Talk:Homeopathy/Archive 15

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

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

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

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

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

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

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

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

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

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

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

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

What about

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

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

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

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

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

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

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

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

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Natural defenses

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

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

Proposal:

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

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

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

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

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

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

(unindent)
I suggest something like:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Strawment Produce text, not attacks

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

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

PROFESSIONALISM ALERT for {{nocomplaints}}

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

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

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

Rationalwiki

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

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

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

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

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

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

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

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

When to refer; when to call emergency services

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

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

Allopathy, and revert wars over Osler quote

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

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

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

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

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

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

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

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

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

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

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

To illustrate a few:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My point?

1. Context is everything.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sure, let's stay focused.

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

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

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

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

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

"Rebound" is used inappropriately

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Merger

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

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

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

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

Replaced "skeptic" with "non-homeopath"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CAM

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

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

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

Government and Institutional Assessment

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

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

Howard, on your user page, you wrote:-

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

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

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

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

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

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

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

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

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

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

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

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

We could add the British Medical Association:

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

Or Japan [3]

Or the US National Council Against Health Fraud:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Suggesting a new strategy for this article

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

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

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

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

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

From Encyclopedia Britannica Online:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rewrite?

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

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

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

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

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

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

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

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

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

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

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

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

The above:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Susceptibility

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Big Wheel Goes Round And Round

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

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

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

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

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

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

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

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

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

Mea culpa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wordsmithing

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

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

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

Gareth's trims and assumption in infectious disease

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

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

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

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

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

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

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

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

Observation by Gareth about prescribing in context

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

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

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

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

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

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

Nonsense. Please stop condescending.

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

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

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

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

Provings, and screening

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

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

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

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

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

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

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

Edits, an explanation

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

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

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

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

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

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

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

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

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

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

Prophylaxis and homeoprophylaxis

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

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

Possibly the subarticle might be on alternatives to immunization.

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

New lede

I just dropped in my rewrite of the lede.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

American Institute of Homeopathy reexamined

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

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

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

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

Wisdom of the body, vitalism

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

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

to

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

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

Footnotes

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

Safe but ineeffective

Gareth removed

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

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

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

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

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

You're probably right. I don't know the extent to which people will spend personal funds for medication in the UK. Nevertheless, the rationale for recalls of ineffective drugs in the US is that if the drug has a risk, but is ineffective for the indication, it is being pulled for safety reasons. There's now little argument that rosglitazone is more dangerous than pioglitazone, but some patients respond to the first drug while not responding to the other. There are other issues, beyond the scope of this article, in US drug licensing and advertising. Howard C. Berkowitz 10:41, 7 October 2010 (UTC)