Talk:Homeopathy/Archive 13

Notable information and formidible [sic] survey

Interesting. The content added followed a market research document about popularity, with no indications of effectiveness to go with the popularity. The BMJ citation speaks of actions, with no rationale or outcomes data. How about some indications not of the popularity of these referrals, not of the hypothesized mechanisms of homeopathy, but of the outcomes of these referrals? Howard C. Berkowitz 00:28, 10 October 2008 (CDT)

Your comment reminds me of skeptics who expect controlled clinical research reports to explain "mechanism of action." Clinical studies are clinical studies. They report results, not theories or explanations about how homeopathics work or may work. Likewise, surveys ask some questions, not all questions. I cannot help but sense that you don't want this information because it suggests greater popularity about homeopathy that you don't want to accept. There is no doubt (!) about the notability about the BMJ article, and the market research survey seems to confirm and expand upon what the BMJ reported. Dana Ullman 16:29, 11 October 2008 (UTC)

"Skeptic", as you use the term, Dana, is something that, whether you intend it to be or not, is becoming offensive. "Sensing" my reasons is offensive, and, I believe, something you have been asked not to do. If you "sense" I am doing something, let me suggest a novel diagnostic technique: ask me, in so many words, to explain my reasoning. That, incidentally, is considered a professional means of collaborative editing.

Given that my comment specifically said "not of the hypothesized mechanisms of homeopathy, but of the outcomes of these referrals", why are you raising the question about randomized controlled trials (RCT) and mechanism of action? In point of fact, most RCT do not define mechanisms of action. In the U.S., when the investigators make the initial application for human subject research to their Institutional Review Board, and (usual sequence) then to the Food and Drug Administration for the Investigational New Drug Application (IND) that grants additional permissions, they will present a proposed experimental protocol as part of those applications. It is those applications that will contain the best understanding of the mechanism of action, which, with current methods, is apt to come from in vitro or animal models. In some cases, it may use human data from a human subject trial for pure research, which thus goes to the IRB but not the FDA.

Certainly, additional insight into mechanisms may come from clinical trials, but that is not their major intent. The intent of phase II and phase III is to demonstrate efficacy, which is an aspect of the question I asked, not the one you assumed I asked, about outcomes.

As to popularity, cigarettes are more popular than medicine, to say nothing of television. There is no "popularity" section in the article on medicine. Speaking editorially, popularity, in general, would be appropriate for the Sociology Workgroup, or for groups dealing with popular culture. I don't see a strong reason for it in something where we are concerned not with social behavior, but effectiveness of health methods.

The market research study is not from an authoritative source by the standards of Wikipedia, and it should be deleted. I intend to do so unless I am overruled, or you come up with more data on its methodology and why the market research group should be considered as credible as the BMJ. That it is consistent with the BMJ report is no more authoritative than a television talking-head arguing about a political speech, unless it passes the criteria for peer-reviewed or otherwise authoritative sources. CZ generally accepts books from reputable publishers, which usually involves review. Not everything has to come from a journal.

Apropos of the BMJ study, I note its date was 1994. You deleted several references I had inserted (see below) on the grounds there were "more recent" studies. The earliest of those studies, however, was 2001, and you have supported a number of quotes from 1905 and earlier, so date alone does not justify deletion. These particular trials were notable in another way, which I shall make even clearer when I reinsert them: they were the first homeopathic trials funded by NCCAM, or peer-reviewed secondary sources abut them. The principal investigator on each was Iris Rose, on the faculty of the University of Arizona and both an MD and homeopathically qualified. Since I cite some of her later publications, I believe it appropriate to establish her pattern of being funded and able to qualify for additional funding. Howard C. Berkowitz 17:14, 11 October 2008 (UTC)

<ref name=NCCAM-FM>{{citation | title = Homeopaths Conduct Groundbreaking NIH Fibromyalgia Study | journal = Townsend Letter for Doctors and Patients | date = April 2001 | url = http://findarticles.com/p/articles/mi_m0ISW/is_/ai_72297189}}</ref> <ref name=Bell2004>{{citation | title = EEG alpha sensitization in individualized homeopathic treatment of fibromyalgia | author = Bell IR; Lewis DA; Lewis SE; Schwartz GE; Brooks AJ; Scott A; Baldwin CM | journal = Int J Neurosci | year = 2004 | volume = 114(9) | pages = 1195-220 | url = http://www.medscape.com/medline/abstract/15370183}}</ref> A 2003 review of CAM methods for fibromyalgia found the most effective methods were "acupuncture, some herbal and nutritional supplements (magnesium, SAMe) and massage therapy"; there were positive results but methodological problems with a study on homeopathy.<ref name=>{{citation | title = Complementary and alternative medicine in fibromyalgia and related syndromes | journal = Best Pract Res Clin Rheumatol | year =2003 | volume = 17(4) | pages = 667-83 | author = Holdcraft LC; Assefi N; Buchwald D | url = http://www.medscape.com/medline/abstract/12849718}}</ref>

Howard, I believe that your desire to not allow the BMJ article about the use and status of homeopathy by doctors in Europe because it does not provide information on what was the result of the use of the medicines or what was the result of the referrals borders on the ridiculous. Yes, it is that bad. I am not saying that your desire for this information is bad or wrong; what I am saying is that the BMJ survey information is notable, but just because the survey doesn't provide this information does not make it less notable. I do appreciate some of your contributions, but I seriously question others, such as the ones above in this section. If you happen to have more recent survey information, please provide it. If not, this survey information still provides value. I did delete some older articles because there were newer studies. The 2003 review of CAM methods did not account for the high quality homeopathic trial on fibromyalgia published in 2004 (by Iris Bell, not Iris Rose). For the record, I am not against information in this article that is negative nor do I want it simply in the skeptics' section. I simply do not want misinformation, and Killen's statement was clearly misinformed. Dana Ullman 18:09, 12 October 2008 (UTC)

The article "does not provide information of what was the result of the use of the medicines"? Then what information does it convey? Your beliefs about my desires are not authoritative, and it is insulting that you think you know them better than I do.

You may do as you will with popularity survey data, but I consider it completely irrelevant to any article in which popularity is not the dominant factor, such as an illection. Killen's statement was the statement of an official in a relevant government agency. Whether it is misinformed or not makes no difference, as it implies a policy. Politicians routinely say misinformed things, but they don't have the opportunity to have it removed. I have yet to hear any substantive reason on why it was a misinformed statement, other than it does not agree with your definition of homeopathy.

When a neutral editor is involved with the article, I shall ask to have the Killen statement replaced, as a matter of historical record that an official of NCCAM said it.Howard C. Berkowitz 03:08, 17 October 2008 (UTC)

Reason for reverting "other compounds"

In an earlier version, the homeopathic remedies were described as small quantities of an ingredient "dissolved" in "water, ethanol and/or other compounds". Dana changed this to "water or ethanol" with an edit note to be more accurate.

Among other compounds are quartz and lactose, mentioned elsewhere in the article, for ingredients that are insoluble in water or ethanol. If these other compounds are no longer used, the article should reflect the reason they were no longer used, which might be interesting and relevant on how homeopathy refines its methods.

Let's assume they are not used, but ethanol is. Is there an assertion and supporting evidence that ethanol has a memory? I could see nanobubbles and silicate chips forming in ethanol, but I haven't heard — doesn't mean it can't exist in authoritative sources — of clathrates with ethanol. There is no question of the existence of clathrates, merely that they would have a physiological effect and they are commonly produced by homeopathic preparations.

Water (H₂O) is among the simplest of molecules, so the idea that it can be affected makes more sense than with other molecules. Ethanol (C₂H₅OH) is a larger molecule, so it may be more stable in forming complexes.

Water is a polar solvent; ethanol is considered both positive and nonpolar, depending on whether or not you are looking at its hydroxyl group. Are there reports of its being involved in clathrate formation?

