Talk:Homeopathy/Archive 15

The talk page has been moved to Talk:Homeopathy/Archive 13 because of its size.
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Sandy's edit to the definition

...specifically "help to cure or prevent illnesses involving similar symptoms." While a homeopath will have to review this, I don't think "illnesses involving similar symptoms" is really a homeopathic concept. They certainly object to "diseases with similar symptoms", and tend to reject "disease" as a medical conceit. The symptoms are signals of the body's defenses to be strengthened, not the effects of a causative factor. Howard C. Berkowitz 04:59, 18 September 2010 (UTC)

I think you're splitting hairs, but, yes, let's hear from a homeopath on this. D. Matt Innis 21:27, 18 September 2010 (UTC)

Sandy's new definition is definitely an improvement. D. Matt Innis 21:32, 18 September 2010 (UTC)

Li'l hard pressed for time. I'm happy with Alexander's definition, but if you guys feel it needs to be simpler, I have a 'simpler definition', which would read:-

(Homeopathy is) an alternative system of medicine, which stimulates the natural healing processes of the body (with the help of sub-physiological doses of a remedy, by using its rebound effect), to restore health (homeostasis) in a sick person.

The matter in brackets is optional.—Ramanand Jhingade 07:36, 19 September 2010 (UTC)

Note that it is alternative medicine and not alternate medicine.—Ramanand Jhingade 07:44, 19 September 2010 (UTC)

Unfortunately, "rebound effect" is not a well-defined term, certainly in medicine, so should not be used in a definition unless it is well defined in an article of its own. The alternate definition depends heavily on homeopathic terminology, such as "natural healing processes", as well as using homeostasis is far broader a context than is used in the biological sciences -- to say nothing amout emerging concepts such as allostasis.

The proposed new definition also overemphasizes the aspect of small doses and does not address the apparent rejection, by homeopathy, of the idea of "disease". Instead, it speaks of "restoring health", without addressing the meaning of the state of non-health.

Please confirm or correct the statement that homeopaths do not believe in the concept of disease, in the sense that disease has an etiologic cause and the cause needs to be corrected. Howard C. Berkowitz 08:30, 19 September 2010 (UTC)

I agree with Howard here, Ramanand, that your version introduces too many vague terms to be considered for use as a one sentence definition. D. Matt Innis 23:44, 19 September 2010 (UTC)

What about

A system of alternative medicine based on the idea of stimulating the body's natural healing processes by administering tiny doses of substances which, when given in large doses to healthy individuals, cause similar combinations of symptoms.

I agree that Ramanand's definition has some problems, and I think the full version is too long, but it seems to me the point about stimulating natural defenses is central. Sandy Harris 03:07, 20 September 2010 (UTC)

Looks good. I have no problem with replacing your previous version with this new version. D. Matt Innis 17:27, 20 September 2010 (UTC)

Friends...first, I understand the need to archive material, but I wish that one would have not archived the most recent material. There was still some important discussion to complete there. Can I encourage someone to consider re-inserting some of it?

I agree with others' concerns about Ramanand's proposal, and I like Matt's proposal, though here's my slight tweak on it (the words in italics are my new ones):

A system of alternative medicine based on the idea of stimulating the body's natural healing processes by administering tiny specially prepared doses of substances which, when given in large doses to healthy individuals, cause a similar syndrome of symptoms.

Dana Ullman 08:40, 21 September 2010 (UTC)

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The above comments have been copied from the Archive. --Peter Schmitt 10:28, 20 September 2010 (UTC)

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Natural defenses

There is an implicit homeopathic assumption here here that natural defenses are always sufficient, that restoring natural defenses equates to health. From a medical standpoint, that is sufficiently wrong that "natural defenses", or the idea that full health is a matter of restoring defenses, is rather basic. Consider, for example, genetic diseases such as cystic fibrosis or hemophilia. The problem, from a medical standpoint, is that the "natural" state is incomplete for health. With genes missing to produce the proteins that produce health in a "normal" person, all the "strengthening" in the world will not strengthen something that isn't there. In severe combined immune deficiency disorder, the most pronmising research to externally insert the gene that encodes the manufacture of the key missing enzyme, adenosine deaminase.

In other words, sometimes the wisdom of the body is pretty damn stupid, and all the strengthening in the world can't replace something that isn't there. It doesn't help explain etiology when etiology can be due to an absent rather than a present cause -- but how else do you talk about sensibly about deficiency and genetic diseases? The evidence that scurvy comes from inadequate vitamin C is overwhelming.

Proposal:

"Homeopathy is a form of alternative medicine that holds that good health is achieved purely by strengthening what homeopaths, but not conventional medicine, calls "wisdom of the body" or "natural defenses". Homeopaths further believe that all problems of natural defenses manifest themselves as symptom complexes, and reject the idea that disease has a cause and health is restored by the removal of the cause. They hold that the symptoms show the defenses that need to be strengthened, and their remedies are based on a symptom, not cause, oriented paradigm. Howard C. Berkowitz 11:05, 20 September 2010 (UTC)

The definition is supposed to briefly say what homeopathy is. It needs to be short enough to fit into a related articles page. To me, your suggestion fails at those goals; either the current text or my suggestion above seems far better.

There needs to be discussion of these issues somewhere in the article, perhaps even in the lede, but it does not belong in the definition. Sandy Harris 12:17, 20 September 2010 (UTC)

I'm fine with both of Sandy's definitions. I hope one of you can make time to correct the definition at the top of this page - it should be alternative and not alternate.—Ramanand Jhingade 15:21, 20 September 2010 (UTC)

Absolute minimum: Homeopathy is a form of alternative medicine that holds that good health is achieved purely by strengthening what homeopaths, but not conventional medicine, calls "wisdom of the body" or "natural defenses", rejecting the medical model that the etiologic cause must be corrected.

The method by which remedies are selected (i.e., provings) and prepared are irrelevant to the core definition. According to Mr. Ullman, not every homeopathic remedy is given in "homeopathic doses", so let's not overemphasize the small dose issue. Howard C. Berkowitz 16:32, 20 September 2010 (UTC)

(unindent)
I suggest something like:

"A system of alternative medicine, developed around 1800 by Samuel Hahnemann, based on the assumption that self-healing can be stimulated by small doses of substances that cause the samesimilar symptoms as those to be treated."

--Peter Schmitt 21:58, 20 September 2010 (UTC)

I am very concerned about Howard's "implicit assumptions" about homeopathy because he is simply wrong about them. Homeopaths do NOT believe that the body's natural defenses are always sufficient for restoring health. To be candid, this is a totally ridicious assumption, and after ALL of this time in which Howard has been editing this article, I am surprised that he would believe such a ridicious assumption. I urge all editors to avoid guessing at what homeopaths think or do. Please consider ASKING before assuming or at least making reference to a specific established expert who made a specific statement. Our encyclopedia here deserves better scholarship than something based on assumptions, let alone "implicit assumptions." When an editor here has some deep antagonism to homeopathy, it is particularly important to avoid making assumptions without specific and references FACTS because such assumptions tend to create "straw men" (a problem about which I have frequently expressed concern in the past).

IF the natural defenses were always sufficient, there would not be any need for healing treatments. That said, homeopaths do believe that our symptoms represent the best defensive efforts that the bodymind can deploy at that time based on its present internal resources. However, such efforts are often not enough, and therefore, medicinal and/or therapeutic efforts are necessary. Homeopaths believe that those efforts that mimic and augment these natural defenses will be the most effective, while methods that suppress, inhibit, or work by counteracting the body's symptoms may provide "benefit" briefly but will tend to create more serious physical and psychological symptoms and syndromes in the longer term (homeopaths refer to this phenonmenon as "suppression of disease," while conventional physicians simply refer to them as "side effects").

Howard is also inaccurate about his understanding above about "homeopathic provings." Howard wrote: "The method by which remedies are selected (i.e., provings)" -- To clarify, "provings" are experiments in toxicology that verify the specific symptoms and syndromes that each substance CAUSES in overdose. After a homeopath interviews a patient, the homeopath looks to find a substance that has been found to cause in healthy people the similar syndrome of symptoms that the sick person is presently experiencing.

I urge Howard to prove and verify that a homeopath and an allopath would have different definitions of "the wisdom of the body." I personally do not know of any such difference. Yes, I do have a deep antipathy to homeopathy, but it's rather hard to come up with citations for negative information. Harrison's and Cecil's, as a start, don't use the term.

BTW, Peter's defintiion above is inaccurate. Homeopaths do not use substances "that cause the SAME symptoms..." but instead "that cause SIMILAR symptoms." Get it? Homeopathy IS based on the principle of SIMILARS. That said, there ARE some applications in homeopathy that "treat SAMES with SAMES" (as in the 4 studies by Reilly and his team at the University of Glasgow in their treatment of people with various allergic ailments, where they used potentized doses of specific ALLERGENS to which people were most reactive. Dana Ullman 09:08, 21 September 2010 (UTC)

I changed the text accordingly. --Peter Schmitt 23:12, 22 September 2010 (UTC)

Thank you, Dana, because you are now being more specific and more limiting about some things that either have been said previously by you, or by Ramanand.

I have never said that an allopath has any assumptions about the wisdom of the body, because I don't know any allopaths. If, by "allopath", conventional physician is meant, the proof is easy: "wisdom of the body" is simply not a medical concept. I don't see it in the index of any of my major textbooks of internal medicine. Ignoring the continued insistence on allopath, the difference on wisdom of the body is binary: one discipline believes in it and one does not. You asked an apparently rhetorical question about belief in wisdom of the body, which I answered that I, and most medical scientists, do not believe there is such a thing.

Whether or not there is a historic use of allopathy, in the United States, people are licensed as physicians (nurse practitioners, physician assistants, etc.), not allopaths. Homeopaths, where licensing applies are, as far as I know, licensed as homeopaths. I can ask him to see if there's a difference, but my best DO friend's licenses to practice in Missouri and Louisiana are for the practice of medicine, not allopathic or osteopathic medicine.

"However, such efforts are often not enough, and therefore, medicinal and/or therapeutic efforts are necessary. " Agreed, but please be specific. The existing alternate rather than complementary emphasis of the article has made quite a point of saying homeopathy comes first. A short list of examples where a homeopath would call for an ambulance would be very informative.

Correction. Remedies are not selected by provings, but are they not the means to find a simillium?

It's now on the archive page, Dana, but I thought you said homeopathic remedies were not always given in homeopathic dosages. If I remember that correctly, then the "wisdom of the body" and strengthening defenses, perhaps with a few words about the difference with medicine, is more central to the definition than the aspect of small and specially prepared doses. Both belong early in the introduction. Howard C. Berkowitz 10:40, 21 September 2010 (UTC)

Howard, thanx for clarifying some issues. You have suggested above that conventional physicians really do not have a specific meaning for or appreciation of "the wisdom of the body." To me, that alone says volumes...and I agree with that. In fact, it seems that the average physician has distrust of the ability of the human body to defend and repair itself, thereby requiring intervention that usually (though certainly not always) works counter to the body's present symptoms.

As for the use of the word "allopathy" and "allopathic," you may be very surprised and even shocked how many conventional medical schools, licensing boards, institutions, US governmental agencies, and accrediting agencies still utilize this word. I highly recommend that you see the "huge body of references" compiled by Brian Hopping at: http://en.wikipedia.org/wiki/Talk:Allopathic_medicine

To clarify on the licensing of homeopaths, there are only 3 states in the USA that license MDs who practice homeopathy (CT, AZ, and NV). Licensing in homeopathy is NOT necessary to practice homeopathy. FYI, these 3 states licensed MD/homeopaths because some MDs who practiced homeopathy were being harrassed by conventional MDs, so they set up their own licensing board. Most MD/homeopaths are NOT being harrassed by other MDs, so it is not necessary to set-up their own boards.

In addition to MDs who practice homeopathy, virtually every type of health/medical professions have some people who practice homeopathy, PLUS there are "professional homeopaths" (individuals who specialize in homeopathy and who are not licensed in any other health/medical profession).

As for when a homeopath would call an ambulance...it would be the same protocols for which conventional MDs would call an ambulance. Is that clear enough? Dana Ullman 17:11, 21 September 2010 (UTC)

OK, please take the following on ...well, good "faith" is singularly inappropriate, for a reason I think you'll soon see. I'm not exactly suggesting there is a consensus, but I would hope that it might be possible for the different sides to have their incompatibilities, and indeed fears, clearly stated.

I could get along with "wisdom of the body" in the context of religion or transpersonal psychology, but not medicine. By "medicine", I use Marcia Angell's definition: there are two kinds of medicine. Medicine that works and medicine that doesn't work. Yes, adults have a right to faith healing -- but courts have held they do not have a right to do so for children. It frightens me, quite literally, that a parent might take a child with diabetes, or a treatable cancer, to a homeopath.

The rejection of etiology also frightens me, given the level of improved certainty that comes with genetic and molecular medicine. I see, in homeopathic writing, a pattern of encouraging fear of medical sciences. I see the emphasis on using the word "allopath" as trying to reopen old political and just plain angry battles.

Now, remember that this discussion has been international, in the sense that Ramanand has been bringing up Indian practices. Perhaps Western homeopaths would never do such things, but he has given me the impression that ambulances -- and yes, they might not be available in some countries -- would not be called until late or never.

That most homeopaths are not licensed or reviewed is not very confidence building.

I can only say that in several decades of working with health care, I have never met a physician who used homeopathic methods. I'm not saying they don't exist -- I'm saying that at least in the U.S., homeopathy does not appear to be a significant form of complementary medicine. I do know quite a few physicians that either themselves use other alternative methods, or integrate care with alternative practitioners.

Howard C. Berkowitz 20:53, 21 September 2010 (UTC)

OK, I may need to be more focused. There's been too much talk page discussion that doesn't have anything to do with improving the article. I'm probably especially irritable about health care at the moment, as I'm dealing with the last comfort-care-versus-euthanasia decisions for my best friend--who, incidentally, may well have benefited from some complementary veterinary medicine.

The "wisdom of the body" discussion is the only thing I'll raise right now. While I don't see that historically as the core of homeopathy, certainly the article can say this is something in which many homeopaths believe, and define it in declarative sentences. Also in declarative sentences, it is fair to say that biologically oriented clinicians find it to have no information that will help a patient, and denies that which has been learned in over a century (well, maybe since somewhere mid-20th century) about etiology and efficacy. Neither side will convince the other, and both sides have equally intense beliefs. Treat it as a religious difference based on faith, stop trying to argue the positions in the article, and move on. Dana can say wisdom of the body is a matter of core faith for him and have it respected as such; note equal respect for the faith of the nonhomeopaths, and move to the next subtopic. Howard C. Berkowitz 22:50, 21 September 2010 (UTC)

Howard, I'm glad that you recognize how much of your writing here is not practical to THIS article, as is your arbitrary differentiation between your "assumed" different definitions of the wisdom of the body. If one believe in evolution, I believes that organisms automatically strive to defend themselves and to survive. I could quote Hans Selye, MD, PhD, AND Walter B. Cannon (author of the classic text, "Wisdom of the Body") in many places where they assert its presence. Even MDs recognize its presence, but they tend to ignore it or have a certain disdain when treating people. Their loss. In any case, unless you can cite a reputable source for your different definitions, please STOP making assumptions and please stop making up your own defintiions. Dana Ullman 02:50, 22 September 2010 (UTC)

I need to also say that Howard's assertion that homeopaths do not believe in "etiology" is just one more unfounded assumption he has made (no big surprise). Homeopaths simply have a more sophisticated viewpoint on etiology than Howard and reductionistic scientists do. For infectious disease, for example, we believe in germs, but we also believe in host resistence. While conventional medicine only focusses on the germ, homeopaths focus on both the germ and host resistence. I am beginning to think that Howard is simply unable to understand homeopathy. Despite editing here for now a long time, it seems that he doesn't seem to adequately understand basic homeopathic principles and methodology (and/or he doesn't want to understand them). I urge us all to ignore what he says unless he provides us with specific reliable references so that we can be more confident that he is not wasting our time. I look forward to Howard's contributions if he can show real intellectual effort here rather than creating straw men and creating arguments/fights when none exist. Dana Ullman 03:00, 22 September 2010 (UTC)

Strawment Produce text, not attacks

Cannon, I would note, is a 1963 book, which appears to be aimed at a lay audience. Of course, rather than the sarcastic "I could quote", a far more constructive approach would be to do so.

Please stop yelling about strawmen and propose text. Please stop making sweeping inferences such as the theory of evolution proving the wisdom of the body, which you have yet to define rigorously. "Even MDs" is meaningless without citation, and citation of current and authoritative ones. As I mentioned, it simply does not appear in the indexes major textbooks: Harrison's Principles of Internal Medicine, the Hopkins Principles and Practices of Medicine, Best and Taylor's Physiological Basis of Medical Practice, or the Guyton-Hall Textbook of Medical Physiology. My copy of Cecil's Internal Medicine does not come immediately to hand. If it is such an accepted, well-defined concept, one might think that some of the most widely used medical school textbooks might mention it, might one?

PROFESSIONALISM ALERT for {{nocomplaints}}

I am beginning to think that Howard is simply unable to understand homeopathy. Despite editing here for now a long time, it seems that he doesn't seem to adequately understand basic homeopathic principles and methodology (and/or he doesn't want to understand them). I urge us all to ignore what he says unless he provides us with specific reliable references so that we can be more confident that he is not wasting our time.

"While conventional medicine only focusses on the germ, homeopaths focus on both the germ and host resistence [sic]." Nonsense. B-lymphocyte and T-lymphocyte immune response are clearly host defenses, although, in some cases, immunoglobulins may be provided externally. Interleukins and other cytokines are signaling mechanisms for host defenses. Granulocyte-macrophage colony-stimulating factor deals with improving cellular responses.

Tumor necrosis factor-alpha is a host defense that frequently becomes hyperactive and needs to be returned to safe levels; the area of overactive host defenses is an important one, as in anemia of chronic disease with the fairly recently recognized roles of hepcidin and interleukin-6, or, overwhelmingly, in autoimmune disease. In other words, sometimes the body is about as wise as a teenager being challenged by peers after non-homeopathic dosages of a remedy with the (vivid) memory of ethanol. --Howard C. Berkowitz 03:53, 22 September 2010 (UTC)

Rationalwiki

I hope one of you can write an article on the rationalwiki refuting their allegations about CZ as well as the CZ article on homeopathy.—Ramanand Jhingade 15:43, 20 September 2010 (UTC)

And why, precisely, don't you do it? I have never read Rationalwiki and have no reason to do so. I certainly won't defend the CZ article on homeopathy, because I frankly wish it were gone. Howard C. Berkowitz 16:32, 20 September 2010 (UTC)

Unfortunately, as long as there is a CZ with which I work, I will defend its integrity -- and my first view of its integrity is that this article, and the interminable arguments to reach a "consensus" on irreconcilable ideas, continues to damage CZ. I am absolutely unconcerned with anonymous criticisms from wikis or stone tablets. Howard C. Berkowitz 10:12, 21 September 2010 (UTC)

I quote: I am absolutely unconcerned with anonymous criticisms from wikis or stone tablets.</quote> A huge, gigantic, mega 'Hear, hear!' from me, Howard. Well said! Aleta Curry 21:39, 21 September 2010 (UTC)

Yes, and 'hear, hear' to Howard's comments on homeopathy above, too. Ro Thorpe 22:14, 21 September 2010 (UTC)

(undent) A bit of breaking news....see User talk:Trent Toulouse for some thoughtful commentary by the operations manager of RationalWiki. I won't say I agree completely with him, but I find I can get along with him more easily than with some who have worked on this article. Howard C. Berkowitz 20:53, 25 September 2010 (UTC)

I am in absolute agreement with Howard, Aleta and Roe on this issue. While I may not believe everything presented in homeopathic medicine, the inclusion of this article has its place at Citizendium, if CZ plans to become the best and all-encompassing online encyclopedia it needs to objectively present articles about all types of subjects. Limiting articles based on personal beliefs would not make a fair, objective and all encompassing online encyclopedia. Base the article on known facts, iron on your differences, and move along to the next article. There is plenty left to write. Mary Ash 15:47, 28 September 2010 (UTC)

I think CZ should be based on scientific research and what we present as facts should be validated. Because of that I think we should put a warning in in the beginning of the article that Homeopathy is based on faith and wishful thinking, and that there are no scientific evidence that it works. Håkan Wester 07:50, 4 October 2010 (UTC)

When to refer; when to call emergency services

I'm afraid that saying a homeopath would call an ambulance when a conventional physician would call one really isn't very informative. If the person using homeopathy is a fully qualified physician, he or she may not even be beginning to use homeopathic principles in the decision. The clinician also may have more facilities and training for emergency interventions.

To make the point that is entirely possible to be specific about either referring or using special care, see examples from chiropractic. I see no reason why a competent homeopath, who claims general health knowledge, can't write a similar list. Alternatively, while we don't have a non-trauma triage list at CZ, another good starting point would be emergency room, or even ambulance dispatch, criteria for putting a patient into the most urgent category. (thinks of a couple of personal experiences when I was more or less tackled in the ER, and run into the treatment area, while still calmly giving a history). --Howard C. Berkowitz 02:01, 22 September 2010 (UTC)

Allopathy, and revert wars over Osler quote

First, precisely what is the value, in other than specific historical contexts, of continuing to insist on the word allopathy being used? It is frequently used, by supporters of alternative medicine, in a rather sneering way that removes context. Osler, below, uses it in a 19th century concept based on "opposites", which make no more sense in molecular biology than do "similars".

Sir William Osler is widely celebrated as one of the true greats of medicine. One reason for the continued popularity of his comments is that they focus on the interaction with the patient rather than try to continue century-old explanations for much better understood phenomena.

Material introducing the Osler quote to follow was deleted, as have several variants of: "Other than in some narrow usages (for example, to differentiate conventional medicine from osteopathy), conventional doctors contend that "allopathy" is not a synonym for the paradigms of contemporary medicine, although osteopaths, homeopaths, naturopaths and other alternative medicine practitioners continue to call it allopathy."

There is, however, a revert war on the Osler quote, deleted again:

A new school of practitioners has arisen which cares nothing for homeopathy and still less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new."<ref>[[Flexner Report]], page 162</ref>

[1] Note that Osler disapproves of both 19th century-early 20th century allopathy as well as homeopathy; the quote, in broader context, calls both "sects" that will be replaced by science-based medicine. Prior to making this comment, Osler indeed did speak of the superiority of contemporary homeopathy over contemporary allopathy, but the comment, in context, refers to high doses of toxic doses of drugs with no established mechanism of action.

A desire to take medicine is, perhaps, the great feature which distinguishes man from other animals.

The 1905 edition of The Principles and Practices of Medicine lists only a few drugs as effecitve (e.g., nitroglycerin and amyl nitrite for coronary artery pain, diptheria and tetanuxus antitoxins, and the arsenicals as an improvement in the mercury treatment of syphilis. On the other hand, the text decidedly did not take a avoid-risk-above-all approach as with homeopathy; he was quite aggressive in recommending surgery -- which was also in need of improvement. With the disclaimer that I was a volunteer copy editor, see A Brief History of Disease, Science & Medicine by Michael Kennedy, a faculty member of the University of Southern California who teaches the first- and second-year Introduction to Clinical Medicine program, another place where one might expect to see the "wisdom of the body" should that be widely accepted in medicine.

Constables, could we please have enforcement of stopping repeated deletions of the Osler quote about the "new school of practitioners"? --Howard C. Berkowitz 04:18, 22 September 2010 (UTC)

I await constable comment before restoring. This is behavioral; there is no Editor ruling on excluding the quote, and, in any case, it would be unfair to have a ruling from an Editor of only one concerned workgroup. Howard C. Berkowitz 23:46, 22 September 2010 (UTC)

Howard, a quick search of the AMA website for "allopathic" gives us some pretty significant current hits. Looking through the links pretty much shows them calling themselves allopathic often and sometimes specifically. Maybe it's not meant to be negative. D. Matt Innis 23:57, 22 September 2010 (UTC)

To illustrate a few:

• State Medical Licensure Requirements and Statistics—The 2009 edition provides updated information on licensing board requirements for the 54 allopathic and 13 osteopathic boards of medical examiners in the US and territories.
• Most US allopathic and osteopathic medical schools routinely incorporate simulation as a standard part of their curriculum.
• Allopathic medicine – Certification is recognition by one of the 24 approved specialty boards (145 specialty and subspecialties) of the American Board of Medical Specialties (ABMS) that an MD has achieved expertise in a medical specialty or subspecialty. Requirements are: graduation from an LCME-approved or COCA-accredited medical school, satisfactory completion of the appropriate full-time residency training program requirements, an unrestricted valid license in the state or region in which they wish to practice medicine, and passage of a written and/or oral board certifying examination. Certification by an ABMS specialty board is not a requirement to practice in a medical specialty.

D. Matt Innis 00:03, 23 September 2010 (UTC)

Correct. (my emphasis} The 2009 edition provides updated information on licensing board requirements for the 54 allopathic and 13 osteopathic boards of medical examiners in the US and territories. "Allopathic" vs. "Osteopathic" has a specific legal and professional history. Allopathic vs. homeopathic, naturopathic, etc., does not have the same sort of history

I'm thinking of one of the most knowledgeable physicians I know. If you were to contrast his approach with homeopathy, would you then call him an allopath? I think Chuck would object, since he's a DO dual-boarded in emergency medicine and family practice, and is widely respected as one of the world authorities in field and disaster medicine. Is the logic here "if you aren't an alternative practitioner, you must be an allopath?" I've noted certain authors to call MDs who use homeopathic methods "homeopaths", just as they do with "homeopaths" with no non-homeopathic training. It might be useful, in this article, to call them "homeopathic physicians" in the sense of distinction between "osteopath" and "osteopathic physician." Of course, if the homeopathic physician is a DO, then can they be allopathic? :-)

Is this really taking us to any useful place? For me, this article is the litter box of CZ, which must be visited frequently by its users, and maintained only slightly less frequently by those responsible for it. Howard C. Berkowitz 00:09, 23 September 2010 (UTC)

So, what you are saying is that the AMA can call themselves allopaths because they are friends, but if homeopaths call them allopaths, it's a slur. Maybe we should just try to explain that. D. Matt Innis 00:58, 23 September 2010 (UTC)

That's certainly along the right lines. Remember how Hayford said, as I remember, if he calls somone a skeptic, he means it as a compliment, but an alternative medicine practitioner often means the word to be an insult? Readers of this article aren't going to know who uses an emotionally ambiguous word, so why, in a presumably objective article, use a word that has such problematic connotations?

With the AMA, it's a little more complex. The AMA grows out of 19th century medicine that did use a concept of allopathy, but the specific legal conflict was with osteopathy. In your quote about medical certification, note that it's very distinctly a binary statement of allopath vs. osteopathic physician. It's not allopath as opposed to everything else. Some of it, in the AMA (representing, as I remember, around 30% of US physicians), is historical.

Consider, Matt, the AMA legal battles with chiropractic. Again, it was a binary dispute between two approaches. The language may have included allopath, but the context was not-chiropractic.

I certainly think it's fair to say that when the average physician or biomedical scientist is called an allopath by someone who does not use a scientific model, they find it insulting. This also gets into the purely silly, as an MD who uses any homeopathic techniques, logically, would be a homeopathic allopath. A non-physician homeopath, though, can't be an allopath as well. I suppose there could be (US) homeopathic osteopathic physicians, but I don't think you could be a homeopathic osteopath in the UK, other than dual licensure. Howard C. Berkowitz 02:14, 23 September 2010 (UTC)

Perhaps when a homeopath uses the word allopath, they just mean those that do not treat with similars, or "homeopathically", regardless of whether they are conventional physicians, or osteopaths, or chiropractors, or traditional chinese practitioners. How about we just make that clear, because there isn't really a better word. Besides, if conventional scientific medical physicians don't use the old allopathic methods, then we aren't really talking about them. They are off the hook. D. Matt Innis 02:37, 23 September 2010 (UTC)

There has been entirely too much use of it in a sneering way for me to let anyone off the hook. I've always thought it elementary human courtesy to assume that it's a personal choice about how one wants to be addressed. Obviously, I'm dating myself, but when Cassius Marcellus Clay wanted to be known as Muhammad Ali, I thought it was his concern.

