised how open I can be to some complementary methods -- and no, I haven't been convinced homeopathy is one of them. After seeing some TCM and shamanic techniques, I'll accept we don't know all -- and I'm still going to insist on an emergency medical protocol for a life-threatening emergent condition. I might even ask a clinician or two, not citizens and not likely to become ones, to review. Howard C. Berkowitz 04:37, 30 May 2009 (UTC)

Dear fellow Citizendium friends…I haven’t check CZ for many months, and I am generally pleased when people want to improve upon previous work. While I do not think that articles should rely upon just one person, CZ is known to respect and utilize the expertise of certain people. This makes sense. I was personally asked by Larry Sanger to be an editor on the homeopathy article many months ago, and I hope that my expertise can be helpful.

I see more biased info here than I’d like to see. Please note that I have purposefully not gone through each correction to determine who made what changes, so it is not my intention to point fingers at anybody. I only want to see a fact-filled, well-referenced encyclopedic article.

I am concerned that the 1st paragraph is inappropriate for an encyclopedia. To actually say that homeopathy is a different model of medicine which most conventional physicians and scientists do not accept even BEFORE discussing what homeopathy is…creates a palpable evidence of bias in action. Please compare the 1st paragraph in the Main Article and see how encyclopedic it is, and then, see how the draft version isn’t.

Further biased and inaccurate info is in the next sentence in the 1st paragraph! “Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.” There is NO consensus from homeopaths on this statement. Homeopaths generally believe that one must evaluate an entire “body of evidence,” which is the totality of basic science studies, controlled clinical trials (double-blind studies as well as outcome studies and cost-effectiveness data), epidemiological evidence, historical evidence, and case studies. Homeopaths do recognize that double-blind studies are helpful, but only when they are conducted in a way that is sensitive to the method of homeopathy itself. Just as double-blind studies are used in a great number of surgical procedures, no one asserts that surgery is therefore “quackery” or “unproven.”

What is written here is non-encyclopedic-like and is simply a half-truth.

The next paragraph has the statement, “it is a homeopathic principle that the more dilute the preparation, the more potent it is.[2] Sorry, this is wrong! “Dilution” is just one part of this process, and anyone who suggests that this is all that there is to homeopathic pharmacy is over-simplifying and trying to set up a straw man.

It is more accurate to say: “It is a clinical observation over the past 200 years from homeopaths and their patients that the more a medicinal substance undergoes a specific pharmacological practice called “potentization” (the medicinal substance is diluted with double-distilled water in a glass vial which is vigorous shaken and then undergoes sequential dilution with vigorous shaking in-between dilutions), the more powerful the medicine acts, the lower it acts, and the fewer doses are necessary.”  (Hopefully later we can discuss the silica hypothesis, amongst other theories that provide potential explanation for what is going on).

At present, it is then written, “Dilution often continues to the point where none of the original substance remains in the remedy.” First, Avogadro’s number is a probability issue, not a definitive one. At the most, one can say that “in all probability none of the original substance remains.” Therefore, at the most, it can only be said, “In all probability, the homeopathic potentization process may leave none of the original molecules of the medicinal substance.” But this is not even the point. Homeopaths assert that although in all probability none of the original molecules of the substance remains, homeopathic medicines change the nature or structure of the water to which certain people whose disease syndrome matches the medicine’s toxicology are hypersensitive.

Further bias: The paragraph that begins with (“Physicians are concerned that some patients seek homeopathic treatment as a first resort, even for conditions where there are effective conventional treatments.”) has no place at the top of the article. Once again, I believe that this paragraph is evidence of people re-writing this article in a way that have an anti-homeopathy bias and who seek to set up a straw man. The fact that some good clinical studies on the homeopathic treatment of people with asthma is oddly missing from this paragraph…and in any case, it should not be at the top. References: -- 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.

OVERVIEW: It is non-encyclopedic (again) to begin this section as it begins about someone’s assertion that “extraordinary” evidence is required for homeopathy even before one provides an overview of the subject itself.

In fact, if a human being claimed that he could fly, he would simply have to demonstrate that he could do so under controlled conditions ONCE or maybe TWICE or maybe a certain handful of times, as long as the conditions were previously determined and met. He would not have to prove “how a biological mechanism could have evolved” this state (as is asserted in a somewhat silly fashion below in the section on Scientific Foundations).

Ironically, I wonder if some people might condemn the evidence that this man could fly by simply admitting that he can fly but he cannot fly as fast as a jet or as high…thereby, this man is a “fraud.”

It is further ironic that some people claim that there is only “one” medicine…there is “proven medicine” and “unproven medicine.” And yet, is it fair to say that homeopathy requires extraordinary evidence? When one considers that the excessive costs of conventional medicine and the truly low costs of homeopathic medicines, one might assume that there should be “extraordinary evidence” for modern technological medicine.

I therefore recommend that the statement about extraordinary evidence has no place here.

The statement that homeopathy has “no scientific plausibility” is also simply wrong. While I certainly agree that we do not yet known with certainty how homeopathic medicines work, there are “plausible” explanations for how it may work (i.e. the silica hypothesis…plus many others). References: -- Bellavite and A. Signorini, The Emerging Science of Homeopathy: Biodynamics, Complexity, and Nanopharmacology. Berkeley: North Atlantic, 2002. --Roy, R, Tiller, W, Bell, I, Hoover, MR. The Structure of Liquid Water: Novel Insights from Materials Research; Potential Relevance to Homeopathy, Materials Research Innovations Online. 9,4, December 2005. -- In this special issue of the journal Homeopathy (http://www.elsevier.com/wps/find/journaldescription.cws_home/623042/description#description) -- The website of professor Martin Chaplin: http://www.lsbu.ac.uk/water/homeop.html http://www.lsbu.ac.uk/water/memory.html

We have to remember the definition of the word “plausible” (Definition: Seemingly or apparently valid, likely, or acceptable). It does not mean “proven.” It simply has to mean that it is theoretically possible and/or explainable, and there are plenty of scientists who insist that it is plausible.

HISTORICAL ORIGINS: In the last words of the first paragraph, it asserts that Hahnemann conducted provings in “high dosages.” First, bad grammar (perhaps someone meant “from” high dosages). However, it is totally unclear what is meant by “high dosages.” For the record, Hahnemann’s provings were primarily with the CRUDE dose of the substance. Only after 2 decades (!) of such experimentation did he and others begin conducting provings with potentized doses beyond Avogadro’s number (this info is a part of both the original article on CZ and the draft). The proving information from 100-200 years ago confirms what is known about the toxicology of hundreds of substances.

Proposed scientific foundations for homeopathy This seems to be an inaccurate sub-heading. “Scientific foundations” could have many meanings, but what this section seems to focus on is the “proposed mechanism of action of homeopathic medicines.” I believe that THIS should be its sub-heading.

It was written, “For instance, homeopaths point out that water is not simply a collection of molecules of H2O, but contain isotopologues.” Where do homeopaths point this out?

It is asked: ·	why the principle of similars might apply in the case of homeopathic remedies Does anyone know why resonance has hypersensitivity, why the C note of a piano is hypersensitive to when other C notes are played?

It is asked: ·	how a biological mechanism could have evolved to recognize the specific nature of homeopathic remedies Is it asked how a biological mechanism could have evolved to benefit from large concentrated doses of conventional pharmaceutical? While the above question is an intriguing one to consider, it is not necessary for the scientific acceptance of homeopathy.