If not, since there seems no question ethanol is used in homeopathic remedies, are clathrates eliminated? Since the Avogadro limit would still hold, is there a homeopathic assertion that ethanol has a memory?

Assuming the preparations with quartz (impure silicon dioxide) and lactose are still in use, how do they have memory, if the Avogadro question still applies?Howard C. Berkowitz 17:32, 11 October 2008 (UTC)

Explanation of deletion text making statement not supported by available citation

While only the abstract is available without a subscription, <ref>Eskinazi D (1999) Homeopathy re-revisited: Is homeopathy compatible With biomedical observations? ''Arch Intern Med'' [http://archinte.ama-assn.org/cgi/content/extract/159/17/1981 159:1981-7 ]</ref> only says,

Increasing numbers of medical consumers seem to seek out homeopathic treatment.

The next citation doesn't actually point to a specific article, but to a BMJ special article on homeopathy. http://www.sciencedirect.com/science/journal/14754916. Correction: that reference isn't the British Medical Journal, but the former British Journal of Homeopathy, now retitled Homeopathy.Howard C. Berkowitz 19:15, 11 October 2008 (UTC)

Dana added the text, "There is body of evidence that suggests that homeopathic medicines are fully compatible with modern biomedical observations and scientific perspectives." fully is questionable on the face of it. Further, "suggests" is more of a qualified word than, say, "confirms". If the evidence confirms, say so. Howard C. Berkowitz 18:27, 11 October 2008 (UTC)

Howard, you are welcome to delete the word "fully." That said, please read this article; it is well-referenced and published in a high-impact journal. Dana Ullman 18:17, 12 October 2008 (UTC)

Scientific basis of homeopathy

Let me assume I were a homeopath, trained as a biochemist, and an experienced writer (well, 2 of 3). If I were trying to convince people with conventional scientific training, I'd tend to go more with a smaller selection of articles of very well chosen articles. There is one paper here that stands out from the others, but it's not emphasized, yet it probably is stronger support than the rest put together, and doesn't apper to depend

First, I was reminded that even if "memory of water" was proven, that doesn't explain modes of action in remedies that use ethanol, quartz, or lactose, all mentioned.

Second, simply to mention that homeopathic remedy preparation creates changes in water, but that these changes have no understood physiological relationship, it is getting into speculation inappropriate for an encyclopedia article. Examples:

<ref>Rey L. Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride, Physica (A) 2003; 323: 67–74.</ref>

What physiological mechanism is affected by thermoluminescence?

<ref>Bell IR, Lewis DA, Brooks AJ, et al. Gas discharge visualisation evaluation of ultramolecular doses of homeopathic medicines under blinded, controlled conditions. J Altern Complement Med 2003; 9: 25–38.</ref>

Nothing here identifies a cellular interaction, and solving memory of water doesn't solve the Avogadro problem in non-aqueous diluents.

<ref> Elia V, Niccoli M. Thermodynamics of extremely diluted aqueous solutions. Ann N Y Acad Sci 1999; 879: 241–8. </ref>

Same as above.

<ref>Linde K, Jonas WB, Melchart D, et al. Critical review and meta-analysis of serial agitated dilutions in experimental toxicology. Hum Exp Toxicol 1994; 13: 481–92.</ref>

Same as above.

<ref>Belon P, Cumps J, Ennis M, et al. Histamine dilutions modulate basophil activation. Inflamm Res 2004; 53: 181–8.</ref>

The above paper is one you should use, and explain further. Modulated basophil response is something that would affect asthma. (addition: not having access to the paper itself, I assume histamine is the active homeopathic ingredient. Correct? Interesting, if so, in that histamine has to be extracted or synthesized; it's not a naturally occuring isolated compount. Howard C. Berkowitz 03:42, 13 October 2008 (UTC)

<ref>Zausner C, Lassnig H, Endler PC, et al. Influence of a homoeopathically prepared thyroxine dilution on the metamorphosis of highland frogs – results of a multicenter controlled trial. Perfusion (Nürnberg) 2002; 17: 268–76. </ref> "that were different from the "control" effects of the water used for the dilutions. The work resulted in considerable controversy, and some other labs were unable to reproduce the reported effects."

Is this the sort of report that strengthens a case?Howard C. Berkowitz 18:22, 12 October 2008 (UTC)

I'm not clear on your point here, but let me simply say that skeptics of homeopathy insist that there is NO difference between the biological activity and clinical efficacy of a homeopathic medicine in comparison with a placebo. All of the above studies that you cite prove otherwise. I also want to clarify that the "active ingredient" in a homeopathic medicine is the entire substsance that is potentized, not any individual chemical within that substance but the whole thing. Like I have said several times in the past, you will become an even better CZ editor when you understand the system of homeopathy, not just individual controlled trials. Dana Ullman 23:55, 13 October 2008 (UTC)

Constabulary: The previous characterization of "making me a better editor" is patronizing and unprofessional. I have repeatedly objected to Dana's analyzing my motives, and also of being extremely patronizing.

It is rather disingenuous to say "I don't understand your point" and then go off about "skeptics" and placebos. I did not write one word about placebo. Let me rephrase: was histamine the substance added to water to produce the remedy? That is what I meant by "active ingredient". Would you prefer "precursor". "Simillum"? The authors did not title the article "the effects of histamine-treated water", but of diluted histamine. The abstract speaks of a preparation.

And, Dana, you don't seem to understand that my lack of interest in learning the depths of homeopathy is irrelevant to my editing this article. An effective encyclopedia article educates. It does not require going off and immersing oneself in the field to understand the nuances of the article. Please stop telling me to go off and study homeopathy, or making sarcastic observations about my "newfound passion" for homeopathy. While I don't know if it can be done, I want to see this article stand on its own and give a coherent explanation. I want it to stop contradicting itself, and I want it to stop usurping and redefining well defined terms. I want non-authoritative testimonials and popularity contests gone.Howard C. Berkowitz 02:39, 14 October 2008 (UTC)

Howard C. Berkowitz 02:39, 14 October 2008 (UTC)

Pinning down some terminology

From the article,

In homeopathic theory, every person has "life energy," sometimes called a "vital force," which today's homeopaths consider to include a person's immune system.

Is the term "life energy" or "vital force", and can it be defined? Is it the same or different than "wisdom of the body"? Some of these terms are wikilinked to null articles, which suggests to me someone thinks they can be defined.

"Immune system", and there's really not one immune system, has a generally accepted meaning among any medical personnel that have studied current immunology. What do homeopaths mean by immune system? Is it wiser to use "vital force' (or your choice of terms) so there isn't an apparent redefinition. The MeSH definition is "The body's defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components." Since some of its parts act in opposition/regularizing o the other, "strengthening" just doesn't make much sense.

The training of the homeopathic practitioner, MD, DO, RN, etc., shouldn't make much difference; any would receive similar training. Howard C. Berkowitz 21:22, 13 October 2008 (UTC)

Someone has changed what I previously wrote. Originally, I had written that a person's life force or vital force (they are synonymous), but I referred to it in today's language as similar to what we call a person's "immune and defense system." Because our body's defenses are not just its immune responses, I recommend that we re-insert what was originally written. I did not write that homeopathic medicines "stimulate" the body's immune system; I had written that they seem to "augment" immune response because there is evidence that these medicines stimulate immune function and at other times they tonify an overly active immune system. A reference for this is: http://ecam.oxfordjournals.org/cgi/content/abstract/3/1/13

Dana Ullman 00:04, 14 October 2008 (UTC)

For vital force or life force, may I ask that one be picked, for the benefit of readers who do not know they are synomomous.

