Talk:Alternative medicine/Archive 23

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QuackWatch and NPOV

Noting revision 10:30, 14 September 2012 (TimidGuy), and in view of discussion connected with the recent decision to merge Whole medical systems, it can be said that mention of QuackWatch (here and elsewhere) may be useful for NPOV. Given that the everyday terms "regular / conventional / mainstream" can be used for a more or less restricted range of medical practice, the name "QuackWatch" points both ways. It alerts those who look further than the more restricted range that the opinions, claims or information which it publicises may lack NPOV, while at the same time it is likely to give comfort to those who favour the use of those terms for a narrower range. Qexigator (talk) 11:24, 14 September 2012 (UTC) (typo correction Qexigator (talk) 07:00, 18 September 2012 (UTC))

--Also noting: 1_ Well-designed studies have shown that most "alternative" methods are used in addition to—rather than instead of—standard methods.;[4] and 2_Quackwatch received a 2003 award as a useful source for online consumer information (article on Stephen Barrett). There is an everyday use of the word "sceptic" and most people probably learn to practice mild scepticism in respect of such matters from any source, including sources using the word as a distinguishing badge or title of their own. --Qexigator (talk) 23:15, 14 September 2012 (UTC)

--For further information: The National Council Against Health Fraud - Scientific Review of Alternative Medicine - Wallace Sampson - Paul Kurtz - Consumer advocacy groups - Committee for Skeptical Inquiry - Council for Secular Humanism. --Qexigator (talk) 00:37, 26 November 2012 (UTC)

...and "propaganda"

"Quackwatch" is cited at the end of the lead, mentioned twice in the body of the article, under "Scientists" and "Criticism", and listed in External links under "Criticism" which also links to the article Quackwatch. That article shows that "Quackwatch" is steeped in its founder's POV. The section for "Site content" links to over 30 articles in a list of products, services, and theories that "Quackwatch" considers questionable, dubious, and/or dangerous, It is a longish article with a short section for "Criticism". On the use of "Quackwatch" as a source Talk:Quackwatch and its links to -- RS/N: Usage of Quackwatch as RS in medical quackery and -- RS/N: How can Quackwatch be considered a "reliable source"? show to a non-partisan that some editors may have been inclined to a Quackwatch's campaigning style and POV. But none of that suffices to support the unexplained use of "propaganda" and "fraud" in the lead of "Alternative medicine" (stemming from the unexplained IP revision of 22:54, 4 November 2012). --Qexigator (talk) 15:14, 23 December 2012 (UTC)

In the past, at least one of the editors with the largest number of edits to this article has been accused of having close links to Quackwatch. Personally though, I've all but given up on this page for the time being as there's almost zero chance of it ever becoming a decent well-written article any time soon. And I'm not merely talking about its content either; in the encyclopedic sense, the article is appallingly badly written. Quite how or why we expect anybody to waste time trying to make any sense of it is, quite frankly, beyond me. Vitaminman (talk) 15:45, 23 December 2012 (UTC)

--Noted that there is a discussion about Quackwatch[5] in connection with "colloidal silver". Extract:...Quackwatch has been discussed on RSN several times and has been found useful in alt-med cases where Quackwatch is in line with mainstream scientific consensus... Like NCCAM, Quackwatch is useful... 2005 Quackwatch entry is suboptimal per WP:MEDRS's timeframe of 2-3 maybe 5 years... A great deal has been written on Wikipedia about the use of Quackwatch for discussing alt med content. Generally it has been deemed to be okay in some situations decided on a case by case basis on the talk page... QuackWatch has repeatedly been discussed in relation to altmed topics, and is established RS on matters of quackery provided nothing authoritative contradicts it, and that it is used with care and attributed... it seems there is more recent content from QuackWatch that can be used, the dating issue can be addressed by using that. Qexigator (talk) 18:21, 29 January 2013 (UTC)

Update

Undergoing improvement with restucturing now in progress.[6] --Qexigator (talk) 22:21, 9 January 2013 (UTC)

This has turned into quite an editing fairground for various energetic IP operators:-- helter-skelter, dodgems, barkers, switchback, aunt sally, coco-nut shy. Meantime others are standing by to see how far the results are acceptable, overall and in particular. Qexigator (talk) 15:42, 14 January 2013 (UTC)

IP operations now subject to semi-protection (2 months). For background see another editor's link (below) viz. Interesting. Qexigator (talk) 08:36, 17 January 2013 (UTC)

--and some recent disruption has resulted in an indefinite block for using multiple IP accounts - Block log 08:13, 18 January 2013[7], [8] --Qexigator (talk) 09:45, 18 January 2013 (UTC)

Regain focus

Given the information in History of alternative medicine may I make a proposal (or re-proposal if it is) that the current AM article be re-focussed so as to be a narrative of the controversy about AM in recent decades (from 1970s? 1990s?), mainly in the USA, if there are accessible sources from which such an article could be derived and there are editors willing to start over. The AM article stems from September 2001.[9] How much progress has been made if an editor today needs to comment (validly) about the use of Stipulative definition? Is the article now practically beyond repair, due to uncertain or shifting topic focus? Sad to say, the best of the article as it now stands is the "see also" link to History of alternative medicine, which (in my view) has a rare standard of excellence. Qexigator (talk) 13:22, 17 January 2013 (UTC)

Such a historical narrative may be relevant but the principal focus of the article should be on the present state of alternative medicine and its relationship to mainstream/scientific/bio/medicine. The History of alternative medicine article is the appropriate article to trace the development of AM historically. FiachraByrne (talk) 15:00, 18 January 2013 (UTC)

Present state of alternative medicine in USA

Why is the revised opening sentence (now moved to Regulation[10][11] per Talk[12]) from a USA government agency? Is undue emphasis given to fraud in respect of "alternative" compared with other? Does it not in fact recognise that Homeopathy is not outlawed as fraud, while also advising the public against Medication Health Fraud and Counterfeit Medicine?

1_The link to the web page is headed "Alternative Medicine Fraud" and could be read as announcing that health care practices distinct from practices "used in conventional medicine" are generally tainted by fraud. The second sentence states "The following information reflects enforcement actions taken by the Agency to protect consumers from fraudulent alternative medicine products". That is immediately followed by a large bold heading "Homeopathic Products". Under that there are links to "Warning Letters". Next "Traditional Chinese Medicine" with two Warning Letters, then" Ayurvedic Products" and four Warning Letters.(That Page Last Updated: 10/25/2010)

• A link in a side panel goes to a page headed "Inspections, Compliance, Enforcement, and Criminal Investigations", and under that is another large bold heading "CPG Sec. 400.400 Conditions Under Which Homeopathic Drugs May be Marketed". The purpose of the document is clearly stated This document provides guidance on the regulation of OTC and prescription homeopathic drugs and delineates those conditions under which homeopathic drugs may ordinarily be marketed in the U.S. That is, it is about control and enforcement. Definition 7 is "Health Fraud", which has a defintion (suited to the legitimate purpose of the Agency) ...have not been scientifically proven safe and effective for such purposes. ... deliberate, or done without adequate knowledge or understanding of the article. *A proving is synonymous with the homeopathic procedure (identified in HPUS as a "Research Procedure") which is employed in healthy individuals to determine the dose of a drug sufficient to produce symptoms. Under the heading DISCUSSION, this: Homeopathic drugs generally must meet the standards for strength, quality, and purity set forth in the Homeopathic Pharmacopeia. Section 501(b) of the Act (21 U.S.C. 351) provides in relevant part: Whenever a drug is recognized in both the United States Pharmacopeia and the Homeopathic Pharmacopeia of the United States it shall be subject to the requirements of the United States Pharmacopeia unless it is labeled and offered for sale as a homeopathic drug, in which case it shall be subject to the provisions of the "Homeopathic Pharmacopeia of the United States and not to those of the United States Pharmacopeia." At the foot is "Page Last Updated: 01/12/2010" (and there is note about revised content). In the end the reader discovers that Homeopathic medical practice is not outlawed as such, but like other medical practice is required to comply with certain standards.

2_There are links in the side panel:

"Information for Consumers (Drugs)"--- one link mentions fraud "Medication Health Fraud"[13], with a bold subheading "General Health Fraud"

"Buying & Using Medicine Safely"[14]. The page was last updated 01/11/2013. The side panel page includes links to

Antibiotics[15]

Counterfeit Medicine[16]

Medication Health Fraud[17] In general, health fraud drug products are articles of unproven effectiveness that claim to treat disease or improve health. In addition to wasting billions of consumers' dollars each year, health scams can lead patients to delay proper treatment and cause serious—and even fatal—injuries. FDA is very concerned about these fraud products, and removing these products from the market remains one of the Agency's top priorities. --Qexigator (talk) 17:49, 18 January 2013 (UTC)

--For the record this editor has no connection with any US department or agency or medical institution, profession or products, and never has, nor any other conflicting interest. Qexigator (talk) 21:23, 18 January 2013 (UTC)

• Reason for letting information about AM from US Dept of Health and its agency the FDA be accepted, subject to sources showing otherwise.

The extensive remit and activity of USA government healthcare departments and agencies are gigantic compared with most other countries. May be they do not yet have all the answers but they probably have a part of them within the limits of current knowledge and practice, and can be expected to be a good source for information about varieties of medical treatments of all modalities, including "alternative medicine", first of all in the USA and perhaps for comparison with other parts of the world, unless otherwise argued by notable sources within the USA or outside. Articles include:

United States Department of Health and Human Services - Food and Drug Administration - Agency for Healthcare Research and Quality - National Institutes of Health.

It can be expected that the content of those articles is monitored by the departments and agencies, but also by critics. If these bodies are considered by USA citizens to be controversial in connection with Alternative medicine, that might show up in the Talk pages. But if so, it is not apparent (to Qexigator) in the case of:

1_Talk:United States Department of Health and Human Services. Article watchers: 61.

2_Talk:Food and Drug Administration. Article watchers: 143.

3_Talk:Agency for Healthcare Research and Quality. Article watchers: less than 30.

4_Talk:National Institutes of Health. Article watchers: 73.

Editors wishing to let the AM article be improved are invited to comment about this. Qexigator (talk) 16:35, 19 January 2013 (UTC)

I personally don't have a problem with the use of the sources quoted, although I am sceptical about the assumption that these articles are monitored by the Agencies concerned. Having worked in a (non-medical) government agency for many years I know that in that particular case they were both uninvolved and totally disinterested in what Wikipedia said. I would however be more convinced about the lack of systemic bias, and in particular American bias (even if unintended), if a wider range of sources were used including appropriate sources from the UK, NZ, Australia, European Union, Canada and other countries. where well developed professional medical services exist and where a thriving alternative medical industry also exists side-by-side. Equally, I believe that in seeking an acceptable definition of Alternative medicine a wider net should be cast rather than relying on a singularly American view.  Velella  ^{Velella Talk}   17:09, 19 January 2013 (UTC)

Good points, but we have to start from somewhere. Thus, if a topic is gathering, analysing and presenting weather information, and one country has a (supposedly) more advanced system, would we not start from there and go on to describe others by comparison. For some practical purposes old fashioned looking at the sky and sticking a finger in the wind may be better, but probably not for long distance flying? Qexigator (talk) 17:23, 19 January 2013 (UTC)

If your point is that the USA has a more advanced knowledge or definition of alternative medicine than elsewhere in the world, where is the citation that supports this assertion ? Quantitatively there may be more American sources but quantity is not everything.  Velella  ^{Velella Talk}   19:34, 19 January 2013 (UTC)

No, I make no such assertion, but only that to structure the article, a start must be made somewhere, and unless there is a more reasonable proposal, given the current state of affairs, let this be it, without in any way implying that others are excluded. Others will be similar and their differences can be noted free from value judgement, unless there is any value judgement which is properly sourced and not offending any rules about UNDUE. You mention quantity: at least it can be said that a major proportion of the populations of English language countries (and this is American / English Wikipedia) are regulated by the FDA under the laws of the Congress of the federal republic, for better or worse. Are there any sources which dispute that? Qexigator (talk) 20:21, 19 January 2013 (UTC)

This suggests that the USA has 251,880,146 English speakers whilst the rest of the globe has 390,416,670 (subject to rounding errors and an assumption about Ireland based on population given in Ireland). But Wikipedia isn't about voting and counting heads, it is about balance and ensuring that topics such as this that have a resonance world wide, address the issue of world view not just a single nation view.  Velella  ^{Velella Talk}   20:43, 19 January 2013 (UTC)

Thank you for continuing to take an interest in this topic. I have noted your earlier comment that you don't have a problem with the use of the sources quoted. But have you considered whether your last comment sounds both too simple minded and rather peremptory, and deserving no more in reply than that it seems to have made a point of missing the point? Of course, not just counting heads: look again- a major proportion of the populations of English language countries are regulated by the FDA. My comment was pointing to the fact that the USA is a single democratic English language polity with advanced science and technology and so on which has organised the FDA as part of its government, ostensibly of, by and for the people. So far as I am concerned my proposal has nothing to do with advancing cultural hegemony, dominance or the like. There is no relevant purpose that I can see in continuing to discuss that aspect of the matter. If you have produced a reasonable proposal of your own somewhere I am afraid I have missed it. Qexigator (talk) 23:03, 19 January 2013 (UTC)

...alternatively

The long edit history of this article suggests that there could have been a proposal way back for the main purpose of the article to be seen as the link from the three articles: 1_History, 2_List of branches and 3_Regulation of alternative medicine. If that were accepted it could be cut back, with two or three sections and See also's, and relieved of much that is liable to be disputed. If there are editors who wish to create a further article with another but clear focus of its own, so be it. Is it too naive or simple-minded to hope for? Qexigator (talk) 12:53, 23 January 2013 (UTC)

It may be noted that Regulation of alternative medicine was created 16:59, 14 January 2013 and the link to it first appeared as of 17:09, 14 January 2013 [18] and Revision as of 17:17, 14 January 2013[19] Compare[20]. It seems to have been a unilateral attempt to make a de-merger. But it may turn out to be useful, as proposed above. Qexigator (talk) 04:05, 24 January 2013 (UTC)

There is now a proposal to rename Regulation of alternative medicine.[21]. Qexigator (talk) 11:57, 10 February 2013 (UTC)

...and including in above proposal: adding a short section Science education per Qexigator 10:30, 26 January 2013 UTC in Top of first section of article[22] below. Qexigator (talk) 11:03, 26 January 2013 (UTC)

--It could be that adopting such an alternative for the article would resolve one of the continuing difficulties in writing this article intelligibly which has been commented on repeatedly in archived discussions and in the sections below. but so far without satisfactory outcome.

At least it can be said that homeopathy has an origin in Europe and spread to North America, and has continued there while mainstream Western medicine has developed another way in the established medical schools. That is already sufficiently explained in other articles, and is a context for sourced information contrasting medical schools and professional practice in USA with continental Europe (and UK and Ireland?). The origin of Chiropractic in 19c. North America may also be seen as a particular development in Western healing practise.

But Ayuvedic medicine is at least as remote in origin, theory and practice from Homeopathy as it is from mainstream/conventional Western medicine. Ditto Traditional chinese medicine and all the practises listed as "Alternative medicine".

From the point of view of communicating information about these, putting them under a common name has raised questions about what sets them apart as "alternative"? That leads to proposing that there is a distinction in principle: "alternative" signifies that they are not "science based". Unfortunately, that would be unsatisfactory, if for no other reason than that there are aspects of medical practice of graduates of western medical schools which are not quite "science based" in any strict sense.

The "alternative" above is proposed as a way out of this dilemma or impasse. Qexigator (talk) 08:52, 27 January 2013 (UTC)

Meantime, for the Introduction

Given recent progress to date per "Lead: propose voluntary editing ban on lead for a month or two" and its following sections, [23] it will be possible to put in the top section "Introduction" something sourced to two scholarly papers by Robert Jutte which two other current editors have brought to attention:

Alternative Medicine and Medico-Historical Semantics(circa 1998?) [24]). "...Most labels used to describe health belief systems other than modern, scientific, Western medicine, are relative terms, as for example "alternative", "marginal", "unorthodox" or "irregular". They are either misleading or carry unfortunate semantic load....", and/or

The Historiography of Nonconventional Medicine in Germany: A Concise Overview, 1999[25] "Even historians have difficulties in finding a language in which simply to name and to describe, without imposing connotative judgement." "Scholars...looked at the period from the mid-nineteenth century to the first two decades of the twentieth, analyzing the rise of modern, scientific medicine and its battle with 'quackery' ... the immediate threat from homoepaths, naturopaths, mesmerists and other healers was eventually stemmed by a number of legal and organizational measures taken by the developing medical establishment."

The following could be given a place in the article:

• According to Robert Jutte, labels used to describe health belief systems other than modern, scientific, Western medicine, are either misleading or carry semantic load, as for example "alternative", "marginal", "unorthodox" or "irregular", and historians have had some difficulty simply to name and describe without connotative judgement. Jutte found that in the period from the mid-nineteenth century to the first two decades of the twentieth, the opposition of the developing medical establishment in Germany, based on modern, scientific medicine, had resulted in the threat from homoepaths, naturopaths, mesmerists and others being stemmed by legal and organizational measures. Qexigator (talk) 11:33, 30 January 2013 (UTC) + Qexigator (talk) 15:46, 30 January 2013 (UTC)

Done. See also below Listing grounds for opposing alt.m.[26] Qexigator (talk) 20:45, 30 January 2013 (UTC)

Later on?

(Placed here to avoid cluttering up other sections or starting a new one.)

Some progress is being made with the first part of the article. But editors may agree that cutting down the quantity of criticism padding out the article is overdue. If the article is downloaded as pdf it runs to 16 pages of text + refs etc on pp. 16 to 24. It is in roughly three parts; 1_ Lead, Intro. and Examples, pages 1 to 5. - 2_Criticism section pages 5 to 9. - 3_ Use and regulation, Research, Appeal etc, pages 9 to 16. Much of its informative value is lessened by the disproportionate criticism section in the middle. This makes the article as a whole read as an undeclared polemic, probably based on counter-advocacy literature and methods. The motivation is obscure (outside USA, the acknowledged host of Wikipedia) but may be due to what is described in the paragraph headed "History" which informs the reader: "Fueled by a nationwide survey published in 1993 by David Eisenberg, which revealed that in 1990 approximately 60 million Americans had used one or more complementary or alternative therapies to address health issues. A study published in the November 11, 1998 issue of the Journal of the American Medical Association JAMA (journal) reported that 42% of Americans had used complementary and alternative therapies, up from 34% in 1990. However, despite the growth in patient demand for complementary medicine, most of the early alternative/complementary medical centers failed." This seems to be addressed to the wrong audience, implying that it is shameful that Americans should favour alternative medicine. The next section, Appeal, attempts to explain this in a variety of ways. There is even the remark (astonishing to see here, if one is not party to the debate): "Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among that minority using them in lieu of conventional medicine", followed by some low level sociological speculations, which might have better belonged to certain types of magazine (supply a name of your choice) but not in any well focused article in a readable encyclopedia. Reasoned comment invited from editors wishing to let the article be improved. Qexigator (talk) 17:38, 31 January 2013 (UTC)

--update, pdf for current version: 17 pages of text + refs etc on pp. 17ff. Of text: Lead and Intro 1-4, Examples 5-7, Criticism 8-9+, Use ....end 10-17 +refs etc. The context for the criticism is now given in the expanded Introduction, and the whole is concisely encapsulated in the lead. Qexigator (talk) 09:15, 25 February 2013 (UTC)

Update 2

Now that the article has been revised to let the principal differentia of "alternative" be openly stated as what is not typically included in the degree courses of established medical schools, it has been possible to clarify certain points in the existing text.

• One is that, if "Alternative medicine" refers to any practice not based on evidence gathered with the scientific method, that extends only to any such practice which typically is not part of degree courses of established medical schools.
• Another, if Alternative medicine practices and beliefs are diverse in their foundations and methodologies, it can be mentioned that (whatever their actual or supposed merits) they typically make use of preparations and dosages other than such as are included in the Pharmacopeia recognised by established medical schools.
• It has also made redundant much of the variations on the theme of terminology. Qexigator (talk) 16:32, 4 February 2013 (UTC)

The article as at 11:29, 8 February 2013[27] remains in need of further source checking and further editing to improve flow and remove repetiteveness or excess, Qexigator (talk) 12:06, 8 February 2013 (UTC)

--now as at 23:48, 10 February 2013[28]Qexigator (talk) 23:59, 10 February 2013 (UTC)

--and in particular, sections 3.1 and 3.2, per "Listing grounds for opposing alt.m." below [29], and per "worth retaining?"[30] --Qexigator (talk) 17:38, 8 February 2013 (UTC)

The report by the UK House of Lords Select Committee regarding the definition of CAM makes the point that it is no longer possible to define it as that which is not typically taught in medical schools. So, I'm not sure on including that as part of the definition or, at least, without qualification (is presence of CAM increasing or decreasing in medical curricula of European/Australian/US (or other) medical schools?). FiachraByrne (talk) 14:58, 22 February 2013 (UTC)

The British Medical Association (BMA) report Complementary Medicine: New Approaches to Good Practice suggests that although the term 'complementary therapies' is familiar to the public, a more accurate term might be 'non-conventional therapies'. The BMA defines these as: "those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses". This definition is now unsatisfactory as the use of some of the therapies traditionally considered to be non-conventional is growing amongst doctors (although practice varies widely). Some medical schools are now offering CAM familiarisation courses to undergraduate medical students while some also offer modules specifically on CAM.

House of Lords. United Kingdom. Select Committee on Science and Technology (2000), Science and Technology – Sixth Report, Science and Technology Committee Publications; British Medical Association (1993), Complementary Medicine: New Approaches to Good Practice, Oxford University Press, p. 7; quote here

Good point, well made. Please consider revision[31]. --Qexigator (talk) 18:41, 22 February 2013 (UTC)

Update: WHO?

As at revision 23:03, 16 February 2013[32] there is discussion about:

• using WHO Guidelines on Developing Consumer Information on Proper Use of Traditional, Complementary and Alternative Medicine, 2004)[33] " These Guidelines will provide governments and other stakeholders involved in the development of consumer information with an overview of the general principles and activities necessary for the development of reliable consumer information. The document will also be a useful reference to consumers in guiding them on the information they need to have in order to choose a TM/CAM therapy that is safe and effective." Its Glossary includes stipulative definitions, "Conventional medicine For the scope of this document, conventional medicine refers to the broad category of medical practice that is sometimes called Western medicine, biomedicine, allopathic medicine, scientific medicine, or modern medicine. Complementary and alternative medicine (CAM)' refers to a broad set of health-care practices that are not part of a country’s own tradition and not integrated into the dominant health care system. Other terms sometimes used to describe these health care practices include natural medicine, non-conventional medicine and holistic medicine[34]
• using WHO with reference to degree of integration with conventional medicine.[35] In an integrative system, TM/CAM is officially recognized and incorporated into all areas of health care provision ... An inclusive system recognizes TM/CAM, but has not yet fully integrated it into all aspects of health care, be this health care delivery, education and training, or regulation ... In countries with a tolerant system, the national health care system is based entirely on allopathic medicine, but some TM/CAM practices are tolerated by law. WHO Traditional Medicine Strategy 2002–2005 “”World Health Organisation (2002)[36] , para. 1.1 What is traditional medicine? Towards a working definition.

