Talk:Homeopathy/Archive 13

The structure of water

I renamed "The debate": "The structure of water". It seems reasonable because 1) "A false debate" was renamed "A common misunderstanding (Hayford is right); 2) The broader question of the structure of water is often considered non-sensical, and we ought to make some clarifications. The random network model of liquid water is not plausible anymore, although most chemists and biochemists consider it as a non-issue.

I began my summary of Structure Of Liquid Water; Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations. This is a dense and informative article, that I recommend (32 pages). I would also recommend the speech given by Rustum Roy, the first author, in a conference on homeopathy at the University of Connecticut. I shared the video in Watchknow's youtube group.

I will add as much as I can reasonably can to this state-of-the-art in the field of materials science, help will be appreciated.

Pierre-Alain Gouanvic 19:43, 12 September 2008 (CDT)

A good beginning. I have just added more, including reference to what I consider to be the most comprehensive body of information and research on the structure of water...by Martin Chaplin. Feel free to tweak and expand. In particular, I need some help in formatting. Dana Ullman 13:38, 13 September 2008 (CDT)

I wonder if we should use Chaplin's work as a template. Even Roy and colleagues refer to Chaplin's work as the most comprehensive and the most valuable review! Once again, Dana, you prove that you're the expert here.

I'll compare the relative importance of both works. I'll see what I can do for the formatting. Wikilinks, reference formatting... those kinds of things.(?)

Pierre-Alain Gouanvic 14:15, 13 September 2008 (CDT)

• I read: Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations. This is a superfluous chaotic article, that I would have rejected without any trace of doubt had I been the referee. In addition, I wish to point out that Rustum Roy, the first author, is also first author on a paper (same journal) in which it is proved that seawater can burn. It would take me too much time to explain my position, and I'm sure that it would start a prolonged discussion on this page that would lead to nowhere. Let me just say that my reasons to judge as rubbish both papers of Roy are purely scientific, I've nothing against burning seawater or homeopathy. --Paul Wormer 06:07, 24 September 2008 (CDT)

I said "this is a dense and informative article, that I recommend (32 pages)". The reply: it is a "superfluous chaotic article", not fit for publication ("that I would have rejected without any trace of doubt had I been the referee)", or, in simpler terms, "rubbish".

I see that Dana enhanced my text:

For a theoretical overview of the structure water from a leading professor of material sciences, see Structure Of Liquid Water; Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations.

instead of

For a more detailed analysis, see

Which is obviously very supportive of what I was saying. However, this whole situation reminds me too much of bad experiences I had on Wikipedia. Call it a Post-Wikipedia stress disorder... or an idealistic understanding of what "strong collaboration" means. But the bottom line is that I won't be able to take part in any more discussions here, or in any other articles where similar situations can occur. Sorry. I can be reached through email.

Pierre-Alain Gouanvic 00:56, 25 September 2008 (CDT)

Pierre, sorry to hear that. I appreciate your work (and learned a few things along the way!). I would have liked to hear Paul's work on water as well, but I suppose it may stray too far from our purpose here, which is to write about Homeopathy. I don't have any problems with having a subpage explaining this thoroughly, just as I think a DNA article could have a subpage explaining all the potential bonds that form. I also think it is just as appropriate to talk about the psychosocial effects of the doctor patient relationship in healing. D. Matt Innis 14:41, 26 September 2008 (CDT)

Thank you Matt. You see, the truth for me is that the inclusion of the research by serious experimenters in mainstream science ("normal science", as Kuhn puts it) is not dependant on the quality of their work but on the theoretical work that is done on the plausibility of homeopathy. And the plausibility of homeopathy rests only on the materials science of water, glass containers, and alcohol. This is unfortunate, but, on the other hand, some people like me really want to know how absent molecules work. It is perhaps more politically acceptable to say that homeopathy "is a system of alternative medicine that uses extremely small doses of drugs", "much smaller and specially prepared doses". But it is false. Remember the Avogadro limit. As I said earlier on this talk page, homeopathy uses preparations that contain little or no molecular trace of the initial molecule or extract. The definition of homeopathy in this article is false. Of course, when one tries to discuss what homeopathy is, trying to understand the properties of the solvent, like I do, it brings all kinds of problems: people don't agree on what they're talking about.

Put the definition of homeopathy in the homeopathy article: then we'll be in business!

Pierre-Alain Gouanvic 02:31, 27 September 2008 (CDT)

The psychosocial effects of the doctor patient relationship in healing is exactly why I don't reject homeopathy (especially for the illnesses where the regular doctors don't have a good remedy).

If somebody would be interested, I could explain in some detail why I call the paper by Roy et al. "scientific rubbish". Moreover, IMHO, the paper has hardly any bearing on homeopathy (or on the structure of water for that matter). --Paul Wormer 02:27, 27 September 2008 (CDT)

A super professor once taught me that we can't ignore the history. The way I see it is that homeopathy started long before scientific medicine, when vitalism was the mainstream. Homeopaths were the mainstream practitioners in the 1800s. I am not an expert on homeopathy, but I am assuming that the concept of "likes cures likes" did not start with doses so low that there were no molecules apparent. In other words, giving small doses of rabies to patients with rabies in the 1800's may well have been in dose limits that were "real" and may well have been the ground-breaking work that gave birth to immunizations, I truly don't know, but would be interested to read about it. I do know that in the US, at the turn of the century, homeopaths were the majority practitioners until the Flexnor report. I have also read that, at that time, due to the lack of "modern" labs, most of the homeopathic schools were closed as inadequate and homeopaths were absorbed by medicine by grandfathering them in. I assume anything that was potentially molecular was accepted, but those that couldn't be explained without invoking spiritualism were not. Because these low dose remedies had no substance, they weren't dangerous and therefore not regulated by the federal government and was unable to restrict their use to MDs. Those remedies that were left over could be given by anyone without an MD degree and are what we now know as homeopathy.

Those who were treated less than desirably by the medical profession (women for instance), took hold of these alternative methods and developed them. I'm not sure, but I am thinking that once the idea of Avocadro's limit became apparent, the only explanation at the time was to revert back to the "spiritual" roots that all healthcare once believed. Now that reductionism is beginning to see it's limits, opening the door for other possibilities such as "the structure of water" to explain what we see (or don't see), opens the door for these same explanations to be used elsewhere. There is nothing wrong with using scientific thought processes to rethink what homeopaths think they see. We have some bright minds here that could make some really reasonable arguments. I think that the bar that we need to reach for inclusion in our article should be whether homeopaths are talking about it - or even those that are talking about homeopathy. For that we need to give way to our homeopathic experts and give our science experts a chance to look things over and keep it real, as long as they are willing to do the background work. It would be wrong to dismiss homeopathic remedies just because we can't explain it. So let's keep going - take our time and get it right. I agree that our definition needs work and that the structure of water has some holes in it, but we can discuss them rationally. D. Matt Innis 12:23, 27 September 2008 (CDT)

Fascinating info, Matt, particularly the first para. If true, then I think the entire article ought to be *seriously* rewritten in order to reflect this info. That would explain, for instance, something that has always baffled me: Why the royal Brits have a Royal Homeopath or whatnot to treat them.... Commenting here as a general reader, nothing more.... Hayford Peirce 13:07, 27 September 2008 (CDT)

You must be right Matt. I am a strong supporter of the approach you describe: let's "take our time and get it right". This article might become one of Citizendium's most impressive achievements. But to get there, we must let this page become like a big bazaar of ideas; take my mithridatization, for instance. It was proposed for deletion by one author, and another editor concurred. The question is: what's the urgency? Who sets the timeline? Not me, for sure! So I spent some of my precious time to rescue this idea. And found that mithridatization was an important historical-scientific foundation of the philosophical thinking of the founder of the GIRI, a research group devoted to the understanding of homeopathy. See the mithridatization and hormesis section. My intuition had brought me on more solid grounds than I thought. But if I hadn't read your kind and supportive words, I would have left completely this (pseudo?)-collaboration. I wonder if I should urge deletionists to be more collaborative and patient. On the other hand, it is not my job to explain what a gentle expert guidance should look like. What I can say is that it is essential, in well-regulated human interactions, to ask the originator of a proposition to explain his or her motives or motivations, when the proposition manifestly misses its goal. If the marvels of wiki collaboration don't allow an enhancement of the ethics of deliberation, what will?

And notice that I'm only talking about a successful rescue of content. When Ramanand invokes various frontier science topics (pseudo- or proto- science, if one prefers), in the quantum physics and nanobubbles sections, I view this as a precious reminder, while others will, more or less rightly, judge that it is off-topic. Well, yes, I agree that it is off-topic. But we'll lose much more if we delete without formally asking: "Who wrote this? Why did you think it was important?" It's not wikipedia here. We are committed to authorship and authority. We don't function by the rule "survival of the nerdiest, most active contributor". If Ramanand has little time to explain where he's coming from, let's wait; and some like me will perhaps add some insight which suddenly will make the off-topic intervention precious, albeit surprising.

Pierre-Alain Gouanvic 21:14, 27 September 2008 (CDT)

Environmental Toxicology

I have added a new section on this subject. There is more research on this topic than I have provided, but this is a good beginning. Dana Ullman 13:38, 13 September 2008 (CDT)

Dana, I was eager to see something specifically about homeopathy used as an antidote. I was saying, above in the talk page,

Beyond placebos (cont'd): in animals

I found a good one. We're dealing with mice, there is a variety of controls, and both principles of homeopathy are involved : 1) a toxin, arsenic, is used to mitigate the effects of arsenic; 2) the doses used are well below Avogadro's limit (no arsenic left). I'dd add that the study was "highly accessed" and published in a BMC journal;

And I emphasised, with the following quote, that homeopathy was considered as a near-ideal solution to a hard to solve problem, arsenic intoxication in several poor countries:

our initial aim was to find out suitable antagonists of arsenic poisoning, which should be i) easy to administer, ii) effective in low doses, iii) inexpensive and iv) without any toxic effects of their own. In course of our search, a potentized homeopathic drug, Arsenicum Album-30, was indeed found that showed highly promising results in combating arsenic intoxication in mice (....)

I think that it will be important to devote some room, perhaps in the closing remarks, to the social, economical, and political stakes involved in the acceptance/rejection of homeopathy. On the skeptics' side, homeopathy is a waste of time and public funds (critics are often revolted by the sums of money used by public health officials to beat the dead horse of this antiscientific CAM); a threat to public education (back to the dark ages, magic...);

On the homeopathy side, there is a concern that the rejection of this therapeutic is costly in terms of human quality of life, missed occasions to address problems (such as arsenic intoxication) that conventional systems are perhaps too slow to adress, especially in poor countries (I think that the World Health Organization and Médecins aux pieds nus (Barefoot doctors?) are favourable to homeopathy (?)).

In other words, it seems justified to describe the wrath of so many conventional scientists, the ridicule thrown on those who dare to study the subject (cf Randi's conferences and public interventions), and, conversely, the disappointment of homeopaths (publication bias (see the bibliography subpage), rejection of the right to respond to critical editorials in mainstream journals.

I don't want to light a fire. It is clear, for me, that controversies require sociological/epistemological considerations.

Pierre-Alain Gouanvic 18:42, 13 September 2008 (CDT)

Broad comments

I'm afraid I have little time just now to help. Generally I see positive and interesting things. Two points, I think it must be made clear that in general scientists and medics doubt that homeopathy has any basis other than placebo effects; I think this has been lost through the edits and I have tried to restiore the key point simply and clearly. The large clinical trials statement I have edited; the statement as written seemed to imply that the trials were designed deliberately to fail. It's a fact that in general such trials are not supportive. Why that might be could be discussed, but please be careful to keep any such discussion neutral, and the intro is not I think the place for that.Gareth Leng 16:36, 13 September 2008 (CDT)

Is homeopathy plausible? The structure of liquid water

Gareth, I agree that CZ articles should not contain an excessive number of sections and subsections. But what we're trying to do, before the great day when we submit this article for approval, is to sort out all the info we are gathering, so that we can summarize it and make it more readable (and entertaining).

There are dangers to deleting the codes for sections. Some of your edits were clever, but when I see that "Structure of liquid water" was lost in the table of contents, I got worried. The structure of water is the basic issue that we have to address. Your intervention made me realize that, in fact, instead of the dry "fundamental research" we could use "Is homeopathy plausible? The structure of liquid water" as a title for ths section.

If we represent correctly the research that is done on the structure of water (both in homeopathic preparations and in the body), we will be able to determine if the claimed "imprint" made in the water by the homeopathic process can be demonstrated or not; we will be able to say if homeopathy is falsifiable or not.

So I reverted your change to reintroduce "stucture of water" as a high priority topic.