What the homeopaths mean, therefore, is essentially irrelevant to the self-identification of other groups. It's fair for them to say "non-homeopath", which is self-evidently accurate. Non-homeopath seems infinitely better than allopath, and avoids conflicts such as calling a DO an allopath, or a US-licensed MD who uses homeopathy a homeopathic allopath. Both groups can contain psychopaths. Now meditating on the possibility of a homeopathic osteopathic pathologist who did a residency under the traditional allopathic American College of Pathology.--Howard C. Berkowitz 02:55, 23 September 2010 (UTC)

I'm not saying that homeopaths are off the hook. I'm saying that homeopaths are not talking about conventional medical physicians because they conventional medical physicians are not "allopaths" in the true sense of the word - conventional medicine is off the hook from being included as "allopaths". That is what we need to make clear. D. Matt Innis 13:10, 23 September 2010 (UTC)

(undent) But what is gained by saying that homeopaths use the term allopath, often in a negative way, rather than simply saying homeopaths and non-homeopaths? The AMA issue is not relevant as its history shows the issue was very clearly osteopathy v. allopathy as used at the time, roughly, of the Flexner Report. Essentially, the distinction is largely historic, just as referring to the Commonwealth of Massachusetts rather than the State of Massachusetts. How the state received its charter from the English crown is not part of American jurisprudence, but the old name is given as a courtesy to the Commonwealth. Insisting on calling people, who don't want to be called allopaths, is not courteous. Howard C. Berkowitz 16:03, 23 September 2010 (UTC)

Analogy: I've heard that the word "nigger" is not infrequently used by black people among themselves, but they object to others' using it. Peter Jackson 17:01, 23 September 2010 (UTC)

Expansion: the word "nigger", a word so highly charged and offensive as to generally not even be spoken or written about except euphemistically ('the "N" word'), is used with varying frequency by some (emphasis important, she says emphatically) black people among themselves and/or in public. Usage varies; in common parlance it seems restricted by socio-economic class and level of education (I very much doubt the participants in various Black American professional conferences employ the word, unless for humourous or ironic effect, even among themselves) BUT it is also used for dramatic or ironic effect (think rappers) and no one objects to such use in historical context or literary use (The Irish are the Niggers of Europe)

Every single Jewish joke I have ever heard was told to me by a Jew. I mean it; I am not in the habit of exaggerating on such matters. That notwithstanding, I have never repeated the vast majority to anyone - not my mother, not my husband, no one, not because I cannot trust those people, but because I found the jokes unfunny and offensive, the religion of the persons who told me is completely immaterial.

My point?

1. Context is everything.

2. The fact that someone else uses a term self-referentially does not stop it being a slur when flung at them by an outsider.

Aleta Curry 06:15, 24 September 2010 (UTC)

I agree: the word 'allopath' is a slur. It is also obscure jargon: how many people have heard of allopathy who have never heard of homeopathy? Ro Thorpe 22:51, 24 September 2010 (UTC)

Pseudoscientist a slur. Crank a slur. Do you really thik there is something wrong with being an Allopath? D. Matt Innis 23:07, 24 September 2010 (UTC)

The people who use the word are homeopaths: from them it is a slur. I'm quite happy to be treated by allopaths, whom I call doctors. Ro Thorpe 00:12, 25 September 2010 (UTC)

But we are not homeopaths, we are editors. Your complaint, then, is that this article sounds like it is written by homeopaths. That can be remedied and still use the word allopath - which is an accurate description of what homeopaths think they differ from.

I added the part about Heroic medicine to illustrate what allopathy was back then. You must realize that in 1799 George Washington died while under the care of a Heroic medicine doctor. This triggered the search for less aggressive ways to treat as they became very unpopular:

• Hahnemann named his system of health care "homoeopathy" (meaning "like disease") - but most people now spell it "homeopathy" - and coined the term "allopathy" ("different than disease") to refer to the conventional medicine of the day, Heroic medicine. Heroic medicine was known for its use of highly toxic compounds to combat disease and resorted to blood letting and leeching as methods to reduce the fever of illness.

D. Matt Innis 00:26, 25 September 2010 (UTC)

The word 'allopath' in its historical context is fine - I think that has already been established. (By the way, I don't think 'heroic' should be capitalised.) Ro Thorpe 00:52, 25 September 2010 (UTC)

(edit conflict - I'll look at Howard's response momentarily)

Then what are we arguing about. There was never any other use. I'm fine with heroic medicine, but as Nancy Sculerati used to say, "..there is a time to use Medicine and a time to use medicine, there is time to use Chiropractic and there is time to use chiropractic." This felt like a time to use Heroic! But, I won't argue dog names, you're the expert with the language! :) D. Matt Innis 01:10, 25 September 2010 (UTC)

Thanks! I remember Ms Sculerati, MD. Eighteenth-century prose or any-century verse, perhaps she meant... Ro Thorpe 02:04, 25 September 2010 (UTC)

(undent) Yes, I agree. I have no problem with using "allopath" in context with Hahnemann, when the methods of the allopaths of the time had no theoretical basis. I have a significant problem that homeopaths still call conventional physicians allopaths. Now, today, bloodletting is quite appropriate in the narrow indication of excessive red cells in polycythemia vera, or as an emergency measure for pulmonary edema. Leeching, of a very minimal sort, is a gentle way to remove congested blood after plastic surgery. In each of these techniques, though, there is a very specific reason for the procedure, and care not to take too much blood.

When allopath is used by a homeopath, it sounds like a slur. Now, I shall pause to say that in a staff role, I will call an anesthesiologist a gas-passer, and observe that the three hardest years of an orthopedist's career are the fourth grade. This is not necessarily a wise form of address by outsiders. Maybe we need some homeopath jokes, as I certainly know enough physician jokes. :-)

If, Matt, you say there are no more allopaths in the 19th century sense, then the modern comparison is moot. If one accepts the homeopathic argument that present practice is allopathy based on "opposites", you're simply wrong -- many treatments supplement a deficient natural mechanism, while others indeed do try to destroy a causative factor that has relatively little to do with symptoms. Howard C. Berkowitz 01:04, 25 September 2010 (UTC)

Again, then what are we arguing about. There is no modern day use of allopath in this article.

Good thing I don't say that there are no more allopaths in the 19th century sense because I would hate to be wrong, though I am a lot. D. Matt Innis 01:15, 25 September 2010 (UTC)

Reviewing the article, two uses of allopathy are historic (Kent's might be clearer about that), and then it appears, inappropriately I think, in the title of a Shang article but that's a legitimate quote.

We would have far less of a problem if the talk page were far more focused. There have been uses here of allopath as a synonym for conventional medicine, with warnings about the latter. Unfortunately, much of the commentary does not suggest or remove text. (Note that I still don't have a ruling on reverts of the deletion of the Osler quote).

Can we agree, then, that allopathy does not belong in the article as a general description of science-based medicine, and simply move on? The argument about licensing boards is irrelevant since it dealt not with homeopathy, but with allopathy as an antonym to osteopathy, and has a historical context. Howard C. Berkowitz 01:23, 25 September 2010 (UTC)

Sure, let's stay focused.

I can agree to use allopathy where it is appropriate, which does not include being a synonym to modern conventional medicine, because that would be inappropriate, but not because it is a bad word. That would be like not using the word chiropractor because some people like to use chiropractic physician. They both have appropriate places. D. Matt Innis 01:48, 25 September 2010 (UTC)

We don't use the term allopath as a slur, but one of the reasons is that it is short for, 'conventional, western, medical doctor'. Most alt. med. practitioners (osteopaths, naturopaths, chiropractors etc.) continue to use the term allopath, so can we mention that here?—Ramanand Jhingade 14:56, 25 September 2010 (UTC)

(undent) If this article were about alt med, it might be relevant. What a pity, however, that it is not, thus the above mentioned practitioners are irrelevant. Osteopathic physicians, not osteopaths, do have a historical reason, in the U.S., to use "allopath" -- except that they go through the same -- what was it? Reductionist, simplistic training to which homeopathy is superior, according to Mr. Ullman's accusations?

As others have mentioned, if a group uses a term internally, it makes it no less of a slur when directed to an external group that considers it a slur. Alt med practitioners have no right to dictate the sensitivities of med practitioners.

Matt, "osteopathic physician" specifically disambiguates a DO program from an "osteopathic" program. While "chiropractic physician" may be a courtesy, does it really clarify anything? I'd accept the term for someone that had a DC and either an accredited DO or MD. Howard C. Berkowitz 03:13, 28 September 2010 (UTC)

"Rebound" is used inappropriately

There is a long list of citations, following one sentence, which purport to suggest the "rebound effect" is a common medical term. It is not; these appear to be articles that simply use that ordinary English word, but not in any well-defined manner. On checking Medical Subject Headings for "rebound" as a keyword, there is no hit, although there are three disambiguation terms that contain "rebound". The word does not appear in the index of Goodman & Gilman's The Pharmacologic Basis of Therapeutics (9th Edition).

This is not to say that the word is not used in medicine. On physical examination, "rebound tenderness" describes pain that takes place after the examiner puts pressure on an area, usually the abdomen, and then releases the pressure. "Rebound" is commonly used to describe increased nasal congestion when topical vasoconstrictors have been used too frequently on the nasal mucosa. Rebound is also exhibited by participants in medical school basketball teams.

I recommend the discussion of rebound be deleted, insofar as it is purported to be a medical concept. Howard C. Berkowitz 04:28, 23 September 2010 (UTC)

A simple review of the article on "Rebound effect" on wikipedia references MANY current studies that have verified its reality AND modern acceptance. I'm glad that Howard at least referenced one good text in this instance, but it is clear that just one reference in this case is not enough. http://en.wikipedia.org/wiki/Rebound_effect Dana Ullman 10:54, 23 September 2010 (UTC)

Again, it seems difficult to get across that Wikipedia is not a relevant authority under CZ policy. As long as the only mention of the term is in individual articles using the word, as long as no major pharmacology or internal medicine text discusses it as a general subject, and it is not in Medical Subject Headings, it does not have widespread acceptance. Cytochrome clearance has widespread acceptance. Zero- and first-order metabolism has wide acceptance. Michaelis-Menten competitive inhibition has had wide acceptance is being refined.

Simply waving hands and referring to Wikipedia is not giving even even one good reference.

It's not my job to prove your point by finding general discussions of rebound, as opposed to, for example, the descriptive use of the ordinary word rebound in dealing with sedative-hypnotics or nasal vasoconstrictors. A reference, preferably from a good pharmacology text, that gives a definition of rebound would be general acceptance would be something of proof. My pharmacology texts don't use it. Howard C. Berkowitz 16:03, 23 September 2010 (UTC)

Howard, I did not chose to provide a link to wikipedia to copy any information for our article. I chose to link to wikipedia because it has a good list of references to some journals such as SCIENCE and many medical journals, and this body of work CONFIRMS that a rebound effect is widely recognized in medicine.

A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism. Dana Ullman 02:44, 24 September 2010 (UTC)

A reference to a pharmacology textbook that states "rebound" is a general concept would be nice, not just that the word is used in a narrative. It can be useful as a word in narrative, to describe dosage over time, as are terms such as saturation, tolerance, etc., but I still challenge anyone to provide a specific reference that it is considered a basic pharmacological mechanism such as competitive inhibition. Howard C. Berkowitz 04:09, 24 September 2010 (UTC)

I've removed the sentence in question, not because of the doubt about rebound, but because it make the assertion that homeopathy uses that effect in its treatment. I think it is misleading to suggest that this is how remedies work without references. So I brought it here:

• Recent research has shown that some conventional drugs, which are normally used to do something, can lead to the opposite effect, when stopped - a rebound effect; homeopathy uses the rebound effect of a remedy to stimulate natural healing.

D. Matt Innis 01:36, 25 September 2010 (UTC)

(undent) Looking through these articles, "rebound" is used in a general way. For example, in a discussion of methylphenidate in childhood attention deficit hyperactivity disorder, "A rebound effect may occur in the late afternoon or early evening, when the medication wears off in about one-third of the children with ADHD.56 With this rebound effect, symptoms of ADHD become evident again as the child becomes more irritable and noncompliant."

Assume, for the sake of argument, that rebound is being used in a general way. Does this establish an equivalency between rebound and similars? I think not. Methylphenidate (Ritalin), given to a normal subject in a high dose, will indeed cause agitation and hyperactivity. It is characteristic of patients with ADHD, however, that medium to high -- not homeopathic -- doses calm them. The "rebound" occurs when the drug levels drop. Howard C. Berkowitz 02:16, 25 September 2010 (UTC)

Yes, its usage here seems to be a generic jargon. All that may be necessary is to say that ".. homeopaths refer to this as a rebound effect." But we would have to explain what they are calling a rebound effect. It appears that:

• "Homeopath's consider that perhaps their remedies work by pushing the body's physiology slightly further away from homeostasis - a balanced state. As a result, the body's healing mechanisms respond by working harder to return to normal. They refer to this as a "rebound effect.""

D. Matt Innis 02:38, 25 September 2010 (UTC)

Howard, Dana has already mentioned that all homeopathic remedies need not be more dilute than 'Avogadro's no.'; even if these refs aren't mentioned in 'Textbooks', they are well known in medical circles - CZ allows such a mention, so I suggest we have the sentence, with you inserting a critique after it. Matt, we only treat a sick person and not someone who is already healthy (homeostatic), so we should not explain it the way you stated above.—Ramanand Jhingade 14:40, 25 September 2010 (UTC)

Of course, Ramanand, that's why I stated "further away from homeostasis" in an effort to show that the patient wasn't at "healthy." Although, technically, a patient could be at homeostasis without being "optimally healthy" since homeostasis just means that the body is balanced at a certain point. You can still try and improve on the sentence if you like. D. Matt Innis 15:30, 25 September 2010 (UTC)

Merger

I suggest we merge the sections, 'Medical organizations' attitudes towards homeopathy' and 'Government and institutional assessments'.—Ramanand Jhingade 15:49, 25 September 2010 (UTC)

What is your reasoning? Howard C. Berkowitz 21:22, 25 September 2010 (UTC)

'coz the contents are almost the same.—Ramanand Jhingade 14:11, 26 September 2010 (UTC)

Sorry, that doesn't tell me any more. What is duplicated? "Almost" isn't "same". Nongovernmental versus governmental is a significant difference of perception, if nothing else. Howard C. Berkowitz 18:58, 26 September 2010 (UTC)

Replaced "skeptic" with "non-homeopath"

First, I believe Larry, some time ago, ruled that "skeptic" was not to be used.

Second, saying "homeopath" vs. "skeptic of homeopath" has an implication that the homeopath is a professional but the "skeptic" may not have any basis for argument.

Third, does this substitution really change any meaning, or does it simply remove a red flag? Howard C. Berkowitz 21:21, 25 September 2010 (UTC)

Keep thinking about a replacement for "non-homeopath"; that would include everyone else. I agree "skeptic" is a misnomer in this instance, but even it has a time and place. Didn't Tom want it used? It would be best to attribute any statement to a particular "skeptic" along with their reasoning. D. Matt Innis 21:53, 25 September 2010 (UTC)

I would be open to a different word, but skeptic, as is allopath, is non-neutral. It has to be something agreed-to by both sides. Allopath in a non-historic context, or allopath, vs. homeopath, positions the homeopaths as the authority. Certainly, homeopaths are the authorities on what they themselves believe, but they are no more entitled to name other groups, especially in a manner that seems deprecatory, than I would be to choose to refer to "conventional physicians and quacks".

The "skeptic" community, broader than anti-homeopathy, isn't necessarily a scientific one. It's not uncommon that a major "impact" publication, such as the New England Journal of Medicine, will present, side-by-side, articles based on competing hypotheses. Neither competitor calls the other a skeptic, suggesting that they are in possession of revealed truth. Howard C. Berkowitz 01:14, 26 September 2010 (UTC)

Agree. When the NEJM presents them in the same article, they attribute them to particular people/advocates by name or by specific group. There are specific "skeptic groups" that could be named. D. Matt Innis 15:32, 26 September 2010 (UTC)

I am not in concrete about using the word "skeptic," but the word "non-homeopath" is simply inaccurate. There are PLENTY of non-homeopaths who disagree with the various statements that Howard is attributing to "non-homeopaths." I think that the term "skeptics of homeopathy" are more specific and accurate. I suggest that we use this term. If not or if we cannot find a more accurate word, we may have to delete those sentences because accuracy is supreme. Dana Ullman 16:32, 26 September 2010 (UTC)

I've made an attempt to rewrite with attribution to avoid the use of skeptic and non-homeopath. See what you think. D. Matt Innis 18:03, 26 September 2010 (UTC)

Matt, you've done an admirable job! I wondered if it was do-able...and you did it. Are we close to closure?

Yes, good job there Matt. But no, I do not think this is anywhere near "closure". Sandy Harris 06:10, 27 September 2010 (UTC)

No. Of course, we could take Mr. Ullman's suggestion further and delete every sentence, which I would applaud. I am not, however, wedded to non-homeopath. The dichotomy here, however, is between homeopaths and what I shall call the mainstream of scientifically based medicine. If, for example the "non-homeopaths" are alternative practitioners, it is simply irrelevant to the matter at hand. I don't call myself, for example, a skeptic of homeopathy, any more than I consider myself a skeptic of flat earth advocates. I find the two equally plausible.

The arguments go around and around; I'd suggest freezing the article until the EC is in place. Howard C. Berkowitz 06:47, 27 September 2010 (UTC)

I think it would be disastrous to delete all sentences that contained the word skeptic (or whatever it is changed to), because that would remove most of the viewpoints Dana and I have - CZ is supposed to have everyone's viewpoint.—Ramanand Jhingade 16:02, 27 September 2010 (UTC)

(undent) Thanks all, it was painful! I haven't read the entire article and compared it to the approved version, so I'm not in any place to vote to approve. I'll wait until everyone is satisfied and then take a look. No use starting the process if there are concerns from someone from another perspective. There is no mechanism to freeze a Draft version and that would be counter to the whole approved version process anyway, so that is not an option either as far as I am concerned. D. Matt Innis 17:12, 27 September 2010 (UTC)

Let's get something straight. CZ has never been a place that is supposed to have "everyone's viewpoint". There's no question that the new Editorial Council will be refining the policies, but the broad pattern is likely continue: the article represents mainstream opinion. It is a reality that homeopathy is anathema to a significant number of scientifically oriented experts, who, among other things, dislike being lumped as "skeptics".

If "skeptic of homeopathy" is used, then "believer in homeopathy" should replace it for supporters. Otherwise, if only those in opposition have a qualifier, homeopathy is presented as the authoritative position, and the skeptics are mere challengers. That is not an attack on homeopathy, but an attack on medicine.

I do not see this article, easily the most controversial at Citizendium, ever representing a "consensus". Perhaps the closest is intelligent design. The best that can be done is to indicate that there are diametrically opposed positions, and one is anathema to biologists -- and, for that matter, to some theologians.

Perhaps working on other articles, even for flow edit and things that do not require subject matter expertise, might give more perspective. There seem recently to be some misperceptions of CZ culture. Howard C. Berkowitz 17:45, 27 September 2010 (UTC)

Scientists are skeptical of everything if they are doing their job right, but that is the skeptical used as a verb. Skeptics are something totally different. Scientists are not skeptics, they are scientists. If we are trying to include scientists and skeptics, then we should say scientists and skeptics. "Homeopath's believe" or "supporters believe" are both appropriate when the science is scant... which is probably just about everywhere. D. Matt Innis 00:58, 28 September 2010 (UTC)

Good points, Matt. Now, I have to be careful to focus on the talk page being supportive of the article, rather than a battleground, but I suspect there will be less conflict if homeopaths do not try to co-opt medical/scientific techniques and theories and turn them into support of homeopathy. Yes, there are superficial similarities between immunization and similars, but, once gets into modern methodology, the analogies break down. Ironically, in some cases, especially synthetic proteins, they aren't "stimulating" the body's defenses, but duplicating the body's defenses--that's the definition of passive immunity.

There may, indeed, be scientific explanations for some things in homeopathy, but the level of evidence for mechanisms is so scant that I don't think it's ready for the article. On the one hand, there are such things as an ill-defined set of hypotheses on memory of water. On the other hand, there is both theory and reproducible laboratory demonstrations that, for example, synthetic tetanus immune globulin fits the Clostridium tetani exotoxin molecule like a key in a lock, and neutralizes it.

I don't challenge someone's religious faith, although I don't share it. I accept that various systems of mathematics derive logically from the selected axioms. It was very difficult for me to vote in a recent election, because all the candidates were so deeply entrenched in negative advertising that it was obscure what they actually supported and proposed. Can we attempt to get this back on what homeopaths believe, biomedical criticism of some of their analysis, and get on with it? Medicine uses controlled trials and looks for high quality. There are new medical techniques for trials for individualized medicine. Can we stipulate and get on with it?

If I'm not being too political, and I'm trying not to be, at least several candidates for Editorial Council feel this article is a travesty. That's not a general challenge to CAM, as acupuncture and chiropractic, among other articles, strike many of the medical experts as reasonable. Workgroups in general are likely to be revised, but constant offense-defense here strengthens the argument against the Healing Arts workgroup. Howard C. Berkowitz 01:27, 28 September 2010 (UTC)

"CAM"? "Something Alternative Medicine" seemed likely, but Citizendium suggests "Crassulacean acid metabolism". Ro Thorpe 02:19, 28 September 2010 (UTC)

CAM

"CAM"? "Something Alternative Medicine" seemed likely, but Citizendium suggests "Crassulacean acid metabolism". Ro Thorpe 02:19, 28 September 2010 (UTC)

Complementary and alternative medicine. I must confess that the homeopathic presentation in this article emphasizes the "alternative" and fails to give much on "complementary" uses other than general statements that some conventional physicians also use homeopathy. Actually, I prefer integrative medicine to "complementary", but I am honestly mystified on how, beyond the decisions of individual practitioners, what an integrative approach using homeopathy might be. Again, one of the problems is vagueness on the cognitive process in homeopathy, and how it might complement conventional methods rather than how terribly risky the conventional methods may be. 02:55, 28 September 2010 (UTC)

Howard, for the record, I too do not agree with Ramanand's statement about including "all" points of view. I do not always feel compelled to respond to everything that someone here says...sometimes, just giving it the silent treatment is sometimes the best response. Dana Ullman 02:54, 28 September 2010 (UTC)

Government and Institutional Assessment

Friends, this section is seriously problematic for several reasons. First, this government report was advisory only in nature, and government chose to not agree with the Report. Perhaps of even greater significance is the fact that the House of Commons' Science and Technology Committee is composed of 14 members, and yet, THIS report's majority vote was only THREE members. Ironically, two of these three votes were such new members to this Committee that they did not even attend a single hearing for this Report. The third vote FOR the Report was from Evan Harris, a politician whose strong antagonism to homeopathy is immense, and he got voted out of office by a 20-something person who was a political virgin. My point here is that this Report had no significant impact on government policy, and it is even hard to say whether or not this Report was meaningful in any way. I suggest that we either highlight the above points OR that we simply delete reference to this relatively insignificant report. Dana Ullman 02:50, 28 September 2010 (UTC)

And only Her Majesty's Government has expressed an opinion on homeopathy? Howard C. Berkowitz 02:55, 28 September 2010 (UTC)

Howard, on your user page, you wrote:-

There is a great deal of valuable information on networking at Wikipedia. There is also a great deal of misinformation, partially due to networking experts leaving in frustration with the process of having authoritative definitions constantly changed by editors who found their high school or college textbook conflicted with primary sources or direct experience in developing networks and primary sources.

Therefore, networking engineers should have a greater say on network engineering here on CZ and homeopaths a greater say on homeopathy.—Ramanand Jhingade 15:32, 28 September 2010 (UTC)

The statement above might have more merit if the homeopaths confined their presumably expert contributions to homeopathy, and stayed out of trying to explain such fields as medical pharmacology. When a homeopath tries to support homeopathy by explaining that vaccinations are really based on the principle of similars, rather than the immunologic methods that were actually used in designing a particular immunotherapy, a therapy that can be replicated consistently in vivo, and in vitro at the molecular level, it is nonsense and I will call it that. I am indeed a network engineer, but have spent 40-plus years in clinical decision systems, especially in pharmacology. My first research project was on competitive inhibition of beta-lactamases (penicillinases) in penicillin therapy.

Since homeopathy does not routinely use scientific methods or the models of molecular pharmacology, a homeopath has no particular qualifications to comment on them. There have been some egregious errors made by homeopaths, usually in a condescending context of how I misunderstand homeopathy, such as homeopaths consider germs and defenses but physicians only consider germs. I gave a long list of wikilinks to articles on how, variously, drugs support bodily defenses, suppress hyperactive defenses and work on indirect defenses of the germs. Would you care to add useful commentary, for example, to the article on New Delhi metallo-beta-lactamase-1, which does need some tuning to adjust for the Verona strain? Of course, there must be a homeopathic medicine that laughs away multidrug resistance and will promply cure a raging infection.

Alas, it must be my poor Internet skills that cause me not to find all the undoubted homeopathic activity in the public health aspects of infectious diseases. Silliness, I'm sure, that I receive several emails per day from the International Society for Infectious Diseases, trying to stay ahead of epidemics. Isn't that a silly organizational name? I think they are really trying to say International Society against Infectious Diseases.

Indeed, it would be helpful if homeopaths here did not try to bring all of alternative medicine into the article. Being told that naturopaths call biologically based physicians "allopaths" is as informative, in an article on homeopathy, as the statements of network engineers on the subject. It would be helpful if some homeopaths understood that osteopathy and osteopathic medicine have quite different training and qualification. Howard C. Berkowitz 15:45, 28 September 2010 (UTC)

It is not "relatively insignificant"! It was a serious evaluation by an official body. Both it and the British Medical Association criticisms should be quoted sufficiently to make their position clear. Of course we should also say that the government chose to ignore these and homeopathic remedies are still funded on the National Health.

None of Dana's attempts to discredit the report — discussion of who voted for it etc. — are at all relevant, and they need not be mentioned. The analysis and report writing were done by staff with access to extensive data. Their conclusions, and the fact that the committee but not the Minister accepted them, are all we need to show. Sandy Harris

Discussions of Evan Harris' political defeat are irrelevant in this context. The report was produced by the House of Commons committee and that is that. You don't like the result of the report (as to be expected), but the article should contain discussion of it, along with other reports from other governments and medical groups. The report is significant in the sense that it has been produced by the government and has been widely reported by the media. I'm perfectly happy if you can find a decent source that explains the objections that homeopaths have to the report to include it as a footnote.