Would these deserve more than inclusion in External links, at most, given that TM and NCCAM have their own articles, linked by the side panel? Qexigator (talk) 10:20, 18 February 2013 (UTC)

The "definition" question

Currently, the first sentence defintion is more descriptive than prescriptive, and is the better for that. For comparison with an earlier tabulation of Definitions a) - By medical associations; national or supra-national political bodies; other important representative bodies [vague]; or uniquely important and influential definitions and b) – Distinguishing between alternative, complementary and integrative medicine see Archive 22[37] Qexigator (talk) 09:57, 20 February 2013 (UTC)

Update 3 +

The lead is now suitably concise but may still need some tweaking.[38] It is followed by "Public discussion", which briefly outlines how "Alternative medicine" got its name in connection with developments in 20c., thus setting the scene for "Proponents and opponents" and for the later sections - "Criticism", "Use and regulation", "Efficacy", "Safety" etc. - which may need some revising (rewording, cutting) to avoid repeating the Introduction. Perhaps some of "Further reading" or "External links" could be reconsidered. Qexigator (talk) 13:27, 22 February 2013 (UTC)

Medical education now[39] moved up to Introduction. Qexigator (talk) 22:09, 24 February 2013 (UTC)

Update 4: incompatible with medical science as applied post-Flexner

The content of the article, as written in various places with citations, makes it self-evident - meaning undisputed by all parties (opponents and proponents) - that the typical attribute of alt.m. of all kinds is that each of them differs from medical practice of that other kind which for a century has been applying the results of medical science, as proposed in the Flexner Report and in its later developments such as listed in Timeline of medicine and medical technology, 1900-present. This is my reason for adding at the end of the 2nd para. of the Introduction:

and they have not become compatible with further advances of medical science such as listed in Timeline of medicine and medical technology, 1900-1999 and 2000-present, nor have Ayurveda, acupuncture or other kinds of alternative medicine.

Editors are invited to comment if they propose some better way of communicating this basic fact to readers. But please note that, given complementary and integrative, it is not proposed that alt.m. is currently incompatible with a licensed physician's practice. Qexigator (talk) 16:05, 23 February 2013 (UTC)

Wording of sentence tweaked as at[40]. Qexigator (talk) 08:38, 25 February 2013 (UTC)

Pending current review of sources etc.

The paragraph now inserted is a concise summary of what follows in the article. The two sources cited are not new. Nothing is excluded which is there now. It leaves open whether and how the lead could be trimmed later. It may need tweaking, but is meant to be non-controversial. If reason to dispute, please discuss here. Qexigator (talk) 22:46, 27 January 2013 (UTC)

My tweak is merely to split the monster intro without deletion. After the criticism it recaps sources and claims, so it works to spit those big paras off into an intro. All the stuff is still here, but now it actually looks like a standard lede. The approach has worked with other monster intros with repetition-- for example see chemical bond. SBHarris 02:20, 28 January 2013 (UTC)

I think it's an improvement as well. I made some tweaks, but there are also a few other things that I'll look at later. :-) Arc de Ciel (talk) 03:08, 28 January 2013 (UTC)

A noble attempt but you know that last paragraph really has two topics. The world won't end with a 5 para lede. It's more total size that counts. Hmm, maybe I can add a segue...SBHarris 04:52, 28 January 2013 (UTC)

I did know that. :-) I prefer to stay at four or less whenever possible, but your edit was good. Arc de Ciel (talk) 05:56, 29 January 2013 (UTC)

Yes, the top section now headed Introduction will need some reworking when sources etc. have been more or less settled. Maybe then some subheadings such as "controversy" or similar. Qexigator (talk) 19:37, 29 January 2013 (UTC)

--Arc: About your Revision 05:53, 29 January 2013 UTC- returning one sentence to lead.[41] If we restore the sentence added back (as it was in previous versions) then for conciseness evidence based could be dropped here (leaving that to be part of the expansion later where appropriate). It would then read:

Alternative medicine is any of a wide range of health care practices, products and therapies, which typically are not included in the degree courses of established medical schools, lack any scientific validation, and whose effectiveness is either unproved or disproved. Examples include homeopathy, Ayurveda, chiropractic and acupuncture.(add links and refs).

Would that be better? Qexigator (talk) 13:39, 29 January 2013 (UTC)

Done, leaving evidence-based in definition for Complementary, where it had been before. Qexigator (talk) 08:40, 30 January 2013 (UTC)

Please consider latest attempt. To let the controversy in principle be given more prominence, in accordance with discussion above on this page and earlier archived pages, now revised so that "controversy in principle" appears in heading above the existing text which follows the opening paragraphs. Note: 1_It would be good to have one or two more citations from medical journals, from N.America, GB, Oz or elsewhere. Citation for BMJ as source needed. 2_There is a redundancy in the two paragraphs beginning 'Critics say the expression “alternative medicine” is deceptive because' but the refs are not identical- which is preferred? Qexigator (talk) 09:21, 28 January 2013 (UTC)

--PS: Sorry Sbh: There may have been an unwitting edit conflict on my part due to timing of my latest effort. Qexigator (talk) 09:29, 28 January 2013 (UTC)

Thanks to Teapeat, the "definition" first para. is now concise and well placed in the first para. and the last para.of the lead segues to the Introduction. But the move of other text to para. 2 and into para. 4 would result in some loss of clarity and the informative development of the article, so should be moved to appear more prominently under the first-off title controversy in principle. Some further tweaking and copy-edit may be needed. Qexigator (talk) 17:09, 28 January 2013 (UTC)

Teapeat's intro is short and elegant. I would add the following

• Add that CAM is a broad term and difficult to define
• Add a paragraph of criticsm
• Add a paragraph to say it is inexplicable popular

Finally had a chance to read the lancet paper, it's a bit dated (1994) and only has 24 refs but looks specifically at definitions and research. I've added some excerpts: it boasts that "in preparation of this review, some 800 articles ... were obtained" and that the "British Library is said to contain 55 000 articles on research in to CAM, to which 150-300 from 60 journals are added each month. It divides CAM into the following classes:

• Spiritual (e.g Art, Dance, Prayer)
• Pharmocological (e.g. Herbalism, Vitamins, Urine therapy)
• Physical/Physiological (e.g. Iridology, Accupuncture, Colonic irrigation, NLP, Psychic surgery)
• Devices (colour light boxes, Abrams oscilloclast)
• Mixed (Anthroposophic, Simontron, Vegatest) and
• Occult (gem therapy, numerology, pyramidology, scientology)

It also discussed the problem in defining and controlling for placebo effects, e.g if you define placebo as a 'non-specific' factor this would encompass most of CAM. It suggests that it may be more useful to examine how CAM practitioners uses the placebo effect rather than whether or not it's a factor in clinical trials Aspheric (talk) 19:50, 28 January 2013 (UTC)

I'm still not happy with the statement we're attributing to the NSF. I don't think it's an ideal source but if we are going to use it it should be to quote the following The American Medical Association defines alternative medicine as any diagnostic method, treatment, or therapy that is "neither taught widely in U.S. medical schools nor generally available in U.S. hospitals."Aspheric (talk) 20:05, 28 January 2013 (UTC)

But unless you intend an article on "US alternative medicine" that definition is best saved for the "culture relative" para or section. TCM is not alternative in China. Heavens I doubt you can say even that homeopathy is alternative in the UK as the queen uses it and in several places the NHS still pays for it with public funds. Of course Lancet objects. I don't know what Brit med schools teach. Certainly a UK doc would not be attacked for recommending it, though. SBHarris 21:04, 28 January 2013 (UTC)

Yep, it's a poor choice of source for lots of reasons and it's continued presence is simply a reminder that we're not taking a rational or policy based approach to sources. Lancet also looks at different cultures, apparently the french word for alt med translates as 'gentle medicine'. Germans have the same problems with euphamisms [[42]] Aspheric (talk) 22:48, 28 January 2013 (UTC)

Speaking as someone in the UK, homeopathy is not really mainstream medicine here, it's considered fringe within most parts of the medical community, and it is not taught to normal doctors during their medical training (there's 400 homeopathic trained doctors in the whole of the UK, they have to do a postgraduate course, as a paitent you can ask to be referred to them), nor is it recommended by NICE, but any GP can prescribe the sugar pills, although health authorities frequently recommend against them doing so. The UK national health service spends about £4m per year on 3 'homeopathic hospitals' and homeopathic prescriptions, which is scandalous, but this is in the context of a total spend of many tens of billions, and the British Medical Association is constantly trying to get this shut down. The number of homeopathic hospitals has gone down fairly recently in fact, there used to be a few more.Teapeat (talk) 22:30, 28 January 2013 (UTC)

Agreed that in UK homeopathy is not usually taught in estabished medical schools. But the current scandals of NHS are very much of the mainstream. It is questionable whether a Wikipedia article should be driven by BMA in choice of scandals. They are an interested party. Qexigator (talk) 23:49, 28 January 2013 (UTC)

For anyone who may have missed it, such as Stafford Hospital scandal. Qexigator (talk) 15:25, 7 February 2013 (UTC)

--History para. moved to near top of Introduction. Qexigator (talk) 00:40, 3 February 2013 (UTC)

Classes

The arrangement in section 2 looks awkward and ripe for improvement: 2 Examples and classes of alternative medicines 2.1 Alternative Medical Systems 2.1.1 Ayurvedic medicine 2.1.2 Traditional Chinese Medicine 2.1.3 Homeopathy 2.1.4 Naturopathy 2.2 Energy Therapies 2.2.1 Biofields 2.2.2 Electromagnetic Fields 2.3 Mind Body Therapies 2.4 Herbs, Diet and Vitamins 2.5 Body manipulation

My concerns are: 1_Isn't Naturopathy one of the Energy Therapies? 2_What has originated in the European-N.America tradition ('Western') should be distinguished from what has originated elsewhere: Ayurvedic, Traditional Chinese (incl. acupuncture). Homeopathy spread to N. America from Europe, and continued while mainstream Western medicine developed another way (per other articles). The origin of Chiropractic in 19c. North America may also be seen as a particular development in Western healing practise. And like it or not Magnet therapy also has its origins in the Western tradtion.3_The distinction between "Veritable Energy Medicine" and "Putative Energy Medicine"[43] seems valid in its way and suited to Alt.med. article.

Qexigator (talk) 23:13, 28 January 2013 (UTC)

Sorry to drop this in here (please feel free to move it elsewhere) but where would Copper bracelet therapy [44] fit in to this structure / article - it is of course nonsense but no more nonsensical than other contenders.  Velella  ^{Velella Talk}   23:23, 28 January 2013 (UTC)

Well, there is nonsense and nonsense (Nonsense verse), but the job here is classifying, and one can certainly make a nonsense of that. My proposal is to let the FDA document be the guide, but not binding, and if in doubt leave it out.Qexigator (talk) 23:46, 28 January 2013 (UTC)

Which FDA document ? Can you provide a link ? The FDA (US) or MHRA (UK) or Health Canada or Medsafe (New Zealand) will tend to only be concerned with medicines and medical devices. There are lots of alt meds that do not use medicines or medical devices (e.g. yoga, prayer, iridology, etc...) and so a proper overview is unlikely to be considered or discussed by these agencies (though i may be wrong).

I've used the Nature immunology classification as it's a high quality secondary source that's reasonably close to the overview on the NCCAMs homepage. It's also reasonably close to the Danish grouping of Cochrane reviews [[45]].The Lancet classification (above) would be an alternative but is a bit dated and is only a single source.

The text describing each treatment is horrifically biased, badly written and badly referenced. I've said before I'd prefer to go back 3 months, so at least we're starting with a half decent article but since we're doing things the hard way, i've tried to provide some sort of rational structure before addressing the content.

If the supposed mechanism of copper bracelets is absorbtion of copper through the skin, i would guess it comes under "biological therapies - herbs, diet and vitamins" in Nature / NCCAM classification. Under the Lancet classification it would come under pharmacological. Transdermal drug delivery is not unusual (e.g nicotine patches, fentanyl patches). There is no good evidence for copper on the skin to help in arthritis but there is some evidence for cabbage leaves to the skin to reduce inflammation[[46]] and most maternity wards will have a cabbage in the fridge [[47]] to treat mastitis. Does that make them complementary or conventional ? Aspheric (talk) 00:29, 29 January 2013 (UTC)

Asp: The FDA doc. I was referring to is mentioned above[48], For consumers:[49] and/or industry [50] This article cannot list every last species and variety of Alt.med. It already links to a complete list per Wikipedia. We have to sift. Let us focus on those chiefly mentioned by FDA plus any others chiefly mentioned by similar bodies elsewhere such as you have noted. Yes, as regulators they are the bodies charged with attending to these issues on behalf of the public, and will not spend more time than is necessary on debates about the supposed basis of "science" according to this or that school of thought, or commercial interest. That is the notable part, not inexpert quibbling of a semantic kind. I mentioned above that a major proportion of the populations of English language countries is regulated by the FDA, under the laws of the Congress of the federal republic, for better or worse, as part of that country's government, ostensibly of, by and for the people. That's good enough reason, for me, to make a start there. The topic is alternative medicine not a discussion about alternative science.Qexigator (talk) 01:32, 29 January 2013 (UTC)

it's a reasonable suggestion but i think the fda will still be biased towards treatments it regulates and won't provide the same objective overview as NCCAM, Nature Imm and Lancet. in any case, i'm happy to go with the majority Aspheric (talk) 02:20, 29 January 2013 (UTC)

Asp: Not so much biased as to some extent incomplete, given the reason for FDA's existence. Look forward to see what you come up with. Arc's tweak[51]: Noted that the words "scientific validation" are expanded via a redirect to Scientific method article, and that it has notices about disputed neutrality and "written like a personal reflection or essay". Results of Aspheric's work on sources awaited with interest. Qexigator (talk) 09:12, 29 January 2013 (UTC)

--Asp: The link you give above to the Danish grouping looks useful [52], but "will not be updated after the 23rd of November 2012 due to the closure of ViFAB." It could be some guide for classifying, and included as an External link. It seems to be a directory for papers in the online Cochrane Library, eg Link from Homeopathy for chronic asthma goes to[53],Meditation therapy for anxiety disorders goes to[54] --Qexigator (talk) 16:50, 29 January 2013 (UTC)

The upshot of above (in my view) is that the article would be improved by applying the classes in The Lancet paper of 1994 (per Aspheric 19:50, 28 January 2013) to products and treatments listed in FDA or similar, as a relevance filter based on what is notable for major regulatory bodies concerned with public health for any given population, and to avoid itrusion from off topic theoretical disputation about the rationality of science and scientism.Qexigator (talk) 16:36, 1 February 2013 (UTC)

Listing grounds for opposing alt.m.

Part of the text of the Introduction has been made into a short list. Some of the remaining text could be brought into the list with existing sources, such as (verbatim):

(Many of the claims regarding the efficacy of alternative medicines are controversial. The safety of alternative medicine is also controversial. Some alternative treatments have been associated with unexpected side effects, which can be fatal.)

• Research on alternative medicine is frequently of low quality and methodologically flawed.
• Where alternative treatments are used in place of conventional science-based medicine, even with the very safest alternative medicines, failure to use or delay in using conventional science-based medicine has resulted in deaths. Qexigator (talk) 20:39, 30 January 2013 (UTC) + Qexigator (talk) 23:32, 30 January 2013 (UTC)

Further listing done as above. Arrangement of remaining text needs attention. Qexigator (talk) 23:32, 30 January 2013 (UTC)

I think the listing is an improvement. The text remains dodgy (at best). Point 2 - that alternative therapies typically lack any scientific validation, and their effectiveness is either unproved or disproved.[13][16][17] Is not supported by reference 16 or 17. I don't know if Ref 13 supports it or not but it doesn't seem to be an appropriate source. I think the sentence needs to be re-written or re-referenced. Aspheric (talk) 21:09, 31 January 2013 (UTC)

If the existing sources do not support, then let this point be omitted, and at the same time, omit words from lead, leaving the opening sentence as: Alternative medicine is any of a wide range of health care practices, products and therapies, which typically are not included in the degree courses of established medical schools. To my mind that would say all that is necessary there, allowing for some properly sourced expansion later. Confirmation about sources either way awaited. Qexigator (talk) 22:57, 31 January 2013 (UTC)

The headings for section 3 Criticism are:

3.1 Misleading use of terminology

3.2 Criticism on scientific grounds

3.2.1 Based on incorrect reasoning

3.2.2 Based on ignorance of basic scientific facts

3.2.3 Ineffective and misleading statements on efficacy

3.2.4 Unfalsifiable

3.2.5 Using plausibility of one practice to support implausible other practices

3.3 Taking resources from real medical research, abuse of medical authority

3.4 Ethics, dangerous misinformation, fraud

3.5 Integrative medicine practitioners intentionally mislead patients

--3.1 has now been put in listed format. Some of the text is badly in need of excision or rewrite. Much of the rest of 3 (3.2 through 3.5) is repetitious and could be merged with 3.2, if not excised. Comments? Qexigator (talk) 12:22, 2 February 2013 (UTC)

--3.2 is now in listed format. It is easy to see that the sub- headings used are grander than the thin almost weightless points under them. Mostly, journalistic and personal opinions, and much of it connected with interested parties getting a share of the Federal budget, per the next heading "Taking resources from real medical research, abuse of medical authority". That is not to question the convictions of the various critics, but only the worthiness of what they assert for the purpose of an article about medicine and medical practice, as variously seen by the established medical schools, by members of the general public who have personal healthcare problems, and by the public bodies appointed in freedom loving countries to protect the innocent from manifestly harmful products and practises. "Testing" is another section which is ripe for cutting down. It seems to be continuing the Federal budget contest by other means. The details about RCT etc. surely belong elsewhere? Qexigator (talk) 19:09, 2 February 2013 (UTC)

--The article in the current version runs to 16 pdf pages of text + refs etc on pp. 17 to 25, in roughly three parts; 1_ Lead, Intro. and Examples, pages 1 to 5. - 2_Criticism section pages 6 to 9. - 3_ Use and regulation, Research, Appeal etc, pages 10 to 16. In this version the Criticism section in the middle remains disproportionate, especially in view of the lightweight content of 3.2: journalistic and personal opinions, much of it connected with lobbying for a share of the USA Federal budget (per next heading Taking resources from real medical research, abuse of medical authority (mentioned in "Classes"[55] 19:09, 2 February 2013). '"Efficacy"' is in part repetitious, part is cogent enough to put in Criticism in place of something more lightweight, and part may be better put in the Introduction. Don't the details about RCT etc. now in the Testing section really belong to some other article? Qexigator (talk) 17:59, 3 February 2013 (UTC)

--In current version,[56] the context for the criticism is in the expanded Introduction, and the whole is concisely encapsulated in the lead. Criticism now in better proportion: Lead and Intro 1-4, Examples 5-7, Criticism 8-9+, Use ....end 10-17 +refs etc. Qexigator (talk) 09:44, 25 February 2013 (UTC)

Better in next section "Examples and classes"?

Of the paragraph beginning Alternative medicine practices and beliefs are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal. and ending African, Caribbean, Pacific Island, Native American, and other regional cultures have traditional medical systems as diverse as their diversity of cultures. the text in between looks like a casually disjointed mention of specific examples, which may be better distributed into the next section "Examples and classes". Meantime, pending revised class headings, listing may be more intelligible, thus:

"Alternative medicine practices and beliefs are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, ignorance or misunderstanding of scientific principles, errors in reasoning, or newly conceived approaches claiming to heal. African, Caribbean, Pacific Island, Native American, and other regional cultures have traditional medical systems as diverse as their diversity of cultures. A short but not comprehensive list is:

• Prayer to heal is the most common alternative medicine in many western countries, and faith healing is a part of many religions.
• Some believe that meditation affects health.
• Yoga as a healing practice involves stretching, exercise and meditation related to the Hindu religion, and makes claims to healing in the spiritual realm.
• Traditional Chinese medicine and the Ayurvedic medicine of India are complex systems developed over thousands of years, both based on regional supernatural belief systems and traditional use of herbs and other substances.
• Acupuncture is a part of Traditional Chinese medicine in which needles are inserted in the body to alter the flow of supernatural energy believed to propel the blood and influence health.
• Chiropractic manipulation of the spine was developed in the United States, and involves manipulating the spine to influence supernatural energies believed to cause disease.
• Homeopathy was developed in Europe before the existence of science of chemistry, which has subsequently proven the premises of homeopathy to be false.
• Magnets and light are used in therapies based on a misunderstanding of electricity and magnetism.
• Dietary supplements that are unproven by science are considered alternative medicines.

The above reproduces the existing wording, but will need some tweaking sooner or later, depending on other revisions. Qexigator (talk) 10:45, 31 January 2013 (UTC)

I've had a stab at rewriting 'Alternative medical systems' will have a look at Energy therapies, Herbal, Manipulative and Mind Body when I get a chance. Nice edits to intro by the way.Aspheric (talk) 21:12, 31 January 2013 (UTC)

Reinstate?

In the general revert of 07:36, 5 February 2013[57] another editor's revisions were lost. They look acceptable enough to be reinstated, subject to any sufficient reason against, which others make known. They were:

• 20:56, 31 January 2013(→‎Examples and classes of alternative medicines: captions changed back to original text)[58]
• 21:22, 31 January 2013 (text unsupported by references)[59]

Qexigator (talk) 09:01, 6 February 2013 (UTC)

The specific wording does not seem to be in the sources, but I think it is a reasonable summary of the sources we have (not just those three). Arc de Ciel (talk) 09:34, 6 February 2013 (UTC)

"Not based on the scientific method"

Noting above 1_The then current definition ("not based on the scientific method") doesn't have to be the definition per Arc de Ciel 06:05, 24 January 2013 (UTC)[60], "2_comment Point 2 dodgy per Aspheric 21:09, 31 January 2013 (UTC)[61], words omitted from first sentence. Qexigator (talk) 12:56, 1 February 2013 (UTC)

The National Science Foundation (and its National Science Board) is currently cited in the second para. of Intro., and has been carried forward from earlier versions of the article. It is again quoted for its stipulative definition of alternative medicine as "all treatments that have not been proven effective using scientific methods." Given the content of the report of which it is a part, it seems an improbable source for the present topic. Qexigator (talk) 19:50, 1 February 2013 (UTC)

• For the document's Table of Contents see here[62]. For chapter 7 Overview and Organization see here[63] The tenor of chapter 7 can be seen from these extracts: "Americans are highly supportive of science and technology (S&T), but lack knowledge of them. ....Statistics on Americans' lack of knowledge of such subjects as history, geography, mathematics, and science receive a considerable amount of media attention and are regularly cited in speeches given by various educators and policymakers. .... it is not always clear how important this deficiency is..... The level of interest in S&T is an indicator of both the visibility of the science and engineering (S&E) community's work and the relative importance accorded S&T by society. ..... Data on public attitudes toward Federal funding of scientific research and public confidence in the science community are included..... information on public perceptions of the benefits and harms (or costs) of scientific research, genetic engineering, space exploration, the use of animals in scientific research, global warming, and attitudes toward math and science education.... discussions on the public image of the science community, including public perceptions of scientists and science occupations, and where Americans get information about S&T. Finally, interest in science fiction and the relationship between science and pseudoscience, including concerns about belief in paranormal phenomena, are examined..." Qexigator (talk) 23:31, 1 February 2013 (UTC)

I didn't say I will not object if all criticism is removed from the lead. :-) While I have not checked every diff, I think that many of the edits were reducing article quality and Harizotoh's recent revert was a good idea. Also recall that even this version still needs a criticism paragraph in the lead. Arc de Ciel (talk) 10:58, 5 February 2013 (UTC)

Yes, when sources sorted, merger proposal decided, and we have got the article in better trim, it will be clearer what can be said succinctly in the lead to cover the criticism in the body. As now re-expanded with "evidence-based", "scientific validation" and unproved or disproved", that can suffice, Qexigator (talk) 18:57, 5 February 2013 (UTC)

I didn't mean to say it needed a fix immediately. :-) Arc de Ciel (talk) 09:20, 6 February 2013 (UTC)

worth retaining?

