Talk:Homeopathy/Archive 13

I'd like to point out that, after the first two paragraphs, I still haven't got the faintest clue what "homeopathy" means. Those paragraphs are also extremely badly written. --Larry Sanger 11:46, 4 November 2006 (CST)

Yes, I agree. I've trimmed this article down from a very long and wandering WP original, and done some re-ordering and reference tidying, but it's still an uncomfortable hybrid. Really needs a complete write-through.Gareth Leng 11:02, 7 November 2006 (CST)

Lead?

It's been suggested (not by me) that the new CZ style might incorprate a short and simple boxed message, and that for this article, that box might contain the text:

"Homeopathy is an Alternative Medicine system that tries to treat illnesses with tiny doses of the drugs that cause the same symptom as the illness. Homeopathy is based on the ideas of Samuel Hahnemann, a 19th century physician who observed that some contemporary medicines evoked symptoms similar to those of the illnesses for which they were prescribed. There is no clear evidence to support the efficacy of homeopathic remedies, and it is likely that the reported effects are placebo effects."

Keeping this here so we can see how it looks if and when style issues advanceGareth Leng 12:25, 9 November 2006 (CST)

That would make more sense. I have been trying to track down the CZ style guide/ideas with no luck. I have seen discussion here and there but nothing concrete. Am I missing something obvious? Chris Day (Talk) 12:31, 9 November 2006 (CST)

Comments by Nancy

Let's imagine that a perosn living in X city, Y country has been advised by a friend to see a homeopath for that problem with his health he is always complaining about. Knowing that CZ is edited by experts, he looks up Homeopathy. I don't think this article, as it stands, will serve him well.

Perhaps the introduction to the article would be less misleading if it described what the current practice of homeopathy is, rather than focused on a more historical definition of its roots. I realize that this is difficult. But it has been a hundred years, plus and minus, that medical practice was divided up into allopathy, osteopathy, homeopathy etc. Often times, I read that medicine, meaning conventional medicine or western medicine is allopathy and I object every time I do. Why? Well, I believe in evolution, but not that I, personally, descended from an ape. I believe my distant ancestors had the same ancestor as the apes. That’s different, you see. Similarly I am a physician but I am no allopath. The allopath was a distant “ancestor” of my teachers., and to infer – or outright state- that current medicine is actually allopathy is frankly ridiculous. If a person was advised to see an orthopedic surgeon and they looked up "allopath" what would they learn?

http://www.op.nysed.gov/06reg.htm according to this link, New York State does not license homeopaths. Yet very few licensed physicians are homeopaths. Meaning, most therapists in New York calling themselves homeopaths are not licensed healing arts professionals. Is there any geographic region where this is not the case? Who today actually is a homeopath? What is the actual practice of homeopathy in the world, currently?

It seems to me that current homeopathy, like most practicing healing arts, draws on the empiric success of the previous generation of clinicians. This is why much of medicine is medicine and actually not ‘human biology’, even though in an idealized sense it is based on human biology. On the level of treatments, it is misleading to suggest, for example, that the physician prescribes X drug because of its proven molecular interactions with the Y receptor. In selected cases, that may be true, but generally, it is not. Let’s face it, Doctor Jones almost never is drawing molecular diagrams when considering treatment.

I have only had contact with a couple of homeopaths, but it has been the same with them. They might have been taught, or read stuff written by, practitioners who were familiar with the original theories, but their practice draws on its own clinical traditions and they don’t puzzle over it for each treatment. More often, homeopathic remedies are delivered by alternative care healers who are not strictly homeopaths.

From my reading of history and medicine, it seems that in an era when mainstreams docs were heavily advocating harsh cathartics, emetics and purges for most illnesses, homeopaths gave out remedies that were mostly water and in fact, many patients did better than when forced to vomit, or repeatedly evacuate stool.

