Talk:Homeopathy/Archive 13

Homeopathy

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Beyond placebos

Let's go beyond placebo effects. There exists research on animals and cell cultures. I proposed to Ramanand that we investigate this field. Chris (Day) manifested his curiosity. Please see Ramanand's talk page. Pierre-Alain Gouanvic 00:47, 1 September 2008 (CDT)

This is what I posted there last: "I'm sure Molecular Biologists are working on studies like that; as a Doctor, I should be healing the sick. The proof of the pudding is in the eating, so I feel people should try Homeopathy before commenting on it."—Ramanand Jhingade 21:55, 1 September 2008 (CDT)

People should try homeopathy before commenting on it? I trust, therefore, there should be no male obstetricians and no astronomers have the right to comment on the Moon unless they had been on an Apollo mission? I suppose I should have rejected the nitroglycerine and morphine I was offered, during an episode of unstable angina, by a vigorous young cardiology fellow?

It's interesting...I've asked you several times how you would approach a patient with a well-defined set of symptoms, without one molecule in the explanation, and you ignored it. You brought up giving an iron salt to "improve" a blood count, and when I followed up with a few questions about that which you would be improving, I didn't seem to get any response. You stated that homeopaths routinely used diagnostic studies, but you were silent when I asked which you might order, again with a specific set of symptoms.

If the pudding is butterscotch, I might be persuaded that it's good pudding. I have to interpret that your comment about as a doctor, you should be healing the sick, and molecular biologists should be doing whatever irrelevant things molecular biologists do. Aren't there some sick people that need your attention more than we unenlightened ones just don't seem to be accepting your world-view and bowing and saying "yes, our studies and experience are irrelevant."

Until you give any indication you have any understanding of immunology or endocrinology, I am less than inclined to pay attention to your statements on how the immune system should be "strengthened".Howard C. Berkowitz 22:29, 1 September 2008 (CDT)

When you can trust a young Cardiology fellow, why not a Homeopath? You skeptics are theorizing, while Homeopaths know the effects of their remedies.—Ramanand Jhingade 22:36, 1 September 2008 (CDT)

Oh, quite a few reasons I'd trust that cardiology fellow, perhaps because I've had a fair bit of training and experience in cardiovascular medicine. A factor might be that cardiologists are constantly asking the question if their approaches meet continuing review of safety and efficacy, and if their techniques of prevention and treatment are consistent with increasingly specific understanding of the underlying mechanisms.

I have an excellent relationship with my primary physician, a general internist with a special interest in endocrinology. Unfortunately, many patients don't have the advantage that we have a common framework, and things aren't on a "trust me" basis. Either one of us can come up with suggested diagnoses or treatments, and we cross-check one another. If I call and say "Can we schedule an echocardiogram before my next visit to we can make an informed judgment about choices in insulin receptor agonists?", there isn't a need for a lot of mysticism; we both know where we are going, and that our collaboration has objectively improved a number of problems.

I haven't, for example, noticed any large-scale meta-analyses by homeopaths showing that a previously accepted standard of care, such as angioplasty and stenting, are rarely more effective than intensive medical management. Medical management is not stuck in materia medica and external observations, but constantly tuned by evidence-based medicine. One of the frustrations of cardiologists is that improvements don't necessarily get into wide use among primary physicians.

In contrast, the message from homeopaths is not "this is how we have refined. This is getting more quality-adjusted years of life in the treated group." The message appears to be "Have faith. Trust us. Don't ask for any verifiable information. Might I offer you a great deal on a 1984 Jeep Cherokee, barely used?" Howard C. Berkowitz 22:59, 1 September 2008 (CDT)

I told Pierre that for me clinical effects are enough and I'm repeating that here. Laboratory investigations like Blood tests, X-rays, C.T./ultra-sound scans etc. show improvements before and after Homeopathic treatment, so Homeopathy is not something that works by faith (I've healed people who had no faith in Homeopathy; I've also healed animals and babies who can't be influenced in any way).—Ramanand Jhingade 21:37, 2 September 2008 (CDT)

Since you are not a Healing Arts or Health Sciences editor, it is not your decision what is, and is not, enough. While I am not an editor in either of those groups, I am an Engineering editor, and I will say that the general standard in reporting on technical matters has a statistical framework, and generic references to a wide range of tests such as "blood test, X-rays, C.T./ultrasound etc." is so vague as to be meaningless.

I request that a Health Sciences or Healing Arts Editor make a content ruling on the standards to be applied to assertions. Indeed, wearing my hat as a Computers editor, there are generally accepted standards of acceptably specific output from a health informatics system. The assertions above do not come close to them; I'd suggest that an appropriate editor bring this content-free repetition to a merciful end. Howard C. Berkowitz 21:59, 2 September 2008 (CDT)

There are clinical trials as well, some of which I mentioned before, which can buttress my claims.—Ramanand Jhingade 22:22, 2 September 2008 (CDT)

Ramamand, above you wrote: "Laboratory investigations like Blood tests, X-rays, C.T./ultra-sound scans etc. show improvements before and after Homeopathic treatment, so Homeopathy is not something that works by faith (I've healed people who had no faith in Homeopathy; I've also healed animals and babies who can't be influenced in any way)"

Unreferenced assertions such a this are not useful to any discussion with respect to this article. We have to consider the whole picture not just your experience. Chris Day 22:29, 2 September 2008 (CDT)

Sweeping statements and a citation are not adequate detail for articles

In dealing with as fundamental a topic as the concept of apparently nonexistent doses having effect, it is totally unreasonable to accept "Foo has the best understanding", and give a reference to Foo, without any details of Foo's model, or authoritative responses to it.

There seems a fundamental misunderstanding that a proponent of a given approach, and I do not in any way limit that to health, can write an acceptable CZ article by stating his or her preferred interpretation of a subjective matter, and then demand everyone else disprove it.

I happen to be writing on Internet Protocol version 6, which involves several articles. They are scratching the surface; my intention was to get some things started, and, indeed, a colleague is doing some good collaborative edits -- for that matter, we are also discussing some aspects by email.