The lead now has a clear "definition" for "alternative medicine". Criticism of the products, practises and putative therapies to which that refers is one thing, but opinions critical of supposedly misleading use of terminology is quite another, and not only inconclusive but not of much interest. The main grounds for opposing are listed in the Introduction. But under the heading Misleading use of terminology there seems to be nothing added which is not said elsewhere in the article, except

1_use of "Western medicine" and "Eastern medicine" is to suggest that the difference is not between evidence based medicine and treatments which don't work, but a cultural difference between the Asiatic east and the European west. If this is worth retaining let it be given a better place.

2_“Whole medical systems” either refers to a spiritual belief, that “spiritual wholeness” is the root of physiological and physical well-being,Ayur veda, Chinese medicine, Homeopathy and Naturopathy are cited as examples or to differentiate widely comprehensive systems from either specific components of the system or from practices that claim to heal only a limited kind of specific medical conditions. This too could be given a place elsewhere.

The next heading is Criticism on scientific grounds. There is little worth retaining except, perhaps:

• Academic study: Edzard Ernst, a professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative.[80] Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist, "statistically indistinguishable from placebo treatments."
• Other: Proponents of an evidence-base for medicine, such as the Cochrane Collaboration take a position that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method. Qexigator (talk) 19:27, 3 February 2013 (UTC)

Further to above now-

propose OMIT:

• 1_'use of "Western medicine" and "Eastern medicine" is to suggest that the difference is not between evidence based medicine and treatments which don't work, but a cultural difference between the Asiatic east and the European west.' Lacks informative value. It seems to be responding to a point which has not been made.
• 2_' "Whole medical systems” either refers to a spiritual belief, that “spiritual wholeness” is the root of physiological and physical well-being, Ayurveda, Chinese medicine, Homeopathy and Naturopathy are cited as examples or to differentiate widely comprehensive systems from either specific components of the system or from practices that claim to heal only a limited kind of specific medical conditions.' This is not an expansion of alternative medicine as that is defined in the lead. It is a distinct topic which could be included in any of the named systems. In fact, the expression is not included in Ayurveda, Traditional Chinese medicine, Homeopathy or Naturopathy.

propose MOVE to become paras. 3 and 4 of Introduction :

• 1_"Edzard Ernst, a professor of complementary medicine, characterizes the evidence for many alternative techniques as weak, nonexistent, or negative. Ernst has concluded that 95% of the alternative treatments he and his team have studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are, according to The Economist, "statistically indistinguishable from placebo treatments."
• 2_"Proponents of an evidence-base for medicine, such as the Cochrane Collaboration take a position that all treatments, whether "mainstream" or "alternative", ought to be held to the standards of the scientific method." Qexigator (talk) 23:32, 3 February 2013 (UTC)

Proposed OMIT Done by... Qexigator (talk) 09:06, 4 February 2013 (UTC)

Proposed MOVE Done by... Qexigator (talk) 09:22, 4 February 2013 (UTC)

Another proposed MOVE: from Misleading use of terminology to Intro. (above Some opponents...)

Some critics say that "Alternative medicine" refers to any practice that is put forward as having the healing effects of medicine, but is not based on evidence gathered with the scientific method, when used independently or in place of medicine based on science. "Complementary medicine" refers to use of alternative medicine alongside conventional science based medicine, in the belief that it increases the effectiveness. Qexigator (talk) 09:47, 4 February 2013 (UTC)

CBT as complementary medicine

The last line of the Appeal section reads:

"Some mind-body techniques, such as cognitive-behavioral therapy, were once considered complementary medicine, but are now a part of conventional medicine in the United States" Source WebMD

To my mind, given that CBT is a kind of unholy amalgam of cognitivism and behaviorialism, that's a pretty extraordinary claim. Is there a better source to support it than that website? FiachraByrne (talk) 02:15, 1 March 2013 (UTC)

Integrative medicine

Moved Integrative medicine from lead to See also, and omitted elsewhere. There appears to be no sufficient reason for treating "Integrative medicine" in this article which is about alternative medicine, as now defined in the first sentence.Qexigator (talk) 23:52, 4 February 2013 (UTC)

"Integrative medicine" is just a re-labeling of Alternative medicine. There is no substantial difference. --Harizotoh9 (talk) 00:03, 5 February 2013 (UTC)

Up to a point, but as it has a whole article to itself anyone looking for what it refers to are welcome to go there. Qexigator (talk) 00:22, 5 February 2013 (UTC)

Which is itself a very tiny article. I think the two articles should be merged. There's likely enough sources discussing the similarities and that it's a re-branding. --Harizotoh9 (talk) 00:26, 5 February 2013 (UTC)

Integrative medicine (or integrative health) is the combination of the practices and methods of alternative medicine with evidence-based medicine.[6]

This is incorrect. This is what they claim. The reality is different. Their claims should not be presented as is. --Harizotoh9 (talk) 00:44, 5 February 2013 (UTC)

Merge? Not sure it would help. But first stage would be clean up Integrative med., such as disentangling EBM. It is quite short, may be add parts from Alt. med. in preparation for merging Int.med. as a section. But if it is no more a factual body of knowledge and practice than, say, writing about Unintegrated or Segregated or Aggregated or Diversified it would be better to avoid conflating it with the generally acknowledged and differentiated CAM. Qexigator (talk) 01:27, 5 February 2013 (UTC)

It should be a sub-section in Alternative medicine. The two articles would cover the exact same things. It's just a rebranding to make Alternative medicine sound more scientific. But these terms functionally very similar and refer to the same thing. For instance, look at the University of Maryland Medical School. Their integrated medicine patient clinic offers ... alternative medicine. Homeopathy, Reiki, acupuncture, etc. --Harizotoh9 (talk) 02:44, 5 February 2013 (UTC)

Not sure about 'exact same things. It's just a rebranding to make Alternative medicine sound more scientific' but will look at UMMS carefully. (Agree with removal of "Should psychitry article...") Qexigator (talk) 09:03, 5 February 2013 (UTC)

University of Maryland Medical School should be added. Are there other schools in USA or elsewhere offering alt. med as part of comp or int.? Integrative medicine says 'In the UK, the universities of Buckingham and Westminster have previously...' Most of that article is a lengthy quote from The New Republic 'an American magazine of commentary on politics and the arts'. If articles merged that quote could be considered for converting to concise Wiki-ese and referenced, if no better source can be found. Qexigator (talk) 18:32, 5 February 2013 (UTC)

It isn't a 're-branding' but researchers do make the distinction between AM, CM, and IM based on the evidence base and prevalence. This should be noted in the article. DVMt (talk) 00:54, 16 February 2013 (UTC)

Here and there in the article 'spiritual' or 'spirituality' seem to be used in opposition to what is being characterised as "science based". Perhaps to clarify, the article (in Appeal section?) could include something based on another Carl Sagan quote, from The Cosmic Perspective 2009, which I see has been added to the Sagan article today:

"Science is not only compatible with spirituality; it is a profound source of spirituality. When we recognize our place in an immensity of light-years and in the passage of ages, when we grasp the intricacy, beauty, and subtlety of life, then that soaring feeling, that sense of elation and humility combined, is surely spiritual."

Qexigator (talk) 15:10, 7 February 2013 (UTC)

I agree that there needs to be updating of the page and a merge is an issue which should be considered. Different organizations, agencies, governments and scientists do in fact separate alternative medicine from complementary medicine from integrative medicine and also traditional medicine. The alt-med label implies there is no body of research supportive efficacy or plausible biological rationales. DVMt (talk) 22:07, 15 February 2013 (UTC)

If you are proposing a merge, then start a new thread about it and follow the proper process:

• http://en.wiki.x.io/wiki/Wikipedia:Merging

It's a small article and could easily be incorporated here. This article is already a merge of three separate articles. -- Brangifer (talk) 04:34, 19 February 2013 (UTC)

Also use the proper templates:

• http://en.wiki.x.io/wiki/Template:Merge_to
• http://en.wiki.x.io/wiki/Template:Merge_from

Do this AFTER a discussion has approved the idea and determined what to do. -- Brangifer (talk) 04:37, 19 February 2013 (UTC)

Who will be the first to comment on Integrative medicine: Revision history[64]? Qexigator (talk) 00:47, 6 March 2013 (UTC)

Neutrality?

The editor who has proposed neutrality of the article as a whole is disputed is overhasty (suggesting POV gambit) and if s/he cannot be specific, the banner should be removed. That editor should make a case and argue it point by point, and not waste other editors time. It is not enough to mention that citations are needed in the Introduction, if supported in the detailed sections below it. There are ongoing discussions about a number of questions. Qexigator (talk) 20:08, 18 February 2013 (UTC)

When the opening lead is not NPOV then how can we be assured the rest of the body isn't? And you have not addressed any of my points as seen above. I have already added 7 citation tags needed and this article relies almost exclusively on primary sources WP:MEDRS explicitly states that "secondary and tertiary" sources are preferred. The weight and tone of the article are also overly critical and there are tons of factual inaccuracies such as chiropractors "manipulating the spine to influence supernatural energies". There are several more issues, these are just the beginning. DVMt (talk) 20:59, 18 February 2013 (UTC)

Not agreed. Let others comment. Qexigator (talk) 21:06, 18 February 2013 (UTC)

To the contrary, as you requested I provided specific arguments on why this article is blatantly NPOV. The article leans far to heavily on critical sources (i.e. Ernst) that are outdated (1995) while not giving mainstream organizations like the WHO, Cochrane and NCCAM a voice at all. Not too mention that there are several systematic reviews published within the last 5 years such as this . PMID 23246998. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) and this . PMID 23355825. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) etc. The whole article's tone and weight is based on outdated, biased and critical sources while not representing the mainstream view of CAM, nor the mainstream research of CAM inteventions. It's deplorable, really. I can't believe this issue has never been addressed! DVMt (talk) 21:40, 18 February 2013 (UTC)

Well good luck DVMt, but in my experience there should be a great big ABANDON HOPE ALL YE WHO ENTER HERE sign on this article for anyone that thinks of doing any editing to make it more accurate. I've said the same things that you are saying years ago: This article is stuck in some dark past while modern medicine has moved forward. But then, what's new about that, eh? The profession itself is notorious for exactly that. I look at it this way: The article is so bad that any intelligent person can see the bias in the first sentence and knows what to expect. Gandydancer (talk) 22:39, 18 February 2013 (UTC)

No luck required. I'll bring this to the attention of WP:MED and they will agree. Cochrane, WHO and NCCAM are simply too big to ignore for this article. I'll leave it to Qexigator to explain that to the medical doctors. DVMt (talk) 22:43, 18 February 2013 (UTC)

Actually, Gandy, the first sentence candidly mentions the origins of the use of "alternative", and the article will return to being unintelligible if something like it is not retained, and expanded a little to account for time and place of origin and diffusion, and present day usage from country to country. You mentioned awhile back your despair about getting the article into better shape, but it looks as though another period of disruption is being stirred up. I hope it may turn out for the better. By the way, there is nothing further to be explained by...Qexigator (talk) 23:00, 18 February 2013 (UTC)

DVMt, I have argued for years for that name change. Thanks and I hope it is not changed back. Gandydancer (talk) 23:23, 18 February 2013 (UTC)

If you want stability it might be best to use the requested moves process. FiachraByrne (talk) 03:40, 19 February 2013 (UTC)

DVMt, have you lost your mind?! Name changes like you made, especially if controversial, must go through a process involving a request, and then long discussions involving many editors. This article is the result of merges of the three articles on alternative medicine, integrative medicine, and complementary medicine. The merges were made after long discussions and weren't made lightly. Since all involve exactly the same methods (alternative), and only the setting changes, it was thought best to mention them here and explain briefly what they were. Separate articles of any length were deemed unnecessary. That was enough and we still have this article. Please stop going around and single-handedly acting like a bull in a china shop. You're messing with years of work by thousands of editors. Show a little respect. -- Brangifer (talk) 03:53, 19 February 2013 (UTC)

Agreed with Fiachra. I will initiate one tomorrow. DVMt (talk) 04:06, 19 February 2013 (UTC)

No progress made so far with the lead? No reference to NCCAM, Cochrane and WHO with an official definition of CAM? Still called alt-med? Why exactly is this called "Alternative medicine" and not "Complementary and Alternative Medicine" as used by every governmental agency that is part of the WHO. Explain your rationale prior to myself requesting a move for the page (with history merge, of course). I'd like to hear your thoughts Qexigator and Brangifer. DVMt (talk) 01:50, 28 February 2013 (UTC)

Have you read through the history of the merges which created this article? The reason we mention and highlight in bold the various terms which are covered is because those were the conditions agreed upon by the large consensus involved in the various stubs and this article. That agreement included that we leave the necessary redirects in place.

CAM is only an acronym, not an independent entity, and that's properly explained in a few words. End of story. No need for a separate article.

Next step would be to build a case for separate articles for "complementary medicine" and "alternative medicine", which are the two elements in CAM. Well, "complementary medicine" is simply alternative medicine methods used in conjunction with mainstream medicine, and that too is explained here. It is only the setting, and not the methods, that are different. It only takes a few words to explain the setting, not a whole article. End of story. No need for a separate article.

We already concentrate all the necessary information right here, where it belongs, since the other things are only about different settings for the use of "alternative medicine" methods and ideas. It is still about the same methods, but just other ways to try to legitimize and slip unproven and disproven methods into mainstream healthcare. It is only the setting that changes, and that's explained here. End of story. No need for separate articles. It would be very odd to have independent stubs that, after a few sentences, had to refer to this article anyway for more information. It serves readers well to provide the whole thing in one place.

NCCAM, Cochrane, and the WHO all discuss alternative medicine, its methods, and ideas, and they also use the acronym CAM. We have no problem with using them as sources, first in the body, and then, if relevant, in the lede.

So far you have not presented any new arguments for a title change that we have not heard before. If you have substantive reasons for making the change that we have not heard before, please explain. -- Brangifer (talk) 04:16, 28 February 2013 (UTC)

It is good to see an editor who has been with this article for a long time explain in simple terms what an attentive editor could infer. The first sentence of the current article is about as neutral as anything could be, especially when read with the Introduction which expands it, equally neutrally, if it is read neutrally and not through the haze of a potent pov. I have one reservation: The first para. of the Intro. (one of my earlier revisions) speaks of "the threat" from homeopaths and others being stemmed by legal and organizational measures. That is taken practically verbatim from the source, but out of its own context looks pov, and I feel should be tweaked by inserting "to them " after "the threat" (DONE). That is a fair and accurate description in a few words of the then state of affairs, which became transferred to N.America and the chiropractors. Please note also, as mentioned above (Update 4) the basic fact described in Intro. para. 2: Among putative medical practices available at the time which later became known as "alternative medicine" were homeopathy... and chiropractic... These conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science such as listed in Timeline..., nor have...other kinds of alternative medicine. That is the case from any point of view or side of the argument. While here would add that DV's recent revisions (rmv and tags) look to me as fair comment and within the range of npov copyediting. Qexigator (talk) 09:14, 28 February 2013 (UTC)

-In my view (see "Omit items of personal opinion"[65]), the Criticism section would be improved by removing Dawkins whose old-fashioned views about medical sciences have little or no weight except among his admirers and disciples (it's a long time since he was a laboratory researcher in Oxford, England and Berkeley, California). The opinionated generalities attributed to him merely repeat what has been cited from weightier sources. Adding Dawkins reduces the mean weight of them taken together. Most of the rest of the Crticism section is unimpressive from a neutral pov, but maybe its purpose is to demonstrate just that. Certainly some other editors may see it otherwise. But are not the external links to Criticism enough? Qexigator (talk) 11:27, 28 February 2013 (UTC)

I would tend to disagree. The greater problem is that someone has added POV special pleading to poison the well against Dawkins. The words "who is not a medical practitioner of any kind nor has qualified as a physician or surgeon" are editorializing that serves no purpose but to attack Dawkins (I'll remove that), who happens to be an extremely notable critic of alternative medicine and all things pseudoscientific and/or unscientific. He has never claimed to be a medical practitioner, physician, or surgeon. If he had falsely done so, such a comment would be in order (and we wouldn't use him). Criticism from non-medical personnel is fair game if they are notable. They are showing that they understand science and critical thinking better than some medical personnel, like Andrew Weil. In this case Dawkins sums up the critical POV expressed by notable medical personages, but does it even better and therefore the quotes of his we have used are far more well-known. -- Brangifer (talk) 15:50, 28 February 2013 (UTC)

OK, I'll take your word for it. Dawkins may be more highly regarded as a pundit elsewhere than UK, and most of this criticism is US sourced. But why does "CAM....medical journals or elsewhere" need citation? It is simply introducing what follows. Ditto "Some of the criticism ...studies of effectiveness?" These sentences could be revised to read: "The following instances show that CAM, and use of the term "alternative medicine", have been criticised in the name of consumers or otherwise on various grounds including misleading terminology or inferences about motivation, or on scientific grounds or for errors of reasoning, or about taking resources from real medical research, or abuse of medical authority, ethics, dangerous misinformation or fraud. Some of the criticism has been with support from independent research or evidence, such as research studies of effectiveness...." Without something like that, the reader is left with a disjointed patchwork. Qexigator (talk) 17:18, 28 February 2013 (UTC)

Hmmm, Dawkins' evangelism for the League of the Militant Godless is one of the few things likely to ever turn me towards some form of religious belief. Dawkins is a notable voice as a scientist, populariser/proselytiser of science, and a very engaged public intellectual. However, his views here are pretty derivative and essentially repeat points already made in the article. Currently, the article states: "Richard Dawkins, an evolutionary biologist, has defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests."[107] He has also stated that "there is no alternative medicine. There is only medicine that works and medicine that doesn't work."[108] He has argued that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.[109]" There are two thrusts to his critique: 1) alt med does not follow scientific norms; 2) there is no alt med, only effective and ineffective medicine. Dawkins is not unique in making these points. Would it not make sense to categorise the different forms of critique and present them coherently together. So, you'd put all those who critique alt med as not following scientific norms, with the various points they raise and attributing them by name if appropriate, in one paragraph; in another paragraph you'd put all those who follow this definition of alt med as medical practices which are ineffective. For instance, this latter definition is also propounded by Angel and Kassirer: "It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments." Angell, M.; Kassirer, J.P. (1998). "Alternative Medicine – the Risks of Untested and Unregulated Remedies" (PDF). The New England Journal of Medicine. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094. {{cite journal}}: Unknown parameter |month= ignored (help) Also, I'm not sure of the logic of having a "Proponents and opponents" section which is followed by a "Criticism" section. FiachraByrne (talk) 18:21, 28 February 2013 (UTC)

Noted, will take time to consider, and respond later. Qexigator (talk) 18:46, 28 February 2013 (UTC)

--".... logic of having a "Proponents and opponents" section which is followed by a "Criticism" section"? The part of the Introduction headed "Proponents and opponents" is to narrate generally the current state of the Public discussion, arising from "how alternative medicine got its name" and "Medical education (20c. to present)". The para. beginning "Some opponents, focused upon health fraud...." could be placed in "Criticism" to introduce the specfic individuals' objections, but I remain unpersuaded from my above critique of Criticism: "Omit items of personal opinion"[66]. Support for removal is lacking, so I would let it be (except to add the introductory sentence as above). As we know, what any one editor might see as an acceptable improvement is to some extent conditioned by the article's history, much of it seemingly connected with strenuous debate in N.America. To me, comment unsupported by survey evidence about the words "alternative" or "complementary" being deceptive is at most polemical trivia. Where is the evidence, outside the mind of the preacher and the converted? This has nowt to do with whether or not the spokesman is a declared atheist (such as Dawkins), rationalist, sceptic, religious adherent or self-styled quackbuster. Qexigator (talk) 23:30, 28 February 2013 (UTC)

No, I think the proponents and opponents section - while it could possibly be renamed - works quite well and while the text could do with some tightening up I think the general structure is quite good. The criticism section does not work well in my opinion. Generally, I'm opposed to criticism sections but I don't think the content should be removed but rather reworked and contextualised. Who are the critics, what do they represent, what are their interests, general ideological position, the nature of the rhetoric, can they and the nature of their criticisms be characterised in some way. Likewise for CAM adherents (and some of the divisions within CAM & alt med). As opposed to content falling under MEDRS (which sometimes might be the same literature) looking at efficacy/effectiveness and prevalence data of alt med we should, I think, treat most of these sources (quackwatch, etc) as primary and look for good, 3rd party secondary sources which have examined this dispute/division within the medical field (broad definition of medical). This would require a source, obviously, probably from the sociological literature and I haven't looked at that in any kind of systematic way. The rhetoric for and against CAM/alt med revolves around issues of competence and legitimacy. Anyhow, we'd need to review the overall literature on this but something like this open-access paper might help: Hirschkorn, K. A. (2006). "Exclusive versus everyday forms of professional knowledge: Legitimacy claims in conventional and alternative medicine". Sociology of Health and Illness. 28 (5): 533–557. doi:10.1111/j.1467-9566.2006.00506.x. PMID 16910946. I might do a little copy-edit if no-one objects. FiachraByrne (talk) 01:34, 1 March 2013 (UTC)

Tagged a bunch more primary sources which are outdated (1990s) and come primarily from websites. Also tons of questionable "notable" people which looks like a soapbox for quackwatch, SBM, etc. Critics can be found in systematic reviews, such as Ernst. Don't rely on primary sources when secondary sources state the same thing and are more current. Agree with Fiachra, the arguments should be condensed instead of having them repeated ad nauseum by different "notables" (according to whom). DVMt (talk) 00:31, 1 March 2013 (UTC)