Pierre-Alain Gouanvic 02:00, 14 September 2008 (CDT)

That's fine, it wasn't my intention to de-emphasise that as an issue.Gareth Leng 05:50, 14 September 2008 (CDT)

Clearly, there is fundamental progress being made on previously unsuspected structure and activity of water. There needs to be stronger connection between water structure and the physiologic effects of homeopathy, as well as verifying that homeopathic remedy preparation affects water. Apropos of the latter, is anyone aware of mass spectrometry of homeopathic remedies, which should be able to verify the presence of clathrates? Howard C. Berkowitz 06:50, 14 September 2008 (CDT)

You may be interested by a recent contribution; I quoted: "the light scattering technologies of Raman spectroscopy and Fourier transform (FT) infra-red (IR) spectroscopy permit examination of remedy samples without fixatives or other potential contaminants (and) allow the co-operative nature of structural differences to be detected".

Inspired by your other question, I created another plausibility section about the other side of the issue: water in living systems. It's empty...

Pierre-Alain Gouanvic 13:21, 15 September 2008 (CDT)

Is this article about homeopathy or the structure of water? In my opinion it is becoming very unbalanced. Chris Day 02:05, 24 September 2008 (CDT)

"homeopathy or the structure of water?" I don't understand. Why don't you elaborate on this in the article? Why does an article exploring the plausibility of homeopathy becomes very unbalanced when it deals with the structure of liquid water?

Pierre-Alain Gouanvic 03:23, 24 September 2008 (CDT)

I'm assuming a reader wants a general overview of homeopathy. An analogy would be the article on DNA focusing too much on hydrogen bonding. Obviously it is important for the function but does it need to be so much of the article? Water structure is also not well understood with regard to function in this case either, unlike hydrogen bonding with respect to DNA, so masses of detail is not really appropriate. It should be mentioned, of course, but as it stands now (and it looks like it is likely to expand) it is an analysis of the primary literature discussing individual (controversial) ideas and (controversial) experiments. Some of the connections that are being made from the chemistry of water to the function in diluted states are not even clearly relevant, yet, there seems to be a narrative forming suggesting this is common knowledge that it is important for homeopathic function. In short there is too much certainty being placed on too little data. Chris Day 04:16, 24 September 2008 (CDT)

Changes to lede and Intro

I made some mostly cleanup, clarifying and filling changes to the lede and the introduction. If I have changed anything in an unacceptible way, feel free to set me straight. D. Matt Innis 21:50, 17 September 2008 (CDT)

I can't parse the phrase "likes cures likes," unless it's an allusion to the title of a story about rodents by Ellis Parker Butler. Bruce M.Tindall 22:16, 19 September 2008 (CDT)

Concerning this long quote

I feel that we have to emphasise that, once again, the textbook explanations are wrong (see first sentence of the quote), and that water has a previously unrecognized role in the whole enzymic machinery (following sentences; abridged). And of course, the notion of water clustering is central.

It is tempting, as well, to salute the visionary insight of Szent-Gyorgyi.

But now, help would be appreciated, especially from the biologists in CZ, and those who will (no doubt) rush to read and enhance this article, during Biology week!

Pierre-Alain Gouanvic 02:16, 18 September 2008 (CDT)

I don't think we can emphasise that at all. The essential involvement of water in all protein function is very well recognised, and not controversial (and when people say that textbook explanations are wrong, I am unimpressed and uninterested; to an expert, textbook explanations are always wrong :-)). There is some question about whether at a subatomic level, the water that is in close proximity to macromolecules might be forced into an altered structure. It seems plausible that it might, although there is dispute about whether it does. However to say that A in a macromolecular matrix the structure of water is distorted is one thing, to say B that it retains this structure when not confined is something else, and to say C that this structure could be recognised and used adaptively by biological mechanisms would be something else again. My view as a biologist, is that A sound interesting but I'm not a chemist. B seems very unlikely, but I'm not a physicist, and C is something for which I cannot conceive any mechanism nor can I imagine how any mechanism could have evolved through natural selection.Gareth Leng 08:30, 18 September 2008 (CDT)

Gareth sums up the "expert" opinion accurately here. I can relate to all his comments, especially the 'textbooks are wrong' one. Chris Day 08:56, 18 September 2008 (CDT)

Definition by Boyd

Matt, you diluted the definition by Dr.Boyd so much that it did not seem to be his quotation. In any case, it was you who gave us the exact quote in the first place. If what I've done is unacceptable, please let me know.—Ramanand Jhingade 20:25, 22 September 2008 (CDT)

Hi Ramanand, I have two issues with the quote: First, having such a long quote in the lede appears as though we can't explain it in our own words and, second, I don't think the average reader will take the time to try to understand what it says. How about paraphrasing it for me.

Homeopathy has been defined as, "a therapeutic method which assumes that a deviation from the fundamental mean within reversible limits, can be restored to normal by means of a stimulus, usually applied in the form of drugs, only sub-physiological doses of which are necessary because of hypersensitivity in disease and whose action is always directed toward normal by virtue of altered receptivity to stimuli in disease".

D. Matt Innis 09:08, 23 September 2008 (CDT)

I agree with Matt here. I think that this quote is too cumbersome and not precise enough to be used in the lead. I think that we should look for another quote or use our own words. Dana Ullman 21:03, 23 September 2008 (CDT)

Dana, much better concerning the quote and you even helped elucidate the "likes cures likes". I am having trouble leaving the latter part of the quote concerning immunizations, etc. as it seems to suggest that immunizations are homeopathic... Can you separate them more. I think it gives the impresssion that an attenuated virus might be part of a homeopathic remedy. It isn't, is it? Do any homeopathic remedies actually include parts of a virus, or just compounds that mimic the symptoms of the disease that that virus would cause? D. Matt Innis 20:39, 24 September 2008 (CDT)

Matt, actually, some doses of homeopathic medicines ARE viruses, just in very small dose. For instance, Influenzinum is made fresh every year. Many (most? all?) homeopathic manufacturers obtain the same 3 types of flu viruses that the Pasteur Institute defines as the most common and that are typically in a "flu shot." The difference is that the doses are simply smaller than those in a flu shot. It is commonly sold as a 9C (1:100 dilution NINE times), thus maintaining some molecular dose. It is also available in the 30C or 200C or 1M (1,000) or higher potencies. The bottomline is that the homeopathic "principle of similars" is at the heart of vaccinations.

Taking this further, I quote from my new book, "The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy," here's part of the section on Emil von Behring (the father of immunology!): Emil Adolf von Behring (1854–1917) won the first Nobel Prize in medicine or physiology for his discovery of the diphtheria antitoxin. Later, he discovered the tetanus antitoxin. For many years he served as military captain of the medical corps to the Pharmacological Institute at the University of Bonn, and then was given a position at the Hygiene Institute of Berlin in 1888 as assistant to Robert Koch (1843–1910), one of the pioneers of bacteriology. He then became professor of hygienics in the Faculty of Medicine at the prestigious University of Marburg. Because of his significant discoveries in immunology, Behring retains a highly regarded place in its early history.

In 1892 Behring actually experimented with serial (homeopathic) dilutions and found paradoxically enhanced immunogenic activity, but he was advised to suppress this experiment due to the aid and comfort it would provide to homeopaths. Only after he won the Nobel Prize did he feel comfortable in making public these experiments (Behring, 1905; Coulter, 1994, 97).

Behring broke from orthodox medical tradition by recognizing the value of the homeopathic law of similars:

"In spite of all scientific speculations and experiments regarding smallpox vaccination, 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. Indeed, what else causes the epidemiological immunity in sheep, vaccinated against anthrax than the influence previously exerted by a virus, similar in character to that of the fatal anthrax virus? And by what technical term could we more appropriately speak of this influence, exerted by a similar virus than by Hahnemann’s word “homeopathy”? I am touching here upon a subject anathematized till very recently by medical penalty: but if I am to present these problems in historical illumination, dogmatic imprecations must not deter me." (Behring, 1905) Reference: Behring, A. E. von. Moderne Phthisiogenetische und Phthisotherapeutische: Probleme in Historischer Beleuchtung. Margurg: Selbsteverlag des Verfassers, 1905. Dana Ullman 23:30, 24 September 2008 (CDT)

As you say, vaccination was introduced long before there was any understanding of its mechanisms of action, and Behring was quite reasonable at that time in pointing out the analogy between homeopathy and vaccination. At that time there was no clear molecular theory. In particular, it was not understood that there are fundamental limits to how much a solution can be diluted while still retaining some of the diluted material, nor was it understood that physiological mechanisms require a process of molecular interaction. If homeopathy involves specific activation of the immune system, then this should be reflected in specific antibody production, and this is something readily measurable; as far as I know it doesn't result in specific antibody production. If I am right, the analagy might be relevant, but it shouldn't be presented as though it could be an explanation for why homeopathy might work.Gareth Leng 04:45, 25 September 2008 (CDT)

Gareth, the bottom line is that both homeopathy and vaccination have something in common and that is that they both use the "principle of similars." We both agree that the analogy IS relevant. Although scientists today give their explanations for specific molecular processes for how vaccines work, they ignore the underlying principle that may explain why they do so.

I have no problem maintaining some humility here, and therefore, we should not say that the homeopathic "principle of similars" explains HOW homeopathic medicines work but that this principle in nature may provide an underlying basis for various phenomena, including vaccination, allergy treatments, and homeopathy.

By the way, for a drug to help prevent a specific disease, there are various processes of the immune system and other defenses at work, not just antibody production. Dana Ullman 13:40, 26 September 2008 (CDT)

Yes I agree that the analogy is relevant, it's not so much that scientists ignore the principle of similars, as that they simply don't accept its validity as a scientific principle. So only a homeopath would say that both vaccination and homeopathy use the principle of similars, but it's fine to say that here. Of course you're right in that the immune system is more than antibody production. Gareth Leng 11:36, 27 September 2008 (CDT)

Nanoparticles

?does this have anything to do with homeopathy? Gareth Leng 11:16, 24 September 2008 (CDT)

Nah, I've been waiting to see if that line develops, but I think it's time to take that one out. D. Matt Innis 11:23, 24 September 2008 (CDT)

Gareth, I would also like to see your post above concerning A, B and C appear in some form in the article. Any chance you can write something up stating something like that in the article proper? D. Matt Innis 11:27, 24 September 2008 (CDT)

Hyperimmune

I've deleted a section of text here - hyperimmune responses are those elicited as a result of excess antibody production - don't think this is relevant here. the messenger pathways are complex and I don't think that this is the place for that kind of detail, it seems to be likely to confuse rather than clarify.Gareth Leng 04:34, 25 September 2008 (CDT)

Mithridisation

I'd suggest deletion of this section. Mithridisation seems to be an archaic term. The basis of tolerance to snake venoms seems to be the same as the basis of vaccination - protection is incurred by the production of antibodies to the venom. See e.g. Coral Snake Venom : Antibody Response in Rabbits. Nature (1967) 213:820-822. Gareth Leng 09:06, 25 September 2008 (CDT)

I agree 100%...with more clean-up soon. Dana Ullman 20:20, 25 September 2008 (CDT)

Dana, Gareth,

I'll copy the contents of my response to Matt :

You must be right Matt. I am a strong supporter of the approach you describe: let's "take our time and get it right". This article might become one of Citizendium's most impressive achievements. But to get there, we must let this page become like a big bazaar of ideas; take my mithridatization, for instance. It was proposed for deletion by one author, and another editor concurred. The question is: what's the urgency? Who sets the timeline? Not me, for sure! So I spent some of my precious time to rescue this idea. And found that mithridatization was an important historical-scientific foundation of the philosophical thinking of the founder of the GIRI, a research group devoted to the understanding of homeopathy. See the mithridatization and hormesis section. My intuition had brought me on more solid grounds than I thought. But if I hadn't read your kind and supportive words, I would have left completely this (pseudo?)-collaboration. I wonder if I should urge deletionists to be more collaborative and patient. On the other hand, it is not my job to explain what a gentle expert guidance should look like. What I can say is that it is essential, in well-regulated human interactions, to ask the originator of a proposition to explain his or her motives or motivations, when the proposition manifestly misses its goal. If the marvels of wiki collaboration don't allow an enhancement of the ethics of deliberation, what will? And notice that I'm only talking about a successful rescue of content. When Ramanand invokes various frontier science topics (pseudo- or proto- science, if one prefers), in the quantum physics and nanobubbles sections, I view this as a precious reminder, while others will, more or less rightly, judge that it is off-topic. Well, yes, I agree that it is off-topic. But we'll lose much more if we delete without formally asking: "Who wrote this? Why did you think it was important?" It's not wikipedia here. We are committed to authorship and authority. We don't function by the rule "survival of the nerdiest, most active contributor". If Ramanand has little time to explain where he's coming from, let's wait; and some like me will perhaps add some insight which suddenly will make the off-topic intervention precious, albeit surprising. Pierre-Alain Gouanvic 23:54, 27 September 2008 (CDT)

I think the problem here is that "mithridisation" is a term that has no hits at all on PubMed (and PubMed includes at least some homeopathy journals). It has no presence at all in science because (in referring to desensitisation as a result of chronic exposure to a toxin) it refers to many different kinds of things with quite different mechanisms of action (for example, in the case of venom, it's antibody production, in the case of other drugs it can be receptor downregulation). So while it's reasonable to have an article on mithridisation to clarify its historical usage, I don't think it has a place here, because it doesn't help to understand homeopathy (as far as I can see anyway). Hormesis I'm similarly unsure about. Hormesis (in drug actions) refers to agents that have different actions at low concentrations to those at higher concentrations. This can arise in many well known ways, and again, hormesis is a term used very seldom in the pharmacological literature because it embraces several different mechanisms. In itself, hormesis has nothing to do with homeopathy; we're not talking here about the high dilutions that homeopaths use, nor are we talking about anything outside conventional scientific explanations.