The astronomer Kepler once asserted, “Nature uses as little as possible of anything.”

It is asserted: “There also needs to be ·	clear and irrefutable evidence for the efficacy of homeopathic remedies, evidence that cannot be explained by placebo effects.” I suggest that we consider saying: “The body of evidence drawn from controlled trials in the basic sciences and clinical trials, epidemiological studies, cost-effectiveness studies, and historical evidence must show benefits from homeopathic medicines as distinct from placebo effects.” CLINICAL TRIALS:

It is written: “Homeopaths strongly value the evidence of their own experience in treating patients, supported by the satisfaction reported by their patients in surveys;”  I suggest that this be changed to:  “Homeopaths strongly value the evidence of the 200 years of usage by hundreds of millions of patients plus their own experience in treating patients, supported by the satisfaction reported by their patients in surveys;

The newest Cochrane Report on the use of homeopathic medicines to help reduce the adverse effects of chemotherapy and radiation in cancer patients should be added.

Also, a new important study on cell cultures seems important due to dramatic effects of some high potency homeopathic medicines, with increasing effects from the higher potencies: http://ecam.oxfordjournals.org/cgi/content/abstract/6/2/257?etoc (For those of you who do not know the journal in which it is published, eCAM, it is published by Oxford University Press, and it has a 2.55 impact factor---that is reasonably good impact factor).

At present, the draft says: “NCCAM's acting deputy director, Jack Killen, said, in a Newsweek article, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." I personally talked with Dr. Josephine Briggs, the Director of NCCAM, about this statement, and she told me that both she and he regretted this statement that was made when Killen was new to the field and was serving as acting deputy director. The CZ article itself shows several studies (the Oscillococcinum studies, for instance) which provides evidence that Killen’s statement is wrong. In this light, I propose the deletion of this confusing and ill-informed statement, unless our desire is to provide an anti-homeopathy assertion, whether it is accurate or not, just because it is from an individual who should be informed (but isn’t or wasn’t).

Later in this section, there is a statement: “Homeopaths respond that the vast majority of the larger high-quality trials simply tested a single homeopathic medicine, without the requisite individualization of treatment common to homeopathic treatment. But this does not explain why small trials should have more strongly positive outcomes than large trials.” Actually, this second sentence is not correct. If small and medium-sized studies used an individualized application of homeopathic medicines, while ALL of the larger studies simply use ONE medicine, the larger studies do not have external validity and are of little consequence in terms of the negative result because homeopathy is rarely practiced like that in typical clinical care. It is akin to conducting numerous studies on penicillin in the treatment of people with allergies, arthritis, and heart disease and then asserting that based on the overall “body of evidence” penicillin has no therapeutic benefits.

If one evaluated ONLY the “high quality” studies from the Shang article in the Lancet (2005), homeopathic medicines were found to be effective: -- Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015. -- Rutten ALB, Stolper CF, The 2005 meta-analysis of homeopathy: the improtane of post-publication data. Homeopathy. October 2008, doi:10.1016/j.homp.2008.09/008

I realize that the above two articles are references in the CZ draft, but I repeat them here because they verify my assertion that we should delete the statement: “But this does not explain why small trials should have more strongly positive outcomes than large trials.”

SAFETY: The CZ draft says: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because they contain little or no active ingredients.” Unless we have a formal reference to this statement, we should change it back to what was originally said: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because of the extremely small dosages.” OR I suggest a new version: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because of the extremely small dosages and because of the 200+ history of safe usage of homeopathic medicines.”

I realize that I’ve covered a lot of ground here. Let’s talk about it…Dana Ullman 04:58, 1 June 2009 (UTC)


 * On the FDA statement: The wording in the article closely follows that in a statement by the FDA's Edward Miracco:
 * "Overall, the disparate treatment has been primarily based on the uniqueness of homeopathic products, the lack of any real concern over their safety because they have little or no pharmacologically active ingredients, and because of agency resources and priorities," explains Miracco.
 * Unfortunately the link presently is broken, though it's available in a cached form at Google. We can wait and see if the link reactivates itself. Raymond Arritt 23:53, 1 June 2009 (UTC)

Answer to Dana
To make the previous section not unduly long I started a new section.

I'm disappointed that Dana still sees so much to criticize and he revived my fears that an article, acceptable by homeopaths and not seen as "fringe" by the rest of the world, is not possible. Dana, are all your objections equally important to you, do they all have to be answered before you can approve the article, or could you be satisfied with a few alterations?

After a quick scan of Dana's text I saw that I'm responsible for two of his objections:


 * Dana asks: It was written, “For instance, homeopaths point out that water is not simply a collection of molecules of H2O, but contain isotopologues.” Where do homeopaths point this out? 

The answer is easy: in the version approved by Dana. I only added the technical term "isotopologue" to the sentence in the approved version, reading: Water is not simply a collection of molecules of H2O, it contains several molecular species including ortho and para water molecules, and water molecules with different isotopic compositions such as HDO and H218O. The technical term for molecules with different isotopic composition is "isotopologue".


 * With regard to Dana's objection: OVERVIEW: It is non-encyclopedic (again) to begin this section as it begins about someone’s assertion that “extraordinary” evidence is required for homeopathy even before one provides an overview of the subject itself.

I moved up the sentence ending with: "... provide the required extraordinary evidence for the benefits of this system" from somewhere further down in the article, and thought that for coherence and style reasons the "extraordinary evidence"  had to be introduced by a short introductory sentence. So, nothing deep here, this is fixable.

Further I must add that I cannot take the work of R. Roy seriously, Roy sees water burn (really, he does literally, see also National Geographic News June 1, 2009). One or more references to Roy's work in an approved article would let me say goodbye to CZ and join the ranks of those who see  CZ as an undertaking where the crackpots rule. --Paul Wormer 07:48, 1 June 2009 (UTC)


 * Thanx for creating a new section, Paul. It does help.


 * I'm a bit confused how or why you've refer to Rustum Roy as a crackpot. Besides being professor emeritus at Penn State (!) and besides being the head of a material sciences lab that is world renown (the ISI once ranked it as the best material sciences lab in the world), Roy has had at least 15 contributions published in NATURE...and you have just pointed to a reference in National Geographic to his work. Are you suggesting that NATURE and National Geographic are crackpot too?  Please note that my reference to Roy was just one of many (!) where I showed that there IS plausibility to homeopathic potencies.  (THIS is what I mean when I say that there is strong bias against homeopathy in this new draft.)


