Talk:Homeopathy/Archive 13

How homeopaths think

I added this section and some to the next section in an effort to develop a picture of what I think a typical homeopathic consultation would look like from what I have been able to pick up from sources on the web and from school curriculums. Take a look and see if it is a realistic outlook and feel free to make any changes that you feel are necessary as I appreciate collaboration and would prefer if they were not all my words. D. Matt Innis 09:55, 4 October 2008 (CDT)

Thanks for getting the ball rolling, though I have reworked this...and will add more later. Dana Ullman 11:12, 4 October 2008 (CDT)

I did a lot of consolidating and cleaning up and adding to this section again tonight. Take a look and see what you think. D. Matt Innis 22:53, 4 October 2008 (CDT)

Explaining reversion of "inaccurate statement"

Dana deleted, which was within his rights, what he simply called an "inaccurate statement"

This theory also rejects the concept of diseases to be treated, and deals purely with the benefits to be gained by giving drugs that emulate symptoms—groups of symptoms, rather than diagnoses, are the fundamental treatment objectives.

I apologize if I have been incorrect, not having the benefit of homeopathic training, but there has been a constant thread, from homeopathic contributors to this article, about the rejection of the "medical" model, and the preference for dealing with "individualized sets of symptoms" and invoking the body's wisdom rather that try to deal with a "disease" that needs to be "corrected". Would someone, incidentally, either write a definition of body's wisdom, or replace it with something a little less mystical?

If that terminology was incorrect, it's been in the article for some time. Why, then, was it not removed?

There are very fundamental questions here. Without going through the revision history, at least some of this came from Ramanand, not Dana. Yet, after quite a bit of wrangling, there has been much discussion of the physical chemistry of water, and very little concise and specific information on how homeopaths assess patients, choose treatments, and when and if they refer or work collaboratively. Howard C. Berkowitz 10:44, 4 October 2008 (CDT)

Howard, it has been said that having a little bit of knowledge can be dangerous. It is true here IF one thinks that their little bit of knowledge is a good or adequate picture of truth. Because you seem to have new passion towards homeopathy, as evidenced by your editing here, I have urged you to read about this field. I hope you do that.

I have no idea how long this statement was here, and I apologize if I didn't change it earlier, but as you know, I have bene working on other parts of this article. Dana Ullman 11:36, 4 October 2008 (CDT)

Dana, this is the second time you have referred, I hope not sarcastically, to my new interest or "passion" for homeopathy. Where I do have a passion is for the reputation of Citizendium as a reliable source of information, reviewed by experts, ideally in complementary disciplines.

My interest goes toward statements made on Citizendium. When some seem to be based on (relatively) ancient sources, such as Hahnemann on miasmas, I begin to become concerned. In the spirit of collaboration and contributing work where I do have expertise, I added the article Koch's postulates yesterday. It is an early draft and needs constructive criticism; I'm not sure how deeply I should go into the current sequence- and immunologic-based principles and literature.

Nevertheless, you used the term "miasm", did not provide a recent definition, and I looked up Hahnemann's descriptions. They seem rather blatantly at odds with Koch's postulates. At least in the case of Neisseria gonorrheae, I have personally taken samples from a patient, cultured it, identified it, and then handed the treating physician the laboratory results. This being some years ago, N. gonorrheae was still penicillin-sensitive, and, when I did repeated cultures after treatment, they were bacteria-free and the patient's symptoms and signs were gone. I can give non-anecdotal references, but your reference to miasms, and the actual text of the definer thereof, hardly encourages me to read more about homeopathic alternatives.

Would you care to redefine (versus history of homeopathy) miasm, in terms that are reasonably consistent with some aspects of the Hahnemann-named infections diseases that are demonstrably false by anyone who is willing to gain (using your phrase ) "a little bit of knowledge" — perhaps undergraduate Microbiology 101? Howard C. Berkowitz 11:53, 4 October 2008 (CDT)

I think that we can all agree that there are two possible ways to deal with infectious disease: to attack the germ OR to do something to augment a person's own immune and defense system. Although the conventional view of infectious disease is that the germ (bacteria or virus) "caused" the illness, another way to view infectious disease is that the germ is a co-factor in the infectious disease. In other words, infection is not adequate for disease to take place. The person must also be "susceptible." For further insight into homeopathic thinking about infectious disease, see my article on the subject here: http://www.homeopathic.com/articles/view,102 Dana Ullman 20:40, 4 October 2008 (CDT)

Let me observe that there seems to be a procedural problem here. I have brought up the point that the homeopathic view of infectious disease, as in the article, does not really explain it in sufficiently specific terms accept that it is clear and plausible to a reader not already steeped in homeopathic tradition.

The very point of an encyclopedia article is to educate. By giving this citation, you are not helping the reader understand the homeopathic viewpoint and how and if it differs from a medical view of infection.

As you have said, "a little knowledge is a dangerous thing", and, regretfully, perhaps I should refer you to some citations about "the conventional view of infectious disease". In any number of diseases, such as botulism, cholera, or tetanus, the respective germs (we tend to prefer "bacteria"), Clostridium botulinum, Vibrio cholerae, and Clostridium tetani never directly damage a cell. The exotoxins they excrete, however, do severe damage. In the case of botulism, it's actually fairly unlikely the organisms are active in the body, but, in addition to respiratory intensive care support, the treatment involves antitoxin to neutralize the bacterial product. In the case of cholera, there may be organisms present, but especially in epidemic situations, the priority is not killing the vibrios, but replacing the massive fluid loss from diarrhea; I consider it a travesty that the researchers that developed the oral rehydration solution technique didn't get a Nobel Prize for their work. With tetanus, if there is a plausible infected wound, it will be surgically debrided and antibiotics given, but often, no such wound can be found (e.g., transmission through intravenous drug abuse). The ideal is immunization beforehand, but if clinical tetanus develops, antitoxin — which often causes hypersensitivity reactions — is one core of therapy, the other being controlling the convulsions. Controlling severe convulsions may require paralyzing agents in distinctly non-homeopathic doses, combined with artificial ventilation so the paralyzed patient does not asphyxiate.

None of the antitoxins mentioned produce symptoms of neurological impairment. Restricting oral fluids (minidose of ORF?) does not produce diarrhea. Nonpolarizing neuromuscular blocking agents such as succinylcholine can cause fasiculations, which are vaguely convulsive, but that is why polarizing agents such as rocuronium are used to suppress fasiculations, which can interfere with tracheal intubation (i.e., inserting a breathing tube).

As far as susceptibility, please look at the discussion and citations of subclinical and carrier states in Koch's postulates. The presence of the HbAS (sicke cell trait) gene reduces susceptibility to the most lethal form of malaria, caused by Plasmodium falciparum. Oh, I managed to find time to write that malaria article, rather than refer people to references. That's the sort of thing one does in encyclopedias.

Now, you were saying something about how conventional medicine views infectious disease? Yes, sometimes the organism directly damages tissue. Certain species of Streptococcus pyogenes, which the media likes to call "flesh-eating bacteria", cause various forms of necrotizing fascitis. Fournier's gangrene, when this damage takes place in the perineum and genitals, tends to make the attending staff look almost as ill as the patient.

You, not I, brought up assertions about your understanding of the conventional medical view of infectious disease, and how the homeopathic view differs. I, not you, was able, at more or less typing speed, to give counterexamples to your assertions. I'll believe homeopathy has the concepts right when I see evidence that homeopathy can disprove the well-identified mechanisms of pathology in every example I have given.