I've no problem with waiting to see if something makes sense with further edits. I was just declaring here that, at present, I don't see where the sections on mithridisation and hormesis can go usefully. Gareth Leng 15:55, 28 September 2008 (CDT)

No. You said: "I'd suggest deletion of this section."

Pierre-Alain Gouanvic 20:24, 28 September 2008 (CDT)

Isn't that the same thing? If you "don't see where the sections can go usefully" then one would probably "suggest deletion of this section". No? I don't see these as being mutually exclusive comments. Chris Day 00:38, 29 September 2008 (CDT)

Chris, I'd "suggest deletion of" your comment.

Just joking. Pierre-Alain Gouanvic 14:11, 29 September 2008 (CDT)

Gareth, Matt, I sincerely hope you can consider the opinion of the others before deleting anything. I can explain things (so can Pierre-Alain and Dana), but I don't have the kind of time y'all do, so I request you to be patient.Thanks in advance for co-operating.—Ramanand Jhingade 21:58, 28 September 2008 (CDT)

Pierre-Alain, I don't have a problem giving you time to explain how and why you think is info IS important. It is good, for instance, that you mentioned that the head of GIRI refers to mithridisation, but Gareth is absolutely correct in noting that if it is not mentioned in Pub-med, it may not have notability. On the other hand, hormesis IS big and very notable. Dana Ullman 00:25, 29 September 2008 (CDT)

My preliminary research on mithridation/mithridatisation (using * can be helpful in pubmed) indicates that Mithridate is considered the first toxicologist. A pubmed + google scholar + dictionary search will reveal that English will tend to speak about Mithridates, about mithridates (=antidotes), about mithridaticum (a specific antidote that was famous for centuries, which contained poisons but also other drugs). My language, French, has a preference for another "plane" ("EN has a preference for reality, FR for reason", as we're taught in translation courses), and will use "mithridatisation" more often - the head of GIRI is French. But still, in the review by Khudar-Buksh we (?; see talk) were talking about (in the lead), the "Mithridates effect" (note that English prefers to point to a reality, the Emperor, and add "effect", rather than to add "ation" or "ization") is mentioned as well. I'd like to emphasise that notability is not assessed by putting a word in pubmed and hitting the enter key. It's the first step. Here, we have a topic that is important in the history of medicine, which helped at least two researchers on homeopathy to think about homeopathy (you know how the history is useful when thinking about homeopathy). I would say that these historical considerations will be especially useful when we introduce hormesis.

The journal "Dose-response", which is entirely devoted to hormesis, doesn't seem to describe hormesis in the same terms as Gareth. In particular, they have published positive results with *very* low doses (right at the point of non-existence of the molecule, Avogadro's limit). It was with cisplatin. These researchers who investigate hormesis wish its mechanisms were well-known, but they aren't. Hence this broad definition; hence the publication of research on tiny, tiny doses. And you have electromagnetic hormesis, a hot topic in this day and age. Nobody assumes that the mechanisms are well known or self-evident, but we call it hormesis.

Finally, I would caution against the use of such expressions as "conventional scientific explanations". It is an appeal to authority. Nobody here is an expert on hormesis. Let's take our time.

Pierre-Alain Gouanvic 14:03, 29 September 2008 (CDT)

Mechanism of action

Pierre-Alain mentioned Khuda-Bukhsh's research into the mechanism of action of homeopathic remedies. Can we have that in the Lead (is it Lead or Lede?) please.—Ramanand Jhingade 22:33, 28 September 2008 (CDT)

I do not think that Khuda-Bukhsh's research on mechanism of action has any place in the lead. His research on this subject has not been experimentally verified and his research has not been replicated. The lead should only have the most important, basic, and verified info. And please, Ramanand, please provide summary info in your edits. You've been told this before...and it IS important. Dana Ullman 00:29, 29 September 2008 (CDT)

As an observer of this article I suggest, again, it is becoming far too detailed down to the level of individual papers. I mentioned this above for the water section and now I see the same thing here. We need to rise above the details of discussing individual studies. Surely that would be for other articles? Chris Day 00:41, 29 September 2008 (CDT)

There is already a reference to this review paper (not a research paper) (Khuda-Bukhsh AR (November 2003). "Towards understanding molecular mechanisms of action of homeopathic drugs: an overview") in the lead section:

There have been various suggestions about how homeopathic medicines might work,[2][3].

the other one being the special issue of Homeopathy (2007) that you brought to our attention, Dana.

This brings us to the central problem of the definition of homeopathy, again. The sentence goes on:

but there is no generally accepted mechanism of action for the extremely small doses used in homeopathy, and this remains a stumbling block to its acceptance by mainstream medicine and science.

Which is indeed a serious stumbling block, considering that it's not even the issue. Those two references deal with the structure of water, not with the effects of "extremely small doses".

Sorry for the digression; Ramanand, are you saying that we should give to the reader a general idea of what these "various suggestions" are? I would say that not doing so would amount to say that they don't *deserve* to be in the lead. I'd say it's self-evident; we have to tell the reader that the scientific research on homeopathy tries to understand the materials science of these preparations.

Pierre-Alain Gouanvic 02:17, 29 September 2008 (CDT)

I want the mechanism of action to be mentioned in the Lead - that small reference can't even be read. I think Dana can do something about that.Ramanand Jhingade 03:33, 30 September 2008 (CDT)

Like cures like

Please, I have edited the lead to remove the suggestion that medicine uses this principle. I do not wish to misrepresent the beliefs of homeopaths in any way at all. However, we must not distort modern medical and scientific beliefs either. The principle of "like cures like" is not one used in any form by modern medicine or science. There are very few principles or laws of any form that are accepted in biology; in physics there are many, because these are founded in a detailed mathematical understanding and are universally applicable. The principle of "like cures like" has no theoretical basis accepted in science. It is quite wrong to say that vaccination is an application of the principle of like cures like; it may be (to some) an illustration of the principle, but modern vaccination is simply an application of contemporary understanding of the immune system. As for the generality of like cures like, remember that medicine used to be contrasted as the application of the opposite principle - allopathy - that medicines should be opposite in action to symptoms. Representing that as a principle was equally inappropriate. Gareth Leng 03:13, 29 September 2008 (CDT)

First, allopathy is NOT the use of opposites. That would be "contrapathy." "Allopathy" derives from "other" or "different" from the "pathy" (disease). In other words, sometimes allopathic medicine uses opposites, sometimes similars, and sometimes something different from the disease itself, though it happens to get rid of symptoms, at least temporarily. Although physicians can describe physiologically or biochemically why vaccinations work, it is also true to refer to vaccinations as the use of "like to cure like." I previously gave a quote from the "father of immunology" about this. Is there a middle ground where we can say what both of us are trying to say? I personally do not think that it is simply "coincidence" that two of the few modern medical treatments that augment immune response (vaccination and allergy treatments) just happen to use medicines in small dose that CAUSE a disease in larger dose. Dana Ullman 19:03, 29 September 2008 (CDT)

Well, consider diseases with the same symptoms; different strains of influenza, and say Weill's disease which has symptoms essentially indistinguisghable from flu. An influenza vaccination will protect against only one or perhaps a few closely related strains of influenza, will have no protective effect against Weill's disease, and in no case will be a cure of any sort against an established infection. So in what sense exactly is this analagous to the principle of "like cures like"? They're not cures, they are preventatives, and they prevent infection by the specific organism, not against like organisms, and do not cure diseases with like symptoms. Allergy desensitisation treatments unlike vaccination, work by depressing immune responsiveness (when they work which is variable, and they can be very dangerous). They work by exposure to the specific agent, not another agent - if you are allergic to housemites and cat fur the symptoms will be the same, you might sometimes "cure" the allergy to housemites by repeated exposure to the house mite allergen (though this is very often ineffective), but if that works you will still be allergic to cat fur (except in rare cases, such as oral allergy syndrome).

As for this article, I think that what homeopaths believe and do should be displayed clearly, fully and fairly. But there should be no misrepresentation about what scientists and medicine believe in the process. It's fair to say that homeopaths believe that the principle of like cures like underlies vaccination. It would be quite wrong to suggest that scientists or medics think this at all. Gareth Leng 03:29, 30 September 2008 (CDT)

George Bernard Shaw offers an interesting perspective on vaccination and homeopathy. I get the quote from Dana's free chapter (see link above), that I devoured:

The test to which all methods of treatment are finally brought is whether they are lucrative to doctors or not. It would be difficult to cite any proposition less obnoxious to science than that advanced by Hahnemann, to wit, that drugs which in large doses produced certain symptoms, counteract them in very small doses, just as in modern practice it is found that a sufficiently small inoculation with typhoid rallies our powers to resist the disease instead of prostrating us with it. But Hahnemann and his followers were frantically persecuted for a century by generations of apothecary-doctors whose incomes depended on the quantity of drugs they could induce their patients to swallow. These two cases of ordinary vaccination and homeopathy are typical of all the rest.

(...) "Here we have the explanation of the savage rancor that so amazes people who imagine that the controversy concerning vaccination is a scientific one. It has really nothing to do with science. Under such circumstances vaccination would be defended desperately were it twice as dirty, dangerous and unscientific in method as it really is."

What later determined the acceptance of vaccination, but not homeopathy, may have little to do with what we construct now as conventional logical explanations, post hoc. See Matt's comment's about the Flexner report, and Dana's chapter. Pierre-Alain Gouanvic 21:54, 30 September 2008 (CDT)

Life time of water clusters

I removed the view that water clusters are short-lived is "outdated". Every year hundreds of articles appear in the regular peer-reviewed literature (model calculations, many kinds of spectroscopy) that prove the opposite. Why are we to believe the claims of Roy and a few of his disciples? Roy is the person who claims that 13.56 MHz radio waves (of which there are plenty in the ether) decomposes salt water into oxygen and hydrogen and ignites the mixture. If he were right all oceans would be afire.--Paul Wormer 08:55, 29 September 2008 (CDT)

"(...) it is pertinent to discuss the evidence suggested by the many scientists who deny water its ‘memory’. (...) They mostly concern arguments involving the ease with which hydrogen bonds between water molecules may break. Individual hydrogen bonds do not last long in liquid water (about a picosecond). Based on this one fact the opinion may be proffered that the mesoscopic structure of water must change on about the same time scale.

Such arguments are completely fallacious as is easily recognized if metal hydrates or solid water (ice) are considered. In the case of ice the hydrogen bonds also only last for the briefest instant but a piece of ice sculpture can ‘remember’ its carving over extended periods. Cation hydrates exist and are commonly described with particular structure (eg the octahedral Na+(H2O)6 ion) but the individual water molecules making up such structures have but the briefest of residence times (<microseconds).

What such arguments fail to address is that the behaviour of a large population of water molecules may be retained even if that of individual molecules is constantly changing. Such behaviour is easy to observe: a sea wave may cross an ocean, remaining a wave and with dependence on its history, but its molecular content is continuously changing.

The remaining evidence presented against the memory of water concerns whether water clusters may retain their organization for time periods greater than a fraction of a second. Evidence denying the long-life of such water clusters is generally based on computer modelling but also includes NMR and diffraction data.5 There are several good reasons why such methods would not show any significant clustering properties for liquid water.

Computer simulations only operate for nanoseconds of simulated time, although taking hours or days of real time. Such short periods are insufficient to show longer temporal relationships, for example those produced by oscillating reactions.6 They also involve relatively few water molecules (of the order of 100–1000 or so) over small (nanometre) dimensions, insufficient for showing large scale (not, vert, similarmicron) effects. They utilize models for the water molecules that are inherently flawed, showing poor correspondence to the real experimental properties of water (except for those properties on which they were individually based) and hence poor at predicting known properties and likely to be highly inaccurate at predicting unknown properties.7 NMR and diffraction both determine individual water molecules as structures averaged from throughout the sample (akin to averaging the world’s population of men and women and coming up with an illusory ‘average’ person) and are incapable of detecting imprecise and mobile clusters where components may change."