A good homeopathic remedy is a placebo, but placebo are particularly effective if combined with positive social interactions with the healer. Many modern medical treatments are essentially placebos and some excellent physicians are quite aware of this. There is a lot to say about placebos, perhaps in a different article that could be linked to this. Writing several articles at once that link (I did that with biology) can be helpful. Regards, Nancy Sculerati MD 07:55, 7 December 2006 (CST)

addendum - the above is not formulated in a manner that really addresses the article, and I'd like to do better. Specifically, the introduction should not imply that homeopathy is a recognized current branch of medicine, Itr is not true (unless I am wrong, and if so - please correct me- that the practice of homeopathy persited in medicine. Instead, others took it up. The historical view as written in the article does imply that homeopathy is a medical specialty, because it once was. It would be helpful to actually discuss who, currently, homeopaths are. This may differ by country. For example, in Germany, where you say homeopaths are licensed - what are the requirements? Exactly? How about UK? What are the regulations for practice? Then, since many practitioners in various fields use homeopathic potions, are these regulated by any country? How? I can tell you that years ago I had these silver/mercury dental fillings removed by a fabulous dentist, who replaced them with these perfectly molded porcelain ones that reconstructed the tooth. He was, in fact, the cousin of the head of the department I was training in. He always asked me if I'd like a little of his special medicine before starting. These were homeopathic remedies, each in a wonderfully shaped and colored bottle with a truly beautiful label. I was doing my fellowship at the Childrens Hospital of Pittsburgh at the time, and we both got a kick out of the fact that I really did want him to sprinkle the stuff on my tooth, and I'd spend some time picking out my favorite at each session. I know from some of my past patient's families that such remedies are available in the US over the counter and by various therapists. Nancy Sculerati MD 10:31, 7 December 2006 (CST)

Many thanks, just the type of radical advice needed. i've taken a sharp knife to it, spinning a lot into homeopathic proving and History of Homeopathy as a start, and done some reorderingGareth Leng 11:50, 8 December 2006 (CST)

Footnotes

The footnotes appear to be slightly out of sync, in the Intro at least:

The word 'homeopathy' was first used by the German physician Christian Friedrich Samuel Hahnemann (1755-1843). Hahnemann was an eminent physician and a prominent public health reformer. He believed that his new system was more humane and effective than the conventional medicine of his time[1], but it was greeted by the establishment with derision and contempt. Today, homeopathy is not an accepted part of conventional medicine, and its theories are not generally regarded as scientifically credible, but nevertheless it has more than 100,000 practitioners worldwide, and 500 million users.[2]

[2] supports sentences 2 and 3, but not sentence 4. I would edit, but don't want to mess it up further, as I don't know which subsequent citations need moving back, or whether one is missing. Thanks, Mike Emmans Dean 10:45, 6 February 2007 (CST)

WP flag

.. is set up for the following few lines of text

• Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious.
• Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental emotional spiritual and physical levels.
• What this investigation has unearthed is appalling.
• Complementary Medicine - Therapies Homeopathy BBCs Complementary Medicine article on Homeopathy.

--AlekStos 14:56, 17 April 2007 (CDT)

AMA

Hi Dana, and welcome. I agree that you're right to say that the AMA is not antagonistic to homeopathy; but would not go so far as to suggest that this means that they believe that there is good evidence supporting its efficacy. I've left your text but reinserted a quote from their adopted policy, just to make this clear.Gareth Leng 11:46, 4 March 2008 (CST)

I may be wrong, but I think that it is very misleading to say that homeopathic manufacturers are regulated as drug companies. I think I'd be right in saying that homeopathic remedies do not need FDA approval for instanceGareth Leng 11:49, 4 March 2008 (CST)