The fact that the government then didn't accept the report doesn't negate the report any more than one's failure to cease smoking in spite of advice from one's doctor is a negation of that advice. I'm perfectly happy to include the reasons they didn't accept the conclusions of the report too: it wasn't because they rejected the scientific conclusions of the report, but because they decided that patient choice was more important than those scientific conclusions - i.e. they think patients should have access to homeopathy in spite of the poor evidence of efficacy. The government also decided to push the decision down the political chain to the Primary Care Trusts, an institution which will soon be replaced - but that is because politicians, when given any hot potato will first do anything they can to pass it on. Saying the PCTs should make the decision is much easier than making a decision which you may be held accountable for! –Tom Morris 10:15, 28 September 2010 (UTC)

Whether anyone of us agrees or disagrees with the Committee's Report, it does NOT deserve as much space as has been written about it in the article. In any case, there DOES need something to be said about what I mentioned above about the "majority" vote above, about the two newest members to the Committee who were added AFTER all of the hearings were completed, AND about the voting out of office of Evan Harris (because this vote speaks to what the people think about Evan Harris and his advocacy against homeopathy and against people's choices in health care. I plan to add this material shortly to the article, but I am hoping that someone else will consider editing DOWN this over-blown section, especially because this Report was only advisory in nature...and was not accepted by the govt.

Howard suggests that we also provide information about other governments' reports on homeopathy. Sure, I'm open, but I don't know of any other such reports, at least not off the top of my head. Dana Ullman 13:46, 28 September 2010 (UTC)

We could add the British Medical Association:

Dr Tom Dolphin, deputy chairman of the BMA’s junior doctors committee in England told the conference: “Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London] there is a National Hospital for Homeopathy which is paid for by the NHS”.[2]

Or Japan [3]

Or the US National Council Against Health Fraud:

Homeopathy's principles have been refuted by the basic sciences of chemistry, physics, pharmacology, and pathology. Homeopathy meets the dictionary definitions of a sect and a cult--the characteristics of which prevent advances that would change Hahnemann's original principles. Most homeopathic studies are of poor methodological quality, and are subject to bias. ...

The NCAHF advises consumers not to buy homeopathic products or to patronize homeopathic practitioners. Basic scientists are urged to be proactive in opposing the marketing of homeopathic remedies because of conflicts with known physical laws.

That's what I found in a few minutes web search. No doubt there is more. Sandy Harris 15:15, 28 September 2010 (UTC)

As one of an eclectic spirituality, knowing it is faith-based and beyond proof, and that contains Jungian archetypes drawn from earth religions, I am bothered by the slur on witchcraft.  :-) Howard C. Berkowitz 16:43, 28 September 2010 (UTC)

To make the homeopaths objections for them, the NCAHF isn't really on the same level as a government or a medical institution like the BMA. It is a small band of skeptics (and I use that word proudly as a skeptic and someone who knows their Agrippa from their Dawkins) running a pressure group. It doesn't really count as an institutional assessment, nor would another minor pro-homeopathy group like, say, the British Homeopathic Association compared to the British Medical Association. This may seem cherry-picky, but basically the sort of standard I was hoping for in the section would be governments (that is obvious enough) and major medical bodies like the BMA, AMA and other national medical bodies that have repute within mainstream scientific medicine. Frankly, any sane reader will know that homeopaths support homeopathy and that skeptical groups like NCAHF do not. Part of the reason why I included the House of Commons select committee report is that it included numerous discussions from bodies like the Royal Pharmaceutical Society of Great Britain - who (sadly, in my view) aren't quackbusters but are a well-respected representative body of a branch of mainstream medicine.

As to Dana Ullman's post: Evan Harris' defeat in the 2010 election is not the subject of this article. That should be the topic of the "Evan Harris" article where editors in British politics can discuss the multiple reasons why Harris lost his seat to a "political virgin". It may have something to do with his stance on alternative medicine, but Harris also advocated a number of other causes including gay rights, being pro-abortion rights, supporting David Nutt when he was sacked by the government, for secularism and most importantly animal rights (Harris supported animal research). I can't recall reports of Harris' constituency being filled with advocates of homeopathy; it was filled with animal rights campaigners. Of the issues which were pushed by Harris' opponents, alternative medicine and homeopathy were not high on the agenda - animal rights and euthanasia were much much higher. Again, this is irrelevant to this article but is of great relevance to the article on Evan Harris. –Tom Morris 18:48, 28 September 2010 (UTC)

While Matt's point is well taken that a specialist in a narrow discipline might only write on that topic, Tom, you have just helped me articulate a concern. Just as I observed that homeopaths are not assumed to be experts on molecular pharmacology, had some homeopath developed a Citizendium track record of writing sensible articles in molecular pharmacology, such a person might have much more credibility in this article. To take your example, had some homeopath have written extensive separate articles on British politics, which passed the review of Politics editors, I'd have to give their criticism more credibility. Going back to Matt's arguments, if the specialist chooses to comment outside their identified specialty, their comments become fair game for critiques by people that have demonstrated knowledge of the subject. It's one thing to make general comments about "germs", and it's another thing to comment on them after you've developed more than a few articles on infectious disease, antibiotics, and antibiotic resistance.

British politics, indeed, are no more the subject of this article than is naturopathy and what it thinks of conventional physicians. "Osteopathic physician" and "osteopath" are not synonyms; what a UK osteopath considers an allopath is irrelevant to this article, although there is some real history between allopathic and osteopathic physicians. Of course, if one brings up the latter, one must not leave out that osteopathic physicians in the US take the same qualifications as allopathic physicians, which jointly are identical to conventional medicine, must one? Howard C. Berkowitz 19:32, 28 September 2010 (UTC)

Sandy...yeah, the NCAHF is not a governmental agency nor an "institution." I'm a little confused and surprised why you'd even suggest it, even though you did later acknowledge that it may not have been appropriate...but still, I am concerned that this strange suggestion was even made and not completely withdrawn.

Your reference to Japan was not a workable link, and as far as I know, there was NO Japanese government agency OR an institution that made any statement about homeopathy...it was just a single Japanese doctor. Sandy, can I ask you to try to show more inner editing and more academic credability to your posts here? I hope that you take this suggestion in the constructive way in which it is offered.

The BMA did refer to homeopathy as "witchcraft," though if anyone actually adds this reference to this article, a short statement about the history of individuals, organizations, and churchs' witch hunts will also need to be noted because there is a consistent fact about witch huts: whenever people or organizations with an agenda hunts for witches, they find them! As such, I don't have a serious problem with referencing the BMA's actions because I think that it reflects more on THEM than on homeopaths. To me, it was one of the most blatant forms of 1984-speak in medicine that I've seen in a long long time.

It is my hope, however, that CZ strive to be encyclopedic rather than to reference every wacko statement, even if that wacko statement is from the BMA. Dana Ullman 01:29, 29 September 2010 (UTC)

Most witches I know these days have very nice huts. Neverthless, I'll claim both neowiccan and Unitarian beliefs; no one will bother me by calling me a witch but I would be offended to be called either an allopath or a homeopath. I can easily accept complementary spiritual therapy in a shamanistic or Wiccan tradition, but I don't confuse it with anything other than psychosomatic medicine, or transpersonal psychology.

While I try to follow the Wiccan Rede ("An it hurt none, do what thou wilt") in personal life, that's not a very good rule for an encyclopedia.

Very seriously, I do not see much possibility of agreement between homeopathy and biologically based medicine, and this article would be better served to recognize this rather than continue the attack-counterattack. Now, I'd appreciate the homeopaths being clearer about what and why they do things, but I've given up on getting specificity. In that case, I would much appreciate that the homeopaths stop trying to explain medical treatments according to their models -- especially when the person making the comment does not make it in a manner suggesting deep understanding of the medical models involved.

Make no mistake -- I'd like to see this article deleted. The fighting is a disgrace, shows no indication of ever resolving, and is unique in hostility in CAM discussions. Regardless of ideals about inclusion, it is a matter of triage -- this article, in my direct experience, is a major reason that some individuals will not join Citizendium. Since the primary homeopathic contributors to this article do not contribute elsewhere, treating it in economic terms, it is a net loss to Citizendium.

A lede that stated the core principles of homeopathy and accepted that it is anathema to biologically oriented health scientists would move the discussion along. Homeopathy is going to be, in good conscience, attacked just as much as was the premise in Ormus or Apollo moon landing hoax. Deal with it, and recognize things that homeopaths perceive as "attacks" will not stop. Where one contributor complains that there must be no attacks on alt med, there is much stronger sentiment that having an "alt med" workgroup with allegedly independent expertise was a terrible mistake. Workgroups in general have proved awkward, but more than one Editorial Council candidate has abolition of Healing Arts as a high priority. There wasn't remotely such hostility over other CAM topics. I wonder why? Howard C. Berkowitz 01:54, 29 September 2010 (UTC)

Thesauruses (thesauri) and web-sites on the net say that witchcraft and sympathetic magic are synonyms and so I'd like that term also to be deleted from the article. If Tom Dolphin and some other skeptics read my user page at User:Ramanand_Jhingade, they will certainly declare that I'm a wizard, for all the things I do, but if they burn me at a stake, I promise to haunt them for the rest of their lives.—Ramanand Jhingade 16:42, 2 October 2010 (UTC)

As a person whose spirituality includes earth religions, I tend to consider casual use of burning at a stake about as fully as suggesting a refreshing breath of Zyklon B to a Jew. If one describes witchcraft (e.g., by Starhawk) by neo-Wiccan concepts, humility is a starting point, and there is very little of it, Sir, in your website. Many modern witches refer to the persecution and democide during the Middle Ages as "the Burnings", in the same tones as "the Holocaust".

I find the conclusion that Citizendium cannot create a high-quality article on homeopathy to be well established, and support the proposal to cut it after a perhaps edited lede, Approve it, and, in the interest of sanity for everyone but the homeopathy proponents, take at least a six month moratorium. Alt med is not being attacked. Homeopathy is being attacked, and, in my opinion, for good reason. Sympathetic magic as expressed in shamanism is a better example of psychosomatic healing than is Wicca, which is not especially healing-oriented -- health maintenance, yes, but much of what appears to be some of the classical hedge witch healing appears to have a large component of herbalism, but with no use of the principle of similars and certainly not homeopathic dosing.

Unitarian-Universalism specifically accepts individual spiritual choices involving earth-oriented and neopagan archetypes. The difference might be that a modern witch might fight back a bit more effectively. Consider me a witch and burn me -- if you can.

Given the spiritual concept that an act reflects threefold on the actor, witches don't curse or use harmful invocations. Howard C. Berkowitz 17:19, 2 October 2010 (UTC)

So you agree that skeptics are witch hunting and that you and me could be declared to be wizards! We, therefore need to avoid terms like witchcraft and magic in this article.—Ramanand Jhingade 15:14, 4 October 2010 (UTC)

Actually, "witch" is the correct term for both male and female neo-Wiccans. "Wizard" is either slang, or perhaps usage from the OTO and Crowley.

Magic, however, is a well-defined anthropological term. Please read the sympathetic magic article to find substantial sourcing on this specific term; sympathetic is not the only anthropologically recognized form of magic. Some authors use "magic" to refer to stage illusionism and "magick" to refer to things that actually are intended to accomplish something. In modern Wicca, the term "magic", with or without a k, isn't used very much. It would be more likely to hear "working" to describe a ritual. Nevertheless, a working is usually more of an invocation to focus imagery of the group. Some regard it as a prayer, either to archetypes within it or to actual deities.

Most workings do not use sympathetic magic, although it is interesting to consider whether Jungian archetypes have some aspects of similarity -- see Carl Jung, Man and his Symbols.

Wiccans rarely use "witchcraft", often reserving that for workings with malicious intent. That's the problem, Ramanand, of potentially offending dark witches -- as opposed to homeopaths, they just might turn you into a toad. Howard C. Berkowitz 21:41, 4 October 2010 (UTC)

Suggesting a new strategy for this article

I suggest we delete all the text of this draft article after the end of its current lede. Keep the subpages. Let the reader follow up on his/her own based on the leads in the bibliography and other subpages.

I consider doing that in lieu of having no article at all on homeopathy in Citizendium. Anthony.Sebastian 07:03, 29 September 2010 (UTC)

By "end of lede," do you mean the several paragraphs before the "Principles" header? Howard C. Berkowitz 08:07, 29 September 2010 (UTC)

Yes, Howard, all the paragraphs in the so-called intro, everything that shows up when one clicks 'edit intro'.

By way of supporting my suggestion, I call attention to the fact that the respected Encyclopedia Britannica Online devotes three paragraphs to 'homeopathy', giving the reader leads for further information on the subject. See below for their treatment:

From Encyclopedia Britannica Online:

"homeopathy, also spelled Homoeopathy, a system of therapeutics, notably popular in the 19th century, which was founded on the stated principle that “like cures like,” similia similibus curantur, and which prescribed for patients drugs or other treatments that would produce in healthy persons symptoms of the diseases being treated."

"This system of therapeutics based upon the “law of similars” was introduced in 1796 by the German physician Samuel Hahnemann. He claimed that a large dose of quinine, which had been widely used for the successful treatment of malaria, produced in him effects similar to the symptoms of malaria patients. He thus concluded that all diseases were best treated by drugs that produced in healthy persons effects similar to the symptoms of those diseases. He also undertook experiments with a variety of drugs in an effort to prove this. Hahnemann believed that large doses of drugs aggravate illness and that the efficacy of medicines thus increases with dilution. Accordingly, most homeopathists believed in the action of minute doses of medicine."

"To many patients and some physicians, homeopathy was a mild, welcome alternative to bleeding, purging, polypharmacy, and other heavy-handed therapies of the day. In the 20th century, however, homeopathy has been viewed with little favour and has been criticized for focusing on the symptoms rather than on the underlying causes of disease. Homeopathy still has some adherents, and there are a number of national and international societies, including the International Homoeopathic Medical League, headquartered in Bloemendaal, Neth."

[unindent] It did not escape me that a small dose of 'homeopathy' seems harmless, and might also seem therapeutic. Anthony.Sebastian 14:52, 29 September 2010 (UTC)

Britannica is very, very gentle, essentially stating it as a 19th century issue and then mentionining "criticism" in the 20th. If, however, it closes this article, I might agree to forget we are in the 21st and the criticism is greater -- and that homeopaths seem to attack medicine even more, in spite of more evidence agaisnt it having any reasonable theoretical basis other than psychosomatic medicine. Howard C. Berkowitz 15:29, 29 September 2010 (UTC)

Homeopathy belongs at Citizendium. Stick to the facts of how it started, the usual range of practitioners, and leave it that. I don't think the article needs to go into the specifics of medical treatments using homeopathy as the article could go on forever...BTW I do not believe that Homeopathy offers much but it COULD offer some medical relief. For example my Great-Grandma suggested using peppermint tea to help my colic when I was an itty bitty baby. The tea did soothe my colicky tummy. That is a form of homeopathy that worked. Scientists and medical researchers are beginning to find a lot of plant based folklore medicines may actually provide medical cures once they are formulated to exact manufacturing standards. Citizendium is an encyclopedia that is supposed to cover all subjects, even if some of the subjects may not always be "scientific". Another good example of this is apparitions. Apparitions, ghosts or spirits have been reported before Biblical times. In fact, the disciples of the Jesus saw Jesus appear as an apparition. There is a lot of anecdotal evidence but not much scientific evidence supporting apparitions. Not much "scientific" proof but an awful lot of historical evidence and many people who have reported such things. Mary Ash 18:28, 29 September 2010 (UTC)

Adding some comments here: My Jesus comments are not religious based they are historically based. You can approach topics as history and not as a statement of faith. So please don't take me task for using this example.Mary Ash 18:48, 29 September 2010 (UTC)

I agree, "Homeopathy belongs at Citizendium". My suggested strategy did not indicate otherwise. I maintain that the history of development of this article indicates CZ cannot come up with a Main Article that meets the highest standards of CZ. Let us go with the several paragraphs of the Intro, delete the rest of the text below that, and keep the subpages. We will then have an article on homeopathy that gives the gist of the subject, plus sufficient leads in the Bibliography and other subpages to allow the reader to pursue the subject on her/his own. If we can succeed in getting approval for that, we can replace the current approved version, and move on to other work. Anthony.Sebastian 19:55, 29 September 2010 (UTC)

Yes. And put this in lockdown for a while. Enough, already. Aleta Curry 21:00, 29 September 2010 (UTC)

I agree. Ro Thorpe 21:18, 29 September 2010 (UTC)

While ghosts, spirits, and apparitions are appealing as explanations for homeopathy, since they are as plausible in scientific terms as the homeopathic speculation, anecdote is not the singular of validated data. My strong suspicion is that a new EC will not consider apparitions any more favorably than homeopathy, moon landing hoaxes, Ormus, etc.

Mary, Citizendium has never been an encyclopedia intended to cover all subjects. Wikipedia may have that role, but I won't work for an encyclopedia that operates on that assumption of coverage. If an Editorial Council were elected that held such a position, you'd see a massive exodus of participants, and likely the end of Citizendium. I'd suggest that before telling people with several years experience here what Citizendium should do, some more experience is in order. Nowhere in the Charter is there a requirement to cover everything.

"Enough, already", is a minimum requirement. Homeopathy, in particular, is to Citizendium as Watergate was to the Nixon Administration: a cancer on the Presidency that is a useless resource sink while we are in disaster-plan triage. Howard C. Berkowitz 21:58, 29 September 2010 (UTC)

Howard straight from the CZ FAQ: See also: CZ:Why Citizendium?

The world needs a trustworthy free encyclopedia. We aim to create that by providing a responsibly governed global community where real-named contributors work under expert guidance and all are accountable

Definition of encyclopedia straight from CZ: An encyclopedia (less frequently spelled encyclopaedia) is a book, a collection of books, or electronic media, that contains comprehensive information regarding all human knowledge or in a particular field, and is used for reference purposes. Famous encyclopedias include Encyclopaedia Britannica Eleventh Edition (1911), Encyclopaedia Britannica, Encarta, World Book, Encyclopedia Americana, Wikipedia and Citizendium. Many specialized encyclopedias have appeared, such as the Catholic Encyclopedia and Jewish Encyclopedia. Since the 1990s electronic publication has increasingly replaced print. Indeed there has never been a print version of Encarta, Wikipedia or Citizendium.

So Howard are you telling me that CZ does not plan to be an encyclopedia? Mary Ash 22:41, 29 September 2010 (UTC)

I certainly don't consider myself part of an encyclopedia that meets your simplistic definition. Fire me.

No, I'm telling you that you don't understand that the only normative document, at this point, is the Charter, not the FAQ. Further, without looking where you got that definition, is it in an Approved article? If so, it is non-normative. If it's in CZ space, it's open to Council review.

Further, the "Online Compendium" is used in other places. Your examples are inconsistent; something like the Kirk-Othmer Encyclopedia of Chemical Technology does not attempt to cover baroque music.

I'm further telling you that I tend to trust people who have been here (gasp) as long as a year more than relative newcomers in lecturing me on mission. Want to match articles? Did I fire five or six rounds from this here .44 Magnum? Howard C. Berkowitz 22:52, 29 September 2010 (UTC)

Questioning putting the NCCAM Report on Homeopathy into a Signed Article subpage

The NCCAM Report on Homeopathy, a National Institutes of Health division report, does not seem to qualify as a 'signed article' any more than single or multi-authored research report of a literature meta-analysis would so qualify.

Why not put it into an Addendum subpage? Anthony.Sebastian 20:27, 29 September 2010 (UTC)

Does the licensing allow that? Why not just link to it, and quote it as necessary, instead? Sandy Harris 08:25, 3 October 2010 (UTC)

It's federal government official report in public domain. It's part of the argument, not opinion, and requiress explicit inclusion as data relevant to the topic. It should not be squirreled away. Anthony.Sebastian 22:20, 3 October 2010 (UTC)

Rewrite?

Some time back, I rewrote memory of water completely, reducing its length by more than half. I feel that this article has the same problems — somewhat incoherent and rambling, quite repetitive, and seriously biased — and needs much the same treatment.

I have a sandbox version at User_talk:Sandy_Harris/Homeopathy. So far, I have rewritten only the lede. Anyone care to comment on that? Should it replace the current draft lede? Sandy Harris 08:39, 3 October 2010 (UTC)

Well, taking it one step at a time, I agree that your version is an improvement over both the current approved version and the draft version. I would be in favor of replacing the draft version with your version. D. Matt Innis 11:31, 3 October 2010 (UTC)

One step at a time is good, and you have improved it. Let me give some preliminary thoughts, as I have to go out in a few minutes, and also am still thinking about the second paragraph. Matt may have some specific terminology thoughts, especially regarding vitalism.

Second paragraph, with my underlines: Homeopathic remedies are intended to stimulate the body's natural healing processes. Homeopathy aims more at healing the patient by restoring balance than at treating the disease. Hygiene and diet are stressed as well as the use of homeopathic remedies. The rationale often involves discussion of "vital force"; in this homeopathy has much in common with other vitalist thought, from the Chinese qi (see Qi gong) and Japanese ki (see Reiki and Aikido) to Indian prana.

I won't say that biologically based medicine absolutely rejects the underlined sections, but, as phrased, they are clearly homeopathic and vitalist terminology reflecting a generally nonbiologic paradigm. Let me address "the body's natural healing processes" from a biomedical standpoint:

• There may be a general healing process, but it it doesn't exist in the patient: This is especially characteristic of genetic diseases such as cystic fibrosis, but also in situations such as Type I [[diabetes mellitus[[ where the insulin-producing islet cells have been destroyed (possibly by a malfunctioning immune process)
• There can be natural healing, but it needs time to develop -- time the patient may not have: An example here is tetanus in a patient who has not received prior immunization. Treatment has multiple parts, but among the first is replacing the absent defense ("passive immunization) with human tetanus immune globulin, while also administering tetanus toxoid to instruct the immune system to produce its own antitoxin.
• There is no specific healing process:This is especially important when there are time-limited treatments to reverse damage, such as Thrombolysis In Myocardial Infarction.
• (merging into the next) There is a healing process, but it has become hyperactive and essentially has become the disease, or is "out of balance": a wide range of autoimmune disease, CD4+ but not CD8+ T-lymphocyte syppression in AIDS, septic shock and a wide range of diseases involving overexpression of tumor necrosis factor-alpha (a very necessary defense mechanism in other diseases)

I'll try to have better text later today, but these may give an idea of my concern. Either make it clear these underlined ideas are homeopathic concepts -- this could just be an introductory sentence and internal wikilinks to discussion -- or find more general terms. I'd probably prefer the former, as quite a few terms with nuanced homeopathic assumptions sound, to a layman, like ordinary words or perhaps things that are accepted by biomedical thinking. --Howard C. Berkowitz 13:41, 3 October 2010 (UTC)

I cannot see why this might be objectionable. I would think that "Homeopathic remedies are intended to ... Homeopathy aims more at ... than ..." makes it reasonably clear that homeopathic views are under discussion. Hence, "homeopathic and vitalist terminology reflecting a generally nonbiologic paradigm" is entirely appropriate here.

One thing I am quite deliberately trying to do is to separate the homeopathic view and the criticism in hopes both can be clearly stated. Some of the critics would insert "which has no scientific support" after nearly every assertion of homeopathic theory, even in the definition. On the other hand, Dana could not accept the simple statement that "To the critics, there is no plausible explanation of how the remedies might work ..." without inserting some weasel words about proposed explanations. "A plague on both their houses!", say I. Give straightforward presentations of both the homeopathic viewpoint and the criticism; don't complicate either one with irrelevancies. Sandy Harris 14:20, 3 October 2010 (UTC)

Let me try a little more, which might be in a "homeopathic definitions" section immediately following the lede. Definitely consider the writing as needing work.

• Homeopaths believe there is a natural wisdom of the body, and that the body has a set of natural healing processes that will relieve symptoms if strengthened by homeopathic treatment. Biologically oriented practitioners disagree that there is any system "wisdom of the body" and that there are body defenses that will work against all malfunctions of health. (some practitioners, looking at autoimmune diseases or things such as cachexia and paraneoplastic syndrome might say the body can be pretty damn stupid.)
• I'm not sure I want to draft this, but as far as I can tell, homeopaths largely reject etiologic and pathologic explanations of disease, preferring to refer to balancing or strengthening wisdom. This is another area where there has been weasel wording. Early statements seemed to suggest that germs were largely rejected as a cause, although challenged on that, Mr. Ullman came back with a comment that physicians are concerned only with the germ but homeopaths consider both the germ and the host defenses. I came back with a long list of wikilinks to drugs that enhance host defenses in infection, which was not answered. Howard C. Berkowitz 16:46, 3 October 2010 (UTC)

The above:

• Homeopaths believe there is a natural wisdom of the body, and that the body has a set of natural healing processes that will relieve symptoms if strengthened by homeopathic treatment.

Homeopath's believe that the body has a set of 'natural healing processes' that will be strengthened by homeopathic treatment and therefore be better able to fight whatever the cause of the disease - germ or otherwise. They only use the symptoms to determine the treatment to use. The symptoms then reduce because the cause is gone. D. Matt Innis 17:24, 3 October 2010 (UTC)

Sandy says "Some of the critics would insert "which has no scientific support" after nearly every assertion of homeopathic theory, even in the definition.". I took a look at that idea.

The talkpage for the homeopathy definition shows that in early 2009 the definition was discussed and a final version agreed to and implemented by a healing arts editor. That version clearly said that most mainstream medical doctors and scientists, particularly those in the West, do not accept this. Was that cleverly inserted by a critic? No, by the man "widely recognized as the foremost spokesperson for homeopathic medicine in the U.S.".

That version lasted eight months until Russell Jones, who is not the man "widely recognized as the foremost spokesperson for homeopathic medicine in the U.S.", decided to remove the part that said most medical doctors and scientists, particularly those in the West, do not accept this with the edit summary "removed irrelevant comment from definition". If that was a critic inserting "which has no scientific support" then he took an unusual approach.

Note at this point that while the foremost spokesperson for homeopathic medicine in the U.S. took to the talkpage to add information about the lack of scientific support for his own profession, Mr. Jones does not seem to have done so to remove it (although I could be wrong, discussions do tend to become decentralized here).

Three months later the definition was "rephrased for netrality" with "has no scientific basis", an edit that was reverted eight months later in September of this year by Ramanand Jhingade with the edit summary "Pls see http://en.citizendium.org/wiki/CZ:Definitions - we don't need additional comments". Quite why Ramanand didn't pick up on the comments sooner, what with the E.S.P. and all, remains a mystery.

What is also unexplained is why CZ:Definitions didn't prove more of an obstacle during the original discussion that led to the eight-month-stable version that was agreed upon by a healing arts editor. Anyway, Ramanands version was quickly updated by Daniel Mietchen with "contrary to scientific evidence", by which time Sandy Harris took over and, without edit summary or discussion on the talkpage (again with the caveat that discussion may have taken place elsewhere), removed all mention of science.

Sandys final edit, five days later, came with the summary "apprximately Dana's phrasing" however what phrasing that is remains unclear, but certainly not his last edit to the definition, nor contribution on the talkpage.

That version was further sanitized by Ramanand (or "shortened" if you prefer) before the recent attempts by Anthony Sebastian to re-insert mention of science in there.

So, "Some of the critics would insert "which has no scientific support" after nearly every assertion of homeopathic theory, even in the definition." is in actual fact, Some of the supporters would remove all mention of science from the definition. Let's just go back to the original version that was discussed on the talkpage and agreed to, by a healing arts editor, before all this occurred. David Finn 00:26, 4 October 2010 (UTC)

Dave, I was fast enough that the coffee didn't spray into the keyboard. Howard C. Berkowitz 00:52, 4 October 2010 (UTC)

Dana accepted that, but he did not insert it. Sandy Harris 01:31, 4 October 2010 (UTC)

The discussion was archived. Talk:Homeopathy/Archive_13#Definition. Sandy Harris 01:31, 4 October 2010 (UTC)

Susceptibility

Matt, homeopaths believe that only people susceptible to infections can get infected by a virus or bacteria, not a healthy person. For example most people harbor staphylococci and streptococci, but not every one of them goes into 'septicemia'.