There is very little substantive support for statements being made here. When the author involved makes references to such things as "improving blood counts" or "strengthening the immune system", yet apparently can give no specifics, such material certainly doesn't belong in the article -- and is questionable on the talk page. Howard C. Berkowitz 22:20, 2 September 2008 (CDT)

I wonder how you have so much time to keep posting here (I make time because I can't let this article be an 'attack piece' like the article on Homeopathy on Wikipedia). Howard, you must stop being so skeptical - I have posted about other clinical trials.—Ramanand Jhingade 22:31, 2 September 2008 (CDT)

Why should I stop being skeptical? You tell me trials are "good", but you have yet to demonstrate any knowledge of the statistical design and validation of clinical trials. I've given you examples that could be used for discussion, I think it's fair to note that Gareth observed that the statistical problems of low-responder individualized medicine -- not homeopathy, but pharmacogenetics -- are a statistical challenge. He and I exchanged some thoughts. You did not participate.

You have made references to things such as "improving blood counts", but, so far, I have no reason to believe that you have any familiarity or understanding of what is in one, how it is interpreted, or that it is essentially a screening test that calls for additional analysis -- testing, history, physical, and systematic thought.

You, not I, suggested "Ferr. Phos." for "improving a blood count", although you did not indicate which of the five or so measured parameters and three computed values in a CBC needed to be improved. I believe there are a fair number of people who could point out a hematologic profile where administering an iron compound is hazardous.

I have read in homeopathy -- and rejected it for reasons as basic as physical chemistry. I might stop being so skeptical if you demonstrated that you had an understanding of what you are rejecting. You speak blithely of strengthening the immune system, but apparently see no conflict between that bit of jargon and the spectrum of autoimmune diseases. The alternative practitioners I most respect are integrative -- perhaps the most knowledgeable person I know in traditional Chinese medicine is also an excellent nurse practitioner. I've had any number of thoughtful discussions about complementary techniques with physicians that also had full pain management fellowship training. People that are trying to find common principles in acupuncture and electrotherapy have my respect.

When you make a comment that you are too busy healing people to worry about what molecular biologists do. When I find a homeopath that can discuss different approaches and finding, and seem interested in a search for integrative results rather than insisting on "trust me", I might be less skeptical. As it is, I'm really hoping that an appropriate Editor gets involved and puts a stop to this.

Revert wars are against CZ rules, so I won't engage in one. I will, however, contiue to question content in your article, when I see a lack of authoritative sourcing, or a flat statement that is utterly contrary to a significant body of knowledge. I will, as is appropriate, explain my reasons for doing so on the talk page, but I have no further interest in pointing out inconsistencies and refusal to answer questions on the talk page. I am not skeptical on the number of times that you have referred to testing, and then been unwilling to discuss any aspect of the test, what specific results you are discussing, or what "improvement" would be.

Res ipsa loquitur. Howard C. Berkowitz 23:23, 2 September 2008 (CDT)

How come you respect acupuncture and electrotherapy? There is hardly any scientific evidence for those forms of treatment (although I believe they work - I've seen results and that's enough for me to accept something, just like Homeopathy).—Ramanand Jhingade 05:51, 3 September 2008 (CDT)

Beyond placebos (cont'd): in animals

I found a good one. We're dealing with mice, there is a variety of controls, and both principles of homeopathy are involved : 1) a toxin, arsenic, is used to mitigate the effects of arsenic; 2) the doses used are well below Avogadro's limit (no arsenic left). I'dd add that the study was "highly accessed" and published in a BMC journal; we can expect some level of fact-checking and authenticity. Several indices were studied, including GSH and ALT. Ameliorating effect of microdoses of a potentized homeopathic drug, Arsenicum Album, on arsenic-induced toxicity in mice, P Mallick, J Chakrabarti Mallick, B Guha and AR Khuda-Bukhsh BMC Complementary and Alternative Medicine 2003. I would also add that there are serious implications to this finding. I quote:

Mainly with such a background (nota: arsenic intoxication in many poor countries), our initial aim was to find out suitable antagonists of arsenic poisoning, which should be i) easy to administer, ii) effective in low doses, iii) inexpensive and iv) without any toxic effects of their own. In course of our search, a potentized homeopathic drug, Arsenicum Album-30, was indeed found that showed highly promising results in combating arsenic intoxication in mice, in regard to a series of accepted scientific protocols used, such as cytogenetical, histopathological and biochemical [10-16]. Encouraged by the positive results obtained in these studies, and also of others [17], changes in activities of certain toxicity marker enzymes like alanine amino transferase (ALT, EC.2.6.1.2, also known as glutamate pyruvate aminotransferase) and aspartate amino transferase (AST, EC 2.6.1.1, also known as glutamate oxaloacetate aminotransferase) and changes in the level of reduced glutathione (GSH) in liver and blood tissues of mice, if any, have now been determined at different periods after single injection of arsenic trioxide. The present investigation also aims at ascertaining if oral administration of either of two micro doses of the homeopathic drug, Arsenicum Album, namely, Arsenicum Album-30 (henceforth to be called Ars Alb-30) and Arsenicum Album-200 (henceforth to be called Ars Alb-200) can ameliorate arsenic toxicity by bringing about positive modulations of these toxicity denoting parameters.(...)

© 2003 Mallick et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Long quote? Sorry. It's simply that I can't believe my eyes!

Pierre-Alain Gouanvic 00:44, 3 September 2008 (CDT)

With all due respect, my concern here is not the performance of homeopathy in a particular trial, but whether best practices in homeopathy are consistently based on trials, or on objective versus subjective diagnostic practices. I'm willing, without reading the article, to accept that it showed certain verifiable results.

My concern with Ramanand, however, is that he will make fairly general statements such as "strengthen the immune system", or, which I find the most telling, give a dose of "Ferr. Phos." to "improve" a blood count. I do not find "improve" a meaningful term with respect to what is actually a set of tests. Perhaps an iron salt is being administered, as a homeopathic dose, to address what might appear to be a situation of iron overload. The complete blood count would only be suggestive of such, with abnormalities in the RBC indices. From a conventional standpoint, further tests would be indicated before treatment for iron deficiency or for overload, minimally including ferritin, serum iron, and total iron binding capacity. If the problem were not iron overload but iron deficiency anemia, these still might be appropriate, but one would want to look for both hemorrhagic or hematologic causes for such an anemia.