Medical sources are not going to be best to trace this dispute in an objective fashion. I think we need to gather the sociological literature - they and related disciplines have the expertise when looking at the structure of the medical marketplace, questions of professionalisation, etc. I'd really like to look at industrialised production of CAM products and commercialisation of CAM generally. Don't get too tag happy as, I think, the goal won't be to remove those sources but make them intelligible through the use of appropriate and (reasonably) neutral secondary sources. FiachraByrne (talk) 01:34, 1 March 2013 (UTC)

I agree but this article makes medical claims as well as having a sociological context. I'm going to work on the medical side of things regarding effectiveness and cost-effectiveness as well as safety. The historical, sociological stuff is not my interest here, and it seems up your alley anyways so it works out well. DVMt (talk) 20:30, 1 March 2013 (UTC)

That, FiachraByrne 01:34, 1 March 2013 (UTC) (proposing Crticism section to be reworked and contextualised), will need some diligent npov editing per outline, viz, Who etc are 1_the critics etc.2_ CAM adherents; and on efficacy/effectiveness and prevalence, look for good, 3rd party secondary sources which have examined this dispute/division within the medical field- probably from the sociological literature (tba), + industrialised production of CAM products and commercialisation of CAM generally. This is a fresh approach, and seems both achievable (absent disruptions) and what the topic needs. Copyedits looking good. Now under perusal: Kristine A. Hirschkorn, McMaster University, Hamilton, Ontario, Canada, with its schema for problematising knowledge and its relationship to legitimacy by distinguishing between the context, form and content of professional knowledge - a reminder of the greater context, while letting the article topic stay focused on its particular portion of all that. Cheers! --Qexigator (talk) 12:24, 1 March 2013 (UTC)

--The main points I found in Hirschkorn are: 1_' In summary, the medical profession would appear to be moving simultaneously in two directions: towards indeterminacy in the embracing of CAM therapies and towards technicality in the push for EBM' p.548/9. 2_'The rise in popularity of alternatives (to biomedical therapies) may be ... a logical outcome of a set of wider socio-political transformations...the emergence of ... a scepticism about the ability of science and technology to provide answers to... illness, and the resultant emergence of.. alternative health care practices’. p.550/1 3_'...consumption of CAM has grown phenomenally in the past 20 years. It is estimated that 1/4 to 1/5 of the populace in Western industrialized nations visited an alternative practitioner in 1999... users of CAM do not differ demographically from users of biomedical therapies: they both tend to be young to middle-aged, well educated, middle-class or affluent women.' p.550/1. Could be worked in somewhere? "Appeal", which may be due for cleanout and rewrite anyway? Qexigator (talk) 17:23, 1 March 2013 (UTC)

I think at this point the paper is most useful in its evaluation of the sociological literature on alt med/cam. In additiona to what you raise above, points that may be relevant, are:

"Much of the relationship between CAM and biomedicine has been characterised as economic, political and conceptual competition (Wardwell 1994). To put this into the language of occupational closure theory, biomedical providers seek to maintain their monopoly position in the provision of health services, and CAM providers on, the other hand, attempt to increase their status and share of the market (Baeret al. 1998). Knowledge claims, while not necessarily the determinants of professional status, represent a key vehicle through which these struggles are rhetorically played out, particularly with regard to science, both across professional groups and within them." P.534

Social closure theorists regard professionalisation as the attempt to establish a – usually legally guaranteed – occupational monopoly over a jurisdiction of expertise and services (Abbott 1988, 1993, Collins 1990, Freidson 1986, Johnson 1972, Larson 1977, 1979, 1990, Parkin 1979, Murphy 1986, 1988, Macdonald 1985, Saks 2000, 2003). P. 536

So from that I want to seek out Wardell and see if we can get a competition framework within which we could contain a lot of the rhetorical conflict currently in the criticism section. I'd like to see something of occupational closure theory used in the article (a good part of which should be about professionalisation). It also provides a context for understanding knowledge claims within this kind of vitriolic discourse.

I profile the opposing trends of both holism and evidence-based medicine (EBM) within the mainstream medical community as well as the propensity within various CAM communities towards the scientisation of their practices and professionalisation of their practitioners.

So CAM, if not the broader field of alt med, is professionalising in a process which parallels that which "mainstream" medicine went through historically. I find the notion of the scientisation of CAM interesting and notable - it doesn't imply that their treatments are necessarily getting more efficacious but just that they're increasingly seeking to construct an understanding of their medical practice within normative scientific principles and that this must change these practices and the understanding of these practices.

Many professions scholars draw a distinction between content and context of professional work, beginning first with Freidson (Freidson 1970). Control over the terms of work – i.e. the context – includes a legal or political monopoly of service provision (i.e. self-regulation) supported by regulatory colleges and a professional code of ethics, whereas control over the content of work includes control over academic credentials and the exercise of discretionary judgement in the professional-client encounter.

Standard context/content division is perhaps applicable when looking at professionalisation of CAM.

The public is important in so far as public opinion or recognition of a professionalising group often provides part of the impetus for state licensure. Willis and White (2004) identify this as ‘clinical legitimacy . . . [which] refers to continuing patronage of practitioners by consumers willing to pay for their services’, itself one of the bases or fore-runners of ‘politico-legal legitimacy’, i.e. regulation and state-supported financing and educational arrangements (2004: 58) 3. Thus, cultivating a positive public image is a necessary strategy that often becomes what Larson would refer to as an ideological project intent on securing public confidence, as part of a broader ‘professional project’ (Larson 1977, 1979, 1990). The notion of a legitimacy or knowledge claim as regards the professions thus represents one component of a professionalisation project.P. 536

This might be relevant to sections on Appeal or Prevalence. Maybe we should have a section on legitimation/delegitimation. However, we'd need to look at more of the literature to get some kind of sense of the sociological field. FiachraByrne (talk) 20:33, 1 March 2013 (UTC)

Yes, I noted those points as I read through Hirschkorn's paper, but I am doubtful about how much can be useful for the Alt.med. article as such. Certainly a brief mention of occupational closure and link, with a view to providing "....a competition framework within which we could contain a lot of the rhetorical conflict currently in the criticism section", if that can be done without straying too far into using the topic to explain the theory (which is what H.'s paper was doing): something concise and concrete enough to let the reader get a handle on the development of what another writer (Ramsey) was describing in terms of 'counter-hegemonic'[67], admittedly an unusual word but it neatly summates much in a few syllables without unduly detaining a reader who is not that interested, assuming one who is interested would recognize 'hegemonic' well enough to get the gist of it. And the article should avoid becoming tied to any particular social-economic theory, such as one which treats "Professionalization" as no more than a pretension for status with a view of gaining a profitable market-share or monopoly. In fact, whether or not CAM practitoners attain a professional status like the licensed physician MD is not all that relevant to the article, if CAM continues to be incompatible in principle with what physicians are taught and practise on the basis of the medical sciences. Qexigator (talk) 00:17, 2 March 2013 (UTC)

The utility of me posting fairly random sociological articles on this topic is limited but what I wanted was to get a feel for the general position and research findings of medical sociology on CAM. Consulting tertiary sources it can be said that the following subjects relating to alt med/cam have produced a reasonable amount of research: overviews of the "holistic health movement"; social profiles of CAM users and reasons for CAM use; social profiles of CAM practitioners & orthodox physicians who use CAM; professionalisation campaigns by CAM therapists (drive for legitimation through creation of professional associations, training institutions, and self-regulation as well as lobbying for licensing or certification; transformation of some "conventional" physicians into "holistic healers; studies on integrative medical centres. Limited studies of commercialisation of CAM/emergence of CAM industry. So, awaiting a more detailed evaluation of the actual literature, these aspects should be considered for inclusion in the article.

Then again, my recent edits have been reverted [68]. What's the bloody point? FiachraByrne (talk) 14:09, 3 March 2013 (UTC)

Tantrum over. Readded deleted text. I think this would work best with separate terminology section (what's in a name) with a limited historical perspective and then a separate history section. FiachraByrne (talk) 14:49, 3 March 2013 (UTC)

Outdated primary sources, incorrect use of references and POV forks (Quackwatch, Science Based Medicine, soapboxing of Barrett, Ernst, etc...

The title says it all. So much wrong with this article. Extreme bias, no balance and outdated primary sources. POV forks and soapboxing. Jargon, run on sentences and lack of clarity. Mischaracterizations as"self-characterizations" is disingenuous as well as many others. Qexigator and Brangifer, this is your baby, I suppose you both can explain to me your defence of the issues I've raised above. Regards, DVMt (talk) 02:26, 1 March 2013 (UTC)

What issues exactly? Specific quotes might give some context. Suggestions would be great as well. TippyGoomba (talk) 02:46, 1 March 2013 (UTC)

First and foremost, the quality of the sources. The majority of them are web-based primary sources or outdated commentary from the 1990s. When determining evidence in effectiveness and cost-effectiveness, one must use high quality, MEDRS sources. The same goes for criticisms and controversies which are published in academic, peer-reviewed journals. Relying on websites such as Quackwatch and it's offshoot Science Based Medicine as opposed to JSTOR and PubMed reaches too far down when dealing with WP:MEDRS articles. Not to mention the fact this article is presently a massive soapbox to its founder Stephan Barrett and his other members of the board of directors at SBM like Steven Novella and other "randomly" selected non notables. Ernst is the only one should be quoted here as his arguments are in newer, secondary sources and encompass all other primary, non-notable sources. They're just piled on to make a WP:POINT. Are you even aware that some CAM has evidence of effectiveness, safety and cost-effectiveness and this article mention none of it? How about we start with evidence-based mind/body therapy: [69]. This needs to be inserted immediately as a is review from 2012. The tone will change considerably when the new evidence is introduced. Like this [70] review on yoga showing benefit as adjunct treatment for neurological and psychiatric disorders. This article is from the Cro-magnon era. Time to modernize it so it accurately reflects the scientific consensus of 2013. DVMt (talk) 03:47, 1 March 2013 (UTC)

Calling out individual editors like this and accusing them of policy violations (WP:OWN) is unhelpful, particularly when they may not have been responsible for aspects of the text which you are querying. FiachraByrne (talk) 04:26, 1 March 2013 (UTC)

This is a valid point Fiachra. Nonetheless, the point stands that the article is full or old primary sources with POV forks and soapbox advertisements for the sCAM team. DVMt (talk) 05:46, 1 March 2013 (UTC)

Thank you for striking those comments. FiachraByrne (talk) 16:19, 1 March 2013 (UTC)

Acupuncture effectiveness for shoulder pain with stroke [71] systematic review, cost effectiveness for some chronic pain syndromes [72], reduced post-operative nausea [73]. Systematic reviews, evidence of effectiveness DVMt (talk) 06:01, 1 March 2013 (UTC)

First, how about removing your references regarding specific method(s) from this section? They don't belong here or in this article, but in their own articles. You are complaining about violations of MEDRS, but proposing using such sources? Take them to the talk pages of those articles and see if they can be used in a way that doesn't violate MEDRS. Maybe they can, maybe they can't.

Second, there is no need for us to defend. You misunderstand Wikipedia. This article, as with most, covers the entire gamut of information on the subject, and that includes primary, secondary, and tertiary sources, all the way from websites, journals, newspapers, and scientific research, all depending on the subject.

Third, MEDRS does not apply to much of the stuff you're criticizing here. It only applies to biomedical claims, not to controversies. Notable critics are supposed to be included. If you get your way this article will turn into the sales brochure you seem to want, and that would violate NPOV in a big way. The age of the sources, when it comes to criticism, is not an issue. If the problems persist, the criticism is still valid. Just because you don't like a person or their criticism doesn't justify you in tagging things as "dubious".

BTW, that's really quite the bold piece of vandalism you pulled off. Not just tagging, but removing whole paragraphs, and don't think that your selective deletion of chiropractic, the "flagship of alternative medicine," went unnoticed. That's like deleting "Ford" from a list of notable car manufacturers. Chiropractic is the ultimate and most notable form of alternative medicine around. You are proving that your COI regarding chiropractic is strongly influencing your editing, even to the extent of deletionism, vandalistic removal, and whitewashing. Step back from the subject a bit.

Instead of tagging, try copying the specific quotes and references here to the talk page and let's discuss them. Then be extremely precise in how you word your concerns. You may well have a point and maybe it can be improved, but the article is not improved by hanging tags all over the place. That's more like graffiti vandalism and doesn't help anything. It only irritates. You need to learn the difference between revamping and tweaking. Articles like this may well need tweaking, and we can do that a bit at a time, but wholesale revamping is a slap in the face to the hard work of multiple editors. Such actions, even if you don't intend them that way, show very bad faith toward others' work. Collaborative editing requires patience and respect for the fact that you are a newbie in someone else's living room. It takes time to get to know the place and the people already here. There is a culture here and you can fit in and make good contributions if you first learn that culture. It's tricky, because it varies from subject to subject. Each one is a different living room with a different culture and different people. -- Brangifer (talk) 06:44, 1 March 2013 (UTC)

Do not remove my comments without permission again Brangifer. You do not have the right to censor other editors like this.

• You want me to delete 2012 systematic reviews of effectiveness and cost-effectivness of CAM therapies (mind/body, acupuncture and yoga) from this article on CAM?
• I do not misunderstand what a quality source is and what isn't. I've read WPMEDS several times and am familiar with Sacketts levels on evidence in EBM. This article fails on high quality, peer reviewed critical sources and reaches down to websites when the better secondary source exists at PubMed.
• *MEDRS does not apply to biomedical controversies? I disagree completely.
• Vandalism is a stong word. I suggest you don't libel other editors like this. Chiropractic was removed because the source used to support the claim didn't say 'Chiropractic' but instead said "Traditional Chinese Medicine. It still does and TG just reinserted it despite the source not stating it directly. That's original research.
• Tagging was appropriate but as a compromise I will tag one section at a time, bring it to talk and we can dicuss the sources. DVMt (talk) 20:40, 1 March 2013 (UTC)

I only reverted your addition because you violated protocol by interspersing your comments inside of mine in multiple places. My edit summary made that plain and I requested that you try again, without the sarcasm. Now you are trying again. No censorship at all.

My request for removal was not about the article, but about your addition, in this section, of stuff unrelated to this section: "Acupuncture effectiveness for shoulder pain..." Can you see that above? It doesn't belong in this section. That's all. When I reread what I wrote above, I can see how you might have missed that I was primarily talking about this section.

Otherwise, yes, we shouldn't be going into such detail about specific methods in this article. That should be done in the specific articles. That's what I meant with the rest of my comment above. I don't know how that "Efficacy" section got so bloated. It's totally out of place here and needs to be pared back to its previous content, which didn't get into the nitty gritty of each method. This article is already very large.

This is Wikipedia. We are writing an encyclopedia, and Sackett's levels don't always apply to content here. Articles have all types of content. We document the sum total of human knowledge as found in reliable sources. That includes websites. You won't find any help from Wikipedia's policies in attempts to delete websites as sources. If they are RS, then they are legitimate sources of content. It just has to be done correctly.

Controversies are documented in all types of sources, and they are rarely found in scientific journals, yet they are part of human knowledge. Therefore we document them using the sources that report them.

Regarding your removal of chiropractic.... What "source" are you referring to? I didn't notice any source. These are just a few examples of notable forms of alternative medicine, and chiropractic is very notable in that regard. That's all. Am I missing something here? What source? Please enlighten me.

Tagging is not alright when you do it like that. It just clutters things. Try the method suggested so we can keep the article clean and readers aren't dragged into the often petty conflicts going on behind the scenes. Copy the precise words and refs you find problematic here and we can discuss it. It may well be that things need to be improved. We both want that to happen, but it must happen collaboratively. Tags don't provide enough information, so doing it here is more effective and helpful. -- Brangifer (talk) 06:35, 2 March 2013 (UTC)

WP:VANDAL is appropriate when it's becoming increasingly clear that you're not WP:HERE but have an alternative motive to try to legitimize chiropractic on Wikipedia and to whitewash negative material about it from it's pages. You're editing pattern is looking like a billboard for exactly what a WP:TE editor is. — raekyt 23:04, 1 March 2013 (UTC)

I think WP:MEDRS should apply to the section on efficacy. However, given that there are some 200+ alt therapies, it would seem unrealistic that this article could give any kind of in-depth evaluation of any particular alt therapy for a given condition. We require a source that can generalise about the field. Thereafter, it may be appropriate to include a small selection of studies of individual therapies as points of illustration. For the relationship between CAM/alt med and the medical mainstream, including the rhetoric of legitimation/delegitimation, my sense is that the best sources will come from other disciplines (sociology, anthropology, history). FiachraByrne (talk) 23:37, 1 March 2013 (UTC)

As I noted above in my reply to DVMt, the "Efficacy" section has gotten bloated. Going into detail about the efficacy of specific methods is not within the purview of this article. It's too much and too big a concept. This should be done in each specific article. Right now we have cherry picking of sources in violation of MEDRS. It's impossible to do the subject justice here. That section used to just touch on the subject, and that was about right. -- Brangifer (talk) 06:35, 2 March 2013 (UTC)

Brangifer if there's bloat in the article it's the soapbox given to critics of alt-med at the expensive of actual literature. The claim stated in the effectiveness section is that it is not effective, in any way, that the studies are of poor quality and there is no research that supports any benefit. I have presented evidence of effectiveness for yoga, mind/body medicine, acupuncture and no effectiveness for homeopathy. It's well within the scope of this article as the section lead suggests. We just have to revise the non-effective part. DVMt (talk) 06:59, 2 March 2013 (UTC)

Efficacy, safety, cost-effectiveness as a minimum apply to MEDRS. When good secondary sources can be found elsewhere, they should be incorporated as well, as per Fiachra's suggestion. DVMt (talk) 00:28, 2 March 2013 (UTC)

MEDRS does apply to those topics. We deal with the specifics of each method in their own articles. It is not appropriate or possible to do it here. -- Brangifer (talk) 06:37, 2 March 2013 (UTC)

Systematic reviews of CAM therapy effectiveness belongs here. We are following what the science says. Doesn't science-based medicine follow the science too? It can't just be for 'science (I like)'. DVMt (talk) 06:59, 2 March 2013 (UTC)

You're forgetting the purpose of this article. It's the "main" article. Specifics of each method are normally dealt with elsewhere in their own articles. We do touch on them as they are related to the general subject, but too much detail is unwarranted, and the cherry picking won't do.

There is also an ironic catch-22 occurring here, and you seem to have forgotten it....the definition of alternative medicine (AM). "What do you call alternative medicine that works? 'Medicine'." Once it has been proven to be efficacious, it's no longer classified as alternative medicine and is adopted by all mainstream physicians. That's the nature of the beast. When mainstream science and medicine have unequivocally accepted a formerly AM method as efficacious, you will be able to find abundant RS in peer reviewed sources that make that plain without doing any OR. For you to point to cherry picked sources of what you consider proof of efficacy and then reclassify a method is OR. We can't do that here. It's always possible to find some research and sometimes an occasional review that favors efficaciousness, but we need the weight of evidence, and that is still lacking for AM methods. Also NCCAM will no longer list the method as AM. When that happens, and only AFTER that happens, can we do it. We are always "behind the curve" here in that regard. We "follow" what RS say. -- Brangifer (talk) 07:59, 2 March 2013 (UTC)

You're drifting off topic: you want to remove scientific evidence that supports effectiveness. The lead into the evidence states there is no evidence. This needs to be changed given the fact that it has been proved wrong by 2012 Cochrane review on CAM. DVMt (talk) 08:03, 2 March 2013 (UTC)

Efficacy section

Per my comments above, I believe the Efficacy section has become bloated beyond what is appropriate for this article. We cannot and should not go into detail about specific methods here. That is done in each specific article about each method. Here is must be short and invited cherry picking of references which violates MEDRS. We can see that happening now. Here is the section from before specific methods were recently added, and I suggest we revert to it:

Previous version from Feb. 22, 2013

Criteria and principles about evidence and the validity of clinical tests or trials applicable to healthcare interventions, including alternative medicine, were considered by Steven Woolf and others in a paper published in 2012 titled Developing clinical practice guidelines: types of evidence and outcomes. This indicated the importance of skill, knowledge and objectivity in the design and conduct of trials and in recording and reporting the benefits, harms, and other outcomes that were considered.

The position of Arnold S. Relman, a physician who has also written on Health care reform in U.S.A., is that most varieties of "alternative" therapies that have not been proven effective in clinical trials should be among the exclusions from health care benefits prescribed by physicians.

Alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication of results (misleading results from only publishing postive results, and not all results), marked differences in product quality and standardisation, and some companies making unsubstantiated claims, call into question the claims of efficacy of isolated examples where herbs may have some evidence of containing chemicals that may affect health. The Scientific Review of Alternative Medicine points to confusions in the general population - a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science based medicine may never originally have had a true illness diagnosed as an alternative disease category.

End previous version.

