Talk:Homeopathy/Archive 13

APPROVED Version 1.1

Discussion for Version 1.1 stopped here. Please continue further discussion under this break.

The Approval includes two copyedits [1] Hayford Peirce 19:13, 11 October 2009 (UTC)

I'm not sure how to add yet another archive and get things to show up properly in the header here. Could someone do so? Howard C. Berkowitz 19:22, 11 October 2009 (UTC)

Beginning with semi-lower-case editorial...

As a first step, I'm going to all footnotes that contain other than bibliographic material or definitions, and either moving the substantive text into the main article, or, in some cases, linking to a subarticle.

While it may be reasonable, in a printed book or journal, to have bottom-of-the-page notes, in this format, the content of the notes will not be seen unless the reader clicks on them. How many readers do that? In effect, the text is being hidden. Howard C. Berkowitz 19:37, 11 October 2009 (UTC)

A balanced blog post on the subject

can be found here. --Daniel Mietchen 09:21, 16 December 2009 (UTC)

I added a comment, as did Paul. Truly delightful, however, is

Personally, I would really like to see a homeopathic treatment for dehydration. You'd have to have a compound that causes dehydration, but what would you dilute it in? you can't dilute it in water or saline, because those will rehydrate, and in homeopathy, you have to CAUSE dehydration to cure it...but you can't having anything that CAUSES dehydration because it would have to be diluted to the point where none of the dehydrating agent remains...

It should be noted that some camping supply stores, in the same aisle as freeze-dried foods, offer cans of "dehydrated water". Ethical staff makes sure that new users understand the purpose of same. Howard C. Berkowitz 15:06, 16 December 2009 (UTC)

Howard, you gave the wrong link for Sympathetic magic. It's http://en.citizendium.org/wiki/Sympathetic_magic And make sure the period at the end does not get connected to the link. Chris Day 15:26, 16 December 2009 (UTC)

That's a reasonable way to look at it, which is unusual for a blog. D. Matt Innis 18:43, 16 December 2009 (UTC)

Put it into the External Links. --Daniel Mietchen 19:27, 16 December 2009 (UTC)

Ramanand's changes

First, the word " most biased medical " is argumentative, does not fit the language of the lede, and is clearly advocacy.

The statement supporting homeopathy in the lede, even if the references were solid, belongs, stylistically, in a later section on the mechanisms of homeopathy. One reference is, as far as I can tell, from a Brazilian university with a site in, presumably, Portuguese, which I do not read. We generally don't use non-English references, especially when they are not clearly from peer-reviewed journals or otherwise reviewed sources.

The other reference is from Khuda-Bukhsh, whom, I believe, has been in the memory of water controversy, is a review of possible molecular mechanisms of action. On first glance, it's an interesting paper, but does not talk at all about efficacy — just how homeopathic remedies may work, if they work. It doesn't belong in the lede, although it's not unreasonable to use it as a reference in a later section.

Neither addition works where it is. The first is advocacy and non-neutral. --Howard C. Berkowitz 17:45, 7 January 2010 (UTC)

The use of "biased" is definitely adversarial. Chris Day 21:12, 7 January 2010 (UTC)

With regard to the rebuttal (it works, and we know how), I am loath to see this article head down the direction of he says, she says tit for tat. Chris Day 21:21, 7 January 2010 (UTC)

The whole article is full of oxymorons, containng both viewpoints, so I don't see anything wrong with what I've inserted, unless the critics' statement is also removed (about what scientists feel). I'm fine if the word biased is removed, if it seems adversarial. The Portuguese and French is only in the references section and shouldn't be a problem.—Ramanand Jhingade 10:28, 8 January 2010 (UTC)

Well, Ramanand, the general CZ, policy, especially in the Charter, is that articles don't equally present all views. They present the preponderance of the expert views, and, in this case, the experts are in health sciences; there isn't a unifying discipline among healing arts. Not all healing arts support homeopathy.

Everyone needs to Neutrally present all views. D. Matt Innis 02:31, 9 January 2010 (UTC)

The foreign language citations have been a problem in many other articles, not just here.