I did not find it terribly hard to write the above description of an approach to a hematologic abnormality. If someone claims to be able to treat an undefined abnormality, based possibly on the result of the CBC, I am skeptical until I discover that person demonstrates an understanding of the measured parameters of the CBC, the calculated RBC indices, and a diagnosis (possibly supported by other testing or examination). In conventional medicine, there would be a very specific purpose, for example, if the clinician chose to administer non-homeopathic amounts of iron salts,

If an overload condition such as hemochromatosis (abnormal iron accumulation) was the diagnosis, then there could be a substantive discussion of the homeopathic approach of using a remedy containing iron, as opposed to the conventional approach directed at reducing iron, including therapeutic phlebotomy, chelation of iron with deferoxamine, and close monitoring of liver function and other indications of significant complications of iron overload. I would find such a discussion to be meaningful and, if the homeopathic approach had comparable evidence for its efficacy as the conventional approach, confidence-building. In this example, if a course of a homeopathic remedy lowered the indicators of iron overload, there would be reason to presume cause and effect.

Does that strike anyone else as an example of a reasonable expectation of dialogue that would not continue to increase skepticism, but to decrease it? Howard C. Berkowitz 11:31, 3 September 2008 (CDT)

Howard, I've Homeopathically healed people with both Hemochromatosis and anemia. The remedy used differs in each individual, so clinical trials are difficult.—Ramanand Jhingade 21:58, 3 September 2008 (CDT)

First, I have repeatedly described a method, on which Gareth commented, in which clinical trials could be conducted on a treatment that involved individualized therapy. Such trials are clearly going to be necessary for research in pharmacogenetics, so this isn't picking on homeopathy.

Second, a claim of "curing" someone needs more substance than a flat statement. In the case of hemochromatosis, there would be specific changes that would indicate it is stable; I'd hesitate to use the term "cure" with a disease such as this, where there is an identifiable genetic abnormality. "Control" would imply an absence of symptoms, but also objective measurements such as iron levels, and also continued normal levels, over an appreciable period of time, of the more common serious secondary effects of the disease. Certainly, liver function tests would have to be consistently normal.

Anemia, with no further qualification, is an abnormal hematological function. It must be further characterized to even begin to say "cure". Now, if a patient was anemic due to trauma, surgical correction of the source of hemorrhage could very well be curative. If a patient presented with aplastic anemia after chloramphenicol therapy, stating a cure would first give the marrow and peripheral analysis that made a diagnosis; to speak of cure, there would be changes in marrow that persisted over years. Were the anemia genetic, as in sickle-cell disease, again, "cure" is a bit strong, although "reduction of exacerbations", along with before- and after- studies, might be something that could help me be a bit less skeptical.

Note that I am not describing generic things such as "anemia". I am being succinct but specific; were I building the evaluation into an expert system -- I do that more in cardiology and infectious disease than in hematology -- I'd be much more specific about signs, symptoms, inferences, etc. It is that level of precision that causes me to be less skeptical. It is also a statement of the probability of error, of adverse effects, of no benefit that also makes me less skeptical. Aside from any work I've done in medical decision support, I've had to make decisions for myself, or as a surrogate, where it was a matter of picking the least bad choice. Overconfident clinicians make me nervous. Howard C. Berkowitz 22:18, 3 September 2008 (CDT)

Beyond placebos (cont'd): in cell cultures

Dynamized Preparations in Cell Culture, (2007) Evidence-based Complementary and Alternative Medicine, Ellanzhiyil Surendran Sunila, Ramadasan Kuttan, Korengath Chandran Preethi and Girija Kuttan

Although reports on the efficacy of homeopathic medicines in animal models are limited, there are even fewer reports on the in vitro action of these dynamized preparations.

(...)

These results indicate that dynamized medicines possess cytotoxic as well as apoptosis-inducing properties.

Pierre-Alain Gouanvic 01:06, 3 September 2008 (CDT)

Pierre, thank God there is someone like you around. Why don't you incorporate these references in the article, since you are a 'constable'?—Ramanand Jhingade 05:36, 3 September 2008 (CDT)

Ramanand, please review the differences between a Constable and an Editor. A Constable has the necessary role of mediating where possible, but also enforcing professional behavior. Constables have full authority about behavior, but no particular authority about content.

Content decisions are made by Editors. They may rule that a certain line of discussion should be removed from an article, as not authoritative, or request authoritative support for a claim. They may make decision about article content being right or wrong, subject to review by other Editors of the same workgroup, or the Editorial Council or Editor-in-Chief. If an Author continues to post material after an Editor has ruled against it, a Constable can enforce that ruling, anywhere from deletion of the material to banning the user.

Very roughly, a CZ Constable has some functions similar to that of a WP Administrator. There is no WP equivalent to a CZ Editor.

So, if Pierre-Alain is acting as a Constable, he has no more authority on the topic content than any other contributor. If you, Ramanand, want rulings in your favor about content, you need support from an Editor. Howard C. Berkowitz 11:13, 3 September 2008 (CDT)

O.K., thanks for the advice Howard. I did not know about this. I will apply for a Status upgrade.—Ramanand Jhingade 21:58, 3 September 2008 (CDT)

Neutrality; Subpage?

Hey all--

I kept seeing this page come up on the recent changes page, and I just wanted to drop in and remind everyone that Citizendium is explicitly supposed to be neutral. As this has been elaborated in the context of anthropogenic global warming, in writing articles we are not trying to formulate the official Citizendium position on Global Warming or Homeopathy or whatever-- Citizendium does not and should not take a stand on a given issue, even if it's a stand that 95% of credible scientists endorse.

This does not mean that we mention every crackpot theory on every subject. In the case of homeopathy, however, there are fairly clearly defined positions on either side of the debate, and the purpose is not to advocate or denounce, but to articulate the positions.

Instead of arguing over what studies are and are not appropriate for inclusion on the main article, let me make a suggestion: make a new article on 'Clinical Studies of Homeopathy' (or something to that effect), and put your energies towards articulating your positions in the context of an article.

I don't have a dog in this fight, but I also wanted to note that, as written, I find the current 'Introduction' section (the one in the article body, not the intro) decidedly non-neutral.

