Talk:Alternative medicine/Archive 17

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RfC comments

here are my reasons for making the disputed changes to this article. my edits can be found here (my revised version), the revert version is here (version defended by various editors). for a diff, see here (diff - revised on left, defended on right). this does not represent a complete list of the changes I made - too much hubbub before the page got frozen - but it will do for the moment. further, some of the changes I made are present in the defended diff. notably the paragraph under 'Regulation" that begins "The production of modern pharmaceuticals...", and the major heading "Alternative vs. evidence-based medicine" that was originally called (if memory serves) "Criticisms." that paragraph in question is currently doubled in the defended version - once where I placed it under regulation, and further down in section 3.2.4 under 'issues of regulation' that was part of the original criticism section.

my changes, with explanations, are as follows:

1. the lead in the defended version is designed to discredit alternative medicine from the start. I had rewritten it to reflect a more balanced perspective (see this diff), but those changes were reverted - the revised version given above only has cite tags designed point out flaws. in particular:
   • wp:weasel words - "Often, the claims made by alternative medicine practitioners are not..."
   • negative conditionals - "Even if there is no evidence showing efficacy, many alternative practices are often licensed and regulated..." - which implies that even licensing and regulation cannot help AM
   • odd, absolutist, and unnecessarily pejorative phrasing - "They may be based on traditional belief systems, folk knowledge, or more recent ideas, but by definition are not based in the standards of conventional medicine". I will add that this particular phrase represents a POV position discussed in the article (evidence-based research) and is not representative of science or medical science as a whole.
2. I renamed the criticism section as noted above, and - based on {{criticism section}} - began reworking it, both to shorten it and to turn it into a discussion of the strength and weaknesses of AM, rather than a full-blown attack on AM. in specific:
   • I removed an assortment of problematical attack-line headers - "Lack of proper testing, Delay in seeking conventional medical treatment, Danger can be increased when used as a complement to conventional medicine, Danger from undesired side-effects..." the material in these sections was retained, because it's important, but it was drastically over-emphasized
   • I compressed this long critical section into a single section of bullet points, with commentary and references moved into footnotes. again, no material was removed, but the new presentation is far more readable and far more neutral in tone
   • I deleted the section called "Critics' explanations for the appeal of alternative medicine" because the very idea of it is irremediably prejudicial.

the end result was that I took 200+ lines of deeply critical text (in a 400 line article - that would be 50%) and reduced it to 75 lines of of neutral discussion, without losing any useful content. I welcome comments. --Ludwigs2 20:11, 15 June 2008 (UTC)

Responses

• Edit: I'd like to make an extra request of commenters, if I may. there seems to be a growing consensus that the large change should have been broken down into smaller changes (which I am rapidly coming to believe myself, thank you very much), but I am a little lost on how to do that. possibly that's because it's stuck in my head as One Big Lump, or maybe it's because it's primarily a structural (rather than content) change. any advice, either here or on my talk page, would be welcome. thanks! --Ludwigs2 03:06, 21 June 2008 (UTC)

• I prefer Ludwigs2's version over the "defended" version. It certainly is more aligned with WP:NPOV. -- Levine2112 ^discuss 20:30, 15 June 2008 (UTC)
• Ludwigs2's versions reads like a POV-push. It is not allowed by Wikipedia policies. ScienceApologist (talk) 14:32, 17 June 2008 (UTC)
  • Pardon me for commenting, ScienceApologist, but I think it is disingenuous to offer a third opinion on an article to which you are already a major contributor, as well as an adamant opponent of my position. it would be better if you added your oppositions above as counter-statements to mine, rather than trying to give the impression of being an unbiased party. --Ludwigs2 19:57, 17 June 2008 (UTC)
    • Um, this is not a third opinion request. Maybe you should direct some of your criticism to other editors commenting here as well. ScienceApologist (talk) 18:17, 18 June 2008 (UTC)
      • I still hold that it's disingenuous. further, I do not criticize editors, I comment on behaviors. the critical statements I have made with respect to your posts have all been over your occasional misuse of Wikipedia policy and your consistent failure to respond to questions or engage in discussion in a direct, open, and good-faith manner. believe me, I recognize that these are important issues to you; they are important to me as well. if you were willing to work with me on the level of equals I'm sure that we could resolve these issues to our mutual satisfaction quickly. to date, however, I have seen no evidence that you are willing to view me that way. --Ludwigs2 19:01, 18 June 2008 (UTC)
• Both versions are insufficiently detailed in their criticisms, and need a major referencing effort. I won't call any a "preferred version", but Ludwigs's is futher from neutrality than the other. Jefffire (talk) 14:40, 17 June 2008 (UTC)
• From scanning above, it seems that some of these changes should have been proposed more before being enacted. I found the original criticism section a bit unwieldy so I would go along with reorganising it. The subsections did seem a little pejoratively framed, but the revision does also in the other direction e.g. non-sequitur on AM's "large footprint" in the opening sentence. I don't see the rationale for separating out the debate on whether AM should be subsumed under EBM, though it could do with some counterpoints. I don't agree with the wholesale deletion of the section on why AM appeals, though I think it needs to be shaped into a more balanced paragraph. The intro (both versions) seems to be an attempt to describe and define the basics of AM; I believe this should be done in a sourced article section, and then the intro summarise that and each other section of the article. EverSince (talk) 18:03, 18 June 2008 (UTC)
• There is merit in some of the proposed changes. They should be discussed individually rather than simply !voting on only two versions. The overall effect of these changes promotes a credulous attitude towards the article subject rather than simply covering its sociohistorical impact. - Eldereft (cont.) 14:38, 19 June 2008 (UTC)
• This article is a mess as it stands, but Ludwig's version is more strongly POV. The article needs to avoid weight given to many of the fringe theories of alternative medicine. Small changes vs. large changes mean nothing, if the end point is further anti-science POV put into the article, as Ludwig is suggesting.OrangeMarlin ^{Talk• Contributions} 03:17, 21 June 2008 (UTC)