Brangifer (talk) 06:57, 2 March 2013 (UTC)

We have soapbox article to CAM skeptics with quotes from "notable" skeptics instead of actual scientific literature. As the front page tag suggests, this article desperately needs valuable secondary sources that eliminates a lot of puffery as well. This article is a white-wash of the actual scientific literature on evidence of effectiveness of certain CAM therapies in modern medicine. I have provided evidence that supports CAM for specific medical conditions. The premise that there is no evidence and that the research is poor is outdated and supported with weak literature. Times are a changing, Brangifer. The bloat suggestion is a farse. The criticisms with random comments section is 1615 words long, composed of 114 lines spread over 17 paragraphs and 4 pages in length. This is clearly an undue point. In contrast the efficacy section currently stands at 445 words composed of 47 lines spread over 11 paragraphs and 2 pages in length. Efficacy is under-stated at the article at the criticism is over-stated. DVMt (talk) 07:49, 2 March 2013 (UTC)

DVMt (talk) 07:14, 2 March 2013 (UTC)

--The article mentions that Ernst "believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine."[74] May we be reminded that on efficacy we can first look near at hand to Efficacy, which links to "Ability to produce a desired amount of a desired effect", at Wiktionary [75] > "Power to produce effects; operation or energy of an agent or force; production of the effect intended; as, the efficacy of medicine in counteracting disease; the efficacy of prayer. Of noxious efficacy, Milton.[76] Under the heading "Medicine"[77] the article reads "In medicine, efficacy indicates the capacity for beneficial change (or therapeutic effect)... When talking in terms of efficacy vs. effectiveness, effectiveness relates to how well a treatment works in the practice of medicine, as opposed to efficacy, which measures how well treatment works in clinical trials or laboratory studies." There is a footnote: "How FDA Approves Drugs see textbox pg 4. There is some confusion caused by the fact that the FDA has a mandate to insure that drugs are "safe and effective," but in reality the FDA will approve drugs that have been proven to have clinical efficacy, without any required proof of "clinical effectiveness" by this definition." The ref to FDA is at[78], which has this: "Efficacy refers to whether a drug demonstrates a health benefit over a placebo or other intervention when tested in an ideal situation, such as a tightly controlled clinical trial. Effectiveness describes how the drug works in a real-world situation. Effectiveness is often lower than efficiency because of interactions with other medications or health conditions of the patient...." The article's next heading is "Pharmacology"[79] with a link to Intrinsic activity which begins "Intrinsic activity or efficacy refers to the relative ability of a drug-receptor complex to produce a maximum functional response. This must be distinguished from the affinity, which is a measure of the ability of the drug to bind to its molecular target, and the EC50, which is a measure of the potency of the drug and which is proportional to both efficacy and affinity." All this could suggest to a reader that science based medicine, and as practised by licensed MD physicians (such as Relman), is by no means the certainty which some may have us believe, and it may be beneficial to read up on '"Paradise Lost"' Book X line 660 (in a passage which happens to be based on the post-Galileo astronomical science of that time).[80] --Qexigator (talk) 16:58, 2 March 2013 (UTC) + Qexigator (talk) 17:20, 2 March 2013 (UTC)

You have addressed none of my points Qexigator. Now is not the time for confabulation. DVMt (talk) 17:25, 2 March 2013 (UTC)

A little more attention would show that the point of this article and efficacy in particular has indeed been addressed. Try and keep up with the discussion. Qexigator (talk) 17:35, 2 March 2013 (UTC)

Like I said, the points aren't clear and are confabulated. I repeat: The criticisms with random comments section is 1615 words long, composed of 114 lines spread over 17 paragraphs and 4 pages in length. This is clearly an undue point. In contrast the efficacy section currently stands at 445 words composed of 47 lines spread over 11 paragraphs and 2 pages in length. Efficacy is under-stated at the article at the criticism is over-stated. DVMt (talk) 17:57, 2 March 2013 (UTC)

Thanks for that clarification. While inclined to agree at least in part, on the whole there is now a better balance than there was, though some of the text is ragged and if not rewritten would be better omitted. More of the sources should be checked out and maybe tweaked. In some of my edits I have been identifying them in text, for the active reader to be able to evaluate as s/he goes along (the reader knows the name or not, some may not be interested or may be surprised). Some editors may see the article as too soft on Alt.m. or chiropractic, others as too hard. Useful editing has to keep emotional response fairly cool while having sufficient motivation to keep going. Earlier on this page (also Archive) I have proposed cutting some of the criticism, but, another Catch 22, the more of it there is the less convincing. The efficacy question, however, is for more than superficial reasons, too problematic for letting this article be the right place to sort it out. Cheers! Qexigator (talk) 18:35, 2 March 2013 (UTC)

No problem. I agree that the effectiveness section needs to be re-written with modern sources as it currently is not in "synch" with the evidence. The criticism just needs to be condensed into main arguments (... ineffectiveness for certain CAM, lack of biological plausibility for certain CAM and we identify which have evidence (acupuncture, manipulation, yoga, mind/body) and which one's don't (crystal healing, homeopathy, and others). I don't believe the efficacy section is that hard to sort out, nor am I proposing to investigate the hundreds of CAM interventions and post them here. Simply the bigger ones that are are being adopted by mainstream medicine. Do you think we can cut out the quotes from the critics and stick to their arguments instead? I think the article would be a lot better off without the puffery. DVMt (talk) 19:36, 2 March 2013 (UTC)

At this stage, I am leaving Criticism for others to take care of. But to summarise my earlier comments on "Instances of criticism by individuals...": (in my view, but not accepted by others) if the citations are critically scrutinised, the criticism is seen to be mostly lightweight journalistic and personal opinions. Much of it is about terminology and adverse inferences about motivation without visible support from independent research or evidence, and much of it connected with lobbying for a share of the USA Federal budget- Sampson, Relman, Novella, Angell, Lundberg(?), Dawkins, Cassileth (letter to US Senate Sub-committee from 'four Nobel Laureates and other prominent scientists'), newspaper staff writer (citing 'a group of scientists'), Barrett (retired from professional practise in psychiatry), Bausell (?), Butler, Gorski (blog?). In the present version, Relman is already quoted in the Introduction (one of my edits), as adequately and concisely representing a point of view which is probably widely held. Do not take my word for it, make your own examination. And be mindful that others feel there is good and sufficient reason for keeping all or most of them. More important, leave it for the time being while FiachraByrne is at work. Qexigator (talk) 20:54, 2 March 2013 (UTC)

I'll definitely work in co-operation with Fiachra and others on the topic. You raise excellent points that it is lighweight journalistic sources, and personal opinions of the various skeptics you listed off. In keeping with the spirit of the section (pointing our legitimate concerns about efficacy, research and marketing tactics) these must stay and be noted. Secondary sources in academic journals notes these concerns and even a single review paper by Ernst which addresses the CAM criticisms would be better than a bunch of old light-weight journalistic sources. Thank you for your input. DVMt (talk) 21:00, 2 March 2013 (UTC)

Support Brangifer proposal. The details of each specific CAM should not be dealt with here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:07, 2 March 2013 (UTC)

It is noted that both Doc James and Brangifer support the removal all scientific literature pertaining to the efficacy of CAM. DVMt (talk) 21:18, 2 March 2013 (UTC)

There seems to be a cotract forming. I have reverted it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:39, 2 March 2013 (UTC)

Good. I do not agree that we advocate removal of scientific literature in a general sense, but oppose any detailed discussion of each alternative method in the efficacy section. That is dealt with in their own articles. It's simply impossible to do justice to the subject in this article. It's already too large and is getting bloated. As efficacy studies are done, it's possible that some methods may be shown to be efficacious, but so far even research by the NCCAM, which is very pro alt med, has failed to demonstrate efficacy: "NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $2.5 billion on such research since 1992; this research has largely not demonstrated the efficacy of alternative treatments." -- Brangifer (talk) 21:49, 2 March 2013 (UTC)

Yes, the skeptics have the day (again) with a justification of massive white-wash of all the evidence for efficacy or CAM interventions. Co-tract is a red-herring argument. There shall be an RfC and Brangifer, Qexigator and Doc James can explain in detail why they oppose the inclusion of any evidence of effectiveness. DVMt (talk) 22:36, 2 March 2013 (UTC)

Concur (again) with Brangifer. What is "co tract" (Doc James), sounds sinister, is it disallowed, why is it said to be forming? Qexigator (talk) 22:24, 2 March 2013 (UTC)

Basically this content is already dealt with on the pages that pertain to the methods at hand. This is an attempt to have a version here as the editor in question has not been successive adding their preferred version in other places. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:34, 2 March 2013 (UTC)

WP:COATRACK, I think. Skinwalker (talk) 22:47, 2 March 2013 (UTC)

The article stated there was no evidence of effectiveness. I presented research to the contrary then you deleted all the evidence of effectiveness. Apparently evidence-based medicine only applies to evidence the skeptics like. Doc James can side with Brangifer and Qexigator, but he is supporting the deletion of all material that demonstrates effectiveness in this article at alt med. Also there are no "racks" to hang coats on here, as there is no acknowledgement of any efficacy of any CAM intervention. Coatrack doesn't even come close to applying. DVMt (talk) 22:59, 2 March 2013 (UTC)

If one of a crowd milling about in a field chooses to go off on his own to one side, it does not result in the rest being on an opposite or different side, especially after repeated invitations to come back in to the discussion. Qexigator (talk) 23:37, 2 March 2013 (UTC)

What exactly are you stating? It's hard to follow. The one side is this: delete all evidence of effectiveness, pretend it doesn't exist, use Wiki-lawyer tactics to support. We get it. This article will not state any evidence of effectiveness whatsoever. DVMt (talk) 23:46, 2 March 2013 (UTC)

This article is NOT for an in-depth discussion of the benefits and risk of every CAM therapy for each indication studied. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:04, 3 March 2013 (UTC)

I never proposed an in depth look at every CAM therapy. This is already stated above. Just the major the ones that the article already refers to (acupuncture, mind/body medicine, body manipulation, herbs and homeopathy. I'm asking clearly: why do you not want the inclusion of any evidence of effectiveness for the major CAM therapies ? You did delete 20+ new systematic reviews and Cochrane reviews that were used to justify my argument. DVMt (talk) 00:14, 3 March 2013 (UTC)

Sure that is easy. Because the conclusions where only from half the available review articles and only the positive half at that. This was not a balanced look at SMT but a very one sided look. This same argument has accrued at chiropractic, spinal manipulation, and WT:MED. There are also the concerns of WP:COATRACK. Where we have multiple articles attempting to cover the exact same content. There is also the issue that most here feel that indepth discussion of efficacy should take place on the article dealing with the practice in question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:22, 3 March 2013 (UTC)

One sided look. Interesting to note that the only side being "looked' at is the skeptical side given that you purged all evidence of any effectiveness. Again, did you disagree with the sources or statements used? If not, this is all conjecture on your part... I did not propose any in depth look, as I have repeated for the third time. What was the coattrack you were concerned about here? There are no hooks as the article says there is no evidence of any effectiveness. I provided evidence to the contrary and then you delete it and use wiki-lawyering to defend you edits. Do you think the sources that were used were not reliable? Systematic reviews and Cochrane reviews from 2011-2012? DVMt (talk) 00:28, 3 March 2013 (UTC)

Is there a source which is reasonably independent and non-polemical that looks at the return on investment for research on this field over the last 20 years or so? Is NCCAM audited in some kind of cost-benefit analysis that has been reported on/evaluated by a secondary source? Also, I agree we can't cover every CAM therapy and the space to even cover one in-depth is lacking. It might be possible or desirable to indicate some illustrative examples but this should be a very small selection covering those with some efficacy, to none, to unproven, to undesirable. This would not require separate sections for each and could be done in a few sentences, I think. Guidance on what if any CAM therapy to include in such illustrative content would have to come, however, from a secondary source looking at the general field. FiachraByrne (talk) 15:16, 3 March 2013 (UTC)

Fiachra, a few of the costs of research on alternative methods, regardless of whether they are used in a complementary, alternative, or integrative setting, do exist. Obviously some sources are polemical since it can't be any other way with this subject, but they can still be accurate and usable for some purposes. The NCCAM publishes its own figures, and the press has also covered the subject. The following are only about NCCAM. There is obviously a lot more money being used elsewhere on research, not to mention the expense to consumers. Here are a few sources:

• $2.5 billion spent, no alternative cures found. MSNBC, June 10, 2009

• NCCAM Funding: Appropriations History. NCCAM

• Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded. Wallace I. Sampson, M.D.

• The Ongoing Problem with the National Center for Complementary and Alternative Medicine. Skeptical Inquirer, Volume 27.5, September / October 2003

• CAM Research – Much Ado About Nothing. Steven Novella, M.D.

• More medical schools teaching alt. remedies. Some critics are concerned about the 'teaching of illogical thinking'. MSNBC, 11/1/2009

The cost to consumers is also important:

• Statistics on CAM Costs. 2007 National Health Interview Survey. NCCAM

Since this article is covered by our Fringe theories guideline, the sources allowed are rather large in scope. Even authoritative blogs are allowed for the purposes of documenting mainstream/skeptical opinions, since peer reviewed sources rarely deal with fringe matters. I have included one reference to the Neurologica Blog. I hope this will help.

• Another source of information is the NCCAM Clinical Digest for health professionals. Subscribe here.

It's a newsletter I have received for years. It publishes the results of their research. It's always interesting reading. While they always try to sound positive, the lack of positive results gets pretty obvious, yet they press on and state that more research is needed. -- Brangifer (talk) 18:08, 3 March 2013 (UTC)

Thanks for the sources. The article in the Skeptical Inquirer is particularly well put together. However, I don't think they're appropriate for this particular section. I'd look for something a little dryer, more quantitative, and where there's less danger of selective examples being drawn from the most outlandish research. What I don't understand is how there appears to be so little evaluation of the general research outcomes from the Cochrane CAM research group or those funded by the NCCAM in the medical press. I'll post the few sources I've found below. FiachraByrne (talk) 03:06, 4 March 2013 (UTC)

In the past 2 days we've seen all evidence of effectiveness removed and now we want to further increase the skeptical viewpoint with primary sources instead of crique found in academic literature where it exists. We shouldn't reach down to web-based primary sources and skeptical websites when the alternative exists. Fiachara, I would caution against relying on material that is clearly biased. These skeptics opt to criticize CAM in newsletters and websites rather than going the academic route and publishing something all the while hiding behind the cloak of "science-based medicine". What's missing is that it's science (i like) medicine, which does not include any CAM interventions whatsoever, regardless of new data which demonstrates effectiveness (the topic of debate with the mass reversion yesterday). I'm not saying we can't use QW and some sites when nothing better exists, but often it does, and I have serious concerns about the soap boxing of (notable?) skeptics. There's a lot of puffery in here and I want to add some scientific evidence. The question remains, how can the evidence of effectiveness be incorporated into the article, in terms of weight. There does seem to be general agreement that itl should be covered here which was behind my rationale of inserting material. DVMt (talk) 19:51, 3 March 2013 (UTC)

Improving the section on the effects of alt med generally might not be a bad idea but will be difficult as it is not one thing. As previously noted the article on medicine does not have a section on effectiveness for likely the same reason. IMO effectiveness is best dealt with on the articles about each technique.Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:15, 3 March 2013 (UTC)

I think there's a good rationale to that proposal but I think we should, if possible, try and find some sources dealing with the general field.

So far this is what I've found (it ain't a lot).

Barker Bausell, R. (2009). "Are Positive Alternative Medical Therapy Trials Credible?: Evidence from Four High-Impact Medical Journals". Evaluation & the Health Professions. 32 (4): 349–310. doi:10.1177/0163278709346810.

Board on Health Promotion and Disease Prevention (2005). "State of emerging evidence on CAM". Complementary and Alternative Medicine in the United States. Washington DC: National Academies Press. pp. 129–169. ISBN 978-0-309-09270-8. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) - free download

FiachraByrne (talk) 03:19, 4 March 2013 (UTC)

To deal with the concern of dealing with "all of the CAM" interventions, why don't we just use the top 5 in prevalence and commonality (acupuncture, body manipulation, homeopathy ,mind/body medicine, and some herbs/supplements. We just follow what the systematic reviews states (pain conditions, or mental health conditions) and we can be succinct but still have a general overview. Specifics can be dealt with at the respective pages. DVMt (talk) 03:46, 4 March 2013 (UTC)

There are reviews here [81] which covers CAM integration into conventional med. DVMt (talk) 04:41, 4 March 2013 (UTC)

New criticisms proposal

Criticism

CAM, and use of the term "alternative medicine", have been criticised, mainly in the USA, on various grounds and for various reasons in the name of consumers, physicians and research scientists, in medical journals or elsewhere. Some of the criticism makes assertions about misleading terminology or makes adverse inferences about motivation, some is on scientific grounds or errors of reasoning, or about taking resources from real medical research, or abuse of medical authority, ethics, dangerous misinformation or fraud, and some of the criticism has been with support from independent research or evidence, such as research studies of effectiveness. Critics state that CAM is the "propagation of the absurd" and argue that alternative and complementary have been substituted for quackery, dubious and implausible.Critics suggest CAM should be reclassified as either genuine, experimental, or questionable medicine. QuackWatch states genuine medicine are methods that have sound evidence for safety and effectiveness, experimental as being unproven but with a plausible rationale for effectiveness, and questionable as groundless without a scientifically plausible rationale. Others argue that when a CAM intervention is effective in properly performed trials, it ceases to be alternative and simply becomes medicine. Skeptics suggest healthcare practices should be classified solely based on scientific evidence, and if an intervention has been found safe and effective, science based medicine will adopt it regardless of whether it was considered "alternative" to begin with. There is a perception absent critical thinking and scientific investigation in CAM research Others argue that some questionable CAM interventions have no biological plausibility and diverts important research dollars away from more established interventions. Despite this, the National Center for Complementary and Alternative Medicine budget has seen on a sustained rise to investigate complementary medicine. There have been negative results in almost all studies conducted over ten years at a cost of $2.5 billion by the NCCAM.

There are concerns by investigating CAM, the NIH is supportive is being used to obtain unfounded legitimacy to questionable interventions such as supernatural or spiritual energies, that are biologically implausible. Others maintain that CAM interventions are no better than placebo effect “diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology”. A 2010 survey of family physicians found that 56% of respondents said they had used the placebo effect in clinical practice. 85% of surveyed physicians believed placebos can have both psychological and physical benefits. Concerns of dubious marketing practices regarding the safety and efficacy of CAM interventions has been noted. Skeptics also criticize CAM for tolerating contradiction without thorough reason and experiment. QuackWatch suggested that there is a policy at the N.I.H. that does not criticize ineffective interventions and suggest different dosing might produce different results.

References

Comments (Proposal: Criticism 1.0)

As mentioned above, I am abstaining from this, and it may be premature. Starting from calling out others as whitewashers is inauspicious, even if in another context whitewash is used to mark a playing field or decorate a clubhouse. Qexigator (talk) 00:47, 3 March 2013 (UTC)

The white-washing has it's own section. I'll wait for comments obviously. It's only a draft. DVMt (talk) 00:50, 3 March 2013 (UTC)

Will comment later when I have a bit of time although I'm not currently satisfied with criticism section in its current state. Minimally we need an independent secondary source - preferably non-medical actually - to contextualise the dispute. However, I've not yet located a suitable secondary source (I have a limited one for quackwatch) so concrete proposals are lacking. DVMt - have a reread through proposal above and copy-edit it please. FiachraByrne (talk) 14:53, 3 March 2013 (UTC)

I did some CE. I'm pretty sure all the germane arguments are covered. DVMt (talk) 04:08, 4 March 2013 (UTC)

White-washing of all evidence of effectiveness at Alt. Med.

Doc James deleted all the evidence of efficacy for CAM interventions here [82]. It's a pretty obvious that this is tantamount to a massive white-wash of any evidence of effectiveness for any CAM intervention. You have a big COI and ignoring mainstream research of effectiveness on CAM interventions, what goes against your personal skepticism is not objective editing. Why do the editors here support the deletion of secondary sources of effectiveness? DVMt (talk) 00:02, 3 March 2013 (UTC)

The concern about overloading this page with too much information is legitimate. We can't get into the weeds of the efficacy of Oscillococcinum on this page, and the acunpucture literature is filled with contradictory claims and should be handled carefully. High-level overviews are appropriate for this page, and discussing efficacy of particular types of treatment might be mentioned inline at Alternative_medicine#Examples_and_classes_of_alternative_medicines (and should be kept brief there). Take a look at medicine or evidence-based medicine for example, where the page is not overloaded with efficacious and ineffacious treatments despite the widespread acknowledgement that not all of mainstream medicine interventions are appropriate. I will note that the documentation of efficacy at a high-level at Alternative_medicine#Testing, added by yours truly (myself) a while back, was not deleted. II | (t - c) 05:58, 3 March 2013 (UTC)

I understand DVTm's frustrations; there are high quality review articles that describe alt med in a fair and informative manner and these consistently ignored on sometimes spurious grounds. When this is coupled with an almost blind faith in EBM and a misunderstanding of how science is applied in medicine it is not surprising that you feel like banging your head against a brick wall. Calling out individual editors and using an 'us and them' approach may be cathartic but is unhelpful and counter productive.

IMO the article was in a reasonable state until November last year. This should be the reference we compare it to. My suggestion is make it easy for everyone if you want change. Find a review article you like (there are plenty, i.e Lancet, Nature Immunology, BMJ, Danish Cochrane website, Univ Maryland, etc...) summarise the text, add a few quotes, wait for comments and slot it in. I was able to make some minor changes this way but it's a difficult article to make progress on.

In terms of deleting sections or content; i would remove the 'examples of alt med' section. This was crowbarred in by a socking editor and still stinks despite my best attempts to polish that particular turd. Whatever "side" you're on, everyone wants to make a better article, even if there own views stop them from doing this in a helpful, effective and useful manner. Aspheric (talk) 13:07, 3 March 2013 (UTC)

Aspheric, are you referring to this section?: Examples and classes of alternative medicines. When did that get put in? Do you have a date/diff to look at? I hate socks and often will undo what they've done, even if good, and then let other editors restore it if it really is good. That way it has some form of consensus from proper editors who can take responsibility for it and defend it if they wish. -- Brangifer (talk) 22:49, 3 March 2013 (UTC)

As a general comment directed at no specific editor could everyone drop the claims around COI, "whitewashing", conspiracy to suppress evidence, conspiracy to promote quackery etc, and just stick to content and structural points. Are there decent, non-polemical medical sources that evaluate the general research field into CAM, or say the financial return from NCCAM research, rather than an individual CAM therapy? FiachraByrne (talk) 15:02, 3 March 2013 (UTC)

Just on COI - the evidence for this being an problem is in the edit content not in the person, their profession or their relationships. FiachraByrne (talk) 15:04, 3 March 2013 (UTC)

I agree the situation could have been handled more tastefully by everyone involved, including myself. I just want to get back to productive editing. I too find the 'examples of alt-med' section below standard and I didn't realize it was crowbarred in by a socking editor. Fiachra has done an excellent job so far in cleaning up the historical and sociological aspects of the article. I do still think examples of effectiveness shouldn't be completely turfed, but could use a look from other editors to see how we can approach incorporating systematic reviews of effectiveness (pro/con) here.