The issue of miasms is quite complex, and I don't have the time to write about it now. If someone wants to take a stab at this, I can email them a chapter that I wrote on this subject in one of my previous books ("Discovering Homeopathy: Medicine for the 21st Century")...the chapter on "Chronic Disease." Dana Ullman 20:40, 4 October 2008 (CDT)

In my article on Border Gateway Protocol, I have, in the available time, been writing up how Internet policy routing works, and giving multiple references as well as writing in an encyclopedic, rather than book, style. I could, I suppose, tell people to go read Chapter 4, "Translating Service Definitions to Technical Requirements: Policies" of one of my previous books, Building Service Provider Networks. I could, I suppose, also refer them to some of my online tutorials at professional meetings. I did not, however, start that topic without the expectation I would have to continue to work on explaining, just as the multihoming article refers to the RFC1998 method implemented with the Border Gateway Protocol NO-EXPORT well-known community. After all, Internet routing policy is complex. It also changes, so I cite work that has been done since my books came out.

Might I suggest that if you don't have time to discuss a concept that you threw out, such as miasm, that perhaps you might consider that if you want it accepted without challenge, you read the words at the bottom of this screen, "If you don't want your writing to be edited by others and redistributed at will, then don't submit it here"? All I have to go on about Miasms is the material quoted from Hahnemann. Sorry, I find those arguments about smallpox, syphilis, and gonorrhea less compelling, and more demonstrably wrong, than anything said about the physical chemistry of water.

I will say this: if you have some material you think covers miasms in depth, email it to me and I will do my level best to edit it into encyclopedic style. Once that is done, however, I believe it also in the spirit of collaborative editing to point out what I might see as gaps in coverage or conclusions that do not follow from the evidence. I've been in medical quality review meetings, and software design reviews, that were sufficiently full-contact that I should have worn my judogi. I was born in Newark, New Jersey, which Nietzche had in mind when he wrote "that which does not destroy us makes us the stronger". Strong review and collaborative editing makes for quality; I wish I had this much interaction on some of my other articles. Howard C. Berkowitz 21:45, 4 October 2008 (CDT)

Next deletion

Dana now removed the words in italic, with the The premise of homeopathy is that the signs and symptoms that accompany a particular set of symptoms, using a homeopathic definition of symptoms, with the edit explanation "Previous changes were wrong and confusing".

This is a collaborative effort. Often, someone writing something that is wrong and confusing elicits a contribution that is correct and clear. I have been asking for some specifics other than structure of water for, I believe, several weeks. I have been chastised for challenging a homeopath who claimed to "use lab tests" to explain when and how they were used, and in what way they affected treatment decisions.

Please, Dana, write something that is correct, but that addresses the points that were raised, and perhaps incorrectly, by my summarization of what I have been hearing from homeopaths. The memory of water doesn't come into my skepticism; my skepticism is much more related to the apparent sole dependence on groups of symptoms and aiding the body's wisdom, rather than diagnosing an etiology and correcting the causative factors of that etiology.

We can do that with case studies if that would be helpful. Howard C. Berkowitz 10:58, 4 October 2008 (CDT)

To clarify, a homeopath may use lab tests to make an diagnosis. S/he usually draws from the patient's specific experienced symptoms (physical and psychological), in light of whatever diagnosis they may have, to determine which homeopathic medicine is indicated. That said, some homeopaths are not licensed health care providers and cannot order lab tests. These clinicians simply use the diagnosis given the patient by other clinicians, but then, the homeopath prescribes a medicine based on the overall syndrome of the patient. Please know that I am not pointing any finger at you (I have no idea who wrote something that I am editing). I am just trying to be as accurate as possible.

I personally do not see much purpose in CZ for case studies. Dana Ullman 11:42, 4 October 2008 (CDT)

On harmony (I did not write about that) and miasms

With the explanation "Totally changed. "Harmony" is not in homeopathic texts!", Dana added new and presumably corrected text. I would appreciate some citations here, but let me emphasize some things that seem quite new for the article. "Practitioners of classical homeopathy usually conduct a conventional medical diagnosis (or acknowledge the diagnosis previously determined by other medical workers) but ultimately seek to treat the overall syndrome of the person, not just a single diagnosis or any local condition. Homepaths inquire with the patient about his/her unique symptoms and place stronger emphasis on these unique symptoms, as well as a person's psychological state, to determine which homeopathic medicine may be indicated for the sick individual. Hahnemann, homeopathy's founder, was one of the earliest physicians to acknowledge genetic links to chronic illness, and he used the term "miasm" to refer to diseased states and syndromes that are passed on genetically. Homeopaths believe that people have different layers of illness, and once a homeopathic medicine effectively seemingly removes one layer of illness, a new different syndrome sometimes emerges and requires a new homeopathic medicine.

Please tell me if I am wrong, but the article, for some time, has disagreed with the idea of "conventional medical diagnosis".

I tried to find more information on precisely what a miasm may be, and, in History of homeopathy, found some of Hahnemann's work from 1816. Among other things, he wrote

He introduced the theory that three fundamental 'miasms' underlie of all the chronic diseases of mankind: 'Syphilis', 'Sycosis' (suppressed gonorrhoea), and 'Psora'. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". In Hahnemann's words: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..."

First, Dana, please indicate if I should assume conventional physicians also base their principles and practices from work in 1816. Second, are the miasms described, in an article that does not seem to have undergone substantial changes since December 2006, accurate as to what Hahnemann wrote, and, if so, did homeopaths start believing that Treponema pallidum, Neisseria gonorrheae, and Variola major might have something to do with, respectively, syphilis, gonorrhea, and smallpox? Would a homeopath prescribe, respectively, benzathine penicillin G or ceftriaxone for the first two? Any therapy for smallpox, is, of course, experimental, but would a modern homeopath try smallpox vaccine, cidofovir, and Vaccinia immune globulin (VIG)?

I'm sorry, but Citizendium to take Hahnemann as an authoritative reference is about as authoritative as taking an 1816 allopathic physician as current best practice. I ask that there be some specificity and more recent references in the main article. If the history of homeopathy article incorrectly uses "miasm", by current homeopathic standards, since you just used it, I would appreciate an updated and specific definition and citation.

Incidentally, no qualified physician would argue that treatments will reveal new problem. In the specific trauma case I described, the point of rapid sequence intubation was to keep the patient alive long enough to do the next level of diagnosis and treatment. Pneumothorax and hemothorax both might receive tube thoracotomy as an emergency intervention, but, while much of the presentation is similar, I need to know which it is before knowing if the tube, for example, should be inserted in the second/third versus fifth/sixth intercostal space.

Again, I am asking no more detail than I would expect in a CZ article on medicine. Howard C. Berkowitz 11:26, 4 October 2008 (CDT)

As I say, I don't know who wrote the deleted text, For homeopaths, health is best described as a state of "harmony" of the body; mentally, emotionally and physically. For them, disease then becomes a state of "disharmony". They are not as concerned with what they consider the material manifestations that develop with chronic disease such as hypertension, high cholesterol, smoking, diabetes, heredity, etc.. They concern themselves with what they consider the root cause of the "disharmony" that led to these same signs and symptoms - i.e. job dissatisfaction. They would then address all of these with their remedies. As such, contemporary medical diagnoses, while helpful in determining the end result of the "disharmony" that perhaps led to the heart attack, is only one factor that the homeopath uses to make a homeopathic diagnosis as to what they consider to be the root cause of the patient's symtpoms in the first place - the disharmony. Once they feel they fully understand the cause of the patient's "dis-stress", they use the law of similars to look for the most likely cure. The law of similars is like using fat and oil to make soap that is then used to clean away fat and oil. They consider their most important function is to find something in nature that is the best match for the particular symptoms that are being displayed by the patient. They challenge themselves to find the right combination of things in nature that will cause the patient, both mentally and physically, to manifest those symptoms.