 * As for isotropologue, I do not think that it helps our article by adding technical terms, and personally, the sentence was already fairly (and seemingly, unnecessarily) technical. Dana Ullman 14:12, 1 June 2009 (UTC)


 * Dana has some good points; I'd agree that we should perhaps avoid technical terms where possible. On the lead, this section "it is a homeopathic principle that the more dilute the preparation, the more potent it is.[2] Dilution often continues to the point where none of the original substance remains in the remedy. This lack of even one molecule of substance leads scientists to doubt its plausibility and generally reject the possibility that the remedy itself is responsible for any of the effects that may occur." is, as Dana says, wrong; this is not a principle of homeopathy, and remedies are potentised by vigorous shaking, not by dilution in their theory. As homeopaths do not themselves believe that potency is imparted by the presence of any molecules, it is perhaps important not to phrase this criticism in terms that may seem to suggest that homeopaths don't realise that there are no molecules present.
 * However, to cite Chaplin's websites as cases for the scientific plausibility of homeopathy as explained by homeopaths would I think be wrong. Chaplin states that "Although there is much support for water showing properties that depend on its prior processing (that is, water having a memory effect), the experimental evidence indicates that such changes are due primarily to solute and surface changes occurring during this processing. The experimentally corroborated memory phenomena cannot be taken as supporting the basic tenets of homeopathy although they can explain some effects" He suggessts that the vigorous shaking "may produce significantly increased concentrations of silicate, sodium and bicarbonate ions by dissolution of the glass tubes and increases in nanobubbles and redox molecules from the atmosphere, respectively" In short, I think Chaplin argues that the water that homeopaths prepare may include some unanticipated contaminants which may mean that it has some effects different to those of solutions diluted without shaking, but he does not say anything that I have seen that indicates that this is a mechanism by which any properties of the original substance that was diluted can be retained.
 * As for Rustum Roy - looking from the outside he seems to be a very distinguished materials scientist, but he is 86; his reputation was not built on his ideas about water structure, and I take Paul's comments as meaning that his current ideas in this area are not given mainstream credibility. I think it would be a mistake to cite him, basically because I don't see how he could be cited without immediately following with an attack on what we're citing him for, to put the mainstream view from materials science.Gareth Leng 14:33, 1 June 2009 (UTC)


 * There's lots of ground to cover here. May I suggest that we proceed step by step? In my view the three sections of the Approved article with the most serious problems are (in order of decreasing severity) "Scientific basis of homeopathy," the lede, and "Overview." Would it be helpful to cover those three sections (or other specific sections) in turn, not moving on to the next section until we reached agreement on a particular section? Raymond Arritt 15:17, 1 June 2009 (UTC)


 * I introduced isotopologue not to show off my knowledge of difficult words, but, as always with technical terms, to condense the explanation why a mixture of isotopic forms of water cannot explain memory. It was not me who thought of isotopes as a possible explanation and I didn't create it as a straw man either. As far as I'm concerned, the suggestion that the presence of isotopologues can explain the memory of water can go.--Paul Wormer 15:31, 1 June 2009 (UTC)
 * A simple Google search shows that water isotopes are commonly invoked as a proposed mechanism for homeopathy. Accordingly I disagree that we should delete all mention of it, though the material could perhaps be reworded for a general audience. Raymond Arritt 15:39, 1 June 2009 (UTC)
 * I sympathise with Paul over isotopologues; this is the type of thing that cropped up again and again as the original article evolved - sometimes it's necessary to explain an argument in detail to show at the end of the day that it should all disappear - that's why in the end we proposed moving all such technical arguments to the article on memory of water. I didn't see any errors in the original version of "Scientific basis" and don't see any in the present version either. I don't see this section as really being an issue. Paul has added explanations of why some hypotheses are untenable the original version tackled that in a different way with this para, now excluded - "These are not mechanisms of memory in any cognitive sense; the term memory here is used as a metaphor, implying only that the past history has a discernible influence on the present properties, but homeopaths believe that, through these or other mechanisms, water can form and retain some useable "memory" of the original medicinal substance[65]. Many homeopathic remedies are however available as solid preparations -"pillules" of lactose and/or sucrose, intended as inert cores which are transformed into homeopathic drugs by impregnating them with a dilution of homeopathic stock." In other words the original version said (1) that just because processing might affect the properties of water it doesn't amount to memory in the sense that homeopaths posit - i.e. an information rich (cognitive) memory of the structure of the diluent and (2) the discussion is by the way because most remedies aren't in liquid form anyway. The lede has problems but I think they should be reconcilable. The position of the overview is probably the crux - originally it was at the end and I worried about it "having the last word", which is why I was careful to try to end it on an open note. I see Dana's point about it setting an editorial tomne for what follows. I am and have always been relaxed about letting homeopaths describe homeopathy in their own terms (with the ground rules that should apply to all articles, about verifiability, sourcing, claims etc.) My understanding was that leaving the scientific perspective until late, and then wording it gently, led some into thinking that the article was unbalanced. I always thought it's not over till the fat lady sings, and that readers can make up their own minds pretty well given the facts without rhetoric, but this is a collaboration and I'm OK with a reordering.Gareth Leng 16:04, 1 June 2009 (UTC)

(undent)Glad to see Dana's response above, but I haven't followed up on all of the issues (that was a long discussion!). I still have only worked my way through the lede. I am a little confused, though. I'm not sure whether Dana had a chance to see the changes that I made late last week because it seems that some of the issues relate to things I tried to handle. (For example, the statement from Dana above: ... biased and inaccurate info is in the next sentence in the 1st paragraph! “Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.”  - I removed that sentence already). I would like Dana to comment on the newer version of the first paragraph before I think about changing more.

If we've gotten something wrong from a homepath's perspective, let's fix it. Obviously, Dana is an expert there, so jump in. This update is meant more to correct any shortcomings from the chemist's perspective, which Paul can handle. The rest of us can cleanup and work on juxtapositioning of ideas - which if we are not careful can taint the neutrality that we aspire to. D. Matt Innis 23:01, 1 June 2009 (UTC)


 * As a general comment, I'm uncomfortable relying on anything that depends on "long history" or, in the case of Roy, an older body of work -- just as I was uncomfortable citing immunology from 1905 outside the history article. Now, I'm willing enough to go along with the history of homeopathy demonstrating a lack of direct adverse effects, but I simply can't say the history justifies claims of efficacy. A huge number of medical procedures and techniques were believed efficacious for many years, but often turned out to be useless or worse.


 * From a presentation standpoint, I just don't think we can get away with being perceived as neutral without a statement, in the lede, that the principles of homeopathy are not medically accepted. That doesn't preclude being more precise about the principles of homeopathy, although I make a distinction between a "principle" such as vital force and similars, and a "technique" such as potentiation. Howard C. Berkowitz 23:19, 1 June 2009 (UTC)


 * I see it as a statement in the lead that states something to the effect of "not being medically accepted" (though this probably even needs some attribution - medically who) would be absolutely necessary in order to make it neutral. Otherwise we would be advocating for one side and not the other.  There is no question that there is dissent, and in some cases quite passionate.  To leave that out would be amiss.  I am not sure which "principles of homeopathy" we're talking about, though.  Medicine uses a lot of principles that are basic to homeopathy.  So we probably need to be more specific when we make a statment like that.  When I try to evaluate what it is that "medicine does not accept", the only thing I come up with is that "not a single molecule" is in the remedies. Isn't that what makes it "implausible".  Everything else, including that there is little EBM, can be said about procedures in each field and, unless we want to debate with the scarce hard data that is available about each, we probably shouldn't bother.


 * I think that as long as we can show that homeopathy has a rich history and is still very much used today, that the science is shaky, its popularity is good, and you can't argue that it isn't safer than any medication, then we are in the ballpark. The risks are related to missed opportunities to diagnose and treat the treatable life threatening diseases and that's about it. I think we pretty much say all of that. D. Matt Innis 00:42, 2 June 2009 (UTC)

Gareth is correct. I evaluated the version of the Draft from last Friday, not the most recent version. I appreciate some of the corrections, though I have some additional hopefully helpful thoughts.