• can you clarify, OM? there very few content differences between the versions, so I'm not sure how I've 'furthered anti-science POV.'--Ludwigs2 15:24, 21 June 2008 (UTC)

• I'm staying out of the "which version is better" debate, which seems to me to be a dead end. Both versions are partisan and (as mentioned above) inadequately referenced, and both include some interesting ideas. I thought it might be better to take a step back and look at the frame of the debate. Is there agreement over the basic definition: "The term Alternative medicine covers any healing practice that does not fall within the realm of conventional medicine"? What does this sentence actually mean? Does it mean anything? Conventional medicine (i.e. medicine practised openly by licensed and respected medical practitioners) is very broad and includes controversial interventions such as EMDR, psychoanalysis, hypericum and indeed acupuncture. Likewise AM (as defined here) includes every folk remedy of every nation on earth, including (importantly) all of Chinese medicine (this article is hopelessly euro/americo-centric). There are lively debates within conventional medicine about the role and limits of EB Medicine, EBM is not synonymous with conventional medicine, and I think it is a false dichotomy to pose EB medicine against Alternative medicine (EBM is primarily a tool for assessing expensive new conventional treatments and is largely driven by health economics). Are we talking here about a difference in worldviews? A clash between rational and intuitive discourses? In which case there will never be agreement because words (such as "science", "health" and "evidence") hold different meanings, depending on which worldview you inhabit. I dont think this paper should include the EBM / AM debate, or look at efficacy / safety etc. This is because (a) AM as a concept is too broad; these discussions of scientific evidence should be located on pages devoted to specific AM modalities (acupuncture, reiki, ear-candling or whatever - which shouldn't be lumped together because some will have a fair level of plausibility and evidence, and and some won't). And (b) it is wrong to bring a scientific discourse to bear on AM because AM is in essence non-scientific -- and this is not a bad thing! Lots of good things are non-scientific, love, ethics and art to name but three. So what is the solution? I suggest (for what it's worth) that this article be pruned back to a meta-discussion of the possible definitions of AM and CM; world-views underlying different parts of the AM/CM spectrum; and a discussion of the conflicting meanings of key words used by both AM and conventional medical practitioners. And leave the "good/bad" discussion to other articles on specific modalities, both "AM" and "conventional". --Anonymaus (talk) 11:39, 2 July 2008 (UTC)

• I see two obvious sides to this debate, and I think that I can see through the problem a little. I'll offer some insight and hope it helps. This should be a portal page, not an article. not all forms of alternative medicine are equal, and some forms of alternative medicine (massage, hypnosis, chiropractic medicine) have moved from the fringe or alternative side into the mainstream as evidence based. A common method of looking for new drugs is searching for "natural remedies", testing them, isolating the active components, and turning it into a new drug or therapy. Attempting a "positive" or "negative" attitude may be less useful than treating this article as a neutral guide to CAM and then refocusing criticism into the specific articles. I think that having too general a discussion about CAM is going to be less productive than working on the one-paragraph descriptions of specific types of CAM, which can balance the criticism there. HatlessAtless (talk) 21:18, 10 July 2008 (UTC)

Request for corrections

{{editprotected}}

The current lead contains some obvious errors that should be corrected:

• The term Alternative medicine covers any healing practice "that does not fall within the realm of conventional medicine."" Commonly cited examples are homeopathy, naturopathy, accupuncture, chiropracty, midwifery and herbal medicine, though many other practices use the term. Alternative medicine is often categorized together with complementary medicine using the umbrella term Complementary and alternative medicine or CAM.