I see a wholesale substitution, with no talk page explanation. No, I wouldn't have been comfortable with the earlier language as well. Until yesterday, however, I had confined myself to the talk page, hoping to suggest things to the experts, and only made editorial corrections to the article. At this point, however, I am simply trying to pin down things that seem to be what homeopathic contributors/citations said, although in a way that confused me. I would not dream of thinking I was authoritative on what homeopaths do, but I am quite prepared to do so in conventional medicine. Howard C. Berkowitz 11:26, 4 October 2008 (CDT)

Hey, I wrote that... thought is was pretty good, but it was mostly a summary from a homeopath's website that I looked at. I am not attached to anything I write, as long as an improvement is made. Keep swimming, just keep swimming... D. Matt Innis 12:03, 4 October 2008 (CDT)

Howard, You are obviously a smart smart guy, but I urge you to think more thoroughly before writing on this Talk page. You assert above some surprise that homeopaths are relying upon information discovered by Hahnemann in 1816. What makes you think that Hahnemann and homeopaths since him have not added to this initial discovery? Your statement is offensive, even though I know that this was not your intent. I am, however, more concerned that you are wasting your and my time by your long posts that make unfounded assumptions. Another concern that I have is your tendency to ask: Do homeopath prescribe this conventional drug or that conventional drug for a specific disease? You're asking an overly simplistic question that can only have a complex answer. This article makes it clear that some homeopaths are MDs, some are DOs, some are RNs and PAs and DCs and NDs, and some have no license. In any case, homeopaths are a part of an overall health care team and can and do refer to other specialists, whether they prescribe or can prescribe a conventional drug or not. Dana Ullman 11:55, 4 October 2008 (CDT)

What makes you think that Hahnemann and homeopaths since him have not added to this initial discovery?

I think that because you referred specifically to Hahnemann, and did not give any other references. Why is it offensive to point out a lack of any current references to a specific homeopathic term, "miasm", which you introduced, and further point out that the only definition on CZ is blatantly wrong by any modern standard in infectious disease?

Do homeopath prescribe this conventional drug or that conventional drug for a specific disease? You're asking an overly simplistic question that can only have a complex answer.

I am not asking anything that I would not be expected to write in a health sciences article, such as Medicine#Practice of medicine; I'd be happy if I had the equivalent level of detail about Homeopathy#Practice of homeopathy. As an example of a reasonable expectation of level of detail at CZ, I wrote Tularemia and Francisella tularensis, and consider them developing articles.

It has been stated repeatedly that there is a very long list of homeopathic remedies that are appropriate for different symptoms, yet there have been no examples of how these symptoms or medicines are organized. While I recognize that antibiotic is a sub-article, can you give me a reference to a homeopathic source that organizes homeopathic drugs in an equivalet way?

Any number of health sciences articles are at the level of I have invited you to offer case studies, either original or with citation of a detailed case report. On this talk page, for example, I gave, identified as an example, a typical set of drugs for rapid sequence intubation. I would have been considerably more detailed in the choices and controversies. To indicate it is not a cookbook solution, I gave a citation to a randomized controlled trial of rocuronium alone versus a defasiculating dose of rocuronium followed by a paralyzing dose of succinylcholine.

I would invite you to go through revision histories and find out how long this article has gone without any clear definition of who homeopaths are, and what is their scope of practice. For quite some time, the article made no distinction among different kinds of homeopaths.

This article is being suggested for Approval, and I believe it is not remotely close to being ready, with many controversial issues stated without citation, or with references (i.e., miasm) to work from 1816. As Matt mentioned, Hahnemann, honored be his name, was well before Koch and Pasteur...and Katz and von Euler and Axelrod and Montagnier and Marshall and Warren.

I request that the Constabulary determine if I am, in fact, being offensive. I confess to having been lengthy at times, but I say that I have done that in the sincere hope it suggests, to homeopathic experts, what is not being covered in the article. The significance of things not being covered is, I assume, a reasonable question that could be asked by a reader inquiring "why should I use homeopathy rather than allopathy"? I doubt a reasonable reader would be terrribly concerned about involved arguments about the memory of water. Howard C. Berkowitz 12:40, 4 October 2008 (CDT)

Relax Howard, Dana made it clear that he knew you were't meaning to be offensive, and I certainly don't think you've strayed from reason. I think we are all honestly trying to make this a good and fair article. The reason I favour omitting the sections on clathrates and nanobubbles is not to undermine homeopathy, if anything the opposite, by avoiding speculations that won't stand up to serious scrutiny. Scientists after all have to keep an open mind and due humility; we don't understand everything. We can live with that; but we can't live with explanations that aren't explanations or very clearly don't hold up. An example is the paper in the nanobubbles section that led me to recommend deletion; if you look at the design of the experiment, it is clear that it was designed to compare homeopathic remedy with a water control, exposed to the same dilution and succussion. The authors in fact found no difference at all between these two. However both showed some heat production increasing over time. This looks to me like an unanticipated artifact possibly involving a reaction of the solute (it wasn't water, don't have the paper to eye as I write) and the container. But the main point is that an experiment clearly designed to test whether there is a difference between a homeopathic remedy and water control found no difference. The structure of water arguments I haven't commented on yet, because I haven't had time to look. From what I have seen, there are problems, as I think Paul pointed out.Gareth Leng 16:58, 4 October 2008 (CDT)

Thanks, Gareth. I agree with omitting those points, but perhaps for a slightly different reason. If I may be allowed a reference to my own books, the first chapter of each is "What problem are you trying to solve?" In many high-technology fields, there is a great tendency to like solutions (no pun intended; truly inadvertent) that people try to fit to the problem.

In this context, homeopathic remedies are either one or two kinds of solution. Since we aren't sure that they contain any solute, I'll just use the other meaning: they are things used in solving a perceived problem. In conventional medicine, ciprofloxacin is a fine drug, but it's unlikely to be useful in classic migraine (diagnosis) headache symptom.

This article goes into exhaustive detail about physical chemistry of water and whether the remedies are physiologically active. As you suggest, it may be going into topics of interest and deserving physical chemistry articles, but the relevance of a nanobubble or clathrate to physiology is not at all obvious. This article goes into very little detail, however, in how a homeopath assesses a patient, defines objectives for any proposed actions, and, where appropriate, the basic idea of how particular remedies are selected. Yes, there is an article on homeopathic provings, but that comes across as a fairly simplistic description of what corresponds to a FDA Phase I trial does.

Dana has used the term "diagnosis", and even "conventional diagnosis". Ramanand, it appeared, objected to the term, on the basis, if I understood, that the idea of a diagnosis assumes that there is an entity called a "disease". A "disease", again based on what had been in the article for some time, implies there is something to be "fixed", and "fixing" went against homeopathic principles of using the body's wisdom. (It's an Americanism, as best I know, but the usual euphemism for neutering a feline is "fixing". What was broken? He was a perfectly functioning tomcat.)

So, at this point, I hear conflicting messages. I think one of the problems is that homeopaths, at least those who have not also had conventional biomedical education, are using terms differently than are used in conventional medicine. The article has spoken of homeopathy as targeting groups of symptoms and not recognizing the concept of a "diagnosis" with an etiology that needs direct, not symptomatic, treatment. "Symptom" seems to be used much more generally than symptom is used in formal medical language. There has been mention of homeopaths using diagnostic imaging, and clinical hematologic and clinical [[biochemistry|biochemical tests, but nothing about how they are used to in assessment and treatment. No one has addressed how homeopaths deal with trauma, if at all. No one has mentioned the role or non-role of surgery.