I strongly recommend that we move the 3rd paragraph and move it to become the 1st paragraph. First and foremost, homeopathy is the “principle of similars.” It is not a good idea to reference the “vital force” first (As I mentioned previously, 9 of my 10 books don’t even make reference to the “vital force,” so as a principle, it is NOT essential.

After that new 1st paragraph, I recommend that we add: Historians today recognize that conventional medicine of the 19th century was not only ineffective, but it was dangerous. Although homeopathy was and still is controversial, it is recognized that homeopathy helped question and ultimately stopped the use of bloodletting, leeching, and dangerous drugs of that time. In fact, Sir William Osler (the “father of modern medicine”) asserted that ““No individual has done more good to the medical profession than Samuel Hahnemann.” [Homeopathy, Time, May 27, 1940.]

The OVERVIEW is much better. Paul or someone made some changes in the paragraph about extraordinary evidence in a way that works. Good work.

However, I cannot accept the statement in this section about the “scientific implausibility” of homeopathy. I have already explained my rationale here. Because Gareth and others have noted that some theories exist for how homeopathic medicines may work (even if we ignore Rustum Roy’s work), there IS plausibility.

The Lancet’s article about homeopathy in India asserts that 100 million people in India today rely solely on homeopathic medicines as the method of treatment is of be of significance. I suggest that we insert this fact in the Overview right after the reference to homeopathy in the UK. The reference: http://lib.hukm.ukm.my/indeksjurnal/2007/lancet/370/lancet10.pdf

The section on THE LAW OF SIMILARS has a dangling fact that doesn’t seem to flow or fit. I suggest that we delete: “Vaccine doses are calculated from the TCID50 dose; the minimum dose required to infect 50% of tissue cultures tested in a laboratory assay. A single dose of measles vaccine will contain at least 1,000 x the TCID50 dose in 0.5 ml.[35] “

THE CLAIMS FOR HOMEOPATHY Because the vast majority of homeopaths see themselves as just one part of a health care team, the list of diseases which homeopaths sometimes treat need to include a statement that affirms that homeopaths do not see themselves as the sole source of treatment. I suggest that we add after the word “AIDS”: The vast majority of homeopaths see themselves as just one part of a health care team, and thus, although they may treat people with a wide variety of chronic illnesses, they do not seek to be the sole health care provider.

My previous statements about clinical studies and scientific foundations still stand and need further discussion. More later… Dana Ullman 05:52, 2 June 2009 (UTC)


 * Dana, you write: The OVERVIEW is much better. Paul or someone made some changes in the paragraph about extraordinary evidence in a way that works. Good work. I wrote that (commonplace etc.) on May 15, since then the paragraph hasn't changed. What version did you comment on above?--Paul Wormer 06:39, 2 June 2009 (UTC)


 * I agree that the principle of similars should probably take a higher priority than vital force and made some changes accordingly. It probably still needs some touching up, so go for it. D. Matt Innis 00:07, 6 June 2009 (UTC)


 * Matt's recent revision of the lede is much better. I agree the measles TCID50 isn't needed.


 * I am a bit confused about the statement that homeopaths see themselves as part of a health team. Ramanand was fairly adamant that he saw homeopathy as primary. NCCAM categorizes homeopathy as a whole, alternative system, not complementary.


 * If the current homeopathic view is that it is complementary, then I think we have to have some discussion on the complementary relationships. In past drafts, we've had, for example, attacks on corticosteroids in asthma. How do homeopaths work in an integrative medicine team? Howard C. Berkowitz 00:08, 6 June 2009 (UTC)


 * Howard, I understand your confusion, but let me try to help you understand. Homeopathy is BOTH an alternative to conventional treatment AND a complement to it, depending upon the situation. Sometimes, homeopathy can be used as the sole method of treatment, and sometimes, it is a part of a complex treatment program that includes conventional medical treatment and various other "alternative" modalities.  Yes, there are certain risks in using homeopathy as the "sole" method of treatment, and there are other risks in using conventional medicine as the "sole" method of treatment.  Dana Ullman 20:30, 7 June 2009 (UTC)


 * I understood that. Specific examples of the complementary use, however, are needed, if the assertion that it is complementary as well as alternative is made. Sorry, this "helping" is coming across as patronizing rather than informative. Please be specific, and do realize that I understand the complementary vs. alternative, and risk-benefit decisions.  I'd note that Ramanand was insistent on alternative-only. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)

Behring, and other things that are history at best
I simply cannot accept, in the main homeopathy article, ", Physicians of the 19th century though Emil Adolph von Behring, the scientist who discovered the tetanus and diptheria vaccines, acknowledged that vaccinations derived from the homeopathic principle."

He may have "acknowledged", but, bluntly, he was wrong.

History of homeopathy, yes. Think of it in this way: let us assume we are dealing with the article on vaccination. Would anyone take 1905 theory on immune response seriously there? Would a reference to homeopathy be appropriate in an article on vaccination? Jenner obviously didn't use the principle of homeopathy as it had not been named, and there's little to assume that he used the principle of similars -- he used the observation that cowpox caused immunity. Von Behring wouldn't be especially relevant to vaccination other than to say he developed certain vaccines; he simply did not understand the mechanisms. Nobel Prizes were being given then for clinical results, not necessarily for understanding -- indeed, there's a Nobel or so (e.g., pernicious anemia) that is based on erroneous explanations.

It is one thing to cite Hahnemann, as directly relevant to tbe development of homeopathy qua homeopathy. It is quite another thing to cite effectively ancient biomedical authorities as justification for homeopathic explanations in an article on modern homeopathy and the direct development of homeopathy. I see quoting Von Behring as a misleading appeal to authority to justify homeopathy's effectiveness. Howard C. Berkowitz 20:00, 6 June 2009 (UTC)


 * von Behring is considered the "father of immunology." When anyone today says that there is no comparison between homeopathy and immunology, it is appropriate to go to one of the sources of this assertion. Then, we can also make reference to modern writings, such as:  http://ecam.oxfordjournals.org/cgi/content/full/nel117v1


 * This combination of original source material and modern references is just what CZ should be about. Dana Ullman 15:45, 7 June 2009 (UTC)


 * As the draft is presently written, it uses a blanket statement that is extreme and wrong. The material that I originally wrote should be re-inserted along with the above reference. Dana Ullman 15:48, 7 June 2009 (UTC)


 * I disagree that CZ should have such a combination in main articles. Historical background is entirely appropriate in subarticles. For example, I have a top-level article, Wars of Vietnam, with extensive subarticles. Some historical background is merely mentioned, or given a sentence, with a link to a more specific article. The French colonization in 1868 is relevant to modern wars, but not in detail, although it is relevant to the subarticles dealing with the war against the French. Even so, there are things relevant to the Vietnamese military view that are sufficiently far removed that they are not even formal subarticles, such as the Nguyen Dynasty and Dai Viet.