Thanks, Brian P. Long 20:26, 3 September 2008 (CDT)

Thank you. I would be much happier if there were fewer "it is obvious", or citing a reference with absolutely no comment about it other than it was good.

Unfortunately, and I would truly appreciate suggestions on how to resolve this, perhaps the most neutral way to phrase things is that some of us are model/causality oriented and some are not. There is also an apparent lack of shared vocabulary, or, alternatively, very different perceptions of what terms mean, and what background knowledge might be inferred from the use of a term.

Any ideas? Howard C. Berkowitz 20:32, 3 September 2008 (CDT)

Removed from lede

I removed this from the lede. I would like to know what Khuda-Buksh says, though.

• The molecular mechanism of action of the potentized homeopathic drugs has been explained best by Khuda-Buksh<-- this is a constables contribution: WHAT CONSTABLE?, PLEASE? NOT IN REVISION HISTORY-->

D. Matt Innis 21:32, 3 September 2008 (CDT)

Again, thank you. I don't know how to respond to statements that give a conclusion but no explanation; I hope that when I cite articles, I give a minimal summary of what seemed relevant. Otherwise, it's a bibliography, not an encyclopedia. Howard C. Berkowitz 21:46, 3 September 2008 (CDT)

Why sure, Howard. I made a couple of edits in the first two paragraphs that I hope clarify it a little. I don't think I have changed the meaning much, but hopefully made it a little more succinct and readable by the lay person. If I am heading in the wrong direction, doo feel free to "adjust" as necessary. D. Matt Innis 22:10, 3 September 2008 (CDT)

Improvement

Matt, your rephrasing,

The underlying premise of homeopathy is that the signs and symptoms that accompany a particular illness are not simply the result of the breakdown of the organism, but instead part of the organism's defenses in an effort to fight infection, adapt to stress, and/or respond to toxic insult. The homeopath does not attempt to inhibit symptoms or suppress disease, but rather considers the remedies that they feel will best "...mimick the body's wisdom and therefore augment immune response."

is a definite improvement; it is a good deal less demanding of proof than a claim of an answer to cancer and schizophrenia -- neither of which are single entities.

My concern, however, is that "immune response", "immune system", etc., are being used very differently by some homeopaths and some people with a more molecular approach. I think it can be stated, with a high degree of solid data, that immune response involves multiple mechanisms, any of which can get out of homeostasis. There is a wide range of autoimmune diseases where different mechanisms in the immune system are hyperactive, directly attacking body cells or indirectly releasing inflammatory substances. In other immune-related diseases, there are specific mechanisms that could be "strengthened", such as the T4 lymphocyte count in AIDS. Strengthening T8 or NK cells would not be good.

A start might be a general agreement that immunity is not one monolithic system. From there, an integrative approach might say that this patient's basophil degradation is triggered too easily, with inflammation from histamine release. A conventional approach to such might be the administration of cromolyn sodium. A homeopath might do something completely different. The point is that I believe there is enough well-proven definition of mechanisms that it is possible to have objectivity about diagnosis (regardless of the theory of the cause) and the observable benefits of some therapy. Howard C. Berkowitz 22:30, 3 September 2008 (CDT)

Thanks, Howard. I have read this entire page and understand your issue and quite agree that the use of the words "immune system" are meant in a more metaphoric manner rather than biochemistry's more immunologically accurate description. I therefore left the quotes around any use of the term "immune", especially if it seemed to come from a quotation that we can reference. I would entertain the idea of removing the use of the word immune altogether if we can find an alternative way to describe it, otherwise, I see no reason why the paragraph that you wrote describing the difference in jargon should not be integrated instead. I am also open to any information that supports the use of the word without quotes. It is possible that there are references out there. I personally trust others with the science and prefer to concentrate on the art. By the way, sorry about your friend. D. Matt Innis 22:53, 3 September 2008 (CDT)

Reversions

We have a "no unexplained reversion" policy. This is why I reverted Ramanand Jhingade's own reversion of Matt Innis a few minutes ago. Please review what CZ:Professionalism says about reversion. The point is that when we have basic disagreements, rather than attempting to "force" our way, we negotiate on the talk page. This must be obvious to everyone involved, but I find it sometimes helps to repeat the obvious. --Larry Sanger 22:39, 3 September 2008 (CDT)

Thanks, Larry. Ramanand, I would be glad to consider your opinions on my edits, please feel free to let me know and I'll do my best to explain myself. D. Matt Innis 22:53, 3 September 2008 (CDT)

Summary, please

I would like to request, in my capacity as Editor-in-Chief, a summary of your complaints, disagreements, and requests or proposals for resolution--not longer than 200 words apiece, from anyone who would like to explain them. I simply refuse to read this entire page, which appears to get into many side-issues. Remember, please that other people have limited time to participate, and so it is a courtesy to them to keep your discussion relatively brief and, especially, to the point.

I ask that you limit yourself to 200 words so that you can give me (and yourselves!) the most pointed, highest-relevance explanation of what is going on here.

Thanks in advance. --Larry Sanger 22:39, 3 September 2008 (CDT)

192 words

Obviously, there are differences between homeopathy and conventional medicine. My impression is that a modest start would be more productive: establish what can be agreed. Ramanand has said that he uses laboratory medicine, so there are presumably is agreement that they may show abnormalities.

Identify where there are significant differences in terminology, and try to agree on definitions, such as: immune response, symptom, and sign.

All methods of treatment have risks and benefit. No system can keep insisting on its superiority, at least without evidence presented in recognized statistical terms. I urge a fresh start in a complementary articles, focusing on agreed principles.

Statistically valid clinical trials for individualized therapies are complex, but not unprecedented. Prospective trials are preferable, then statistically based meta-analysis is next $DEITY knows there are enough arguments over the efficacy and cost-benefit of "orthodox" medical treatments. A policy may need to say that claims that "everything is individual so I cannot offer any generalizations" simply are not encyclopedic.

Let us try to put aside the areas where there are fundamentally different models, such as the effect of chemicals on the structure of water, and focus instead on objectivity in diagnosis and evidence-based improvement. Howard C. Berkowitz 23:12, 3 September 2008 (CDT)

202 words : Pierre-Alain (not a constable BTW)

I quote Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies, J Hoffer, Can. Med. Assoc. J.