"Miasms" were put into the article text, but not defined other than with a reference to Hahnemann. Following the CZ article on History of Homeopathy, I found Hahnemann's explanations, to put it mildly, erroneous by Koch's postulates in three specific diseases where the pathogen is well known. In two of those cases, curative treatment that kills the pathogen is well known. When I asked Dana about that, he took offense and asked whether I thought homeopaths had done nothing since Hahnemann.

Since Hahnemann was the source given, it is not totally unreasonable to believe that no, perhaps homeopaths, using Hahnemann's term "miasm", still used his definition of them. Dana has made various suggestions that I "read up", but that is not an appropriate response to collaborative editing; I could easily take offense at the suggestion that I suffer from "a little knowledge being a dangerous thing". In the cases cited by Hahnemann, syphilis, gonorrhea, and smallpox, I have a sufficient knowledge to help build clinical decision support tools in infectious disease, and, while I haven't worked with Variola virus specifically, I have have worked in virology labs (including full containment). I've done quite a few serological tests for syphilis, chocolate agar cultures of N. gonorrheae, and researched antibiotic resistance.

I am not asking for an explanation of the mechanism of action of homeopathic remedies. I am pointing out that the article is massively deficient in describing the cognitive process in homeopathy, the scope of homeopathy, and the diagnostic techniques used. I am asking for no more detail than I would expect in a medical article. Answering questions about "scope" with an answer that there are lots of kinds of homeopaths still doesn't tell me when homeopathic methods are used and not used by a MD homeopath. Harold Griffith's Nobel Prize was not given for anything remotely resembling homeopathic remedies described here. Clearly, he had some idea of the scope of homeopathy being different than the scope of allopathic anesthesiology. I believe the article should address such issues, and they are far more relevant to an encyclopedia article on homeopathy than a discussion of the thermodynamics of preparing remedies. Howard C. Berkowitz 17:56, 4 October 2008 (CDT)

Is this a representative "textbook" as mentioned in the section on the homeopathic consultation (now footnote 12)

<ref name=HPUS>{{citation | title = The Homœopathic Pharmacopœia of the United States | author = Homeopathic Pharmacopoeia Convention of the United States | url = http://www.hpus.com/whatishpus.php}}</ref>

If so, I think it should be cited both where it is (as an example of regulation) and as a textbook, or whatever type of reference it may be considered. Howard C. Berkowitz 22:39, 4 October 2008 (CDT)

The Homeopathic Pharmacopeia is ONLY used by homeopathic drug manufacturers because it is a good that tells the reader how to MAKE the medicine. It has NO therapeutic information in it. I have previously made reference to two type of important homeopathic textbooks: repertories and materia medica.

A thought on different thinking and mutual understanding

Different professions have their own cultures, and I am fascinated on how homeopathy and conventional medicine apparently started diverging, perhaps in the 1950s, about accessibility to the knowledge of their drugs. If I may be forgiven a bit of reminiscence, I was a bratty nerd kid that was more interested in pharmacology than dinosaurs; I whined and whimpered until I got a copy of the Merck Index of Chemicals and Drugs for my tenth birthday. A little before then, it was considered that the patient should know nothing of the prescription the physician wrote; it was a professional secret between physician and pharmacist. One of my physicians -- sometime in the late fifties or early sixties -- was at first annoyed, then amused, that I would almost invariably find out what had been prescribed, and began giving me the previous year's Physician's Desk Reference. Maybe it was a sixties thing and free love had something to do with it, but there was an increasing openness about medication and patient awareness. It was also learned that having bottles labeled with clear drug names could help in poison control emergencies.

One of my professional areas is electronic prescribing tools. The Institute of Medicine of the National Academy of Sciences, for at least ten years, has been saying that the handwritten prescription should be obsolete in three years. Even when prescriptions were being compounded from ingredients, there is considerable safety data that shows major errors being caused by the use of pharmaceutical Latin, especially when it was abbreviated and became ambitious.

There is very hard data that Latin pharmaceutical names, and bad naming choices in general, increased errors. Indeed, the Food and Drug Administration has been known to demand renaming of commercial drugs because the name was too easily confused; on the current FDA list of 20 drugs under close surveillance are Fluorouracil Cream (Carac) and Ketoconazole Cream (Kuric), for the reason "Adverse events due to name confusion" http://www.medscape.com/viewarticle/580145

Why does homeopathy stay with the Latin names? Yes, there is tradition and familiarity, but, even aside from issues of patients' knowledge, do homeopaths not consider the safety experience in conventional medicine significant? Howard C. Berkowitz 22:39, 4 October 2008 (CDT)

World-wide, Homeopathy 'stays' with Latin names so that there is no confusion. Please correct me if I'm wrong, but shouldn't the plural of software be softwares, especially if the plural of people is peoples (now accepted by both Websters and Oxford English Dictionaries)?—Ramanand Jhingade 23:39, 4 October 2008 (CDT)

No, "software" is always written that way, whether it is for one or a million. There is a distinct difference between "people" being used as a collective plural ("there are 2,000 people in that town"), and "peoples" being used in an entirely difference sense - ("various peoples have different customs and languages.") Hayford Peirce 23:59, 4 October 2008 (CDT)

There has been a problem with national generic names for pharmaceutical preparations, although the IUPAC (International Union of Pure and Applied Chemistry) notation is awkward but unambiguous. Under the World Health Organization (WHO), however, there is an active program to standardize International Nonproprietary Names. Given WHO already promulgates the International Classification of Diseases (ICD-9, ICD-10), there would be every reason to believe that would be accepted as well.

Current work in reducing prescription errors not only discourages the use of Latin in ingredients and drug names, but in abbreviations for how the patient is to use the drug [1]. There is an interesting 1916 textbook on pharmaceutical Latin, Lessons in Pharmaceutical Latin and Prescription Writing and Interpretation, Hugh Cornelius Muldoon, [2] Pages 66-67 of the PDF (book page 52-3, section 99) give examples of exactly the sort of potentially deadly mistakes that can come from abbreviating pharmaceutical Latin: Hyd. chlor. could be chloral hydrate, "corrosive sublimate" (mercuric chloride) or "calomel" (mercurous choride; one is among the most poisonous simple inorganic compounds where another is a laxative and the other a sedative. As far as the major reports on error, I have citations but haven't gotten the link at the National Academies of Science Press:

• Committee on Quality of Health Care in America, Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
• Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.

As far as software, English is not the most consistent language in the world as far as plurals. Nevertheless, in forty-odd years of software development (the closest article I could find to "software"_, I have never encountered software as having a plural — it's a collective noun. The plural of program is indeed programs. System software, or operating system software, does not involve user applications at all; it's the internal software of the computer, such as Linux or Microsoft Windows.Howard C. Berkowitz 00:06, 5 October 2008 (CDT)

Environmental Toxicology??

We are struggling here; if you want a section on the structure of water, I suggest it must be approved by a Physics editor, and this section by a biologist. In any case, here and throughout I think we must exclude citing multiple single studies like this unless exceptinally notable, but confine such sections to references to literature reviews. I'm just going to delete these references from this section. I'd do it on any science article similarly.Gareth Leng 08:10, 5 October 2008 (CDT)

This has been a problem for a while. I just want to emphasise with Gareth's point that this is about style. These points would apply to any entry article on any topic. Chris Day 08:28, 5 October 2008 (CDT)

Yes, this is a general editing, or general encyclopedia point perhaps: authors and editors always must be ready to say "this needs a brief mention and a subarticle". Sometimes, that's just for flow and space reasons. Sometimes, it's for reasons that the topic has gotten too specialized for the general level of article that is involved.