I would argue strongly against "immune and defense system", but have no objection to "defense system". Since "immune system" is a well-defined technical term in biomedical sciences, if that term is used, it is reasonable that it be used precisely, which, in part, means using it with that precision. "seems" to is not acceptable scientific language and immune system is a scientific term. An authoritative article in the field might use "seems" in an abstract, but I am confident that no quality journal would allow that unless there is hard statistical data, with quantitative values of trust/error, elsewhere.

Indeed, what your cited article actually says, in the last sentences of its abstract, are "It is our hope that this review of literature unknown to most people will give an original and useful insight into the ‘state-of-the-art’ of homeopathy, without final conclusions ‘for’ or ‘against’ this modality. This kind of uncertainty may be difficult to accept, but is conceivably the most open-minded position now." That's a lot weaker than "seems to". I would appreciate that when you cite abstracts, you stay with the level of certainty they have, not spin it into greater support than is written.

I have absolutely no idea what it may mean to "tonify" an immune systems. I could describe a number of mechanisms that modulate specific immune mechanisms, or, if they faily, result in immune disease, but that is inappropriate at this level and in this article. Now, I shall go back to the article and edit it so it does not give the impression of pre-empting precise terms. Incidentally, I have been adding articles that carry referenced definitions of immunological terms. Perhaps, if you want to use such terms, you also might contribute in that manner. So many proteins, so little time...Howard C. Berkowitz 00:39, 14 October 2008 (UTC)

"Unsubstantianted and vague"

Dana deleted my addition of a sentence "Not all homeopaths recognize the model of a disease being a disturbance that needs to be corrected." He did not follow the practice of explaining a deletion on the talk page, which I have tried to do.

I would observe that homeopaths in this article, and certainly in easily obtained references, repeatedly reject the concept of disease, especially as something that causes symptoms, and instead insist that the symptoms are merely the manifestation of the body's own healing. Doing anything that is not focused on those symptoms gets away from the concept of simillium.

So, Dana, how many references do you need? Give me a number. Howard C. Berkowitz 02:29, 14 October 2008 (UTC)

I think I would have deleted that one myself, Howard ;-) I'm not sure what it means. I think I know what you are trying to say, but that wasn't it. Keep trying.

I don't see anything wrong with homeopaths entering the 21st century trying to explain what they do in modern terms. I also don't see that we can take this article space to try to explain how the body defends itself, especially since this is extremely difficult to fathom, much less explain. As our previous reference suggests, we don't know the mechanism that makes homeopathy work, assuming it does, but that does not mean that it has no value, whatever that might be. Our error is in trying to suggest that we know anything about how it works, or whether it works. I like the idea of succinctly describing "life force" or "vital force" as a centuries old metaphor for explaining everything we don't know about what makes us tick, and even that the "immune system" and our "body's defenses" are part of that, especially if this is what homeopaths tell their patients. However, we need to be sure that the reader knows that we don't know how it affects the immune system, or for that matter "vital force". I think you are both working in that direction, so I don't see any need to drastically interfere with your progress other than a few clarifying or copy edits.

D. Matt Innis 02:58, 15 October 2008 (UTC)

The problem here Matt, is that some theorizing, skeptical, critics who have never tried homeopathy think they know more about homeopathy than homeopaths themselves.—Ramanand Jhingade 03:04, 15 October 2008 (UTC)

That's part the problem :-) Though theorizing and skeptical are pretty much the definition of scientist. Criticism can be constructive if given and taken in the right way. Homeopathy has it's place, as evidenced by the fact that it has a place. We just need to explain it that way. As professionals, we work every day taking care of our patients, but we don't really know if we are helping our patients better than other forms of therapy are working. For this we need the research. D. Matt Innis 03:33, 15 October 2008 (UTC)

You make a very good point, Matt, about the 21st century. I am impressed, in a way, about the amount of commentary up to 1905 or so, but then dropping radically. I don't dispute that Osler questioned the doses being given by physicians of the time; very few modern physicians will argue that there were very, very few effective drugs at the time Osler spoke well of homeopathic dosages. I would make the point, however, that just a little has been learned in 103 years, including the rejection of things that don't work, and the substitution of things that do. I'd like to find, for example, a contemporary equivalent, in homeopathy, to the continuous improvement of treatment of metastatic breast cancer in postmenopausal women. Offhand, in 20-30 years, I can think of at least 5 changes, all demonstrating better efficacy, to the standard treatment, from the 5-drug Cooper regimen to aromatase inhibitors. Howard C. Berkowitz 03:32, 15 October 2008 (UTC)

Homeopathy was working then as well as now, so why change something if it's good?—Ramanand Jhingade 03:36, 15 October 2008 (UTC)

Well, of course Abraham Flexner played a big role in that along with the AMA. Homeopaths were the majority practioners before the turn of the century. The AMA started somewhere around 1845, right. Somewhere in the late 1800's, they began to investigate the ingredients in nostrums and homeopathic remedies. Homeopaths, still invoking the vital concepts of "life force", had not placed much emphasis on scientific evaluation, because they considered the active ingredients to be immaterial and thus, by definition, undetectable. As most physicians of the times used homepathic remedies at least with some illnesses, they didn't question much. Rockefellar/Carnegie and Flexnor forced things to change in 1906-1910 - effectively placing healthcare squarely in the hands of science and materialists. Doctors virtually stopped practicing homeopathy. Of course, then comes WWI, the flu epidemic, then penicillin, the great depression, vaccines, WWII, the polio outbreak, railroad insurance, federal funding of university research, etc... until the late 1960s (Vietnam) and the social unrest and distrust of authority (Nixon) - which included the AMA. That is when interest in alternative medicine was renewed... but Medicine hadn't noticed until 1996, when the research showed that their patients were spending as much on alternative medicine as they were on primary care. It's all very interesting. D. Matt Innis 04:05, 15 October 2008 (UTC)

Matt, I'd hesitate to use U.S. healthcare economics as evidence for anything related to reality. As I've suggested before, I'd be very interested in seeing outcomes and spending in a situation where there are no economic incentives or disincentives to a form of therapy. The AMA, incidentally, has been declining for years; their membership is distinctly a minority, for all the complaints against it.

For-profit insurers do things that minimize their costs, but it is a complex situation involving short-term and long-term costs. If, however, there was substantial evidence of efficacy for homeopathic treatment, I'd suspect the insurers would be screaming for it to be tried before other methods. There is a lot of very interesting economic analysis that could be in this article.

It isn't just that the amount of medical knowledge is increasing, but the rate of acquisition is increasing. In the seventies, the number of citations in MEDLINE doubled about every 7 years. They are now doubling every 3-4 years, and it's a matter of tools and techniques of research as well as funding. Witness, for example, that the R&D budgets of most pharmaceutical companies is exceeded by their marketing budgets; the peer-reviewed articles keep coming. It appears that homeopathy has not especially changed in the last century or so, which is not the case for all forms of CAM. Some here suggest, apparently, that it was immaculately conceived, or the equivalent, and does not need to improve. Howard C. Berkowitz 04:19, 15 October 2008 (UTC)

The National Center for Homeopathy

Dana, I believe the National Center for Homeopathy (web-site: www.nationalcenterforhomeopathy.org)needs to be mentioned in this article - I hope you can look into it.—Ramanand Jhingade 03:01, 15 October 2008 (UTC)

Preparation with other than water

The section entitled "Preparation of homeopathic remedies" still includes quartz and lactose. Quartz was removed in the lead. Should it be removed here? If both are to be removed, is it to be concluded that homeopathy no longer uses similliums that are insoluble in water?

What about ethanol? For chemical as well as regulatory reasons, it is unlikely that 100% ethanol is used; given the formation of an azeotrope at approximately 95 percent, it's hard even to get 100% ethanol. Is ethanol used only for initial solutions, which are then diluted in water, a common enough chemical technique?

If a substantial amount of ethanol remains in subsequent dilutions, is there an assumption that it has a memory, or is ethanol simply a means of exposing the simillium to water?