... the "rules of engagement" ... need to be clearly defined and the goals must be explicit and common to both parties. To do otherwise leads to the risk of unintended confusion and heightening of the barrier of mistrust that already stands between many individuals involved in this debate. Proponents of alternative therapy have an obligation to provide grounds for (1) biological plausibility, such as sound (a) theoretical or (b) preclinical data, or for (2) clinical plausibility, in the form of authentic, well-prepared case reports ... But plausibility, not proof, should be sufficient to initiate the process... (evaluating CAMs)

Let's

1.a.) Continue to explore the various theoretical models and physicochemical explanations

1.b) Cover the data on animals and cell cultures (see Beyond placebos, above).

2. Provide ample space to describe the healing art of homeopathy, its use of words, symptoms and intuition. Case reports. Ramanand told me he could provide his own reports, or others published in a specialized journal. This will help enormously in the present context.

Pierre-Alain Gouanvic 00:04, 4 September 2008 (CDT)

Pierre, if I may call you that, I think you have outlined a valid path. I would appreciate your efforts. Howard, I'm not sure that I've seen any reason to expect that the policies that Citizendium has in place won't result in a tenable outcome. Working with real names and gentle expert guidance has some benefits. Input from all sorts of positions is important to produce a well rounded article. I'm not sure what an encyclopedia article is supposed to say, or if that is what we are looking for here, but I do agree that the article needs to be a neutral look into homeopathy (and perhaps homeopaths). I'd say keep it coming and weed through it all. D. Matt Innis 09:04, 4 September 2008 (CDT)

Matt and Pierre-Alain, the thing I hear from both of you is that the article needs to make it clear when something is a matter of plausibility rather than certainty. I look for quantitative and statistical presentation; do consider that. I welcome your frank observations on what my comment may or may not bring. I'll comment that I think I've improved some articles with anecdotes, but always as signed article subpages or citations of my own published and reviewed work. It must be clear when something is an illustrative anecdote, rather than revelation. Howard C. Berkowitz 09:45, 4 September 2008 (CDT)

I have two specific-but-illustrative comments, which I will keep brief. I am not "taking sides."

Howard, you say that we should "establish what can be agreed," that we focus on "agreed principles" and "put aside the areas where there are fundamentally different models," and that "the article needs to make it clear when something is a matter of plausibility rather than certainty." This represents a misunderstanding of our Neutrality Policy, which requires that we attribute differing positions to their adherents, so that the article states only who believes what. The article should not state whether something is "a matter of plausibility rather than certainty," simply because people often disagree about all that. Rather, judgments of plausibility and certainty, together with the grounds of such epistemic evaluations, should be reported and attributed to their owners.

Second, I saw an excellent example where the latter policy can be applied. Howard, you removed this sentence: "The molecular mechanism of action of the potentized homeopathic drugs has been explained best by Khuda-Buksh." You explained: "It is not acceptable to make a sweeping statement, with a value judgment, about a model, but give no details." The latter is correct, as far as it goes. But if the sentence represents the common view of homeopaths, you should have simply attributed it to them and thereby avoided controversy: "According to many [?] homeopaths, the molecular mechanism of action of the potentized homeopathic drugs has been explained best by [first name needed] Khuda-Buksh." The latter is neutral and fact-stating, and you and I need not have any problem with it. If you feel it is important to say that modern medicine does not agree, you should add that, rather than removing the sentence entirely. In short, more information about the debate, rather than removing all debated points, is the way forward. (But note: if after requests, and some time, nobody elaborates an unclear claim, we should remove it, on grounds not of bias but of comprehensibility.)

I hope this is helpful, and let me say again that I am not "taking sides" against Howard or endorsing the cause of homeopathy. I merely saw these two points rather clearly and thought that stating them might help both sides understand better how wiki collaboration works. --Larry Sanger 10:21, 4 September 2008 (CDT)

Thank you, Larry. Is there a way to rephrase the first point not to say "plausibility versus certainty", but to suggest "X is an axiom of group Y. Their reasoning derives from it." It's one thing to say that the Y's have a structure based on X, but a very different thing to say "the Z's are wrong and the Y's are right". From what has been, I have been reading "homeopathy is right and should be used in preference to medicine." Is it fair to say that Z's are of the opinion that Y's have not proved their case; there is no immediate evidence the views will reconcile.

I see your point about "modern medicine does not agree". My interpretation is that the person bringing up Khuda-Buksh should describe enough of K-B's explanation so that, if it appears to conflict with a medical explantion, that an equally short response stating the disagreement can be made? A practical issue here is that people of either view are more apt to have access to the journals in their own field, and it is a courtesy to give just enough information so the other side need not go on a journal hunt to see if they agree or not.

Alternatively, and I am not being at all sarcastic, I don't think it's useful to say "Khuda-Buksh offers an explanation acceptable to homeopaths. The Avogadro Number argument, for people of a molecular orientation, rules out, in their opinion, the idea of potentiation when molecules are unlikely to be present?" (that latter could be a citation, although I'd rather see an equally succinct summary of Khuda-Buksh").

I would ask that anecdotal case reports of "I have cured", or "I have personally observed", be either external citations in a reputable source, or signed articles. Howard C. Berkowitz 10:35, 4 September 2008 (CDT)

Howard--just a few short comments. I'm not sure about the other sentences you say are not "useful" (I didn't notice or comment on them), and I generally agree about properly wording statements about purported "cures" and "observations" (both are loaded terms), but it depends on the case of course.

As to the Khuda-Buksh sentence, simply attributing the judgment, no matter how unclear, to its owners will remove the need for arguing and disagreement about what it says. Then you can work on getting the sentence's author to expand the thought and provide a reference. Can you propose a wording?

Another, more basic issue. I've noticed that we spend our talk page time disagreeing, arguing, and instructing, often at great length. I think our time could be more gainfully spent by working creatively toward a mutually agreeable solutions. The more that our well-intended efforts are aimed at exposing the subtle mistakes of others, the more work we unwittingly create for each other: others of course feel impelled to prove us wrong, and on it goes. This back-and-forth is not really aimed at solving the underlying sentence wording and article titling problems. If we all were focused not on proving each other wrong, but instead proposing new, creative, and kind ways to resolve conflicts, we'd have far fewer conflicts and far higher productivity.