The title of this article is "Homeopathy", not "The structure of water, with homeopathic implications", or "Possible physiological effects of possible water structures of homeopathic remedies". In my opinion, there is far too much about the remedies, and far too little about the cognitive process of homeopathic evaluation and planning health improvement (neutral enough?). In U.S. medicine, there is a constant struggle that status and payment are higher for doing procedures than talking with the patient, thinking about the problem, and organizing a response. For all homeopaths talk about an alternatives, in this article, remedies are to homoepathic cognition as, in U.S. reimbursement, procedure-based is to cognition-based professional service.

It's not that material here should be lost, but it should spawn into a sub-article. Perhaps, Gareth, it might be useful if, rather than deleting these references, you would create a stub as a placeholder stub (or a section of a bibliography subpage here?) so they aren't lost. Howard C. Berkowitz 08:58, 5 October 2008 (CDT)

I disagree with the deleting of the many references in this section. The many arsenic studies may have the same author but they are not the same study. Each article shows a different measurement, and each objective measurement has its own importance. Even the deleting of the human arsenic study should not be deleted. I initially listed the "preliminary" study and the follow-up study. The 1st was in a journal that is accessible online, allowing people easy access to it. While the 2nd study is in a higher impact journal. I believe that both have their place. Dana Ullman 11:45, 5 October 2008 (CDT)

This is the whole problem. We should not be adding masses of individual studies to this article and discussing each one. It makes the article unapproachable for the average reader. This has nothing to do with too many articles from one author and all about too many primary literature articles, whether by one author or not. Chris Day 12:05, 5 October 2008 (CDT)

I do not think that there is too much info about the structure of water, and I think that Howard's statement is overly dramatic when he wonder if the "title" of this article should be changed. We will bulk up other parts in this article in time. I am a bit concerned that some people are wholesale changing the article very fast these days...I just want quality to go with the quantity. Dana Ullman 11:45, 5 October 2008 (CDT)

Dana, it would be helpful, in the spirit of professionalism, collaborative editing, etc., if you would avoid judgmental terminology such as "dramatic", "a little knowledge is a dangerous thing", or speaking of my "newfound" inerest. I might also suggest that I have very, very carefully tried to avoid characterizing what homeopaths think; I am trying to discover that because I honestly don't know. I would suggest that unless you have a detailed background in a medical topic, it might be advisable not to assume you understand what conventional medical scientists think about it. I don't claim to understand what homeopaths generally think about infectious disease; I simply said that Hahnemann's material about miasms in History of Homeopathy is blatantly wrong by any modern concept of microbiology and infectious disease. Some subsequent homeopath may have come up with an utterly magnificent model of the indeed complex role of microorganisms in disease. I would be quite interested, for example, to see if any homeopathic investigations or practices might have synergy with the increasing suspicion that organisms not detectable by ordinary testing, such as Ureaplasma and Mycoplasm, may be associated with symptomatic but otherwise unexplained inflammatory disease. We know that some joint inflammations respond to long-term therapy with tetracyclines, sometimes in surprisingly low doses, or second-generation macrolides such as azithromycin. One of the puzzling things about such responses, also in things such as Lyme disease, is that the treatment must be quite prolonged, far longer than the usual therapy. No one is sure why.

Part of my concerns is that Approval has been mentioned. Articles that need "bulking up in time" are not remotely ready for Approval. I would suggest any further pushing for Approval be postponed, as I think I can say that I am not alone in assessing this article, for reasons of flow and coverage alone, needs substantial improvement. It may be practical to cut this back to a "capstone" article with a number of subarticles. Doing so would certainly reduce the complexity.

I have read "Chapter 3: Literary Greats: Write On, Homeopathy!", but I'm afraid it does not give me any more understanding about the cognitive process of homeopathy. It has some interesting literary material; I always wondered what the JD in JD Salinger stood for, but, as far as contributing to this discussion, it seems only to include lay testimonials. Howard C. Berkowitz 12:53, 5 October 2008 (CDT)

Investigations, diagnoses, and typical visit

In the paragraph below, which I have commented out in the text, are utterly critical inputs to the understanding of the cognitive process of homeopathy, but, in their present form, are essentially without meaning. If this were an article on medicine, I would have exactly the same concerns about the first sentence — the issue of when and where which studies are needed are critical to quality, cost control, and, in medicine, diagnosis.

Investigations like blood and urine analysis and imaging studies are also suggested where and when required. Alternatively, they may refer for these tests to be performed and evaluated by others, but generally classical homeopaths do not concern themselves with these tests as much as the person's symptoms. Homeopaths also acknowledge and when appropriate, use the diagnosis previously determined by other medical specialists.

Blood and urine analysis often do not correlate to any symptom, as the word symptom is used in medicine. "Chest pain", even "My chest feels like an elephant is standing on it", or "The pain starts in the middle of my chest, goes into the left shoulder, and down the arm" are critical symptoms to a physician. With a patient presenting with that chief complaint, he would probably get some immediate actions that variously are likely to relieve symptoms, will relieve symptoms if and only if there is a specific etiology (diagnosis if you will), and some of which will be supportive:

• Morphine and oxygen (latter relieves pain from effort of breathing)
• Nitroglycerine (if it relieves pain, it points to, but does not diagnose, one of several coronary arterial disorders. Those can exist &mdash from painful personal experience! &mdash even if coronary artery disease is later firmly diagnosed
• (preferably chewed) aspirin and establish IV access

At that point, a physician is pretty much stuck in what treatment to do next, without diagnostic information, and without sudden crises such as cardiac arrest. In this example, this is what absolutely confuses me about "concern...[with] symptoms". From my medical model, if I plan to do anything more specific about relieving symptoms, much less trying to correct a problem, I need diagnostic information, and that is going to come from the laboratory, bedside sensors, and imaging. The patient might be sweating, but that could be caused by wildly different things for very different causes. Yes, the sweating is visible, although I'd call it a sign rather than a symptom if it is observable, but it is nonspecific.

In medicine, this is where differential diagnosis comes into play. If the patient's symptoms are being caused by a clot in a coronary artery, I have a few hours in which the process can be stopped and the damage reversed by administering thrombolytic agents. If the pain is being caused by internal bleeding, that same drug will kill the patient.

So, I am very confused by how a homeopath would use laboratory diagnosis in a homeopathic way, when the majority of test results aren't directly correlated with a symptom. If I do an electrocardiogram and see ST segment elevation, get elevated blood levels of troponin and creatine kinase of myocardial origin, and a bedside PA and lateral chest X-ray shows the lungs are clear, and couple these to the symptoms and signs, there's a pretty strong pointer to coronary artery disease rather than Tietze's syndrome, pneumonia, or aortic dissection. Relief of pain by nitroglycerin would also point there.

If angiography were not available, this be justification for thrombolytics, but if it was available, it could tell me a lot more about what was appropriate for the patient.

It would help me enormously to see how an office-based homeopath would deal with a patient presenting with a potentially critical condition such as chest pain of sudden onset. Would he simply call an ambulance? Under what circumstances would he not refer? Just as a reference, here's a link to the differential diagnosis of chest pain. [[3]]

there is little in the homeopathic system isThe role of other medical specialists vis-a-vis is a critical issue, needs elaboration, and cannot be dismissed with "it depends on the kind of homeopath and his scope of practice". Personally, I'd suggest that an MD homeopath with an office patient with this symptom would give nitroglycerine, morphine, probably aspirin (after asking a few questions), oxygen, and would be out of his mind not to call an ambulance.