If I am using "simillium" incorrectly, please give me the correct term for that which is added to the solvent. I have been chastised for calling it an active ingredient; I would prefer to call is a solute that is dispersed in solution. "Remedy" is something I would prefer not to use, as the term makes assumptions. Howard C. Berkowitz 16:47, 15 October 2008 (UTC)

I do not know where you are getting your information on homeopathy, and I am again concerned that you're wasting your and my time here. I urge to consider decreasing your questioning my actions UNLESS you have evidence that I've erred (heck, we all err). I just don't understand how you can say or defend that homeopathic medicines are dispensed in quartz. Nor do I understand why you want to create a hyper-technical lead to this article. The people who edit on CZ are supposedly experts. I urge you to edit on your expertise and keep your questions to your expertise. In the future, I will avoid answering your Talk points that stray, like this one above.

To clarify, the word "simillimum" is the word that means: the homeopathic medicine that is most similar to the overall symptoms of the sick person. I do not want to see homeopathic lingo in the lead, nor do I want to see any hyper-technical information there. Dana Ullman 22:01, 15 October 2008 (UTC)

Above you say that "The people who edit on CZ are supposedly experts." This is not true. Anyone with an account can edit any article in CZ, in a similar way to wikipedia. The difference is that you need to provide your name to get an account and there are some experts available to approve articles and adjudicate arguments over content if necessary. Chris Day 22:11, 15 October 2008 (UTC)

And may I add that contributors to CZ are not supposed to push any specific agenda or hobbyhorses of their own -- they are supposed to both write and edit with a scrupulous neutrality, which you are obviously not doing. Hayford Peirce 22:56, 15 October 2008 (UTC)

Where have I gotten quartz? From the lead of the homeopathy article itself. It was there when I first saw the article, and I had no reason to challenge it. If you don't want "homeopathic lingo", give me a term to use for the substance dissolved in water. When I said "active ingredient", there was homeopathic objection to that, because it was said the "entire preparation" is active. Will "solute" suit you, or is that term, from high school chemistry, "hypertechnical".

Please define what you mean by "hyper-technical". It's no more technical than in any health sciences article, and less so, than, say. complement or eosinophil. So far, I'm afraid I find that anything that is less than supportive of homeopathy is taken to task for some reason. Comments about wasting time get very close to unprofessional conduct, as do judgments on peoples' motivations.

If you didn't like quartz in the introduction of the article, or in the body of the part on preparation, you have had weeks to remove it. I didn't put it there. Howard C. Berkowitz 23:50, 15 October 2008 (UTC)

I take exception to Hayford's statement above. Previously, there were four references in the lead to the skepticism or unproven or unaccepted nature of homeopathy, and this redundancy didn't make sense to me. There are many sentences that I have written in this article that have expressed some type of skepticism of homeopathy and will continue to do so when appropriate, but I will avoid doing so when it seems overdone or redundant.

Howard, my apologies if I inferred that you have placed the word "quartz" in the lead. I simply saw you defending it and didn't consider it worth defending (because there is no basis of fact in it).

To clarify, homeopathic medicines are called THAT or "homeopathic remedies" or "homeopathic drugs." Just as people refer to "home remedies" which does not mean that they are "scientifically proven" or not...but that they are used to remedy a problem. The above reference to the word "solute" is too technical and seemingly not clear to the average reader. Dana Ullman 21:24, 16 October 2008 (UTC)

Note that quartz is still used elsewhere in the article. If it's wrong, take it out, but quarts and lactose do seem to be used with historic sourcing.

I'd expect a high school student to understand solute, but please pick two acceptable words. Let's assume water is the only solvent used. What general term do homeopaths used for the substance that is put into the water and shaken? Since there is so much emphasis on shaking, clearly, there is an interaction between this unnamed thing and water. Surely there is a name for the thing, because until it is appropriately mixed, shaken, and diluted, it is not yet a remedy. Howard C. Berkowitz 03:02, 17 October 2008 (UTC)

"Synonymous with" and other items

I deleted this: "is synonymous with what people today refer to be a patient's over defense system." Since most people today do not use any such term as "life force"--even I know that is taken as a long-discarded, antiquated notion--it certainly is not "synonymous with what people today refer to" as the body's defense system. This is simply to say that most people do not equate it with anything that they believe exists, because they think a "life force" doesn't exist. If I am mistaken, I'd like to see some explanation. Also, "a patient's over defense system" doesn't make sense to me. --Larry Sanger 00:39, 16 October 2008 (UTC)

By the way, on the above point, I'm very open to restating the point so that it makes a claim about what all or some homeopaths believe. If homeopaths use the phrase "life force" (or whatever), and if they equate that with the the body's "immune and defense system," grand--say so. Just don't say (or imply) that this is an equation that physicians would make, because (I gather) the vast majority of them would scoff at the notion of "life force," which went out of style along with the vitalism that it implies. --Larry Sanger 01:37, 16 October 2008 (UTC)

I also deleted this:

Because of their "respect for the wisdom of the body," homeopaths do not try to inhibit symptoms or suppress disease. The extremely small and specially prepared doses of remedies that homeopaths use are chosen for what they consider to be the unique ability of remedies to mimic the body's own defenses and initiate the healing process.

This, the first sentence in particular, does not make sense in context. The very word "remedy" implies that homeopaths are trying to inhibit symptoms or "suppress" (I assume this means cure?) disease. Is there supposed to be a difference between "suppressing disease" and "initiating the healing process"? If so, the article should explain that explicitly and then make the point in light of that distinction.

Also, what any of this has to do with something called "the wisdom of the body" is completely cryptic to me. That, too, needs to be explained in advance. --Larry Sanger 00:44, 16 October 2008 (UTC)

This is very confusing and seems overstated: "Some randomized controlled trials that have tested the efficacy of all forms of homeopathic medicines have reported positive results..." This sounds like there were several trials that each tested every homeopathic "remedy," and secured positive results for every remedy thus tested. That surely can't be correct; and "positive results" is vague, anyway. I've reworded it to mean what I believe the author meant. --Larry Sanger 00:54, 16 October 2008 (UTC)

Larry, it is always a pleasure to have you come visit and to give your input. To clarify, the words "life force" or "vital force" are homeopathic lingo for what most people today refer to as a person's "overall" defenses (I mis-typed previously and simply used the confusing word "over"). As such, it does make sense. And yes, homeopaths have a GREAT respect for the wisdom of the body...and for symptoms. Thus, because the correct homeopathic medicine is one that will "mimic" the person's symptoms and help the body's defenses. This should not be cryptic.

Larry's last comment is a good one. I believe that we should delete "all forms of" and replace it with "select". Dana Ullman 03:17, 16 October 2008 (UTC)

Text reverts on 12 October...ongoing

Ramanand, I restored changes made by both Hayford and myself. Let me try to explain.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reality (pardon the expression) check?

It annoys me that I can't find a cherished book in my medical library, a 1934 volume entitled Modern Office and General Practice. I cherish it because I have never seen, collected in one medical publications, as many things that are useless or actively dangerous. Glancing around, the first medical book that greets my eyes (the medical shelves are in another room) is a 1985 text on immunology, growing dated.

May I ask why there is so much emphasis on what Osler and Hahnemann said about physicians I will cheerly stipulate were clueless? Would it not be more to the point to find current and respected physicians taking current therapies to such task--perhaps things that have a reasonable base in molecular pharmacology, such as substance P transmission in chronic pain, or in insulin receptor insensitivity and the bleeding-edge work with incretin analogues, with immunomodulators, with any number of things? Where, in homeopathy, are the hotly debated discussions on what some large-scale randomized controlled trials really mean in current therapy?