In short, let's reconceive of talk pages: they are venues for discovering the best compromise solutions to problems of sentence wording and article titling, which problems we are all concerned to solve as quickly, creatively, and kindly as possible. Then we wouldn't fill up talk pages with 100K of argumentative text nearly as quickly. I don't think we'll ever entirely eliminate debate, but we can sure cut down on a lot of useless debate.

I could be full of it :-) but I don't think so. --Larry Sanger 13:49, 4 September 2008 (CDT)

A try at wording

See notes; I'm looking for acceptable vocabulary rather than trying to argue right vs. wrong.

Homeopaths find the work of Khuda-Busch to be a compelling argument that their remedies [note 1] have a sound therapeutic base. The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology. Since there is unlikely to be a resolution of these quite different models, a more effective means of finding common value may be evidence-based medicine (EBM). EBM is routinely used to compare the efficacy of medical methods, and also explicitly incorporates complementary and alternative medicine [Note 2]

• Note 1: Is remedy the right word? Drug? Someone suggest a word for the stuff that the patient ingests. "Remedy" feels non-neutral; I don't assume a "drug" will work.
• Note 2: I may be incorrect, but I believe it has been suggested that homeopathy is so individualized that that it becomes impossible to create a group of patients, with common presentations, so that outcomes can be compared. If so, I'm stuck, although I have suggested one statistical method, with which Gareth had some agreement (hope I'm quoting correctly) that could be used for highly individualized therapies, be they pharmacogenomic or homeopathic.

I hope I am wrong in the Note 2 suggestion, because if there are no ways to compare, I find myself stuck. Howard C. Berkowitz 14:13, 4 September 2008 (CDT)

Physicochemical plausibility

Howard, all,

I want to assure that I tried to suggest rewordings to your proposed text, but the following

The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology.

cannot be taken for granted.

I went on to summarize the review by Khudar-Bukhsh, emphacizing that it was published in a journal read and reviewed by biochemists. I inserted my contribution in the section Scientific Research Testing Homeopathic Medicines. This is where it belongs, for sure, but I question the validity of putting this fundamental section after The popularity of homeopathy and The skeptical view of homeopathy. It belongs in the introduction.

Pierre-Alain Gouanvic 16:47, 5 September 2008 (CDT)

First, let me congratulate you; what is there is nicely phrased. I will be interested in how the clathrate theory is elaborated. That clathrate formation does affect the "structure" of water is not in dispute, but consider two things (open to question from people more current in physical chemistry):

• Clathrates, as far as I know, form a "cage" of water molecules around an atom or molecule of low-molecular-gas. Now, I'll hypothesize that the shaking and such, perhaps with the homeopathic substance acting as a catalyst, encourages clathrate formation. Assuming my understanding of clathrates are correct, then the action of the remedy would be a result of the physicochemical changes by the clathrates, or by release of the gas in the clathrate. Mass spectromety of the preparation, if clathrates are present, should show the released gas molecules.
• Where are the gases (if that's the case) coming from? The atmosphere during shaking? If the water at the start was gas free, and the shaking done under anaerobic conditions, could clathrates form?

This is not an attempt to dispute, just some points that you might want to cover.

As far as the placement, I completely agree that any fundamental scientific data should precede subjective popularity or skepticism. I'd probably put under a section heading just after the short introduction, for ease in linking to it.

Howard C. Berkowitz 17:34, 5 September 2008 (CDT)

First, it is much improved. Thank you.

Regarding the wording above,

The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology.

Might I suggest an alternative?

Work by Khudar-Bukhsh suggests a means, consistent with some work in general physical chemistry, by which the process of homeopathic preparation might indeed have an effect on water. Assuming, for example, that clathrates form, there is no current understanding, in molecular pharmacology, of mechanisms by which clathrates would have a metabolic effect.

I think this gives credibility to a breakthrough on the pure chemical questions of water, but that does not go directly to physiologic effects. Howard C. Berkowitz 02:55, 6 September 2008 (CDT)

First and foremost, I want to express my gratitude. Your appreciative remarks helped me to do this work which was, at times, quite heavy. Now that the science section is moved to the top and the intro is more readable, let's take care of those clathrates!

I'm moving your suggested text unedited in the Clathrate section; then, we could try to address the questions you were formulating above.

Cheers,

Pierre-Alain Gouanvic 11:12, 6 September 2008 (CDT)

References

I will put references that I find useful in the bibliography subpage, starting with this one:

Journal of Molecular Liquids, Volume 135, Issues 1-3, 31 July 2007, Pages 158-165 Conductometric studies of the serially diluted and agitated solutions on an anomalous effect that depends on the dilution process V. Eliaa et al.

I'm not assuming that it will accepted as a useful reference, but I think that it would be counterproductive to burden the talk page with that. Pierre-Alain Gouanvic 12:32, 6 September 2008 (CDT)

One of the nice things about the Bibliography subpage is that you should feel free to annotate the references; it's not like an inline citation. If you were to have a sentence or paragraph describing the significance or criticism of the reference, that's exactly the purpose of that subpage. Howard C. Berkowitz 13:16, 6 September 2008 (CDT)

A good model is the Trends in ..... review journals. They actually star the significant references at the end of the review with a little blurb on why it is a significant paper. It is very useful. Chris Day 22:21, 6 September 2008 (CDT)

Howard, Chris, Pierre, When we post about articles on Homeopathy or its' effects, it's important to see if they have considered the individualization process, if not it will not be accurate.—Ramanand Jhingade 23:56, 6 September 2008 (CDT)

I have repeatedly used an example in pharmacogenetics that, by definition, would be individualized. Gareth understood my point, and that an individualized treatment can still be tested on a group. Will I consider that an individualization process, without some fairly specific molecular bypothesis, can be judged purely on individual results? No, because I don't accept statistical trials are impossible for individualized treatments. They cannot be done meaningfully on samples of one, and I would not, under any circumstances including those of my probable death (but with palliation), consider participating in them or recommending them. I repeat: randomized controlled trials of individualized methodologies -- not results in a given case -- are possible, if difficult.