David, I promise to apply to become a healing sciences editor and make more time for this article from Dec. 2011, but I don't have the time to keep posting here now (I'll post a sentence or two if I'm really irritated by something). My 2 cents - http://en.citizendium.org/wiki/CZ:Definitions says the definition should be short and concise, so we don't need additional comments like what's been added to the definition at the top of this Talk pg. now.—Ramanand Jhingade 15:47, 4 October 2010 (UTC)

It is an error to assume that simply because staphylococci and streptococci live in a commensal state, that all strains are identical, or that there aren't scientific reasons for infection. At the most basic, they may invade only when the skin is broken. There may be other influencing factors, such as suppression of ordinary intestinal flora by appropriate antibiotic therapy (e.g., clindamycin for methicillin-resistant Staphylococcus aureus) leading to an overgrowth by Clostridium difficile. This is not a condemnation of treating the MRSA; antibiotic-associated pseudomembraneous enterocolitis is simply a side effect to which practitioners need to stay alert. If it develops, it can be treated; the usual preferred therapy is oral metronidazole. this is another example of a cognitive process.

Those nasty little germs also change, as with horizontal gene transfer conferring new infectivity or antibiotic resistance mechanisms.

Susceptibility is also, for some pathogens, mediated by specific host genotypes, not handwaving. Opportunistic infection may also relate to depletions of laboratory-demonstrable protection mechanisms, such as CD4⁺ T-lyphocytes in AIDS.

Please do not make assertions about how biomedicine works without an understanding of the subject. Howard C. Berkowitz 21:52, 4 October 2010 (UTC)

The point I was trying to make was that homeopaths believe that only people susceptible to infections can get infected by a virus or bacteria, not a healthy person; I understand how biomedicine works, but don't have the time to argue with you (the Homeopathy course in India is like the Osteopathy course in the US - we study subjects the MD studies, plus the Homeopathic subjects).—Ramanand Jhingade 14:23, 17 October 2010 (UTC)

Whether we go with Sandy's sandbox lede or the draft's current lede, lets delete the remainder of the article

Whether we go with Sandy's sandbox lede or the draft's current lede, lets delete the remainder of the article.

For the reasons I've given previously, and because this group cannot get beyond inclusion of advocations of pseudoscience. Anthony.Sebastian 22:27, 3 October 2010 (UTC)

My intention is to rewrite the whole thing, probably shortening it drastically in the process and certainly getting rid of some pseudoscience. However, I'm busy with other stuff, so that's not likely to be done quickly. Anyway, I'd rather be working on other articles. I'm only editing here because it seemed the only way to eliminate a blot on the CZ landscape.

I would not go quite as far as Anthony's suggestion. There is some good material in the article which I think is worth saving; mass deletion strikes me as throwing the baby out with the bath water.

However, I'd encourage massive editing. I think the article badly needs that. Sandy Harris 03:33, 4 October 2010 (UTC)

Actually, I give up. Looking at it in detail, this is not something I can rewrite adequately. The article is enormous, complex and out of my field. Rewriting it well would require more effort from me than I want to invest. Perhaps someone else has more relevant skills, more time or more interest? If so, they might rewrite. Sandy Harris 06:30, 4 October 2010 (UTC)

I don't know if homeopathy includes surgery -- I'd suspect not -- but I think Anthony is right in his approach to triage. While it has been suggested, as by Mary, to work out common ground, there really isn't any, among the available participants. We might get through the lede, but the detailed arguments over trials, the repeated attempts to describe medical treatments in homeopathic terms, and, at least for me, so much emphasis over 19th century methods that have not significantly changed. In my library is a cherished 1934 book called Modern Office and General Practice, which I like because I can't find a single efficacious treatment in it. Medical knowledge, when I last looked at the MEDLINE trends, doubles every seven years. In over a century, if homeopathy were so superior, could it have been so hidden? Extraordinary claims require extraordinary proof.

Perhaps Cold Storage for the sections past the lede. Howard C. Berkowitz 08:33, 4 October 2010 (UTC)

It may be worth noting in this context that the posting of many doctors to the front in the 1st World War resulted in more babies delivered by midwives instead, which actually improved outcomes. Peter Jackson 09:44, 4 October 2010 (UTC)

I want to go on record asserting that no one should delete large portions of this article without clear consensus, and at present, there is no clear consensus for such actions. Various editors put hours and hours of time and expertise into each section. Please respect these contributions. Please also remember that just because you don't understand or "believe" in homeopathy does not give anyone to right to delete verified and reliable statements of fact and evidence.

I also want to say that I find some humor in Howard's statement above about that 1934 book. In 1978, I received my MPH from UC Berkeley, and I can guarantee that Howard (and others) would find very little proven efficacy of treatment in the vast majority of medical treatments of that era...and in a decade or two, we will probably all say the same assertion about medical care of 2000...and then 2010...and on and on, until we start understanding the difference between symptom and disease suppression as compared with real healing (but this is a subject for another article and time)... Dana Ullman 21:13, 4 October 2010 (UTC)

First, consensus is not unanimity. Invoke it too often, when a majority is getting increasingly frustrated, the results may not be what one wants.

Ah, your sense of humor. I suppose I can go and look at Goodman & Gilman and list things introduced in the 1970s, but two things are apt to come out. First, there are things introduced then that still have efficacy. Second, there has been continuous improvement in medical treatment, because biomedical types recognize they keep learning. They rely very little on 19th century references.

It's interesting that you mention the seventies. My mother died, in 1975, of metastatic breast adenocarcinoma. Had her disease happened about six months later, she would have had the postoperative low-dose CMF adjuvant chemotherapy rather than less effective adjuvant radiotherapy. For palliative therapy, the internists in her community hospital put her on the then-obsolescent Cooper 5-drug regimen. When a medical oncologist joined the staff, he switched to doxorubricin and she went into remission until the expected cardiac toxicity occurred. Doxorubricin is still a useful drug, but there's been hard work to synthesize others of the anthracycline class with reduced or no cardiac toxicity, rather than continuing to rely on largely static repertories. Mitoxantrone is an improved anthracycline, but by no means an endpoint.

If she had the same diagnosis today, she'd probably go on aromatase inhibitors with tamoxifen as a backup, the drug choice in part being made with genetic analysis. With these drugs, patients have a reasonable chance of dying of something other than breast cancer. The smug superiority expressed by "the difference between symptom and disease suppression as compared with real healing" suggests "we have all the answers and you are out to get us." Sir, my attitude toward your statement of difference is that one paradigm originates in the aft end of a male bovine, and one does not. The only difference between us is which goes into the bull.

There's no place for consensus between these diametrically opposed views, but there is room for it to be decided that homeopathy is a distraction and essentially supported here by two advocates. Incidentally, I prefer to be told what is, and is not, "encyclopedic", by people who have demonstrated experience and understanding of a wide range of subjects in an encyclopedia. --Howard C. Berkowitz 02:04, 5 October 2010 (UTC)

The Big Wheel Goes Round And Round

We've been here before you know. Check out Archive 7. Dr. Sanger explained how we might deal with this situation. Rather than link you to it, it is important and relevant enough to reproduce here. This is what Larry said in response to Hayfords suggestion that we simply delete the entire article for a year.

It's worth thinking about really. In the last couple of weeks, while the moratorium has gone on, I think the project has actually benefitted from our not having Recent Changes filled up with endless back-and-forth between partisans writing on Talk:Homeopathy, who chronically refuse to compromise or to hear the other side sympathetically. With the lack of anything like a neutral moderator who might try to rewrite the article in a way that will keep both sides happy, and none seems forthcoming (I can't make the commitment myself), it does look like we're stuck with endless debate or taking your advice, Hayford.

Here is what I would like us to think about, if we want to go down this path: what is the principle involved? How about this: "If (1) there is a dispute about whether an article is biased or not, (2) the dispute concerns the article from top to bottom (cannot be solved by tackling just one or two sections), (3) there is no neutral moderator who is willing and able to go through the whole article and essentially mediate the dispute, (4) no one side is at fault for being unreasonable, ignorant of rules, etc., and (5) the dispute seems intractable, i.e., after weeks (or months) of back-and-forth, no agreement seems reachable, then we move the article to a talk page for one year (or some similar lengthy period of time), protect it, and protect the talk page, where an ending date for the moratorium is announced. A Constable is contacted to unprotect the page after the prescribed moratorium.

Here's another question: what exactly is the primary purpose of moratoria? Is it to save the community from the wrenching process of an intractable and frustrating debate? Or is it to prevent one side from wearing the other side out, "winning" by default? The latter would be a very bad situation--it is de facto the way many Wikipedia disputes are handled, I think. If I were to support the rule, it would be primarily for the latter reason, rather than the former, but they are connected. This is not obvious, and is very interesting, I think, so I'll try to explain. I think the reason that Ramanand and Howard are going at it for so long is that our rules require debate about significant changes to articles--and therefore, if they stop debating, they in fact relinquish the authority to impose their edits on the other side. What small authority we have to make edits, in our more or less egalitarian system, is secured by the outcome of a rational debate rather than by expertise (although expertise can be used to make an end run around debate, in the right circumstances--and that's a CZ advantage, I think). If edit wars are to be decided by exhausting one side, then evidently, like it or not, we have the same "rule of the most persistent" that Wikipedia has. Now notice that if there were not the threat of losing through exhaustion, then there would not be intractable edit wars. Since matters in dispute are more or less informally decided by who wrote on the talk page last, to stop debating is to lose authority just by keeping silent--which is not only a little humiliating perhaps, it actually feels like you're being unjust to your own cause. That's why these debates are wrenching and heated; they are really power plays.

Hayford's notion of extending moritoria for a long time basically cuts the Gordian knot. Does it look like a dispute is intractable? Then (given the other conditions are met) we just take the article down. This would have the effect of making the disputants think twice about their (to me) very frustrating failure to compromise or think in terms of neutrality. They and their work will be penalized by not being displayed, if they fail to cooperate with each other. Moreover, I note that right now there is no such incentive to cooperate; our incentives are, rather, to disagree persistently with anyone who it seems cannot be expected to arrive at an agreement with us. A game theoretical analysis is probably in the offing here.

I must say that I concur. This is an encyclopedia, yet the Recent Changes are filled with edits concerning homeopathy. But this isn't the homeopathy encyclopedia. I suggest another moratorium, to last until the current elections are completed, at which point we as a community should decide if this article is currently more trouble than it is worth. Deleting all but the intro (which is already longer than many CZ articles) may be the only way to preserve the integrity of this encyclopedia. David Finn 07:08, 5 October 2010 (UTC)

We are the very model of a modern encyclopedia, so we should cut the Gordian knot with Occam's Electric Razor. One reason for curring it back to what, as you observe, is the length of many CZ encyclopedias, and taking a moratorium, is that, to pick an arbitrary number, in three or six months, there will be a functioning Editorial Council. Not to single out Healing Arts, but there's likely to be a fundamental change in the Workgroup model -- we may not have Workgroups at all. There will be a mechanism of dispute resolution. Hypothetically, one could have a Special Master or the like review this article, not from the perspective of homeopathy or medicine, but if there is any likelihood that the article will ever be more than an argument between two sides. We will, I hope, have policy for such situations. Maybe we will have pro- and anti-forks of a article. I don't presume the result, but at this time, the arguments are going nowhere closer to resolution. Howard C. Berkowitz 08:30, 5 October 2010 (UTC)

Yes, one of the things that I noticed from the archives is that Dr. Sanger had an opinion but didn't feel he had the authority to act on it. The new elections will empower people to act, and however they choose to act it seems sensible to call a temporary moritorium here until they are able to do so, if even just to let everyone concentrate on other things.

I like Larrys explanation, and calling for a moritorium is not a reflection on the participants thus far. There simply is a difference of opinion that will persist until the situation is resolved outside of the encyclopedia. In the absence of a bill of health for homeopathy from mainstream medicine, the best we have is to leave it up to the new Editorial Council. David Finn 08:44, 5 October 2010 (UTC)

Mea culpa

Long ago, I put in some text about such things as the ability of homeopaths to recognize fatal conditions, perform CPR and more advanced techniques, etc., when frustrated over different homeopaths' unwillingness to be specific about their legitimate scope of practice. I had expected them to remove it. Since licensing is not required in all countries, and Dana has said only three U.S. states have licensing, it's probably best to remove this. If some homeopathic organization has a code of ethics that requires safety knowledge, that's one thing --- but an experiment in challenging turned into quite something else.

On the talk page, this has been subject to handwaving about homeopaths sometimes also being trained physicians so these things are in their scope of practice. That's handwaving, because a number of homeopaths have no other training or licensure.

In another section, there is mention of homeopathic treatment for gangrene. If "gangrene" includes such things as Clostridium perfringens gas gangrene, I'm trying to rationalize how that can go unchallenged. Even with intensive surgical and medical treatment, that has a serious prognosis, and time is quite critical. Howard C. Berkowitz 04:27, 4 October 2010 (UTC)

Larry told me that this article is for the 'whole world' to read and that I'm welcome here when he welcomed me some 2 yrs. ago. Licensing is a must in most countries and in the countries that allow homeopathy to be practiced without a license (like the UK and US), there are qualified, licensed doctors as well, besides in case of a fatal condition, most rush to a (allopathic) hospital, so pls leave those things alone. Gas gangrene is pretty uncommon and I know that it can be fatal and people can die in just a few hours and I do recognize and treat/cure such patients—Ramanand Jhingade 16:21, 4 October 2010 (UTC)

You are contradicting yourself. You said that gas gangrene can be rapidly fatal, yet you say you treat it. When there are several potential diagnoses in medicine, and only one is life-threatening, you assume the worst case unless ruled out. Unless there is no possibility of surgical referral, you have, in my mind, no business treating gangrene. I just had to face this -- my terminally ill cat had an abscess that smelled a bit like Clostrida, something one never forgets, and it would have taken hours to get him to a veterinarian. There was, in my judgment, no choice other than to do needle aspiration and flushing, which made it clearer that it was not clostridial -- and did give him relief. I knew I was outside my scope of practice, but had a very specific set of goals, with a basis for it, and the needed equipment.

In the chiropractic article, there is a detailed list of things that need to be referred, or for which consultation is needed. I would feel much better if homeopaths would commit to such a list, unless they are to be regarded as a completely alternative system of medicine.

As far as licensing, Dana said only 3 of 50 U.S. states require it.

Larry is no longer Editor-in-Chief. You have no authority to tell me to leave things alone. Howard C. Berkowitz 20:29, 4 October 2010 (UTC)

Howard, you are being American-centric. Ramanand's point is that homeopathy is licensed by governments all over the world. For instance, "licensed homeopathic physicians" in India provide primary care medicine to 80 million people in India who do not use any conventional medicine.

Howard has been wanting treatment guidelines on various diseases, even though he seems to be the only person that thinks this is relevant. I don't. His writings on gangrene is strange, and I see no real purpose in it. If there were multiple homeopathic organizations that had specific treatment guidelines for gangrene, it might then be appropriate...but clearly, that is not the case. To me, this is another straw man argument. Dana Ullman 21:39, 4 October 2010 (UTC)

I don't think it is all that appropriate to take one isolated statement from Dr. Sanger and try and divine anything from it. For example, if we take a look at Archive 6 of this page we find Dr. Sanger reverting Ramanands additions to the article before personally emailing him to discuss his professionalism or lack thereof (it's all in black and white, check out Archive 6, where you will also see many of the same arguments from Archive 1 repeated, and also some arguments you might recognize from Archive 13 and soon-to-be Archive 14). David Finn 06:36, 5 October 2010 (UTC)

Reverted deletion not discussed, and does not constitute "editorializing in the lede"

I reverted a substantial deletion by Dana Ullman, not first discussed here, which had an edit note of "no editorializing in lede." What was deleted, to me, was not editorializing, unless any sourced criticism of homeopathy is editorializing.

First, it removed "scientifically unproven" from "based on the scientifically unproven premise that "like cures like" or the "principle of similars"". Look at the structure of the sentence. It's even addressing whether homeopathy, for undefined reasons, is safe and effective. It is talking about the premise, which isn't even formulated as a scientific principle. It's not scientifically proven. Deal with it, unless the goal is to make this an article that doesn't recognize the deep distaste for homeopathy of the great majority of biological scientists.

Further, he deleted a sourced reference "For them, there is little, if any, objective evidence that homeopathy is effective and it lacks a plausible mechanism to explain how the remedies might work, given that many of them are so dilute that they contain not a single molecule of the active ingredient." This is a very accurate statement of why many are dubious about homeopathy; it's not editorializing.

These two deletions essentially convert the lede to a soft endorsement of homeopathy; it certainly dims the reality of criticism. Howard C. Berkowitz 21:17, 4 October 2010 (UTC)

The lede to an article is an explanation of the subject. It should not include what other viewpoints exist on it. Should we have a homeopaths' viewpoint on every medical subject? Should an article on Buddhism say that Fundamentalist Christians believe that all Buddhists will go to hell? NO. And likewise, the lede to the homeopathy article should not include similar viewpoints outside of what homeopathy is. We NEED to have this sound like an encyclopedia, with objective information. Dana Ullman 23:34, 4 October 2010 (UTC)

No. Objectively, homeopathy has strong opposition and a small role because of that. If the subject is highly controversial, that information is essential to the lede. In the case of Buddhism, one can assume the general knowledge that there are multiple religions and they don't agree with one another.

To make this worse, there is the widespread perception that Citizendium has been overly soft on homeopathy, and it hurts us. Let me avoid Godwin's Law and point to our article on Communism. While it doesn't explicitly say that capitalists object to communism, it does say the communists want to overthrow capitalism. Homeopathy -- and this is a point not well developed -- presents itself principally as alternative medicine, not complementary medicine, and thus is in opposition to medicine. --Howard C. Berkowitz 00:03, 5 October 2010 (UTC)

I'd agree with some of Dana's deletions. I do not think "scientifically unproven" or similar text belongs in the opening paragraph or in the definition. Those should just say what homeopathy is.

On the other hand, the (quoting Howard) "very accurate statement of why many are dubious about homeopathy" most emphatically belongs in the lede.

Dana: Any comment on my rewrite, linked above? Sandy Harris 00:45, 5 October 2010 (UTC)

This is why this argument, as it stands, is intractable. On the one side you have 'believers' in homeopathy, and on the other you have mainstream scientists. This encyclopedia aims to recruit experts from many fields, but by definition that will produce more unbelievers than believers. There will always be people who disapprove of removing mention of science from the intro or definition. The longest lasting version of this article (for almost a year) did contain mention in both intro and definition that homeopathy is not scientifically accepted. Removing this is always going to be seen as advocacy rather than neutral presentation by a sizeable portion of the community this encyclopedia seeks to recruit.

See the above thread for Larry Sangers suggestion on how to resolve such a situation. David Finn 07:18, 5 October 2010 (UTC)

Just because it was unchallenged for long, it doesn't become a fact. http://en.citizendium.org/wiki/CZ:Definitions says the definition should be short and concise, so we don't need additional comments like what's being added to the definition at the top of this Talk pg.—Ramanand Jhingade 16:06, 11 October 2010 (UTC)

We again have evidence this discussion is intractable. An interpretation of relatively old guidance, by someone who is neither an Editor nor has experience with CZ practice outside this article, appears to be being used to move the definition back to something that only encompasses homeopathic ideas. Desperately trying to avoid Godwin's Law, it would be inappropriate to have a definition of some highly criticized movement or group without noting it is a minority or deprecated position. Howard C. Berkowitz 19:05, 11 October 2010 (UTC)

Wordsmithing

To provide a better balanced view of this subject I did a bit of wordsmithing. Nothing was removed but a sentence was moved to a different location in the intro. See:

"Homeopathy or homoeopathy—from the Greek hómoios (similar) and páthos (suffering)—is a system of alternative medicine based on "like cures like" or the "principle of similars", the idea that substances known to cause particular combinations of symptoms can also, in low and specially prepared doses, help to cure diseases that cause similar symptoms. Homeopathic medicine uses scientifically unproven methods to treat the patient. "Alternative medicine" here refers to:"

The sentence in italics was moved so the intro fairly introduced the subject. Countering the claim is the unproven methods. Both to need be in the article but they should be fairly written or presented.Mary Ash 21:49, 4 October 2010 (UTC)

Gareth's trims and assumption in infectious disease

Gareth, you've cited homeopathic claims for efficacy in infections. I wonder, though, if there are some strong counterexamples.

For example, the role of antimicrobial agents in cholera have been decreased in favor of oral rehydration fluid. Oh, antibiotics are used when available, but the gold standard in medicine is to support the function of the body and avoid dehydration, with the key ORF observation being that carbohydrate must be present for effective rehydration.

I would observe that everything in ORF was available to Samuel Hahnemann. ORF clearly is supporting the body and eradicating Vibrio cholerae is secondary -- as bad an infection as it causes, the infection proper is often self-limiting if the effects of the diarrhea and vomiting are controlled. Note that there is no attempt to suppress either, but to replace the lost fluid. If homeopathy is so sensitive to the body's normal functions and supporting them, why did it take infectious disease physicians to introduce ORF therapy, especially as a substitute for the more expensive, skill-intensive, and often not available in less developed countries intravenous hydration?

That which I say for cholera is equally true for self-limiting but lethal viral gastroenteritis.

As another example, the priority in treating tetanus is controlling symptoms that, in and of themselves, can kill. The next priority is neutralizing toxin through passive and active immunization. Only if a source of infection is known is active antibiotic treatment likely to be used.

Now, homeopaths might claim that this makes them right, because the host's defenses are being supported, but if this is the real hypothesis for the treatments, why didn't they discover them first? Certainly, the ORF team wasn't homeopathically oriented, and there are no microdiluted remedies used for diarrheal diseases.

From a pure editing perspective, there are two problems. One is that the homeopaths have tended to claim that supportive and defense-strenghening care, actually developed without an consideration of the principle of similars, justifies their paradigm. Frankly, I find this illogical and offensive. Second, perhaps homeopaths do continuous process improvement and come up with better remedies. There's no discussion of that in the article, however, if they do it. Maybe they do -- it would be far more informative if they discussed what they do in this area rather than attack medicine. Howard C. Berkowitz 11:41, 5 October 2010 (UTC)

? Didn't add anything, I may have left something in on this.Gareth Leng 17:06, 5 October 2010 (UTC)

Observation by Gareth about prescribing in context

Gareth wrote, "Homeopathy: as anyone can prescibe, the important issue here is how homeopaths prescribe". This is another way of describing my futile requests for getting a description of what I call the "cognitive process" in homeopathy. It simply confuses the article to suggest that because some homeopaths are conventional physicians, they will do the medically appropriate thing. Even there, we have only some gross statistics that some physicians use homeopathic remedies as a complement, but not their rationale for doing so.

The Chiropractic article has an excellent section on when to refer or seek consultation. Again, I only get generalities, and sometimes confusing ones, such as both referring gangrene and treaing it. Why is it so difficult, unless homeopaths are truly acting as an alternate system of medicine completely rejecting conventional medicine, to get a list equivalent to that in chiropractic?

I'm afraid the answer is that homeopathy simply isn't that cognitively based and the list cannot be created, much as Dana keeps saying that it's too hard to explain to a layman, or that homeopaths don't think that way, or it's too detailed for this article. I would challenge anyone to give me an area of medicine where I can't prepare, either from my own knowledge or with a short amount of research, the basic cognitive approach that used. I include, especially from primary and emergency medicine, red flags on when consultation or referral are needed.

The inability to get this basic model is one reason I find creating an article to be intractable. Howard C. Berkowitz 11:56, 5 October 2010 (UTC)

Howard, you continue to create strawmen. Please give reference to where I wrote that "it's too hard to explain to a layman." I have previously invited you to do whatever research is necessary to add the information about when homeopaths should refer to other health and medical providers, but if you choose to do this, please provide appropriate references. I simply told you that I was not interested in doing this work.

You have asserted above that homeopathy is not "cognitively based," but this simply proves that you still do not get homeopathy...but worse, you just make things up. Please stop. Instead, please provide reliable and verifiable references to whatever you say. If not, I (and perhaps others) will simply ignore such statements as your own fabrications. Dana Ullman 18:34, 6 October 2010 (UTC)

Nonsense. Please stop condescending.

It's not my job to define when homeopaths should refer; I'm asking a homeopath to cite the same sort of material that the chiropractors quite nicely defined. I have not seen a sufficient body of homeopathic research, or concern about safety, to satisfy me that homeopaths without full medical training, in fact even consider this.

I, and others, consider homeopathy to be nonsense. How do I provide reliable and verifiable references that the earth is not flat?

I have said, and continue to say, that homeopathy is intractable as an article here. Please do not lecture me about what is, and is not, encyclopedic, until you demonstrate your "getting it" by showing you can contribute meaningfully to encyclopedia material on other topics. If, however, you ignore my statements, I should be delighted. That some of those will be challenges without response....ah, the pity. I am tired of changes labeled "greater precision" that simply convert a balanced statement to pro-homeopathy.

Soon, there will be an Editorial Council, and this will probably come to a final decision. Howard C. Berkowitz 20:56, 6 October 2010 (UTC)

Provings, and screening

A few issues not addressed come to mind. I dare to suggest that a proving has some loose similarity to a Phase I clinical trial, which addresses safety. Now, while homeopathic remedies in practice may be too dilute to produce any ill effects, the amount used a proving, by definition, produced symptoms.

What are the specific rules used in modern provings to ensure safety? For example, a subject might say that a high dose calls itching, but the underlying cause is drug-induced liver failures. What safety guidelines exist for the use of laboratory tests before and after provings? Citations, please.

If homeopathic intervention is triggered only by symptoms, what is the role, if any, of laboratory screening in homeopathy? Just as one example, if one trained in midwifery and homeopathy only delivers a baby, when would phenylketonuria be detected and treated?

I think that the symptoms recorded in a proving are self-reported - i.e. there are no objectively determined outcomes. The symptoms include the subject of dreams. Provings, as I understand them, still use doses that would probably be insignificant. I've looked at only one in detail however; frankly it wouldn't conform even minimally to any conventional protocol in any respect (purpose, design, methodology, analysis, interpretation); the similarity with phase 1 trials isn't there.Gareth Leng 16:59, 5 October 2010 (UTC)

In other words, there's no real safety oversight beyond hope the dose isn't too high, even in a hypersensitive subject.

You raise an interesting editing point for the whole article. While I agree that the distinction isn't often made, there is a difference, in medicine, between subjective symptoms and objective signs. Homeopathy doesn't seem to differentiate at all. I have looked at repertories that treat "anemia" -- but anemias are laboratory-diagnosed, not necessarily symptomatic.

I wonder what level of effort goes into new provings and finding new remedies? Some readings suggest that Hahnemann got it mostly covered, while others suggest there is some ongoing discovery. I've not been able to fund anything quantitative and reliable, but I don't get the impression that remedy research is a hot discipline. Howard C. Berkowitz 17:09, 5 October 2010 (UTC)

Edits, an explanation

I read through this article afresh by way of considering whether there must be a radical rewrite or whether this still forms a useful basis; I'm not sure whether I've made my own mind up on that, but lean to the view that the article does have a lot of useful material that would have to be rediscovered in any rewrite. Along the way I made numerous mostly minor edits to perform what I saw as pretty obvious clean-ups, on the basis that if you remove obvious redundancies it's easier to read and easier to see what is valuable.

I have read the Rationalwiki article on homeopathy and have to say I think it's well written, and an excellent article for its target. This article has a different scope, it attempts to include an account of homeopathy that homeopaths would consider a fair account of the history and present nature of homeopathy, and a fair representation of their case for its efficacy, as well as an account from the perspective of scientists that scientists would regard as inclusive of their understanding of the weaknesses of homeopathy. That's never going to be easy, but there are some things that will help make it more tractable.