I've restored the former text on the Lancet study, partly because your text did not summarise its conclusions but just directly criticised it, but more importantly because there were some major errors in your critique. Your text is in italics, my comments in bold: The researchers choose to only evaluate those studies that met certain criteria for “high quality” scientific investigations. No, this is a misunderstanding; they first did a global analysis of all trials and then a selection of high quality trials Of the original 110 trials, they found that 21 of the homeopathic studies fit this definition but only 9 of the conventional studies did so. The researchers did not provide any analysis of these high quality studies but instead chose to reduce these numbers to only those trials that had a large number of patients, claiming that these larger trials had less bias inherent in them. This wasn't a claim, nor does the issue of bias arise, it's merely an uncontroversial statement that larger trials have greater statistical power The researcher then compared 8 homeopathic trials with 6 conventional medical trials, even though these trials were no longer matched in any way. Well they weren't comparing the trials, so the point isn't relevant. They were comparing only the size of effect. Recall, the authors' premise was that if an effect is real, the size of the effect will not depend on the study size. If it is not real, then only small trials will show an effect, these being published because of the publication bias effect that maximises the likelihood that studies will be published when their effects are positive The final results of this small number of trials was that there was no significant difference between patients given a homeopathic medicine and those given a placebo. The authors claim that no further research on homeopathy is necessary, while advocates of homeopathy assert that almost all of the 8 homeopathic trials lacked external validity, that is, they used only a single homeopathic medicine given to every subject without the typical individualization of treatment that is commonly used in homeopathic practice. The last point is a fair point - if a treatment's efficacy depends critically on the ability of the practitioner to diagnose an appropriate treatment for an individual, then it becomes virtually impossible to test in a controlled way - and so there isn't much point in further research of that type at least.

I referenced rebuttals of the Lancet study and feel free to add to those. I wrote this section at some length because the study is unusual and notable for that reason, and also because it is so often misunderstood. What I tried to do was to explain what the study did - it's not our job either to endorse it or attack it; translating it to make it understandable (and it is a very complex paper) is however very much what we should be doing.

The bottom line is that we do not endorse or promote homeopathy, nor do we denigrate it. Gareth Leng 12:13, 4 March 2008 (CST)

It's important to avoid any suggestion that there is any acceptance of the theory behind homeopathy from any significant element of conventional medicine and science. There must be no confusion on that point. We needn't insist that the conventional science and medicine has got it right, but the general consensus of their views is clear, that the effects are those of the placebo effect. It is important to explain the theories and beliefs of homeopaths in a way that they would consider fair and accurate, but the representation of any scientific or medical views must be done in a way that they would consider fair and accurate too. Gareth Leng 03:49, 5 March 2008 (CST)

Gareth, it is a pleasure to discuss issues with you in a rational and non-emotional way. Thanx for improving upon my work, though you did edit out some important things (IMO). First, to clarify, companies who make homeopathic medicines ARE legally recognized and regulated by the FDA as "drug manufacturers." That is a fact. As for the Shang article, I re-inserted the reference to the concern that the homeopathic studies on which they based their conclusions lacked external validity. This does not mean that homeopathic research is not do-able. It simply means that there are only a limited number of conditions for which a single homeopathic medicine can be given effectively to everyone with a specific broadly defined disease. I am, however, confused why Shang and his team included only 1 trial testing Oscillococcinum in the TREATMENT of influenza, when the Cochrane Reports (2006) notes that there have been at least 3 large high quality trials. I am further confused why they completely ignored the allergy research by Reilly and team...and ignored the meta-analysis of Jacobs and team in the treatment of childhood diarrhea (instead, they included 1 of her 3 trials, even though the combined meta-analysis would have provided larger numbers). The bottomline is that Shang and team showed bad faith and bias in several design elements of their work that many reviewers have noted. Dana Ullman 08:07, 8 March 2008 (CST)

Fair enough, though I wouldn't use terms like bad faith and bias; they may have had good reasons - or there may be mistakes and shortcomings. I edited out "external validity" only because I felt this was a jargon term the meaning of which wasn't self evident. Maybe you can expand on that?Gareth Leng 05:43, 10 March 2008 (CDT)

This needs something

This sentence:

• Many homeopathic medicines sold in health food stores and pharmacies today are "low potencies," that is, at doses that do contain tiny amounts of the original medicine, while homeopathic medicines at potencies higher than about 24X, D24, or 12C (10^-24) contain no detectable ingredients apart from the diluent (water, alcohol or sugar). There is considerable scientific doubt about whether these doses can have any biological or therapeutic effect, but some scientists assert that homeopathic doses are compatible with biomedical experiences. .