Martin Chaplin, expert on water structure, courtesy of Pierre-Alain Gouanvic 14:32, 29 September 2008 (CDT) (you can find this if you follow reference 2 in our article)

Why don't we quote Roy and also reference Chaplin, but also give Paul Wormer an opportunity to add something. However, Paul should not bring to this table other statements by Roy that deal with other subjects. I have no opinion or expertise on the fire and water issues, but let's maintain a focus here on THIS subject. Dana Ullman 19:10, 29 September 2008 (CDT)

Before I saw this reaction, I answered Pierre here. As I say there, this discussion saps my energy and obstructs me from writing other stuff for CZ, so I stop participating in it. Good luck with your superstition about liquid water, I find that it degrades the quality of CZ, mais c'est la vie. --Paul Wormer 05:01, 30 September 2008 (CDT)

Certainly this is not a homeopathic superstition, is it? Shouldn't it be in the Water article. Perhaps Paul could talk about it over there and then we can just link it here. I think this gets too technical for what I envision as an introductory article on homeopathy, as I expect this is why it was in a reference rather than in the article. D. Matt Innis 08:39, 30 September 2008 (CDT)

Famous People and Homeopathy

In the lead, there is reference to many famous people who use and/or advocate for homeopathy. Some of you may know that my newest book is a highly referenced review of hundreds of the most respected "cultural heroes" of the past 200 years, including literary greats, politicians, corporate leaders, clergy and spiritual leaders, sports superstars, musicians, artists, monarchs, and film/tv celebrities. For details, see: http://www.homeopathicrevolution.com/ (see the link to the Table of contents). See this review from a peer-review journal: http://ecam.oxfordjournals.org/cgi/content/extract/nen024 Due to conflict of interest issues, I will not add these references and will let others decide if it is worthy of inclusion. By the way, reference in the lead section is to the British Royal Family. This book has the most detailed chapter on the history of monarchs' involvement in homeopathy, and the Foreword to this book is written by Dr. Peter Fisher, the Physician to Her Majesty Queen Elizabeth II. Dana Ullman 22:21, 29 September 2008 (CDT)

I'm thinking that this is not the place. There are lots of celebrities that use all sorts of controversial cures, Steve McQueen comes to mind. It's another form of "appeal to authority" that I see as a distraction for an article, though as a marketing tool I'm sure it works well, but we don't want to go there. D. Matt Innis 08:52, 30 September 2008 (CDT)

I'm comfortable with selected historical references, uncomfortable with anything that might look like celebrity endorsement. I am happy with adding Dana's book to the bibliography list linked to the review and with a brief account of its coverage; I'll ddo that when I have the time (please forgive me here).Gareth Leng 08:56, 30 September 2008 (CDT)

That sounds reasonable, thanks Gareth. D. Matt Innis 09:00, 30 September 2008 (CDT)

Appeal to authority is when an expert of x says that we should believe him on y, when the link between x and y is not in fact clear.

What Dana has done is that he has collected a serie of case reports of people whose lives were changed by a therapy that they have no expertise on.

The large RCTs are heavily criticized for their lack of external validity, or lack of accordance with the principles and practice of homeopathy. A recent meta-analysis by the Lancet called for the end of homeopathy trials (it's all placebo! it's all water!); its transparency, methodology and interpretations were violently criticized and even mocked.

Dana, in response to this deadlock situation, brings the problem in the citizen's arena, with case reports which should have a sociopolitical impact and should appeal to common sense. He makes the case of clinical plausibility (while Roy, Chaplin and others bring the biological-physical plausibility in the citizen's arena as well. See my comments under the crystals section).

Of course, the fact that notable physicians and scientists "came out of the medicine closet" (Darwin, William Osler, Cushing, von Behring, etc.) and left a trace of their acceptance of homeopathy (and of its effects on their lives) is impressive (good marketing??), and can be taken as a fallacious appeal to authority. But none of these people contended that they had found how homeopathy works biologically or that it works (statistically) and that we should accept their expert opinion. They wrote or said, despite of the risks associated with such an endorsement, that it worked for them. I'd say those are very, very interesting case reports.

Because now, the mainstream scientific opinion is that they all experienced placebo effects motivated by pseudoscientific beliefs.

NB: We may find interesting things about the Flexner report and the dissapearance of homeopathy in America.

Pierre-Alain Gouanvic 00:31, 1 October 2008 (CDT)

There is a misconception here; the placebo effect has nothing to do with pseudoscientific beliefs; it is a strong, robustly demonstrated effect caused by suggestion or of expectation; exactly how the placebo effect works is not known, but that it is often a very significant effect is - which is why all drug tests must be placebo controlled. Gareth Leng 04:35, 1 October 2008 (CDT)

Sorry if I promoted this misconception. But my point here is that the the suggestion or the expectation, for these bright minds, is that homeopathy can't work. It is not true to say that the placebo effect has nothing to do with pseudoscientific beliefs: the expectations are often motivated by beliefs.

Let me point out as well that, no matter how significant placebos may be, they are often considered unethical, as I pointed out in the EBM page, because it's basically negligence. All drug tests must be placebo controlled? Controversial.

Those case reports may refute that we're dealing with placebos.

Pierre-Alain Gouanvic 12:31, 1 October 2008 (CDT)

In the course of making a general edit of the article, I've moved the list of "celebrity endorsements"--which, however interesting, is essentially what they are--to a footnote. This gives adequate detail for purposes of putting teeth on the general claim. My concern about having the long list in the article itself is that this seems to imply that CZ is very impressed that all of these people have, perhaps once, received homeopathic treatment. But, believe me, not all of us are. It's equally unimpressive to me that Nancy Reagan relied on horoscopes, and all sorts of very smart people (I remember one philosophy grad student--of all things--in particular) take them half-seriously.

One other point: we absolutely do need a source for such a detailed list of names--I'd ask Dana or someone to add that in. --Larry Sanger 13:33, 1 October 2008 (CDT) --Larry Sanger 13:33, 1 October 2008 (CDT)

Needless to say, we should all be honored that Larry is participating in this article. Thanx. Although I consider this information to be worthy of inclusion in the article itself and not just the footnote, I will let others decide this. This information is in part an "appeal to authority" but it is also notable history. Homeopathy has a long history of support from the most respected cultural heroes of the past 200 years, not just monarchs but leading literary greats, sport superstars, corporate leaders, world leaders, and on and on. My own father was a pediatric allergist and professor emeritus at UCLA, and although he was skeptical of homeopathy, he was impressed to learn that Yehudi Menuhin was the President of a leading British homeopathic organization. The bottomline is that we all use different information to determine whether something is worthwhile or not, and "scientific research" is not the only means to this end, especially since there are many barriers to good research (just ask any surgeon--surgery is not amenable to double-blind studies; and just ask any psychologist; let alone the limitations on availability of research funding).

Actually, my new book provides detailed references to each person mentioned in the footnote...and a lot of others. It may be more beneficial to not simply reference the website for this book but the book itself. I have no problem providing the information in the book, but I would prefer if someone else placed the specific reference in the article (it was published by North Atlantic Books, Berkeley, 2007). Because one of the amazing and well-referenced stories in the book is of Charles Darwin, I chose to provide some summary information at my website: http://www.homeopathic.com/articles/view,128 (If anyone here considers this worthy of reference in the article, I would prefer if he/she placed it there.)

For those people who wish to beef up this article, my new book is a veritable treasure trove of historical and modern-day information about homeopathy. See for yourself. Dana Ullman 17:50, 1 October 2008 (CDT)

Water Crystals

Does this have anything to do with homeopathy? We have to draw the line somewhere. Just because somebody thought of something doesn't mean we have to write about it - and more importantly - paint it as mainstream. These things take time. D. Matt Innis 08:50, 30 September 2008 (CDT)

Chaplin, Roy, Emoto, Wüthrich (a Nobel 2002 co-laureate (multidimensional nuclear magnetic resonance spectroscopy in the study the structure of proteins)), and others took part in a new documentary on water, Water: The Great Mystery, which is promoted by the What the bleep site. As most of us know, What the bleep (do we know) was a huge success, despite of the fact that it wasn't featured in most theaters (and mainstream science, evidently). It's a growing phenomenon, and it's causing great controversy.

If we choose to ignore this movement of citizen+expert (pseudo?) science, we decide that they're not bringing a paradigm that may better explain water and homeopathy. We may as well reject Roy and Chaplin's works, which are already rejected by mainstream journals (in the sense that they don't get a fair hearing or a right to properly respond; our colleague Dana received an answer from FASEB's editor which exemplifies my point quite well). Where do we draw the line indeed: Roy and Chaplin with Emoto in a documentary for the general public, not ok? Roy and Chaplin in the scientific community, ignored or misrepresented, ok?

I'm not assuming that you have already made your mind, Matt, and I understand that this contribution seemed far-fetched. I wouldn't accept it "as is".

I think that we need a philosopher of science. I will consult The structure of scientific revolutions, by Thomas Kuhn.

Pierre-Alain Gouanvic 21:20, 30 September 2008 (CDT)

As you say, the work is rejected in mainstream circles. We know that things are rejected that might subsequently gain acceptance; science in general does not claim that its theories are true, only that they are the best explanations currently available by their criteria. As editors we must seek to report facts and disputes neutrally, without appearing to take sides in disputes. Where appropriate, we report that a theory is not generally accepted (or is generally rejected) by science and medicine (as shorthand for the community of academic scientists and medics), if we are sure that this is the case. Scientists and medics get things wrong lots of the time and don't always agree with each other. Fringe theories can be covered on Citizendium, but their status should be clear and they should be written about neutrally, without editorial endorsement or denigration. If you want to cover a theory about the structure of water, it must also cover its status and any known objections to it that explain its status. I think this will be a diversion from this article, which is about homeopathy. Personally I think that this article would be better served by a simple acknowledgement that there is no accepted understanding of how homeopathy might work, that some ideas have been suggested (with references) but these are not at present accepted as adequate scientific explanations. Sometimes, the less said the better, especially where I don't think anyone would claim to be able to explain how homeopathy might work, any more than I would claim to know how placebos work.Gareth Leng 12:05, 1 October 2008 (CDT)

The debate on the scientific plausibility of homeopathy, today, as I quoted above (Chaplin answering to Paul) and emphasised both in the article and the talk page, is that

a)the establishment rejects as null and void the notion that water can retain anything (no memory of water, no long-term structures). It can be stated in two sentences

b)the other side, represented by mainstream researchers who went nuts / came to a high degree of sophistication, questioned the textbook assumptions that make the structure/memory of water look like a mere superstition.

This can be explained, but in more than two sentences and with several links to the water page and to several subpages that we may create. If this technique, which was used in Diderot's Encyclopedia to insert paradigmatic considerations, can be a middle-ground (between your less-is-better and my less-is-biased), so be it. The requirement is that this article must state clearly that the subpage is a scientific refutation that has not been addressed by the mainstream (a refutation which states that the assumption a) is, according to the evidence presented by b), not scientifically defendable).

This is in the best interest because those who think a), which makes the majority of CZ's potential readers, won't have to listen to what the mainstream circles don't address. But they will find the response, stated in all fairness to its degree of sophistication, if they want to.

I reiterate that Kuhn's work and philosophy of science may be useful. We do have 2 paradigms here. Materials science vs. molecular science. Mesoscopic vs. microscopic. Water vs. H2O. Things aren't that bad after all: both sides are not talking about the same thing.

A subpage for that as well?