Howard C. Berkowitz 04:55, 7 September 2008 (CDT)

Reply to Larry Sanger

Dear Larry, I'm sorry for the delayed response, I was busy. The article on Homeopathy on Wikipedia has been taken over by the theorizing, skeptical, critics who have never tried Homeopathy. They tried to do the same with the other Alternative Medical Systems like Osteopathy, Naturopathy and Chiropractic, but could not succeed because those people 'control' those pages by banning the skeptics, although it is by an illegal method. When I saw that Citizendium gives preference to the views of the experts over the ideas of the theorizing, skeptical, critics who have never tried Homeopathy or whatever else, I was really happy. One needs to understand that the trials in Alternative Medical Systems are not upto the mark of the trials for Allopathy (the ordinary medicine available in the Medical stores). Please allow the expert Editors to over-rule the ideas of the theorizing, skeptical, critics who have never tried Homeopathy/Naturopathy. Thanking you, Yours faithfully,Ramanand Jhingade 23:34, 6 September 2008 (CDT)

This is a wonderful quote by Larry, "If we all were focused not on proving each other wrong, but instead proposing new, creative, and kind ways to resolve conflicts, we'd have far fewer conflicts and far higher productivity". We should all follow it in letter and spirit.—Ramanand Jhingade 23:40, 6 September 2008 (CDT)

Howard, Pierre, Can we mention the clathrate evidence in the Lead, before the 'Introduction' section? Can we come to an understanding about the mechanism of action of Homeopathic remedies, which most likely, is by active transcription?—Ramanand Jhingade 00:05, 7 September 2008 (CDT)

Nice to have you back, Ramanand! I relate to your experience with theorizing skeptics; they only accept the science that is popular, and minimize the results of their "own" science when it doesn't follow the mainstream.

I think that I see what you're referring to ("active transcription"). The water or ethanol clathrate crystals would activate the transcription of various genes. The subtlety of homeopathic actions would be best explained by subtle modifications in gene expression. Whether this clathrate theory proves right or wrong, I agree that it must clear that the processes taking place in cells are not entirely explainable with conventional pharmacologic approaches. I read (in another text by Khudar-Bukhsh... do you know him? Let's invite him....) that there is already evidence that some crystals can act upon receptors.

In any case, moving modern enigmas in the intro of an old "prescientific" healing art might be difficult, but necessary. When I tried to update the science on acupuncture, showing that NMR imaging proved the existence of (at least) some acupoints, I had to refrain from talking about the modern theory of acupuncture (organizing centers rich in gap junctions). I knew that these notions would be taken as random hypotheses by some sophisticated snake oil vendors.

I would suggest that we tackle together those difficult issues that the theories of homeopathy bring. I brought the notion of mithridatization to show that "information" might be relevant in biological systems, and that homeopathy is not an an orphan therapeutic. We need to focus on the oddities (compelling anomalies, as Kuhn or Popper said), if we want to let some room for an healing art as original as homeopathy.

NB: Please add as many references as you deem useful in the bibliography section of the article, here. Thanks in advance!

Pierre-Alain Gouanvic 01:18, 7 September 2008 (CDT)

Larry, I have a one paragraph request for clarification of my understanding of CZ policy below this, which is the shortest honest answer I can give to Ramanand's questions, which I do not completely understand. Howard C. Berkowitz 05:06, 7 September 2008 (CDT)

Ramanand, Let me answer indirectly: there times where I have gone into "conventional" medical treatments where I did not know if I would die during the procedure, and was quite aware of that going into the situation. I made my choices, and did it because the potential benefit, to be, justified the risks. In some cases, I was conscious, and, my own request, not sedated -- and by every subjective and physiologic mechanism available, I stayed calm.

One of the people that holds durable medical power of attorney for me happens to have a strong trust in certain aspects of herbalism. The question arose of whether or not, if I was diagnosed with a cancer for which medicine could offer nothing but a fairly quick death, I would want the herbal remedies tried. I have much more detailed criteria in writing, but my basic directions would be: no, do not try the herbal remedy, assuming that a competent palliative care specialist can ease my dying. There are some specifically defined cases where I delegate the authority to put me into a high-risk clinical trial, but I definitely rejected the herbal treatment. The herbal treatment has only anecdotal evidence, and I believe there are times when the correct choice is to die comfortably rather than go onto a search with nothing but hope. There have been time when I was the surrogate, and supported the decision of a patient, lucid at the time, that I would not have chosen for myself.

I have tried both experiemental complementary medicine in cases where I felt there were competent people involved -- usually a trusted physician who had a well-defined relationship with an researcher or alternative practitioner -- and also have that others consider it. I have seen, in a clinical setting, alternative therapies (moxabustion, for example) do measurable things that seemed worth continuing.

I literally do not understand what you are asking me. If you are asking me, hypothetically, if I would personally try homeopathic treatment, based on anecdotal reports and that I hadn't tried it for a life-threatening condition, my answer is unequivocally no. In that case, I would focus on comfort care, and have seen enough work by experts in palliative medicine to say that no one should have to die in agony.

If you are asking me if there should be controlled research into whether, for example, the clathrate hypothesis should be further examined, under scientifically controlled conditions, the answer is yes. If I was asked to participate in a randomized controlled trial of an individualized technique, such as pharmacogenetics, I would give it careful consideration. If I was asked to particate in individualized therapy that the investigator claimed was not subject to any formal testing, no, I would not.

So, if you are asking me if I will agree to support trials experimental treatments that do not meet the standards of allopathic trials of individualized therapies, the answer is no. If you are asking me to accept the hypotheses for the action of either an individualized genetic treatment using a customized monoclonal antibody, or accept the hypotheses of potentiation of water, I will not accept them for more than testing, unless I see much more solid theoretical evidence. No molecular biologist has a really solid explanation for gene activation and expression; why should I assume a less formalized discipline does?