Suggested changes:

1. The double quotes can be removed;

2. "accupuncture" should be spelled without the double "cc", IOW spelled acupuncture;

3. "chiropracty" should be chiropractic;

4. any of the links in the "Alternative medical systems" box can be added to that list;

5. and "midwifery" should be removed altogether.

These changes should be non-controversial. -- Fyslee / talk 15:35, 5 July 2008 (UTC)

agree with all except (possibly) the last. midwifery was considered alternative medicine as recently as ten years ago, and though it's received a certain amount of acceptance recently (due to cost-cutting practices of HMOs - midwives are cheap compared to doctors) I don't know its current standing with respect to the medical profession as a whole. --Ludwigs2 17:21, 5 July 2008 (UTC)

Unprotected article. Let's all get along, please. --MZMcBride (talk) 18:56, 5 July 2008 (UTC)

Midwifery has always been a standard part of medicine in the UK and has never been seen as alternate--Vannin (talk) 19:35, 5 July 2008 (UTC)

I'll tell that to my midwife friends (I have a couple) who are sick of American doctors sneering at them. you may get a couple new citizens over there.  :-) --Ludwigs2 18:19, 6 July 2008 (UTC)

Even in the USA the status of midwives varies quite a bit. In other countries it is often an integral part of the healthcare system. The objections in the USA are purely related to turf protection, perceived safety issues (which are real in some cases), and legal regulation, which varies from state to state. They are not related to unscientific practices and beliefs or to evidence issues. -- Fyslee / talk 06:41, 7 July 2008 (UTC)

tone issue

the Critics' explanations for the appeal of alternative medicine needs some serious revision, or needs to be deleted. as written it is smarmy and patronizing - basically a statement to the effect that "we don't want to call these people stupid, so lets make up some nicer-sounding excuses for why they do such stupid stuff." it's possibly the most unencyclopedic thing I've seen on wikipedia, and may need to be memorialized as such elsewhere, but it shouldn't be in the article as is. --Ludwigs2 20:03, 7 July 2008 (UTC)

P.s. - I don't happen to like that section at all, in case that wasn't clear.  ;-) --Ludwigs2 20:04, 7 July 2008 (UTC)

Sorry, don't see it. Removed the tag until you can explain yourself clearly. ScienceApologist (talk) 20:15, 7 July 2008 (UTC)

I'm sorry you don't see it, SA, but please don't remove the dispute tag until others have had a chance to discuss the issue. --Ludwigs2 20:23, 7 July 2008 (UTC)

accidentally tagged the preceding as a minor edit. --Ludwigs2 20:23, 7 July 2008 (UTC)

If you can't explain it, there is no dispute. ScienceApologist (talk) 20:42, 7 July 2008 (UTC)

please note that Fyslee (at least marginally) approved of this addition in the section above. further, I can explain it. this section is written from the perspective of critics, trying to explain the psychology of alt med use. it is patronizing by definition, paternalist by default, and insulting in tone. --Ludwigs2 20:48, 7 July 2008 (UTC)

Ummm, I'm not sure I endorsed anything. Please enlighten me with a diff and some specific wording. -- Fyslee / talk 03:16, 8 July 2008 (UTC)

Would you quit endorsing things, especially when you have no clue where you did it. It's confusing. LOL. OrangeMarlin ^{Talk• Contributions} 03:46, 8 July 2008 (UTC)

Just a note regarding principles here. Wikipedia policy doesn't forbid the use of comments or sources that are "patronizing by definition, paternalist by default, and insulting in tone." Far from it. We report what the sources say, and obviously critics are going to make critical statements that are just as offensive to believers as the statements of believers are perceived by skeptics and scientists as stupid, foolish, and dangerous. We air all significant POV here. If not, then we shouldn't air the beliefs of homeopaths that homeopathy can cure any disease, a belief that is downright dangerous, but we do present those beliefs here, and we should do it. NPOV requires it. Now those are the principles of the matter. They are not specifically applied to this situation, since it may include confounding factors that I haven't noticed yet. -- Fyslee / talk 03:14, 8 July 2008 (UTC)