Pierre-Alain Gouanvic 14:41, 1 October 2008 (CDT)

Actually, I'd suggest this was a whole different article not a subpage. In the context of the "homeopathy related articles" subpage above, that would be a subtopic. It would also be a subtopic of water (Water/Related Articles). Chris Day 14:55, 1 October 2008 (CDT)

literary greats and politicians

Why should we, or anyone else for that matter, be impressed by the assertion that "literary greats and politicians" have advocated for homeopathy? If you told me that Sabin, Salk, DeBakey, and people of that ilk practiced it I would be more impressed. Hayford Peirce 13:24, 1 October 2008 (CDT)

It is irrelevant as far as i can tell. Or is the idea that great thinkers do not denounce homeopathy? But being great in one field does not preclude ignorance in other unrelated fields. Actually, even being great in genetics does not preclude you being a dunce in biochemistry and vice versa. Chris Day 15:02, 1 October 2008 (CDT)

I'll wait a day or so, then remove it unless there are strenuous objections from others. Hayford Peirce 15:10, 1 October 2008 (CDT)

The other edit that is needed in the sentence is "Many well-known people, including literary greats and politicians, have used or have advocated for homeopathy..." They could have used it and found it worthless. Or have used it and found it fabulous and therefore now advocate for it. I've "used" that little red string on the Band Aid (R) pack and found it hit or miss, I've "used" the string on the old Quaker Oats (R) box and found it absolutely useless. I find that for me, a cold lasts seven days if I use Vitamin C and one week if I do not. Aleta Curry 16:28, 1 October 2008 (CDT)

I would strenuously object to the deleting of this information about the various respected cultural heroes who used or advocated for homeopathy. See my recent writing above under the earlier topic about famous people. I can also add: Facts are facts, and these facts are notable. As for famous physicians and scientists, the list of such individuals whose experiences or quotes are discussed in my book include: Charles Darwin, Sir John Forbes, Sir William Osler ("the father of modern medicine"), Emil Adolf von Behring ("the father of immunology"), Sidney Ringer, Charles Frederick Menninger (founder of the Menninger Clinic), August Bier (inventor of spinal anasthesia), Harold Randall Griffith (father of modern anesthesia), Royal S. Copeland, William J. Mayo and Charles H. Mayo (founders of the Mayo Clinic), C. Everett Koop, Brian Josephson (Nobelist). That said, it IS notable that so many literary greats, world leaders, and other cultural heroes used or advocated for homeopathy because such information suggests that homeopathy is some type of "new age" treatment or some type of "quack" therapy. While it may not be notable if there were only a handful of such individuals, it is helpful for people to know that so many cultural heroes used AND appreciated this often neglected and often misunderstood medical system. Dana Ullman 18:44, 1 October 2008 (CDT)

You don't explain why it is notable that a writer uses homeopathy, no matter how famous he may be -- why should we be impressed by the fact, say, that Ernest Hemingway, say, used it? Maybe William Faulkner used acupuncture. And maybe 60 other Nobel Prize-winning authors went to regular doctors. What do writers know about medicine? Or even about their own health? I used to know a lot of famous science-fiction writers, names on request -- I wouldn't trust their advice about medical matters as much as I would my internist's. Also, I don't know that we can take at face value citations that come from your own book. Hayford Peirce 18:59, 1 October 2008 (CDT)

In due respect, I do feel that I have explained why it IS notable when famous cultural heroes, whether they be literary greats, world leaders, clergy, corporate leaders, and other major people who have had a major influence on culture, have used or advocated for homeopathy. That said, there is a range of use and/or advocacy that varies from each cultural heroes. For instance, I have uncovered only one instance in which the Mayo brothers mentioned homeopathy in a mildly postive way, while most others listed above, including Sir William Osler, von Behring, Bier, Menninger, and Josephson have given many positive statements over many years. My point is also that smart and successful people who are not physicians still have their own experiences with homeopathy (and have their own intellectual appreciation of its system and its principles), and these experiences are valid, are notable, and have had an impact on culture. I am therefore curious how many of you have gone to the website previously mentioned...and then saw the one sample chapter that I placed online...the one on literary greats...see it here: http://www.homeopathicrevolution.com/pages/excerpt.jsp Enjoy it...it may even intrigue you to read more chapters...and to learn more about the richness of homeopathy's history and present status. Dana Ullman 00:38, 2 October 2008 (CDT)

Okay, I can't seem to get my meaning across to you. Let's try it this way. You start a list, or a Catalog (Larry would like that), of famous people, writers, politicians, etc., who have either used, or tried, or advocated for homeopathy, you can mix them all together, I don't care. Maybe some of them used it and subsequently died, but I won't worry about that. You make your list. And then I'll make my list -- of all the thousands, hundreds of thousands, and even, dare I say, millions of famous writers, actors, politicians, sports stars, etc. who haven't used homeopathy. Out of 40 U.S. Presidents, say, are there two who have advocated for it? If so (and I seriously doubt it), that means that there are also 40 or so who haven't. You cite Boris Becker, the tennis player -- I could cite a hundred other tennis players, all of them equal to Becker, more or less, who haven't used it. Can't you see that this is a fatuous argument. If you must, start a Catalog on a separate tag at the top of the page and list all the people you want. Just as long as this long list of totally irrelevant names isn't in the article itself. Hayford Peirce 22:47, 2 October 2008 (CDT)

Hayford, first, please avoid the exaggerated exasperation of me not understanding you. I understand you, but I simply disagree. Most (not all) of the people in my book went out of their way to advocate for homeopathy. That is notable. If you have a list of cultural heroes who have equally strong positions against homeopathy and have gone on record for doing so, that can be notable. The fact that many other tennis players used some other medical treatment other than homeopathy has no place in this article, and your suggestion that it may have a place is flippant. Let's take each other seriously and work collaboratively. You're working a lot now on this article. I hope that you are beginning to educate yourself on its principles and methodology, its history and present status, and its clinical and basic science research. Homeopathy provides a real treasure trove of truly fascinating bodies of information and experience. Dana Ullman 23:12, 2 October 2008 (CDT)

Typical homeopathy consultation

This section should be greatly expanded, made another top-level section, and include information about what the patient says to the practitioner, how the practitioner examines the patient, as well as what typically goes through the head of the practitioner thereafter (how the homeopath decides upon the remedy), how the remedy is prepared and administered, etc.--and whether the practitioner ever refers a patient to a physician. There should also, in this section, be some critical remarks reflecting the views of mainstream medicine about what is going on in such consultations, and also some comparison and contrast between such consultations and regular physician consultations. Such a narrative would shed great light on the nature of homeopathy, I suspect. --Larry Sanger 14:45, 1 October 2008 (CDT)

Linked articles

The linked articles, History of Homeopathy and Homeopathic proving appear to have been imported from Wikipedia a year or two ago, and, except for Chris adding an image, don't appear to have had any substantive changes since then. As I understand the CZ rules on Wikipedia material, unless it is actively updated, it should be deleted.

The material in those articles may be in this main one. Are the links to them, or the articles themselves, still needed? Howard C. Berkowitz 15:53, 1 October 2008 (CDT)

It depends what our experts say. One of our approved articles, Barbara McClintock, has changed very little from the original wikipedia version. Chris Day 15:55, 1 October 2008 (CDT)

Accuracy and clarity, please

Hi all,

I find the opening sentence confusing, and I think opening sentences in CZ articles should be easy for the layman to understand.

I suggest simply 'Homeopathy, or homoeopathy, is a system of alternative medicine Its practitioners, called homeopaths, intend it to be a therapeutic method.' Then go on to explain the method of using small doses of drugs, blah blah.

Also, in reading the Note no. 6, I was directed to an advertisement for Dana's book. Now, I have no problem with Dana quoting from his own work if it is definitive on the subject. My problem is that the cited reference does not reflect what the note says that it does, specifically, that the British Royal family has advocated homeopathy since the 1830s. Such a broad and bold statement should be accompanied by specific examples. A simple (even factual) statement that HRH Royal Name is Patron of the Society for Better Widgets does not cut it, as the Royals patronise a great many societies in which they may or may not have any expertise.

This makes me question the validity of other notes, without having the least bit of interest in examining them all for accuracy. I feel that readers should not question the validity of CZ notes, that sort of thing makes us lose credibility very quickly.

Aleta Curry 16:20, 1 October 2008 (CDT)

Aleta, I agree that you that the opening is not good. Just as the article on acupuncture doesn't need to say that people who practice acupuncture are called acupuncturists (this is somewhat obvious and is unnecessary for the 1st paragraph), the 2nd sentence is useless...and the 3rd sentence is insulting and has no meaning. I will take a stab at rewriting this opening and am open to feedback.

It seems that Aleta has not read my book or may not have seen some of the above comments about it, but the chapter on monarchs in this book is the most definitive body of information on the use of homeopathy by monarchs presently available. The fact that the British Royal Family does advocate for homeopathy and has a long established history of doing so is notable. They choose their subjects of advocacy very carefully. As for "expertise," Prince Charles was the President of the British Medical Association. You seem to be seriously under-estimating his and others expertise. It seems that you are suggesting that only "medical doctors" or "scientists" are experts on health subjects, when, in fact, they are like our President Bush, a politician who uses "select intelligence" rather than real intelligence. Please correct me if I'm wrong, but isn't one of the differences between wikipedia and citizendium that CZ is written by experts, while on wiki, experts are often considered to have an "conflict of interest." Dana Ullman 19:05, 1 October 2008 (CDT)

Aleta, thanks for the critique! We need more, so keep it coming. Dana, don't take anything personally, these guys don't bite ;-) Do rememeber, it's not written by the experts, it's gently guided by the experts. That doesn't mean authors have to be gentle, just professional. Of course, that also includes experts that disagree, even in their own fields, much less the controversial ones. But, that is what should make a collaborative effort more credible, if you don't implode :-)

D. Matt Innis 19:40, 1 October 2008 (CDT)

I have really tried to stay out of this, but citing Prince Charles as qualified to comment, because he has been president of the British Medical Association -- an honorary role -- is as plausible as saying Her Majesty Queen Elizabeth II is qualified to compare the AS90 and M109 155mm howitzers because she is current Colonel-in-Chief of the Royal Artillery Regiment. For Aleta, the Queen might really have a conflict of interest, since she is also current Colonel-in-Chief of the Royal Regiment of Australian Artillery.

The second paragraph of the lead comes across as sneering at "mainstream physicians". A point I have made, and Gareth has observed as well, is that there are types of randomized clinical trials that are highly appropriate and statistically valid in dealing with individualized medical testing, as in pharmacogenetics. That which is being tested in such a trial is not the "remedy", but the means of selecting the remedy in a statistically significant group.

There's also a continuing suggestion that randomized clinical trials are necessarily placebo controlled. This is simply not consistent with current principles of medical ethics, as articulated by the World Medical Association current version of, and commentary on, the Declaration of Helsinki. I offer some analysis in the article I wrote here on informed consent. If there is a recognized medical treatment for a condition, then the control arm will receive the "gold standard" treatment, not placebo. See point #29 (and footnote) at http://www.wma.net/e/policy/pdf/17c.pdf.

Dana, I do not claim to know, in detail, how a homeopath approaches a consultation or treatment. I would, in turn, ask the homeopaths to stop characterizing what people in medical sciences think and do. There is not the slightest question that at the time of Hahnemann, no one had a particular idea of molecular medicine, so suggesting Jenner's 1796 work on vaccination as somehow justifying 21st century ideas of immunologic theory, in my mind, is questionable.

I will again give my opinion, formed, in part, by nearly 40 years of analyzing physician communication in order to build clinical decision support software, that words as basic as symptom and diagnosis are being used quite differently by homeopaths and contributors with a background in conventional medicine and medical sciences. Too many errors, in conventional medicine, come from imprecise wording; much current work in reducing medical error is focused just on confusion caused by misunderstood terminology.

May I suggest that this article would be more valuable if the sneering were reduced, and, to take Larry's suggestion, do things like detail exactly what is done at a homeopathic history-taking, consultation, or whatever the correct word or phrase is done at a professional encounter? I assure you that anyone experienced in medical history and physical examination, even without getting into specialized areas, could give a quite specific, organized description of what happens in a first encounter. Howard C. Berkowitz 21:24, 1 October 2008 (CDT)

I don't know what Prince Charles has to say about homeopathy but this summer he had the following to say about GM crops. "the biggest disaster, environmentally, of all time". He also said that biotech corporations are "conducting a gigantic experiment with nature, and the whole of humanity, which has gone seriously wrong". This sensationalist, and frankly ignorant, kind of comment is exactly why we should ignore celebrity testimonials. Chris Day 21:48, 1 October 2008 (CDT)

He's also well-known for his (expert, hehe) views on architecture. They can be mentioned prominently in any architectural articles that CZ generates. Hayford Peirce 22:55, 1 October 2008 (CDT)

See also my new comments above in the section, Literary Greats and Politicians. The bottomline is that it IS news and therefore noteworthy when certain cultural heroes speak on certain subjects...history is made by such actions, and these advocacies play a role in culture. When just one or a handful of cultural heroes express support, it may not be noteworthy, but when larger and diverse groups of cultural heroes do so, it is once again noteworthy, especially for bodies of information like CZ that seek to be encyclopedic. Lord (and others) know that the sources of our information must not just be reductionistic science but more comprehensive sources too. Dana Ullman 00:50, 2 October 2008 (CDT)

An impressive list. Some very great people on it, but I'm afraid I seem not to be finding something. You remind me, though, that everyone on that list deserves at least a stub article, and I shall create those; for that I thank you. Indeed, I am familiar with most; I had already contributed to the Osler article, and started the Bier and Griffith articles.

• Sir William Osler, (1849-1919). Certainly one of the greatest healers and teachers of history. The textbook he started, teaching the art as well as science of medicine, is still being updated today. Those updates tend to be more in the science than the art, because in Osler's day, there wasn't very much science.
• Auguste Bier (1861 - 1949); invented spinal anesthesia and intravenous regional sympathetic block
• Harold Randall Griffith anesthesiologist; introduced total skeletal muscle relaxation for surgery in 1942
• C. Everett Koop(1916-) pediatric surgeon and U.S. Surgeon General
• Brian Josephson (1940-) Nobel laureate in Physics

I had not known that Griffith and Bier had homeopathic as well as allopathic training, and I have personally experienced both the Bier block and the muscle paralyzation (well, I was already unconscious for the latter), but watched the surgery for decompression of my right radial nerve with no pain control other than the Bier block.

It concerns me, however, that you cite very good physicians who did most, or all, of their work before there was any molecular understanding of the drugs they used. Curare, lidocaine, ethylene, and guanethidine are certainly not used in homeopathic doses. Curare is obsolete in medicine, because, years after Griffith's work, enough became known of the molecular pharmacology involved that much better agents could be synthesized.