The first is strict sectionalisation, so that each section has a clearly defined scope, to stop arguments and counter-arguments bleeding repetitively across the article. The second is adherence to the distinction between the scientific perspective and the homeopathic perspective. In this, it is I think essential to (for example) use the term "remedy" consistently for homeopathic drugs and reserve "medicine" for conventional drugs; it's essential that homeopathic practices are not described in terms that might lead them to be confused with conventional practices - "trials" for example has a well defined conventional meaning that would not include provings, and describing provings as trials invites contention.

Allowing the homeopathic (scientific) perspective to be expressed does not mean allowing either to say anything - for both there must be a distinction between belief/opinion and fact, and facts must either be generally accepted or else supported by a credible source. I removed one reference to a source that claimed repeatability of studies with ultradilutions when on reading the source it appeared that repeatability generally involved repeat publications from the same authors. That's not repeatability for me.

I think, from a scientific perspective, it's right to acknowledge that placebo treatments still have an important place in medicine, that the placebo effect can be considerable, and that it may be that the mode of treatment of homeopaths is conducive to maximising the benefits that can be obtained by placebos. It is fair to acknowledge that there are many conditions for which there is as yet no effective conventional treatment and that even when there are conditions for which there are generally effective treatments, there are some patients who do not respond to treatment. For these, placebo treatments may be the best that conventional medicine can offer. We don't have to say that here, there are other articles on placebos, but should remember it.Gareth Leng 16:32, 5 October 2010 (UTC)

Provings have a different goal than Phase I trials, but both share concern with toxicity -- it's just that provings deliberately try to provoke it, at least as symptoms. For conventional Phase I trials, there is considerable safety review, but I haven't heard anything about safety monitoring for provings -- especially tghings things that don't produce externally visible symptoms. To take an extreme case, leukopenia doesn't produce symptoms; only a subsequent infection will produce them. Howard C. Berkowitz 16:51, 5 October 2010 (UTC)

See my comment above. I don't think provings engage safety issues. They use crude doses - but still heavily diluted. I removed the statement about overdose - can't see that this arises, and it has other problems; as written, placebo treatments would continue until symptoms of overdose were encountered.Gareth Leng 17:09, 5 October 2010 (UTC)

If the placebo were sugar, the results of overdose might manifest with the comment that a waist is a terrible thing to mind. :-)

Seriously, given homeopaths are so given to attack medicine due to its dangerous treatments, it seems only fair to look closely at its assumptions on safety. Are you sure, Gareth, that the diluted doses can always be trusted not to trigger hypersensitivity reactions? What, if any, emergency drugs and equipment are present in a proving room?

I don't think this can be dismissed, and shrugged off to the "wisdom of the body". Autoimmune diseases demonstrate a fairly unwise body. Can you really say, with a straight face, that homeopathic remedies may not be placebo, but they only produce favorable results? For that matter, suggestion and placebo can trigger strong reactions. Howard C. Berkowitz 17:16, 5 October 2010 (UTC)

Prophylaxis and homeoprophylaxis

Is the James Tyler Kent material significant enough to be in a text box? Perhaps it should move, leaving a brief reference and link, to a subarticle.

The text box is actually improperly labeled from my perspective, as Kent didn't have much to do with the Cuban work.

Possibly the subarticle might be on alternatives to immunization.

Wherever it winds up, if it stays, I'd really like to understand more about the homeopathic view of prophylaxis. If treatment is individualized and based on symptoms, how does one select a remedy when there are no symptoms and the disease is not present? Howard C. Berkowitz 08:32, 6 October 2010 (UTC)

New lede

I just dropped in my rewrite of the lede.

See discussion under "Rewrite" above. Matt said there he liked it, albeit an earlier version. Howard said more-or-less "Yes, but...". Gareth has said on my talk page he likes it. I think it is a large improvement. Sandy Harris 09:32, 6 October 2010 (UTC)

Much improved. I do think, however, that the second paragraph needs work. Our ledes have tended to go directly into the remedies/treatments, with relatively little on the very different paradigm created by what I'll call, for short, vitalism. There's also been a lot of homeopathic handwaving in this area, such as comments that physicians only consider the germ but homeopaths consider resistance and the germ -- yet I had no response to the examples of resistance support with which I responded. Earlier, there seemed to be denial a germ needed to be treated at all.

Also, the variation in homeopathy needs to be clear. There are at least three classes: a medical practitioner with additional homeopathic training, the only sort acceptable to the American Institute of Homeopathy. There are, in the U.S., pure alternative homeopaths who are licensed, according to Dana, in only three states. You have situations as in India, where homeopathy is an acceptable total alternative system of medicine. It's hard to generalize. For an article that spends as much time attacking medicine, it's interesting that the AIH wants medical credentialing first, making homeopathy complementary rather than alternative. Howard C. Berkowitz 10:35, 6 October 2010 (UTC)

Sandy, thanks, looks good and is definitely an improvement over both the previous lead and the approved lead. Howard, lets take those medical attack areas that you are talking about. Do you have an example that you would like us to look at? D. Matt Innis 11:25, 6 October 2010 (UTC)

The second paragraph could be expanded, but I think it covers the main points well enough now. It does mention, and wikilink to, vitalism.

I think the variation in systems and certification certainly needs to be discussed, but probably not in the lede. Sandy Harris 12:05, 6 October 2010 (UTC)

Let me try, Matt. Part of the problem is that so many of the attacks have been, at least recently, on the talk page, rather than in the article, and it's easy to confuse them. Nevertheless...

The von Behring material, whether you call it an attack or not, has to go. It is completely unreasonable to use work done in the late 19th century, rewarded with a Nobel in the first decade of the twentieth century, to continue the claim that current immunotherapy is based on similars. This hurts the credibility of the article, since any current immunologist is going to be able to tell you how things are done at the molecular level.

Agree and I cut this, started to move to History article but it's already thereGareth Leng 16:22, 6 October 2010 (UTC)

Even earlier and more out of context is "Jenner’s discovery remained an erratic blocking medicine, till the biochemically thinking Pasteur, devoid of all medical classroom knowledge, traced the origin of this therapeutic block to a principle which cannot better be characterized than by Hahnemann’s word: homeopathic." Move to history subarticle or delete. Pasteur was, as I remember, a 19th century chemist, but in no sense of the modern word a molecular biochemist.

"Homeopaths respond by claiming that using homeopathic remedies can delay or reduce the use of conventional medicines that are ineffective and dangerous. " This is an attack without support. Of course some conventional drugs are dangerous, but this sounds like an unsupported claim that homeopathic remedies are both safer and more efficacious. The phrasing here has gone through many modifications, but, if we go back to the two Osler quotes (can we put them back?), it was fair to say that allopathic -- I use the term as Osler used it to condemn it -- drugs of 1870 -- heck, even 1930 -- often were more dangerous than helpful. Once we got into molecular pharmacology, however, the risk-benefit analysis changed but the homeopaths don't admit it. They can't just say they are safer, but that they also are at least as effective, especially for serious diseases. Of course there are bad surprises with conventional drugs, some with things that don't show up in the test popularion, and, sadly, some where commercial interests may have concealed risks. Still, can anyone seriously deny that there is a constant attempt to improve the risk-benefit of medical drugs?

"Homeopaths assert that corticosteroids are immunosuppressant drugs that only provide temporary relief of asthma symptoms and may lead to more serious chronic disease and to increased chances of death. " While the article does debunk this, why is it there at all? A nonphysician homeopath isn't qualified to make this unreferenced assertion. No distinction is made between inhaled (nonabsorbed) and systemic corticosteroids.

OK, I just cut the whole section which I think is superfluous; with the response on balane I thought that this section especially with the robust rebuttal was on balance anti homeopathy, so the section deletion is I think a change that favours homeopathy - except it was so obscure/tangential as to be unhelpfulGareth Leng 16:28, 6 October 2010 (UTC)

Another area is that of things that are labeled as history, but not all readers will catch that. "One reason for the growing popularity of homeopathy was its relative success in combatting the infectious disease epidemics that raged at the time.[21] Cholera, scarlet fever, typhoid fever, and yellow fever killed many people, but death rates in conventional hospitals were typically two- to eight-fold higher than in homeopathic hospitals for patients with these diseases.[22]" Yep, at the time. Now, respectively, rehydration (preferably oral), penicillin, fluoroquinolones or third-generation cephalosporins, and a combination of antipyretics and H2-inhibitors and maybe ribavirin. With all, supportive care, often intensive. I'd note that it appears that a great number of the deaths from the 1918-1920 influenza pandemic were actually acute respiratory distress syndrome, treated with modern respirators.

This is in the history section, is clearly history, and is important history, and it's central to homeopath's understanding of their field. Trying to understand homeopathy without it would be like trying to understand America without mentioning the revolution and the declaration of independence.Gareth Leng 16:33, 6 October 2010 (UTC)

Put the 19th century stuff in a history subarticle but don't leave it in the mainline where it might confuse people. Howard C. Berkowitz 13:01, 6 October 2010 (UTC)

Alexis de Toqueville and others concisely explain American exceptionalism in terms of values, not of detailed history. The same is possible here. As a student of American history, it is important to know there was a Revolution, but it is less important, in a general article on American politics, to deal with the detail of the Declaration. See American exceptionalism and see if it tells you more or less than Declaration of Independence or the details of the American Revolution -- synthesis and all that.

As long as the history section is positioned early in the article and makes appeals to authority, those appeals need to be in strong perspective: the greats for their time, Pasteur and von Behring, were dead wrong. Well, for that matter, they are just dead. :-) Howard C. Berkowitz 18:50, 6 October 2010 (UTC)

American Institute of Homeopathy reexamined

After Gareth's trimming, I recognized the AIH reference might need to be modified, but there's a reason for it being there. It appears that the AIH acted much as did the osteopathic organizations after the Flexner report: it recognized that the core medical knowledge was essential, with homeopathic training to be additional and complementary. At least for it in the U.S., there was no longer a place for a homeopathic professional that was not, at some level (i.e., full MD/DO/DDS vs. PA/APRN), a fully qualified medical professional. This does away with the scope of practice and emergency issues, for if an MD/DO failed to treat asthma or gangrene by accepted standards, there would be little question their licensing board would have questions.

Remember that osteopathy in the UK is not the same thing as osteopathic medicine in the US. India, as one example, uses a very different paradigm.

If the AIH is good enough to be a counter, historically, to the AMA, then it's good enough to make the argument, in the US, that people without medical training have no business relying on homeopathy. While this isn't the case on a licensing basis -- homeopathy in the US has quite a few licensing loopholes, as with the FDA -- AIH clearly puts homeopathy into complementary, not alternative, medicine.

I have much less problem with the article if responsible homeopathy is regarded as complementary medicine -- although I'd still like to know more about how a homeopathically trained physician selects modes of treatment. Howard C. Berkowitz 18:44, 6 October 2010 (UTC)

Wisdom of the body, vitalism

Dana changed, with an edit note of "more precision and accuracy"

Homeopathic remedies are intended to stimulate the body's natural healing processes. Homeopathy aims more at healing the patient by restoring balance than at treating the disease. Hygiene and diet are stressed as well as the use of homeopathic remedies. The rationale often involves discussion of "vital force"; in this homeopathy has much in common with other vitalist thought.

to

Homeopathic remedies are intended to stimulate the body's natural healing processes. Because homeopaths maintain a high respect for the "wisdom of the body," homeopathic medicines are prescribed for their ability to cause or mimic the similar symptoms that the sick person is experiencing, thereby aiding their own defenses. Hygiene and diet are also used by homeopaths in conjunction with the use of homeopathic remedies.

It may be more precise if Citizendium made no attempt to contextualize, but the CZ approach to "being encyclopedic" does include contextualization. It's important to point out that homeopathy uses vitalist ideas. Further, re-introducing "wisdom of the body" adds no more information than "natural healing processes", but does reintroduce impressive sounding but undefined homeopathic jargon. Howard C. Berkowitz 19:16, 6 October 2010 (UTC)

Of course I prefer my text.

I think the mention of and link to vitalism are absolutely essential. Sandy Harris 13:03, 7 October 2010 (UTC)

Are you thinking vitalism in the "the body is controlled by a higher power/mystical" sense, or the "emergence" sense. If you're thinking the mystical sense, I'm not sure that the principle of similars or the infinitismals require it or suggest it. From a historical sense, I do think Kent suggested it, and Hahnemann may have believed it, but do homeopaths believe that today? If you're thinking about it in the "the body is too complicated to figure out/emergence" sense, then sure, everyone is vitalistic to some degree. D. Matt Innis 13:29, 7 October 2010 (UTC)

See above. It's Dana that reintroduces "wisdom of the body" without defining it. Given there is no specific definition, it seems to fall into vitalism. No, I don't believe the body is too complex to figure out -- eventually, although we will always learn more Howard C. Berkowitz 13:49, 7 October 2010 (UTC)

That's the point. Emergence certainly suggests that there is a mechanistic cause and effect that can theoretically be figured out, only that it is complicated and full of variables that change moment to moment depending on the environment (in this case, the patient). If your not careful, it looks like it's got a mind of it's own - or is being controlled by some other intelligent form - a wisdom of its own. D. Matt Innis 16:24, 7 October 2010 (UTC)

Does emergence, however, have anything to do with homeopathy and the undefined wisdom of the body? Howard C. Berkowitz 16:50, 7 October 2010 (UTC)

Indirectly, but only if you call it vitalism. How about this for a re-write for your two sentences above:

• Homeopaths believe that symptoms are the body's response to disease. Since the homeopath's intention is to assist the body, they choose remedies that cause similar symptoms that the sick person is experiencing. Hygiene and diet are also used by homeopaths in conjunction with the use of homeopathic remedies.

D. Matt Innis 17:48, 7 October 2010 (UTC)

Howard seems to be ill-informed again. Dr. Walter B. Cannon's seminal book, THE WISDOM OF THE BODY, has no mention of homeopathy...and Hans Selye's STRESS OF LIFE continued with this respect for the body's adaptive capabilities. "Wisdom of the body" is not homeopathic jargon. Once again, Howard just makes things up. My point is that conventional medicine AND homeopathic medicine both have a certain respect for the wisdom of the body, but homeopaths act on it, while most conventional physician only give lip-service to it. I sincerely wish that he would do some homework first before spouting. I have provided references here. If Howard or others disagree, please provide reference. Dana Ullman 17:56, 7 October 2010 (UTC)

I was thinking of vitalism in the spiritual sense when I wrote that. As I understand it, that's historically a large part of the rationale for homeopathy. Sandy Harris 23:47, 7 October 2010 (UTC)

I agree that historically it probably played a large role as many of the top scientists and physicians of the time were vitalists in the spiritual sense. My (very little) understanding of Kent suggests to me that he pushed the profession in that direction for awhile, but he remained controversial even for homeopaths. I'm thinking that, even though some homeopaths might believe in a higher spiritual power (just as some conventions docs might), it's not a prerequisite. It definitely should go in the history and I have no qualms with using the word vitalism in the lead. Just make sure you know it means different things to different people. If you are trying to be clear, it might be too complicated to just give it a short mention in the lead. You do a good job wording things well, so I remain open to your thoughts. D. Matt Innis 00:25, 8 October 2010 (UTC)

"The wisdom of the body" may be a good book title but is not a phrase that would be recognisable as part of the conventional canon. Cannon introduced the term "homeostasis". Selye was a pioneer in sress endocrinology. Both made major contributions to the early development of physiology; but science has moved on a very long way since, and only some of us older guys remember these names. Neither are read today, and rather little of their thinking survives. Vitalism, as Matt alludes to, is often associated with a mystical belief in some spiritual force or power - and this is not part of modern science. However "vitalist" constructs, in the sense of concepts that do not yet have an fully reductionist explanation, are common and indispensible as "working constructs" - obvious examples are consciousness, and intelligence - it's rather difficult to avoid using these terms, but they can't (yet) be pinned down to a fully described (reductionist) explanation, and many think that these are examples of emergent properties of complex systems that will never be adequately amenable to fully reductionist explanations. My point here is that scientists avoid using the term vitalism now because of its mystical connotations, but still use vitalist constructs. Matt is right here, in that the word vitalism carries the connotation of mysticism which is discredited, but, stripped of their mystical trappings, vitalist constructs survive and may be indispensible in some areas.Gareth Leng 08:41, 8 October 2010 (UTC)

Well said, Gareth. As I tried to make clear, my greatest objection to it, especially in the lede, is that it's essentially a classic axiom in terms of homeopathy -- it has to be accepted as existing and not subject to proof. Your point is also well taken that Mr. Ullman frequently argues with the authority of out-of-date scientists and physicians.

If I, tactically, were to be trying to write a homeopathy-supportive article, I would avoid such references, as well as such people as von Behring, to forestall the criticism of homeopathy being stuck in the 19th, or indeed early 20th, century. You are quite right, to observe in the language of another book title, that medicine is the youngest science, and direct comparisons between 19th century thinking and present thinking make no sense. I've started heroic medicine, and even there, something different was meant in the 18th and 19th century versus today.

I'm not insistent on vitalism being used, but neither do I believe wisdom of the body belongs in the lede. Howard C. Berkowitz 13:31, 8 October 2010 (UTC)

I'll offer up my suggested replacement again. We can improve from here:

• Homeopaths believe that symptoms are the body's response to disease. Since the homeopath's intention is to assist the body, they choose remedies that cause similar symptoms that the sick person is experiencing. Hygiene and diet are also used by homeopaths in conjunction with the use of homeopathic remedies.

D. Matt Innis 13:36, 8 October 2010 (UTC)

Footnotes

Speaking purely from experience in human interface design, readers, once they recognize that numbered references are generally bibliographic, have no way to know that supplemental material has moved to a footnote. This is perfectly reasonable to do in a paper book, as I've done in my own, but is not good Web design. I'm going to move the commentary in footnotes to subarticles and wikilink them. Howard C. Berkowitz 19:21, 6 October 2010 (UTC)

ThanksGareth Leng 12:19, 7 October 2010 (UTC)

Safe but ineeffective

Gareth removed

Proponents of homeopathy also note that some of the conventional studies analysed by Shang et al. may have shown a treatment effect but that some of these treatments have since been withdrawn because of side effects. Critics of homeopathy agree—they say that in conventional medicine, treatments are abandoned when trials show them to be ineffective or unsafe, or when a better drug is found; by contrast, no homeopathic treatment has ever been withdrawn after a trial showed it to be ineffective. Homeopaths contend that flawed trials cannot be used to show that homeopathic treatment is ineffective.

with the edit note "what's good about safe but ineffective?" (somehow, that reminds me of the argument for eunuch guards in a harem)

A very good point indeed. While there may be a better way to phrase it, one common generic homeopathic attack on medicine is that medical treatment is dangerous.

Here, I'd certainly want to see a citation for "no homeopathic treatment has ever been withdrawn", and that put in proper perspective. At least in the US, the regulatory standards for homeopathic remedies are much weaker, so it's less likely anyone is going to enforce a recall. In the US, but not UK, safety is the primary reason for recalls; the UK NICE looks for evidence of efficacy. Now, it can get subtle in the US, when a drug has some efficacy but another drug is safer; see the current questions on pulling rosiglitazone from the market -- its labeling now calls for prescribing when no equivalent agent will work. Howard C. Berkowitz 20:14, 6 October 2010 (UTC)

I'm not sure you're right about NICE. I don't think it orders recalls for ineffective medicines. What it does is deny them state funding. Peter Jackson 10:23, 7 October 2010 (UTC)

You're probably right. I don't know the extent to which people will spend personal funds for medication in the UK. Nevertheless, the rationale for recalls of ineffective drugs in the US is that if the drug has a risk, but is ineffective for the indication, it is being pulled for safety reasons. There's now little argument that rosglitazone is more dangerous than pioglitazone, but some patients respond to the first drug while not responding to the other. There are other issues, beyond the scope of this article, in US drug licensing and advertising. It is worth noting, however, that NICE can deny funding because a new drug is no better than those on the market, while the US FDA cannot deny licensing for that reason alone. Howard C. Berkowitz 10:41, 7 October 2010 (UTC)

If you repeat a LIE often enough, people believe it. People who say that "homeopathy is ineffective" are repeating a lie. There is plenty of evidence to show that the effects of homeopathic medicines are beyond that of a placebo. The studies on Oscilococcinum in the TREATMENT of the flu, the 4 studies by Reilly on respiratory allergies, and the 3 studies on childhood diarrhea are just a small part of the body of replication studies. I will be re-inserting some of the deleted material. Dana Ullman 18:01, 7 October 2010 (UTC)

How about giving me a chance to read it first. I'm catching this at work and will get time tonight, I hope, if the election stuff doesn't get too much of a handful. D. Matt Innis 19:38, 7 October 2010 (UTC)

I think you'll find that I haven't actually deleted anything substantive; and the studies Dana mentions all remain prominently, Dana's actually misunderstood my edit summary - it refers not to homeopathy but to the deleted material, and specifically to the argument that I deleted which appeared to make the case that maybe homeopathy doesn't work but at least it's safe, which I thought was a point not worth making.Gareth Leng 21:26, 7 October 2010 (UTC)

Done now

Sorry I've done so much with inadequate edit summaries. I found a window of a few hours so thought it better to drive on. I hope I've not added anything or changed anything substantially except to correct obvious mistakes, but have trimmed, re-ordered, clarified, re-worded and cut occasional sections or moved them as seemed appropriate, some to the History article. I've tried to give a better, more clearly organised and sectionalised shape, and to eliminate repetition, tangential detail and pointless argumentation. Probably will have little time from here on; I strongly suggest resisting the tendency to repeat points, and the tendency to add material without subtracting. The article is probably already too long for purpose, and any additions should be considered against whether it or some existing material is better in a subarticle (a new one, or an existing one). Gareth Leng 12:29, 7 October 2010 (UTC)

Thanks, Gareth. I'll take a look. D. Matt Innis 12:54, 7 October 2010 (UTC)

I do appreciate this, Gareth. Let me mention some changes I would make:

• Lede: In assorted external criticism, the point has been made, with previous versions, that there is nothing to indicate that homeopathy is not fully accepted, until the fifth paragraph. I agree with this. I'd add a single sentence to the first paragraph, "Homeopathy is not accepted by the majority of biomedical scientists and physicians."
  • 2nd paragraph: "wisdom of the body" is homeopathic jargon. Frankly, I still don't know what it means rather than handwaving. Earlier, I had an edit removed suggesting it was the homeopathic view of vitalism, a term we do define and discuss elsewhere. If jargon is to be used in the lede, I believe it must be explained, if only by a wikilink. However this is defined, I'd bold it, because it is as important in as the remedy principles in the next paragraph.
  • 4th paragraph: I would question "well-accepted" without numbers. Perhaps the 4th and 5th paragraphs need to merge, but, as it stands now, paragraph 4 reads to me as an endorsement of homeopathy.

I'll leave this to SandyGareth Leng 15:25, 7 October 2010 (UTC)

• Principles of homeopathy, and their historical origins. I'd make more drastic moves to history of homeopathy.
  • 3rd paragraph: end sentence after "heroic medicine". I'm willing to write heroic medicine dealing with both Hahnemann's area and today. As it is, it's fear-inducing. The issue was inappropriate use of toxic chemicals. Therapeutic phlebotomy can be lifesaving in a number of situations, and even leeching has controlled applications, such as gentle blood drainage following plastic surgery.
  • 5th paragraph -- again, I think it's a bit fearmongering unless it's made clear that there are etiologically-specific treatments for the first four diseases of Cholera, scarlet fever, typhoid fever, and yellow fever, and still very specific treatments for the pathological mechanisms of yellow fever. (Yes, fluid management is the key to cholera--nods to Anthony the Nephrologist)

--Howard C. Berkowitz 13:09, 7 October 2010 (UTC)

See my changes hereGareth Leng 15:25, 7 October 2010 (UTC)

Importance of history

In the 19th century, all medicine was pretty dismal, a great deal was counter-productive, and if you had to choose a practioner you'd be far better off with a homeopath generally. In the early 20th century, some of the mish-mash of medical practioners committed their profession to a wholehearted alliance with science (partly under duress), and that led to conventional medicine as we know it today. That alliance meant that they committed themselves to abandoning historical precedent, abandoning accepted teachings and dogma, and allowed all that they did to be subject to a perpetual process of change and re-evaluation according to evolving, increasingly stringent criteria and objective test. This root-and-branch denial of any body of dogma or "given" knowledge means that history before the 20th century adds little to our understanding of modern medicine, but this is far from true of homeopathy. Homeopathy, at its core, remains entrenched in the 19th century. I don't think it's possible to neglect this.Gareth Leng 16:13, 7 October 2010 (UTC)

People who do not understand history are apt to create the same mistakes as in the past! Conventional physicians have attacked homeopathy for the past 200 years, and they have always said that "medicine of the past" was dangerous, but "now" medicine works. When Gareth says that homeopathy "remains entrenched in the 19th century," he ignores the 200+ clinical trials and the several hundred basic science trials, and he ignores the fact that the vast majority of homeopaths in the USA and Europe use expert system software (how 19th century is that?).

Will Gareth re-write the acupuncture article and say that it is 0 B.C. and has no modern usage?

Actually, many homeopaths think of homeopathy as very futuristic due to its appreciation of complexity, of body/mind syndrome, and of individualization of treatment. It is only 19th century to those people who are not current on its present status. Dana Ullman 17:46, 7 October 2010 (UTC)

Again Dana, you're missing the point here - I was defending the importance of history in this article, and defending keeping it. Maybe from a different perspective than yours, but nonetheless. The point I was making in the talk page, - but not in the article, is that homeopathy's principles, methodology, beliefs were forged in the 19th century and haven't materially changed since. By contrast, modern medicine is maybe 50 years old - doctor's before then simply wouldn't recognise or understand current practices and theories, just as we wouldn't give theirs the time of day.Gareth Leng 21:31, 7 October 2010 (UTC)

The comment above about expert systems is either an attempt to impress, or shows a lack of understanding of expert systems (as opposed to other forms of artificial intelligence). An expert system is no better than the human-created rule base in which its knowledge resides. Arguing that expert systems make something of a given century is a non sequitur. There is nothing that is done by an expert system that I cannot replicate with paper logic, only more slowly. Machine vision and pattern recognition would be quite another matter.

200+ clinical trials. Really? My dinkum word, that number is SO much greater than the number of medical trials. Homeopaths think it's 21st century. I am so impressed.