 * Someone may be a spiritual father of an idea, but that's their main significance today and it is not appropriate to go back, at least in basic understanding of the current situation, to a source whose specific ideas have long since been proven to be, at best, glimmerings. This is especially true in fields that go through constant self-criticism and improvement. I sincerely doubt any approvable article on immunology would cite von Behring as authoritative. Howard C. Berkowitz 18:27, 7 June 2009 (UTC)


 * I find it odd that Howard tell us that von Behring was "wrong" when he asserts the link from homeopathic principles to vaccinations. This is re-writing history.  von Behring discovered two important vaccinations, and he attributes in part his discoveries to homeopathic principles...and yet, Howard is suggesting that he did not, while von Behring asserts that he did.  Even if Howard doesn't believe in the potential benefits of homeopathy, he should not write homeopathy out of history based on HIS beliefs.  And while I agree that we should not provide too much detail about history, I also believe that we should not ignore it.  My efforts to add ONE sentence about the history is certainly not dwelling in the past but is providing some important context.  THAT is why encyclopedias do.  Dana Ullman 20:24, 7 June 2009 (UTC)


 * No, I did not say von Behring did not associate his discoveries to homeopathic principles. I said that he was wrong to do so, by the much better modern understanding of immunology. While one can say Copernicus, Ptolemy, and Galileo had details wrong in the heliocentric model of astronomy, one can also say that the earth-centric model was flatly wrong. Any implication that diptheria and tetanus vaccines are based on the principle of similars or other homeopathic models, as opposed to antigen-antibody reactions on a molecular basis, are flatly wrong. Any encyclopedic mention that his assumption is other than wrong is not to rewrite history, but to rewrite reality.


 * As long as there is an implication that Von Behring's idea means that vaccination works by homeopathic principles, yes, it should be ignored. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)

Mutual respect
I think we need to maintain mutual respect for the different views of scientists and homeopaths; we should not imply that somehow they are compatible or that scientists have some similar beliefs when they don't. The principle of similars is not held in any form by scientists today, a principle is a universal truth and no scientist would consider this a universal truth. It is the case that in the 19th century the idea was part of the reason for experimenting with vaccination, but that's all that can be said. Darwin was never an advocate of homeopathy; he was a skeptic, he did try homeopathy for a while, though skeptical throughout, and when he concluded thatit didn't work he reaffirmed that skepticism strongly. I don't think it's right to list adcocates of homeopathy, that just invites the response of a longer list of more distinguished skeptics. Gareth Leng 11:28, 7 June 2009 (UTC)


 * Concerning lists of advocates, I agree. We can explain homeopathy without creating long lists of advocates and skeptics. Let's not go there. We wouldn't list all the people that advocate for conventional medicine and their skeptics, so why do it here. D. Matt Innis 14:01, 7 June 2009 (UTC)


 * History IS important, and highly respected "cultural heroes" who have gone public with their use of or advocacy of homeopathy is noteworthy. Likewise, those "cultural heroes" who have spoken against it might be similarly notable.


 * As for Darwin, he definitely was a skeptic of homeopathy, though the RESULTS that he received from Dr. James Manby Gully are notable. Just prior to his visit, Darwin was unable to work one out of every three days, and he said that he was "going the way of all flesh."  Within one month of treatment, he was totally re-invigorated and became an "eating and walking machine."  For details on this history, go to:  http://www.homeopathic.com/articles/view,128


 * As for the "principle of similars," it may not be recognized as a "universal truth," but it is a principle that has been acknowledged since ancient times, and it is still used in modern medicine, though it is simply described in a different way. Dana Ullman 15:59, 7 June 2009 (UTC)


 * I have to agree that the principle of similars is not, in any meaningful way, part of biomedical thinking. Claiming that it is is either a failure to understand modern models or an attempt to justify support that is simply not there. That an antigen is "similar" to a receptor is an observation, with substantial theoretical and experimental support, which is completely different than the idea of similar effects in a proving. Howard C. Berkowitz 18:31, 7 June 2009 (UTC)


 * We need to be careful to avoid black/white statements. Here's a 2nd reference to link homeopathy with modern concepts of immunology:  http://ecam.oxfordjournals.org/cgi/content/full/3/1/13?ijkey=2c71ff01e079f4832810794bbcd0f7ae8038282a  Dana Ullman 20:13, 7 June 2009 (UTC)


 * Oh, I think this is very, very dark gray rather than black and white, but I do not see attempts to link homeopathy with modern concepts of immunology as any more than an attempt to strengthen the position of homeopathy. Immunology (simplifying) is about antigen-antibody reactions, not similars, not vital forces, not potentiation by dilution and succussion. The mechanism of immunization does not need to hypothesize about memory of water but is directly demonstrable at a molecular basis, in vitro and in vivo. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)


 * Darwin's experience with Gully is fully covered in Charles Darwin's illness, it is clear that whether he experienced any benefits or not, he was severely skeptical throughout, he certainly was no advocate of homeopathy - quite the opposite. To argue that he benefited from it, even though he concluded it was ineffective is not something I feel we can include here.


 * The link Dana provided just discusses basophil degranulation - the benveniste studies - these are cells of the innate immune system responsible for inflammatory responses - the adaptive immune system that generates immunity is quite separate. Immunity depends on antibody production which requires recognition of an antigen, without an antigen you can't generate antibodies to recognise the antigen - so the presence of an antigen in a vaccine is essential; it's very much not an example of like cures like - the antibody recognises the particular molecule, and will not recognise a different molecule even if the different molecule produces identical symptoms. Which is why vaccinations against one flu strain are ineffective against another. Thus, vaccination is actually a counterexample to the principle of similars, and thus a disproof of it. Gareth Leng 08:31, 9 June 2009 (UTC)

A seeming impasse
I'm afraid that I see no resolution to the idea that clearly disproven/obsolete statements by biomedical figures belong anywhere except the History of homeopathy area. The matter is even stronger for the issue of endorsements and lay advocates.

Realistically, there can be an Editor vote here. I'm trying to work with Chris to get the Editorial Council election moving, but it is inactive at present, and Larry is not often available. Howard C. Berkowitz 21:04, 7 June 2009 (UTC)

Gangrene
Gangrene has been in this article for some time, with a reference on its homeopathic treatment. Why remove it? Now, if you were asking my opinion, I'd regard homeopathic treatment of gangrene as insane, but no non-homeopath put that into the article.

Claims that severe diseases can be treated homeopathically, I believe, do belong in the article, to let the reader judge plausibility. Now, if as I had asked, there was an example of how homeopathy might complement other methods in the treatment of gangrene, I'd find that quite interesting and informative. The claim that was removed, however, did not consider debridement or the carefully considered use of optional therapies, including hyperbaric oxygen and anti-clostridial antibiotics. Howard C. Berkowitz 22:29, 7 June 2009 (UTC)


 * The gangrene discussion is a straw man. Unless Howard can show that it is somewhat common for homeopaths today to treat it solely with homeopathic medicines, it has no real or clear purpose.  There is already enough info on this section on the prescription of homeopathic medicines to treat serious illness.  Please cite some type of reference to your assertion or let it go...  Dana Ullman 14:30, 8 June 2009 (UTC)


 * Why was it not a straw man when Ramanand brought it in, but no objection was raised by homeopathic experts? If there are to be claims for treating cancer, as vague a term as that is, multiple sclerosis, etc., please cite some sort of reference to your assertion or let it go...


 * Further, I am still waiting for concrete examples of how homeopathy is used in specific complementary treatment plans, not vaguenesses about balancing risks. I ask for nothing more than would be in a risk-benefit analysis of a medical procedure.