From our statement above, it follows that remedies lower than 24X might have some plausible explanation in biomedical medicine, as they do contain a measurable amount of compound. Essentially, the first sentence seems to be talking about two different things (one plausible to skeptics, one not), while the second sentence seems to be lumping them into one - and it is unclear which one we are referencing. Is this intentional? --D. Matt Innis 19:49, 8 March 2008 (CST)

Good catch, Matt. I have made the correction in the article by adding "in low and high potencies." Please note that the reference to the Eskinazi article supports the evidence on the low potencies, while the other two references provide support for how high potency medicines fit within modern scientific foundations. Do you prefer if we separate out these references to the specific contention that supports, or is my grouping together OK? Dana Ullman 14:25, 9 March 2008 (CDT)

I am not a fan of inline references. I don't have access to the references, but I don't dispute that there isn't some sort of support out there for either contention. At this point, I'm really not as concerned about what others think of homeopathy as much as what homeopaths themselves are thinking. I haven't made my way through the entire article yet, so I'll let you keep going and jump in when I think I can help. --D. Matt Innis 19:08, 9 March 2008 (CDT)

Procedural aspect of reversion; no endorsement of content implied

In no way have I ever seen any convincing evidence that homeopathy has a rational foundation, although it is an excellent description of some classic principles of ritual magic (see The Golden Bough: A Study in Magic and Religion by Sir James George Frazer; online at http://www.bartleby.com/196/).

That being said, I am troubled by the procedural aspect here. Please correct me if I misunderstand, but my impression is that while complete reversion may be appropriate, a notice of intent to do so should be on the talk page, and the action taken by a Constable, possibly on the recommendation of a relevant Editor. This does not seem to have happened here.

Howard C. Berkowitz 12:36, 23 August 2008 (CDT)

Yeah, I suppose you're right. I'll revert it back to what was here earlier and then leave other people, more qualified than me, to do what they think is necessary. Personally, I don't think it should be allowed to stand as it is, though.... Hayford Peirce 12:42, 23 August 2008 (CDT)

Current content

From the introduction,

Tests of the efficacy of homeopathy have occasionally reported positive (where the principle of Homeopathy have been followed) as well as negative (where the principle of Homeopathy have not been followed) results, though the precise mechanism of action for its extremely small doses has not yet been verified and remains a stumbling block to its acceptance from mainstream medicine and science.

I'm trying to be fair here, and I'll freely admit a preference for molecular pharmacology. Nevertheless, from a purely statistical standpoint, I don't know how to interpret "tests...have occasionally reported".

If I understand some of the principles of homeopathy, they generally reject randomized clinical trials, and the associated statistical analysis, because homeopathy is individualized and trials on groups violate the principles. Is there, then, any way that the results of these tests can be expressed in statistical measures of confidence, etc.?

Howard C. Berkowitz 12:53, 23 August 2008 (CDT)

Revisions

I have taken a look at recent changes, and am sorry that I have felt it necessary to make significant revisions and delete many references. First, it is essential that this article does not appear, at any stage, to endorse the claims of homeopaths, while equally it should not denigrate homeopathic beliefs. This article should report those beliefs fairly and describe accurately and reasonably what homeopaths do. However, the article should not claim, or appear to assert, that homeopathy has a scientific validity or clinically attested efficacy that is not accepted by science or medicine. There is no need to labour the criticisms of homeopathy, they should be explained simply, clearly and concisely. Insofar as homeopaths reject the appropriateness of scientific scrutiny, that can be stated and explained.The article should clearly declare the skeptical view and the homeopathic view, ideally in a way that allows the reader to judge

The deletion of references is essential. On Citizendium, no article will be approved without editorial endorsement of the quality and appropriateness of the references; this large number of references in weak sources simply stretches demands on editorial scrutiny beyond acceptable limits. I've started by eliminating those references which prima facie would not meet my minimal criteria for noteworthiness. The others I will look at more closely before I consider removing them.