What exactly is the "tone" to which you refer? Which definition are you proposing makes the section "patronizing"? You aren't explaining yourself, just offering a bunch of meaningless platitudes in a vain attempt to claim dispute. ScienceApologist (talk) 20:51, 7 July 2008 (UTC)

SA - I'm not going to sit here and debate the matter with someone who has proven themselves unwilling (time and again) to enter into good faith discussions of any sort. tone is a subjective matter, not subject to slide rule measurements, and I have raised this flag in order to get feedback from the community on what proper tone for this section should be. your continued removal of the dispute tags is a clear example of bad-faith editing practice, and I've filed an AN/I asking for intervention.Ludwigs2

I've come here from AIV and I have to say that the section certainly looks strange. Why does it only contain critics views ? Why not change it to "appeal of alternative medicine" put both critics and advocates views and also write it in a normal encylopedic way rather than a list? Theresa Knott | The otter sank 21:13, 7 July 2008 (UTC)

I would contend that gives undue weight to fringe ideas. I would agree that maybe two sections would work. OrangeMarlin ^{Talk• Contributions} 21:16, 7 July 2008 (UTC)

Undue weight surely means letting advocates have equal weight with critics. What is happening here is they get no weight whatsoever. Theresa Knott | The otter sank 21:18, 7 July 2008 (UTC)

I respectfully beg to differ. NPOV does not state that we have to give equal weight, if nearly all of the verified and reliable sources support the "critics." According to WP:FRINGE and WP:WEIGHT, the advocates deserve much less weight than do the critics. The wealth of peer-reviewed research says most of alternative medicine is bogus. OrangeMarlin ^{Talk• Contributions} 21:22, 7 July 2008 (UTC)

But there is only one source for the whole section and that is an opinion piece. Theresa Knott | The otter sank 21:26, 7 July 2008 (UTC)

Theresa has made two good points here, both about the way the section is organized and about due weight. Also there are several more problems with that section of the article:

• the entire section is supported by only one reference that is the opinion of one writer
• the section heading and first sentence are inaccurate: one author's opinions are not a summary of what critics in general have stated about the issue
• some of the information is uncited and questionable (such as the statement that some people choose altmed for economic reasons)
• some of the statements are quite unique and cannot be used without careful attribution and context.

The section needs a total rewrite and more references. Until then, it is appropriate for it to have a disputed tag. --Jack-A-Roe (talk) 21:19, 7 July 2008 (UTC)

Ludwigs2 did not put a disputed tag on it. And I completely disagree with your statements above.OrangeMarlin ^{Talk• Contributions} 21:22, 7 July 2008 (UTC)

In what way? Theresa Knott | The otter sank 21:25, 7 July 2008 (UTC)

On further review, that section really is badly written. WP:MOS doesn't like bullet points, and I personally think it's lazy writing (like using parentheses). I'm going to throw some tags on the section. I hate defending something like THAT section. Meh. OrangeMarlin ^{Talk• Contributions} 21:26, 7 July 2008 (UTC)

Personally I couldn't care less about the tags. Let write an encylopedia here and start rewriting. Theresa Knott | The otter sank 21:28, 7 July 2008 (UTC)

Yes indeed. I only addressed the tags because that was what was reverted but the important thing is the content. --Jack-A-Roe (talk) 21:37, 7 July 2008 (UTC)

Googling Scott Lilianfeld is interesting - [1]. Cheers, Casliber (talk · contribs) 22:11, 7 July 2008 (UTC)

I'm writing away!!!!!! OrangeMarlin ^{Talk• Contributions} 22:35, 7 July 2008 (UTC)

Let's stop the petty edit-warring over tags here. It's pretty ridiculous. Since there is such a small population on these Wikipedia articles, one person is a dispute. I request that people who are going to engage in petty edit-warring (OrangeMarlin, ScienceApologist) please leave this page alone. Further, I agree with Ludwigs2; there is substantial POV issues across this page, and I question the motives of OrangeMarlin's removal of the POV tag at the top. However, I despise tags in general, so I don't really care that much. Most of the mainstream criticisms in this page are not properly referenced. II 02:09, 8 July 2008 (UTC)

Petty edit-warring? Motives? Huh? What POV tag? OrangeMarlin ^{Talk• Contributions} 03:45, 8 July 2008 (UTC)

Erm Orangemarlin has already agreed about the section needing to be rewritten, and added the tags back himself! So asking him to leave the page alone looks to me somewhat like you are trying to stir up an issue that has already been settled. I note that he has already started rewriting the section. Perhaps you would care to help with that? Or maybe you could look for references which are missing? Theresa Knott | The otter sank 05:03, 8 July 2008 (UTC)