So, I'd be far more likely to agree that homeopathic training was key to their success. Literally, they did not know the principles by which their drugs worked; much of the theory was developed decades later. Now, if you were to quote contemporary physicians that have been trained in both homeopathic and allopathic techiques, and can use molecular medical principles if they choose, I'd be much more impressed than by work done no later than the 1940s.

I'm afraid these come across as an appeal to authority, but without enlightening the value of homeopathy. Could you provide some current physicians as respected in both fields? Howard C. Berkowitz 02:06, 2 October 2008 (CDT)

Perhaps this information is more responsible for popularity. Maybe as long as we write it in such a way as to qualify that these people may have helped make it popular, but making it clear that this doesn't add validity to it's usefulness would help the reader understand how something that medical science does not support can be so popular. I also think that, in order to protect the integrity of CZ, rather than citing Dana's book, we cite the sources that Dana uses in his book and put Dana's book in the bibliography. D. Matt Innis 07:40, 2 October 2008 (CDT)

Matt, that's a good way to handle it. To take something that I consider a U.S. shame in conventional medicine, consider direct-to-consumer ads for prescription drugs, and now medical devices as specific as a coronary stent. Interventional cardiologists are much troubled by conflicting large trials about whether to use stents, and if so, what kind of stent. I follow the literature fairly well, and the issues are extremely complex. I doubt many of those cardiologist could coach a winning football team, so why is a football coach (and a good one) pushing complex devices?

I think it's perfectly fair to say that some of these outstanding physicians were formally trained in homeopathy as well as allopathy, but to make clear that much current relevant theory — not clinical trials, but the conceptual models that came first — I cannot see much similarity between the action of what is seen as a preparation that helps the wisdom of the body, and a drug that paralyzes the wisdom of muscles required for breathing.

Apropos books and such, if I might make a suggestion that I use for my own published material. Even when I cite public domain peer-reviewed publications, I try to mention that on the talk page to avoid the suspicion of conflict of interest. If I quote from one of my commercially published books, it's usually a very specific illustrative point. When I mention my books in a bibliography subpage, I make a point of including potentially competitive ones, although it's a narrow subject. In some cases, when I had an illustrative and funny example, I paraphrased it and put it on a signed articles subpage. Just some thoughts that I think help CZ credibility. Now, there were times at The Other Place when I kept correcting an error, and finally cited the definition in a peer-reviewed, public domain technical specification of which I was an author or coauthor. History is a little softer to use than explaining the difference among an Internet Service Provider core router and an interprovider border router and a customer border router. In the latter case, I was not speaking of history, but of current research in which I was involved, and was accepted in peer review. Howard C. Berkowitz 11:36, 2 October 2008 (CDT)

Activity today

Good to see lots of good activity today. I know sometimes it looks confusing, but after re-reading, I think the net movement was good. I agree with Larry that the section about the homeopathic consultation could use some expansion so we can know what to expect; do they treat cancer? Do they use MRIs? Do they refer?, etc.. I was afraid we'd open a bag or worms with the "name dropping" and I still don't think it belongs in this type of an article, other than perhaps a brief mention - I know the Prince of Wales made a speech in which he advocated the increaseed usage of homeopathy, so that is probably important for many reasons. The rest is just good advertising (though I raised a brow when I saw C. Everett Koop - the past US Surgeon General), so I guess there is some value there.

There are several places where the same concepts are repeated in section after section, so some consolidation might be in order. Remember that sometimes less is more. There is no reason to say things more than once; it is more important to place it so that the ideas flow in order and questions are answered even before the reader thought to ask them. In particular, there are several places that pronounce that Hahneman developed it.... and several places that the memory of water concept is explained again and again. If I am reading this article all in one sitting, I only want to read that once.

Hope this helps. How close are we to approval? D. Matt Innis 19:33, 1 October 2008 (CDT)

Interdisciplinary cooperation

It's worth repeating two things about randomized clinical trials

• They are not always placebo controlled (see informed consent) if there is a recognized treatment
• They can be adapted to individualized treatment.

Could we agree on a term, acceptable to homeopaths and people involved in "the other side", to describe a clinical trial adapted to individualized treatment? This is, for example, something that is being done in pharmacogenetics, where treatments are selected based on an individual's genetic coding. If so, I'd like to develop an article that discusses the methodology of such trials.

An issue that may have hurt homeopathic trials of the past is that that large trials of the path used a broader separation by major diagnosis. Just as placebo control is not always appropriate,

What such a trial tests is not necessarily the drug/remedy, but the method used to assign patients to categories of treatment. Cruder versions of such methodology might subdivide, for example, breast cancer patients into premenopausal and postmenopausal. An area where I've participated in some research is the first drug to be used for high blood pressure: there are 3 or 4 choices, all of which are roughly equivalent in the general population. When one starts looking at pre-diabetic states or active diabetes, pregnancy, and possibly ethnicity, the choices are not equal.

In other words, the trial is not examining whether a thiazide diuretic or a beta-adrenergic receptor antagonist or a calcium channel blocker or an angiotensin-II converting enzyme inhibitor is effective against early hypertension. We know they all are, in a large population. What we don't know, but strongly suspect, is that there are subpopulations where each class would be a best or worst choice. What is being tested is the ability to recognize the subpopulation, not the remedy.

If homeopathic treatment is such that every patient of every homeopath will get completely different treatment, there's no way to test the treatment; there's no way to compare it. I really doubt that is the case. What is true in medicine is that first nothing was available for women with metastatic breast cancer, and then a few randomly selected protocols (e.g., CMF, 5-drug Cooper), but now the clinician checks menopausal status, the presence of the BRCA2 gene, receptor sensitivity, etc. With some, but sadly not all, subpopulations, it is possible to say "there's a good chance you will die of something other than breast cancer."

Competent physicians constantly improve methodology and throw out ineffective treatment. So far, I'm hearing testimonials going back to the 18th century, and some possible means of water memory that, as yet, have no linkage to biological mechanisms. I think we can all do better than that, right here. Howard C. Berkowitz 14:20, 2 October 2008 (CDT)

Urgent

Sorry to interrupt, Howard.

I recently edited the plausibility section (see here). Paul Wormer, who has left the discussion and the article, told us: "Good luck with your superstition about liquid water, I find that it degrades the quality of CZ, mais c'est la vie."

Now, I received an important email which has an incidence on these recent edits. I won't discuss these personal matters, but I can, however, provide an example of what is expected from me: before; after

My recent edits of the plausibility section I was talking about will receive the same treatment, since they were also (my own honest) attempts to adapt Paul's contributions.

I will let editors take care of my "superstition about liquid water". My conscience dictates that I should not obey and revert what I just did (it was before I received this email).

If editors agree that discussing and editing with me is a waste of time, energy and a regression for CZ, well, be assured that I'll know how to professionally and politely deal with all this. CZ will remain the most promising project because it welcomes and respects experts. All experts.

Pierre-Alain Gouanvic 16:13, 2 October 2008 (CDT)

Help me understand what is at the links you gave, and how you'd like it regarded. I'm especially confused about the link, in the bibliography part, which links to the home page of a journal, Materials Science Innovations that describes itself as

Because of its super peer review procedures, the journal is especially suited for the publication of results which are so new, so unexpected, that they are likely to be rejected by tradition-bound journals

The journal is produced by Maney Publishing UK, but I get link errors trying to go to Maney's home page or "about us". Their jobs page does seem to work.

Please correct me if I misunderstand, but is this journal, its review process, and the specific paper by Roy the key thing that you think is relevant to the CZ homeopathy article, or am I taking that out of context? This journal claims to have a nontraditional peer review process, and, while this is not the place for it, I do believe, especially in the U.S. and with its funding conventions for research journals, there are some systemic problems to address.

Increasingly, though, I'm confused on the role of detailed discussions about new theories about the properties of water in an article on homeopathy. Let me try an analogy. In 1929 or so, Sir Alexander Fleming published a paper saying a substance, later called penicillin, inhibited the growth of Staphylococci in culture plates. During WWII, it was tried in people. It was a good deal later when the molecular activity of penicillin, in interfering with mucopeptide synthesis in the cell wall of bacteria, was understood.

Today, however, if one publishes an article on a new class of drugs, both the structure and unusual properties are discussed, but it is also expected to explain how these characteristic affect specific biological subsystems at a molecular level: they interfere with the synthesis of some protein, or sensitize a cellular surface receptor, or increase intersynaptic levels of a neurotransmitter by blocking reuptake.

Let's assume that all manner of unsuspected properties of water have been identified, and in thoroughly reproduced experiments in reputable journals. I do not, however, then see how this maps to those properties have specific effects on human cells that have a health benefit. That is where I lose the thread of what things from physical chemistry have to do with homeopathic medicine.

What am I missing in your rewrites? I'm also confused about what qi means in this context and why it is significant. Howard C. Berkowitz 16:52, 2 October 2008 (CDT)

(apologies for indentation changes and inline comments; tell me if you hate it and I'll go back to the traditional way. Inline, with signatures, is something I find to reduce the size of talk page posts)Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

a very short answer, for the reasons explained above

qi: it's Paul's contribution.

Roy's paper: like Chaplin's, its a bone of contention (skeptics of homeopathy discuss these papers)

biological mechanisms: I have begun to address this, after Gareth's intro (in water in living systems). My addition is... judge for yourself. For more on this, you can read Dana's work. (keyword: nanopharmacology)

Pierre-Alain, I cringe a little every time I hear the phrase "skeptics of foo"; it has a negative connotation, to me, as "unbeliever", or, when used in a very similar context in theological discussions, can imply "sinner who will go to the Pit if they do not accept the True Faith." Will you bear that in mind? I certainly have scientific disagreements with colleagues, even with a largely shared context. I don't speak of "skeptics" of link state routing or clindamycin for certain infections. I hear their arguments and often agree to disagree, or agree on specialized requirements for both. Your use of "skeptics" suggests anyone that does not accept homeopathy, at least to the extent one accepts conventional medicine, is wrong and needs to be converted to the True Way. Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

peer review, super peer review, etc.: we need a section on the difficulties associated we publishing in mainstream journals when dealing with homeopathy. See Dana's recent responses in this talk page (and mine). I also put useful references in the bibliography subpage, a long time ago).

Pierre-Alain Gouanvic 18:07, 2 October 2008 (CDT)

We? It would be more accurate to say that advocates of homeopathy have difficulty publishing in mainstream journals, and the entire peer-reviewed journal process deserves its own article. Sometimes journals reject things for good reasons, and sometimes for bad. Two people named Barry J. Marshall and J. Robin Warren won an all-expenses-paid trip to Stockholm to accept the 2005 The Nobel Prize in Physiology or Medicine for their discovery of "the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease". Earlier, what is perhaps the most prestigious single journal, the New England Journal of Medicine, rejected their paper. I haven't stopped reading the NEJM as a valued source. In this case, they continued submitting and presenting, until their work was considered the standard in the diagnosis and treatment of gastrointestinal disease. In general, however, I find the peer-reviewed system is generally fair, and, so far, I have not seen here the level of correlation among cellular mechanisms, molecular pharmacology, and clinical correlates that would meet the standards needed to publish a report on a new class of antibiotics.

Be very, very careful in assuming that CZ is an appropriate place for homeopaths' arguments that the medical establishment discriminates against them. I am hearing a great deal of desire that this article take such a position, or that the article should assume that homeopathy works. In contrast, look at biogenic amine receptor. It's still very stubby, but that would be the sort of structure I'd need to see for any serious proposal to accept a given class of medicine. Second-generation antidepressant is even stubbier, and, while there is solid evidence that certain of the drugs often work for certain of the conditions, that article needs its place for "skeptics" about there being alternatives, safety issues, and their use for conditions other than depression. Filling in the gaps in an article like that seems more core to CZ than being a place of argument about lack of faith in a paradigm that, other than believers, seems to be lacking quite a few details of how and why it works. You haven't said it to me, but comments such as "you can't know it until you try it" are pure emotional arguments and, IMHO, do not belong in CZ. Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

There are quite a few issues of the scientific journal publication process, many which have nothing to do with homeopathy. In principle, for example, work done under U.S. government funding is public domain, but most journals are not online and are very expensive. Just having the authors put their work on webpages, however, doesn't deal with the review process, which is where a good deal of the journal subscription cost goes. There's no simple answer.

If you wanted to have a sentence or two in this article saying something like "non-mainstream fields, including homeopathy, may suffer from problems in the peer-reviewed scientific publication process", I would not object, and I would help write an article on the process. That the process may be hostile to homeopathy, however, is an editorial comment that belongs in this article only if sourced or as a signed article.

The purpose of this article is to describe homeopathy, and, reasonably enough, to describe there is resistance to it in mainstream journals. I do not see it as remotely appropriate to CZ to have the homeopathy article arguing that the scientific establishment is biased against homeopathy. Stating that, with a source, is acceptable. Arguing the point is in no way neutral.