I just thought the claim that the effectiveness section was "bloated" when I added the reviews was questionable since there is far more bloat in the article (in forms of quotes and "notable" skeptics). Always willing to discuss these concerns. DVMt (talk) 17:12, 3 March 2013 (UTC)

The Examples Section was added on 10th January in a series of edits by an editor using several ip addresses. They were subsequently blocked for socking [[83]] and the article semiprotected. If the decision is to keep this section the references need to be re-checked. For example, ref 90 (A quackery with a difference—New medical pluralism) is used to support the statement that 'most physicians consider homeopathy quackery'. The statement may be true but the reference does not support the assertion.Aspheric (talk) 02:18, 4 March 2013 (UTC)

I don't see a consensus to keep that section as is anyways, whether it goes completely or is rejigged will be up for discussion. The lead too has references that don't back up statements with weasel words added in. The article is big and could use a diet since there is a lot of bloat and puffery going on. DVMt (talk) 04:57, 4 March 2013 (UTC)

Concur with Aspheric on this one. Qexigator (talk) 09:12, 4 March 2013 (UTC)

So do I. The main account of that person should have been blocked. Did they ever find out who it was? Avoiding the scrutiny of other editors by logging out and then editing is not allowed here. The idea of an examples section isn't totally off-the-wall, but I'm not sure of the best way to do it. Whatever the case, the refs should be checked. I'm wondering about the one Aspheric mentions. I don't have access to the whole article, so I can't categorically say it doesn't support the wording. Does anyone here have access? The homeopathy article may well have other references that could support that wording. -- Brangifer (talk) 15:57, 4 March 2013 (UTC)

Terms

Please back this statement with references or change it. The term alternative medicine is used in information issued by public bodies in the United States of America[10] and the United Kingdom.[11] Like everyone else (other than Wikipedia) they use the term CAM rather than alternative medicine. The refusal to use the more up-to-date term here baffles me. At the very least the editors here should not take Wikipedia's terminology one step further and say that the "public bodies" are being just as misinformed and just as reluctant to be up-to-date in the terms that they choose to use. This article should be called "Complementary and alternative medicine" and no amount of cherry picking will change that. Gandydancer (talk) 14:50, 3 March 2013 (UTC)

I'm coming more around to this view - CAM is the prevalent term and used in other encyclopedias. I like "alternative" due to its flexibility - and it has been an enduring term - but CAM is the typical designation. I also think CAM is a more accurate reflection of what is happening in this very diverse field (professionalisation; limited and subordinate acceptability within biomedical practices; increasing public usage as adjunct to conventional care, etc). Could someone link to previous discussions & page move requests? FiachraByrne (talk) 14:58, 3 March 2013 (UTC)

Yes, it has been discussed before but IMO no convincing argument has been made. I agree with what you say above and have for years been hoping to see an article name change. Actually only about 2% of the population (if I remember) ignores conventional med in favor of alt med. It makes no sense at all that this article should carry a IT'S ALL SNAKE OIL!!! tone/approach while most Americans and Europeans are complementing conventional meds/treatments rather than replacing them, and especially considering that the more highly educated a person is the more likely they are to use CAM. Gandydancer (talk) 15:35, 3 March 2013 (UTC)

Agree. DVMt (talk) 16:30, 3 March 2013 (UTC)

Gandy: As you know there is a proposal for name change above, "CAM vs. AM". You can see for yourself the refs for "... issued by public bodies in the United States of America and the United Kingdom" back the statement:

• Straight quote from FDA[84]: The term "alternative medicine” encompasses a wide array of health care practices, products, and therapies that are distinct from practices, products, and therapies used in conventional medicine. Examples of alternative medicine include homeopathic, traditional Chinese, and Ayurvedic medicine.Page Last Updated: 10/25/2010
• Straight quote from NHS[85]: There are numerous complementary and alternative medicines (CAM) available in the UK.

We all know that "CAM" is not a word in itself but stands for "complementary and alternative medicine". Thus any reference to CAM presupposes "alternative medicine", which itself needs to be explained, irrespective of the title of this article. Is it your proposal that once something has been adopted or accepted by MD physicians as "complementary" to conventional western medicine as taught in established medical schools (per opening description in present version of the article) then it is regarded by those bodies as no longer "alternative"? I have not seen anything which spells that out, have you? Note the three phases described by Winnick (last para. above "Medical education (20c. to present)" in the section now headed "Background", where by the third phase of the 1990s "struggles to outlaw CAM were abandoned, physicians began learning to work around or administer CAM, and the subjugation of CAM to scientific scrutiny became the primary means of control". But CAM still stands for "complementary and alternative". That is my reasoning for what currently stands in the lead, as expanded in "Background". If I have missed the point you were making, please say. Qexigator (talk) 00:27, 4 March 2013 (UTC)

You can see that the FDA does use "complementary and alternative" here [86] I believe that your information should be deleted since it is not correct. Gandydancer (talk) 03:12, 4 March 2013 (UTC)

Qexigator,I agree with Gandydancer and Fiachra in the prevalence of the term and the credibility of the organizations who run them World Health Organization, National Institute of Health, and the majority of the literature. It is only skeptics who wish to retain the term 'alternative medicine' which many CAM practitioners find pejorative. According to the evidence, alt-med refers to practices that have very weak to non-existent literature, regulation, prevalence around the world, effectiveness, etc, research capacity, etc. Complementary medicine refers to medicines that are used side by side with conventional medicine and integrative medicine refers to wholesale integration of conventional and CAM approaches in daily practice kind of way. So, for those reasons and many more I support the renaming of this article and the terminology. Otherwise QuackWatch, Science-Based Medicine and other skeptical organizations get to use their preferred language which flies in the face of mainstream consensus, by and large, use the term CAM in official publications. DVMt (talk) 00:56, 4 March 2013 (UTC)

(edit conflict)

CAM is the wider term and encompasses the truly marginal or even oppositional (i.e. alternative) as well as those who have gained or are gaining some kind of (generally subordinate) foothold within mainstream biomedicine. I agree with Qexigator that its use does not indicate that it is somehow equivalent to conventional medicine from any perspective. I think alternative would have been the appropriate title about 10 years or more ago for this article. But since the 1990s, there's been a vast change in its status particularly in terms of its public usage (and, more importantly, visibility of same). Either way, the argument for a name change should derive from sources. So preliminary to any request for an article move, here's the result of a simple Google Scholar search:

Google Scholar results for "Alternative medicine" versus "CAM"

Search Term	Date Range	Results	Link
"Complementary and alternative medicine"	2003–2013	37,600	[87]
"alternative medicine" -"complementary and alternative medicine"	2003–2013	18,800	[88]

Bear in mind that it's essentially impossible to search for the acronym CAM, but I think it's clear that "Complementary and alternative medicine" is the more prevalent term in recent scholarship. It would be good to get some more input before anyone even considers initiating a formal page move request. FiachraByrne (talk) 01:22, 4 March 2013 (UTC)

Pubmed

PubMed results for "Alternative medicine" versus "CAM" in article Title fields

Search Term	Date Range	Results	Link
(("Complementary and alternative medicine"[Title])) AND ("2003/01/01"[Date - Publication] : "3000"[Date - Publication])	2003–2013	1,594	[Title%29%29%20AND%20%28%222003%2F01%2F01%22[Date%20-%20Publication]%20%3A%20%223000%22[Date%20-%20Publication]%29]
(((("Alternative medicine"[Title]) NOT "Complementary medicine"[Title]) NOT ("Complementary and alternative medicine"[Title])) NOT "Complementary alternative medicine"[Title]) AND ("2003/01/01"[Date - Publication] : "3000"[Date - Publication])	2003–2013	253	[Title%29%20NOT%20%22Complementary%20medicine%22[Title]%29%20NOT%20%28%22Complementary%20and%20alternative%20medicine%22[Title]%29%29%20NOT%20%22Complementary%20alternative%20medicine%22[Title]%29%20AND%20%28%222003%2F01%2F01%22[Date%20-%20Publication]%20%3A%20%223000%22[Date%20-%20Publication]%29]]

You'll have to copy and paste those urls into the browser address bar; the square brackets in the url mess the whole thing up. FiachraByrne (talk) 01:49, 4 March 2013 (UTC)

As always, Fiachra, great job with the prevalence of use research. As an evidence-based clinician, I'm following the scholarly data and the mainstream organizations. Strong support for page move to Complementary and alternative medicine or Complementary/alternative medicine. Regards, DVMt (talk) 02:04, 4 March 2013 (UTC)

We also have WP:COMMONNAME. "Alternative medicine" pull in 179 million hits "Complementary and alternative medicine" pulls in 4.2 million hits. If one subtracts one from the other you still get a much greater usage of "alt med". Should probably put this up for discussion via WP:Requested moves Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:19, 4 March 2013 (UTC)

RfC is probably needed but to continuously omit the word 'complementary' seems unjustified. DVMt (talk) 02:43, 4 March 2013 (UTC)

We use "complementary and alternative medicine" a bunch in the article. Alternative medicine is the older term (used first in 1974). The complementary bit was added latter. The OED has an interesting entry [89] for those able to get access. Under alternative practitioner it mentioned that "many alternative practitioners prefer the term complementary or supplementary therapies for their work".Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:50, 4 March 2013 (UTC)

Re the number of hits, remember that "diabetes" would probably get more hits than Diabetes mellitus but we still use the correct term. All of the modern sources now use the term complementary/alternative medicine or CAM for short. Gandydancer (talk) 02:57, 4 March 2013 (UTC)

That is because we have diabetes insipidus. We call our article the "common cold" rather than rhinopharyngitis and croup rather than laryngotracheobronchitis. Our article is still called "sexually transmitted disease" rather than the newer term "sexually transmitted infection" even though the later is much more used in the medical literature of the last 10 years. I am not saying we should not change the name to the new term just that we should get wider input. The WHO often uses "traditional, complementary and alternative medicine" [90] Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:15, 4 March 2013 (UTC)

@DocJames - a given term may suit the interests of one perspective more than another (and obviously some editors would be delighted with a name change). I think we have to lay aside whose interests may be served in this kind of analysis and concentrate on the preferred term in reliable sources. WP:COMMONNAME suggests that measurement of prevalence should be based on an analysis of reliable sources. I'd suggest that Google Scholar gives a more accurate measurement of the term used in reliable sources than a general Google search.

Results for Google Books (surprised me)

Google Books results for "Alternative medicine" versus "CAM"

Search Term	Date Range	Results	Link
"Complementary and alternative medicine"	2003–2013	98,300	[91]
"alternative medicine" -complementary-and-alternative-medicine	2003–2013	192,000	[92]

Which is preferable, Google Books or Scholar? FiachraByrne (talk) 03:47, 4 March 2013 (UTC)

Scholar, IMO. Books can be written by lay people and aren't necessarily scholarly whereas all scholar is scientific. DVMt (talk) 04:29, 4 March 2013 (UTC)

Google News

Google News results for "Alternative medicine" versus "CAM"

Search Term	Results	Link
"Complementary and alternative medicine"	408	[93]
"alternative medicine" -complementary-and-alternative-medicine	12,900	[94]

FiachraByrne (talk) 03:51, 4 March 2013 (UTC)

I am undecided to tell you the truth. We should get WAID to weight in. It would be good to get input from groups that are not medical and none alt med. This is why I think a formal move request is a good idea as this would draw in that input. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:59, 4 March 2013 (UTC)

My prejudices would be for Google Scholar but the I can't deny that the usage outside of those sources deemed "scholarly" by Google are vastly in favour of alternative. What is WAID? Anyway, I agree that a formal move request would be the only way to go and I'd be inclined to just present the evidence as neutrally as possible, walk away, and let the uninvolved come to a determination. FiachraByrne (talk) 04:21, 4 March 2013 (UTC)

NCCAM's definition is something else again. It doesn't help that the NCCAM at NIH insists on using "CAM" as a single nonseparated gemish of all stuff that is unorthodox, and even goes so far as to define "complimentary medicine" as "CAM plus orthodox medicine" and "alternative medicine" as "CAM instead of orthodox medicine." See here And in this wacky usage, the NCCAM wants to define "integrative medicine" as "complimentary medicine" for which there is a lot of good evidence and a lot of safety data! SBHarris 04:02, 4 March 2013 (UTC)

NCCAM is American only and I would prefer a global definition. The WHO [95] definitions are probably a good start. DVMt (talk) 04:12, 4 March 2013 (UTC) Edit: Full guidelines: [96] DVMt (talk) 04:15, 4 March 2013 (UTC)

I think that the WHO is the way to go. Gandydancer (talk) 04:33, 4 March 2013 (UTC)

In my opinion, given the definitional confusion and that the definition of CAM/alt med is part of the very terms of the debate, it would be a mistake to favour any one definition. Aside from which, the WHO one is a very particular creation arising from their preoccupation with traditional medicine. I think the article should present all the major definitions and, sources allowing, give them their relevant context, derivation, and spell out the implications for each. Each definition has a very strong ideological component (in the sense that they're defined from a particular perspective and in relation to particular interests) - perhaps most evident in the definition of alt med as that which has not been scientifically validated (and which ceases to be alt med if scientifically validated). Cochrane CAM group addressed that one quite well in their article on the operationalised definition [97]. That NCCAM definition, be it a "gemish" (what a lovely word!) or not, has been very influential (well, at least the 1995 OAM definition, rather). It has to be included as well, I think.FiachraByrne (talk) 04:58, 4 March 2013 (UTC)

Also, what has been ignored is the definition of (variously) mainstream, official, conventional, scientific, cosmopolitan, biomedical, Western, scientific, allopathic medicine. As alt med/CAM is a dependent category this is important to spell out too. FiachraByrne (talk) 05:04, 4 March 2013 (UTC)

After perusing above, now reply to Gandy (03:12, 4 March (UTC) ). The simple fact remains, "CAM" stands for "complementary and alternative medicine" etc. Winnick has written of three phases. Perhaps the story has moved on to a fourth. Maybe Fiac. or others will uncover something which supports that. I know of no good or sufficient reason for letting self-styled quackbusters in USA, UK or elsewhere, dictate or control the language used for the discussion of medical topics, directly or indirectly through USA institutions, foundations or Federal agencies, or public bodies of any kind. Or anti-quackbusters or any similar. They may be a part of the story for explaining an official, popular or jargon usage, which comes into vogue for a shorter or longer time, like Relman who can be heard and seen as speaking and writing as and for USA MD physicians (right and proper if openly acknowledged). Perhaps there could be a title Evidence based terminology? My more general question (seriously intended, and not off topic) remains: whether "mens sana in corpore sano" is an ideal accepted across the board, without notable dissent from MD physicians, alt.med. practitioners, psychiatrists, persons in the street, middle class women who have been reported as among the main users of c...a...m..., WHO, FED and the rest? The article's terminology etc would be more intelligible if that were explained (generally and in particular), with corroborating sources. This might swing it (name change) for me. Qexigator (talk) 09:56, 4 March 2013 (UTC)

Well, if we're in a fourth stage it's probably a backlash but I couldn't support that without original research. E.g. Colquhoun, D. (2012). "Scarcely credible treatments do not merit university attention". BMJ. 344: e1628. doi:10.1136/bmj.e1628. PMID 22395936.

Re "mens sano in corpore sano" I don't think there's much doubt that most of these practices are "health" directed - although health is actually a very broad and variable term with no accepted definition. What constitutes health may differ radically from the perspective of patients and practitioners or even between different (conventional) medical disciplines ostensibly looking at the same condition (See this fantastic little book: Mol, Annemarie (27 December 2002). The Body Multiple: Ontology in Medical Practice. Duke University Press. ISBN 978-0-8223-8415-1.). There may obviously be a range of other ideals/objectives associated with medical practice or seeking medical care than health ideals (status, social distinction, commercial interests, self-realisation, professional advancement, etc). For behaviour of middle class patients in such health consumption I'd probably favour a model as outlined in Bourdieu, Pierre (1984). Distinction: A Social Critique of the Judgment of Taste. Harvard University Press. ISBN 978-0-674-21277-0. But that would be original research again and this question has been one of the most studied in the literature.

In terms of who gets to name the field, for our purposes, we should probably go with the most prevalent term in reliable sources. Winnick himself states: Medical practices outside the orthodoxy can be referred to and defined in a number of ways. While some still call them “quackery” (Barrett and Jarvis 1993; Dawkins 2003) or, less derisively, “unorthodox” or “unconventional” therapies, the current custom among researchers is to refer to treatments such as acupuncture, chiropractic, homeopathy, naturopathy, and herbal remedies collectively as “complementary and alternative medicine” or CAM. The term CAM acknowledges both their disjuncture or lack of “conformity with the standards of the medical community” (Eisenberg et al. 1993:246), and the simultaneous growth of public acceptance and their integration into conventional treatment regimens. I think that in itself provides a pretty good rationale for renaming the article Complementary and alternative medicine. However, your writing style is a little aphoristic so I may have misinterpreted your argument. FiachraByrne (talk) 11:37, 4 March 2013 (UTC)

Re quackbusters & antiquackbusters. I kind of agree. There's no doubt that Barrett etc represent a minority view (as measured by publications) within the health field. Where such views have institutional support, however, and are replicated in the literature we have to give them greater weight. FiachraByrne (talk) 11:48, 4 March 2013 (UTC)

I guess you got the message through the aphorismic style (no surprise there). Good to have those sources and comment. I am neutral about article title, and oldstagers here should be respected, and may be coming round. But all would do well to be mindful that "CAM" has no meaning other than "complementary and alternative medicine", and let no imprecision on that score be deemed admissible. If it is desired to mention something as being complementary to one of the diverse "alternative" medicines, so be it, and likewise if referring to something as complementary to the (er...) dis-alternative (hegemonic counterpart?) medicine (which is not factually monolothic, other than, roughly, what MD physicians do, in N.America and similar elsewhere, sometimes counter-indigenous). Better stop there.... Qexigator (talk) 12:51, 4 March 2013 (UTC)

If I have said that I believe that the article should use the name CAM for the definition I apologize for using the short version when I meant to say, "complementary and alternative medicine". Also, when I said that I think that we should go with the WHO definition, I mean only for the initial definition--I agree that others definitions should be included in the body of the article. Gandydancer (talk) 13:23, 4 March 2013 (UTC)

Sure, but Fiac has pointed out that "the WHO one is a very particular creation arising from their preoccupation with traditional medicine". Is it objectively descriptive or aspirational / programmatic/ policy-making? And note also[98] The opening para. of its Intro. reads "The terms complementary/ alternative/ non-conventional medicine are used interchangeably with traditional medicine in some countries." This is of little help to an uncommitted reader wanting to know for starters what is the distinction which is made between them when it is made, not when they are conflated by WHO or any other body or person. Qexigator (talk) 15:45, 4 March 2013 (UTC)

Yes we seem to have half a dozen terms used interchangeably by some. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:50, 4 March 2013 (UTC)

The WHO definition and approach seems most relevant to non-Western contexts (where the applicability of "alternative" is problematic). Oftentimes, you're looking at pretty hybrid medical systems there. It's a big topic in and of itself really. Terminology/definitions should be done first and without a view to presenting a final definition where none exists. Terms, definitions, contexts, history, proponents, meanings & implications of each (sources allowing) should be included. And it should be in readable coherent prose (unlike this comment) - not bullet-points etc. FiachraByrne (talk) 15:34, 5 March 2013 (UTC)

Fiachra, I agree that all terms should be mentioned (NCCAM, WHO, Cochrane, etc).  Your wording above was an excellent incorporation, one which I support. Terms, definitions, contexts. etc. as you mention must be defined ASAP which will allow us to do better work in the body of the article which at times reads like a trade publication as opposed to an encyclopaedia. Regards, DVMt (talk) 18:55, 5 March 2013 (UTC)

Vankevich and Barrett

Noting[99] can we have some Vankevich here please (Limiting Pluralism: Medical Scientism, Quackery, and the Internet. Chapter published in "Plural Medicine: 19th and 20th Century Perspectives. Routledge Press, UK, 2002): Vankevich criticizes Barrett for attempting to limit "medical diversity", employing "denigrating terminology", categorizing all complementary and alternative medicine as a species of medical hucksterism, failing to condemn shortcomings within conventional biomedicine, and for promoting an exclusionary model of medical scientism and health that serves hegemonic interests and does not fully address patient needs. Qexigator (talk) 17:14, 4 March 2013 (UTC)

Interesting, and a good addition at the QW article. Not that I'd give it any real validity, but it's their POV and they have a right to have it. This isn't relevant for this article. This is one of about 2-3 criticisms of Barrett found from non-quack, non-scammer sources. All the other criticisms are from totally unreliable sources. -- Brangifer (talk) 08:22, 5 March 2013 (UTC)

Sorry, but I'm too new at this to know what are "non-scammer sources". But I have been exercising rationally critical judgement long enough to ask: why Barrett's rancorous or resentful remarks (as distinct from MD physician Relman) are so highly esteemed for the information of uncommitted others who are not of a similar school of thought? Vankevich as quoted is stating the clearly observable facts about Barrett and his ilk. Why must the opinions of a brawler be given such undue prominence here? Is it to demonstrate that such opponents are of little worth? Qexigator (talk) 08:52, 5 March 2013 (UTC)

User:BullRangifer may be referring to attack sites aimed at Barrett and Quackwatch that would not qualify as reliable sources and that defame him with concocted allegations. There is a question of weight in regard to Barrett/Quackwatch which we can establish pretty much objectively with regard to Winnick's paper. Winnick, T. A. (2005). "From Quackery to "Complementary" Medicine: The American Medical Profession Confronts Alternative Therapies". Social Problems. 52: 38–61. doi:10.1525/sp.2005.52.1.38. I haven't myself assessed those additions in the criticism section for undue but I'd rather not have a criticism section as such and instead either integrate those comments into the rest of the article or perhaps create a new section on the reception of alt med/CAM by the "conventional" biomedical and scientific community in which their perspectives could be contextualised to some extent, perhaps, through the use of sources like Vankevich. However, all the talk page additions are diverting me from actual article edits.

In regard to the additions to the Quackwatch article the quote was misattributed to Ernst instead of Vankevitch while the criticisms were contracted to "personal objections" - a very misleading summary of the substance of the paper - not that I think Barrett would actually object so much to most of Vankevitch's characterisation. I'd imagine he'd be rather happy to be placed in a medical cultural tradition embracing figures as Flexner while the criticism he might interpret as so much politically correct, relativistic, feel-good, post-modernistic bullshit. I fixed the Ernst section now as it seems you wanted to include it - her remarks are from the introduction to that the same edited collection that Vankevitch's paper appears in. FiachraByrne (talk) 12:42, 5 March 2013 (UTC)

Noted, OK. My search leads to site with spelling "Vankevich". Whence the 't'? Qexigator (talk) 13:45, 5 March 2013 (UTC)

My error.FiachraByrne (talk) 15:17, 5 March 2013 (UTC)

Qexigator, Fiachra is correct about the sources that criticize Barrett. Most of them are so bad that they are even blacklisted here. They engage in total fabrications, libel, mudslinging of the worst types, etc.. That's why it's been so difficult for us to find good sources that criticize him in a serious manner. Whether they are correct in their criticisms is irrelevant, as long as it's serious and doesn't engage in fraudulent and libelous accusations. Anyone as prominent as Barrett (he is the world's top authority on the subject, and has dared to speak out) who criticizes alternative medical practices (and his criticisms vary depending on the type) makes themselves a lightning rod for attacks. They are threatening a religio/economic system of selling cures which lack evidence. That is often illegal, and always unethical. In mainstream medicine, when a researcher or doctor criticizes another researcher or doctor, they reply by analyzing the evidence base. In alternative medicine, if one criticizes the seller of a fraudulent product, they attack you personally and totally ignore the fact that they have been called out for their illegal behavior and selling of products which totally lack an evidence base. That's the response of someone religiously attached to their ideas, who also doesn't like their unethical and illegal activities being brought to light. They don't want to lose money or go to jail. It's not the typical scientific response.

99% of the criticisms of Barrett and QW you'll find on the internet are tied to such people and one cannot trust what they say at all. There is a very concerted campaign to defame Barrett. I have been on the receiving end one time, and was sued with Barrett and over thirty others by those connected to a prominent quack of the worst kind, now deceased. We were all required to write responses to the court before the trial judge would make the decision whether to try the case or not. The case was thrown out because it was fabricated with no evidence at all. The wording of the trial judge's brief was nearly a verbatim quote of much of my written response to the court. I'm not a lawyer, but I analyzed the situation well enough that my reasoning matched that of the judge. Note that I was named, not because of any collusion with Barrett. We don't know each other, other than name, and that he has not been very nice to me when I have contacted him by email. In fact sometimes downright dismissive and offensive! I just happened to have a website which also criticized the quack, and everyone who criticized that quack was named. All totally unrelated people who happened to share one interest. After that I have had to suffer the attacks of ignoramuses (including in this discussion) who claim I have some connection with Barrett or some COI. That's BS. We just share the same concerns about illegal and unethical practices. My mother died because of it.