I think you mean contradictions or rather or challenges, not oxymorons. An oxymoron would be a "heroically large dose of a homeopathic simillum." An oxymoron is a contradiction in terms.

Sorry, I'm in favor of removing both additions. You will need to face the reality that the article will not be as pro-homeopathy as you want, just as others wish it weren't here at all. It's a compromise. --Howard C. Berkowitz 15:48, 8 January 2010 (UTC)

I applaud, encourage and appreciate collaborative efforts to work toward improvements, but I think this lead still needs significant work to add any substantial improvement to the approved version's lead. D. Matt Innis 02:28, 9 January 2010 (UTC)

I forgot to wish all of you a Happy (belated) New Year. The presently approved article's Lead isn't 'neutal' at the moment. It should either explain homeopathy plainly or if y'all want criticism in the Lead, it should contain both viewpoints. Where's Dana, by the way, in Germany again?—Ramanand Jhingade 09:14, 9 January 2010 (UTC)

Happy New Year to you, too! Please let me know where you think the present Approved version lead (as opposed to the draft lead) is lacking and I'll be glad to take a look. Dana approved the current lead, too, but I'm sure he'd take a look if we asked him. D. Matt Innis 15:00, 9 January 2010 (UTC)

I'd posted a whole lot of links to homeopathic articles, late last year, but did not have the time to add it in the article. I was expecting someone here to do it, but no one did (not even Dana)! I already wrote what I wanted above, "It should either explain homeopathy plainly (without criticism in the very 1st sentence) or if y'all want criticism in the Lead, it should contain both viewpoints."—Ramanand Jhingade 08:34, 12 January 2010 (UTC)

We certainly can't add every link ever written to this article. This is the overview article in an encyclopedia type format and summarizes homeopathy pretty well, I think. Again, don't confuse the lead in the Draft with the lead in the main Homeopathy article. I agree the lead in the draft needs more work and is not an improvement in its current form. D. Matt Innis 12:45, 12 January 2010 (UTC)

If nothing else, bibliographic links not directly related to the text belong on the bibliography page, preferably in articles. Also, in other articles, there is some selectivity. In some cases, reviews are more appropriate than small primary studies. In other cases, peer review and responsible publications are appropriate. In yet other cases, there is more leeway on publications but the reason needs to be explained.

It's not necessarily reasonable to assume someone else will edit and add articles with which they aren't familiar, or with which they might disagree.

What principles of homeopathy are in not in the lead? It should go without saying that homeopathists believe what they are doing, or the article wouldn't be here at all. Having a small number of dissenting comments from people who question hematology simply establish it isn't universally accepted, and the details and pros and cons should be in the article, but later. Howard C. Berkowitz 13:27, 12 January 2010 (UTC)

RE: provided references from Ramanand, this must be the list and I do remember it, but it's mostly primary research. They could be used for a more detailed article to support a specific claim where reviews aren't available, but to cite them here would result in too much detail for the general nature of this article. Primary research doesn't belong in a bibliography either. I'm not sure that we have a subpage that would be appropriate for primary research, though it's an interesting idea for some other project, or way in the future for this one. Otherwise, I'd think it would be a problem with CZ:Maintainability. There are other sites that do list all the research for each particular subject. D. Matt Innis 14:51, 12 January 2010 (UTC)

This is one page (Homeopathy/Trials) that exists with a tabulated summary of some of the voluminous primary literature. I agree maintainability is an issue. I bet there are hundreds of articles like this and the main problem is reducing it to the most important articles in the field. If that could be done well it might make a good catalog. Chris Day 17:18, 12 January 2010 (UTC)

Matt, I made some time to read the entire (presently) approved article. I don't see any sentence saying there is evidence for homeopathy (the feg pdf document I've inserted in the present draft is accepted by 'mainstream' scientists as well). I object to the term 'placebo' in the lead (Edzard Ernst is known to be a ridiculed homeopathic baiter in the U.K.). I also object to the term 'fraud' in the Overview section

They also are interested in whether positive results against expectation sometimes reflect manipulation of data or perhaps even fraud.