My apologies to OrangeMarlin. I'll admit I didn't look closely at the changes. My comments on the edit-warring that happened prior to OrangeMarlin's rewrite still stand: it was ridiculously petty. I agree that the section is much improved, and much better referenced, but removing the POV tag might have been a bit premature. Let's hear what Ludwigs2 has to say first (although I can't see him having substantial problems with it). I pointed out in an above section that the "Testing of efficacy" section is entirely unreferenced, and completely false. A substantial number of RCT exist for alternative medicine of all sorts. People just haven't taken the time to dig them up. Of course, I should do it myself... the most recent issue of JACM is free access, and an editorial there claims that there have been over 40 RTC of chiropractic manipulation, all of which showed it to be better than placebo at treating acute low back-pain. A look at Oxford's eCAM (up till now, open access) will offer a fair amount of evidence. Evidence-based alt. med. is not a contradiction of terms, and has not been a contradiction for some time, despite the widespread misconceptions on Wikipedia (reflected in this article, in the first paragraph of the "Testing of efficacy" section). II | (t - c) 18:20, 8 July 2008 (UTC)

I'm sorry but JACM is hardly a reliable source of evidence based medicine. Unless we're going to throw around the "there's a conspiracy against chiropracty" argument, I don't see a lot of confirmatory articles in other peer-reviewed journals. I'd suggest we take that argument to the chiropractic article, which, from what I see, is about as much fun as jumping in a pool of lava naked. OrangeMarlin ^{Talk• Contributions} 19:26, 8 July 2008 (UTC)

I certainly don't think we should be citing the editor's offhand comment; if there is a systematic review, however, it would be citeable. No offense, but I doubt you've looked all that hard for confirmatory evidence, remember what I found on Alzheimer's and aluminium after you said there was basically no evidence? Chiropracty clearly falls under the broad umbrella of alt. medicine. Anyway, I'll be glancing through journals, but it will take time. In the meantime, perhaps you should look for actual reviews from the mainstream on the multitude of alt. med. studies out there; these reviews exist. Update: The chiropractic article already has a bunch of systematic reviews cited, which is nice. We can include a section on chiropractic here noting that its efficacy is disputed, citing to the best reviews in a brief paragraph. Ideally, we could do the same with other areas: naturopathy, herbalism, acupuncture, mind-body intervention, ect. II | (t - c) 20:09, 8 July 2008 (UTC)

I guess because someone found a bunch of non-peer-reviewed news articles that continue to repeat the same old "myth" proves me wrong? That's not evidence. That's just repeating an urban myth. But I appreciate the update on the status of urban myths. OrangeMarlin ^{Talk• Contributions} 22:49, 9 July 2008 (UTC)

If you're talking about aluminium -- did you follow the wikilink, OrangeMarlin? I pointed you to 6 recent reviews from PubMed on aluminium and Alzheimer's as well an Elsevier book on Aluminium and Alzheimer's, all leaning towards aluminium as a contributing factor, some strongly. II | (t - c) 04:22, 10 July 2008 (UTC)

OrangeMarlin - just because you and I squabble a lot doesn't mean I can't appreciate when you do good work. your revisions are a vast improvement over what was there... thank you. --Ludwigs2 21:32, 8 July 2008 (UTC)

To OM and II, it's "chiropractic", not "chiropracty". As to the JACM, it is a reliable source for opinions about alt med, but not usually for good research. The good quality research on alt med definitely exists, and it is found in mainstream journals. Mainstream journals include both confirmatory and non-confirmatory research. If it's not very good quality research, the mainstream journals will reject it and it ends up in JACM and is of course usually confirmatory. The journal has no other choice or it would lose its advertisers. I question the statement that "Evidence-based alt. med. is not a contradiction of terms..." Hmmm, well, to scientists and skeptics it certainly is an oxymoron, but I understand what you mean, and in practice (not ideally) there's some truth to it. The definitions of alt med and EBM require that when an alternative medicine method becomes scientifically proven, it no longer should be classified as alt med. It simply isn't "alternative" anymore, but mainstream EBM. That has happened a few times in recent history, but will happen less and less with time. That's the nature of the beast ;-) It can't be any other way. But the reality is that such methods continue to be called alt med for some time before the transition becomes complete. That all takes time. We're humans and it can't be any other way, but to keep definitions from becoming self-contradictory and oxymoronic, we need to stick to them and be careful how we use our terms. It is the dream of every sincere believer in alt med that their methods become EBM. It is the dream of every quack that their method remains the object of persecution, otherwise their paranoid delusions of persecution will crumble and their customers lose faith in them as the courageous rebels against the evil big pharma conspiracy. Randi's million dollar prize has always run into this problem. The only ones who apply for it are the truly (and naively) sincere, while the big scammers stay away. They don't want to be exposed and publicly humiliated. -- Fyslee / talk 21:39, 8 July 2008 (UTC)