 * First, I would simply say that not all homeopathic "experts" are equal. Gangrene-out.  We can also take out multiple sclerosis, simply because I am not familiar with the modern literature's reference to it in homeopathy, while there is a significant literature on homeopathy and cancer (I cited some...and as such, I'm wondering why you're asking for it here).


 * Howard, I am not certain if you are being obstinate without purpose or you are simply not reading our article or Talk sections, but I recently discussed and referenced a 2009 (!) Cochrane Report on the use of homeopathic medicines to reduce the side effects of chemotherapy and radiation. I would assume that THIS is quite strong evidence of the use of homeopathy as a complement.


 * Please also note that the use of homeopathy as an alternative or as a complement is also dependent upon the patients' desires. Some patients do not want any chemo or radiation...or they have had it already and don't want any more.  Some patients, on the other hand, want to use conventional and homeopathic treatments together.  Dana Ullman 23:52, 8 June 2009 (UTC)


 * Obstinate? I might prefer to say that I am following what I consider to be standards of encyclopedic writing, with which, here and there, I have just a bit of experience outside a single subject. Simply citing a study, without context, without explanation, is neither evidence nor encyclopedic writing.


 * Telling me some patients want to use conventional and homeopathic treatments together tells me absolutely nothing about the best homeopathic thinking about how the disciplines can be complementary. Howard C. Berkowitz 00:48, 9 June 2009 (UTC)


 * I inserted the section on gangrene. I think it's important to recognise that many physicians believe that it is often better not to treat mild self-limiting conditions, and in these circumstances are perfectly comfortable with homeopathic remedies as placebo treatments that reassure the patient while doing no harm. However, most are incensed by the claim that homeopathy can cure anything, and consider its use in serious conditions as irresponsible and potentially dangerous in deflecting patients from effective treatments. I'd be only too happy to remove mention of gangrene, AIDS etc if we can find an authoratative homeopathic source condemning this use. Otherwise I think we must tackle this important issue explicitly. Dana, can you point to statements from homeopathic organisations condemning the use of homeopathic remedies in such cases, and we can cite those?Gareth Leng 09:06, 9 June 2009 (UTC)


 * My recollection, Gareth, is that several people were involved in bringing in material on gangrene. It was Ramanand, I believe, that mentioned the homeopathic remedies. Again trusting to wetware memory, I believe you mentioned dry and wet gangrene, which surprised me a bit since that distinction is not used in the quick scan of trauma surgery texts I have at hand. If I may suggest avoiding the provenance of the gangrene material, I think that would be a good idea.


 * "Incensed" is, indeed, not at all hyperbole, especially when it suggests alternative treatment for emergent presentation of conditions where minutes may make the difference to survival. This did come up for several respiratory emergencies, where it was not at all clear to me that all were even referring to the same entitities with asthma, bronchitis, and anaphylaxis. I happened to spend yesterday at a tertiary care veterinary center, trying to assess what may be related bronchospastic, sinus, and skin disorders in a very dear cat. I should have a good many more test results today, although it's frustrating that many of the immunologic diagnostics from human practice aren't available. Nevertheless, while I am quite willing to work with elimination diets and careful observation for Mr. Clark's obviously uncomfortable skin lesions and mild respiratory disorders, incensed would be too mild a word for my reaction to someone that tried to suggest using other than bronchodilators and corticosteroids if he has another frightening respiratory exacerbation.


 * So, Gareth, I agree that explicit condemnations are needed here, or a much more detailed discussions than "some patients make choices." Indeed, I can think of the very soul-searching explorations I've made in choosing between aggressive and palliative cancer therapy for both two- and four-legged family members, where the responsibility was mine. I considered science and quality of life, but I do not regret that I physically intimidated people that tried to block the decision once made. Howard C. Berkowitz 10:48, 9 June 2009 (UTC)

I simply recommend that we delete the paragraph about gangrene unless or until someone finds modern references to its treatment. There are, however, good modern references to the treatment of many non-self-limited conditions, ranging from COPD, AIDS, and cancer. Dana Ullman 02:19, 10 June 2009 (UTC)


 * Modern references to the use of homeopathy for treating gangrene are abundant. Just beginning to scratch the surface, we find a mix of practicing homeopaths and academic sources:


 * Diabetic foot (gangrene) cured by homeopathy, Dr. Prabhakar Shetty (Licentiate Certification in Education of Homeopathy)
 * Arsenicum album recommended for treatment of gangrene in Homeopathy: An A to Z Home Handbook by Alan Schmukler, founder of the Homeopathic Study Group of Metropolitan Philadelphia and teacher of homeopathy for Temple University's adult education program.
 * Subramanyam., B, 1999:Gangrene of tail in a dog cured with homeopathy Indian Veterinary Journal 76, 241-242.
 * Sivaraman, P., 2003: Skin Troubles Cured By Homeopathy. Published by B. Jain, 404 pp. Materia Medica with numerous references to gangrene.
 * Additional sources available if you need more. Raymond Arritt 02:53, 10 June 2009 (UTC)

I don't understand something
The following just doesn't parse: "because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA."

Now, if this means that it is impossible to detect any of the simillium in a remedy, I suppose I can understand that from an Avogadro standpoint. It also reinforces the idea that there is no practical means of using memory of water.

It's also a bit confusing to say that there has been no deterioration, if, using current methods of analytical chemistry, there is no difference between a just-made remedy and one that is years old. One might need to assume that water modifications are immune to entropy, or simply that pure water doesn't deteriorate. Howard C. Berkowitz 22:41, 7 June 2009 (UTC)


 * Howard, I am confused by your question. Perhaps you do not understand the meaning of the word "simillimum."  "Simillimum" is the most similar medicine to a specific person.  The only way to know if a medicine is the simillimum to a specific person is what their response to treatment is...and this has no meaning to drug regulation.


 * What I wrote is accurate. Please note that I did not say that there is "no deterioration" but that homeopaths "have not found a deterioriation of effects over time."  There may be some deterioriation over time, but there is not yet evidence of it.  By the way, the French require an expiration date of 5 years on each homeopathic medicine.  Dana Ullman 14:27, 8 June 2009 (UTC)


 * Oh. Homeopaths have not found any deterioration. Homeopaths aren't routinely qualified in analytic chemistry at the nanochemical level.


 * I used "simillium" as the medicine, selected for the patient, that is introduced into double distilled water, succussed, and potentized. Since selection of the medicine is individual, it seemed the appropriate term, certainly better than "active ingredient" since there needs to be causality shown for a pharmacologically active ingredient.


 * Again, please watch the patronizing; "perhaps you do not understand" is quite different from "the definition of simillium is...". Now, if the only way to tell if a simillium is appropriate to a person is that it works, how would it be possible to distinguish a remedy with the wrong simillium from a deteriorated remedy with the right simillium?


 * As far as I can see it, the blunt truth is that homeopaths do not submit to drug regulation as applied to any other area of therapy, but hand-wave about "history of not doing harm" and "prove it doesn't hurt." Howard C. Berkowitz 14:47, 8 June 2009 (UTC)


 * Actually, I thought that my choice of words was not patronizing, but my apology if it seemed such. Now that you know what it is, you hopefully understand that there is no objective measure of a simillimum and that the only way to know if a simillimum was found was by the reactions to the medicine from the patient.