(cues up Rocky Horror soundtrack) Let's all do the time warp againHoward C. Berkowitz 23:03, 16 October 2008 (UTC)

Strengthening the natural healing processes of the body

Please reread Larry's comments. If you want to write "homeopaths believe they are strengthening the natural healing powers of the body", that is a perfectly acceptable statement of homeopathic belief. As soon as you make it a flat statement that they are strengthening the natural healing powers of the body, you throw the subject back open to challenge.

That challenge, as long as you state it as more general than homeopathic theory, means that you have to define those healing powers and how the remedies affect them, or be subject to having it removed. Don't believe me; reread the Editor in Chief as to vitalism. Howard C. Berkowitz 04:43, 17 October 2008 (UTC)

Life force is an obsolete term even among homeopaths (we use the term, 'vital force' in the classrooms), but the word, 'theory', which you've put there, is fine with me.—Ramanand Jhingade 16:42, 17 October 2008 (UTC)

OK. I hope this is noncontroversial. I will change all occurrences, other than in direct and attributed quotes, of "life force" to "vital force". I will also reword the occurences of "natural healing powers of the body", or words to that effect, so it is clear the reference is to vital force. Is "Homeopaths believe they are strengthening natural healing processes, which they define as "vital force"," OK?

I am not suggesting whether there is or is not a vital force, or trying to define it. That definition should come from homeopaths, as clearly as possible. What I am trying to do is make it clear when homeopathic versus medical models are being used to discuss a point. Howard C. Berkowitz 17:36, 17 October 2008 (UTC)

Trials in humans: editorial questions

Under "Trials in humans", there are nine conditions mentioned in the introductory paragraphy, but ten appear in the list. Should the text say ten?

I also split "allergies" and "upper respiratory infections", since seasonal allergic rhinitis appears in the table. The closest MEDLINE/MeSH heading to the latter is "Respiratory Tract Infections". Is that an acceptable replacement? What part of the body do homeopaths consider falling into that category?

My guess is pharyngitis and bronchitis; sinusitis and rhinitis have their own lines. Anything else? Pneumonia strictly limited without lower lung involvement? Infection-related bronchiectasis? Howard C. Berkowitz 17:59, 17 October 2008 (UTC)

Misplaced text

This was in the section on vaccinations, but has no obvious connection to the heading.

Second, a homeopathic remedy is generally prescribed in a highly individualized fashion, not simply based on a person's conventional medical diagnosis, but based on the unique syndrome of symptoms that the person experiences.

It may go into the section on the examination, but it is quite misinformed to say that a physician will prescribe only on diagnosis. Many other factors are involved, beginning with the situation where the patient has more than one diagnosis (i.e., comorbidity) or is taking additional medications. In both these areas, one drug might be best for the comorbid conditions even though it might not be the first choice for either in isolation. Drugs may also have synergistic or antagonistic interactions with other drugs prescribed for other reasons.

If a patient reports difficulty in falling asleep, although the chief complaint is headache, a wise prescriber might choose a preventive, sedating drug to be taken at bedtime, rather than one taken several times daily that also prevents migraine. Any number of factors including age, sex, pregnancy status, weight, difficulty in swallowing, impaired metabolism, use of tobacco or alcohol, activity level, and many other factors go into a thoughtful prescribing decision. The entire discipline of pharmacogenetics can make one drug appropriate and another drug inappropriate for a patient based on the presence or absence of certain genes.

Incidentally, one of my professional areas is the development of decision support systems to guide prescribers. In a seemingly routine matter such as prescribing the first drug for mildly elevated essential hypertension, there are at least four distinct classes from which the drug could be chosen, and, in addition, choices within classes. While essential hypertension has a single International Classification of Diseases code, there can be perfectly sound reasons to start one patient on a thiazide, another patient on an ACE inhibitor, and another on a beta-adrenergic antagonist.

It is agreed that homeopaths are expert in what they do in the practice of homeopathy; it does not follow that they are expert in the practice of medicine, or vice versa.Howard C. Berkowitz 00:13, 18 October 2008 (UTC)

Good, so I hope you keep off homeopathic terms like vital force. I was just reading Hahnemann's, 'Organon of medicine' - he used the term, 'vis medicatrix naturae' for the natural healing processes; while vital force was much more than that. I'll try to describe (there is no fixed definition) vital force better in some time.—Ramanand Jhingade 01:23, 18 October 2008 (UTC)

I think the term, 'vital force' need not be in the article - we can use, 'natural healing procceses of the body' instead. Vital force is a near obsolete term.—Ramanand Jhingade 01:46, 18 October 2008 (UTC)

"Natural healing processes of the body" is too long a phrase, and is ambiguous. Conventional medicine certainly recognizes defenses such phagocytes, complement and agglutination, but the patient may be dead by the time they can act in a fulminant infection. Pick something that is a term unique to homeopathy for the things homeopathists want to affect.

You also can't write an encyclopedic article about things that have no fixed definition. Howard C. Berkowitz 04:56, 18 October 2008 (UTC)

The best description I can think of for the vital force is, "the power for intrinsic healing and/or maintaining homeostasis (biology)", but should we use the term everywhere in the article?—Ramanand Jhingade 02:04, 19 October 2008 (UTC)

Hahnemann thought vital force was acceptable. It's short and to the point. Homeostasis (biology), however, is not a synonym. Many quite appropriate natural mechanisms deliberately disturb homeostasis for some survival reason. Literally, one can have a particular biochemical pathway in a homeostatic state that is still terribly wrong for the rest of the body. Howard C. Berkowitz 02:39, 19 October 2008 (UTC)

Results of TGI Survey

The results of the TGI Survey needs to be in the body of the section titled, "Popularity of Homeopathy".—Ramanand Jhingade 02:35, 18 October 2008 (UTC)

Sorry, but the TGI survey is essentially a press release, the website is a marketing agency, and there is nothing whatsoever that makes them authoritative. If you want polling data, get it from a well-recognized polling organization (U.S. examples would be Roper or Gallup, or from specific faculty). Howard C. Berkowitz 14:03, 18 October 2008 (UTC)

One problem is the ambiguous nature of the questions asked in any poll. As written it claims that 18% of Americans trust homeopathy. But what does that mean? Trust it is safe? Or trust it is effective? I just saw a CAM survey that indicates that homeopathy has been used by 3.7% of the US population (once only counts). Again ambiguous, of those approx 4% who have used it how many found it helpful? And if 18% of Americans trust homeopathy why have so few ever used it? As always it is very hard to understand what the findings of any given poll really mean. Chris Day 19:32, 18 October 2008 (UTC)

Hello Ramanand, this is the talk page. Please use it. Chris Day 17:58, 19 October 2008 (UTC)

Another ongoing edit war

Ramanand, can you stop edit warring and discuss the text? Certainly do not try and hide them as corrections to "grammar, spelling and syntax". Most would consider the differences below to change the meaning of the text.

"...and the treatments themselves are generally considered safe, if ineffective by mainstream doctors. Some physicians maintain that homeopathy, like other alternative medicine, is relatively unsafe because it in some cases might delay the most effective, medically proper treatment."

"...and the treatments themselves are generally considered safe, if ineffective by skeptics. Some physicians maintain that homeopathy, like other alternative medicine, is relatively unsafe because it in some cases might delay the conventional, medically proper treatment, if it doesn't work. "

Obviously this is a case of neutrality vs weight. Please explain why you think the previous version by Hayford is not neutral given the weight of mainstream medicine against homeopathic medicine. Personally I find the word skeptic, as used in this article, is like liberal as used by Republicans in the US, or atheist by evangelicals in the US. While technically correct the words are used in a way to give less weight to the opinion. You may consider mainsteam doctors in that light? So what is acceptable to all? Chris Day (signed late, forgot first time.)