. Like you said, can we edit the (presently) approved article?—Ramanand Jhingade 17:34, 23 January 2010 (UTC)

David (Ellis), can you please tell me what objections you have to the feg pdf document?—Ramanand Jhingade 17:42, 23 January 2010 (UTC)

(undent) Placebo in the lead is perfectly appropriate; conventional medicine routinely accepts the placebo effect as a component of therapies.

Fraud is mentioned gently as a possibility by some observers, seemingly far more gently than some of the homeopathic claims of the danger of medicine. Sorry, it's not unbalanced. Please do not go to "known" homeopathic baiters anywhere, else that you start having people bring in medical baiters from homeopathy. The problem with bait is that it often has a hook inside.

By edit the presently approved article, no, other than for typos, it's frozen. It is possible to edit the draft, and eventually to have the edited draft become the newly approved.

Again, what specific principles of homeopathy 'are not in the lede? --Howard C. Berkowitz 18:03, 23 January 2010 (UTC)

Friends, it has been a while since I check-in here. I have not re-read most of the new draft, but I can tell you that I do not like the lede paragraph. It is simply not encyclopedic or impartial. Anyway, we only recently spent a lot of time approving the previous edition. I suggest that we let it sit for 3-6 months or more before we re-do it. Dana Ullman 05:28, 1 February 2010 (UTC)

Dana, I hope you can insert sentences that read something like, "there is scientific evidence for homeopathy", using the PDF for "Scientific framework of homeopathy: evidence-based homeopathy" available at http://www.feg.unesp.br/~ojs/index.php/ijhdr/article/viewFile/286/354 wherever appropriate.—Ramanand Jhingade 08:21, 2 March 2010 (UTC)

British House of Commons Science and Technology Committee report

The committee commissioned by the British government has reassessed homeopathy as a treatment option under the national health service. It's enquiry sought written evidence and submissions from concerned parties (See News in brief: Homeopathic assessment and Evidence check: Homeopathy). Both sides of the debate were represented and presented written evidence to the committee. In addition there were oral presentations from the following individuals:

• Mr Mike O'Brien QC MP, Minister for Health Services, Department of Health;
• Professor David Harper CBE, Director General, Health Improvement and Protection, and Chief Scientist, Department of Health;
• Professor Kent Woods, Chief Executive, Medicines and Healthcare Products Regulatory Agency
• Professor Jayne Lawrence, Chief Scientific Adviser, Royal Pharmaceutical Society of Great Britain;
• Robert Wilson, Chairman, British Association of Homeopathic Manufacturers;
• Paul Bennett, Professional Standards Director, Boots;
• Tracey Brown, Managing Director, Sense About Science;
• Dr Ben Goldacre, Journalist.
• Dr Peter Fisher, Director of Research, Royal London Homeopathic Hospital;
• Professor Edzard Ernst, Director, Complementary Medicine Group, Peninsula Medical School;
• Dr James Thallon, Medical Director, NHS West Kent;
• Dr Robert Mathie, Research Development Adviser, British Homeopathic Association.

A summary statement from the House of Commons Science and Technology Committee was released with the report in Feb 2010:

‘

... the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA. The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible. The Committee concluded - given that the existing scientific literature showed no good evidence of efficacy - that further clinical trials of homeopathy could not be justified. In the Committee’s view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice-which the Government claims is very important-as it means patients do not have all the information needed to make choice meaningful. Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS. Source: UK Parliamentary Committee Science and Technology Committee - "Evidence Check 2: Homeopathy"

’

From the full report the committee also stated:

‘

We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals — hospitals that specialise in the administration of placebos — should not continue, and NHS doctors should not refer patients to homeopaths. Source: Evidence Check 2: Homeopathy, Fourth Report of Session 2009–10, House of Commons Science and Technology Committee, 20 October 2009, parliament.uk

’

In conclusion the chairman of the committee said:

