Talk:Homeopathy/Archive 15

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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)

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)

"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)

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.