Fiachra, I suspect you're right about Barrett/Flexner. I suspect he sees himself in that tradition. Flexner wasn't popular either, and he's been reviled ever since by those who still oppose any regulation of medical education. The Flexner Report was a milestone. The rest of your description ("interpret as so much politically correct, relativistic, feel-good, post-modernistic bullshit") sounds pretty much like something Barrett might write, but with a slightly different choice of words! -- Brangifer (talk) 16:42, 5 March 2013 (UTC)

OK Brangifer (battle-scarred) I am now much better informed about the state of affairs in that country of yours. (Sure, we have our problems too.) Seeing some of your comments here I'm not surprised your reasoning could be used verbatim by the judge. At this point, let me mention[100], citing Lewis who gave quite a picture of those not-so-bygone days. Qexigator (talk) 17:14, 5 March 2013 (UTC)

A good example is Barrett's current lawsuit. He criticized a company called Doctor's Data that (among other things) measures mercury levels in urine for doctors who do chelation treatment of supposedly mercury poisoned people. The problem being that the company was using normal mercury urine reference values, and not bothering to tell anybody that a dose of chelating agent will increase urine mercury in ANYBODY two or three fold, for a few hours. So doctors were giving their patients a doses of chelator, measuring their mercury in the urine, and getting back "high" values from Doctor's Data. This led to a number of very expensive unneeded chelation treatments and some very ill patients (including children) and medical bills of up to $80,000 for IV chelation that wasn't needed.

So what was Barrett's crime? He pointed out what was happening. Doctor's Data sent him a "cease and desist" defamation letter, but refused to correct their own lab reference values for urine mercury (to say-- for example that they are not scientifically valid after a provocative chelation challenge and should not be used to interpret urine values after one). Barrett said "What did I say that was incorrect?" So then, they sued him. The discovery phase for which is the usual "war of attrition" where both sides' attorneys spend $500/hr in long depositions, and processing wide fishing-subpoenas for all your personal printed material. Everybody spends money like water, and nobody gets it back (typically, not even if one side loses, do they have to pay the other side's bills for this). So this is barratry-- legal harassment for the pure purpose of shutting off criticism. And it's all based on very shady dealings by a company that could easily have been honest, but chose not to lay their cards on the table about the validity of their testing, and its meaning.

Now-- will you learn the truth about this case from the AM crowd? Well not from the Tom Bolen Letter and a number of places that liken Barrett to Satan incarnate. Does Bolen tell you about Doctor's Data and the problem with their urine mercury tests? No. Bolen will tell you that mercury causes autism, despite the unfortunate fact that available studies show that autistic kids have no more mercury in their bodies than matched control kids who are fine (wups). It takes a very special kind of dishonesty to keep this kind of thing up, and one cannot read it for very long without forming an impression of some fraction of these folks as just crazy. It's not a complex scientific issue. It's a matter of people who want to believe what they want to believe, and no facts can stop them. And they have money. And they will sue. SBHarris 22:36, 5 March 2013 (UTC)

It's a very good exposé [101]. I'd imagine commercial interests are the overriding factor here. FiachraByrne (talk) 23:44, 5 March 2013 (UTC)

Abuse of commerce and civil legal process, and good reason for giving Barrett support. But is that an instance of abuse purporting to be on a scientific basis of analysis and measurement when actually operating negligently, perhaps recklessly or worse? In other words, quackery within the field of the orthodox and not of the kind which operates on an "alternative" basis incompatible with such scientific procedures. That is, dodgy or pretended use of scientific methodology, not a claim based on some other methodology? Therefore, it would be faulty reasoning to count instances of that kind against "alternative", but should be counted against conventional. Is any of that within the scope of this article? The topic would be "Dishonest practices, Medical". But "alternative" medical practises, merely as such, are not dishonesty of that kind, while some "orthodox" are, and I daresay in terms of quantity of damage done among a given population, the greater is on the part of the orthodox (ably assisted by legal process, maybe) (allegedly). Qexigator (talk) 00:12, 6 March 2013 (UTC)

Mercury chelation therapy for autism (the entire "DAN!" protocol is not orthodox medicine; it is quackery. Example: [102] Alas, there are some quacks out there who have M.D. degrees. A minority, but they exist. "Alternative" doesn't mean that no M.D. does it. It means that it is not standard of care in the medical system run by M.D.'s and D.O.'s. Which chelation therapy surely is not.

Now, if you look at the record of people who have been delicensed or disciplined for hurting or killing or scamming autistic children with chelation therapy, most will be M.D.s. The reason for that is simple: D.C.'s aren't too good with I.V. therapy! (I doubt your average D.C. could even start an I.V. in your average child, even if Baxter or Abbott would sell him the equipment, which they won't). But there are plenty of chiropractors out there as well as people with no degree at all, doing "oral chelation" or in some way contributing to the idea that autism (as well as a dozen other diseases) are due to mercury poisoning, mercury-containing vaccines, or the like. This idea is "alternative." Also wrong. If you want a list of damaged people and problems from it, Barrett gives a partial list of state actions and civil suits at the end of this article: [103]

Please remember that when you give mercury chelating agents to a five year-old autistic child and he dies, this is not just a social situation involving "hegemony". It isn't a question of hegemony but one of physiology. The sociologist who knows no chemistry has no choice but to examine it using the tired leftist idea that all problems must be examined and analysed in terms of social power structures, and nevermind the science. Unfortunately science won't go away. The truth is that orthodox medicine doesn't use or recommend doing this kind of thing, and it's dangerous (unlike many other alternative therapies which are not-- homeopathy for example). Let us hope that these people are eventually sued and prosecuted out of existence. [104]. The homeopaths and juicers do no harm, but that isn't true of the worst of the quacks.

And while its of course true that orthodox medicine does harm in one way or another (errors, mistakes, screwups, and also surely wrong ideas), it's also true that orthodox medicine must be compared with the proper control, which is Christian Science or something. It's not what the surgery, radiation, and chemo does to you only-- it's what not having them does, as well. Ask Lance Armstrong. Or Steve Jobs. Oh, wait, I guess you can't do that last. SBHarris 03:06, 6 March 2013 (UTC)

True that - some of the major alternative/heterodox practitioners have always been licensed doctors. Also the relationship to science has hardly always been strictly oppositional; rather, many have sought the authority of science, translated their practices into the language of science, without have any real validity. There's a fair bit of movement across boundaries at the fringes. FiachraByrne (talk) 03:27, 6 March 2013 (UTC)

As the science expands, we'll begin to see full scale integration of complementary medicines, and some considered alt-med today might graduate to the complementary base as their research base expands and proves effectiveness and safety, and some will die off Homeopathy? as the systematic reviews pile up and demonstrate no effectiveness. DVMt (talk) 05:07, 6 March 2013 (UTC)

And as that research piles up, if it's convincing, mainstream medicine will make it plain that the practice is proven and it will be used, not as an alternative, but as the main treatment. Then Wikipedia will follow suit and document that fact, but not before. -- Brangifer (talk) 05:31, 6 March 2013 (UTC)

As far as Barrett's criticisms goes, the largest share of those he criticizes are fellow MDs. He always seeks to make the scientific evidence the deciding factor (*), not popularity, not culture, not the press, not what some MDs or hospitals or universities do or teach. To him it's all about objective evidence. Even then, his criticisms vary according to the practice and how it's marketed. He has a very logical and sensible way of dividing things up. This article is well worth reading: Quackery: How Should It Be Defined?. He's not some wild fanatic, but uses sound reasoning and doesn't place everything in the same box, or subject things to the same degree of criticism. (*) "Judgments about individual methods should be based on whether or not there is scientific evidence of effectiveness." -- Brangifer (talk) 05:31, 6 March 2013 (UTC)

History section

"...suggestions on talk page welcome",[105] so here goes. As work in progress, so far so good. Helps to raise the depth and extent of comprehension- broadens the mind. But needs some sharpening up. For example, "As a relational concept...": is that over-academic for this context? Would that be as in Relational dialectics, if not what is the first time, not so academic, reader to make of it? Could be a head-spinner for some instead of a step in a line of reasoned informative communication. But it would be good to see Ramsey's "hegemonic" concept coming somewhere in "Background" too. Could phase 4 be "medical pluralism", as yet no more than a Wp stub but appearing in the literature, such as Johannessen 2006 (above)? By process of read around now have the pleasure of[106]. --Qexigator (talk) 18:08, 5 March 2013 (UTC)

Well, we've always had medical pluralism, to a greater or lesser degree (arguably that's the historical norm) and it doesn't actually displace other models (professionalisation; dominant medical orthodoxy). But, yes, it's being used more and more by sociologists, anthropologists and historians. You're precisely correct in regard to the use of "relational concept" - what I wanted to say was that it was dependent category that can't exist or be analyzed without relation to a mainstream medicine. I'm not sure if it was my own phrasing or taken from the source (I'll check - probably the former) and it doesn't, I think have any relationship to Relational dialectics (yah Mikhail Bakhtin). Suggestions for rephrasing or total extirpation welcome. FiachraByrne (talk) 18:21, 5 March 2013 (UTC)

Rephrasing: After looking at de Blecourt's preface (cited),[107] this may be more suited to our article: "In fact, the category of alternative medicine can only be understood in terms of whatever is the current medical orthodoxy of the particular time and place."? Would that there were also an acceptable way of bringing Rabelais into the article, and Bakhtin. Qexigator (talk) 20:13, 5 March 2013 (UTC)

Perfect and that's probably where I got it from originally. I'll fix shortly (once I get a little time). Regarding Bakhtin - delightful, but altogether too exotic! [108] FiachraByrne (talk) 21:57, 5 March 2013 (UTC)

I'd never read that book with medicine in mind at all [109]. FiachraByrne (talk) 22:02, 5 March 2013 (UTC)

and a belief....

Complementary medicine is alternative medicine used together with conventional medical treatment, in a belief, not proven by using scientific methods, that it increases the effectiveness, or "complements", the treatment.

None of the outdated, primary sources uses the words "in a belief, not proven by scientific method". These are weasel words inserted into the material which is OR. Unless a source can be found which uses those exact words, then they do not belong in that sentence. DVMt (talk) 00:21, 2 March 2013 (UTC)

The words not proven by using scientific methods were part of revision[110] citing Science and Technology: Public Attitudes and Public Understanding Science Fiction and Pseudoscience - Belief in Alternative Medicine". National Science Foundation."alternative medicine refers to all treatments that have not been proven effective using scientific methods" If others agree, no objection to this being reworded or omitted is seen by....Qexigator (talk) 02:05, 2 March 2013 (UTC)

That said, this article owes the reader a bit more explanation of what things really fit the AM and CAM definition above. If you read the article, as pointed out above, you might come away with the idea that all use of yoga is AM or CAM by the definition of non-scientific. Wrong. No more than all use of dance therapy is CAM.

There is plenty of evidence that yoga (like dance and jogging and so on) improves strength, balance, flexability, and even some evidence that it improves mood and other psychiatric disorders that are susceptable to motion-therapies: [111] These uses are not "complementary" meaning not science-based. Science suggests these things work. Modern medicine does not suggest that you sit on the couch until your veins clot up and your mind shuts off. It is orthodoxy that you should get up and move, and that moving is better than not moving. The AM and CAM parts come in when yoga is claimed to cure cancer or add years to your life. Or indeed whenever yoga is claimed to be better than an equivalent amount of Jane Fonda's low impact aerobics, or ballet training, or whatever. We don't know that it is. We only know that for some mental and physical problems yoga is better than doing nothing, but we expected that. It's not the case that a counterclaim was made and modern medicine rejected it ( NO, disregard yoga! It will do you no good! You must sit and clot!) before being pulled down kicking and screaming by the science. That didn't happen. That's a fantasy. The studies showing that yoga is better than doing nothing, involve just the things you'd expect it to involve, and are thus not studies in which any standard medical advice is at issue.

What is at issue? The "medicalization" of yoga is what is at issue. The claims of yoga are at issue. Along with the claims made (or not made) by promoters of aerobic exercise, dance, weight training, swimming therapy, etc. Some "therapies" remain complementary with medicine not because there's no science behind them, but because of social beliefs that they aren't medicine per se. This includes doing things like playing chess, watching old movies to laugh, walking, going to church, etc. Most of us believe that such activities are inherently not medical therapies, even if (some of them) can be shown scientifically to improve your physical and mental health. Any choice will (or won't) do that. Your doctor should probably worry about other things than recommending them, and Medicare should probably not pay for a trainer for you to learn how to (say) jog or do yoga or learn to swim. Or get film advice as part of cinematherapy to treat your depression, either. If we go down that road, we find that since nearly every action you take in your life affects your physical and mental health, then every action you ever take now becomes a medical action, and should be something you should be going to your physician to get advice on, and perhaps to Obamacare to pay for. But that's not a good social model for medicine (although some of this may make for a healthier society in general, with everybody doing tai chi, etc.).

To a large extent, then, the idea of "science based medical care" involves first a definition problem that is philosophical as much as scientific. There is a certain body of therapy that we all agree first is 1) inherently intrinsically medical (so that it doesn't include tickets to the symphony or $ for iTunes for music therapy to help your depression), and 2) is better than what you could do for yourself, requiring the taxpayer to help you out with it, if you really need it. Thus, the key question is not whether (say) yoga is better than nothing (making it complementary to medicine), but whether it is better than standard non-yoga physical therapy, which is part of the orthodox medical system. I can find no good evidence for that.

However, the definition problem of use of inherently non-medical things in CAM is something this article probably should deal with, and break out. First we must realize that this is not only a matter of science, but also definition/taste. SBHarris 03:02, 2 March 2013 (UTC)

I absolutely agree. This article is not clear on what is considered integrative medicine, what is considered complementary, what is considered fringe. Also, I proposed that we use the WHO definitions on CAM as found here [112]. I was reverted because there was a challenge of the credibility of the WHO (the article currently uses a strong US centric lens). I have yet to hear a coherent response why we shouldn't use a well-respected, credible, international, mainstream medical body's definition of CAM. DVMt (talk) 07:25, 2 March 2013 (UTC)

I, for one, have repeatedly told you that I'm all for using the WHO and other bodies as sources here, including appropriate definitions, first in the body, and then, if appropriate, in the lead. That still doesn't preclude that we also use our own definitions in the lead, since the lead is supposed to sum up the body of the article. That means that Wikipedia articles sometimes have definitions that are more complete and all-encompassing than those found elsewhere, but we can still use them too.

So, if you would like something from the WHO, please propose it here, including the exact wording, reference, and how and where to use it in the article. I'm very open to that. We might be able to craft a collaborative version that will "stick" and be defended by all. -- Brangifer (talk) 07:43, 2 March 2013 (UTC)

KISS: The terms "complementary medicine" or "alternative medicine" are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.[WHO]. CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. [NCCAM]. Examples include acupuncture, spinal manipulation, yoga and mind-body medicine. DVMt (talk) 07:58, 2 March 2013 (UTC)

Essentially, I suggest the point is to keep on topic, and not go chasing the chimera of definitive definitions. (I write here as an editor, not as an adherent of any particular school of medical thought, theory or practice.) If 'It is orthodoxy that you should get up and move, and that moving is better than not moving' (SBH) then it is so taught in Flexner model medical schools, and does not conflict 'in principle with the developments in medical science upon which the Flexner reforms were based, and ... further advances of medical science such as listed in Timeline of medicine and medical technology' (per article[113], hence it is not alternative, per Relman thesis[114]: in the end there will only be treatments that pass and those that do not, those that are proven worthwhile and those that are not. (sc. per like-minded physicians). Is it not sufficiently obvious that the Flexner model schools founded in China, and similar western medicine in 20c. India, were "alternative" to the indigenous systems of medicine? My question: does that apply to psychiatry? Is "mens sana in corpore sano" an ideal accepted across the board? Do MD physicians, Alt.med. practitioners, psychiatrists, persons in the street, typically dissent from that? I think we should be told, with corroborating sources. If the WHO description for CAM or anything else is current usage, then so be it. Qexigator (talk) 10:19, 2 March 2013 (UTC)

The lead relies exclusively on outdated primary sources and does not use any mainstream sources including Cochrane, WHO or NCCAM. Also, you please address my concern: the words, in a a belief, not supported by science, are not used in the sources stated to make a claim. DVMt (talk) 16:35, 2 March 2013 (UTC)

Bump DVMt (talk) 20:36, 10 March 2013 (UTC)

Surgical medicine: "alternative" or "complementary"?

There has been a surprising lack in the article of any mention of surgical medicine and treatments, which, when a layman comes to think of it (belatedly), makes the persistent agonising about the use of "alternative" as the article title, and the revival of a proposal for putting "complementary" analphabetically there, look like a put up job (which it isn't so far as this layman knows). What does the Surgeon General of the United States, as 'leading spokesperson on matters of public health in the federal government', have to say about "alternative medicine"? The Wp articles about surgery hint at but do not clarify the question: is surgery regarded by western type MD schools and physicians as "alternative" and/ or "complementary"? If not, why is that? Either way, let this article have a short explanation about the customary distinction between what physicians are qualified to do (does that still include minor surgery?) and what surgeons do which physicians do not, and why it is not usual to speak of "alternative surgery" (or is it?). Please will those who have the answer(s) point this editor in the right direction:....Qexigator (talk) 09:40, 7 March 2013 (UTC)

Um ... there is Psychic surgery ...FiachraByrne (talk) 11:17, 7 March 2013 (UTC)

Really, though you'd need to think about setting (conventional surgery at least is almost exclusively performed in biomedical hospital settings), practitioners (surgeons are licensed by recognised medical institutions) and history (Company of barbers to College(s) of Surgeons and importance within hospital system). There's no precedent for regarding mainstream surgery as anything other than as a part of "conventional" biomedicine (even when experimental) there's no good reason we should do so. FiachraByrne (talk) 11:30, 7 March 2013 (UTC)

That seems to be further (and compelling) reason for removing the tie to physicians typically graduating the Flexner way (my earlier edits) and using "diagnostic methods" as the distinguishing feature, in the wording proposed above by Brangifer for the first sentence. Asp.'s comment above that the biggest concern is that alt practitioners know their limits (and about TEETH often applied to GROLIES with NAD, and most people call an ambulance if they're having a heart attack) confirms that in the real world, where an affordable offer of western type surgery is available when it is needed, most persons will accept it (while there will still be some who are conscientious objectors for a variety of reasons or convcitions). But is the concern that practitioners know their limits not also applicable to MD physicians and surgeons? Or are they entitled to some exemption, or benefit of doubt not given to others? Qexigator (talk) 11:56, 7 March 2013 (UTC)

What does this have to do with the article? IRWolfie- (talk) 12:44, 7 March 2013 (UTC)

Obviously a proposal to revise the first sentence of the article has to do with the article. Qexigator (talk) 13:02, 7 March 2013 (UTC)

@IRWolfie- some of your edits have been improvements but please familiarize yourself with the sources before engaging in mass revisions. The thesis of the Winnick article, while its integration into the article could certainly have been improved, clearly mirrors the standard historical accounts of CAM/alt med - see Mike Saks etc.FiachraByrne (talk) 13:58, 7 March 2013 (UTC)

Well, when I first mentioned Flexnor I was somewhat surprised that you gave it quite so much coverage in the article. Medical education, its locales & institutional basis, epistemology, value-systems, authority, and extra-medical (state) support, are important in differentiating between medical sub-systems (and dominant and non-dominant medical systems). Flexnor is important enough but its inclusion in the lead is probably unnecessary. Flexnor, in a US context, is most relevant to the so called "Golden Age" of biomedicine, approx. 1920s-1960s, when it had the greatest level of dominance (based on greater marginalisation of other medical sub-systems and legitimated, primarily, by growing effectiveness of medical treatments). US is a little different as the medical market up to the early 20th century and advent of Flexnor was very unregulated. FiachraByrne (talk) 13:17, 7 March 2013 (UTC)

So, is it acceptable to switch the lead to "diagnostic"? And shall we abide by "-er" not "-or" where the name occurs elsewhere? Qexigator (talk) 13:31, 7 March 2013 (UTC)

Shall I make a table detailing the prevalence of "-er" and "-or" in reliable sources? Re use of diagnostic. I probably wouldn't see it as fundamental but I haven't given it a lot of thought. I'd rather do the rewrite and then summarise but I have no specific objections and personally I hate writing leads. FiachraByrne (talk) 13:55, 7 March 2013 (UTC)

Do you want to re-add the Winnick point (movement to CAM) back into the lead or wait until I rewrite the history since the 1970s section. I'd favour the later and by then it should be possible to add back into lead without citation. FiachraByrne (talk) 14:13, 7 March 2013 (UTC)

You are writing Winnick's opinions in the wikipedia tone. She, for example, expects the adoption of homeopathy by the medical community in that work, do you seriously think that is accurate or represents the mainstream position? IRWolfie- (talk) 15:03, 7 March 2013 (UTC)

I didn't add it to the article but the general point is that these therapies are less marginal than they were in the 1970s, that they are less frequently referred to as quackery and that their policing and relative exclusion is performed through scientific (in)validation. They wouldn't have merited so much attention 40 years ago and certainly there wouldn't have been so many clinical trials of alt meds - they simply would have been rejected as scientifically absurd & implausible. In the interim they've been professionalising. Conventional medicine's change in tone is largely dictated by increasing public consumption of alt med (i.e. the commercial realities are compelling & it's better to capture that market than exclude it). Political and social factors are also at play. In any case, there's been a noticeable change in the medical reception of alt med over the intervening period. As to Winnick's projections, I don't see why that might warrant inclusion.FiachraByrne (talk) 16:02, 7 March 2013 (UTC)

Given a reasonable amount of time, I'll incorporate Winnick's main points into the history section (maybe a subsection on medical reception?) and with reference to other material covering the same topic. FiachraByrne (talk) 16:04, 7 March 2013 (UTC)

Fiac. re Winnick's proposed 3 phases: When the dust settles, that could be good. But I am itching for some suitable source to put diagnosis in the text. I have found something I am working on, but if anyone gets there first, better still. Qexigator (talk) 16:13, 7 March 2013 (UTC)

Yeah - I'd rather wait myself; we'd have a better idea of weight and what should be in the lead when we get further along. Personally, I'd see the most fundamental markers of medical orthodoxy/unorthodoxy & dominance/subordination in the relative marginalisation or proximity and distance from medical mainstream (including state recognition, licensing, access to research funds, third party payments, public acceptance etc). I think defining it (or indeed the medical mainstream) in terms of its contents and practices is difficult - they are (both) pretty diffuse. Scientific validation is used to police those boundaries but I think the projection of mainstream medicine as exclusively scientific rests on an idealization. In terms of diagnosis what is the difference between diagnosis in alt med (as an entire field) and conventional medicine (as an entire field) that serves as a basis for stable differentiation? FiachraByrne (talk) 16:38, 7 March 2013 (UTC)