Please discuss more about homeopathic decision-making and less about the nature of remedies. Howard C. Berkowitz 09:43, 5 October 2008 (CDT)

Friends, I realize that some of my previous writing here is not as accurate as I would like it to be. It is better and more accurate to say that homeopathy is a system of TREATMENT and that there is no separate diagnostic system to homeopathy. Further, homeopaths will conduct a diagnosis using conventional diagnostic tools as needed, though some homeopaths are also trained in other systems as well (Chinese medicine, Ayurvedic medicine, etc.) and may use the diagnostic tools from these systems. However, the treatment will be based primarily on the patient's physical, emotional, and mental symptoms and in light of the diagnosis determined. Dana Ullman 11:54, 5 October 2008 (CDT)

An office-based homeopath would deal with a patient presenting with a potentially critical condition such as chest pain of sudden onset by generally administering one of the Homeopathic remedies like Amyl Nitrate, Carbo Veg., aspidosperma, Lycopodium, China etc. (depending on the symptom syndrome), which generally relieves the acute problem.—Ramanand Jhingade 22:37, 5 October 2008 (CDT)

Bluntly, if the patient is having a myocardial infarction, amyl nitrite (not nitrate) might give some relief, although less effective than nitroglycerine. If an office-based homeopath doesn't get that patient into a coronary intensive care unit quite soon, that patient is likely to become extremely calm as a result of the administration of homeopathic remedies. Dead people tend not to respond to stressful events with strong emotions and other disturbing actions. I recognize that ambulance services providing advanced cardiac life support paramedics and appropriate emergency rooms with direct ICU admission are not available in the United States, but, if that situation arose in the United States, a "prudent layman" would be expected to call for emergency transport.

If that chest pain is coming from a high-grade occlusion of the left main coronary artery, emergent thrombolysis, angioplasty or coronary arterial bypass grafting may be the only definitive way to stave off a spreading infarction, ventricular fibrillation, and asystole. In the U.S., it is common practice for exercise facilities to have automatic defibrillators and oxygen available, to buy time until more definitive treatment is available, along with transport to where continuous monitoring is available. I cannot imagine a situation, in the U.S., if anyone purporting to be a healthcare provider did not take the well-accepted emergency steps, which means calling for ACLS services if they cannot be provided, and the patient died in the office, that provider would be prosecuted for felony manslaughter.

CZ standards of courtesy do not let me express the intensity of my reaction to that answer. I shall quote the a comment from the U.S. National Center for Homeopathy. "Each state has its own licensing requirements [for homeopathy]. "Whether that person is a medical doctor or a physician's assistant or a naturopathic physician, I feel that anyone who's treating people who are sick needs to have medical training," says [Jennifer] Jacobs, [who has a family practice and is licensed to practice homeopathy in Washington state] [4] At least by U.S. standards of medical training for the Boy Scouts,[5] much less the most minimal level of nursing technician, would recognize the symptoms I describe as immediately life-threatening.

Again trying to stay professional, it is for this reason that I have been asking for specificity in the selection of "conventional medical tests". If, in this situation, you don't have an electrocardiogram and defibrillator, and the knowledge to use them, you have no ethical alternative other than to call for instant transportation to people who do. Even defibrillation is only buying time to get to definitive therapy, just as CPR buys time to get to a defibrillator. I see little point in reviewing the definitive ACLS emergency procedures. Howard C. Berkowitz 23:29, 5 October 2008 (CDT)

I'm not speaking for all Homeopaths, but if I don't see a result within a few seconds, I send for an ambulance.—Ramanand Jhingade 23:52, 5 October 2008 (CDT)

I'm not speaking for everywhere in the world, but anyone was not fully equipped, at least for defibrillation, and preferably with a full setup for advanced cardiac life support (defibrillator/cardioverter/cardiac monitor, airway control (including RSI drugs if endotracheal), oxygen, IV access, just as a start epinephrine/lidocaine/atropine/metoprolol/morphine)...these are drugs for an ACLS ambulance or office practice, not the wider range in an ER) -- unless you have prior informed consent from the patient -- your delaying that ACLS response might be the difference between life and death. Yes, I'm not in an utterly serene psychological state. Howard C. Berkowitz 00:08, 6 October 2008 (CDT)

I think this illustrates the concern of mainstream medicine (whether real or perceived); that people will not get the proper care for life-threatening conditions, either in emergencies or for long term care for things like diabetes, etc. It probably could be handled in a sentence or two in the proper place. D. Matt Innis 09:41, 6 October 2008 (CDT)

Thanks, Matt. That is indeed one concern, as is mentioned in the article quoting the head of the Royal Homeopathic Hospital, and, as I quoted in talk, a U.S. licensed physician, quoted by the Food and Drug Administration as saying, essentially, an individual has to have a level of medical training appropriate to treat the level of sickness in people in active distress.

For example, Ramanand mentioned using diagnostic imaging as appropriate. He specifically cited X-ray computed tomography. There has been substantial data in the last year or so that CT, especially some of the newer spiral high-resolution types, is not a benign test; it gives enough X-radiation to raise the incidence of cancer in the retrospectively analyzed patient. I'm on the Trauma and Critical Care mailing list (www.trauma.org), and there is much discussion of when CT, CT angiography, etc., are appropriate -- and the discussion is for clearly emergent situations where the speed of CT imaging could give hard information. I can't imagine one of the trauma experts, who brings up the subject of CT at all, just waving his hands and suggesting "when appropriate"; everyone who has brought up such, within the space of an email, manages to define at least some guidelines as to when the perceived benefit does and does not justify the risk. Incidentally, I expect to be having, with informed consent, either CT or SPECT in the near term.

Remember that not long ago, there was a resolution about medical disclaimers in Health Sciences articles. Healing Arts should be under no less a standard.

What would enrich the article is some narrative about how homeopathy is used as complementary to medicine, as opposed to an alternative to all medicine -- I was doing some searching yesterday and found some rather frightening examples of the latter. A friend is an osteopathic physician (boarded in family and emergency medicine), and is eloquent about when manipulation does and does not complement standard techniques. Indeed, he talks about how things can be complementary in the reverse direction: certain manipulations are effective, but have to be done under general anesthesia because of the pain they would cause.

Telling the reader there are homeopaths with all sorts of training that use homeopathy within their scope of practice really doesn't say anything. I'm thinking of academic physicians I know who routinely work with practitioners of various manipulative therapies, acupuncture, visualization, massage, and even moxabustion -- they don't assume that any given complementary therapy will help a patient, but, especially in pain management and palliative care, they are seen especially as ways of improving quality of life. Perhaps there are such collaborations, or a dual-trained physician (Harold Griffith, anyone) has written specifics on the collaborative approach. Howard C. Berkowitz 11:34, 6 October 2008 (CDT)

Okay, I made some changes to address at least some of these concerns. See what you think[6]. D. Matt Innis 12:49, 6 October 2008 (CDT)

Let's look at the paragraph

Medical doctors who use homeopathy perform their usual tasks of inquiring about the chief complaint, associated complaints, past history, family history, the developmental history. They also conduct a physical examination or clinical examination - the process by which a health care provider investigates the body of a patient for signs of disease. They note any indications of abnormalities of the organ systems (cardiovascular system, respiratory system, nervous system etc.), by obtaining vital signs like body temperature, blood pressure, pulse and respiratory rate using tools that include inspection, palpation, percussion and auscultation. Investigations like blood and urine analysis and imaging studies like X-rays, ultrasonography, computerized tomography, and magnetic resonance imaging, are generally not essential when considering homeopathy as an intervention, but may be used to determine the need for more conventional approaches. Classical homeopaths do not concern themselves with these tests (other than for disease diagnosis) as much as the person's symptoms.

What, I think, would be illuminating is to constrain an example to a homeopath who also has full allopathic training and certification. When does such a physician move away from the conventional model and into the homeopathic model? Clearly, Harold Griffith did not use the principle of similars in his Nobel-prize winning work in anesthesia. Some reports, however, seem to suggest that homeopathic methods might be worth a trial in chronic pain, diffuse diagnoses such as chronic fatigue syndrome and fibromyalgia, etc.