Gareth Leng 04:20, 25 August 2008 (CDT)

Absolutely. We need to push hard for scientific accuracy in these articles. I think that the article as it currently is could be improved by merging the 'skeptical view' and the 'scientific research' sections, since - as far as I can see - the skeptics are right, and we have thus got redundancy in the article. --Tom Morris 05:33, 25 August 2008 (CDT)

Gareth, or anyone---

I have a question about homeopathic clinical trials, or, if they exist in a form reasonably compatible with a double-blinded randomized clinical trial. Without having read the references, I have the impression that they are principally meta-analyses.

This is a question where I am trying to get information, rather than demonstrate a preconception. Does the homeopathic principle (if I understand it) that each patient's treatment must be individualized prevent the use of prospective randomized double-blind studies, because there cannot be a meaningful experimental arm if every patient receives a different set of drugs? I suppose this could be double-blinded if the homeopathic clinician does the appropriate diagnosis and treatment recommendations, sends the presciption (if that's the correct term) to the pharmacy, and the pharmacist breaks the seal on a sequential blinding record and fills the prescription either with the homeopathic preparations or placebo, and sends it back, blinded, to the clinicians?

Part of the reason I'm curious about this is a broader methodological problem than homeopathy. If genomic medicine becomes highly individualized, there may be a comparable blinding problem; the only way I see it working is the pharmacist, again, either prepares the genomically defined prescription or placebo, and sends it back to the clinician.

Am I missing something fundamental about the homeopathic clinical trials? Are any of the "high quality" trials prospective and double-blinded? For want of a better term, is there a recognized reference for "statistical design of homeopathic clinical trials" that is statistically respected? I keep thinking that if such doesn't exist, and genomic trials deal with more than one or two variables, the statistical problems will be comparable -- that is not meant as an endorsement or criticism of homeopathic trials; merely a thought pharmacogenomics and homeopathy might face similiar statistical challenges for prospective trials.

Again, this is a request for information to any qualified person that has gone through experimental designs in detail. Unfortunately, I'm in a fishing village several hours from the nearest medical library of quality, and I don't have a large journal budget.

Howard C. Berkowitz 05:47, 25 August 2008 (CDT)

This is a well phrased and apt question and you are right in that this is a much broader problem than homeopathy. Perhaps generally for clinical trials the issue is that while we know that genetic diversity and diverse disease aetiologies means that most treatments will have "responders and "non-responders", the design of "gold standard" trials is predicated on the assumption that a treatment is only useful if there is a high proportion of responders. Their power to detect subpopulations of responders is generally limited.

You are right that a rigorous double-blind trial could be performed for homeopathy in the way you describe, but would need a lot of organisation, and cooperation from many homeopaths. Interestingly some of the early homeopaths (including Hahnemann) were well aware of the need to exclude placebo effects, and proposed placebo controlled trials well before these became routine in medicine. Their proposed designs were naive by current standards, but for the time they were exceptional.Gareth Leng 12:03, 25 August 2008 (CDT)

Hi, I guess we need a discussion here. I provided 40 trials that were deleted from the article. Was there something wrong with them? -—Ramanand Jhingade 21:20, 26 August 2008 (CDT)

I wanted to get some interpretation of the statistical methodology, not just a list of references. Howard C. Berkowitz 21:24, 26 August 2008 (CDT)