As the teenagers would say, either "not" or "whatever." Howard C. Berkowitz 23:52, 12 October 2010 (UTC)

Deletion

After Dana's comment I checked that I hadn't made any unintended deletions. I however found one that must be deleted- the Cochrane review on "Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes.". This has now been withdrawn from publication [4]Gareth Leng 12:10, 8 October 2010 (UTC)

Gareth...This article was "withdrawn" from publication because the authors could not "update" it due to no new research on this subject. However, this article is still at the Cochrane site, and its "withdrawal" does not diminish or influence in ANY way the evidence that it uncovered...and this evidence is that four clinical trials have shown some benefit in the treatment of influenza. Dana Ullman 23:18, 8 October 2010 (UTC)

Happy to check on the status of this; don't understand why it would be withdrwn on that basis alone, but if I'm wrong, I'm wrong and will restore.Gareth Leng 11:19, 9 October 2010 (UTC)

The explanation given is "The editorial group responsible for this previously published document have withdrawn it from publication. Reason For Withdrawal This review was withdrawn from The Cochrane Library, Issue 3, 2009 as the authors were unable to update it. The review will be updated by a new team of authors." My reading of this is that it is no longer published; that's the meaning of withdrawal, I read the explanation as meaning that the Cochrane collaboration judges that it requires udating, that an update is underway, and that the existing version is unrelaiable. I don't see how else to read this, and I don't see how we can cite anything withdrawn from publication for any reason - it's effectively citing unpublished work.Gareth Leng 11:28, 9 October 2010 (UTC)

It is a tad confusing, but I just googled this info, and this link to the Cochrane Library is NOT withdrawn: http://www2.cochrane.org/reviews/en/ab001957.html Dana Ullman 15:18, 9 October 2010 (UTC)

second deletion

Childhood diarrhea. I checked this reference by Jacobs et al, that concluded there was enough evidence to try homeopathy as an alternative to oral rehydration. However I found that the same authors had indeed gone on to try this with negative effect. See:"Homeopathic combination remedy in the treatment of acute childhood diarrhea in Honduras. Jacobs J, Guthrie BL, Montes GA, Jacobs LE, Mickey-Colman N, Wilson AR, DiGiacomo R. J Altern Complement Med. 2006 Oct;12(8):723-32. PMID 17034278. Accordingly I deleted the reference rather than insert a refutation.Gareth Leng 14:23, 8 October 2010 (UTC)

For several reasons, I'm not sure this should be deleted. First, it does confirm, probably to the benefit of homeopathy, that research, even with negative findings, continues. Second, one can examine this talk page and find an attack for ignoring Oscilliococcinum work -- which I had not been aware had been withdrawn. It does cast question on the credibility of a homeopathic expert that would defend it based on that study, when an expert would know it had been withdrawn. (I hear "strawman" being woven...) Howard C. Berkowitz 14:35, 8 October 2010 (UTC)

We have responsibility for the article as experts, and shouldn't be deciding the content of that on the basis of points scoring in disputes.Gareth Leng 14:57, 8 October 2010 (UTC)

Third modification: Kleijnen J et al. was cited as though it was supportive of homeopathy when in fact the opposite is the case (the article is open access and can be reached via the PMID link now given); this must be made clear, and I've inserted the abstract conclusion to do that.Gareth Leng 14:57, 8 October 2010 (UTC)

Gareth...please SLOW DOWN here because you are erring. That reference that you deleted was a meta-analyses of 3 previous studies, and it was published in a good journal. The 4th study was the use of a combination homeopathic medicine, without INDIVIDUALIZED treatment. This 4th trial did NOT disprove the previous 3 trials because the 3 trials tested "classical homeopathy." Please consider doing deletions only when you have greater certainty. Dana Ullman 23:22, 8 October 2010 (UTC)

Thanks Dana, I'll certainly review this. I'll make no further edits for a while now.Gareth Leng 11:17, 9 October 2010 (UTC)

Fair point Dana and I'm restoring the Jacobs ref.Gareth Leng 11:35, 9 October 2010 (UTC)

Lede sentence

This sentence needs work. It suggests that homoepathic remedies endure double-blind trials and are called drugs. It gives the misleading impression that homeopathic remedies go through similiar approval standards as other drugs, which the average reader will not understand. We can't leave it like that.

• The basis for determining what symptoms and syndromes a homeopathic medicine is effective in treating are experiments in toxicology called drug provings, which are single- or double-blind trials in which healthy subjects are administered remedies in homeopathic doses on a daily basis until symptoms are elicited.

I've made my alterations at one point, but it apparently wasn't satisfactory, so let's work it out here. D. Matt Innis 20:07, 11 October 2010 (UTC)

The use of toxicology here is also questionable, unless it's an explicitly homeopathic form of toxicology. While the toxicologists I know certainly are very aware of the need for emergency and chronic exposure treatment, they seek molecular models in addition to purely symptomatic ones. Anyone have a copy of the definitive clinical reference, Goldfrank's Toxicological Emergencies? --Howard C. Berkowitz 22:50, 11 October 2010 (UTC)

Evidence for homeopathy: International Journal of High Dilution Research

Reverts seem to be bouncing over Some researchers claim that there is scientific evidence that homeopathy helps in many problems and diseases<ref name=Van_Wassenhoven>{{citation | | title = Scientific framework of homeopathy: evidence-based homeopathy |first= Michel | last = Van Wassenhoven | journal = Int J High Dilution | date = June, 2008 | url = http://www.feg.unesp.br/~ojs/index.php/ijhdr/article/viewFile/286/354}}</ref>

I'm troubled by the "researchers", as if that is makes it neutral. The IJHD's home page describes it as "the first full free open-access electronic journal specialising in the multidisciplinary field of High Dilution (HD) research." It turns out, however, to be a broadened publication of the journal Cultura Homeopática, which seems less neutral. Again from the homepage, it is indexed by a number of sources, MEDLINE not among them. There is a home page announcement celebrating an anniversary of Hahnemann's Organon; there is a section on materia medica.

In other words, the source of support for homeopathy appears to be largely homeopathic.

Howard C. Berkowitz 20:16, 11 October 2010 (UTC)

That feg doc mentions articles in scientific journals (like the BMJ, Lancet, Eur J Clin Pharmacol, Br J Clin Pharmacol, Ann Intern Med, J Clin Gastroenterol, Rheum Dis Clin North Am., Rheumatology etc.) and is therefore, titled that way.—Ramanand Jhingade 16:13, 14 October 2010 (UTC)

And your point about it mentioning scientific journals? That doesn't make it true or false, but it is not a scientific journal with much impact in biomedical literature or listed in MEDLINE. There is a very strong push for disclosure in biomedical reporting, such as mentioning whether drug companies had any control over the paper, or even the study being reported upon.

When the author is a homeopath, but simply described as a "researcher" and the journal name does not make it obvious that it is homeopathic, those facts are reasonable, even required, to disclose. They were not disclosed. Howard C. Berkowitz 17:08, 14 October 2010 (UTC)

This article is now clearly a disaster

Since the last time I looked at it, this has become a disaster, an agenda-driven article written by the homeopaths amongst us. It takes 4 long paragraphs and hundreds to words to even *hint* at the notion that homeopathy is a non-science, fringe-science, pseudo-science bit of quackery and nonsense. I frankly don't see how anyone here at CZ who is not an agenda-driven homeopath can read the first four paragraphs and not cringe. For shame! On all of you who permit this. And for the two of you who continue to inflict your medieval notions on the rest of us -- who, apparently, are too timid to fight back!

This will change if I am elected to the Editorial Council. Trust me on that! Hayford Peirce 22:42, 11 October 2010 (UTC)

I endorse Hayford's view. Howard C. Berkowitz 22:44, 11 October 2010 (UTC)

I do not. Granted, the article has problems, but the current draft is much better than the approved version. Sandy Harris 23:29, 11 October 2010 (UTC)

Well at least someone has restored "Scientists conclude that homeopathy is ineffective because the remedies are diluted to the point of no molecular content, and any positive effects are likely to be placebo." to the bottom of the first paragraph, so it isn't *quite* as disastrous as half an hour ago. Hayford Peirce 23:32, 11 October 2010 (UTC)

(undent) Execrable as I consider the time and effort that sinks into this topic, I have just made what may be some simple organizational changes to the lede. By and large, everything that was there is still in the article, but wikilinked from the lede rather than inline.

The only substantive change, I believe, was I to the statement that homeopathy is "established" worldwide. I also removed a somewhat apologetic inline suggestion to go to external links. Howard C. Berkowitz 23:49, 11 October 2010 (UTC)

I'm ashamed of this article. I'm ashamed that it has been approved. I'm ashamed of all the time we waste on it. If I had my way, I'd replace it with a three-line stub explaining what homeopathy is and that people find it controversial, and seal it up so we don't touch it until we've got 100,000 articles on other topics written. I thought reality television was the ultimate waste of life: then I found out about arguing about alternative medicine on the Internet. Sigh. –Tom Morris 00:45, 12 October 2010 (UTC)

Well, yes. But if it were sealed, would Indiana Jones open it? It's so terrifying that I find myself in agreement with MBE's election statement on fringe. Howard C. Berkowitz 01:14, 12 October 2010 (UTC)

Trusting that claims of arrogance will cancel

While my general practice has been to discuss here before changing, I cannot stand by and watch yet another round of biased pro-homeopathy changes made under the rubric of improving accuracy, and also the claim of being more "encyclopedic" from one who does appear to have any encyclopedic experience other than advocating homeopathy.

The elections can't come soon enough. Thank you, advocates, for at least establishing a point-of-the-spear case for different policy views of Citizendium. Howard C. Berkowitz 01:37, 12 October 2010 (UTC)

Disastrous edits

In the context of talking about medical & scientific opinion, we had: "There is little, if any, evidence of the efficacy of homeopathic remedies." I think that is an accurate statement. The only question would be whether "little, if any" should be changed back to "no" in this context.

Dana replaced that with "Although there are numerous studies that show the efficacy of homeopathic medicines, there has been little replication of these studies to truly verify efficacy beyond that of a placebo." If I were an editor here, I would immediately revert that. However, I am not, so I am asking for opinions from other editors.

In my opinion, we need both a clear statement of homeopathic ideas and a clear statement of the scientific and medical attitude to homeopathy. I think it would be an error to clutter up the statement of homeopathic ideas with "for which there is no scientific basis" in every sentence. That is true, of course, but it does not belong there. This may be why Hayford objects above to the first four paragraphs.

On the other hand, I feel quite emphatically that Dana's apologetics have no place in the section on medical and scientific opinion. I am not at all sure they have a place in an encyclopedia, for that matter, but to the extent they do, they belong in a section on evidence & research, not in the lede and especially not in a section on medical & scientific opinion. Sandy Harris 01:53, 12 October 2010 (UTC)

Part of the problem is there is no longer any realistic Editor oversight. Since there are several editor-authors, from wildly different viewpoints, there's no mechanism for resolution until the EC creates one.

May I suggest, as a simple edit of ""Although there are numerous studies that show the efficacy of homeopathic medicines, there has been little replication of these studies to truly verify efficacy beyond that of a placebo."

Although there are numerous studies that argue homeopathic remedies demonstrate efficacy, none have shown a sufficiently high level of evidence that independent researchers have been motivated to suspend work in other areas and try to replicate them."

Let's put it in pure criticism of medicine. What the world does not need, at least to split the health care budget, is yet another statin with marginal if even statistically significant benefit over currently marketed drugs. More of a case can be made for slight variations on antibiotics, since a slight variation sometimes can overcome resistance -- but new antibiotic classes desperately are needed. One of the more promising areas is pharmacogenetic testing to determine whether a patient is likely to respond. I can't ethically say that the hand-waving symptom complexes, with dubious repeatability even among homeopaths, is worth one cent of diversion of budgets from molecular and genetic medicine/

The above is, some extent, a statement of faith -- but is argument here any more likely to settle it than those who dispute evolutionary biology?

Did my reorganization of paragraphs 1-5, at least before the changes you mention, help? Howard C. Berkowitz 02:09, 12 October 2010 (UTC)

I thought not, but it is certainly a matter of opinion. To me, my rewrite of the lede was nearly perfect, and almost none of the changes since have been improvements. Some, like yours, are mainly matters of style; I may not like them, but that does not much matter.

Other edits are matters of substance, and I object fairly strongly to some of those. Your compromise text above is OK. Sandy Harris 02:15, 12 October 2010 (UTC)

Sandy, it seems that you have kept yourself un-informed about the body of randomized, double-blind, placebo-controlled clinical trials and/or you've chosen to only read articles written by ardent antagonists to homeopathy. I encourage you to do more academic review of the body of evidence that exists on homeopathy. If and when you do, you will realize that you cannot say that there is "no evidence" or "little, if any" evidence that homeopathic medicines work beyond that of a placebo.

There is a diverse body of evidence showing that homeopathic medicines work from clinical trials, basic science trials, cost-effectiveness studies, outcome studies, and more. At the least, Sandy, I hope that you read the studies that are presently referenced in this article. If you have difficulties obtaining certain articles, contact me personally and I will see if I have digitized copies of them. The limitations of this research is that there are an inadequate number of replications of clinical trials, though, as you shall soon see, I will reference several reviews of basic sciences research that show dozens of replication trials.

The bottomline is that Howard's statement above is not accurate, and his reference to "homeopathic medicines" as "remedies" is not adequately accurate either because these medicines are recognized as DRUGS in virtually every country in the world. Dana Ullman 23:45, 12 October 2010 (UTC)

My reference to remedies and drugs? I thought I was following a convention suggested by Gareth.

"Recognized"? In many cases, purely through a traditional or political mechanisms, not a scientific one. Abraham Lincoln once asked "if you call a horse's tail a leg, how many legs has a horse?"

"Five?"

"Four. Calling a tail a leg does not make it one. "

The reality is there a tiny body of evidence that is generally not considered sufficient to divert the main practice of medicine. There is, however, enough of a body such that advocates can demand all be impressed. Wow, 200 clinical trials! I wouldn't be surprised if 7 East, the cardiac unit of the NIH Clinical Center, runs close to 200 a year, itself. Howard C. Berkowitz 01:38, 13 October 2010 (UTC)

Homeopathy in practice

Why is the lede of this section about famous people? I feel comfortable to asset that even more famous people overindulge in alcohol than use homeopathic treatment.

Many famous people over the past 200 years have been users and advocates of homeopathy<ref>Dana Ullman (2007) ''The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy.'' Berkeley: North Atlantic, 2007; www.HomeopathicRevolution.com</ref>

When I cite my own work, it has gone through some independent review. I am far less prone to cite my books than, say, collaborative reviewed articles at the IETF, but when I do, it's on a highly technical subject, perhaps with an original synthesis. It is my understanding of CZ self-promotion policy that one does not cite personal works that are not the only source for the material. I do not believe this book, which is advocacy and aimed at a general audience, qualifies.

It would seem to me that the essential of this section is about how homeopathy is practiced, not argumentum ad populum. "famous people" think about it. I would move up "a typical homeopathic visit" after a short lede, and then have subsections dealing with the prevalence, regulation, etc., of the discipline.

I also put back the reference to Royal Copeland and the FDA legislation, and removed another complaint by homeopaths in the section on medical views, not sourced and argumentative. Howard C. Berkowitz 06:02, 12 October 2010 (UTC)

"Why Famous People and Cultural Heroes Choose Homeopathy"?!? Good grief. David Finn 06:27, 12 October 2010 (UTC)

Yes, it is one giant appeal to (non-)authority. We could go the whole hog and take out all this tedious medical rubbish and replace it with "Homeopathy is awesome. David Beckham *and* Pamela Anderson like it. They are celebrities so they must be right." –Tom Morris 10:50, 12 October 2010 (UTC)

Ms. Anderson, however, can reasonably claim experties in recovered mammaries. Howard C. Berkowitz 16:01, 12 October 2010 (UTC)

Lede plus

Suggest going with lede in "Revision as of 23:32, 11 October 2010", then deleting remainder of text of main article, keeping subpages.

I suggest that because it appears we cannot develop an article to satisfy all contributors. Give the reader a bibliography and a set of external links so that reader can pursue the topic.

Anthony.Sebastian 06:34, 12 October 2010 (UTC)

That idea has been revisited quite a few times over the past few years. I outlined a few of the revisits a few threads ago. In general, the particpants ignore this and just carry on. How do we stop this? Your idea is the most sensible I have seen so far. Let's have a vote. David Finn 06:38, 12 October 2010 (UTC)

Oh, I agree with this as one sensible solution. Procedurally, though, it may not be possible, or will need EC guidance.

The simplest way would be to make the deletions and find three editors of relevant workgroups (health sciences, healing arts, chemistry) to approve it. I'm not sure, however, if an Approval can be done over the explicit objection of a fourth editor (guess who). Also, there is no Editor mechanism that I know to impose an overall lock on the topic, so the battle would start all over in the new Draft page. Can three Editors direct a Constable to do that? I don't know.

Realistically, what will probably have to happen is for the EC to form, and either directly order these changes, or, which would be more indirect, get rid of the Healing Arts workgroup as an aberration. Qualified Healing Arts Editors could transfer to Health Sciences. Unfortuantely, until there's an EC in place, much as I'd like to triage this to Black Tag, I don't think the rules cover it. Howard C. Berkowitz 06:51, 12 October 2010 (UTC)

Suggest content of this article await decision by the post-Charter Editorial Council, which will undoubtedly let all interested Citizens have their say. Anthony.Sebastian 07:07, 12 October 2010 (UTC)

Agree. Personally I've always felt that whether you support or oppose homeopathy, the most effective case for either side must include coolly and carefully explaining what homeopaths believe, why they believe it, and exactly what they do, and allowing readers room to draw their own conclusions. But I don't see consensus support for that, and we're locked in intractible wrangles less about content than about tone and presentation. I would rather strive to avoid any editorial tone, except one of cool dispassion.Gareth Leng 08:45, 12 October 2010 (UTC)

Anthony, I don't have a version with that date. Apparently the versioning process doesn't change dates when we're in different time zones. Can you specify the version number so I can see if I agree with this suggestion this time? Thanks in advance. D. Matt Innis 13:38, 12 October 2010 (UTC)

Matt, don't know how to find "version number", but the Homeopathy/Draft revision I referred to comes up at http://en.citizendium.org/wiki?title=Homeopathy/Draft&diff=100719695&oldid=100719691 Anthony.Sebastian 02:44, 13 October 2010 (UTC)

Thanks, Anthony. That is a different version than I came up with the first time. If we were to do something like that, the version you chose is the version that I would go with as well. D. Matt Innis 03:14, 13 October 2010 (UTC)

Of course, the other alternative is to break the article up into many smaller articles (like throwing water on gremlins). D. Matt Innis 17:16, 12 October 2010 (UTC)

Recognizing realities

Offhand, I see at least five, and perhaps more, Editorial Council candidates participating in this discussion, perhaps more than five. The only regular advocate for a pro-homeopathy bias comes from one person.

Is this masochism, defiance, or something else? Now, the classic phrase about elections is that they aren't over until they are over, but it's fair to say that there is a strong anti-homeopathy sentiment by a good number of the like EC members. Dana, are you really, really sure you want to fight to the last minute, or can you accept that no matter what you do, there will be drastic changes to what this article will do. Is it really to your advantage not to explore any compromise, or see if more might be saved than in the worst case? With all respect, I plead you don't claim your approach is more encyclopedic, because it's long past the time where you might have participated elsewhere and had a credible opinion what an encyclopedia of this sort should be.

Truly, I am trying to reach out to avoid what would otherwise be confrontational, time-consuming, and yet have no real change in output. Your best outcome, in my opinion, is to cooperate with a much-reduced article followed by a moratorium of at least six months or so. You are balancing that against an outright ban to the article, not just due to questions about its content but also about the overall drain it puts on stressed resource. Perhaps in 6-12 months, the resource will be less critical. Howard C. Berkowitz 11:21, 12 October 2010 (UTC)

I want an article that contains well-sourced interesting material, cool presentation of facts, an accurate account of what homeopathists believe and do and why, a dispassionate and honest account of the best scientific and clinical evidence a clear concise and logical summary of the scientific and medical objections to homeopathy, and no overt editorialisation. Personally I don't give homeopathy any credence, but that's not the point; you cannot make an honest case against anything without understanding the case for it, and why put words in the mouths of homeopaths when they are here to speak those words; we all must use verifiable good quality sources, avoid both promotion and denigration, and be honest and constructive. If homeopaths consider that the fact that celebrities and many famous people in history have used it is good reason for believing it, then this is something we should say and let readers judge the strength of that argument for themselves. We do not say the fact that celebrities and many famous people in history have used it is good reason for believing it; we say that this is what homeopaths say. I don't see the value of putting "but this is obvious nonsense" after such statements; it demeans the reader.

Some things just don't get me agitated, and one is order of presentation. Some people think that an article must be balanced even for readers who read just part of it. In my professional life I'd consider that bonkers; if you don't read to the end, how on earth do you expect to make a balanced appraisal, and if you do read to the end, the last word counts as much as the first. But that's my two pence worth.Gareth Leng 15:27, 12 October 2010 (UTC)

I can agree to that without question. At the risk of being shot with a .44 Magnum, and just thinking out loud; looking at this talk page, and the immediate edits that occur after any rewrite, I'd tend to believe that we are still missing a viewpoint. That is why there is so much disdain. Someone is not being heard in relative proportion to the pro-homoeopath and I'd say it is the anti-homeopath, whomever that might be. It wouldn't matter how big the article is - they'd still be unhappy. While you and I might think that the pro-homeopathic tone and the anti-homeopathic tone are equally annoying and do not serve their purpose well, we either have to include neither, or both. How to do that is the challenge. If we don't want to go back and forth (most annoying) then maybe we let the anti-homeopath viewpoint have its own section - unopposed. This, of course, is different than the scientific viewpoint, which I think we have well represented here. D. Matt Innis 17:13, 12 October 2010 (UTC)

Gareth, most people are not you, and are not going to read to the end of a 10,000-word article (or however long this interminable one is) -- they are "going to cut to the chase", as they say. If we don't indicate clearly, and VERY NEAR THE START, that, in the view of mainstream scientists, homeopathy is nonsense, but leave this vital information to paragraph four, or nine, or seventy-three, then most people aren't even going to see it. Hayford Peirce 17:19, 12 October 2010 (UTC)

Fair enoughGareth Leng 09:52, 13 October 2010 (UTC)

From the peanut gallery*, I wish there more Gareths. When I suggested he arrange for Scottish colleagues to clone him, he declined. It's too bad Dolly the Sheep wasn't a Citizen so we could keep using copies.

• True American trivia, but I was actually an in-person studio member of the Peanut Gallery of the Howdy Doody Show. Am I up to importing the WP article on said show? Howard C. Berkowitz 19:33, 13 October 2010 (UTC)

(undent) I have to agree with Hayford -- the average reader, these days, wants fairly instant gratification. (Brief pause while I beat my head against the wall for the housemate that thinks Fox News is fair, balanced and accurate). He is an intelligent man, but it's frustrating because, for example, he hears on simplistic statistic but no hypothesis, and objects when I try to restate the problem for Bayesian reasoning -- not knowing in advance what inferences can be drawn.

Long articles are certainly comfortable for researchers, and for author of significant paper documents. I find I have to keep a document shorter, though, if I'm using endnotes rather than footnotes.

Quite seriously, what do you mean by "anti-homeopath"? I'll stand for one position: that the level of effectiveness firmly demonstrated, the lack of repeatability among practitioners, and the fact of better founded parallel research makes it very difficult to me to rationalize research investment -- the probability of significant return is just too low. That's public budget policy as much as science. Howard C. Berkowitz 17:42, 12 October 2010 (UTC)

The anti-homeopaths would be the ones that think the pro-homeopaths are baby-killers. D. Matt Innis 20:03, 12 October 2010 (UTC)

OMG are we still here. This draft article is the tenth longest on CZ, yet it and it's parent are only seen by CZ members and a few people who have read about how this article is CZs black hole, sucking the life out of it. What an asset to the encyclopedia this one article is. David Finn 06:52, 13 October 2010 (UTC)

The problem is that some people want to criticize and condemn every sentence in the article.—Ramanand Jhingade 16:26, 14 October 2010 (UTC)

Perhaps. Others, Ramanand, really don't want to argue (translation: disagree with homeopaths). Those others would like the article cut back to a definition with bibliography, or even deleted. And why, perhaps, are they doing it? Could it have anything to do with the constant attempt, by two homeopathy advocates, to avoid any serious criticism of a 19th century approach to medicine that others consider to be worthless? The above statement is a complaint; it doesn't propose a solution.

We have very reasonable articles on other CAM forms. What is it about homeopathy that divides Citizendium? You assume it works. I don't. Thanks to the unwillingness of the advocates to stop trying to get a pro-homeopathy article, I predict, with the election of an Editorial Council, that special action will be taken to reduce and freeze this article. Healing Arts will almost certainly no longer be a separate workgroup, but its editors, if qualified, taken into Health Sciences. Howard C. Berkowitz 17:08, 14 October 2010 (UTC)

"Completely unnecessary"

I will revert Ramanand's deletion of the underscored words, Homeopathy is used worldwide both by some medical doctors and other licensed health practitioners who use it as an alternative or a complement to conventional medical treatment for both acute and chronic ailments, by homeopaths either without medical training or homeopathic training only, and by consumers who use it to treat common non-life-threatening acute conditions,, which was deleted with an edit comment of "completely unnecessary".

Even without going outside this article, the deletion flies in the face of facts, and is yet another blatant and unsupported defense of homeopathy:

• UK common law is described as permitting anyone to call themselves a homeopath.
• (More detail here) Many US states do not require licensing of homeopaths. Three states license homeopathic practitioners without non-homeopathic training.
• While India recognizes homeopathy as an "alternate system of medicine" within its core approach to delivering health services, few other countries, none in the West of which I am aware, give it that strong an endorsement.
• (lost track of revert status) The American Institute of Homeopathy admits only, as full members, people currently licensed with an physician or dentist degree, and, as associates, advanced practice registered nurses or physicians' assitants.
• There is abundant description of over-the-counter consumer remedy sales. I may need to go to the supermarket/pharmacy; would anyone be happier if I stopped at the display of Oscillococcinum* and quacked at it? Yes, Hayford, I agree you would find it amusing to see me quacking in the aisle of a large public place. :-)

In other words, the deletion is blatantly unsupported.

Another edit is argumentative and draws an unsourced conclusion of the reasoning of HMG: The British Government has decided to continue funding homeopathy on the NHS because the British health minister declared that doctors should be free to decide whatever treatment they think appropriate in individual cases. Could there, perhaps, have been any political reasons for said minister to be doing so? If doctors have such freedom, may they then prescribe drugs, withdrawn from the market for safety reasons, because they think it appropriate?

• Is this a slur? Heavens no! I would be paying respects to the sacrifices of the simillium.

--Howard C. Berkowitz 17:29, 14 October 2010 (UTC)

As to the motives of the British government in their response to the Evidence Check - it is perfectly easy to see what their motives are. All one has to do is read the statement put out by the relevant health minister. 'Not funding on the NHS' is different from not being available. What is available via the NHS is a subset of that which is available. If a treatment - homeopathic or otherwise - were banned from use, it would be banned both on the NHS and from private practice. But certain things the NHS doesn't pay for - it doesn't pay for white composite dental fillings, it only pays for amalgam fillings - because one is considered cosmetic. Certain forms of orthodontic treatment aren't available on the NHS for the same reason. Expensive cancer drugs aren't available on the NHS if NICE determine that the cost per quality-adjusted life year (QUALY) makes it uneconomical. Certain less honest providers of alternative medicine are always trying to dilute the truth here (heheh): they want to take arguments about whether the NHS should be funding a particular treatment (which is done both on clinical efficacy *and* on cost-effectiveness) and conflate it with whether or not particular treatments are available generally. Whenever it is brought up that a particular alternative intervention probably shouldn't be on the NHS (like homeopathy, for instance, which is there only for historical reasons as far as anyone can tell), it gets painted as an attack on the availability of that treatment as a whole. –Tom Morris 00:13, 15 October 2010 (UTC)

I will be reverting Howard's reversion because he has again shown how mis-informed he is on homeopathy. I have previously shown Howard's propensity to say and write things that are unsupported, and he has done so again. Please provide evidence of your points 2 and 3 (because there are simply made up out of thin air). Sad, but true. Tom's comment is simply a weak effort at humor, and even his serious points are off-topic. –Dana Ullman 00:48, 15 October 2010 (UTC)

I should have diluted the humour more to make it more effective. The comment I made is not off-topic at all: it was a somewhat long-winded response to Howard's second point. –Tom Morris 01:22, 15 October 2010 (UTC)

As to point 2, Mr. Ullman, I could take many examples, but I rather like comment from the American Medical College of Homeopathy.[5]

While many practitioners are medically licensed, many are non-licensed. Quality varies greatly from those who take a weekend course and hang up a shingle, to those who have seriously studied homeopathy for many years and are certified in their practice.