In this specific matter, there is also a huge gap that has not been bridged. Assume that peer-reviewed journals had agreed to everything about water memory. Just as a medical journal will normally want an explanation of the molecular pharmacology of a new drug, I believe it a reasonable editorial standard to say "if water memory causes homeopathic effects, the way water changes biological effects is XXXX." I have not yet seen anything beyond "well, homeopathic preparations may alter water", and "there are theories about water memory". Unless there is a clear connection between the two, it isn't even original research, but guessing that doesn't belong in a CZ article. Howard C. Berkowitz 18:35, 2 October 2008 (CDT)

Approval?

Matt raised the issue of approval, I think rightly. I believe that it is important to focus on what is needed to make it possible for this article to be approved speedily, to avert the danger that it becomes an andless drain on energy. Some issues are best delegated to other articles where they can be developed in a more leisurely and considered way.

My view, for what it is worth, is that the issue is not whether homeopathic remedies work, there is I think probably quite wide acceptance that they might work at least for some people in some cases. The issue is rather why they work. Scientists such as myself believe that they probably work via the placebo effect; i.e. the phenomenon that when people expect that a treatment will work, an expectation strongly bolstered by the confidence and authority of the physician, then often there is an improvement in reported symptoms. The belief that the placebo effect is responsible is part a reflection of the robustly demonstrated power of suggestion in many cases, and part a reflection that no explanation of alternative mechanisms has come close to convincing scientists or medics generally as being plausible. There have been many suggestions of possible mechanisms, as far as I can see they either involve proposals that the homeopathic remedies are contaminated in some way (clathrates, silica particles), or that they do contain some active material (in the case of low potency remedies only, i.e. not strictly homeopathic), or they involve some alteration in water structure (generally discounted but a topic still under some consideration). An alteration in water structure would not comprise an explanation, as the really key issue remains, of how a change in water structure could be detected by a biological mechanism, and how that detection mechanism might be coupled to adaptive biological responses. With no explanation for the latter, a change in water structure is not an explanation of the efficacy of homeopathy, but is simply an assertion that homeopathic preparations might be physically different from pure water.

I will later suggest some changes that I think are needed to contemplate approval.Gareth Leng 04:40, 3 October 2008 (CDT)

Has anyone heard that saying that a true sculptor is the one who can look at a block of stone and see the figure that needs help to come out? At present, this article is a block of stone, perhaps with some odd rocks stuck to the outside.

Seriously, there is a good deal of material that might both support (or not) homeopathic ideas, which either has enough non-homeopathic information to stand and develop on their own, or have gotten so convoluted here that their relationship to homeopathy proper is vague. The structure of water is the best example; there are others. I'll come back.

I'm going to hypothesize that this article were about the only kind of medicine that was practiced. If so, one of the first things that would be explained is the scope of practice of homeopathic physicians, what cognitive processes the physician uses at the first encounter in coming up with a plan, and the process of continuing care. There is very, very little about the first. For example, a patient presents from an auto accident, with multiple long bone fractures, a traumatic amputation of the left hand below the wrist (clean, and someone brought along the hand), looking "shocky", and let's say a BP of 70/30, a hematocrit of 19%, is having trouble breathing, and reports having been kicked in the chest. What does a homeopath do here? Does the homeopath treat this, or call for a trauma surgeon? A boarded emergency physician, incidentally, would do immediate stabilization, probably do additional chest examination, FAST ultrasound, and at least PA and lateral X-ray views of the chest, if not spiral CT. There would be no question that the patient needs to be under the care of a trauma surgeon. What is the role of homeopathy in such a situation?

If it would be constructive, I can describe several other scenarios, both of chronic complaints and things that would be considered life-threatening, and try to help elicit "what would a homeopath do?" This is not a trap for homeopaths; if they have some means of handling major trauma, then it would be a great opportunity to explain what it is.

For the non-emergent situation, I suspect both homeopathic and non-homeopathic physicians do something along the lines of history and physical. To me, it is apparent that the two groups do not use terms such as symptom, diagnosis, sign, drug, etc., in the same way. If consistent definitions are not possible, we need to find unambiguous words so a medical person reading the article does not say "nonsense, that's not a symptom." That person can, instead, say "OK, this is how the homeopath takes a history and decides on examinations and tests."

Rather than to into the esoterica of water, I think it is fair to say that homeopaths do not understand, in a scientific sense, how their treatments affect molecular biology, the standard in conventional medicine. Nevertheless, I would be willing to say that there is a good deal of case reporting that says homeopathy may be useful for some things defined in a way a non-homeopath would understand, and then talk about what would be done.

Popularity is not really relevant. Accurate numbers of homeopaths and patients that see homeopaths for all of their treatment would be informative. It's fair to say that homeopaths have difficulty getting their work into mainstream journals, and then link to an article on mainstream biomedical journal reviewing and publication, which has issues separate from homeopathy.

Neither homeopaths nor pharmacogeneticsts' approaches are handled well by the basic randomized clinical trial of a treatment, but I suggest -- and some of this may be appropriate for a more detailed article -- that linkage to an article on emerging trends in clinical trials may be useful. Just as one aside, there seems to be a littile misinformation on RCT's; all are controlled but not all are placebo-controlled. Split off an article about attacks on homeopathy, simply because it leads to emotion on all sides and gets away from the core information needed here.

I have other ideas, but I will merely mention one and then stop going on for too long. Hormesis is a part, I believe, of the broader disciplines of dose-response studies and pharmacokinetics. There are totally non-homeopathic situations in which issues that could be considered hormesis come up. I believe that a separate article or set of articles, linked from here, would work much better from an editorial sense that produces multiple values of articles, not one fight. Howard C. Berkowitz 07:51, 3 October 2008 (CDT)

I disagree with Gareth's suggestion that we need to understand the mechanism of action for homeopathic medicines before we can consider seeking approval of this article. Aspirin was used by doctors for almost a century BEFORE there was any understanding of how it worked, but I do not know a single doctor who chose to not prescribe it due to this deficiency. Further, the explanations for how and why drugs work change decade to decade, and in this light, having an explanation does not mean that this explanation is true. I have no problem acknowledging that there isn't at present consensus how homeopathic medicines work, but we can and should acknowledge that there are several plausible hypotheses. As for attacks on homeopathy, there IS a place for this part of homeopathy's history in THIS article. That said, we should not dwell on them. Dana Ullman 12:52, 3 October 2008 (CDT)

Gareth never said we need to know the mechanism before the article is approved. I interpret his comments as saying we need to remove attempts to describe the mechanism when there is little or no evidence of their relevance to the topic beyond speculation. While there are hypotheses out there we do not need to describe them in detail, and maybe not at all, especially when there is little quality work out there. See Gareths comments below for his specific points re: specific experimental data that is cited. Chris Day 13:27, 3 October 2008 (CDT)

That's right Chris, I'm sorry to have misled you Dana. My feeling is that it's better to say briefly that we don't understand some things than to get into what are really rather flimsy speculations that seem to sound profound but which fall apart rather readily. There's nothing to be feared from declaring that some things are not understood; believe me, I'm a scientist and there's plenty we don't understand.Gareth Leng 17:06, 3 October 2008 (CDT)

I think you all just said the same thing, so I think we are on the same page. I agree that it is not our purpose to prove or disprove homeopathy here, we just report the reality of what it is. It's an alternative system. That means it is not part of mainstream, likely because there is no plausible explanation other than placebo - which Pierre points out is unethical for conventional medicine to use. If there were a plausible explanation and if the RCTs proved its validity, then it would no longer be alternative and this would be a part of health sciences instead of healing arts. That says nothing about its value either way, it is not for us to decide. I am quite sure that homeopathy is the best treatment option for someone out there. I also agree that what we really want to know is how a homeopath decides what he/she is going to use.. and yes, is there ever a time when they would not treat, or refer? In other words, do homeopaths consider that homeopathy has a niche, or is it a panacea for all ills? I do think the science is important and all of these things have a place, but probably in articles of their own that we can mention and link to. Dana, is there anything else we need to include (anything that we are missing) before we would move to approve? D. Matt Innis 20:38, 3 October 2008 (CDT)

Let me start by saying that I could draft proposed language that, based on the information in the article, appears to be what you are saying are principles of homeopathy, from the standpoint of a homeopath. You'd be free to comment, revise, etc., but I'd like to try specifics to show where I am having problems.

No country of which I know requires understanding of the complete mode of action before approval. Most industrialized countries, however, require demonstration of safety and efficacy, and a number of countries, such as the U.K., also have strong initiatives to establish that a new drug is superior to accepted treatment. There is also an increasing tendency for Institutional Review Boards, which review the safety of proposed experiments in humans, to ask for more and more explanation of mode of action, but also potential dangers as would be suggested by molecular pharmacology.

Demonstrating efficacy is considerably more of a challenge, and I must again ask that some homeopath clarify terms and expand on the professional interaction. In conventional drug testing, which is agreed not to be workable for highly individualized treatments such as pharmacogenetics, efficacy is determined by testing the treatment against a randomized group of patients with a common diagnosis, and comparing the outcome with the current best treatment if one exists (placebo is ethical only if there is no treatment).

Correct me if I misunderstand, but it appears, from the article, that homeopaths do not accept the concept, as used in conventional medicine, of "common diagnosis". Patients do not have diagnoses, but have sets of "symptoms", which I put it quotes because I strongly suspect that homeopaths do not use symptom in the same way as is used in conventional medicine. I will reiterate that a major problem with acceptance of this article is that some seemingly basic words mean different things to homeopaths and medical scientists. Even differentiating between "homeopathic symptom" and "allopathic symptom" would be a good start. I believe a much more detailed description of a homeopathic consultation would go a long way in identifying and clarifying these apparent discrepancies.

I have previously suggested, and Gareth commented upon, that the randomized clinical trial approach proposed to test pharmacogenetic therapy would be suitable for testing individualized homeopathic prescriptions. I have not yet gotten any comment on that from a homeopath. Perhaps I have misunderstood, but I essentially hear that homeopaths don't want to be subjected to any form of randomized clinical trial.

Are you saying, however, that the standards of approval of all therapies should be at the level of which allowed aspirin to be used? Are you also saying that there should be the same level of hazard warning for homeopathic preparations as there are for aspirin, such its drug-drug (e.g., aspirin with anticoagulants) or drug-disease (e.g., asthma or gastrointestinal bleeding) or caution (e.g., benefits of aspirin specifically must outweigh the risks of Reyes' Syndrome in susceptible patients)? Do homeopaths support the idea of a centralized body, with all the problems they have, that serves as a registry of adverse events?

While the level of substantiation of claims on talk pages is lower than in an article, I would appreciate if you avoided sweeping statements such as "I don't know a single doctor who chose not to prescribe it..." Given aspirin was introduced in 1899, you could not know of all the doctors who made choices not to prescribe it. As I have mentioned above, there are significant reasons today not to prescribe it, just as there are specific indications to approve it. Howard C. Berkowitz 13:25, 3 October 2008 (CDT)

Yes, Howard, I get the impression from what I have read (Dana, correct me if I am wrong) that remedies are chosen strictly based on symptoms (what conventional medicine would call signs and symptoms as determined by what conventional medicine would consider something akin to a physical examination) without regard to whether a disease has been diagnosed or not. Remember, homeopathy was here long before Pasteur or Koch. The question is whether the system has changed since its inception to include the use of modern tools such, i.e. MRI/blood work/US. These would be interesting to know and help illuminate the reader as to the skills of the practitioner. Having said that, considering that some people who practice homeopathy are MDs, they likely use all the tools at their disposal, but we also know that some lay people are buying products in health food stores based on word of mouth or self evaluation using software, etc. So I think it's a little of everything.. Dana? D. Matt Innis 20:54, 3 October 2008 (CDT)

qi

Pierre-Alain Gouanvic wrote: qi: it's Paul's contribution. Although I had the intention to keep silent, this short sentence annoys me so much that I feel that I must defend myself.

Let me copy what I wrote to Pierre here:

You changed my wording on qi. May I remind you that I simply shortened the following sentence (p. 600):     [...] before and after implantation of “qi,” or intention, by Dr. Yan Xin, the best known of China’s Qigong grandmasters.

The page reference, p. 600, is to a page in the paper of Roy et al.. Previously, I had extended Pierre's summary of Roy's paper by entering this fact about qi. After seeing my change, Pierre inserted "putative", which is Pierre's interpretation. Roy does not imply in any way that the QiGong work is putative, hence this judgmental adjective does not belong in a summary of the paper.

I think Roy's paper is rubbish and one other citizen called the paper "utter garbage" (see my talk page). To underpin my opinion I want to point out that there are only four experimental figures on water in Roy's paper.