‘

This was a challenging inquiry which provoked strong reactions. We were seeking to determine whether the Government's policies on homeopathy are evidence based on current evidence. They are not. It sets an unfortunate precedent for the Department of Health to consider that the existence of a community which believes that homeopathy works is 'evidence' enough to continue spending public money on it. This also sends out a confused message, and has potentially harmful consequences. We await the Government's response to our report with interest. Source: UK Parliamentary Committee Science and Technology Committee - "Evidence Check 2: Homeopathy"

’

The Evidence Check definitely needs to be in the article. It has been hilarious watching the homeopaths squirming around trying to explain it away by butchering the quote from Cucherat's systematic review. It is like those reviews you see on movie posters where it says something like "Tremendous, Exciting (Evening Standard)" and then you go and look and see what the Evening Standard actually say and it is "A tremendous waste of time and money, has difficulty exciting all but the clinically insane". –Tom Morris 15:12, 3 March 2010 (UTC)

For some reason, I couldn't access Citizendium yesterday at this time. Meanwhile, I got a reply from Dr Peter Fisher to my e-mail in which he says that the individual specific rules of Homeopathy were not followed in prescribing/administering the Homeopathic remedy, so I hope good sense prevails over the 'UK Parliamentary Committee Science and Technology Committee'.—Ramanand Jhingade 13:43, 12 March 2010 (UTC)

With regard to "the individual specific rules of Homeopathy were not followed in prescribing/administering the Homeopathic remedy" what is Peter Fisher referring to? How does that impact the report? Chris Day 16:25, 12 March 2010 (UTC)

As I understand it, the individual specific rules of homeopathy mean that every patient is unique and the remedies appropriate for one will not be appropriate for another. Let's assume this is exactly correct. That would make classic randomized clinical trials, in which there is a standard treatment arm and a control arm, inappropriate, because there is no homeopathic standard.

A very similar problem, however, applies to highly individualized pharmacogenomic therapies: within a cohort of patients with, say, metastatic breast adenocarcinoma, the experimental hypothesis may be that a given treatment is applicable only to those patients with a specific BRCA gene coding. Panaceamycin is only expected to be effective in patients with that characteristic, and the others should get an aromatase inhibitor, the standard of care. Given there is a treatment, a placebo control is ethically unacceptable.

RCT's have been designed that still have statistical power, but are testing the diagnostic and treatment model, not panaceamycin. The clinician selects the treatment and sends an order to the pharmacy, where the pharmacist opens the next blind assignment envelope. If the patient is assigned to the experimental arm, the IV drug unit sent back to the care unit has panaceamycin in it if the genomic model calls for it, and the control treatment if not. If the patient is assigned to control, she gets control. It is the decision to assign that is being tested, more than the drug itself.

In like manner, homeopaths could prescribe a totally individualized remedy, but they would be blinded to whether or not the patient gets the remedy -- control could be placebo, or a medical treatment. With a sufficiently large sample, if the homeopathic model is correct, the patients receiving the remedy should do better.

It is not clear that homeopaths are willing to be tested in such a manner, which should obviate the argument about individualization not being permitted. --Howard C. Berkowitz 17:05, 12 March 2010 (UTC)

Brings me back to a question that I have never seen an answer to. How can remedies be mass marketed and sold off the shelf at places like wal-mart and whole foods and be so effective (as claimed)? These remedies are either robust or need to be highly individualized. If the latter, I don't see how how a mass market product will work. If the former, then they have indeed being found wanting (no better than placebo). Their defense against accepting the failed results of clinical trials precludes claiming successes from the mass market products. Which is it? Chris Day 19:15, 12 March 2010 (UTC)

A question, Chris, that I've asked myself. Let me respond indirectly. One of the major mass-marketed products is Oscillococcinum, about which I did write an article. What is the sound that is made by the creature from which the simillium is obtained? --Howard C. Berkowitz 19:28, 12 March 2010 (UTC)

Given that they are a £1.5bn industry we can expect to hear a lot of noise like that in the next few months. Chris Day 19:40, 12 March 2010 (UTC)