That's one perspective. Another perspective, one that is not well-reflected in this article (in violation of NPOV) is that alt. med. is not practiced by mainstream medicine. Mainstream medicine has had plenty of practices which are not supported by strong evidence, and some, arguably many, continue to have to this day. Take a close look through Cochrane.org. I would wager that most physicians have not taken a close look at Cochrane.org, and continue to use many of the therapies which it claims have only questionable evidence. Look at the back therapies, for instance.[2] Examples of mainstream back/hip-related therapies without sufficient evidence: (these are the first I clicked on, honestly):[3][4][5]

Someday we will be able to separate the two groups into EBM and non-EBM, but currently neither can be considered EBM. The emphasis on good RCT and systematic reviews only began 15-20 years ago, with the first scholarly mention in 1992 (look at the history section of evidence-based medicine). This probably comes prior to when most mainstream physicians graduated. It is quite possible that some alt. med. right now has significant evidence behind it, but that knowledge hasn't diffused outward to the mainstream physicians, or they are simply unwilling to accept it, fighting tooth and nail, because mainstream medicine has an irrational bias against nutrition. In fact, when it comes to using nutritional therapies to treat mental problems, it seems that CAM therapies are fairly effective, as are certain herbs. Similarly, the evidence for naturopathic diet approaches to prevention are pretty decent. Getting mainstream medicine to admit that, however, would be like pulling teeth; Bruce Ames is one exception.[6] For instance, mainstream med. is still worried about the liver toxicity of kava kava (PMID 18322868), even though people in the Fiji islands have shown no toxicity by using the root for thousands of years. Everyone in alt. med. knows that it is the leaves that are toxic, but after 7 years mainstream med. is just beginning, reluctantly, to figure it out (PMID 18271308). I don't see how this is possible without some degree of willful negligence. Anyway, sorry to rant. Not really the place for it. Also, vitamin C probably doesn't cure cancer, but the "Mayo Clinic" studies refuting Pauling's study, which used intravenous vitamin C where they used oral, is inexcusable from a scientific perspective.[7] Additionally refusing to publish Pauling's commentary on these studies in the journal is just undignified; the NEJM should be ashamed of itself. II | (t - c) 22:44, 8 July 2008 (UTC)

(outdent) I agree with you quite a bit of the way, because I haven't meant to imply that EBM is equal to modern medicine. I made it clear somewhere above that modern medicine still has baggage from its past, baggage that hasn't undergone very much study, but the EBM movement is what's unearthing the evidence, good or bad, regarding many practices that we still use. Some get confirmed as good, others are shown to be no better than placebo and are gradually discarded. EBM functions as a winnower of the chaff in the existing baggage, and as a sieve for newer "applicants" from alt med, applicants for acceptance into modern medicine. Modern medicine already has problems with getting rid of the chaff when it is discovered to be chaff, without uncritically accepting newer "applicants" without thoroughly screening them.

Evidence-based methods are effective, and effective methods should be evidence-based. If a method appears to be effective, then it should be possible to prove it. If the research has not been done yet, it should be. We must remember that "Absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research." - Robert Sydenham. "Lack of evidence in the literature is not evidence of lack of effectiveness." Until that research is done, claims of effectiveness are uncertain, unusual claims of effectiveness doubly so, and consequently the marketing of products and practicing of methods based on such uncertain, unusual, and undocumented claims may be unethical, possibly dangerous, and often illegal.

Your other comments about Pauling are a very complex matter, and not simple at all. Much of that matter is disputed because the evidence isn't always as clear as the orthomed movement paints it to be. Until the evidence is clear for all to see, it will remain controversial. If it becomes clear, then mainstream medicine will gradually accept it. -- Fyslee / talk 05:26, 9 July 2008 (UTC)