1. Fig. 4 is from a reputable journal and are experiments at 1 GPa (is 10,000 atmosphere = 145,000 psi). Roy et al. claim that shaking of water generates this kind of pressure so that this paper is relevant.
2. Fig. 13 is textbook material, disputed by nobody.
3. Fig. 16 originates from: Tiller WA, Dibble E, Kohane MJ (2001) Conscious acts of creation: the emergence of a new physics. Pavior Publishing, Walnut Creek. A magnetic field of the strength of the Earth's magnetic field changes the pH of water by 1 (makes water less acidic).
4. Fig. 17 (completely illegible and therefore useless) originates from Zuyin L (1997) Scientific QiGong Exploration. Amber Leaf Press, Malvern, PA. It supposedly gives the effect of qi on Raman spectra of tap (!) water.

I've tried to locate the last two references in university libraries in Holland, so that I could borrow them through Dutch interlibrary loan, they are not available.

Finally, the question arises: is the "homeopathic memory" of liquid water due to high pressure (shaking), weak magnetic fields, or qi? Roy et al. do not give the answer.

--Paul Wormer 05:07, 3 October 2008 (CDT)

Yes, Paul and Pierre, I appreciate your valiant efforts here to get to the heart of the cases for and against homeopathy, that is important. You have illustrated to all of us that we are talking about very minute forces, weak fields, and very theoretical concepts that are just not far enough along in the review process for us to be able to cite anyone in any authorative way as being related to how homeopathy might work. I have no problem with mentioning them here and then exploring them in separate articles - especially if the earth sciences and biologists could take a serious look at it, then we can link to it. D. Matt Innis 21:23, 3 October 2008 (CDT)

Beginning clean-up

• I've deleted the section on quantum mechanics. First, the text below had nothing to do with quantum mechanics. It described some reports of the biological effects of focussed electromagnetic fields on tissue growth. These interventions alter the electrical excitability of cells, with diverse effects depending on cell type. They seem to have nothing to do with homeopathy. The suggestion that homeopathic remedies work on frequencies is unclear to me (after reading about it) and certainly very unclear what these have to do with e-m fields. I saw no prospects of this section becoming acceptable I'm afraid, if there is something worth following up, I suggest another article is the place for it.Gareth Leng 07:25, 3 October 2008 (CDT)

• I've deleted the empt section heading on solitons. I looked them up and have written a stub soliton. I cannot see any plausible link to homeopathy; the claimed association of solitons with homeopathy appears to rest on some misunderstandings.Gareth Leng 07:52, 3 October 2008 (CDT)

• I've liooked up clathrates and written Clathrate. I can't see any link unless it is proposed here that the effects of homeopathic remedies reflect contamination, which I don't think is the case. I suggest deleting this from the present article, but perhaps the text might go to the Talk page of clathrate for incorporation there?

• I suggest deleting at least the second paragraph of mithridisation. I've added the link to the external links page and moved the reference so these would survive. I'd delete it simply because I could not make sense of it as written. I'm not saying that it's rubbish, only that if I can't understand the logic my guess is that others won't eitherGareth Leng 08:18, 3 October 2008 (CDT)

• I've looked up the silicate literature, see here PMID 11212084 PMID 11212083 and PMID 11212090 ([1]; "Experience has taught us that outstanding results are generally merely due to artifacts, of which the paper of Milgrom et al is a reminder"; J-L Demangeat and B Poitevin). On this basis I'd suggest deleting this section. Briefly, it seems that differences in NMR results achieved with homeopathic solutions and pure water seem to be an artifact arising from silicon chips displaced from the tubes containing the homeopathic solution. As far as I can see that is all there is to the silicate story. Gareth Leng 09:47, 3 October 2008 (CDT)

• Nano bubbles: I'd suggest deleting this section. I've looked at "Permanent physio-chemical properties of extremely diluted aqueous solutions of homeopathic medicine"[2]. First it doesn't mention nanobubbles. Second it reports that "The only clear and simple behaviour common to all samples, is the increase of the parameter χE as a function of time. an increase of [excess conductivity] over time" in solutions exposed to successive dilution and succusion. Most relevantly, this was true of dilutions of water as well as for dilutions of homeopathic remedies. Most irritatingly the abstract describes "some significant experimental results were obtained." As they applied no statistical tests whatsoever. They state that "Some differences appear to be related to the preparation procedure, and to depend on the degree of dilution or the method of dynamization, but the correlation is not yet clear." This work seems below my threshold of "worthy of serious consideration."Gareth Leng 10:31, 3 October 2008 (CDT)

I agree that these sections seem to drag on and don't answer how they are related to homeopathy directly, however, rather than deleting, how about consolidating them together in one short section on "explanations, past and present" or something like that. If homeopaths consider these as explanations, then they probably do need to be mentioned. D. Matt Innis 21:32, 3 October 2008 (CDT)

From a pure lower-case editorial position, if something is considered an explanation, it's reasonable to expect why it is considered a credible explanation. Either leave out the explanation completely, or have it reasonably tied into why it is credible, not "foobar explains and Dr. Foobar is highly respected". Again, I can't emphasize how much I believe this article would be improved by dropping the speculative water properties and getting into real fundamentals like the details of a homeopathic consultation and treatment plan, whether they have a niche and when/if they refer, etc. On this talk page, I repeatedly asked one homeopath, who said he used tests such as blood counts, to explain how the results affected his treatment plan — a question that any medical doctor should be prepared to answer. I am not holding homeopaths to a higher standard than anyone who can legally prescribe a test.

My grandmother thought that anything could be cured with enough chicken soup and enough seltzer. Both modifications of water, right? :-) Howard C. Berkowitz 21:44, 3 October 2008 (CDT)

If she grew up during the depression in the US, then it is likely that it was more water than chicken ;-) D. Matt Innis 22:22, 3 October 2008 (CDT)

Martin, please do not delete the sections on nano-bubbles and on clathrates. Let integrate some of Martin Chaplin's writings on these subjects. The shaking of the solutions clearly create bubbles and nano-bubbles. That is known. To clarify, the references provided do not mention bubbles, but they do show how homeopathic medicines influence thermodynamics...with two good references. Dana Ullman 12:36, 4 October 2008 (CDT)

Trying to understand the homeopathic model

I put up a first draft article of Koch's postulates, with modern modifications. Improvements are welcome. It is my hope that it could serve as a point of reference for elucidating some aspects of homeopathy I don't yet understand, and no, I'm not talking about remedies and water.

Am I correct, Dana (or whoever wants to take a crack from the homeopathic standpoint) that the basic idea of Koch's postulates is not consistent with the homeopathic model of diagnosing and healing based on symptoms? I note that homeopaths and non-homeopaths may use "symptom" differently, but I think we would get a lot farther on the article by articulating homeopathic diagnosis and treatment planning than arguing about the physical chemistry of water.

Really, I'm putting aside the Avogadro issue. My biggest problem with the article is that I do not have a clear idea of how homeopaths, with modern diagnostic tools available, evaluate a patient and form a course of therapy.

For that matter, there has been no discussion at all about how homeopaths deal with trauma. Would a homeopath treat, refer, or collaborate with a multiple gunshot wound victim, with a compound fracture of an extremity, a bullet entry wound in the chest (and the patient is having difficulty breathing), and entry and exit wounds through the intestines? Howard C. Berkowitz 19:01, 3 October 2008 (CDT)

I hope you saw my answer in two sections above. I would suggest putting your finger in the holes and yell "MEDIC"! :-) D. Matt Innis 21:36, 3 October 2008 (CDT)

Yes, but it was my mother who grew up during the Depression. I must thank her for teaching me to be an excellent cook: with her cooking, I took it over when I was about 11. The Depression recipe that was most common was her elder brother's favorite sandwich: chill Campbell's Condensed Vegetable Meat Soup until firm, cut slices, put on Wonder Bread or equivalent, and perform an act reminiscent of eating.

A little more seriously, since some of my work has involved decision support and patient simulation in emergency and trauma medicine, I'd act in various ways, depending if I were in the role defined as a layman first responder, a paramedic licensed for Advanced Trauma Life Support, or the leader of the trauma team in the receiving ER. In the latter two roles, after doing a very fast primary survey, one of the first steps would be respiratory support. It would not be appropriate to describe the primary surgery, or the first steps in definitive care, but, perhaps ironically, one of the first steps would be rapid sequence intubation (RSI), a good part of the anesthesia portion being an update of the curare work by Harold Griffith, physician with allopathic and homeopathic training. First starting oxygen, then pretreatment with fentanyl, lidocaine, atropine, and a defasciculating dose of a nondepolarizing neuromuscular blocking agent such as rocuronium, none of these in homeopathic doses would precede anesthesia, full paralysis, and tracheal intubation. Slamming in an ultrashort-acting anesthetic such as etomidate, followed by a paralyzing agent such as the depolarizing agent succinylcholine or a full dose of rocuronium (there is discussion on the best choice — dare I say randomized controlled trial?[3]]. Once the patient was anesthetized and paralyzed, an appropriate tube would be inserted in the trachea, connected to oxygen — and then (virtual) I would start secondary assessment, knowing the patient is not going to asphyxiate while his chest injury is assessed in more detail.

I'm really not trying to show off here, but make a point that someone oriented to conventional medicine can explain how they decide what to do, in what order, and, in the example above, can usually describe molecular mechanisms for every drug above, and the anatomical/surgical reason that the RSI (including preoxygenation and IV access) would come first. I can go write an article on assessment (physical at least; hard to get history from an unconscious patient) in a trauma emergency. There are a host of other things that would be going on around that patient, such as very controlled fluid support following permissive hypotension before his impending visit to the operating room.

Am I asking anything that would not be perfectly reasonable to ask in an article on "medicine", or perhaps "trauma medicine"? There are things now in the lede such as the body's wisdom, and I don't know what that is. I do know that patient, without some distinctly aggressive intervention, may be dead in minutes unless he gets advanced respiratory support — first getting him on artificial ventilation, then doing differential diagnosis of the respiratory problem, since the basic symptoms of pneumothorax or tension pneumothorax or hemothorax look alike without additional physical examination and imaging.

I could also use a non-emergency but life-threatening situation, and describe very specifically how the evaluation and treatment plan would emerge. Matt, one of my favorite books, which I first read as a teenager, is Not as a Stranger, a novel about a depression-era physician, who is challenged by a friend and skeptical lawyer, about all the things the protagonist doesn't know — why the heart beats, how an anesthetic works, the mechanisms of death, etc. I read that every so often, and, over the years, have seen how each of those challenges can now be answered. In homeopathy, however, I see adherence to what appears to be a mystical model, and the authorities cited being largely in the 19th century or earlier.

Is "How Homeopathy Develops and Improves" an unreasonable section to expect? Evidence-based medicine evidence-based homeopathy? Howard C. Berkowitz 10:37, 4 October 2008 (CDT)

Section on "The skeptical view of homeopathy"

At the present time, this section seems to suggest that the fundamental reason for questioning homeopathy is that the mechanism of homeopathic remedies is not understood, and starts to drift into those deep waters. I suggest that much more fundamental issues are involved in the lack of acceptance of homeopathy by mainstream biology and medicine. I write the points below not to attack homeopathy, but either to have homeopaths clarify any misconceptions, or to have these more basic issues addressed as reasons for skepticism.

As I understand it, and I have tried to clarify in the lead, homeopathy does not recognize the concept of "disease", in the sense of a pathological malfunction of metabolic or mechanical functions of the human body. If, as has been stated, homeopaths only recognize collections of symptoms (the word "symptom" being used in a homeopathic context), it is logical to infer they reject the concept of infectious disease and treatment intended to prevent or destroy pathogenic organisms. While homeopaths have said they use laboratory tests, it is completely unclear how they would make use of hematological or biochemical abnormalities that do not correlate with any externally visible symptom or sign (links indicate medical definitions are used).

Differential diagnosis is a fundamental concept in medicine, which seems the antithesis of categorizing groups of symptoms. A set of patients presenting to an emergency room with a symptom or chief complaint of chest pain, perhaps described as a sensation of substernal pressure with radiation of pain into the left arm, from the medical viewpoint, all could be having the same symptoms for completely different reasons. Each one of those reasons would involve a different pathological mechanism, and, other than common supportive measures such as the relief of pain, would call for quite different treatment. If homeopaths reject the idea that there could be different causes for the same presentation, and different appropriate treatments for each.

I'll be happy to draft a new section, but I believe its present form is unacceptable, in that it assumes the controversy is about mechanism of action of homeopathic remedies, rather than the evaluation of the patient and the determination of a treatment plan that might or might not involve remedies at all -- or do homeopaths (serious question) do not believe in surgery? Something that basic has not been mentioned, and needs to be discussed, not more esoterica about water. Howard C. Berkowitz 00:18, 4 October 2008 (CDT)

I think this is a reasonable request and would very much like to see Dana take a shot at it and give us some direction, particularly concerning your assumptions about diagnosis and infectious disease and if homeopaths see limits to their system - which may not belong in the skeptical section at all.

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 [4]. There is an interesting 1916 textbook on pharmaceutical Latin, Lessons in Pharmaceutical Latin and Prescription Writing and Interpretation, Hugh Cornelius Muldoon, [5] 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)

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)

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. [[6]]

The 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)

there is little in the homeopathic system is