Howard, you got it right - for example, Ipecacuanha can't be given where Antim. Tart is indicated. Chris, classical homeopaths don't accept 'over the counter'/'off the shelf' products because anything between 2 to 20 remedies are mixed in one 'combination' (Hahnemann used to call such homeopaths the 'mongrel sect'), but since it's popular, the classical homeopaths can't do much about it. In India, homeopathy is a half a Billion $ 'industry' - and that is only counting the medicines sold 'over the counter' and not what is spent on homeopathic doctors - so we're not gonna let people talk rubbish about it. It really works (See the 'feg' pdf document I've posted in the previous section)!—Ramanand Jhingade 09:22, 13 March 2010 (UTC)

Ramanand, you didn't get right the essence of what I was saying: there are statistically powerful testing methods, which have been developed for biological therapies that indeed are individualized, which could answer the homeopathic objection to more traditional randomized clinical trials. I have not seen any evidence that homeopaths are willing to use such methods, but instead continue to insist on either statistically weak retrospective analyses or anecdotal/testimonial evidence. Howard C. Berkowitz 16:21, 13 March 2010 (UTC)

Sources

I'm surprised that this article does not reference or discuss Paul Starr's Pulitzer Prize and the Bancroft Prize winning book on the social transformation of American medicine. Any article that wishes to understand the difference between allopathy and homeopathy needs to understand that this debate has less to do with science or medicine and everything to do with politics as the British report makes clear. Russell D. Jones 15:41, 2 March 2010 (UTC)

At one time, it was indeed appropriate to compare allopathy and homeopathy. While some dictionary definitions still use allopathy as a synonym for conventional medicine, I find the modern usage to be more often by CAM practitioners, as that-which-we-do-not-do. (For the record, I happen to find some complementary medicine useful, or at least worthy of trial in non-critical situations.)

As far as a "modern" comparison, however, I cannot do better than William Osler:

A new school of practitioners has arisen which cares nothing for homeopathy and still less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new."(Flexner report, page 162)

Unquestionably, there was once a competition between something one could legitimately call allopathy, as a "doctrine of opposites", and homeopathy as a "doctrine of similars". Homeopaths often selectively quote Osler as saying that the homeopathic remedies were safer than most allopathic remedies of his era (i.e., late 19th-early 20th century). You'll note that there was insistence on keeping the 1905 quote from von Behring.

It ain't the 20th century any more, and conventional physicians don't prescribe based on opposites, nohow. Yes, there are political residues, but there's now a lot more in the way of evidence-based medicine...and protecting turf. Howard C. Berkowitz 19:37, 12 March 2010 (UTC)

The memory of sugar

is being discussed here and provides a nice illustration of the topic. --Daniel Mietchen 21:56, 3 March 2010 (UTC)

I thought the "memory of sugar" tended to go either to the abdomen or buttocks, depending on genetics? :-)

Seriously, the discussion at that link is what I'd suggest is an expectation. It is possible to be neutral, I think, and mention, in the lede, that homeopathy is not generally accepted. We still do not have a way of dealing with the situation where homeopathy supporters will support a lede that doesn't consider it reasonably credible. Of course, in no other workgroup do we have an equivalent to the health sciences/healing art splits. Should Religion be joined by Atheism? Alternatively, is it possible to have a reasonable Atheism article in Religion? Howard C. Berkowitz 22:46, 3 March 2010 (UTC)

The problem just isn't there with religion and atheism. If you, say, are interested in philosophy of religion, you can get a degree in it regardless of whether you are an atheist or a theist (or something else entirely). I say this from experience - I have a BA in Philosophy, Religion and Ethics from a Catholic college but am an atheist. There are some - I guess the polite way of saying it is 'non-mainstream' - ways of getting a doctorate in religion. You could become a "Doctor of Scientology" (D.Scn) - I read today that Ron DeWolf - Hubbard's son - had been given one, and stated in court that he wasn't sure whether they gave him the Doctorate before or after he'd been given the Bachelors! Or you could get a phony Ph.D from a diploma mill - as quite a lot of the creationists have. The problem with Healing Arts is that you can quite feasibly become a Healing Arts editor with a degree from a non-mainstream parallel academic institution. When mainstream academia isn't bending over backwards to certify degrees in quackery (as two universities in Britain shamefully have), the quacks create their own academic institutions.