I'm sorry, I di'n't have time. It's not just the mainstream doctors, but a whole lot of others (if we mention all, it would be too long), so skeptics should be enough. 'Conventional' is required to differentiate it from alternative medicine - most effective is questionable, because it depends on the hospital - treatment in a hospital in Redmond may not be as effective as a hospital in LA.—Ramanand Jhingade 02:21, 19 October 2008 (UTC)

"Skeptics" is not the right word. "Unbelievers" would be closer to the way it's being used here. A serious suggestion: stop trying to compare, stop trying to prove this way is superior to everything else, and just state what you do. I'm sorry, but if the response is always "it's too individualized", few people with any biomedical science experience find that credible. Pharmacogenetics is individualized, yet the diagnostic and treatment protocols can be described. In some of those cases, we may not yet have a specific treatment, but we can be much more specific than "symptoms".

There are times when I don't want holistics, but something specific. If I were to present with a confirmed plague infection (Yersinia pestis), I want my treating physician to know enough about me to know that the second-choice drug, doxycycline, is a better choice than streptomycin. I'm deaf in one ear and streptomycin can attack the auditory nerve. Howard C. Berkowitz 02:39, 19 October 2008 (UTC)

Good general point, Chris (I, also, missed signing a note). There are several words or phrases with which people may or may not be neutral, or that there simply is not a generally recognized word or phrase for a key subject. Just below, I am placing a table of such items; do not take the first column as being anything but a (hopefully) humorous way of things that don't seem to have widely accepted definitions.

Things in italics are terms that are ambiguous, have a non-neutral feel, or are less than satisfactory.

I'm going to add something that does not quite fit in the table, but where, I hope, Ramanand and I have made some progress. There are terms and practices that are clearly homeopathic. There are terms and practices that are clearly not homeopathic.

It's perfectly reasonable for a homeopath to say "this is what a homeopath will do", and for a person with a [foo] orientation to say "this is what a medical practitioner" will do. If, for example, a homeopath speaks of "vital force", we note that as a homeopathic definition and go on. If someone educated in conventional diagnosis and treatment says "this is how drugs are prescribed", we note that as medical and go on.

I agree, with Chris, that "skeptic" is primarily used here in a deprecatory manner, and its use should be deprecated.

Where we get into trouble is where terms overlap. "Natural healing processes of the body" is a problem, because physicians augment them as well as using treatments for processes that appear overwhelmed and failing (e.g., acute and severe bronchospasm), or for which there is no known natural defense (e.g., botulism, tetanus, rabies). I am also reasonably convinced that homeopaths and physicians have different definitions of a "symptom".

When a homeopath refers to immune system, it's fair for a physician to have expectations of measurable changes [Notes 1 and 2] if therapies are directed at the immune system.

Could we see if we can get consensus, not deprecatory, terms to fill into any part of the table below? Who knows -- perhaps it might eventually be a suitable subpage? Howard C. Berkowitz 15:29, 18 October 2008 (UTC)

Problematic terminology

Concept	One side's term(s)	The other side's term(s)
That form of healthcare practiced by trained and licensed professionals who have never heard of Hahnemann.	conventional physicians, allopath	Physician, biomedical specialist, non-homeopathic physician
That form of healthcare practiced by trained and licensed professionals who believe Hahnemann is the greatest healer in history	Homeopath	Alternative practitioner using homeopathy
Someone who believes that Hahnemann defined an essentially perfect system that needs only minor refinements, and that every case is inherently different	?? some distinctions as made in types of chiropractic approach	Physician, biomedical specialist, non-homeopathic physician, mainstream medicine'
Someone who believes that Hahnemann defined a system that was superior to what the other kind of practitioner did in the 19th and early 20th century, but was largely made obsolete by processes that can be defined and measured, yet used with judgment appropriate for the individual, who hasn't tried alternative medicine	skeptic, critic	Biomedical scientist, one trained by the evolved system proposed by Abraham Flexner
Bodily responses to abnormality (symptoms or signs), for which molecular or other objective mechanisms can be described in substantial detail	???	no single term: metabolic homeostasis (biology) (including anabolism and catabolism, mitosis and apoptosis, immune mechanisms (see note below) including cell-mediated [note 1] and humoral immunity [note 2]
Bodily responses to abnormality (symptoms or signs), for which no formal mechanism is defined	Vital force, natural healing processes of the bodywe also call it symptoms amd signs (see my description of vital force)	???
The thing added to a larger amount of something so the thing can be taken by the patient	similimum	active ingredient; drug
Guidance on best treatment	(medical training and literature (Note 4), clinical decision support system & materia medica, repertory	(medical training and literature (Note 4), clinical decision support system
The thing administered to an individual to cause a measurable physiologic reaction	???	active ingredient; drug
The thing administered to an individual to cause a measurable immune response, usually active immunity. There may be immediate symptoms, but producing them is not a goal	vaccine/antigen	vaccine, antigen
The something to which the small amount of the other thing can be added	water (but there apparently are things that are not water, such as ethanol), or, in the body of the article, lactose. Is water the only something that has memory?	Diluent (water & ethanol), vehicle(lactose)
Opinion and trust not based on statistical analysis	Popularity	Lay opinion
Administration of a substance to healthy volunteers to determine its effects [Note ]	Homeopathic proving	Phase I randomized controlled trial

Note 1: phagocytosis, agglutination as by eosinophils, nonspecific recognition by macrophages

Note 2: changes in immunoglobulins, complement, opsonization

Note 3: terminology conflict: while a homeopathic preparation is considered, by homeopaths, to have the desired effect of producing symptoms, physicians do not necessarily regard symptoms as physiologic changes. signs, clinical pathology results, and changes in diagnostic imaging do indicate change

Note 4: A pair of standard texts such as Harrison's Principles of Internal Medicine, cross-referenced to Goodman & Gilman's Pharmacological Basis of Therapeutics are regarded as starting points -- but need not be consulted in every case.

I've commented on each point, so take a look.—Ramanand Jhingade 02:49, 19 October 2008 (UTC)

This is a start. Please try not to change the text in the first column, so can work on the definitions in the second and third columns.

I struck out who hasn't tried alternative medicine, because it added nothing. Ramanand, please listen to a point: people, such as myself, who do not think that a form of alternative medicine is safe and effective will never, never, try it, no mattery how many times you repeat they should. Would you please stop bringing up that argument, because it isn't going to change anyone's mind? This article is not about convincing people to use homeopathy. It is about getting a clear definition of what homeopathy is. By all means, call such people skeptics; it's at least unambiguous.

"we also call it symptoms amd signs (see my description of vital force)" is a real editorial problem. If you are going to use "symptoms and signs", call them "homeopathic symptoms and signs", because you use the term quite differently than in conventional medical usage. I urge you to use "vital force" because it it is short, won't be confused with other definitions, and is historically accurate from Hahnemann. Please stop redefining terms that are used in medicine, or we will get nowhere. Howard C. Berkowitz 16:58, 20 October 2008 (UTC)

Popularity vs. efficacy

There is a relatively long first-level heading, "Tests of the efficacy of homeopathic remedies", and a shorter one called "The popularity of homeopathy". Several citations simply had a URL, so I've started going to the actual references, and putting in a complete citation whenever possible. Reading some of the papers, however, raises questions if some of the work described as evidence for "efficacy" belongs under "popularity".

No one has objected to these two headings being separate. Are, however, the citations under the correct headings? I have difficulty thinking of papers, in major journals, that do not measure efficacy in terms of an objectively measurable outcome. Such an outcome might be negative (e.g., death) or positive (e.g., laboratory marker within normal limits), expressed over some specific period of time. If a treatment is efficacious, there will be a statistically significant difference in measurable outcomes -- fewer deaths, more people with normal tests.

Rather by definition, "satisfaction" is subjective. There's a classic anecdote that goes to the heart of satisfaction: "Dr. Smith is such a wonderful, caring doctor. He goes to all of his patients' funerals." Aha! But does Dr. Smith have more patient deaths than Dr. Jones, who has a detestable personality but perhaps better technical skills?