That same organization notes "The American Medical College of Homeopathy was granted full accreditation in 2005 through the Council on Homeopathic Education, the accrediting agency for homeopathic programs in the United States (not recognized by the Dept of Education).

I note the many assertions you have made about how most homeopathic physicians have medical training. In such contexts, "medical training" is usually, in the US, constrained to clinical degrees with licensure requirements. The American Institute for Homeopathy requires an MD, DO, or DDS with licensure for full membership, and appropriate degree and licensure as an advanced practice nurse or physicians' assistant to be an associate member. What, an MPH isn't among these credentials? Pity.

Frankly, I rapidly approach the point in which argument is futile. On the other hand, elections are in progress. Several candidates for Editorial Council have expressed a great dissatisfaction with homeopathy and its effect on CZ. Indeed, depending on the outcome of the election, some people will almost certainly leave Citizendium. If, however, a sufficient number appalled by homeopathy win election, don't wait long for drastic action on this article. The only reason the Healing Arts Workgroup might stay for a time is that it might be deleted only as part of an overall structuring of workgroups. Very few people have a problem with CAM, and think we have quite decent articles on acupuncture and chiropractic, with things such as traditional Chinese medicine that have room for improvement. The specific problem is homeopathy.

If elected, I will vote to take some form of the proposal begun, as I remember, by Anthony: cut the article back to a small lede with a bibliography, freeze it, and lock the page as other pages have been locked, to preclude yet another round of endless drafts. Alternatively, a quite well-precedented approach would be to send homeopathy to CZ: Cold Storage, since it is evident that CZ cannot produce a quality article on this subject. If this is not acceptable, don't vote for me.Howard C. Berkowitz 02:38, 15 October 2010 (UTC)

While I agree with some of the above and disagree with other parts, it sounds more like we've denigrated into advocacy and campaign speeches and public service announcements. I don't see anything that I would consider really helpful toward improving the article and really wastes time and effort.

I also feel that the article is not an improvement over the approved version in it's current state and I'll check back at some later date. D. Matt Innis 02:55, 15 October 2010 (UTC)

Matt, with due respect for your time, why bother? Might I suggest you lock the article and talk page until after the election? We're in a revert war now and nothing is going to get accomplished. I don't care enough to keep arguing reverts with the advocates. I'm not the only person saying that there is no possible useful outcome of this, but there is no enforcement mechanism at present.

As a more useful exercise, go consult Kilometres Deboutish. I await Hayford's commentary there; one really needs to speak French to appreciate it, I suspect. Howard C. Berkowitz 03:37, 15 October 2010 (UTC)

You might have missed it Matt, but that's where Citizendium has been for nigh on two years. Are you going to respond to the repeated suggestion to lock this whole process until a decision can be made or aren't you? David Finn 04:28, 15 October 2010 (UTC)

De toute façon ("of all fashion", as Kilometres Deboutish would say but actually "In any case" ) the elections are underway and soon we will have the results. I will be astonished if, on the 23rd of October, we do not have an Editorial Council that will rapidly sort out all of the nonsense that has been propagated in this mindless "time sink" over the last two years. I think that two or three months from now this article, if it even exists anymore, will be *very* different -- and CZ can go on to other things.... Hayford Peirce 04:38, 15 October 2010 (UTC)

On what authority do I act. I am but a fouth editor on this page. Whether I agree or not, if I were acting as a constable I'd be obliged to remove most of your comments as complaints and inflammatory. I am more saddened at the refusal to collaborate by all parties. There has been a failure. It's up to cooler minds to find out where we went wrong. D. Matt Innis 11:45, 15 October 2010 (UTC)

By the way, the article has been locked for two years, that's the idea of approval. D. Matt Innis 11:50, 15 October 2010 (UTC)

(undent) Matt, there is indeed an locked approved article, but we cannot assume that a random outside user is going to understand the nuances of approval, when there is bitter wrangling on a Draft.

Yes, I agree that it needs to wait for the election. Once the EC is in place, however, I suspect quick action will be taken.

What's wrong with the reality that some articles, at least under the existing rules and customs, are not suitable for collaborative article generation? My clinical (and military) colleagues recognize that you can't always save everyone and, with real lives, will go insane if you don't accept it.

Rather than call it a "failure", I'd prefer to call it useful negative results from an experiment. If there has been a failure, it is the long, long time it has taken to accept that, and the stress on all participants. Do you really think I care much about homeopathy per se? I do care about the quality and integrity of CZ, and have been active here to do my best to protect it.

No, I don't believe every topic is appropriate for a CZ article. That usually applies to things such as a report on a high school sports team, but it also should apply -- never mind whether it's fringe or not -- when substantial effort shows no plausible consensus outcome. No, I don't believe some of our best writers should spend large amounts of time trying and trying to get an acceptable draft. --Howard C. Berkowitz 20:45, 15 October 2010 (UTC)

Larry created CZ to get articles that are approved by experts in the field, just so that they don't become attack pieces, I hope we can all remember that even after the elections.—Ramanand Jhingade 15:02, 17 October 2010 (UTC)

First, I remember Larry is no longer Editor in Chief. Second, there has been a charter that creates a new and empowered Editorial Council. If I or several others are elected, you can be sure of drastic action to freeze this article and probably take it to Cold Storage. I'm informing, not arguing, that, in the kindest of phrasings, it's impossible to reach consensus on this article in the current system. Apparently, it's OK for experts in homeopathy to attack medicine, but not the reverse. Forget it. Howard C. Berkowitz 16:08, 17 October 2010 (UTC)

Text here was removed by the Constabulary on grounds of civility. (The author may replace this template with an edited version of the original remarks.)

A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism.. Dana Ullman 04:09, 20 October 2010 (UTC)

It is the likely removal of this article from mainspace, certainly in its present form, and the end of the Healing Arts Workgroup that may well be its resurrection. Howard C. Berkowitz 04:22, 20 October 2010 (UTC)

A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism.. Dana Ullman 14:36, 20 October 2010 (UTC)

It seems that a certain person editing above prefers to continue to provide mis-information and to not provide adequate or accurate references to the information he has written...and instead, he would prefer to complain that request that the evidence that I provide of his errors be stricken. I am disappointed that he has been successful and am confused by such actions.

Once again, I will assert that Howard's statement about the 3 states in the US that license homeopaths is WRONG. The 3 states (Arizona, Nevada, and Connecticut) allow ONLY the licensure of MDs who add homeopathy to their medical training. How Howard (or anyone) can construe this fact as evidence that 3 states that license homeopaths do not require medical education is confusing. I have repeatedly asked that Howard provide evidence for his ongoing assertions, but it seems that he would rather avoid providing evidence. The homeopathic medical school in Arizona that he references is a new school that will be offering medical education AND homeopathic education. How or why anyone would insist that this school does not offer medical education is also confusing (and simply inaccurate). Hopefully, we want our information here to be as accurate as possible. Dana Ullman 20:12, 20 October 2010 (UTC)

I dispute the lack of evidence, but I'm simply not going to waste my time until the Editorial Council deals with homeopathy. If, hypothetically, Anthony's proposal is adopted, the article won't contain this level of detail. If the whole article goes, for example, to CZ: Cold Storage, the details also are moot. Howard C. Berkowitz 20:45, 20 October 2010 (UTC)

It is a tad ironic that Howard is now wanting the article to be shorter, even though he had been badgering me and others for a long time wanting to expand the article with details about how homeopaths think and how they would choose to treat numerous rare conditions, such as gangrene (a subject that is still a part of this article and for which I could easily forego). Dana Ullman 23:30, 21 October 2010 (UTC)

Finlay Institute

The Cuban trial was run by the Finlay Institute, the commercial producers and suppliers of the product, and authored by the employees of the Institute. I can't think of a more flagrant example of conflict of interest. The flaws in the trial are pretty obvious and I won't dwell on those.Gareth Leng 12:39, 19 October 2010 (UTC)

In response to a request from Dana for further information on this: "VACUNAS FINLAY S.A. is the company that holds the exclusiverepresentation for negotiation and commercialization of the products, technical services and consultancies of Finlay Institute. To grant, acquire, transfer, and receive technologies, licenses, patents and trade marks under any title for the development, production and commercialization of pharmaceutical products are responsibilities of the company."

[6]. The problem is that the Institute has a direct commercial interest in the outcome of the trial, and was run and authored by employees of the Institute; all authors were employees. (nosoLEP is a registered product (Registration numbers: nosoLEP 200C: N-09-184-S01, nosoLEP 10MC: N-09-182-S01) developed and produced at Finlay Institute.)

Whether it is ever acceptable for drug companies to conduct clinical trials on their own drugs is controversial:here, Vincent Lawton argues that "Trial designs and protocols are assessed and endorsed by regulators who assiduously guard against inadequate trial design, insist on good clinical practice standards, and ensure high quality analyses. Ethics committees, who are fully independent (normally established and funded by the NHS in the UK through health authorities), do not countenance a substandard study design. They frequently intervene before a study is allowed to proceed. An impartial data monitoring committee (funded by the trial sponsor), comprising distinguished academic clinicians, monitors the analyses and trial results and protects the safety of participants, the credibility of the study, and the validity of results. Indeed, some evidence suggests that industry sponsored studies have higher methodological quality than those funded by other bodies."

The converse case (that the financial interests of drug companies lead to distorted evidence), is argued here.

In the case of the Cuban trial there is no indication that any of the safeguards mentioned by Lawton were in place except ethical approval. Most importantly, there was apparently no external regulation of trial design and no impartial data monitoring. Thus the issue of conflict of interest is that the manufacturers of a commercial product conducted their own trial by their own design with their own employees and published by them alone without impartial oversight of design and data collection and analysis; given that the company has a clear financial interest in the outcome this is unacceptable (in my view); we've seen too many tarnished trials in conventional medicine in the past. Gareth Leng 09:04, 20 October 2010 (UTC)

Yes, given the above, I'd say we have to leave that out. We probably should avoid most primary research at this level. There are plenty of reviews available. Other articles that deal with details can cite primary research. D. Matt Innis 19:30, 20 October 2010 (UTC)

Where from here

Gareth's comment was moved to CZ:Editorial Council/How to address Comprhensive, neutrality and objectivity D. Matt Innis 12:46, 22 October 2010 (UTC)

Thanx Gareth, for your refreshing objectivity. People here know that I am NOT interested in having a puff piece "for" homeopathy. People here know that I have not deleted many statements about homeopathy that are not "positive" spins on the subject. That said, I have shown concern about unsupported statements. Dana Ullman 23:42, 21 October 2010 (UTC)

You are part right Gareth - it ought to have been many things. But it's not. Maybe you ought to just get over it and allow the encyclopedia to move on. It's just one article. David Finn 08:27, 22 October 2010 (UTC)

Inappropriate deletion

The following was deleted, with an edit note that the non-MD homeopaths were't allowed to prescribe antimalarians

Despite this, an undercover investigation by BBC Newsnight uncovered a large number of high street homeopaths willing to prescribe homeopathy instead of anti-malarials.

If they aren't allowed to prescribe something even MD homeopaths accept as reasonable, why (insert minimally appropriate expletive) aren't they referring? Howard C. Berkowitz 00:59, 22 October 2010 (UTC)

What is WTF? D. Matt Innis 13:04, 22 October 2010 (UTC)

In the context, Howard is saying "Why the flip" aren't the homeopaths referring people to a traditional doctor? Except 'flip' may in fact be a particularly uncivil term for the act of copulation. –Tom Morris 13:21, 22 October 2010 (UTC)

When one goes to a non-MD homeopath, one generally goes for homeopathic medicines, not for conventional drugs that the homeopath cannot legally prescribe. If one goes to an MD who practices homeopathy, THAT practitioner can and may prescribe conventional drugs too. The "problem" is a straw man. On the other side of the argument, one might also express concern that conventional physicians are not referring to homeopaths and other clinicians who practice various safer methods to honor the "First, do no harm" ethic. Dana Ullman 05:56, 23 October 2010 (UTC)

Revision 100723625

Mr. Ullman removed from the article the following text:

Despite this, an undercover investigation by BBC Newsnight uncovered a large number of high street homeopaths willing to prescribe homeopathy instead of anti-malarials.

As well as the citation pointing to the BBC article on the topic. He provided the following justification:

Straw man argument because the non-MD homeopaths interviewed are NOT allowed to prescribe anti-malarials!

How is reporting that high-street homeopaths recommended using homeopathic anti-malarials instead of effective anti-malarials a 'straw man'? It is simple reporting of fact. Unfortunately, it isn't very good for the PR of homeopaths as there is a fairly substantive difference between telling people with chronic uncurable conditions to try an alternative treatment and telling healthy people to not take a medicine which prevents them from catching a deadly disease.

It doesn't matter if they aren't able to prescribe anti-malarials. A responsible medical practitioner should be able to refer people presenting with a particular need to the relevant place. We have a right to expect under consumer protection laws that people who claim to be medical experts don't recklessly endanger our health by - oh - conveniently forgetting to tell people to take anti-malarials in order to sell them some homeopathic pills instead.

Removing this strikes me as being the homeopathic equivalent of the No True Scotsman fallacy. One just conveniently recategorises the homeopaths who are doing some quite questionable stuff as not homeopaths using an arbitrary, post hoc categorisation. If the only homeopaths out there are those who are also MDs, how do we refer to people who sell homeopathic remedies from shops that call themselves homeopathic pharmacies and who put "homeopath" on their business cards and advertising?

It is all totally irrelevant of course. We have to deal with the medical regulatory system (or, sadly, lack thereof) as it currently is, not as something that can be tailored to Mr Ullman's apolgetic purposes. –Tom Morris 09:50, 22 October 2010 (UTC)

Thank you for the greater diplomacy, Tom. If there is a strawman here, it's the frequent raising of the argument that homeopaths usually are also medically qualified, until an example, such as this, comes out when they are not. Ironically, Hippocratic traditions are often invoked, but conventional medicine would consider it a serious ethical violation if, in a situation other than a desperate emergency, a physician tries to do a specialized treatment for which the physician is not trained or qualified. It was perfectly reasonable, because it was an emergency, for an Australian emergency room physician (under telephone guidance from a neurosurgeon) to use the maintenance department's power drill to put burr holes into the skull of a patient who could not survive the trip to a neurosurgical facility. Had the situation been less desperate, it would have been unethical not to stabilize and transport. Howard C. Berkowitz 14:41, 22 October 2010 (UTC)

In due respect, I am not clear how or why Howard and Tom still do not seem to understand that there are "medically qualified homeopaths" and "non-medically qualified homeopaths." Should we expect yoga teachers to refer for anti-malarial Rx? How about coaches? How about nutritionists or herbalists or acupuncturists? How about psychotherapists? I believe that there is a big difference between referrals from MDs and other medical professionals and ALL others...Dana Ullman 06:18, 23 October 2010 (UTC)

I think that Tom's edit makes an important implicit point about the lack of effective regulation in the UK; that's a point that it's right to make, though I hope there would be a better source of evidence for it than a BBC documentary ( - I'm sure there is). I say this because I've seen some scientific documentaries that are just absurd. On the other side, it is important to know if there is evidence of effective regulation by the homeopathic organisations - have any members been expelled or disciplined for breaches, and if so does this stop them practising? If there is evidence of the profession actively seeking to regulate itself effectively, then perhaps we should say so. I think we must also be aware that there may be important differences between countries - homeopathy is minor in the UK but massive in India. Let's get the general point here; the assertion is that homeopathy is essentially unregulated, allowing individual practioners to make unsubstantiated claims about its effectiveness without sanction or constraint. OK, strong evidence sources for this. What is the evidence for the converse - that there is regulation with teeth that is effective?

Seeing Dana's point - how can homeopaths be blamed for not prescribing conventional medicines when they are not empowered to do so - I can see the point here. The issue has to be about what advice do they give - do they tell patients that this is an alternative, or do they advise that they should seek effective conventional cure? How this is worded should not seem to be attacking homeopaths for not doing something they can't do, but for not doing something they can and should do. Gareth Leng 13:54, 26 October 2010 (UTC)

That would be the logical next step in any conversation on the subject; are there regulatory bodies that monitor homeopathy and act on behalf of the public? What is their response to the malaria claims? A short half sentence like ", but the (Homeopathic Regulatory Body) does not condone such advice", or "the (Homeopathic Regulatory body) encourages the use of these products as a method to prevent malaria", whichever is the case. D. Matt Innis 15:59, 26 October 2010 (UTC)

I have added a link and some pages from Singh & Ernst (2008) referring to the malaria investigation. John Stephenson 16:09, 26 October 2010 (UTC)

Hi John, the piece that you added has this:

• "...which found that seven out of ten high street homeopaths visited did not provide general advice about bite prevention or delve into the supposed patient's medical history, and that all of them recommended homeopathy instead of referring them to a doctor for conventional treatment."

I don't have access to the report. What was the patient population here? Am I safe in assuming that they were patients preparing to travel to areas of malaria risk? Do you know whether "advice about bite prevention or delve into the supposed patient's medical history, and conventional treatment" is evidence based best practice for whatever that population was? I don't see any malaria patients in the US, but if any patient had symptoms of malaria, I'd be referring them over. Are these patients that already have malaria, or are we talking about healthy patients just going for prevention of malaria? D. Matt Innis 17:01, 26 October 2010 (UTC)

The test they did was to go into homeopaths (in the UK) as someone who was planning to travel to a country with a high malaria risk and asked what they would recommend to protect against malaria infection. –Tom Morris 17:13, 26 October 2010 (UTC)

The point that homeopathy practice and regulation differs significantly among countries cannot be overemphasized. It would appear that the acceptable variation is generally greater than in medicine. The medically- vs. not-medically-trained distinction makes it even more confusing.

There are numerous World Health Organization and other recommendations about malaria prevention for travelers. Often, physicians do refer to infectious disease specialists for this when they don't have experience, in part for reasons exactly that Matt mentions -- bite prevention is important even for individuals; communities or groups need to take more preventive steps other than drugs.

Yes, there have been some bad experiences with some antimalarials that turned out to have significant side effects -- enough to reserve them for treatment rather than prophylaxis. On the other hand, the prophylaxis was being prescribed for people going to extremely high-risk areas with multidrug-resistant Plasmodium falciparum.

I have a vague and perhaps incorrect recollection that High Street is a prestigious area for health practitioners, but could someone from the UK expand a bit? Howard C. Berkowitz 19:00, 26 October 2010 (UTC)

Thanks, Tom and Howard. If people came to me and said they were going to the Congo, I have to admit, I would probably not think to tell them to go get a malaria shot. I suppose I might ask them if they are required to get extra shots to go there, but it would be more out of curiosity than professional requirement. But, then again, people know that I don't give immunizations, and hopefully don't expect me to know which ones they need. If you went to your cardiologist and told him that you were going to the Congo, is he required to give you a malaria injection. or tell you how to prevent mosquito bites? Is this the standard for all medical professionals? I am asking as much out of curiosity because my license does not allow me to even talk about medications, even tylenol. D. Matt Innis 03:22, 27 October 2010 (UTC)

I'm fairly experienced as a traveller, though with no medical or related training. As far as I know, there is no shot for malaria resistance. There are pills that need to be taken regularly through your stay in a risky area, starting a few weeks before you go. Several different drugs are used with different ones recommended for different areas. Some are taken once a day, some weekly. Some can have fairly nasty side effects. The average GP in a non-malarial are probably cannot get this right; it takes either a tropical medicine specialist or a GP with local expertise. Sandy Harris 03:42, 27 October 2010 (UTC)

Do look at the malaria article, and please note any questions on the Talk Page. No, there's no immunization -- if anyone/team develops an effective immunization for malaria or HIV, they get a trip to Stockholm. If there's no known resistance in the area of travel, chloroquine or doxycycline are the most common chemoprophylactics, neither of which being completely benign. For some areas with resistant forms, pills like mefloquine (Lariam) are recommended, but much riskier -- it has had significant psychiatric side effects, including a cluster of suicides in US military personnel sent to a dangerous area in Africa. Howard C. Berkowitz 03:54, 27 October 2010 (UTC)

Undenting and returning to the original point, I'd say the deleted sentence should obviously go back in. Sandy Harris 05:07, 27 October 2010 (UTC)

Yes, but a better reference found, and if no better reference found reconsider. Consider whether the point might also be already made elsewhere, if so reconsider. Consider whether the implicit point about ineffective regulation is already made and if not how and where it should be made.Gareth Leng 10:47, 27 October 2010 (UTC)

What is wrong with the reference? Yes, it is by a news organization, but it describes their equivalent of primary research.

In general, with the tensions in this article, it would be unwise to leave anything implicit and thus subject to dispute. Now, the point might be brought together with the British common law principle that allows anyone to become a homeopath, but, given the wide range of worldwide regulatory practices, I think that it really needs to go back in. Howard C. Berkowitz 12:15, 27 October 2010 (UTC)

I'd rather discuss the regulation explicitly. Does Britain have a homeopathic regulatory process? D. Matt Innis 17:06, 27 October 2010 (UTC)

Homeopathy in Britain is regulated by the Faculty of Homeopaths. Rather, the Faculty of Homeopaths regulate doctors and other qualified medical professionals who wish to practice homeopathy as well as their existing medical training. They hand out accreditations based on one's existing medical practice - so a doctor would be given an MFHom, and they have others for nurses, pharmacists and vets.

But you can go and setup as a homeopath without being accredited by the Faculty of Homeopaths. Non-medically-trained homeopaths tend to be members of groups like the British Homeopathic Association, which does require its members to submit to some regulation (I'm not sure what, I'm sure their website would explain in more detail). Of course, one doesn't have to be a member of the BHA.

There is now a government regulator for all alternative medicine practitioners but it is opt-in. It's called the Complementary and Natural Healthcare Council, but not many people have signed up for it. It does have some disciplinary oversight, but it doesn't attempt to see if the practices are reasonable or evidence-based.

There are some statutory regulations that apply to non-medically-qualified alternative medicine practitioners: the 1939 Cancer Act makes it illegal to claim to have an effective treatment for cancer if it isn't actually an effective treatment for cancer. This is enforced by local officers of the local Trading Standards Office. Beyond that, the other regulations applicable to alternative medicine practitioners are the same as are applicable to any other commercial operation - the Sale of Goods Act and its various amendments, and the Advertising Standards Authority, which can investigate claims in adverts. The ASA have investigated claims by homeopaths. Here is an example - note how the ASA have upheld the complaint on the grounds that the advert in question broke the rules in claiming to offer 'professional medical advice' - the advertising code in Britain requires that advertisments for homeopathy must include the instruction to "to consult a doctor if symptoms persist".

The Advertising Standards Authority have the power to demand adverts are not put on air, to demand modifications to an advert, or to require that all future adverts be submitted to them for 'advice' before publication. The Advertising Standards Authority also refer claims to the Office for Fair Trading.

The previous link to the ASA judgment is actually not a bad source for noting the (lack of) regulation for non-medically-qualified homeopaths in Britain.

One way we could use this kind of information is to create a table listing countries with two columns: one for 'regulation of medically-trained homeopaths' and one for 'regulation of not-medically-trained homeopaths', and we can then link off to a separate page for each country's detailed regulations. –Tom Morris 19:26, 27 October 2010 (UTC)

Good info, Tom. Here's info on the licensure and regulation in the USA from www.naturalhealers.com:

Homeopathy is not regulated in any state, so technically, anybody can use it in the legitimate course of their business. However, there's a catch; if by calling yourself a "homeopathic doctor" you imply that you are practicing medicine, you will be regulated by the laws governing the practice of medicine in that state. In all states, you cannot practice medicine without a license. You can "counsel" people on their health as long as you do not state or even imply that you can diagnose or treat illness.

Tom, in sincere and due respect, most of your info above on regulation in the UK is not accurate. The Faculty of Homeopathy does NOT "regulate" homeopathy. They educate physicians on homeopathy. The vast majority of non-medically trained homeopaths are NOT members of the British Homeopathic Association (BHA). The BHA is the lay organization that supports the work of the Faculty of Homeopathy. The organization that represents the largest number of non-medically qualified homeopaths is the Society of Homeopaths.

The bottomline is that the English has a long long history of the common law practice that allows freedom of choice in health practice.

I am not clear who wrote the above statement that references the "naturalhealers" website, but PLEASE know that this website is not a "high quality" source of information, and their above statement is evidence that they are plain wrong. We all know that 3 states in the US license "homeopathic physicians," that is, MDs who can practice homeopathy (Arizona, Connecticut, and Nevada). In Nevada, a MD/homeopath can supervise 3 non-MD homeopaths.

In the US, something like 13 state license naturopathic physicians (those people who complete undergraduate pre-med training that is the same as those going to medical school, and then, who complete a 4-year medical education that resembles the 1st two years of conventional medical school, with the last 2 years providing naturopathic medical training and clinical supervision.

Because homepathic medicines are regulated as "drugs" (mostly OTC drugs), it IS possible that unlicensed homeopaths could be construed as "practicing medicine without a license," though such arrests are very rare (back in 1976, I was arrested, though we won an important court settlement 10 months later).

Every state in the US defines "medical practice" differently, and because they define "medical practice" in very vague ways, regulators choose when to enforce strict or non-strict interpretations of "medicine."

I urge us to avoid writing on this subject without real evidence that your information is accurate. I hope that I can help. Dana Ullman 04:18, 28 October 2010 (UTC)

Egregious use of homeopathic reference to mischaracterize medical position

Dana inserted,

though both homeopathic and medical organizations acknowledge the significant and increasing resistance to conventional anti-malarial drugs and to the common minor and serious side-effects that these drugs are known to cause<ref>[http://www.trusthomeopathy.org/export/sites/bha_site/hh_article_bank/first_aid_and_travel/summer_2005.5_first_aid_on_holiday.pdf The travelling homeopath] Travel advice from The Faculty of Homeopathy and the British Homeopathic Association</ref>

A homeopathic reference is highly inappropriate to declare the positions of medical organizations. Indeed, there is very significant concern with some serious side effects. Mefloquine is one of the most dangerous drugs--but it is used prophylactically in situations where there is endemic multidrug-resistant P. falciparum. Cerebral falciparum malaria can approach 100% lethality on the order of 24 hours; it's risk-benefit. Every effort is being made to use alternatives, an increasing number of which are available.

This section needs to be removed. Even for homeopathy, a popular "travel advice" is hardly authoritative. Howard C. Berkowitz 05:10, 28 October 2010 (UTC)

I should add that while I find relying on a homeopathic health guide for mainstream medical opinion on malaria to be egregious, relying on it even for homeopathic information is questionable unless it cites a reputable poll. Howard C. Berkowitz 18:34, 28 October 2010 (UTC)

My point is that risk/benefit ratio issue is complex...and there is no "one size fits all" because different people who define risk/benefit differently. When one goes to a homeopath, you get homeopathy. Just as conventional doctors do not give recommendations for homeopathic treatment, we cannot expect conventional medical advice from homeopaths...and as I wrote before, to whom shall we expect this conventional anti-malarial advice from: coaches, yogi teachers, nutritionists, psychologists, and on and on. I belief that we can hold MDs to certain standards but other professions have their own standards.

I would like to follow-up on Howard's suggestion above that we simply delete this whole section that deals with the malaria. If others want to keep it, we have to honor some of the more complex issues that I have previously raised. Dana Ullman 04:33, 29 October 2010 (UTC)

No! Not the whole discussion of malaria, just the nonsense under "Dana inserted" above.