 * As for your reference to homeopaths not being analytic chemists is another strawman. My point is that homeopaths use their medicines for many many decades, and sometimes, they use medicines that have been handed down to them from old homeopaths, and these medicines still seem to work.  My statement above still holds, but please don't assume that I said or implied that homeopaths did some type of chemical testing (I never said such nor implied such).  Howard, you do have a strong tendency to make assumptions that try to make homeopathy and homeopaths much stranger than they are.  I hope that you will become aware of this, just as I will try to not patronize you, so that we can work together more effectively.  Dana Ullman 00:01, 9 June 2009 (UTC)
 * (EC) "Seem to work". Quad erat demonstratum.


 * The point is that for historical and political reasons, homeopathic remedies get a pass that no other therapeutic modality gets. I wouldn't say I make assumptions that make homeopathy stranger than they are. I would say I observe when homeopaths make claims that are acceptable in no other field of health care. If there's no chemical testing, and there's no way to detect the efficacy, I suggest that is part of the reason a majority view is that homeopathy, as opposed to many other alternative medicine, comes across as unconvincing fringe. Howard C. Berkowitz 00:48, 9 June 2009 (UTC)

There are all types of exceptions in every field of endeavor. Take surgery, for instance. We all realize that one cannot conduct double-blind placebo controlled studies, but no one (!) refers to surgery as quackery or unproven, even though there is a long history of mis-using surgerical procedures. Dana Ullman 02:08, 9 June 2009 (UTC)


 * I don't think it is a big leap for us to disconnect homeopathy as a profession from homeopathy as a treatment. In the case of a treatment option, it isn't hard to imagine an MD using homeopathy in a patient where "watch and wait" is considered a reasonable choice for a variety of reasons, i.e. childhood ear infections.  Head colds, rhinitis, allergies, anxiety and things that may not necessarily require antibiotics or be the result of a chemical imbalance (or perhaps the risks outweigh the benefits), the onus sits on the physician to guide that patient through to health.  We, as a community, tend to trust the MD when he/she uses homeopathy because we know that he/she could have used antibiotics, etc..  The fear is that the homeopath or alternative practitioner would continue to treat past the point of no return.  The question is whether this fear is real or imagined. I think what Dana is saying is that his training may lend more to the complementary model than Ramanand's, who lives in a region where treatment protocols are totally different, in other words, the traditional medicine of the region is more apt to prevail - in his case, it's not considered alternative medicine at all, but just plain ole medicine. D. Matt Innis 03:59, 9 June 2009 (UTC)


 * I think, Matt, I agree with the spirit of what you just said...I think. :-)


 * If this disconnect could be made more clear in the article, it would help. An implicit acceptance of watchful waiting can make sense to someone with a reasonable amount of medical sophistication, but isn't necessarily obvious to the general reader. Further, when I think of complementary medicine, I think of experience with very closely collaborative integrative medicine, where, for example, an MD works with an OMD in acupuncture, or the MD may be dual-trained in medicine and TCM/acupuncture. I think of how my primary internist, a quite academic sort, routinely cross-referred to a dual-certified DC/PT; the latter would not have dreamed of treating chest pain until emergent medical causes had been ruled out. In like manner, the internist routinely referred for chronic pain.


 * Just to say there is complementary work, or to cite a study or two, just isn't enough for this article. Howard C. Berkowitz 04:17, 9 June 2009 (UTC)

Need help finding a source
I was looking for the FDA source for this statement, but the link does not seem to work for me.

FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and which indicates that the drug is homeopathic.

D. Matt Innis 00:04, 9 June 2009 (UTC)


 * Matt, this recently disappeared from the FDA website. Who knows why -- maybe they are reorganizing their site. Google has a cached copy but I don't know how long cached pages stick around. There are numerous verbatim copies posted around the web, such as here and here and here (among others). Raymond Arritt 00:45, 9 June 2009 (UTC)


 * Thanks Raymond. I see that we have quoted this work verbatim as well and therefore need to put it in quotes, but Dana's last edit made an addition that is not part of it. It makes it appear as if Dana's statement was the reason that they made the decision, which of course, would be misleading.  We either need to put this in our own words, or take Dana's part out (italics)and quote the whole thing.


 * cited version
 * FDA regulates homeopathic drugs in several significantly different ways from other drugs. Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and indicates that the drug is homeopathic. The imprint on conventional products, unless specifically exempt, must identify the active ingredient and dosage strength as well as the manufacturer.


 * our current version
 * FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and which indicates that the drug is homeopathic.


 * D. Matt Innis 01:10, 9 June 2009 (UTC)


 * My bad! Apologies.  Please know that I had thought that I had corrected that error...but I guess I didn't.  It was NOT my intention to change that quote.  Dana Ullman 02:03, 9 June 2009 (UTC)


 * No problem. Until and unless we come up with a rewrite of that blockquote, I'll go ahead and change it back. You may feel free to make a comment below that if you like and we can all go to work on it from there. I'll leave the FDA sourcing for now but we probably should see if we can find it again or cite another source. D. Matt Innis 03:24, 9 June 2009 (UTC)

Changes
1) Dana replaced this sentence "Thus conventional treatments involve application of measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic preparations above the $$24X$$ ($$12C$$) potencies do not contain enough molecules to activate any known metabolic or signalling pathway." with a sentence suggesting that some remedies have been shown to induce an immune response. That is wrong; the paper describes the contested effects on basophil degranulation, while these are part of the innate immune system this is not "an immune response" - that phrasing specifically referes to induced immunization - i.e. antibody production, which is the key mechanism of action in immunity.

2) the lede change - I have to contest Dana's change, it is simply not right to state that homeopathy follows a principle unless it is clear that this is their own principle not accepted by anyone else.

3) Again, publication bias is not specific to "small studies with chance false positive outcomes", it's unrelated to either the size of the study or to whether the results are valid or not; publication bias simply is about the fact that studies without positive outcomes are less likely to be published. Gareth Leng 14:48, 9 June 2009 (UTC)


 * concerning 1); I agree. Feel free to make your adjustments.
 * concerning 2); unless it is clear that this is their own principle not accepted by anyone else. Then maybe principle is the wrong word?
 * concerning 3); I agree. Publication bias is just one of the factors we should all look at with any study.  Just as I am sure that everyone considers the source when Johnson and Johnson releases their findings about Tylenol. D. Matt Innis 17:12, 9 June 2009 (UTC)

How close to re-approval
Do we have any issues that would keep this from being re-approved? D. Matt Innis 17:42, 9 June 2009 (UTC)


 * Enormous ones, such as the attempt to use vaccination as a means of explaining homeopathy or vice versa, a lack of specificity in the complementary medicine aspect, and the harping on "long history" as justification or suggesting that the lack of RCTs in surgery imply there's no more EBM there than in homeopathy. Personally, I'd be happier with a CZ with no homeopathy article at all than this constant back-and-forth. I'd rather see the existing version un-approved.Howard C. Berkowitz 17:51, 9 June 2009 (UTC)


 * We've also found a number of instances where reference citations don't support the text to which they're attached. Just now, I noticed that the sentence Hormesis has been hypothesized as an explanation for some homeopathic affects, [sic] although hormetic doses still are constrained by the Avogadro limit. refers to Calabrese and Baldwin (1998). But in that reference the sole mention of homeopathy is that they included it as a search keyword: Based on information obtained from the initial searches described above, additional search strategies were employed using the same three databases and the following key word descriptors: low dose plus stimulation, beta curve plus dose response, adaptation plus pollution, and homeopathy. Nothing about using hormesis to explain homeopathy.
 * The article should not be approved until someone has gone through all of the references with a fine-toothed comb. In fact I would argue that until such a check can be done for the current approved version, the approval should be revoked and the article placed in cold storage. Repeated misuse of references (whether accidental or otherwise) just isn't on. Raymond Arritt 18:35, 9 June 2009 (UTC)