As now written, the wording about diagnostic imaging and laboratory test really adds no information for the reader. If it cannot be made more specific, perhaps in links to subarticles, it should be deleted. I would, incidentally, tighten the examination description, possibly linking to the stub article Physical examination. It adds no information to mention taking blood pressure when it has already been said that the cardiovascular system is being evaluated.

I will very carefully suggest some draft wording about scope of practice, response to emergency conditions, and perhaps areas of conflict:

• A physician qualified in homeopathic and allopathic methods may, after diagnosing a chronic condition that does not have consistently effective allopathic treatments, may first prescribe a homeopathic remedy likely to have fewer side effects than allopathic drugs.
• Homeopaths recognize that trauma is a surgical emergency and is outside the scope of homeopathic remedies.
• There is disagreement in the role of immunization and chemoprophylaxis for infectious diseases. Really should have more about infectious diseases in general, especially since miasms were mentioned
• Situations for which complementary teamwork between allopathic and homeopathic practitioners is particularly useful include ------.
• At any level of training, a homeopath will recognize, to the level appropriate of that training, symptoms that indicate that an acute and potentially fatal condition may be present. Assuming that emergency medical services are available where the therapist is practicing, such symptoms as unexplained chest pain of sudden onset, especially with other symptoms suggestive of a major cardiovascular event, ethically will activate EMS for immediate transfer to an appropriate staffed and equipped facility. The practitioner is expected to have emergency medical training and equipment appropriate to his or her level of medical training in the place of practice (e.g., dressings and basic airway management tools for an individual with training at the emergency medical technician level, and preferably an automatic external defibrillator; at the MD/DO level, advanced cardiac life support resources generally accepted as appropriate for an office.Howard C. Berkowitz 13:25, 6 October 2008 (CDT)

Oh Holy Moly, Howard, your writing is fine. Do feel free to jump in with the rest of us! It can only get better! I'll double check yours :-) D. Matt Innis 13:31, 6 October 2008 (CDT)

OK, I'll go for it. Meanwhile, I discover physical examination and medical history taking are very stubby; I just added some content to the physical exam, but lots of expansion is needed (thinks of some horrible and hysterical examples of medical students and interns not quite getting all the details).

Clearly, there are areas where I've put dashes, such as the areas where there's some evidence that allopathic and homeopathic techniques may indeed be complementary. I've found a few studies, but there are probably people better qualified than I.

It's a more general question, not for this article alone, on the indications for particular laboratory and imaging studies. I can try writing some additional articles "forward and backward" -- in other words, describing common batteries of tests defined in Current Procedural Terminology, as in "what is in a complete blood count or basic metabolic profile", and also articles/links to the specific tests in them or the more specific additional tests they may suggest. In reverse manner, a discharge found on examination presumably needs microscopic analysis and culture; if Kernig's and Brudzinski's signs were positive on physical exam, imaging and laboratory workups for meningitis are appropriate.

I will ask for constabulary/editing help if the changes just keep getting reverted, with no discussion. Howard C. Berkowitz 14:46, 6 October 2008 (CDT)

Of course, go for it. All those articles need to be written! You have editors on this page that determine content and you can feel free to call in another editor if you like. We do appreciate all authors who contribute, as long as everyone realizes that their words will be altered to appease the editors that will be putting their reputations on the approval. There shouldn't be any reverts, but anyone can clarify and clean them up till we get it right. Let the editors have the final say if there is an argument. Constables are for CZ:Professionalism problems. Also remember that I am not a constable on healing arts articles. D. Matt Innis 15:02, 6 October 2008 (CDT)

Sure. I wonder, given that a good deal of concern here is about the intersection of homeopathic and conventional medicine, if it makes sense to add Health Sciences to the metadata. Clearly, if it's a question of the medical indication for a test, or the perceived risk of a symptom, that's more of a call for a conventional medical editor. Howard C. Berkowitz 15:33, 6 October 2008 (CDT)

I'm not totally sure it's necessary. If you look at the workgroups, Healing arts includes Health sciences. You can be a healing art without being a science, but MDs are still in the healing arts. Besides, no-one here should expect to say anything about MDs or what MDs do without them reviewing it, just as we wouldn't expect an MD to say anything about a homeopath without a review. Hopefully, when we are finished all will have signed off on everything. D. Matt Innis 16:16, 6 October 2008 (CDT)

Okay, Howard, I see your line of thinking in the article and I'll let this develop for a little while. Keep going. I notice this "Still unclear if any imaging or laboratory testing helps a homeopath understand a symptom--will try an example ". I do notice things like anemia in the repertory. I don't see any reason to suspect that a classical homeopath wouldn't consider using blood work to determine if pernicious anemia is not the "condition" they are treating. Notice, that I agree that pernicious anemia is not a sign or a symptom, it's a condition that is the result of a B12 deficiency that results in large erythrocytes and is diagnosed with a CBC (blood work) and other blood tests. It may not have symptoms associated with it, though fatique may be a complaint. So I suppose that a patient may start with a complaint of weakness, for which a lessor therapist might prescribe one thing, but a therapist that was aware of the pernicious anemia might prescribe something else. Of course, I have no idea if the outcome would be different, because the concept of likes cures likes seems to mean you treat the fatique, not the anemia (unless you treat with something that causes macrocytic anemia - which is really not a symptom). Thus your mind twisting dilemma. D. Matt Innis 21:34, 6 October 2008 (CDT)

Repertory

Absolutely fascinating; thanks for the reference. As Yoda might say, "stunned am i. yes!"

The real stunning came when I saw "bubonic plague". While even in the U.S., there are isolated areas of endemic plague, I can't think of any industrialized country where that would not be a reportable disease to public health authorities. On checking, the World Health Organization expects reporting. I can't think of any public health authorities that wouldn't be insisting on contact tracing, evaluation of epidemic hazard, prayer there will be no pneumonic incidents, and mandatory antibiotic therapy. The bubonic form of Yersinia pestis infection, I suppose, could be suspected by history and physical, but laboratory confirmation -- and in a specialized lab -- really is appropriate. I have this sinking feeling that having a homeopathic remedy listed might, just might, suggest that the homeopath might not report this. Scary, if so.

Now, scanning through the list, I see a number of conditions that I'd hardly call "symptoms", but definitely pathological diagnoses, and, in many cases, with a differential diagnosis that would call for laboratory and imaging studies, and possibly exploratory surgery. For some, if a primary physician suspected them, there would be immediate calls for specialists. Examples:

• Acromegaly
• "Anemia" in various symptomatic forms; is "anemia" being used to describe something that can be determined without hematology?
• Addison's disease
• Plague
• Cancer, with localization to places such as the cecum and omentum. How does one begin to make that diagnosis without perhaps some good imaging, but more importantly a biopsy, perhaps laparoscopic?
• Dropsy: it's used so generally I'm not sure how to interpret it.
• Hodgkin's disease. A symptom. Right. Which of the 5 recognized types does that remedy help, and how does one know, symptomatically, it isn't some other lymphoma?
• "Leucocythemia", which I'm guessing is a British synonym for leucocytosis. By definition, leucocytosis is an elevated white cell count. It's neither inherently symptomatic nor diagnostic. Is there some magical symptom I don't suspect? Further, once one finds leucocytosis, there's quite a bit of differential diagnosis: infection of many sorts, possibly an inflammatory response, four or more kinds of leukemia since there is no WBC differential...

Me now more confused. Shaman who diagnose these by "symptom" have strong, strong magic. Skeptic must be careful; his magic might be up to making one a frog.