The fact that some homeopaths sometimes give advice that risks patients lives is important, much as Dana would like to deny it. The text Dana deleted as discussed in the section above should clearly be restored. Sandy Harris 06:29, 29 October 2010 (UTC)

"If you go to a homeopath, you get homeopathy." Yes, but what do you get from a non-physician homeopath in a minimally regulated environment? Does the consumer know? To me, both sources are relevant but complementary, and I'd like to see both returned. One deals with the position of a responsible hospital that — correct me if I err — does include medically trained homeopathic physician. The other describes an independent investigation that explored, indeed with a small sample, what UK nonphysician homeopaths do. Yes, it's small, but also there was a very simple statistical hypothesis to test.

The advice that is to be given is, indeed, "one size fits all": "If you are going to an area of malaria prevalence, you both need to know methods of reducing your exposure, and medical opinion, from the World Health Organization down, is that you will almost certainly need protective drugs. These are specialized drugs and probably need a specialist to prescribe. That is outside my scope of practice" OPTIONAL: If the practitioner knows a qualified individual, refer, or at least refer a source of referrals.

Some of this might well go into the malaria, or perhaps an article on homeopathy and malaria. Perhaps that should be TCAM (traditional and CAM) and malaria. Some real-world problems are ugly, as the over-the-counter availability of antimalarials in parts of Africa, and the common assumption that all fevers should be assumed to be malaria and treated as such. (Source: personal discussions with a Sierra Leonean extended family; descriptions from medically trained family members that lived in Sierra Leone and Guinea; also readings in the malaria literature). Howard C. Berkowitz 07:37, 29 October 2010 (UTC)

I am concerned that no one has responded to the question that I have now posed several times: from whom should we expect a referral to a anti-malarial drug treatment...should we expect coaches, trainers, nutritionists, dietitians, psychologists, clergy, acupuncturists? The quote that is given by Dr. Peter Fisher may be appropriate for MDs who practice homeopathy but not for non-MDs.

My additional point is that THIS issue is not notable. If anything, it should be a part of a separate article, not in this main article on homeopathy. That said, IF we choose to keep it here, we HAVE to provide adequate and appropriate CONTEXT for why some non-MD homeopaths (and many leading medical and public health officials) have well-reasoned concerns about anti-malarial drugs. These concerns are NOT mischaracterized...they are well-established. Dana Ullman 19:26, 30 October 2010 (UTC)

Hi Dana, no need for concern. There is no answer to that question, so we pretty much moved on. I'm not clear about which part you think is not notable, but that doesn't matter, we're working on your second paragraph now. See below. D. Matt Innis 20:07, 30 October 2010 (UTC)

Malaria kills about a million people every year. Anyone who advises people to ignore medical advice on this, should expect to be condemned unequivocally.Gareth Leng 21:59, 30 October 2010 (UTC)

You might want to link to malaria, as I've put up some studies that indicate that a million a year was the conventional wisdom, except that it excluded Africa, which has 90 percent of the infected people. It's really worse. I hope this is on-topic, as cross-links between this and the malaria article might be appropriate, as well as perhaps a malaria and CAM article. I am concerned, however, about any suggestions that the "conventional medicine is dangerous" meme continues to be replayed.Howard C. Berkowitz 22:07, 30 October 2010 (UTC)

All of us certainly understand that every intervention has a risk/benefit ratio. It would have to be a pretty bad medicine to be worse than a million+ deaths a year. I'm also pretty sure there is no data that says that there are homeopathic remedies that have a better benefit than no treatment at all (unless it included Deet) or medical preventive treatment/advice. This is a non-starter. The point again, though, is that non-regulated homeopathic "advisors" might be acting irresponsibly and there is nothing anyone can do about it. Other professionals will fall in line with best practice or risk malpractice and losing their licenses. D. Matt Innis 03:34, 31 October 2010 (UTC)

For those that are wondering why it matters; there are people that do not want the drugs and are willing to take risk - in this case you are using the remedy as an alternative. The essential point is informed consent. In the "High Street/Main Street" example, the "advisor" is under no obligation to obtain informed consent. This is a legal requirement under most regulations and professionals can lose their licenses and be subject to neglect and malpractice charges for not obtaining informed consent. D. Matt Innis 15:29, 31 October 2010 (UTC)

(undent) I think it's important to link to informed consent and the Declaration of Helsinki, and explain that the unregulated alt med people are not applying this. Non-homeopathic example I encountered recently: an herbalist recommended high-tryptophan supplements to a patient taking prescribed both antidepressants and cyclobenzaprine, both of which increase serotonin. Tryptophan is the precursor of serotonin, and I don't think the herbalist understood any of this -- although the combination is potentiall lethal. Yes, there's the homeopathic argument that their remedies won't interfere with anything, but there is a broader concern about if the true alt people know what they are doing if there's concurrent medical treatment. Howard C. Berkowitz 16:54, 31 October 2010 (UTC)

Well, thats off this subject and I certainly have my input on that one! :) D. Matt Innis 17:33, 31 October 2010 (UTC)

Interesting stuff

There's a lot of interesting stuff emerging here - Tom, is it possible you can take Dana's corrections on points of fact and see what needs inserting to get the message on regulation right? Inter alia. who regulates what, and is there any effective regulation anywhere - coming back to it - in some places only some people are allowed to practise as homeopaths; once they are allowed is there effective restraint on what they do - i.e. are tehre any examples of them being sanctioned?

Someone asked above what's wrong with a news source? Well, it's not peer reviewed, and on any scale its on the extreme weak end of evidence. We're excluding mention of small single trials here, and this sounds rather lower on the food chain. There's probably a much better study somewhere, which is why I suggested hold pending a better. If tehre is no better source I'd drop it. There are cases where such so-called "grey" sources of evidence are accepted - but only if there's no better source, only if the point is unique, and only when the point is of significant interest. I think we've already covered the point that some homeopaths make claims that even other homeopaths find outrageous, so don't think personally taht we need sweat over this. I'd delete if a good source for equivalent information isn't found. Including weak sources on one side and rejecting them on the other is dual standards, however you look at it. Gareth Leng 18:07, 28 October 2010 (UTC)

(wrote the above before seeing your post Howard - note that I agree with a consistent approach to source quality )Gareth Leng 18:08, 28 October 2010 (UTC)

Surely, the quality of the source needs to be proportional to the claim it makes? We reject low quality clinical trials as a source for claims as to the truth of the medical claims in question. Tht scientific studies can range in quality is something well established, hence the whole process of meta-analysis and systematic review, as well as the mechanics of peer review, post-publication review and occasionally retraction. A scientific study needs those because of both the complex and specialised background knowledge that underlies areas of research and because of the complexity of many of the causal claims being studied. In the malaria story, neither of these is in issue: the causal relationship being tested is "I go into shop, ask for X, get given Y", not "drug X is used which has a whatever-percent probability of activating a complex network of protein reactions which has some-other-percent probability of reducing the size of tumours in a specific period of the disease cycle". Requiring the standards of evidence – rather, requirements for source backing – that is used for the latter when dealing with claims more like the former is crazy. This means simply that it won't be possible to provide sources for the vast majority of claims in articles outside certain specific parts of the hard sciences.

What the source is establishing in the case of the 'Newsnight' BBC review and the accompanying sources is simply that someone has done a sample of a small number of high street homeopaths. When the Newsnight source is taken together with the reaction from the British Homeopathic Association and Peter Fisher, it seems more reasonable than unreasonable to believe that what is stated in the article has been carried out – namely, someone has gone and visited a number of homeopathic high street retailers and asked them what they recommend for someone who is planning to travel to countries with a malaria risk.

BBC Newsnight is a reasonable enough source for what is being claimed in this instance - namely, that there has been some controversy in the United Kingdom following this investigation. That Fisher and the BHA have acknowledged the Newsnight investigation as a problem is indicative of how non-controversial a source it is: if this was, you know, the Weekly World News, would Fisher and the BHA feel compelled to respond in the manner they have?

If advocates of homeopathy use a weak source to establish a weak claim and it does that, that is perfectly fine. If, oh, purely hypothetically, someone were using weak sources to establish very strong claims, that would be a different matter.

We don't need 'consistency' in source quality. We need the source quality to match what is actually being claimed. (This is something we need to develop policy on.) –Tom Morris 21:39, 28 October 2010 (UTC)

Yes, I had seen it was a grey judgement which was why I hesitated. But as you'll see, in the last revision but one, it actually makes exactly the same point as made elsewhere - i.e. there's no doubt because even the Faculty of homeopaths accepts this happens and condemns it. So we dont need to say it twice, hence I moved the full text of that to external links.

The bigger issue still not nailed is that of (?) ineffective regulation: I'd like this nailed one way or the other, is this a profession that is effectively self-regulated - are there any bodies with teeth who use them to impose any standards on what homeopaths do? I don't know and would like to know. Hence I've put Tom's text in that section, I know its not referenced or accurate, it's just holding a place that needs proper filling.

I also agree we need a policy on source quality. Be very happy to help with that.Gareth Leng 21:50, 28 October 2010 (UTC)

From what I am seeing (see section below), the licensed homeopathic practitioner is regulated according to the license of the professional that is using it. In other words, if you're an MD, the medical board will regulate your actions. If you are a chiropractor, it might be the chiropractic board, naturopath, nurse practitioner, etc. However, it appears that any person can open shop and "sell" homeopathic products without any license-provided they don't present themselves as a doctor. These are the type that were interviewed in the "High Street" research. There are many ways to obtain homeopathic remedies, the least common of which is through a medical doctor. It looks like MDs are not happy that others are giving bad advice (i.e. malaria) and are trying to separate themselves from the pack. Thus the condemnation by the director of the Royal London Homeopathic Hospital. Dana's explanation is feasible. Interesting. We need to make this distinction.

Obviously, as Howard suggests, I imagine(don't know) that the MDs use it as a complement-integrating it into their practices (while probably some use it exclusively somewhere). Some mixer chiropractors do (if their state allows it-mine doesn't). They are regulated by their respective boards, while the lay homeopath is not regulated by anything other than the FDA and FTC (in the US). It is also interesting to note that these "High Street" shops sell more than just ultra-dilution remedies; some have therapeutic levels of products like zinc and other herbal combinations that could be quite dangerous in wrong dosages without supervision. D. Matt Innis 01:11, 30 October 2010 (UTC)

Nevada's state law

Nevada is one of the three states that has laws regulating Homeopathy. They have a NV State Board of Homeopathic Medical Examiners. The law requires three of the seven members to practice "allopathic" or osteopathic doctors and practice homeopathy. Their purpose includes "protect the public." There are mechanisms for complaining to the Board and they can refer to the State Attorney General.

I'm getting the impression that other states allow the use of homeopathy to be practiced by MDs, DOs, DCs, and others under their licenses and therefor under the scrutiny of their state boards. In other words, if an MD has a complaint about using homeopathy, his State Medical Board will review the case and act the same way that they would if it were any other treatment. But, this is just my first impression. I know that in my state, North Carolina, the Medical Board closed down medical practitioners that practiced homeopathy in the early 1990s and the chiropractic board followed suit the same year. Other states have undoubtedly done the opposite. I'm also thinking that other healers can use homeopathy as long as they don't call themselves doctors and they don't need any regulation whatsoever.

I'll keep looking. D. Matt Innis 01:08, 29 October 2010 (UTC)

Tom, I put this in then took it out after checking

"The Complementary and Natural Healthcare Council aims to give the general public in the UK access to a list of practitioners that have been assessed as meeting national standards of competence and practice. It has some disciplinary oversight over those who do register, but doesn't attempt to see if the practices are reasonable or evidence-based." I checked - it doesn't seem to register homeopaths?Gareth Leng 19:09, 30 October 2010 (UTC)

How many licensed homeopaths Nevada has.

Nevada has a mechanism for filing a complaint

D. Matt Innis 01:36, 29 October 2010 (UTC)

Here's the section of the Nevada law that governs what Advanced Practitioners of Homeopathy (not the MDs) can do. Howard, this might answer some of your concerns about Emergency care (emboldened by me):

NAC 630A.480 Acceptable activities.

1. An advanced practitioner of homeopathy may perform only those acts which he is: (a) Qualified to perform, as determined by his supervising homeopathic physician; and

(b) Authorized to perform pursuant to the protocol established pursuant to NAC 630A.490.

2. A homeopathic physician may authorize the advanced practitioner of homeopathy whom he supervises to:

(a) Systematically assess the health of a person or family by:

(1) Taking, recording and interpreting a medical history;

(2) Performing a physical examination; and

(3) Performing or initiating any specific diagnostic procedure which is authorized in the protocol established pursuant to NAC ::630A.490.

(b) Manage the care of a person who has a common, acute, recurrent or chronic health-related problem, based on an assessment of the health of that person by:

(1) Initiating a program of treatment;

(2) Evaluating the response to health-related problems and programs of treatment;

(3) Informing a patient or a member of his family about the health of the patient and the alternatives for treatment;

(4) Evaluating the compliance of a patient with the program of treatment that was agreed upon by him or his family and the advanced practitioner;

(5) Modifying a program of treatment based upon the response of the patient to that treatment;

(6) Referring a patient to an appropriate provider of health care, if necessary;

(7) Treating minor lacerations which do not involve damage to a nerve, tendon or major blood vessel; and

(8) Commencing care which is necessary to stabilize the condition of a patient during an emergency until a physician can be consulted or the patient can be transported to a facility where emergency medical care is available.

(c) Perform any other procedure related to the practice of homeopathy if:

(1) The advanced practitioner is certified to perform that procedure by an organization which is recognized by the board;

(2) The advanced practitioner learned how to perform the procedure in a program of education which he attended;

(3) The advanced practitioner learned how to perform the procedure during the successful completion of a comprehensive program of instruction which included clinical experience; or

(4) The act is within the authorized scope of practice of an advanced practitioner of homeopathy as determined by the board.

(Added to NAC by Bd. of Homeopathic Medical Exam'rs, eff. 10 25 96)

D. Matt Innis 02:17, 29 October 2010 (UTC)

Potential replacement for offending statement

Despite this, an undercover investigation by BBC Newsnight uncovered a large number of high street (retail store) homeopaths willing to prescribe homeopathy instead of anti-malarials. This highlights a particular controversy among homeopathic practitioners, as those practicing with professional regulation (i.e. MD, DO, DC, ND, etc.) are required to properly inform their patients of the risks and benefits of any proposed treatment. Comment by the director of the The Royal London Homeopathic Hospital illustrates this divide and his concern for apparent weakness in the regulatory process:

I'm very angry about it because people are going to get malaria - there is absolutely no reason to think that homeopathy works to prevent malaria and you won't find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.

Still having medicine v. remedy revert wars?

Gareth, obviously you can't mediate this being a participant, but if my observation is correct, would it be appropriate to have an ME ruling? Howard C. Berkowitz 18:40, 31 October 2010 (UTC)

Don't think this is deliberate - just people forget or didn't notice. Haven't seen any objection to this.Gareth Leng 22:20, 31 October 2010 (UTC)

Because homeopathic medicines are legally recognized throughout the world as "drugs," we should be referring to them a "medicines" more often the "remedies", unless the CZ wants to refer to ALL drugs as "remedies" rather than "medicines" (which obviously would not be smart). Dana Ullman 02:56, 1 November 2010 (UTC)

Legally, not pharmacologically. Gareth, I did not start making this distiction, but when someone started doing it, it seemed viable. Most drugs today, which is not 1830, have a reasonably understood mechanism of action. Howard C. Berkowitz 03:11, 1 November 2010 (UTC)

I introduced this as a convention here to avoid having to qualify everything - if we said "homeopathic medicine" , "conventional medicine", "homeopathic remedy" "conventional remedt" every time the article would be unwieldy; so I simply used "medicine" whenever we talk about a conventional treatment and "remedy" every time we talk of a homeopathic treatment. We can explain this in a footnote I think.Gareth Leng 09:16, 1 November 2010 (UTC)

If the use of "remedy" versus "medicine" is a matter of dispute here then defining for the purpose of the article is a good solution. --Peter Schmitt 09:53, 1 November 2010 (UTC)

(undent) It was defined in the second paragraph, but not as clearly as it might. I put a new sentence at the end of the first paragraph, which I really tried to make non-inflammatory by simply saying what a remedy is in this article, mentioning only homeopathic principles. It doesn't include anything about pharmacology, etiology or randomized clinical trials. Look at the definitions in the first and second paragraphs; we only need one.

I would observe that a continuing problem in the article, which should be operating largely by scientific principles, is to claim legal recognition when there is no scientific recognition. Not limiting this to homeopathy, many countries have health laws that are based on historical or political views, not anything relating to efficacy and safety. Howard C. Berkowitz 13:05, 1 November 2010 (UTC)

True; but this article must be comprehensive, and legal status reflects political/social acceptance, which should be acknowledged. Homeopathy is a social phenomenon, not just a scientific controversy.Gareth Leng 16:47, 1 November 2010 (UTC)

I agree it is both, Gareth, but legal status must not be equated to evidence of efficacy. I would not object, for example, for an accurate statement that the sponsor of the US law establishing the Food and Drug Administration was a homeopathic physician who put through a wording that exempted, and still largely exempts, homeopathic medicines from needing to go through clinical trials. Even if I stipulated that homeopathic dilutions are safe, that still doesn't say the legal recognition says, or could rationally say, the remedies are effective.

So, perhaps in addition to drugs and remedies being distinct, we need to add "unregulated" or "untested" remedies. That may upset homeopathy advocates. That, however, is the majority view, considering also that the pharmacogenetic people do use statistically valid methods to test the diagnostic paradigm for their also individualized treatment. Howard C. Berkowitz 20:01, 1 November 2010 (UTC)

My thoughts:

• The FDA just makes statements about safety, not effectiveness.
• Homeopathic remedies are safe, particularly the ultra-diluted ones.
• They are tested and we pretty much state they have no effect above a placebo.
• The remedies are regulated, it is the people that sell them that are unregulated.
• MDs, insurance companies, pharmaceutical companies, etc. present bills every day.
• If we make weak, biased arguments about homeopaths, it only dilutes the strong, unbiased arguments.

D. Matt Innis 20:19, 1 November 2010 (UTC)

The problem is, Matt, is that legality is being used as a homeopathic argument that their remedies are real drugs, in the absence of serious scientific confirmation. That's misleading in the article.

I would correct the statement that FDA doesn't make determinations of effectiveness as well as safety. It does want to see evidence of efficacy from clinical trials. What it does not do, and NICE does, is evaluate relative efficacy: "Yes, this statin is safe and effective. Is it any more so than things already on the market?" Howard C. Berkowitz 21:10, 1 November 2010 (UTC)

Don't see where in the article legal status is equated with efficacy, but maybe you can just make an edit and we'll see what you're getting at.Gareth Leng 09:59, 2 November 2010 (UTC)

See above, talk page comment by Dana, beginning "Because homeopathic medicines are legally recognized throughout the world as "drugs...." Howard C. Berkowitz 13:47, 2 November 2010 (UTC)

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since this isn't signed and dated, the horizontal rule tries to show it doesn't immediately follow the last comment ----------- Howard C. Berkowitz 13:47, 2 November 2010 (UTC)

Text here was removed by the Constabulary on grounds that it is needlessly inflammatory. (The author may replace this template with an edited version of the original remarks.)

Rewording

I've reverted medicine back to remedy as above - I just can't see the sense of going through everthing to put "homeopathic" before remedy or medicine.

I changed this "By selecting a medicine that has been found to cause in overdose in healthy people the similar symptoms the sick person is experiencing, homeopaths claim that this medicine mimics and augments the body's own defenses." to "Remedies are derived from substances which, when given in overdose to healthy people, cause symptoms similar to those of the patient being treated; homeopaths claim that these augment the body's own defenses." just because the former seemed poorly worded.Gareth Leng 09:44, 1 November 2010 (UTC)

How homeopathy influenced medicine

Gareth deleted "Its growth in the 19th century influenced how conventional medicine organised and how it came to formulate its present vision of evidence-based medicine. ", with an edit note of that it's not developed, but I think it could be developed. Looking back in the history, I think it had been developed, but the endpoint was removed as anti-homeopathy. Can we re-introduce it in a balanced way?

There are two key comments from Sir William Osler. In the earlier one, probably late 19th century, he spoke highly of homeopathy as being wise and gentle. When interviewed later for the Flexner Report, however, he spoke of both homeopathy and the heroics of (properly) allopathy as medical cults, to be replaced by science-based medicine. We don't have, and need, a good article on the history of medicine, which includes science-based medicine. I think it's fair to say that homeopathy did influence medicine around the turn of the 20th century.

An excellent reference on how the science-based medical system evolved is John Barry's The Great Influenza. While there's little argument that science-based treatment took off exponentially in the 1940s and 1950s, there was a period of science-based research from perhaps 1910 to 1940. It had produced a few rational treatments that were largely replaced by better ones.

I would question, however, if non-homeopathic physicians were especially influenced by homeopathy beyond 1920 or so. This is not to say that some homeopathic physicians didn't later introduce some brilliant work (e.g., curare in surgery), but those treatments were in no way homeopathic. Considering a whole patient is not unique to homeopathy, especially in pharmacogenomics.

I'd like to see this developed and can do some work on it, but perhaps it belongs in a new article -- development of modern medicine? Howard C. Berkowitz 14:17, 2 November 2010 (UTC)

I strongly agree that it would be good to have probably several articles on the History of Medicine - but especially one on the emergence of modern science and evidence-based medicine. I agree also that the superiority of homeopathy in the 19th century to Hippocratic heroic medicine was a key factor in turning Hippocratic medicine away from Hippocratic dogma towards embracing science and evidence - it's the change from medicine as a healing art (based on individual skill, and individual knowledge and judgement based on clinical experience) towards medicine as a science (based on the denial of dogma, on a changing knowledge base as science developed, objective test and validation, and consensus guidelines and standards). It's a transition still in progress of course.

I think the influence of homeopathy was indirect - partly through the appreciation of the placebo effect, the importance of hygeine and public health, and partly because the denial of science by homeopathy allowed conventional medicine to define itself in contradistinction to its competitors. The alliance of science and conventional medicine energised the new medical schools, opened the way to political support and public funding of research, and forced the discarding of dogma.

The indirect influence of homeopathy continues: the Shang Lancet study is important for conventional medine in showing very powerfully the importance of publication bias and the unreliability of small trials, and is having a major impact on meta-analytical approaches. I think we'll see that coming through increasingly in Cochrane collaboration work.

Gareth Leng 15:17, 2 November 2010 (UTC)

Thank you, Gareth. I don't think the sort of discussion I have in mind is anti-homeopathy, but it also does not support some of the homeopathic claims as a basic motivation. Hippocrates is in many ways symbolic and a way of bonding with one's predecessors, but let's not take "do no harm" out of context. It also says, as you know, that the physician should not cut for stone (i.e., surgically remove gallstones, kidney stones, and the like). Now, I probably would prefer lithotripsy or a catheter with a laser cutter to an open or laparascopic lithotomy, but we certainly now know how to cut safely. Hippocratic Oath probably needs improvement with history and modern context. If nothing else, there are people with deep objections to swearing by Apollo and the Gods, but usually accept this is symbolic.

I'm all for hiving off articles from here, even including homeopathic reference, and addressing the subjects with less heat. Howard C. Berkowitz 15:51, 2 November 2010 (UTC)

Oh I agree. Hippocratic medicine, as I used it above, refers to the four humours theory of illness - hence the heroic obsession with bloodletting, purging etc.Gareth Leng 16:54, 2 November 2010 (UTC)

I like the constructive tone that we are taking here. On this same subject, here's a quote that good ole Mark Twain, as he wrote in 1890 in Harper's Bazaar, "When you reflect that your own father had to take such medicines as the above, and that you would be taking them to-day yourself but for the introduction of homoeopathy, which forced the old-school doctor to stir around and learn something of a rational nature about his business, you may honestly feel grateful that homoeopathy survived the attempts of the allopathists [conventional physicians] to destroy it, even though you may never employ any physician but an allopathist while you live." (Twain, 1890)

The point here is that homeopathy played a major role in having conventional physicians question the safety AND efficacy of their treatments...and this is as true yesterday as it is today.

Paul Starr won the Pulitzer Prize for his "Social Transformation of American Medicine," in which he make the following statement: "Because homeopathy was simultaneously philosophical and experimental, it seemed to many people to be more rather than less scientific than orthodox medicine." Dana Ullman 23:47, 2 November 2010 (UTC)

An alternate explanation, however, is that basic sciences had been progressing, with early starts on effective treatments, marginally beginning with things such as arsphenamine, but very much accelerating in WWII -- antibiotics, safe intravenous fluids, vascular surgery, etc., and then accelerating significantly as molecular biology improved. I don't argue that the properly-called allopaths of Hahnemann's time were more dangerous, in most cases, than no treatment. I just don't see a strong causal relationship between safety in modern medicine and homeopathy. I'm afraid I don't see Mark Twain as a medical historian.

Question: what is the homeopathic position on surgery? We don't have anything about that. Howard C. Berkowitz 00:04, 3 November 2010 (UTC)

I think Twain was probably a good medical observationalist: Hahnamann (1745-1843), Mark Twain (1839-1910), Flexnor report 1910. Hahnemann quite possibly could have been the biggest influence in changing medicine from heroic medicine in the late 18th century to mid 19th before scientific medicine really took hold at the turn of the 20th Century (1890 - 1910). I think Twain's point is that the physicians that practiced the business of homeopathy, a kinder, gentler medicine, made the allopathic physicians have to find another way (1800 - 1865ish [during his early lifetime]), and that made them accept science as the way forward. All the "cures" and "potions" (homepathic and allopathic) weren't really tested in any scientific way until well into the late 1880s [Twain's later lifetime] and culminating with the Flexnor report in 1910 and leading to the rapid downfall of unscientific medicine. Dana's point was that this same phenomenon occurs every time society feels intimidated by the treatments of the time or loss of faith in those in control, i.e. it happened in the 1930s and the 1970s. This is what Gareth hints at with homeopathy (and perhaps alternative medicine in general) being a social phenomenon. D. Matt Innis 00:49, 3 November 2010 (UTC)

(Undent) Yes, Matt. There are social phenomena, but, to take the seventies, it was more than homeopathy alone in CAM. We have to be careful here; there have been a number of claims for homeopathy which, when the original reference is checked, turns out to be a more general CAM number.

I wouldn't argue that Hahnemann was a significant influence in the late 19th century, the Flexner Report being of immense significance in the early 19th, and also the start of efficacy concern around 1920 and the start of significant drug development in the late 1930s. The Elixir Sulfanilamide disaster triggered the creation of the FDA in the US (1937? from memory). Howard C. Berkowitz 00:56, 3 November 2010 (UTC)

Please read what I wrote again, Homeopathy's effect was from 1800-1865ish. This caused the downfall of heroic medicine and allopathic physicians were forced to look at why. That is the influence homeopathy had on the history of medicine. Science became the way forward because people lost faith in the conventional medicine of the time. It took years of investigation of medicines of the time and finding out that most were alcohol or water (or worse) and begin to develop and market suitable "alternatives" to homeopathy. The Germans were the best at it apparently. This process culminated with Carnegie and Rockefeller and the Flexnor report that essentially crushed homeopathic and allopathic schools. I didn't argue that Hahnemann (or homeopathy) was a significant influence in the late 19th century. That is when they threw in the towel. Scientific medicine was the significant influence at that point. However, it does flow and ebb depending on the atmosphere and the trust factor. Homeopathy is just one of the least expensive alternatives that benefits from those flows. D. Matt Innis 01:17, 3 November 2010 (UTC)

You are right; I missed that, but I think my eye scanned over the "ish". There has been a certain suggestion that homeopathy was the dominant effect after the Flexner Report. Howard C. Berkowitz 01:29, 3 November 2010 (UTC)

I didn't catch that. You might be a little trigger happy. Maybe it was the reference to Twain, but he was dead by then ;-) D. Matt Innis 01:39, 3 November 2010 (UTC)