"Dr" Gillian McKeith "PhD" has a degree from a place called Clayton College of Natural Health in Birmingham, Alabama. Said college is not accredited by any accrediting body recognized by the Department of Education, and a number of states in the U.S. list it as unaccredited on their websites for student loans (etc.). This does not stop McKeith claiming to have a PhD on her website, nor did it stop Channel 4 television or her publisher from touting this to promote her books and TV programme. She also likes to mention how she is a member of the American Association of Nutritional Consultants. You too can be a member of the American Association of Nutritional Consultants if you send them $60! McKeith has pushed notorious nonsense like the idea that green vegetables are good for you because the green shows they have chlorophyll (true), and the chlorophyll will oxidate your blood (how? Human beings are not plants. They tend to get their oxygen through respiration rather than photosynthesis. And even if they were getting their oxygen through photosynthesis, even your local tanning salon lamps aren't quite powerful enough to penetrate your small intestines).

Another graduate of the Clayton College of Natural Health is cancer quack Hulda Clark who sells a whole variety of magic 'zapping' toys that make funny noises and shine lights and do little more to cure cancer than extract money from punters - I mean, cancer sufferers.

Take any philosopher of religion or even most theologians - they'll certainly be able to say something useful on an article about atheism in the Religion WG. Same for the non-believers within the same fields. The problem with Healing Arts is it lets people with completely bonkers views about reality approve articles on their favourite pseudoscience. If the claims of the homeopaths were true (and, blimey, even our politicians can tell what a big pile of nothing the evidence of two hundred years of homeopathy has amounted to), then most of the articles in the Biology and Chemistry workgroup need rewriting.

I'll repeat myself again: we need to fix the Healing Arts bug. It is nothing more than a bug. It is a bug that is bringing down the great work done by other WGs. It says to anyone who has spent years of their life working on getting a PhD in physics or literature or psychology or whatever that you can get a fake degree from a non-accredited university and also be considered an expert on the same level. How can I, in good conscience, tell the experts in my field to contribute given this significant vulnerability in the Editorship system? –Tom Morris 01:21, 4 March 2010 (UTC)

Religion seemed the obvious parallel, but we could, I suppose, have an Absolute Pacifism workgroup with Military -- not that quite a few professional soldiers don't hate war. Why can Engineering debunk a hoax theory but Health Sciences cannot? Howard C. Berkowitz 02:15, 4 March 2010 (UTC)

Howard, you're one of the eight Charterists. Are you a loud and strong voice therein trying to *remove* Healing Arts as a Workgroup, so that some of this nonsense could then be addressed in the future in a rational way? Hayford Peirce 02:49, 4 March 2010 (UTC)

Compromise in the Charter Committee, I believe, means that the Workgroup and some other details will be passed, without detailed guidance, to the Editorial Council. Personally, I am urging the draft to go to discussion and markup, so we can proceed to the next steps after ratification. While this is an especially galling problem, there are less egregious workgroup structure problems that also need addressing and can't happen at the Charter level. --Howard C. Berkowitz 03:21, 4 March 2010 (UTC)

Even with Pacifism and the Military, there is an implicit understanding that most of the facts are the same. The Pacifist will agree with the General that the U.S. dropped the bomb on Hiroshima or that Nelson died in 1805. They have different opinions, but they do not care out their own facts in quite the same way as the Healing Arts gang. –Tom Morris 07:32, 4 March 2010 (UTC)

No, the analogy may hold. There are those that will insist that any enemy can be defeated through passive resistance and good thoughts, just as some of the healing arts believe that it is utterly wrong to immunize against an infectious organism or use an antibiotic against one. Howard C. Berkowitz 07:43, 4 March 2010 (UTC)

Tom mentions non-mainstream ways of getting doctorates in religion. In fact the Archbishop of Canterbury still has the legal power to award them, which might explain why Church of England bishops always seem to be Dr. Peter Jackson 14:29, 12 March 2010 (UTC)