If you are asking me if I would consider randomized controlled trials, with various safeguards, of an individualized treatment, I can't tell you in advance -- that would be a case-by-case decision. The answer might be yes. If you are asking me to accept that homeopathy can be a viable treatment based purely on your being "... expert Editors (presumably with credentials accepted only by Homeopaths/Naturopaths) to over-rule the ideas of the theorizing, skeptical, critics who have never tried Homeopathy/Naturopathy" the answer is no, because I am not yet convinced that there are experts in homeopathy as appropriate treatment. Will I accept that an expert in homeopathic preparations can prepare a treatment for evaluation by essentially molecular means? Yes. Howard C. Berkowitz 04:49, 7 September 2008 (CDT)

To Larry specifically -- I am perfectly willing for a homeopath to state what homeopaths believe, and have an alternative view represented. Perhaps I am misunderstanding Ramanand, but what I hear him asking is for me to accept, as generally true, homeopathic beliefs are true simply because "expert homeopaths" believe they are. With that I cannot agree; any more than I can say that the positions of one political party are true because their adherents say they haven't been tried and disproved. Please clarify if this seems an appropriate distinction for CZ. Howard C. Berkowitz 05:06, 7 September 2008 (CDT)

Pierre (ou Monsieur Gouanvic), merci pour tous les infos.—Ramanand Jhingade 23:02, 7 September 2008 (CDT)

Howard, God forbid you get an 'incurable' disease, but between Euthanasia and Homeopathy, you should choose Homeopathy - there's a good chance of being healed. I'll make you an offer - I'll treat you or someone you love, for free (if you think Homeopathy is placebo, you shouldn't have a problem trying it for a day or two). This article should state what Homeopaths believe, but can have a section for criticism much lower down (not in the Lead), because it should not look like an 'attack piece'.—Ramanand Jhingade 23:17, 7 September 2008 (CDT)

I really don't want to argue the issue of what I will and will not do, but I felt I had to respond to what seemed to be your suggestion that it was acceptable to have something more than an accurate statement of a consensus among homeopaths. I do not believe any text along the lines of "until it has been tried, it can't be ruled out" belongs in the article. I would welcome discussions of non-anecdotal plans for statistically sound trials of individualized therapies, pharmacogenetic, homeopathic, individualized monoclonal antibodies, etc.

This is a general question -- are homeopaths rejecting participation in trials that are designed to look at the sort of thing Gareth and I discussed for pharmacogenetics? Pharmacogenetics, rather by definition, is individualized. Assuming that the proposed treatment is for a disease that has no known treatment, a placebo-controlled trial is ethical. The geneticist/clinicians would analyze the patient, and design what they believe to be a specification for an appropriate treatment, and send that specification to the preparation specialists. The preparation people would open the next sealed envelope, determine whether to send back an IV of saline or genetically active substance, marked only as to which patient would receive it. The clinicians administer it and observe the results, with independent monitoring by a non-blinded safety panel.

It would be reasonable for the homeopathic section of the article to make a definitive, preferably sourced, statement, that this type of trial is or is not something in which they will participate. If yes, then a pointer to the ongoing work would be valuable. If not, I think it's fair to ask the reason, since I am asking no more and no less than I would be asking of a molecular pharmacologist proposing individualized therapy, which would be tested. Howard C. Berkowitz 23:50, 7 September 2008 (CDT)

I found this article titled, 'Series of studies confirm action of homeopathy on childhood diarrhea', at http://findarticles.com/p/articles/mi_m0ISW/is_243/ai_109946495

I also found this article, an abstract of which is on my web-site, by Rastogi, D.P., Singh, V.P., Singh, V., Dey, S.K., and Rao, K., titled, “Homeopathy in HIV Infection: A Trial Report of Double-Blind Placebo Controlled Study.” British Homeopathic Journal. 1999. 88(2):49–57.

There are lots of other articles which I'll keep posting about from now. Can we mention the clathrate evidence in the Lead, before the 'Introduction' section? Can we come to an understanding about the mechanism of action of Homeopathic remedies, which most likely, is by active transcription?—Ramanand Jhingade 00:38, 8 September 2008 (CDT)

Healing Arts Workgroup

I see that this article is under the Healing Arts Workgroup. Here are your Healing Arts Editors. Perhaps you might ask for some guidance there. D. Matt Innis 12:25, 8 September 2008 (CDT)

There are so many Editors, I'm scared of being banned for spamming all those Editors. Can you please do the needful or at least tell me how to do the same?—Ramanand Jhingade 00:17, 9 September 2008 (CDT)

You just go through the list, pick a few who seem that they might be interested, and contact them. If they've been inactive as determinable from their contributions, try to email them, but try to contact actives. Don't worry about what you've worried about! Besides, editors may appreciate prodding about a concrete case where they might help. Stephen Ewen 00:37, 9 September 2008 (CDT)

Comments

Adding to what Matt said:

Gosh, it seems that a very great deal of energy has been used unproductively here. I think this was Larry's core-most point, above, and if I'm right about that, I obviously heartily agree. While not venturing to become an author here, I just want to make a few comments that might prod things to get "unstuck".

I see folks actually debating homeopathy, as if somehow this will convince diverse authors to come over to one side and write the article to represent a particular point of view. It'll never happen, folks. I know that my own personal belief about homeopathy, based upon my worldview and private study since about 1989, is that it is a false system; no amount of arguments here or anywhere is likely to convince me otherwise.

But my point is that that should be assumed from the get-go, and throughout; that there will ever be stark disagreement over homeopathy; so, there ought be a shift in focus about how to neutrally describe the system, to set it strongly in its own light in its own terms, and to then set the opposite view from materialistic science in kind.

So how will specific sections and paragraphs be worded in this regard?

Stephen Ewen 23:50, 8 September 2008 (CDT)

Stephen, Billions of Homeopaths have had results with Homeopathy through the ages (including me). Citizendium gives preference to the views of the experts over the ideas of the theorizing, skeptical, critics who have never tried Homeopathy, so, while there can be some criticism in the article, it should not look like an 'attack piece'. Thanks in advance for your co-operation.—Ramanand Jhingade 00:24, 9 September 2008 (CDT)

Obviously, it should not favor one or the other experts but fully educate readers neutrally about the views of experts on both sides, believers and non-believers If you are trying to maximize positive views of the system and minimize critical views of it, that's not neutrality. While you might wish to present it in a very positive light only, others will want to present it in a very negative light only, in accordance with the major contrastive worldviews about it. No one get's their full plate in an article like this. No one. Stephen Ewen 00:39, 9 September 2008 (CDT)