Broadly agree. Is the inference from[115] that "...conflicted in principle with the developments in medical science upon which the Flexner reforms were based, and they have not become compatible with further advances of medical science" cannot be relied on as a principal distinguishing feature? These points are getting away from surgical medicine (OK, no prob.) but what the Surgeon General has pronounced about alt.med could be useful to know about. Qexigator (talk) 16:57, 7 March 2013 (UTC)

It's unsourced and I think difficult to maintain as a strong basis for differentiation. The main relevance of the Flexner reforms was that a lot of heterodox medical practices were marginalised (medical schools closed, medical curricula expunged of alt elements, etc) and what became/was becoming/had become "official"/"mainstream" medicine was able to assert greater dominance (assisted by growing legitimacy from increasing therapeutic effectiveness - a point that wasn't very clear for much of the 19th century). One of the problems with the current text is that norms of mainstream medical education and medical science are not static (the Flexner model is not perpetual); the scientific basis of some mainstream medical disciplines may be less apparent than others which can open up a lot of problems (e.g. ParkSehJik's campaign against psychiatry); and that within alt med there are a variety of attitudes to "science" ranging from outright opposition, to acceptance of scientific principles & attempts (at least) to adhere to a scientific model (some of them are just scientifically inadequate rather than really "alternative"). Also, there are obviously attempts to translate some alternative therapies or their (putative) mode of action into scientific terms [116] - even where they have emerged out of systems not amenable to scientific norms. The section on 20th century medical education needs better sourcing - the Flexner Report is a primary source & you'd need a secondary source to interpret its significance. Also, no particular need to privilege the American experience to such a degree. FiachraByrne (talk) 18:30, 7 March 2013 (UTC)

In terms of diagnosis in the "Western medical tradition" from the 18th century there's a diminution of patient power to negotiate illness and treatment & increasing reliance on physical signs to diagnosis disease. Also mirrors change in setting and movement to medical institutions (hospitals, laboratories). Lab tests also reduce the power of the physician in regard to diagnosis (less clinical art, etc). There's scientific content to these changes but they also reflect social/political changes in doctor-patient relationship. This quasi-Marxist reading of these changes has been pretty influential [117]FiachraByrne (talk) 18:40, 7 March 2013 (UTC)

Flexner footnote added, from secondary source. Now awaiting further developments. Qexigator (talk) 19:11, 7 March 2013 (UTC)

I've been editing the background section (Terminology) but hiding the text. I guess it should really lead with just a simple laying out of terms and definitions before getting more complex? FiachraByrne (talk) 20:02, 7 March 2013 (UTC)

Presumably for start of Terminology (not lead as in "lede"). Not sure what you have in mind- some rearranging of the present text, including hidden? Lets not have more quasi-definitions if we can avoid it. Please show. Qexigator (talk) 20:42, 7 March 2013 (UTC)

Lead as in start with; not "the lede". I'll get back to you on the rest shortly. FiachraByrne (talk) 21:54, 7 March 2013 (UTC)

Kinda tricky as most sources are defining CAM (or trying to) as a total field and set of relationships rather than alt med. Really is synthesis. FiachraByrne (talk) 22:12, 7 March 2013 (UTC)

OK- I'll post here before elsewhere, but the central feature of all definitions is that it is not or is other than conventional medicine (astounding!); being other than is defined in either socio-political terms (distance from the "dominant" medical practitioners and system) or scientific terms (not validated, not accepted epistemology, not effective, not medicine). Some definitions in terms of other intrinsic characteristics (holistic, greater value on patient choice, not invasive, etc) but really not applicable to whole field. FiachraByrne (talk) 22:49, 7 March 2013 (UTC)

Distracted by pertinent comments relating to article name change. I think I just initiated the article move request because I like making tables. Besides, IRWolfie is moving stuff around in the article, usefully I think, so I'll wait till he's done. FiachraByrne (talk) 02:17, 8 March 2013 (UTC)

Would Surgeon General's announcement,[118] for example, have any connection with Danell's boundary work concept/ analysis/ study? Perhaps we need a table, subjoined to the article? Qexigator (talk) 11:00, 8 March 2013 (UTC)

LOL. Yes the article needs to be entirely tabulated. It does indicate growing integration and consumer orientated policing of alt med/CAM practitioners - differentiating between bogus and upstanding. But, Danell's paper is really looking at the reception of scientific papers from the CAM field. The sources dictate what we can reasonably link to boundary work. FiachraByrne (talk) 11:43, 8 March 2013 (UTC)

--An article with serious intent about CAM ought not knowingly be without TAM and WAM. Qexigator (talk) 11:36, 8 March 2013 (UTC)

I also just came across COM (which doesn't rhyme unfortunately) for conventional allopathic and orthodox medicine. FiachraByrne (talk) 11:43, 8 March 2013 (UTC)

Perhaps anagramatic tables is the way to go for multiplying acros. but a break is now in order for...Qexigator (talk) 11:59, 8 March 2013 (UTC)

Not finished yet, but here is my reedit of terminology & definition section [119]. FiachraByrne (talk) 03:48, 12 March 2013 (UTC)

I'm guessing that it'll take 5 minutes or so before it is reverted. FiachraByrne (talk) 03:50, 12 March 2013 (UTC)

I see one or two picky points needing little more than copyedit, but these are likely to be tweaked out or subsumed by editors with bigger points, so will leave alone at this stage. Generally, this seems to give a fair account of the state of affairs with alt.med. but the style may need some tweaking, for a reader looking for simple information more than a discursive essay. It would be easier for a lay person new to the topic to read the History section, with its factual account, before being drenched in the inconclusive and sticky pond of terminology (if it has a point it has less to do with medicine and more with promoting commercial interests, protecting professional exclusivity, or personal commitments or convictions about the contingencies and meaning of life, and might be better discussed in an article about the sociology of health, illness, disease and medical practice). Perhaps to avoid overload some of the content would be better in the "History" article (while retaining the "History" section in this article)? The very use of the term "definition" is not apt, for something which is inherently imprecise, except as now stated in the article's opening sentence and as expanded in the article to explain how alternative medicine got its name, and retains it, whether or not reputable MD physicians and hospitals are habitually using this or that in a complementary way. The inset quote mentions "evidence-based medicine", but that is an equivocal expression which itself is liable to confusion or abuse out of a precise context. Even "science-based" is fuzzy, though its proponents may use it in the belief of their kind of precision, a trap which the opening sentence of the lead has avoided. Cheers! Qexigator (talk) 16:00, 12 March 2013 (UTC)

LOL - damned with faint praise indeed. OK. It is probably too discursive and some of the redundant verbiage can certainly be excised; possibly some of the detail could also be hived off to the history or other sections. However, I think it's necessary to tackle the problem of definitions and terms - defining the article topic itself - immediately after the lead. That is the logical sequence for any subject really and is necessary to orientate the reader somewhat to the issues at stake in the use of particular terms and definitions of alt med. In doing that, it's not possible to offer a single preferred definition for the field because, as reflected in the sources, there is no preferred definition. In my opinion, the best one can do is outline the most influential definitions - applying some kind of loose typology or progression - and the available critiques of the same.

I used the quote boxes to present two particularly influential and opposed definitions of alt med/CAM as, I believe, based on an assessment of the sources, they represent the major fault lines in the characterisation of the field. The use of the term definitions is appropriate as almost all the sources offer definitions of the topic and this article has to reflect those sources even if we might personally find the definitions inadequate, imprecise of fuzzy.

As regards the definition of alt med in terms of scientific norms (evidence base, etc), that is unavoidable - it's a significant perspective which has to be covered in the article and the appropriate place for that is in a section dealing with terms and definitions.

I believe, as I would, that the historical perspective on alt med is important (and should inform the terms and definitions which precedes it), as indeed are sociological and anthropological ones, but it's neither a privileged perspective nor is it one which can adequately address on its own the position of alt med in the present day.

I think the current definition in the lead is problematic. It states: "Alternative medicine is any of a wide range of health care practices, products and therapies, using methods of medical diagnosis and treatments which, at least up to the end of the twentieth century, were typically not included in the degree courses of established medical schools teaching western medicine, including surgery, in the tradition of the Flexner Report or similar." It defines alt med in terms of an institutional exclusion that doesn't sufficiently apply in the present to form the basis of a definition. It doesn't adequately reflect any definition that I've come across in the sources. The definition of alt med in terms of medical education has been specifically criticized by a range of sources as no longer adequate. In citing the Flexner report it is overly specific to a particular region and time period. Better to say, I think, that alt med refers to therapeutic practices, systems of belief (etc) that are commonly regarded as non-conventional (kind of tautological, but what have you) and/or which are regarded (by most mainstream medical practitioners) as lacking in scientific validity. FiachraByrne (talk) 01:01, 13 March 2013 (UTC)

Thanks for comments. Flexner's report and its impact is a defining fact, which is both confirmed and mitigated by mention of China and India, as expanded in "History", and which begins to become modified about 1970's until FDA and SG and others publicly acknowledge alt. med. as phase 2 becomes phase 3. My comment at this stage has to be that, after taking into account all of what you say above, I personally remain unconvinced that the opening sentence is amiss, but I shall be glad to see an improved version which escapes being trapped in opinion generated false dichotomies, half-truths or the lexicographical fallacy, now hovering miasmically around. A mosquito net may be advisable for the avoidance of an attack of evasive denial, even in the face of western surgical practice and the incompatibility of so much other-based therapies with current typically microbiologically based medicine of MD physicians and surgeons. Qexigator (talk) 01:42, 13 March 2013 (UTC)

Flexner's report is important for the development of a medical orthodoxy in the US - which until that date had been an extremely and perhaps uniquely unregulated medical market. It marginalized but did not remove a variety of "irregular" or "sectarian" practitioners and medical systems. The US model, exemplified in institutions like Johns Hopkins Hospital, does have an international significance but the relationship between medical orthodoxy and heterodoxy in regions such as China or India only minimally reflects the US experience (there were unsuccessful attempts to ban traditional medicine in China in the 1920s followed by equally unsuccessful attempts to create a "syncretic" medicine formed of traditional and biomedical components - they have proven essentially incompatible, unsurprisingly). More importantly, as we're tied to the available sources, Flexner's report does not feature in any frequently cited definition of the topic. Medical education used to, but it's been heavily and appropriately criticised as no longer adequate to distinguish between conventional and non-conventional medicine. Neither conventional nor non-conventional medicine are static, they're relational concepts, so descriptive terms (defining alt med in terms of whether its practitioners are licensed, regulated, etc) is always likely to be highly specific to a given region or time period. FiachraByrne (talk) 02:06, 13 March 2013 (UTC)

Quite so, and this confirms the need to be specific and not get lost among abstract quasi-defintions snatched from their specific time-limited contexts which are invariably specific to a particular purpose. The merit of using Flexner as a datum is precisely because it is widely known both for its influence and effect (as mentioned above) and because it has been open to reconsideration in the light of later and current developments. But alternative continues even now to be alternative to that type of medicine, unless otherwise specified in respect of a particular region. Qexigator (talk) 02:38, 13 March 2013 (UTC)

Unlike a normal encyclopedia, we haven't been commissioned as experts to write an original survey of the topic - although even if we were one would expect the article to reflect the "best" sources on a given topic. For the purposes of Wikipedia, article content should reflect the sources, whatever your opinion of the sources. The definition of alt med in the lead is unique to this article; it should not be. It should reflect the most pervasive and influential (widely cited in peer reviewed literature) definitions and any editor's opinion (in the context of Wikipedia) as to the quality of those definitions is essentially irrelevant. Any argument for a preferred way of defining a topic, in this case by the propagation of a particular model of medical institution, must be source-based.FiachraByrne (talk) 03:07, 13 March 2013 (UTC)

Well, and so far as it goes, good. But if the present sources do not suffice, it is difficult to accept that others are not available in all the literature for the sentence to be improved so as to let the lead read no less as a concise encapsulation of the body, while avoiding those opinion generated traps of false dichotomy, half-truth and lexicographical fallacy. Format-wise, the notes section makes a good improvement. Qexigator (talk) 08:05, 13 March 2013 (UTC) + Qexigator (talk) 09:58, 13 March 2013 (UTC)

--On this theme, it would be expected that there is sourceable information about the extent of medical treatment in hospitals (country by country) and not in hospitals, separating surgical from other, and distinguishing "western" model hospitals from others, and showing the extent to which "alternative" medicine is being used in those hospitals. Homeopathic hospitals are in a class apart, and ayurveda, and others such as exemplified in List of hospitals in Thrissur. But this tends to show the need for a separate article about medical systems outside the western tradition, and that the present article should be explicitly about treatments considered to be alternative (whether included in anybody's CAM list or not) to the western tradition (i.e., German-European-JHU-Flexner-present...), while making references to other traditions indigenous and possibly hegemonic in other parts of the world. Our present article has mentioned a survey of the extent the public, of their own volition, have been resorting to "alternative". Is there any comparable survey information of the reverse in places such as India, where western medicine is not hegemonic, similar to Usman's in the twenties? If not, the article can mention not available, showing how incomplete is the information which is being offered here. Qexigator (talk) 12:00, 13 March 2013 (UTC)

There is some data, I think. The WHO is probably the best starting point for this kind of overview. See Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review & WHO Global Atlas of Traditional, Complementary and Alternative Medicine (With Atlas) Volume I

Limiting to the article to the "West" would probably require an article rename. I guess you could create different articles on alt med for different regions. It should be said that just as with "biomedicine", CAM has at this point become something of a globalised concept (if no less muddled for that).

Survey data for the even the industrialised/post industrialised (western/developed, etc) countries is less complete than you might think but even the observation of an absence of data is ultimately dependent on some source making that observation for us. FiachraByrne (talk) 17:31, 13 March 2013 (UTC)

Thanks for those links, will follow up. Re-name? Surely all along the article has been proceeding on the basis that conventional = western, and the topic is the range of others = alternative. As I have mentioned before, we may be getting into phase 4 when this has to be reconsidered, but right now the sophisticated people who formulate UN policy including WHO will consider the western type medicine as in some sense in the lead, especially in connection with modern hospitals and surgery, blood transfusions, tropical and other disease management etc. (including disaster area interventions), from Japan and Peking to Brazil and Peru, taking in Qatar and other such places in between. Times are changing, healthcare systems and policies are at risk: breakdown of immune systems and vaccines, the known and unknown unknowns. Too much sociological padding and aspirational crystal-balling must be eschewed under the severities of NPOV, OR and SYN (and probably others as yet unmentioned), but surely absence of data is mentionable? Qexigator (talk) 20:28, 13 March 2013 (UTC)

Two more which I stumbled upon - and not for article inclusion ideally - indicating prevalence of CAM in US hospitals. Top Hospitals Embrace Alternative Medicine, CAM Services Offered at Growing Percentage of U.S. Hospitals. I can't confirm the figures are accurate but surprised me - I've never heard of any such services in my local hospitals. We need a source about missing data because, being merely mechanical devices for rephrasing sources & stitching them together as semi-readable pastiches, we editors cannot make that observation ourselves. The sources have to indicate that such an absence is significant. I have one source, for instance, which states that despite the constant references to the rising use of CAM in the "West", there's only longitudinal data to support this contention for the US. See Thomas, Kate (2004). "Alternative sources of advice: traditional and complementary medicine". In Jones, Robert; Grol, Richard; Britten, Nicky; Mant, David; Culpepper, Larry; Silagy, Chris; Gass, David (eds.). Oxford Textbook of Primary Medical Care. Oxford University Press. pp. 116–121. ISBN 978-0-19-856783-7. So we have one source supporting that observation as of 2006. I prefer biomedicine (based on the biological sciences) to western medicine, but there are many terms, some rarer than others. There are lots of alternative medicines indigenous to the west and TCM and Ayurvedic medicine in a western context bear little relationship to their practice in their country of origin (especially notable how violent treatments were removed). The focus will be on the US, UK and to a much lesser degree, the other English speaking countries (Canada, Australia, NZ, etc). That's just a function of sources and linguistic barriers. There are some accessible sources to bring in other countries (Germany, with the highest usage of alt med in the Europe and historical "arrangement" with alt med practitioners, would be a particularly important addition). But we can't entirely ignore wider contexts either - and there are some sources for a limited discussion of such issues. Questions of neutral point of view, synthesis or original research do not impact on the proper inclusion of scholarly literature, given considerations of due weight and realm of expertise, regardless of the discipline. FiachraByrne (talk) 20:52, 13 March 2013 (UTC)

Longitudinal data available for UK also. See Artus, M.; Croft, P.; Lewis, M. (2007). "The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain". BMC Family Practice. 8: 26. doi:10.1186/1471-2296-8-26. PMC 1878478. PMID 17480212.{{cite journal}}: CS1 maint: unflagged free DOI (link) FiachraByrne (talk) 00:29, 14 March 2013 (UTC)

Again not an ideal source (blog) but, according to the American Hospital Association’s Annual Survey of Hospitals, in 1998 7.9% of US hospitals offered some CAM therapies; this figure had grown to 19.8% in 2006. See A Steady Growth in CAM Services. See also Details on Hospital Inclusion of CAM - A New Health Forum-AHA Report. I'm having difficulty tracking down the actual reports. CAM presently offered in 50% of Norwegian hospitals and 33% of Danish hospitals Salomonsen, L. J.; Skovgaard, L.; La Cour, S. R.; Nyborg, L.; Launsø, L.; Fønnebø, V. (2011). "Use of complementary and alternative medicine at Norwegian and Danish hospitals". BMC Complementary and Alternative Medicine. 11: 4. doi:10.1186/1472-6882-11-4. PMC 3033860. PMID 21244655.{{cite journal}}: CS1 maint: unflagged free DOI (link) FiachraByrne (talk) 01:15, 14 March 2013 (UTC)

From the Norwegian/Danish study cited above: "The proportion of [US] hospitals reporting use of alternative treatment has increased from 7.7% in 1999 to 37.7% in 2008 [16]. Little is known beyond these [US, Swiss & Israeli] studies about the extent of CAM offered in hospitals in other countries.. Jebus. The actual report costs about $300, but they issued a press release: Latest Survey Shows More Hospitals Offering Complementary and Alternative Medicine Services. FiachraByrne (talk) 01:24, 14 March 2013 (UTC)

These sources being noted for consideration. Noted also that improving edits are continuing. Phase 4, when the aforesaid distinction between "western" and other necessarily holds (by conceptual definition and language usage), but the "other" is being allowed and sometimes promoted within the selfsame hospital healthcare systems (wherever situated globally): integrationally- by stealth, default or benign intent. Phase 4 conjectures that convergence of some unexpected kind could be emerging for medical interventions and treatments of all acceptable kinds. Qexigator (talk) 02:53, 14 March 2013 (UTC)

Surgery in hospitals

Most of the argy-bargy cited about the status of "other" vis-a-vis "conventional, western" pays no attention to "western" surgery, which for at least a century has been dependent on microbiological and other western style lab. research and clinical trials. This is surely a major distinguishing feature. Generalities about CAM in hospitals do not bring this out. Is there anything about comp. in military and or civil surgical hospitals and/or in connection with surgical interventions in operating theatres (and/or any specialities such as ENT, heart, organ/limb tranplants), in A&E departments, paramedic first aid (speaking as a layman)? (Other continuing improvements in article noted, including panel's definition now for "alternative" and not "CAM" which had induced the move, now reversed).[120]) Qexigator (talk) 17:10, 14 March 2013 (UTC)

I'm not sure what you are proposing here? IRWolfie- (talk) 19:12, 14 March 2013 (UTC)

Thanks for asking. One of the main concerns with this article is whether or not there is one (or more) distinguishing feature which objectively and npov marks off "conventional western" from "other", rather than having to rely too much on opinionated sloganeering, whether of a milder or coarser kind. Is it not the case, as another editor has previously mentioned a little while back, that those proponents of one of the alternative schools - such as homeopaths, chiropractors, naturopaths, herbalists - who claim (right or wrong) that their system is based on something other than the medical sciences upon which conventional western medicine and surgery rely, will in the main not decline for themselves or others surgical treatment for broken bones, or external or internal wounds or injuries, of the kind practised in conventional surgical hospitals. In my view the article will remain incomplete without some mention of this. But the catch is, however obvious it may be to common sense, there are enforcers about who will not allow such a thing unless there is some source. Can you help with this one? Qexigator (talk) 19:50, 14 March 2013 (UTC)

While I think the figures for the penetration of CAM into US hospitals can be queried (how are they defining CAM; what proportion of total hospital services/procedures are CAM or conventional) we'd need a source to do that. Could surgery - or surgery of the type performed at conventional hospitals - act as a new line of demarcation? Maybe, but I doubt it and I don't believe any source has tried to use surgery in this way. I guess it's worthwhile bearing in mind that if the current medical paradigm is evidence-based medicine, surgery fits poorly within this model. Moreover, its basis in the biological sciences is hardly unique to surgery. I'm not convinced that it will be possible to define alt med/CAM by some zone of exclusion. Hospitals are introducing it primarily, not because they believe it is effective, but because patients consumers want it. Reading that Walter Sampson blog some time ago (can't remember name), there were moves to introduce acupuncture for frontline/battlefield pain relief of injured US soldiers (I'd take the opioids, myself). But the central question is whether there is a source that uses hospital-based surgery to differentiate between CAM and conventional medicine? The closest to that is that CAM is mostly used for chronic conditions or palliative care where conventional medicine performs relatively poorly (and so does CAM all in all). FiachraByrne (talk) 19:44, 14 March 2013 (UTC)

Opioids: Would that be an instance of conventional pharmacopeia, or herbal=alternative, or herbal+conventional=CAM? Does it depend on the practitioner, MD physician or other? What about self-medication? How much of current conventional practice is similar: Arnica, "used for centuries", and still effective if you can get it? Calendula officinalis? All rather indefinite when scrutinised.To a layman, if not modern surgery, then more and more it looks like professional exclusivity and/or commercial interest becomes the deciding factor as against the health or sickness of those in need of medical care, which may account for the variations around the world which the CAM 1995 conference attempted to encapsulate- healing resources encompassing practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. Some of the sources seem to point that way. IRWolfie (or others), can you help with this one for the purpose of the article? Qexigator (talk) 21:41, 14 March 2013 (UTC)

Diacetylmorphine delivered by subcutaneous injection and lots of it. FiachraByrne (talk) 22:57, 14 March 2013 (UTC)

Not sure what that is, but out of reach from this donkey's tether. Oh yes, something about painless. ummm... conventional or other? That would be into hows and whys and circumstances, straying beyond the topic. But anyhow I have seen it said this is not a medical article so MedMos n/a? Qexigator (talk) 23:24, 14 March 2013 (UTC)

I'd see MedMos as applying to medical content (efficacy, safety, etc) rather than the topic as a whole. Whether it applies or should apply to the article title, I've no idea. FiachraByrne (talk) 15:09, 15 March 2013 (UTC)