There are four papers, described as meta-analyses, in Metaanalyses indicating efficacy". Unfortunately, none are available online, so I cannot tell how and if outcomes were measured.

The next four citations (below) are from the section on "Metaanalyses indicating no efficacy". I suggest they are misplaced; they deal with popularity and not efficacy. First in the list is an article from a lay encyclopedia from the NHS; it is not any kind of analysis, meta or otherwise. Next is a press release with a media contact, which refers to the third; the third is not available free. I have, however, bolded key words in the title of the article. Since they do not mention outcomes, but satisfaction, I contend they belong in the popularity section; they simply have nothing to do with efficacy. The fourth is available online, only refers to patient-reported satisfaction and not outcome, and thus does not measure efficacy

1. Health encyclopaedia. National Health Service. Retrieved on 2007-07-25.
2. British Homeopathic Association (24-07-2008), Press release: new multi-centre study confirms the value of homeopathy
3. Thompson EA, Mathie RT, Baitson ES, et al. (July 2008), "Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals", Homeopathy vol 97:3: pp. 114-121
4. Marian F, et al. (2008), "Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine", BMC Complementary and Alternative Medicine 8: 52, DOI:10.1186/1472-6882-8-52

Many things are popular. If popularity is a measure of efficacy, I suggest thinking about the correlation between efficacy and popularity of politicians. Howard C. Berkowitz 23:04, 18 October 2008 (UTC)

There are lots of things in this article which both the skeptics & believers have put in.—Ramanand Jhingade 02:55, 19 October 2008 (UTC)

Do you really consider it constructive to keep referring to anyone who raises questions about homeopathy a "skeptic"? I happen to think skepticism is a good thing anywhere, but, as I see your use of the term, it feels like an epithet. Would you like it if a "skeptic" started referring to the "believers" as "charlatans"? An occasional use of "skeptic" is fine, but, over and over again, it sounds like a politicians' code word for "enemyy". Howard C. Berkowitz 18:13, 19 October 2008 (UTC)

Howard--I'm trying to catch up with the discussion and see if and how I might be of help here. Personally, I would both consider and label myself a skeptic with regard to homeopathy (and a whole lot of other things, too). If Ramanand wants to refer to you as a skeptic at least here on the talk page, I say wear the label proudly. --Larry Sanger 02:00, 20 October 2008 (UTC)

If he wants to call me a skeptic, but also answer the questions, that's fine. It's when I ask a substantive question, or ask for a clarification on the article, and get no other answer, that's a problem.

Also, dismissing, in the article, anyone who does not accept without question as a skeptic is a real problem. Look though the history and find how many cited references have been dismissed as "skeptics". The problem is not restricted to the talk page. It appears in the article in a dismissive manner. It is also used as an evasion when attempting proper clarification of the article in talk page discussion. Just don't call me late for dinner. "Skeptic" spraying, however, is the least of the problems here. Howard C. Berkowitz 02:16, 20 October 2008 (UTC)

Obviously, if anyone removes a reference just because it is critical of homeopathy, that is way out of line. That would be a very clear example of a violation of our neutrality policy, and according to our rules, person who persists in that behavior could be excluded from the project. For what it's worth, however, I personally haven't been presented with any evidence of that yet, so... --Larry Sanger 03:06, 20 October 2008 (UTC)

Well, I haven't removed any references Larry.—Ramanand Jhingade 02:18, 21 October 2008 (UTC)

Hippocrates, Osler, Hahnemann and his time, and the introduction

There are two kinds of problem in the lead. I have inserted a temporary heading of BREAK; the text before that, with some additions, is not unreasonable when a few quotes are added and the deprecation of "mainstream medicine" is deleted.

Unfortunately, there is a sense, in much of the article, that Hahnemann's work is contemporary, and there has been, in homeopathic eyes, not much change in medicine since 1805 or so. This sense hurts the legitimacy of the article.

From BREAK to The Basics of Homeopathy, the rest of the lead text is out of place. Some belongs in other sections. The first paragraph, which needs sourcing about "commercial" and "user-friendly" since there are multiple definitions, logically is part of the section "Preparation of homeopathic remedies".

Following that, there is a rather rambling paragraph about modes of action. It's perfectly reasonable to say, in the lead, that the mode of action of homeopathic remedies is controversial. There is no generally accepted scientific explanation, although recent research offers avenues of explaration. Move the materials science material down to memory of water and related topics.

Following that, a brief mention of randomized controlled trials, their mixed results, and a simple statement that many homeopaths consider the RCT methodology inappropriate for the individualized techniques of homeopathic therapy. I'd like to see a note that some current areas of medical investigation, such as pharmacogenetics, also have issues regarding testing individual therapy; there are, however, some statistical approaches that could be applicable to all forms of individualized therapy.

The last paragraph with popularity data, if it belongs in the article at all, belongs in the section on "Popularity of Homeopathy".

Working with some of these issues could produce a much better article with a much stronger and more accurate lead. Howard C. Berkowitz 01:38, 19 October 2008 (UTC)

Was it a comparison or deprecation?—Ramanand Jhingade 03:00, 19 October 2008 (UTC)

If you are referring to "mainstream medicine", it did not read as a comparison, but a deprecation. It recognized no change from Hahnemann's time. In his time, what Hahnemann said was perfectly true: no one knew why drugs worked. The situation is now radically different, but that is not acknowledged. Those last few words about "mainstream medicine" do not add information about homeopathy. They are not necessary to explaining what homeopathy is, but they can easily be interpreted as an attack on treatment that is not homeopathic. Howard C. Berkowitz 03:10, 19 October 2008 (UTC)

Citation and fact checking on "Medical Organizations' Attitudes" section

I have been verifying the actual cited document against claims made in the article. As mentioned above, a number of URL-only references turn out not to be to journals, but to press releases from homeopathic organizations, government factsheets for laymen, and other less than authoritative sources.

In another section, the highest standards of citation, quoting in context, and accurate paraphrasing were not followed:

Medical organizations' attitudes towards homeopathy

First, the article cited the National Center for Complementary and Alternative Medicine. Following the URL, the citation changed the article title to "Statement on homeopathy". when the actual webpage title is "Questions and answers about homeopathy", and completely omitted the subhead (contribution) title of "What has scientific research found out about whether homeopathy works?" The article then described the position as "controlled clinical trials of homeopathy have produced mixed results; in some, homeopathy appeared to be no more helpful than a placebo, but in others, more benefits were seen than expected from a placebo." But what did the actual text say?

The results of individual, controlled clinical trials of homeopathy have been contradictory. In some trials, homeopathy appeared to be no more helpful than a placebo; in other studies, some benefits were seen that the researchers believed were greater than one would expect from a placebo.

.<ref name=NCCAM-QA>{{citation |url = http://nccam.nih.gov/health/homeopathy/#q8 | author = National Center for Complementary and Alternative Medicine, [[National Institutes of Health]] | title = <!--statement on homeopathy--> Questions and Answers About Homeopathy | contribution = What has scientific research found out about whether homeopathy works?}}</ref>>

Minor errors and slightly sweetening the text. Next, however, the article text says (my emphasis): Historically, the American Medical Association (AMA) was founded in 1847, three years after the forming of the American Institute of Homeopathy in part to slow the growth of homeopathy. Unfortunately for CZ accuracy, the citation at http://www.ama-assn.org/ama/pub/category/13638.html has not one word about slowing the growth of homeopathy.

It goes on to say, "Today, the AMA is no longer overtly antagonistic to homeopathy. Their current policy statement says:

1. "There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies".(same citation as above.)

But is the full statement as supportive as its point 1?

2. Physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated.

3. Patients who choose alternative therapies should be educated as to the hazards that might result from postponing or stopping conventional medical treatment.

4. Courses offered by medical schools on alternative medicine should present the scientific view of unconventional theories, treatments, and practice as well as the potential therapeutic utility, safety, and efficacy of these modalities.