The orthomed doesn't paint the evidence particularly strong; they don't cite RTCs very commonly, although they had a few successful ones way back in the day. Hoffer claims that niacin works only for a certain type of "depressive schizophrenic". Currently (finally) there is a trial testing Hoffer's actual claims.[8] It will be fascinating to see what happens. What bothers me about the mainstream position doesn't go straight to the evidence, and denies the orthomed people the right to their say (the Task Report did not consult the orthomed people; Pauling was not allowed to send a comment into the NEJM). I'm skeptical of megavitamin therapy, but I withhold judgment until I see the RTCs -- I am a Pyrrhonian. Bruce Ames has recently produced interesting research in favor of megativatamin therapy.[9] I actually did the research on the VC debunking and found out that the so-called replication of Pauling's study didn't replicate intravenous vitamin C. I still think vitamin C is unlikely to cure cancer, probably not even a little bit. Given the way that the mainstream treated Pauling study, however, I'm suspicious of the way they treated other studies, and Pauling, for whatever its worth, found major problems.[10] The best way to do controversial trials like this is to have both parties involved in the same trial. I haven't looked closely at the niacin/schizophrenia RTCs yet, but the oft-cited APA Task Force is not especially compelling.

I'd like to throw this out just as a matter for thought. the real distance between conventional medicine and "alternative" medicine is that (with lots of exceptions, yes, but allow me to paint in broad strokes for a moment) ConvM focusses on fighting disease, where as AltM focusses on promoting health. In effect, ConvM measures all of their practices against the body's innate ability to heal itself (that's what the placebo effect is, yah?), while AltM tries to magnify the body's innate ability to heal itself (in sometimes strange and freaky ways). these are largely incommensurate worldviews about healing. it's why scientific medicine sometimes fumbles completely on things - chronic pain, backaches, menstrual problems, etc. - that some forms of AltM has tried and true procedures for. what I'm getting at is that EBM, which is based in the 'disease-fighting' worldview of ConvM, may not have the tools to effectively make distinctions about all forms of AltM. what will happen is that EBM will say "this particular technique doesn't seem to make any scientific sense, so we have to say that any results it has are just a placebo effect," and the AltM practitioner will say "you can call it the placebo effect if you like, but the patients get better, so who cares what you call it?" it's really not a conversation that can be resolved within one worldview or the other. --Ludwigs2 18:56, 9 July 2008 (UTC)

This simply isn't the case. Any Dr who isn't interested in preventing illness by promoting healthy living is a bad doctor. The claim that EBM is only concerned with fighting disease is also false. EBM is also based on evidence (hence the name). If a technique works, but we aren't sure why, then the technique may be adopted if it is thought safe, with due caution and consideration. EBM only calls the placebo effect when the technique produces an effect no better than the placebo effect, ie when there is no real (measurable) effect. You are confusing experimental evidence and scientific theory to explain the evidence. --SesquipedalianVerbiage (talk) 21:01, 9 July 2008 (UTC)

you misunderstood me. I didn't say that doctors weren't interested in promoting healthy living; I said that the medical model used (and not just by EBM, but by conventional medicine in general) is a disease-fighting model. the placebo effect is the general measure against which the effectiveness of medicine is compared. this is pure Wittgenstein (google "wittgenstein ruler"). all I'm trying to suggest is that evidence-based assessment is not going to be effective in all (or possibly even most) cases. but I'm thinking this might be going way off-topic, and I don't want to cram the talk page with irrelevancies. if you'd like to talk about it more, we can take it up on my talk page. --Ludwigs2 21:37, 9 July 2008 (UTC)

Manifestly false. The hospice care movement is part of conventional medicine. It is not interested in fighting disease. ScienceApologist (talk) 21:52, 9 July 2008 (UTC)

again, that confuses medical practice with medical science. --Ludwigs2 22:03, 9 July 2008 (UTC)

How's that? OrangeMarlin ^{Talk• Contributions} 22:42, 9 July 2008 (UTC)

Ludwigs, you thesis is clearly incorrect. I did not misunderstand you, rather from the evidence it seems you have misunderstood EBM and the role of modern doctors. Maybe it's different wherever you live. --SesquipedalianVerbiage (talk) 06:31, 10 July 2008 (UTC)

Please allow me to make the suggestion (again) that we move this conversation elsewhere. I'm happy to continue discussing it, but as I said, this is likely to stray far outside of normal talk-page boundaries.

that being said...