 * All the more reason for re-approval I suppose! Let's get it right so we can replace the old version.  Anyone here think Hormesis is an important enough concept to keep in this article? If so, I need to some sources to review. D. Matt Innis 18:47, 9 June 2009 (UTC)


 * In the approved version, the wording is "Both mithridatization and homeopathy might be considered as instances of hormesis, which describes the phenomenon that some chemicals at high concentrations have opposite biological effects to those at low concentrations. [34]" which is accurate; the citation refers to the definition of hormesis. Where are there any incorrect statements in the approved version? I don't think it's perfect by any means, but I'd be surprised if it was inaccurate; in fact I've not seen any example given here of anything factually incorrect in the approved version. I certainly checked all the references and didn't spot any instances where the ussage was incorrect. Again Howard, in the approved version there is not this problem with vaccination - there, it's handled properly, there's no distraction re surgery, the gangrene section is included. and I think the reference to historical precedent is there and appropriate - it's absolutely correct to say that homeopaths think that its use for centuries is an argument for its continued use, and I think it's important to see the arguments that homeopaths give. People can make up their own minds about the strength of that as an argument - I think we can all think of daft things that have been done for centuries, and all know that science is something that does not stay unchanged but continually evolves, rejecting old mistakes once held for centuries. It has reasonably been argued that the approved version leaves the scientific view too late, that it includes some material not specific to homeopathy, and doesn't cover some things in adequate detail, but where in the approved version are any statements that are wrong? Taking that article down seems a retrograde step. I agree that the present draft article has some more serious problems. Gareth Leng 20:36, 9 June 2009 (UTC)


 * (EC) Thinking about it, is not hormesis still a chemical phenomenon, so that it would be inapplicable beyond the Avogadro limit? Howard C. Berkowitz 21:10, 9 June 2009 (UTC)


 * I haven't specifically said the approved version is wrong in specifics; I do, however, believe, for reasons such as the positioning of the scientific view that you mention, that it is a detriment to CZ.


 * Whether in the current or old version, history has to be handled in perspective. For example, it is not reasonable to invoke medical history, such as von Behring, to assert vaccination is homeopathic. Von Behring may have said that, but his 1905 statement is flatly wrong by some very solid modern understanding.


 * That homeopaths believe their remedies are safe, based on history, is reasonable enough. Using history to claim efficacy, however, is not. There is an enormous difference among the active harm done by 19th century medical dosing, essentially inert substances, and molecular pharmacology. They can't be equated, yet there is now that implication. Howard C. Berkowitz 21:08, 9 June 2009 (UTC)


 * I agree - but the point is that homeopaths think that history provides evidence of efficacy, and it's important that we explain that they use this argument, an argument that you and I agree is erroneous, and an argument whose value can be judged by anyone for themselves. I agree that von Behring should not be cited as though his reasoning was today regarded as valid, when it's clearly not. Hormesis indeed cannot be an explanation of effects below Avogadro's limit, but Dana has been at pains to point out that some homeopathic remedies do have some active substance in them. More importantly perhaps, for substances that show hormesis there is some justification in regarding these as cases justifying the use of the 'principle of similars'.Gareth Leng 21:28, 9 June 2009 (UTC)


 * Apropos hormesis, how do you see the principles of similars? My understanding of hormesis is that it is a model that shows nonlinearity in dose-response and even effect of dose. Hypothetically, that could mean that a hormetic dose might be an agonist at one level and an antagonist from another. Those are molecular concepts. Where do the similars come in? Howard C. Berkowitz 21:37, 9 June 2009 (UTC)


 * The relevance is that hormesis provides a justification for expecting that a highly diluted substance will have biological effects opposite to those seen at high concentrations - hence providing some reason for thinking that symptoms that follow a high dose might be cured by administration of a very low dose - like cures like. Don't ask me to defend that reasoning closely, but I can see where it's coming from.Gareth Leng 21:40, 9 June 2009 (UTC)

[unindent] This section from Hormesis could perhaps be adapted for the Homeopathy article:
 * Whereas hormetic (chemical) responses are induced by small but measurable concentrations (above Avogardo’s number), homeopathic concentrations are often far below this. The use of a remedy with a "concentration" of 10-400 of the stem solution is common practice in classic homeopathy....Hormetic substances do not require any special preparation. Homeopathic remedies, in contrast, require a lengthy and exacting process before they are ready for administration.[29]

Important points are the Avogadro limit (as you have discussed) and the irrelevance of homeopathic methods of preparation (esp succussion) to hormesis. It is interesting that on the one hand homeopaths emphasize the importance of succussion in changing the properties of the solution, while on the other they propose a mechanism (hormesis) that has nothing to do with succussion. Raymond Arritt 21:43, 9 June 2009 (UTC)


 * This is true. I have also toned down the staetements about hormesis which I do not think are accurate; Calabrese is certainly a serious and powerful advocate, but it's not really attracted much interest - and nobody has shown its practical utility as far as I am aware. It's not in itself controversial, it's easy to say many ways in which hormesis can arise, and Calabrese has argued that the standard model of the monotonic dose response relationship has been overused mainly as a knee-jerk reaction to homeopathy. He may be right; that's not a defence of homeopathy, it is an eloquent attack on rather dogmatic scientific attitudes. In pharmacological terms it's pretty clear that hormesis will be common - many substances are partial agonists, and accordingly at low concentrations will act as antagonists (by displacing endogenous ligands that are more potent) while acting ass agonists at high concentrations. Accordingly effects are expected at the lower limits of binding - typically 10-12M. Gareth Leng 21:57, 9 June 2009 (UTC)


 * Gareth, your statement "Don't ask me to defend that reasoning closely, but I can see where it's coming from" is very much to the point. There are quite a number of topics in the current draft: hormesis, homeopathy as complementary medicine, vaccination, etc., where if it's going to be in the article as a basis of homeopathy, it needs a strong defense from homeopaths. I'm sorry, I don't go along with neutral writing being a homeopath throwing off a citation or general statement, at the same time when there is something as explicit as Avogadro. Neutrality is equal force; I don't go along with the idea that an expert-guided encyclopedia has specifics on one side, "might-bes" on the other, and the excuse the reader will see that only one side has a case. Howard C. Berkowitz 22:15, 9 June 2009 (UTC)

hyphens
the first sentence now needs some hyphens. as the Kop who may be approving this rewrite sometime, i suggest that you ask Heaux Noble Rheaux at User:Ro Thorpe to do the necessary.... Hayford Peirce 21:50, 9 June 2009 (UTC)


 * The writing style also is a bit rough in places, but I think it's best to wait until content settles down to do the final polishing. Raymond Arritt 01:47, 10 June 2009 (UTC)


 * And apropos of content settling, if you're not part of the solution, you must be part of the precipitate. Mind you, I have known a few gels and colloids.Howard C. Berkowitz 02:01, 10 June 2009 (UTC)