I'm sorry, but I am finding much of the writing distinctly non-neutral, selectively quoting, using non-authoritative references, making flat statements where the cited source doesn't say anthing about the subject, etc. Any questioning is variously dismissed as "skeptic", or "biased against homeopathy", or "I don't have time to explain this." Howard C. Berkowitz 22:36, 19 October 2008 (UTC)

Howard, I'm glad you are trying to improve the quantity and quality of references. The reference to the founding of the AMA being, in part, to attack homeopaths and other "irregular practitioners" is derived from: William Rothstein, American Physicians in the Nineteenth Century, Baltimore: Johns Hopkins University, 1972, pp 170-174. As many medical historians know, this text is one of the leading seminal sources for American medicine.

Please note that the AMA has, in the past, maintained a strong anti-homeopathy position, and clearly, they do not maintain that position any longer. You are welcome to incorporate some of the material above, but we should acknowledge that today's view of homeopathy is much more neutral than in the past which was extremely antagonistic. Dana Ullman 00:46, 21 October 2008 (UTC)

I can do without thanks in improving quality and quantity of references; my concern is that the reference given had nothing to do what was said in the text. I really don't care how many medical historians regard the text as seminal; I care that it was not cited yet it was the source. This is not the first time I have read the actual cited document and found it had little or nothing to do with a claim in the article.

Dana, I'm glad you recognize that the present situation is different than in the 19th and early 20th century. Frankly, I'm amazed about how "stuck" the article seems to be in references going 100 to 200 years back. If one does want to go back to the early 20th century, Osler said

A new school of practitioners has arisen, which cares nothing for homeopathy and less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new.

I would be delighted to see more current information on homeopathy; there is a History of Homeopathy article that might be a better place for a good deal of this information. While the AMA is influential today, its membership is a minority of American physicians.

John Snow's work from the mid-nineteenth century has survived, but, in general, the work of pre-scientific physicians of that time is largely irrelevant to current practice. I care as much, or as little, about 19th century medicine as I do about 19th century homeopathy. Howard C. Berkowitz 01:15, 21 October 2008 (UTC)

Some ground rules

Here are some brief comments that I hope will help reinforce our ground rules. I'm sorry I don't have time for more detailed engagement right now.

Some Citizens have complained to me that homeopathy's advocates on this page are tending to purge criticisms. On this I will absolutely put my foot down. You may not do so. You may maintain that (and say in the article how) homeopaths reject the criticisms, but you may not simply delete points, and source material, simply because you disagree with them or you think they are misinformed. If you have a strong disagreement about a published criticism, you should voice it in the article, rather than removing the criticism. There may be exceptions to this rule, but (I understand) not in several recent cases in the present article.

Of course, the "reply, don't delete" rule assumes that a source and criticism are important enough from the point of view of homeopathy's critics to be included. While they can have input of course, this is not ultimately a matter that homeopathy's defenders are best placed to decide.

The word "skeptic" should not be used, pejoratively, to identify those who reject homeopathy in the article. If there is a need repeatedly to identify the skeptics of homeopathy, you may not use a term that the skeptics themselves reject. You must find a mutually agreeable term. I suggest "mainstream physicians." "Allopaths" won't do, either, although it certainly can be introduced, and it should be.

It should not be necessary for me to point out that the article can neither endorse nor roundly condemn homeopathy. The article does not take a stand; it presents both (or all) sides on all controversial issues it presents, and leaves it up to the reader to decide for himself. The article does not endorse a position.

Precisely because homeopathy happens to be a minority viewpoint when it comes to the health issues it discusses, criticism of homeopathy does not belong in a separate "criticisms" section of the article. I have my doubts whether there is any need for a "criticisms" section at all, but I can't say so until I've read the current version, which I haven't done.

Selective and uncritical reporting of references is contrary to CZ's neutrality policy: this makes it appear that we officially think the literature says such-and-such, when there is legitimate disagreement about whether it does say that. When, therefore, a "skeptic" raises a question about a statistic such as 18% of Americans, we must absolutely deal with this question. I am very uncomfortable publishing information about the percentage of Americans who accept homeopathy, when it has not been made clear what "acceptance" amounts to in the survey that was performed. Therefore, either this essential interpretive information must be included in the article, or the information about the statistic must be excluded. Anything else would be, quite simply, misleading and unscientific.

More generally, on a topic with this much disagreement, we simply cannot add heaps of studies and statistics to the article without adequate explanation and without critical responses where such may exist or be possible. Uncritical reportage of the results of disputed studies has an inherently biasing effect.

Finally, I want to underscore that if anyone repeatedly reverts significant parts of the text without explaining and defending his actions here on the talk page, I will consider banning that person. I would ask those who are following the article more closely to make a list of such unexplained reversions, and provide it to me privately. On the basis of such information I will either issue a warning or, if the problem is very serious, a temporary ban.

Let me finish on a positive note. Despite the amount of struggle over this article, or perhaps because of it, this article has grown and in many ways improved, and other articles have spun off. This is a good thing. As I like to say, if everybody is equally frustrated, that means that work is getting done and the article isn't too biased one way or the other. Still, if we can all follow the above ground rules, I think we'll get along quite a bit better. --Larry Sanger 16:22, 20 October 2008 (UTC)

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

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

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

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

I have also removed from the article

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

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

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

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

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

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

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

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

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

Stevinson and colleagues published "Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery" [1]. Jacobs et al. published "Homeopathy for Attention-Deficit/Hyperactivity Disorder: A Pilot Randomized-Controlled Trial" [2]]. A meta-analysis of "Homeopathy for Childhood and Adolescence Ailments" specifically addressed prevention as well as treatment [3]].

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

This article should be

about what homeopathy is, rather than how it is criticized.

. I'm wondering what was wrong with

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

which Dana had inserted?—Ramanand Jhingade 02:52, 21 October 2008 (UTC)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Responses, have been indented to incoherence

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

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

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

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

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

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

I have occasionally made errors, and when it is noted, I acknowledge it. We all make errors. I sincerely hope that Howard will acknowledge this error below. Ramanand above noted, This article should be

about what homeopathy is, rather than how it is criticized.

. I'm wondering what was wrong with

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

which Dana had inserted.

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

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

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

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

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

Statistic given in article does not appear in cited source

I have deleted this bit:

42% of British doctors refer patients to homeopaths.

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

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

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

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

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

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

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

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

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

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

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

Questioning the answer of 42

Doesn't anyone read Douglas Adams?

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

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

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

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

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

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

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

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

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

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.

Homeopathy/catalog added

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

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

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

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

Statistical methods for testing highly individualized therapies

It's probably easier to create some notes again than find the previous postings in the archives. Gareth had some very eloquent things to say on the topics.

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

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

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

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

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

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

Specific immune benefits of chickenpox and measles?

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

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

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

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

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

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

Editing "Trials in humans" section for flow and citations

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

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

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

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

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

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

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

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

Other meta-analyses

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

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

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

• A meta-review of homeopathy in dementia did not actually analyze any studies. The investigators were unable to find papers that met their inclusion criteria, and said they could not assess the extent of homeopathic treatment of dementia. <ref>{{cite journal |author=McCarney RW ''et al.'' |title=Homeopathy for dementia |journal=Cochrane database of systematic reviews |pages=CD003803 |year=2003 |pmid=12535487|http://www.ncbi.nlm.nih.gov/pubmed/12535487 }}</ref>

• One reference was not from a journal, but a lay health encyclopedia produced by the National Health Service. :<ref>{{cite web|url=http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=197&sectionId=27 |contribution=Homeopathy results | title= Health encyclopaedia |accessdate=2007-07-25 |publisher=[[National Health Service]]}}</ref>. It could not be considered a meta-analysis, as it contained little quantitative information.

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