SV - no, I understand EBM perfectly, and I don't even object to it - it seems like a perfectly sensible approach. my comment was methodological. let me try to put it differently. Every form of science (without exception) begins by making assumptions, and these assumptions dictate what that form of science can and cannot legitimately investigate. for instance, classical (Newtonian) physics made assumptions about atomism and the independence of mass and energy that makes it completely unsuited for studying high-energy or sub-atomic physics, not to mention chemistry or other semi-related scientific fields. practitioners - people who use the science - often don't care and often extend the science beyond its proper scope, but this does become an issue for researchers. when I say that modern medicine focuses on disease-fighting, I mean that quite literally - you will find almost nothing in the research literature that studies how to strengthen the body's healing powers (even saying that sounds pseudoscientific, doesn't it?). generally speaking, medical research seeks out ways to inhibit or destroy disease factors so that the natural healing process has an easier time (think chemotherapy, interferon, penicillin, SSRIs, etc...). and yes, this is a good thing. however, these disease-fighting assumptions do not lend themselves to studying procedures or techniques that are built out of a worldview that assumes that the healing powers of the body themselves can be augmented or supplemented. sure, medical practitioners do have a great concern for the health of their patients - just a few months ago my doctor recommended I start taking over-the-counter (i.e. naturopathic) melatonin supplements to help with some sleep issues - but to the extent that they do that, they are going beyond what is demonstrable within medical research properly understood.

I'm not saying that EBM is wrong, or bad, or misguided. I'm saying that (like all scientific approaches) it is limited to the things that are already pre-built into its assumptions. --Ludwigs2 14:45, 10 July 2008 (UTC)

"you will find almost nothing in the research literature that studies how to strengthen the body's healing powers".

Vaccination, Diet, Exercise? Jefffire (talk) 14:55, 10 July 2008 (UTC)

You are confusing experimental evidence with theory. EBM is concerned with what works, not how it works - although doing something without knowing why it works should be done with appropriate caution. Your central thesis is incorrect. --SesquipedalianVerbiage (talk) 16:35, 10 July 2008 (UTC)

jefffire - point taken. I guess I was thinking primarily about drug research.

SV - possibly, though all I'm really saying is that there are certain things may not be testable under EBM methodology. for instance, if we take something like chronic pain, or chronic fatigue syndrome - what does EBM do with that? the conditions are a subjective collection of symptoms which may or may not be psychologically derived (at least, there is no objective, observable, biological cause as yet determined in either case), the AM solutions that exist (I think acupuncture and certain forms of bodywork have claimed effective treatments for these conditions) may or may not be a psychological response. there's really not a lot in the way of concrete evidence, empirically speaking, to suggest whether the treatment works or has actually done anything at all, except that the patient subjectively reports that they got better. see what I mean? --Ludwigs2 18:17, 10 July 2008 (UTC)

You're sort of right. Except everything you're saying also applies to things like hypochondria or Munchausen's syndrome. ScienceApologist (talk) 00:47, 11 July 2008 (UTC)

yes. there's a whole range of issues that medicine recognizes as problems but is hesitant to address because they can't ascribe an etiology to them. AltMed doesn't worry about that as much, and sometimes offers apparently effective treatments. it reminds me of Freud, who originally started working with things like glove anesthesia (a physiological loss of sensation in the hands that - so he decided - was purely psychological in origins). very difficult to assess in concrete evidentiary terms. --Ludwigs2 18:25, 11 July 2008 (UTC)

Towards a global picture of CAM

I think we should try to do two things in this article: attempt to identify what both the mainstream and CAM communities broadly have to say about some of the most prominent approaches along with their respective evidence, and elaborate on the different global perspectives and usage. This is a very US-centric article, which is discouraged, unless we're writing the "Alt. Med. in the United States" article. I've already noted in the lead that herbs are officially integrated into medicine in Germany. According to this article, "traditional Chinese medicine" has a "protected status" in China (and this is becoming controversial). Ayurvedic medicine is likely to be quite popular in India, although I have no idea on its official status. Acunpuncture is probably popular in Asia. If you're going to reply to this post, please try to keep to the point, and try to provide articles on the issue.

Some reading from eCAM:

• Science of CAIM: What's Next for Complementary, Alternative and Integrative Medical Research?’
• Presentations at a 2005 Conference: An idea of what people are working on -- no references though.
• Developing CAM Research Capacity for Complementary Medicine
• Evidence-Based Research in Complementary and Alternative Medicine II: The Process of Evidence-Based Research

These are just general overview type things. Clearly there is a movement in CAM towards evidence, although how much action rather than talk is a legitimate question (and how legitimate the action is, is another question). I haven't looked through eCAM thoroughly, but I'll admit that it seems light on systematic reviews of RCTs and similar evidence, and seems to have a bias towards traditional chinese medicine and ayurvedic medicine. I'll start looking at evidence from the mainstream next. II | (t - c) 21:16, 8 July 2008 (UTC)

It definitely exists, so good luck. -- Fyslee / talk 21:42, 8 July 2008 (UTC)