Seriously, the existence of these items in a repertory means one or more of several things:

• Homeopathy is not about symptomatic diagnosis alone, or there are a lot of words being used in a very unconventional way
• If some of these were correct diagnoses, they range from world-reportable events to potentially fatal, and also medically treatable, conditions. A number of Hodgkin's forms are going into the "curable" category, or at least 20 years without symptoms.
• At least in the U.S. and Canada, anyone trying to treat the things on my list had better have a license, and also hope that the medical licensing board doesn't find out that these are the treatments being used.

Ribbbit....Howard C. Berkowitz 22:30, 6 October 2008 (CDT)

Archive please, and comments on Toxicology

There are numerous important issues above. On general editing, for this article eventually to be approved (I agree that seems a way off at present), the editors will have to feel that any referenced literature is reliable and notable. The scientific literature is vast and full of papers that are poorly performed, poorly analysed, and of good studies that are unrepeatable and were wrong for a host of reasons. It is also contaminated by publication bias, some fraud, and conflict of interest. This is the whole literature I'm talking about, not the homeopathy literature. Thus it is possible to cherry-pick through the literature to support almost any case anyone wants to make. So secondary sources (good peer-reviewed reviews). What a good review does is survey the literature in a critical, balanced and reflective way, to take an informed overview - sort out the wheat from the chaff. Not all reviews are good, but if we're looking at reviews in major journals, and several reviews from different viewpoints, we can get a picture of the general strength of a case.

In general, I would be reluctant to support inclusion of any reference to a primary paper for a point likely to be controversial without independent replication, without clear warning flags around it, and even then only if I've read it and seen no obvious flaws.

I've now looked at several primary papers from Khuda-Bukhsh et al. and cannot support citing these. I looked at Sci Total Environ. (2007 384(1-3):141-50) the way I would as an editor. This reports two sets of comparisons a) of a small number of subjects in one village treated with two homeopathic remedies and another untreated community in a different village. This comparison has no controls and is not valid. The second set is of the treated community with placebo groups from the same village. The size of the samples was 20 for the two remedy groups combined (sizes aren't reported separately)and 5 for the two placebo groups combined (again sizes not reported separately, so there must be 2 and 3 in these groups.). The data are in Figs 13-19 and the statistical values in Table 3. I looked at the Figures and concluded that there is no significant effect, so was surprised to find the results quoted as significant; but then I saw first that the authors were using a significance threshold of P<0.5. Yes, I have not misprinted, P<0.5. However even this is subverted as they declare in one case a P value of 0.66 as significant (for GSH). Much of the statistics I couldn't make sense of (couldn't see how in some cases, low P values were plausibly achieved), this is not helped by the misprints, dislocated figure labeling and misreferencing of Figures.

I've checked his citation record on ISI Web of Science. The most highly cited of the homeopathic primary papers (in MOLECULAR AND CELLULAR BIOCHEMISTRY) has been cited just 8 times, of these 5 are self citations (authors citing themselves). His most highly cited paper (the review) has 14 citations, I think 11 of these are self citations.

So, this work has apparent problems of statistical naivety (I've only mentioned the two problems most obviously understandable) and lack of notability as reflected by impact.

This illustrates why I am so opposed to citing primary work for controversial points. I don't have the time to do this systematically for more than the occasional exception, and can't believe anyone else has, but if we don't I don't see how we can approve. So please, eliminate primary papers and use selected secondary sources for potentially controversial findings.Gareth Leng 06:37, 6 October 2008 (CDT)

Gareth, I looked at another homoeopathic study that was published in CHEST and saw a similar pattern (Talk:Homeopathy/Archive_1#Notability_of_citations). As you say we can cherry pick all we want but will the article improve? The big picture scope for this article is "what is homeopathy?" but, as is often the case in controversial topics, we end up try ing to "prove" it, or not. After the long "proofs" one is still left asking "what is homeopathy?". Chris Day 08:13, 6 October 2008 (CDT)

I agree. The bottom line is that the science just isn't there for any explanation of any effects of homeopathic remedies, I propose we just take out or move the relevant sections and simply say "At present, there is no scientifically acceptable explanation for how homeopathic remedies might work. Some homeopaths and a few scientists have proposed that research on solitons, clathrates and nanobubbles might suggest how homeopathic remedies might differ from pure water. Some think that better understanding of hormesis might help also in understanding biological responses. See articles on solitons, clathrates, nanobubbles and The memory of water." I honestly can't see a way forward otherwise.

I hesitated over this for a while as I looked into Roy's papers. He's obviously been a great scientist, but he's now 84 and has only got into water structure recently; I can't really evaluate the ideas but it worries me where they were published and especially the views of physicists like Paul. I've looked at Chaplin's site and think his concluding paragraph is good:

"Many ridicule homeopathy out of serious consideration as a clinical practice, sometimes resorting to unscientific, unbalanced and unrefereed editorial diatribe. One of the main reasons concerning this disbelief in the efficacy of homeopathy lies in the difficulty in understanding how it might work. If an acceptable theory was available then more people would consider it more seriously. However, it is difficult at present to sustain a theory as to why a truly infinitely diluted aqueous solution, consisting of just H2O molecules, should retain any difference from any other such solution. It is even more difficult to put forward a working hypothesis as to how small quantities of such 'solutions' can act to elicit a specific response when confronted with large amounts of complex solution in a subject. A major problem in this area is that, without a testable hypothesis for the generally acknowledged potency of homeopathy, there is a growing possibility of others making fraudulent claims in related areas, as perhaps evidenced by the increasing use of the internet to advertise 'healthy' water concentrates using dubious (sometimes published but irreproducible) scientific and spiritual evidence." Gareth Leng 08:59, 6 October 2008 (CDT)

I agree with a succinct paragraph to deflect the detail to other articles.

Re, Roy: In archive one I wrote "What needs to be considered here is that not all papers, even those published in high impact journals, are notable. " This can also extend to "not all work by respected scientists is notable." Previous publications are obviously relevent but should never be use as a crutch to support poor work. Chris Day 09:09, 6 October 2008 (CDT)

"At present, there is no scientifically acceptable explanation for how homeopathic remedies might work. Some homeopaths and a few scientists have proposed that research on solitons, clathrates and nanobubbles might suggest how homeopathic remedies might differ from pure water. Some think that better understanding of hormesis might help also in understanding biological responses. See articles on solitons, clathrates, nanobubbles and The memory of water."

Absolutely agree that this is the way to handle this article. I could approve with the statement of Gareth's above (or something to that effect). D. Matt Innis 09:37, 6 October 2008 (CDT)

OK, to facilitate a redirection strategy I've created a stub on Memory of water precised from Chaplin's site. I've already created stubs on clathrates and soliton.Gareth Leng 09:44, 6 October 2008 (CDT)

Complementary research

I put in a heading and some preliminary material, more to spark discussion. Unfortunately, I do not have access to the full text journal, or a good frequency-of-citation database; perhaps someone could check that. All three of the studies funded in 2001 had Iris R. Bell, at the University of Arizona, as the primary investigator. As yet, I have not found other NCCAM funded research on homeopathy specifically as a complementary technique.

This is intended as a starting point. Howard C. Berkowitz 21:00, 6 October 2008 (CDT)

"Simplification"

The changes I made were paraphrased, but from a cited source that did not use the terms "defense or immune system". I don't know what a "defense system" is with respect to the human body. I do know that "immune system" is a massive oversimplification. The "simplification" is no longer true to the citation.

Please define "wisdom of the body". I don't know what that means, other than perhaps as an expression of religious belief.

It is not a "simplification" to remove the in-context objection of medical scientists. I would suggest it is a way of pushing the absolute, undeniable, truth of homeopathy. Howard C. Berkowitz 22:37, 6 October 2008 (CDT)